Health Promotion International, Vol. 23 No.

1
doi:10.1093/heapro/dam044
Advance Access published 8 January, 2008

# The Author (2008). Published by Oxford University Press. All rights reserved.
For Permissions, please email: [email protected]

Understanding barriers and facilitators of fruit

and vegetable consumption among a diverse
multi-ethnic population in the USA
MING-CHIN YEH1,3*, SCOTT B. ICKES2, LISA M. LOWENSTEIN2,
KEREM SHUVAL3, ALICE S. AMMERMAN2, ROSANNE FARRIS4
and DAVID L. KATZ3,5
1
Nutrition and Food Science, Urban Public Health Program, Hunter College, School of Health Sciences,
425 East 25th Street, New York, NY, USA, 2School of Public Health, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA, 3Yale Prevention Research Center, Derby, CT, USA, 4Centers for
Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, Atlanta, GA, USA
and 5Yale University School of Medicine, New Haven, CT, USA
*Corresponding author. E-mail: [email protected]

SUMMARY
A diet high in fruits and vegetables (F&V) has been
associated with a decreased risk of certain cancers,
reduced morbidity and mortality from heart disease, and
enhanced weight management. Yet to date, most of the
US population does not consume the recommended
amount of F&V despite numerous interventions and
government guidelines to promote consumption. Research
has found various impediments to F&V consumption,
such as high costs, an obesogenic environment and low
socio-economic status. However, studies have not sufficiently focused on barriers and enablers to F&V intake
among adult multi-ethnic populations. The present qualitative study examines 147 focus group participants perceptions of impediments and enablers to F&V
consumption. Twelve focus groups were conducted
among African American, Hispanic and Caucasian men
and women in North Carolina and Connecticut. Focus
groups were audiotaped, transcribed verbatim and entered
into QSR NVivo Software. Text data were systematically
analyzed by investigators to identify recurrent themes

both within and across groups and states. Focus group

results indicate that most participants were aware of the
health benefits associated with a diet rich in F&V. Yet
many admitted not adhering to the Health and Human
Services recommendations. Individual impediments consisted of the high costs of F&V and a perceived lack of
time. Early home food environment was perceived as
affecting F&V consumption later in life. Other barriers
reported were ethnic-specific. The African American participants reported limited access to fresh produce. This
finding is consistent with numerous studies and must be
addressed through health promotion intervention. Both
the church and primary care clinics were described by
African Americans as appropriate settings for health
behavior interventions; these findings should be considered. Hispanic participants, mostly immigrants, cited
inhibiting factors encountered in their adopted US
environment. There is a need to improve the availability
and access to fresh F&V commonly available in the home
countries of Hispanic immigrants.

Key words: fruit and vegetables; barriers and facilitators; qualitative

42

Understanding barriers and facilitators of F&V consumption

43

INTRODUCTION

METHODS

Ample research has indicated that nutritional

factors contribute substantially to the burden of
preventable illnesses and premature deaths in
the USA and worldwide (Beaglehole and Yach,
2003). A balanced diet has been shown to
promote overall well-being and health (USDA,
2000). Dietary patterns with higher fruit and
vegetable (F&V) intake are associated with
treating and preventing metabolic syndrome
(Feldeisen and Tucker, 2007) and promoting a
variety of health benefits; including decreased
risk for certain cancers (Lee et al., 2006),
reduced morbidity and mortality from heart
disease (Feldeisen and Tucker, 2007), enhanced
diabetes prevention (Hodge et al., 2007) and
improved weight management (Bazzano, 2006).
Recent studies indicate that the US population
is not meeting the recommended levels of
F&V consumption (Casagrande et al., 2007;
Larson et al., 2007). While Casagrande et al.
(Casagrande et al., 2007) found no statistically
significant increase in F&V intake among adults
between the years 19881994 and 1999 2002,
Larson et al. (Larson et al., 2007) actually found
a mean daily decrease in consumption among
adolescents.
Numerous interventions, such as social
marketing, printed educational material and
environmental approaches, aim to increase the
intake of F&V by targeting both the general
population and at-risk subgroups (Marcus et al.,
1998, 2000; Havas et al., 2000; Langenberg,
2000). Results of the National Cancer
Institutes (NCI) 5-a-day Program were found
to have modest success (Baranowski and
Stables, 2000).
Studies have found numerous correlates
inhibiting the consumption of F&V, such as
low socio-economic status, inaccessibility to
fresh F&V and lack of self-efficacy (Kratt
et al., 2000; Siega-Riz and Popkin, 2001;
Pomerleau et al., 2005). Yet research has not
sufficiently focused on the impediments to
F&V consumption among adult multi-ethnic
populations (Hill et al., 1998; Campbell et al.,
1999; Cullen et al., 2003). The present qualitative study attempts to illuminate the barriers
and facilitators to F&V consumption among
African American, Hispanic and Caucasian
populations and provide suggestions for
program planners when developing future
intervention programs.

