Development and reproducibility of a brief food frequency questionnaire for assessing the fat, fiber, and fruit and vegetable intakes of rural adolescents.

OBJECTIVE: To describe the systematic development and reproducibility of a food frequency questionnaire (FFQ) designed to meet the specific research requirements of the Goals for Health cancer prevention intervention program for rural middle school children. DESIGN: A 4-step process was used to develop a brief FFQ for scoring intakes of total fat, fiber, and fruits and vegetables. The resulting questionnaire consisted of 25 food frequency items and 10 supplemental questions. Reproducibility of the questionnaire was determined by comparing responses at the beginning and end of a 4-month interval. SUBJECTS: Study subjects were sixth- and seventh-grade students attending middle schools in rural areas of Virginia and upstate New York. Seventh-grade students participated in the pilot study, and sixth-grade students participated in the reproducibility study. The final version of the FFQ was completed twice by 539 sixth graders. After exclusions for missing and unreliable data, the usable sample size was 415. Boys were somewhat more likely than girls to be excluded for missing data. African-American students comprised 32% of the population. STATISTICAL ANALYSES PERFORMED: Each food frequency item was associated with 3 scores--a fat score, a fiber score, and a combined score for the number of servings of fruits and vegetables. Means and standard deviations were determined for nutrient variables, differences between repeat administrations were tested for significance by paired t test, and Pearson correlation coefficients were calculated for nutrients and for individual food items. RESULTS: Correlation coefficients for nutrient scores were 0.58 for fat, 0.49 for fiber, and 0.51 for fruits and vegetables. For individual food items, correlations ranged from 0.24 to 0.59 (mean=0.41). APPLICATIONS/CONCLUSIONS: Using a systematic approach to developing a study-specific FFQ for rural adolescents is feasible. Further, the reproducibility of the Goals for Health questionnaire was demonstrated for the 3 nutrient scores it was designed to measure. This developmental approach may be readily adapted to other populations, study designs, and nutrients of interest. The validity of the questionnaire remains to be tested.

Peer drug associations and emotional restraint: causes or consequences of adolescents' drug use?

A 3-wave longitudinal design was used to examine the relationships among emotional restraint, peer drug associations, and gateway drug use in a sample of 1,256 middle school students. Structural equation modeling was used to compare 3 models: (a) One model viewed drug use as a consequence of emotional restraint and peer variables; (b) 1 viewed drug use as a cause of restraint and peer variables, and (c) 1 included reciprocal effects. All 3 models fit the data fairly well. However, the reciprocal model fit the data significantly better than either of the others. Within this model, low emotional restraint was significantly related to subsequent increases in gateway drug use among boys. In contrast, peer drug models and peer pressure were not related to subsequent changes in gateway drug use. Changes in peer drug models were, however, predicted by previous levels of gateway drug use.

Relationship between drug use and other problem behaviors in urban adolescents.

This study tested the generality of Jessor and Jessor's (1977) problem behavior theory, which states that a variety of problem behaviors constitute a behavioral syndrome in normal adolescents. Relationships among 5 adolescent problem behaviors (cigarette use, alcohol use, marijuana use, delinquency, and sexual intercourse) were examined in 7th-grade boys (n = 556) and girls (n = 715), and 9th-grade boys (n = 481) and girls (n = 485) in an urban school system in which the majority of students were African American and from low-income families. Measures of problem behavior frequency were positively correlated with each other and negatively correlated with several measures of conventional behavior. Confirmatory factor analyses replicated findings of previous studies that a single common factor underlies adolescent problem behaviors.

Risk factors for drug use in urban adolescents: identification and cross-validation.

Examined the relationship between 26 dichotomous risk factors and drug use in derivation (N = 1,352) and cross-validation (N = 1,309) samples of seventh graders in the public school system of a large southeastern city. The majority of students was African American, many came from low-income, single parent families. A total of 20 risk factors representing a variety of variables was significantly related to at least one category of drug use in both samples. Regression analyses identified a subset of 11 risk factors with minimum overlap. The simple sum of these 11 risk factors was significantly associated with prevalence of use for cigarettes, beer and wine, hard liquor, marijuana, and other drugs. The total number of risk factors also showed a curvilinear relationship with the frequency of 30-day use for each category of drug. Theoretical and practical implications of these findings are discussed.

Risk factors for drug use in rural adolescents.

This study tested the relevance of a risk factor model for predicting drug use among rural adolescents. A questionnaire battery assessing drug use and the presence/absence of twenty risk factors derived from a previous study of urban adolescents was administered to a sample of seventh graders (N = 235) in the public school system of a rural community. All but one of these risk factors were found to be significantly related to at least one category of drug use. In addition, a risk factor index based on a subset of ten risk factors was significantly associated with the prevalence and frequency of use for cigarettes, beer and wine, hard liquor, marijuana, and other drugs. These findings support the generalizability of a risk factor approach to predicting drug use, and underscore the need for increased prevention and research efforts directed at rural adolescents.

Work-site health promotion: the effects of a goal-setting program on nutrition-related behaviors.

