Promoters and Barriers to Fruit, Vegetable, and Fast-Food Consumption Among Urban, Low-Income African Americans—A Qualitative Approach

摘要

To identify promoters of and barriers to fruit, vegetable, and fast-food consumption, we interviewed low-income African Americans in Philadelphia. Salient promoters and barriers were distinct from each other and differed by food type: taste was a promoter and cost a barrier to all foods; convenience, cravings, and preferences promoted consumption of fast foods; health concerns promoted consumption of fruits and vegetables and avoidance of fast foods. Promoters and barriers differed by gender and age. Strategies for dietary change should consider food type, gender, and age. Diet-related chronic diseases—the leading causes of death in the United States 1 , 2 —disproportionately affect African Americans 3 – 7 and those having low income. 8 – 10 Low-income African Americans tend to have diets that promote obesity, morbidity, and premature mortality 3 , 4 , 11 , 12 ; are low in fruits and vegetables 13 – 18 ; and are high in processed and fast foods. 19 – 23 Factors that may encourage disease-promoting diets include individual tastes and preferences, cultural values and heritage, social and economic contexts, and systemic influences like media and marketing. 24 – 30 Because previous research on dietary patterns among low-income African Americans has largely come from an etic (outsider) perspective, it has potentially overlooked community-relevant insights, missed local understanding, and failed to identify effective sustainable solutions. 31 Experts have therefore called for greater understanding of an emic (insider) perspective through qualitative methods. 31 However, past qualitative research on dietary patterns among low-income African Americans has been limited, focusing mostly or exclusively on ethnic considerations, 28 , 29 workplace issues, 10 women, 32 – 38 young people, 38 , 39 or only those with chronic diseases 34 , 36 , 39 , 40 and neglecting potentially important differences by age and gender. 31 , 41 – 43 To build on prior research, we conducted interviews in a community-recruited sample using the standard anthropological technique of freelisting. 44 – 46 Our goals were (1) to identify the promoters of and barriers to fruit, vegetable, and fast-food consumption most salient to urban, low-income African Americans and (2) to look for variation by gender and age.