Study design and study participants

Twelve focus groups, ranging from 9 to 16
participants, 90 min each, were conducted,
involving African American, Hispanic and
Caucasian men and women representing the
primary ethnic groups in the USA. These focus
groups were conducted both in North Carolina
(n 81) and Connecticut (n 66) to account
for possible differences between rural and
urban environments. Within each of the aforementioned states, two focus groups were conducted for each of the three ethnicities. Focus
groups were held separately for Caucasian and
African American participants between the
ages of 18 and 50 and participants 50 years to
account for potential age-related differential
perceptions. Hispanic groups, however, consisting primarily of immigrants, were divided by
degree of acculturation rather than age. The
rationale behind this decision was that acculturation was more likely to yield a more accurate or valid picture than would age (Larsen
et al., 2003).
Participants were recruited through advertisements at local churches, schools and a
community-based cooperative extension service
in North Carolina and Connecticut. Focus
groups were conducted in four North Carolina
counties (mostly rural areas) and three
Connecticut counties (mostly urban areas), to
represent different regions of the respective
states.
Development of focus group guide
Prior literature was searched regarding determinants and barriers related to F&V consumption
and draft questions were compiled. An expert
panel of health educators and public health
researchers with training in cultural competency
was recruited to review the questions and to
provide a rigorous focus group guide (Ickes
et al., 2005). Focus group questions regarding
fruit and vegetable consumption were divided
into: (i) general determinants, (ii) perceived
barriers, (iii) enablers, (iv) knowledge and (v)
attitudes.
Data collection
Five trained research staff moderated the focus
groups, with the same moderator conducting

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M.-C. Yeh et al.

both groups for each ethnicity within each state.

Moderators were matched to participant race,
except for the two African American groups in
Connecticut which were led by the same
Caucasian moderator who also moderated the
two Caucasian groups. The four Hispanic focus
groups were conducted in Spanish. The interviews were first transcribed verbatim in Spanish
and then translated into English prior to analysis. All focus group interviews were
tape-recorded. All participants were compensated $25 at the end of the sessions. This
project received approvals from the UNC and
Yale University Institutional Review Boards.
Tables 1 5 illustrate the questions used during
the focus group sessions.
Data analysis
All focus groups were transcribed from audio
recordings and then entered as text and coded
using QSR NVivo Software (QSR NVivo,
2000). Text data were carefully read by investigators and systematically analyzed to identify
recurrent themes both within and across groups
and states. Researchers read all transcripts individually and then convened to discuss themes
and patterns. Two researchers (S.B.I. and
L.M.L.) concurrently coded all text data to
ensure consensus and consistency. Data coded
under the nodes were organized into three
major categories relating to F&V consumption:
(i) general determinants, (ii) barriers and (iii)
facilitators. General determinants were defined
as factors that had an inconsistent effect within
and across groups, that is, they promoted and
inhibited F&V consumption. Facilitators were
defined as factors that promoted consumption,
and barriers were defined as factors that ultimately inhibited consumption. A matrix-based
approach using rich text was used to analyze
text from all focus groups (Pope et al., 2000).
This method reduces the possibility of selectively reading the data, and allows for direct
comparison of nodes and categories between all
participant groups so that both the presence
and absence of comments are noted.
RESULTS
The following results present barriers, facilitating factors and general determinants for F&V
consumption in the context of ethnicity