A Goal Attainment Scaling procedure was used to quantify and evaluate change in nutrition-related behaviors of participants in a work-site wellness program. Goal Attainment Scaling is a procedure for quantifying change over time, in five categories varying from "less than expected" success to "more than expected" success. The sample consisted of 60 enlisted military personnel who had indicated, on a screening questionnaire, their desire to improve dietary practices. The subjects were assigned to three groups but remained unaware throughout the study that nutrition was being investigated. The Goal-Setting/Goal Attainment group (GSGA, no. = 19) received a full 8-week health promotion program, based on goal-setting, fitness information, and skill development (12 sessions). The Goal-Setting group (GS, no. = 19) received only the part of the program that focused on setting goals (two sessions). The control group (no. = 22) received no instruction. Results from analysis of variance indicated that GSGA had significantly higher "Change Scores" in nutrition-related behaviors than the control group (p less than .05); "Change Scores" reflect degree of dietary improvement. Frequency data indicate that dietary improvements were sustained for 84% of the GSGA members, 64% of the GS members, and 37% in the control group. These findings suggest goal-setting skills enhance individuals' capabilities for making and maintaining improvements in nutrition-related behaviors.

Dietary change: prescription vs. goal setting.

This investigation assessed the effectiveness of two teaching strategies, dietary prescription (Diet-Directed [D-D]) and individual goal setting (Self-Directed [S-D]), on compliance with the U.S. Dietary Goals and Guidelines. College women, 18 to 30 years old, enrolled in a one-credit course that met for 1 hour and 15 minutes weekly for 10 weeks to learn the principles and application of the U.S. Dietary Goals and Guidelines. The D-D group received a prescribed diet; the S-D group learned goal-setting skills; and a Control group received no treatment. Caloric, total fat, and polyunsaturated fat (PUFA) intake decreased significantly in both treatment groups. The D-D group reduced caloric, fat, and PUFA intake by week 5 and maintained those changes for the remainder of the experiment. The S-D group decreased caloric intake by the eighth week and decreased fat and PUFA intake between weeks 5 and 8. Those changes, however, were not maintained for the duration of the experiment. The results demonstrate that the study population made dietary changes in the direction of the U.S. Dietary Goals and Guidelines. Further investigations are required to assess the effectiveness of various teaching strategies on long-term dietary compliance.

Effect of a helping skills transfer program on dietitians' helping behavior.

The ability to form effective helping relationships clients constitutes an essential element in dietary counseling. Still, little evidence exists which supports the fact that dietitians have the necessary communication skills to achieve this end. This study evaluates an attempt to have nutrition students use skills in their dietary counseling sessions to facilitate the development of helping relationships. Results showed that students previously trained in helping skills significantly increased the use of verbal responses which convey a willingness to help and an accurate understanding of clients' problems.

The anatomy of a dietetic counseling interview.

Dietetic students in a course on interviewing skills were given an opportunity to practice interviewing, first with "coached," volunteer clients, then with real clients. Their interviews were taped and later analyzed as to content and approach. In trying to develop rapport during the "relationship-establishing" phase of the interview, the students asked questions which required mininal self-exploration by the client to answer (closed questions), five times as often as any other type of question. For effective counseling which results in changed behavior by clients, skills in counseling which develop an understanding of clients' feelings must be learned and implemented in counseling settings.

The effects of self-selection on trainees' verbal helping skills performance.

Self-selected paraprofessional trainees enrolled in a helping skills training program participated in a 6-minute pretraining helping interview from which their frequency of continuing responses was obtained. Continuing responses allow helpees to present their concerns in a nonthreatening, supportive environment and are important in the relationship establishing stage of the helping process. For data analysis purposes only, trainees were divided into three groups, a high, medium, and low group, based on the frequency of continuing responses made. Following training, at posttest, no significant differences were found among the three groups on the amount of continuing responses made during a second identical 6-minute interview. Implications for various selection procedures and training are discussed.

Untrained paraprofessionals' verbal helping behavior. Description and implications for training.

The verbal behavior of untrained paraprofessionals in simulated initial helping interactions was studied. Taped interviews conducted by 131 helpers-in-training were evaluated on the Helping Skills Verbal Response System, a category system consisting of continuing, leading, and self-referent responses. Helpers were found to vary considerably in number and types of responses given. Leading responses were twice as frequent as continuing responses. The most often used response was the closed question. Few responses focusing on helpees' feelings were given. The implications for training were discussed in terms of the facilitative role of helpers in initial helping interactions.

Assessing intertrainer effects on the Empathic Understanding Scale: training the trainer.

The purpose of this study was to develop a procedure that would provide a preliminary assessment of the level of intertrainer agreement on the Empathic Understanding scale. To illustrate the proposed procedure, a pilot study was undertaken in which 30 excerpts of helping interactions that included the client's statement, therapist response, and client's subsequent response were rated by experienced raters trained by a Carkhuff trainer and a non-Carkhuff trainer. Results indicated that raters trained by different trainers make significantly different judgments about the level of therapist empathy at high levels of empathy. Results of this study were discussed in light of possible scale reliability and construct validity problems. A detailed description and rationale of the proposed procedure was outlined.

Developing helping relationships in dietetic counseling.

Counseling involves (a) the development of rapport between conselor and conselee and (b) the use by the counselor of strategies to create behavior change in the counselee. Dietetic educational programs have apparently focused on the latter, action-oriented procedures, with little attention being given to training in the development of helping relationships. A training program, designed to build such skills in human resource workers, is described. Listed are six steps considered essential, all of which involve an understanding of self by the counselor, some knowledge of the helping skills, and experience in practicing them. Steps in skill training are also enumerated. The program merits inclusion in dietetic education programs.