Qualitative and quantitative analyses of cancer-related dietary risk among public housing residents

A9

Background: Improving diet among low income populations is one important pathway to addressing disparities in cancer risk. Because elements of diet are interrelated, studies of dietary patterns and behaviors can complement more specific analyses of individual nutrients. We conducted both qualitative and quantitative analyses of 468 24-hour dietary recalls from 156 African American women residents of Washington DC public housing, in order to better understand contextual factors associated with dietary patterns. Recalls were collected at baseline from women participants in an American Cancer Society funded nutrition education intervention, conducted from 2001-2003 in 11 public housing communities in the District of Columbia.
 Methods: Recalls were rated for five cancer-related dietary characteristics (fruits/vegetables, %fat, calories, alcohol, and Healthy Eating Index score), and dietary patterns were examined to determine if a single underlying construct capturing cancer-related dietary behavior was exhibited in respondents’ habitual diet. Qualitative textual analyses of dietary records were used to identify contextual aspects of food patterns within and across these index score groups, such as the timing, setting, and social composition of eating events, and the characteristics of foods and food groups consumed. Multivariate models were used to identify individual psychosocial as well as community-level variables associated with cancer-related dietary index scores.
 Results: 61% met none or only one dietary goal; alcohol abstention was most common (64%). Only 12% achieve either 3 (6%), 4 (4%) or all 5 (<1%) goals; 5 fruit and vegetable servings was least common (15%). We tested the underlying scale structure of responses, and found that among these respondents, response patterns could be used as a Guttman scale, with an index of reproducibility of 0.90. This suggests that the most uncommon cancer-related dietary goal (consuming five or more servings of fruits and vegetables daily) is seldom achieved in this population in the absence of the other scale components. This reinforces the value of a comprehensive approach to cancer-related nutrition intervention.
 Survey analyses showed that high risk was associated with younger age, depressive symptoms, smoking, and being D.C. born; protective community characteristics included grocery stores and %high school graduates. Qualitative analyses of dietary records further illuminate differences between low and high risk dietary patterns. Combined interpretations of qualitative and structured findings suggest avenues for intervention with urban women and their families, to improve cancer-related diet.