Table 1: Questions used by facilitator about

General Determinants of fruit and vegetable
consumption
1. When you go to the grocery store what affects the
kinds or amount of fruits and vegetables you buy?
2. What do you think causes you to eat more or less
vegetables when you eat in a restaurant?
3. How do other people in your life impact how many
fruits and vegetables you eat? Who influences how
many fruit and vegetables you eat?
4. Do you think people eat more or less fruits and
vegetables as they get older?
5. Lets think about the kinds of fruits and vegetables we
eat now, and try to see if we think there is a
connection with what we learned as children from the
people around us, or just where we grew up and the
things we were exposed to. How do you think this
affects the kinds of fruits and vegetables you eat now?
6. How do you think your background influences the way
you prepare your fruits and vegetables now?
7. Are you more likely to eat fruits and or vegetables at
breakfast, lunch or dinner?
8. When you go to the store or market to shop, what are
the things that affect the type and/or quantity of fruits
and vegetables that you buy?
9. Why do we eat more or less fruits compared to
vegetables?
10. Are you more likely to eat some fruits and vegetables
during certain times of the year? If yes, why do you
think this is so?
11. How do the people you live with influence what you
buy?

(African American, Hispanic and Caucasian)

and the age (,50 versus 50) of participants.
No substantial differences by degree of acculturation for Hispanics or regional differences
were found and therefore results are not
presented.
The common facilitators of fruit and vegetable consumption across all groups included
family traditions, health benefits and advise by
physicians. The predominant barriers among all
groups included inaccessibility, cost and time. A
review of findings by ethnicity and age groups
shows some variations that are described in the
following sections.

Ethnicity
Barriers
Many of the factors that negatively influenced
F&V consumption were common across ethnic
groups. The high cost of F&V was the most
prevalent concern regardless of ethnicity: I just
dont have the money . . . . You get the basics:
meat, milk, and maybe vegetables. Fruit is an

Understanding barriers and facilitators of F&V consumption

Table 2: Questions used by facilitator about
Barriers to fruit and vegetable consumption
1. What do you believe is the main reason people do not
consume fruits and vegetables?
2. What makes it hard to eat more fruits and vegetables?
3. What kinds of things might keep you from buying more
fruits and vegetables?
4. Think about when you are at home; is there anything
that prevents you from eating fruits and vegetables?
5. What do you think causes you to eat more or less
vegetables when you eat in a restaurant?
6. What do you think are the reasons Latinos do not eat
the quantity of fruits and vegetables that they should?
Remember, when we say fruits, this includes juices, and
when we say vegetables, this includes the vegetable
juices and salads.
7. What things keep you from purchasing fruits and
vegetables?
8. When at home, what prevents you from reaching for an
apple instead of the Oreo cookie?

extra (African American, Connecticut- CT).

Lack of energy and preparation-time was commonly mentioned barriers: I just dont have the
time . . . . I dont get home until 5:30 or 6:00 . . .
who wants to cook a meal that late? . . .
(Caucasian, North Carolina-NC,). Moreover,
the convenience of pre-packaged foods and the
high spoilage rate of F&V were regarded as
impediments to F&V intake. Media advertising
was cited as having a negative impact on consumption as well: If you go home and turn on
the TV, theyre selling McDonalds, Wendys
and Pizza Hut. . .. You dont see fruits or vegetables in commercials (Hispanic, CT).
Several reported factors were unique to
specific ethnic groups. African Americans most
commonly described a high-fat, high-sodium
preparation style where meat fat was used for
seasoning. We doctor up vegetables so much
with fat back and pork that there is no nutrition
left (African American, CT). Inaccessibility to
Table 3: Questions used by facilitator about
Enablers to fruit and vegetable consumption
1. What are the most important reasons people eat fruits
and vegetables?
2. Are you more likely to eat fruits and or vegetables at
breakfast, lunch, dinner, or as a snack or desert?
3. What would make it easier for you to eat fruits and
vegetables on a daily basis?
4. If you could change one thing that would make you eat
more fruits and vegetables, what would it be?
5. What do you think are the most important reasons that
make people eat fruits and vegetables?

