Strength and weakness of a nutrition communication strategy to health opinion formers: examples from a case study.

BACKGROUND: The nutritional image of diary products is challenged by the fact that milk fat contributes to a high intake of saturated fatty acids. On the other hand milk is promoted as an important source of calcium and other important micronutrients. In order to balance the debate on the nutritional value of milk Danish Dairy Board in 1991 initiated a strategy for nutrition communication directed at health opinion formers. In 1997 an evaluation study was performed. OBJECTIVE: The purpose of this study was: (1) to estimate the image of dairy products among selected opinion formers, (2) to elucidate the opinion formers' attitude to the engagement of the Danish Dairy Board in nutrition communication, (3) to disclose barriers and possibilities for future collaboration among important health opinion formers and the dairy industry on nutrition communication about milk and milk products. MATERIALS AND METHODS: Twenty important Danish health opinion formers representing the authorities, nutrition science, the medical community, the government, the parliament and media took part in the study. All the participants were interviewed by phone or in person following an interview guide. RESULTS: On the whole there is support for the official recommendation of daily consumption of half a litre of milk and 25 g of cheese-preferably the low fat varieties. The majority of the informants strongly urge the diary industry to produce more tasty low fat products and to promote them heavily through marketing campaigns. It is recognised as a positive feature that the diary industry in Denmark in a formulated nutrition policy has taken on a co-responsibility for public health. But it is put forward that this public policy obliges the dairy industry even more strongly to live up to their responsibility, which only a few of the opinion leaders find is the case. The informants find a dialogue with highly qualified nutrition staff of the industry as a prerequisite for future collaboration. It is recommended that the dairy industry invests more resources in visualising its co-responsibility for public health and that a two string strategy is implemented: 1. Product-related nutrition communication putting dairy products into a holistic perspective and 2. General nutrition information activities in collaboration with authorities and other interested parties (ideal organisations or producers of e.g. vegetables and bread).

[Attitude of general practitioners to the importance of gender and diet in disease prevention]. / Praktiserende laegers holdning til kønnets og kostens betydning ved sygdomsforebyggelse.

Three hundred and seventy-four general practitioners (GPs) in Denmark filled in a questionnaire on attitudes to include information on gender and diet in the strategy for prevention of coronary heart disease, cancer, osteoporosis, and overweight/underweight. Risk factors for disease in general were ranked as follows: smoking, alcohol, stress, diet, physical exercise, heredity and hygiene. The patients' lack of motivation, insufficient time for each patient, and inadequate knowledge about nutrition were stated as barriers to dietary counselling. The GPs stated that the gender of the patient was important only to the counselling on osteoporosis. Lack of time and insufficient knowledge were perceived as barriers for including gender specific issues in prevention. It is concluded that GPs consider dietary counselling important but lack time and knowledge. The results point at a need for better pre- and postgraduate training in nutrition, and for a better reimbursement system for time spent on prevention.

[Prevention in general practice. Are female and male patients treated the same way? A questionnaire study]. / Sygdomsforebyggelse i almen praksis. Gøres der forskel på kvinder og maend? En spørgeskemaundersøgelse.

Three hundred and seventy-four general practitioners (GPs) in Denmark filled in a questionnaire on practices regarding prevention of coronary heart disease (CHD), cancer, osteoporosis, and overweight/underweight. Half of the GPs were questioned about the issue of prevention based upon female case stories and the other half on male case stories with identical wording. The GPs more often in relation to: Prevention of CHD gave dietary counselling and recommended weight loss to slightly overweight male than female patients. Prevention of cancers gave dietary counselling and recommended weight loss and increase of exercise to female than to male patients. Prevention of osteoporosis recommended a supplement of calcium and vitamin D to female than to male patients. Treatment of underweight recommended weight gain and discussion of psycho-social issues to underweight female than male patients. In conclusion, GPs distinguish between men and women in relation to prevention strategies in general practice. There is a need for well-described prevention and action strategies with relevant gender differentiation for use in general practice.

Importance of diet and sex in prevention of coronary artery disease, cancer, osteoporosis, and overweight or underweight: a study of attitudes and practices of Danish primary care physicians.

General practitioners (GPs) in Denmark (n = 374) answered a questionnaire on attitudes toward including information on diet and sex in the prevention of coronary artery disease, cancers, osteoporosis, and weight problems. Risk factors for disease were ranked as follows: smoking, alcohol, stress, diet, physical exercise, heredity, and hygiene. Patients' lack of motivation, insufficient time for each patient, and inadequate knowledge about nutrition were listed by GPs as barriers to dietary counseling. GPs stated that the sex of the patient was important only for counseling on osteoporosis. Lack of time and insufficient knowledge were perceived as barriers to including sex-specific issues in prevention. One-half of the GPs were questioned about the issue of prevention on the basis of female case stories and the other half on the basis of male case stories with identical wording. Responses to the case stories indicated that GPs would give dietary guidance and recommend loss of weight to slightly overweight male patients to a much greater degree than to overweight female patients for prevention of coronary artery disease, give dietary counseling and recommend loss of weight and exercise to female patients more than to male patients for prevention of cancers, recommend a supplement of calcium and vitamin D for prevention of osteoporosis to female patients, and recommend weight gain and discuss psychosocial issues more with underweight female patients than with underweight male patients. Female GPs included measures of prevention such as dietary counseling, exercise prescription, dietary supplement prescription, and discussion of psychosocial issues to a greater extent than did male GPs.

The effect of a nutrition education programme 'learning by teaching' on the dietary attitudes of a group of adolescents.

