Stages of Change for Dietary Calcium Intake Among Rural Adults

Abstract

Stages of change models provide one type of theoretical framework to explain health behaviors and predict which individuals are most likely to successfully make behavior changes. These models have been applied to fat, fruits and vegetables, and fiber intakes. Application to other dietary components has not been explored. The purpose of this study was to examine stage of change with regard to dietary calcium intake in rural adults. Data were collected from 66 males and 308 females, 18-89 years. Subjects were recruited from 2 community health screenings. Most were college educated (60%) and the average age was 48 y. A standard stage question for calcium intake was administered to classify individuals to precontemplation, contemplation, preparation, action, or maintenance. Dietary assessment was collected with a quantitative food frequency (Block) using the Nutrition DISCovery™ program. The distribution of males by stage status was significantly different from females. About a quarter (24%) of the males were in precontemplation compared to 8% of the females, whereas 58% of the males were in the action or maintenance stage compared to 60% of the females. The self-reported stage classification was significantly associated with total calcium (P<.001), calcium per 1000 kcal (P<.001), and servings from the milk, yogurt and cheese group according to the Food Guide Pyramid (P<.00l). The servings from food distinguished individuals the best (precontemplation 1.5, contemplation 1.2, preparation 1.3, action 1.8, and maintenance 2.3) consistent with people's perception of calcium intake being related to specific food items rather than nutrients. In addition, individuals taking calcium supplements were more likely to classify themselves in the action or maintenance stages compared to non-calcium supplement users (P=.014). Nutrition education programs addressing prevention of calcium-related diseases may benefit by incorporating stage based screening questions to their protocols. These results show promise for the stages model with dietary calcium intake.