Introduction
In recent years, family issues and health concerns become a core of social; support work. The issue selected for analysis concerns a healthy diet among mid0lie women population and dietary patterns which help women to prevent obesity-related problems. The main organization involved in this issue is Agency for Healthcare Research and Quality. Using materials and promotion literature of this agency, it is possible to say that for mid-lie women diet is an important risk factor in the development of cardiovascular disease and cancer. Consistent evidence suggests that a diet high in fat is positively associated with hypercholesterolemia, which is a key risk factor for heart disease. In particular, diets high in saturated fats increase levels of low density lipoproteins (LDLs) that appear to be most important in the development of atherosclerosis in both women and men. Women with blood cholesterol levels over 265 mg/dl have a two times greater risk of developing heart disease compared to those with levels under 200 mg/dl. Although cholesterol levels among Americans have been declining, 20% of adult women have cholesterol levels over 240. Moreover, during menopause women experience a steep increase in their average cholesterol level due in large part to their decreasing estrogen levels
The Problem Overview
For mid-life women, dietary factors have a somewhat more complex association with cancer risk. Two large epidemiologic studies of women, the Nurses Health Study conducted with over 120,000 female nurses and the Iowa Women’ s Study conducted with over 30,000 women, found that consumption of red and processed meat products was associated with as much as a twofold increase in women’ s risk of colon cancer. However, neither of these large studies of women or five other studies have found a relation between total dietary fat or saturated fat consumption and increased risk of breast cancer. In contrast, the evidence of a protective effect of fruit and vegetable consumption is consistent and overwhelming, with more than 200 studies indicating significantly reduced risk of cancers of the breast, cervix, and colon among women. Evidence for the protective role of fiber independent from that of fruits and vegetables is as yet inconclusive, with case control studies indicating stronger effects than prospective studies. Thus, reduction of dietary fat and increased consumption of fruits and vegetables are essential components of health promotion programs for women (Agency for HealthCare Research and Quality 2010).
Diet has an indirect effect on women’s health through its influence on body weight. Eating a diet high in fat is positively associated with overweight and obesity. Lifetime weight gain of as little as 5 to 8 kg after age 18 increases women’s risk for coronary artery disease. It is encouraging that even modest weight loss, on the order of 10% of initial body weight, can improve blood pressure, lipid profiles, glucose, and insulin. Approximately, 35% of American women are overweight, defined as 20% above their ideal weight. Although the prevalence of overweight has increased for the American population as a whole, it is consistently highest among women, particularly African American and Hispanic women, and those with low socioeconomic status. Data from the most recent National Health and Nutrition Examination Survey (NHANES III) indicate that 33% of White women, 49% of African American women, and 48% of Mexican American women are obese, that is, they are 30% or more above ideal body weight. Being obese substantially increases women’s risk of hypertension, hyperlipidemia, Type II diabetes, and coronary artery disease, as well as postmenopausal breast cancer, cancers of the endometrium, and gall bladder. Consistent evidence demonstrates that the average American’s weight increases steadily with age. For women, pregnancy has been suggested as an important determinant of this lifetime weight gain. In a large multisite coronary risk factor study of young adults, women who became pregnant experienced greater weight gains (2–3 kg) over a 5-year follow-up than women who remained nulliparous. African American women gained almost twice as much weight as did White women. Interventions that encourage women to maintain an optimal weight over the life span are a necessary component of health promotion efforts for women (Agency for HealthCare Research and Quality 2010).
Cultural factors have a complex influence on women’s likelihood of adhering to dietary guidelines. Two studies have indicated that less acculturated Mexican American women were less likely to avoid foods high in fat and more likely to consume high calorie foods than highly acculturated women. However, these same less acculturated women consumed more fiber than highly acculturated women. The health promoting and health compromising components of different ethnic diets must be considered in health promotion activities. It has been widely argued that for women, dietary practices are deeply enmeshed with their concerns about body weight. Studies of adolescents in particular indicate that girls believe more strongly than boys in the benefits of a healthy diet for weight control and improving their appearance. Often, this translates into unhealthy dieting practices that in their most extreme form can lead to eating disorders, including anorexia and bulimia. More prevalent, however, is women’s reported dissatisfaction with their weight, ongoing restriction of calorie intake, and active dieting as compared to men. African American women, although heavier on average than women of other racial ethnic groups, do not appear to have the same level of weight concerns or a high prevalence of dieting. Thus, the presence or absence of weight concerns, other personal motivators, as well as the cultural and socioeconomic environment, are important considerations in effecting dietary behavior change among women (Women diet and Fitness 2010).
Community Efforts
Factors that influence dietary change among mid-lie women can be categorized as those that predispose and enable the initial adoption of behavior change and those that reinforce or maintain these changes. Knowledge of the fat and fiber content of foods, beliefs in a diet-disease connection, being motivated, and perceiving benefits to dietary change all have been noted as factors that predispose individuals to reduce their dietary fat. Enabling factors, such as access to low fat food choices in community, school, and worksite settings, perceived norms, and social support favoring low fat diets have also been positively associated with reductions in dietary fat. Comparison of the relative contribution of these predisposing and enabling factors have shown that predisposing factors are better predictors of dietary intentions, self- efficacy, and likelihood of reducing dietary fat than are enabling factors. Others have shown synergism between these factors with women’s motivation to make dietary changes particularly enhanced if they have support for such changes from their friends. In the longer term, factors such as feelings of wellness and a development of a distaste for fat that occur after dietary fat reduction have been positively associated with maintenance of fat reduction. In contrast, feelings of deprivation concerning food choices are important deterrents to maintenance. Moreover, women who have made dietary changes also cite increased time for meal planning, preparation, and costs of low fat menus as additional deterrents to long-term maintenance of dietary changes. Thus, interventions that enhance motivation, as well as the perceptions and experienced benefits of healthy dietary practices, have the greatest likelihood of success. Moreover, recommended dietary changes must be incorporable into women’s daily lives, be within their economic means, and include foods that are accessible and palatable to multiethnic and low income communities (Agency for HealthCare Research and Quality 2010).