The purpose of this study was (1) to examine the structure of attitudes towards healthy food in a group of adolescents and (2) to evaluate the impact of a health education programme on these attitudes. The strategy used was to make 14-year-old schoolchildren learn about nutrition and dental health by teaching these topics to 10-year-old children. A pre-test/post-test non-equivalent control group design was used. The experimental group consisted of four classes of 14-year-old children from two schools and the reference group of four classes of the same age from two comparable schools. The data were collected prior to, immediately after, and, for the experimental group, two months after the implementation of the programme. Factor analysis revealed three dimensions of attitudes: PROHEALTH, TASTE, and SIGNIFICANT OTHERS. Analysis of covariance with pre-test measures as covariates showed a significant effect of the programme on PROHEALTH, no effect on TASTE, and a significant study group by gender interaction effect on SIGNIFICANT OTHERS, which, however, was impaired two months later. It is concluded that the change in attitudes can be explained by two mechanisms: dissonance arousal and discrepancy between personal attitudes and group norms; and that future programmes should emphasise affection rather than cognition.

Prediction of sugar behaviour.

The purpose of this study was to identify determinants of sugar consumption in terms of personal and environmental variables. The study group comprised 127 14-year-old schoolchildren in Aarhus. Data were collected by means of semistructured interviews and self-administered questionnaires. Forward selection multiple regression analysis was the analytical method of choice, and the relationships were interpreted using the problem behaviour theory. The results showed that environmental variables were more important than personal variables for sugar consumption. In particular, degree of peer orientation was closely linked to sugar consumption (beta = 0.29). The full model including both sets of variables explained 14.5 per cent of the variance in sugar consumption. Sugar consumption seems to be a way of demonstrating adherence to and identification with peer group norms for adolescents at this age.

Effect of a nutrition education program, "learning by teaching", on adolescents' knowledge and beliefs.

The purpose of this study was to evaluate the impact of a health education program on a group of adolescents' cognition (knowledge of sugar and caries (SUCA), knowledge of sugar and nutrition (SUNU), and beliefs about susceptibility (SUSC) and self-efficacy (SELF]. The strategy used was to make 14-yr-old students learn about nutrition and dental health through teaching 10-yr-old students this topic. A pretest-posttest non-equivalent control group design was used. The experimental group consisted of four 8th grade classes from two schools and the reference group of four 8th grade classes from two comparable schools. The data was collected prior to, immediately after, and, for the experimental group, 2 months after the program implementation. Analysis of covariance with pretest measures as covariates showed no effect of the program on SUCA, SUSC, and SELF, while a significant interaction effect of study group and gender was found on SUNU. Neither social class of mother nor caries activity had a significant interaction effect on knowledge and beliefs during the course. Future health education research should focus upon the effect of different educational approaches addressing beliefs more salient to adolescents.

Dimensions of dietary and other health-related behaviors in a group of Danish adolescents.

The relationship between dietary, dental health behaviors, and other health-related behaviors was studied using factor analysis. The study group comprised 234 8th graders from 11 schools in the municipality of Aarhus. A semi-structured interview included 12 items of health behavior (e.g. sugar intake, meal pattern, sports activities, sleeping habits, and consumption of alcohol, cigarettes, vitamin pills, candy, and milk). The analysis is based on the assumption that the 12 observed variables are determined by a reduced number of underlying but unobservable factors. Four dimensions of health behavior which explained 38.6% of the variance between the variables were produced. The four unrotated factors accounted for a varying proportion of the total variance (17.6%, 11.8%, 4.4%, 4.3%, respectively). Factor 1 was denoted "Sugar behavior", factor 2: "Regularity of dietary behavior", factor 3: "Problem behavior" and factor 4: "Spare-time activity". This could imply that the motives underlying sugar consumption are different from those of other health-related behaviors. The present behavioral pattern is consistent with that of other studies in which health behavior has been shown to be multidimensional.

Relationship between diet-related behavior and caries in a group of 14-year-old Danish children.

Dietary factors related to dental caries may be both biological and behavioral. In the present study the relative contribution of a number of behavioral characteristics is analyzed in order to differentiate between caries-active (CA) and caries-inactive (CI) children. The study group comprised 49 CA and 55 CI 14-yr-old Danish children, constituting the dichotomous dependent variable. Several variables related to the social and cultural context in which food and snack consumption takes place were studied. Subsequently, their relative contributions to the discriminant function (CA vs. CI) were estimated using discriminant analysis. The three strongest discriminating variables were "weekly milk consumption" (-0.726), "packed lunch from home" (0.554), and "weekly consumption of candy in DKK" (0.306) as measured by standardized canonical discriminant function coefficients. These variables may be indicative of the impact of the social environment on dietary habits, pointing to the need for incorporating the social network as reinforcing agent in dietary counseling if dietary behavior is to be changed.

Validity of a dietary interviewing method for use in caries prevention.

A suitable method for determining the usual diet of an individual is a prerequisite for dietary counseling in caries prevention. The purpose of this study was to develop a method that was able to obtain relevant information on the dietary habits of an individual and to test the validity of this method. During a series of interviews a dietary history interview was therefore developed with special emphasis on dietary factors known to be important in caries etiology, such as frequency of eating and frequency and duration of sugar intake at meals and in-between meals. The validity of the method with regard to caries-related factors was tested by interviewing 49 caries-active and 55 caries-inactive 14-yr-old Danish schoolchildren. It was possible to detect a higher frequency of food intake and a more frequent and long-lasting use of sugar in the caries-active group. No difference was found in the consumption of sticky sugars between the two groups. With the present method it should be possible to pinpoint dietary problems in caries-active persons, so that dietary advice can be given in quantitative terms.