Today, intensive health promotion interventions that target the individual for dietary change have had some success. The Women’s Health Trial, a multicenter feasibility study to lower dietary fat among women, demonstrated that relatively dramatic reductions in dietary fat can be achieved among highly motivated women. A sample of 300 women from age 45 to 69 was randomized either to a control or intervention group. Women assigned to the intervention attended small group sessions over a period of a year. Sessions were led by a nutritionist who instructed women how to choose low fat foods, modify recipes, self-monitor fat intake, and develop individualized low fat eating plans. Women in the intervention group experienced a mean reduction in dietary fat from 39% at baseline to 21% at the 6-month follow-up. In contrast, women in the comparison group experienced a nonsignificant reduction in fat from 39% to 38%. Significant treatment effects were maintained over 24 months of follow-up (Women diet and Fitness 2010).
Women’s influence over the dietary practices of their families is also evidenced by results of the Women’s Health Trial. Husbands of the women who participated in the trial experienced reductions in dietary fat that were comparable to those of their wives. Moreover, because women place more value on, and are at more advanced stages of readiness to adopt healthy eating patterns than men, they are likely to be the most receptive to dietary interventions. Family-focused dietary interventions that engage both children and their parents, primarily mothers, to participate in home-based nutrition education activities and increase physical activity also have had success. These family-based interventions represent an important area for further research (Women diet and Fitness 2010).
Future Projections
According to these principles, behavior is determined by the consequences (i.e., reinforcing, neutral, or punishing stimuli) it produces. Rotter’s social learning theory carried the ideas underlying these principles into the realm of more complex, cognitively influenced, social behavior. Two critical determinants of behavior, according to social learning theory, are the value individuals place on a specific outcome and the expectancy that the behavior in question will produce that outcome. Thus, at the core of theory is the individual’s belief about what will result from a given action. If someone expects good things to result from a given action, that action has a higher likelihood of occurring than if the expectation is for a bad outcome. In other words, people will behave if they believe their behavior will produce a desired effect. Within this framework, outcome expectancies are essentially beliefs about the way the world works, that is, about how contingencies are arranged or the relationships between actions and their consequences (Women diet and Fitness 2010).
Tailored health education materials that provide the optimal characteristics of intensive and interactive interventions, but are relatively inexpensive and easily disseminable, hold promise for application to dietary interventions. Using standard questionnaires and computer algorithms, the content of written materials can be tailored to the factors most salient to a woman’s dietary practices. Using these techniques, researchers evaluated a one-time mailed nutrition information packet with a sample of predominantly female family practice patients. Materials included in the nutrition information packet were tailored to the participant’s stage of readiness, dietary intake, motivation, self-efficacy, and barriers to dietary changes. Those who received the tailored packet were significantly more likely to have used the materials, and reported significantly greater decreases in dietary fat intake than those who received nontailored and control materials. In contrast, other targeted approaches that have not customized materials to psychosocial variables have had less success in influencing dietary fat reductions. Larger scale environmental and health marketing interventions that are characteristically less intensive but have broader reach have also been evaluated. Worksite-based interventions that encourage employees to implement changes in the worksite environment, such as increasing availability of low fat food items in vending machines, have had limited success. However, initial results of the Working Well worksite trial have indicated a nonsignificant downward trend in dietary fat consumption and significant increases in fruit and vegetable consumption among intervention participants compared to those in the control worksites. Motivating employees to participate in intervention activities and to support each other’s efforts to make dietary changes has been difficult. This intervention is being tested in 22 community health tenters that employ a large proportion of low income women who live in the surrounding community (Agency for HealthCare Research and Quality 2010).
The family component includes a learn-at-home program, annual family newsletters, and family festivals to encourage a home environment that is supportive of worker’s attempts to change their eating patterns. Preliminary results indicate that consumption of fruits and vegetables was positively associated with household support. This worksite project and eight other interventions to increase fruit and vegetable consumption are part of the national Five A Day program that is being funded by the National Cancer Institute. The program objective is to promote a simple, positive message: Eat five or more servings of fruit and vegetables daily as part of a low fat, high fiber diet. The Five A Day program is being conducted n partnership with the food industry, including supermarkets, restaurants, food merchandisers, and suppliers. The retailers and their suppliers participate by displaying the Five A Day logo on eligible products, incorporating the program message in print and broadcast advertisements, and sponsoring taste tests and supermarket tours (Women diet and Fitness 2010).
Conclusion
Adoption of healthy diets is a central tenet of health promotion for women. The combination of individual, family-based, and environmental interventions to promote decreased dietary fat, and increased fruit, vegetable, and fiber consumption, has shown promise. However, personal motivators and stage of readiness to adopt dietary changes, as well as the socio-cultural contexts of minority and low income women must be considered in the design of dietary interventions. Recent advances in health communication strategies that enable tailoring message content to the needs of specific groups may help to expand the reach and appropriateness of dietary interventions to important demographic subgroups of women. Although the notion of locus of control recognized that individual perceptions of influence over actions were determinants of action, the perceptions in question still concerned outcome expectancies. Locus of control, like the earlier conceptualizations of outcome expectancies, primarily assessed beliefs about how the world works. In contrast, if the belief that they are capable of performing a particular behavior is strong, then self-efficacy for the behavior in question is strong.
Works Cited
Agency for HealthCare Research and Quality. 2010. Web.
Women diet and Fitness. 2010. Web.