45

Table 4: Questions used by facilitator about

Knowledge of appropriate fruit and vegetable
consumption
1. How many servings of fruit and vegetables do you
think people should eat each day to stay healthy?
2. How many fruits and vegetables do you eat a day?
3. How many fruits and vegetables a day do you think
most people eat?
4. Does consuming certain kinds of fruits and vegetables
prevent certain diseases or colds?
5. Have you heard the slogan 5-a-day for better health?
What does this mean to you?
6. What do you think equals a serving of fruit or
vegetable?
7. How is the food pyramid related to fruit and vegetable
consumption?
8. What do you think are the most important reasons for
people to eat fruits and vegetables?
9. Could you tell us which cooking methods are healthy
and which are unhealthy?
10. Why do you think people need to eat fruits and
vegetables?

grocery stores was also a barrier described by

the African American group. In some cases,
due to the infrequency of grocery store visits,
F&V were consumed quickly and would not be
replenished for several days. On other
occasions, F&V would perish before they were
consumed; this was perceived as frustrating and
caused some members to purchase other foods
with a longer shelf life: When you live in the
city . . . some people have to travel great distances to get fruits, plus they dont have the
economic resources to get to the fresh fruit
(African American, CT). Additionally, many
African American participants discussed a
decrease in home gardens and agriculturalbased households: My father loved to plant and
grow things in the back yard . . . . It was more
Table 5: Questions by facilitator about Attitudes
towards fruit and vegetable consumption
1. How do other people in your life impact how many
fruits and vegetables you eat?
2. For those who immigrated, how do you think your fruit
and vegetable eating habits have changed (if at all) since
you came to this country?
3. What is the connection (if at all) between your current
or past surroundings and the way you were brought up
to your fruit and vegetable intake today?
4. Do you think the fruit and vegetable consumption
depends on the place you reside in?
5. What would people say in if a meal at church would
consist of fresh fruits and vegetables (with no added
meat)?

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M.-C. Yeh et al.

accessible back then . . . I dont have this luxury

nowadays (African American, NC).
Hispanic immigrants to the USA have found
F&V to be less accessible than in their country
of origin. Others lament the rarity of specific
items such as plantains, or complain about poor
quality: I try to keep my Moms tradition of
preparing native vegetable soups and many
salads. But unfortunately in this country you
cant buy the same tropical fruits that we had in
our country (Hispanic, CT). Another participant living in North Carolina noted: In our
countries, although we do not have much, we
live on farms, this makes eating fruits and vegetables easy. Lack of familiar F&V and tools
for traditional preparation styles also limited
consumption: The customs of where we came
from affect this a lot, our parents gave us the
fruit that they chose, and then we arrived here
and we saw other fruits and we say, I dont
know how it tastes, I wont buy it, this has a big
repercussion in the fruits that we consume,
perhaps, we dont consume anything more than
what we know how it tastes, and the others
(Hispanic, NC).
A specific impediment among some
Caucasian participants was the fear of an
adverse health effect from consuming F&V that
might be contaminated with pesticides: There
is a problem with apples, using pesticides. For
the pesticide is illegal to use in the US but not
to make, so they ship it overseas, spray the
apples, and ship them back. This is directly
linked to breast cancer in women . . . You think
you are eating something good, but youre
eating something that is killing you (Caucasian,
CT). Another participant noted that: The fertilizer spray, the whole business, I dont trust it.
The total chemical uses on it. So you dont
think washing it (helps) . . . no, no (Caucasian,
NC).
Facilitators
The key enabler to F&V intake reported across
all ethnic groups was knowledge level about the
health benefits of fruits and vegetables (F&V).
Although many participants admitted to not
eating enough F&V, it was well understood that
these foods are an essential part of a healthy,
balanced diet and that fast food was generally
an unhealthy food source. Furthermore, participants recognized that preparing F&V with
added fat, salt and sugar was unhealthy.

Another prominent enabler to purchasing and

consumption, common to all racial groups, was
a concern over childrens health: The family
habit . . . is one very important factor, because if
you have young ones, you keep a basket of
fruit, the kids get used to that. If you keep a
basket of cookies, they get used to those
cookies (African American, CT). All groups
preferred fresh F&V over canned or frozen
ones.
Despite lamenting certain familial and cultural shifts away from ample consumption,
African Americans and Hispanics made frequent comments about the importance of
growing up eating F&V and developing a
taste for them. Several African American participants noted healthy changes in their preparation style, while some Hispanics described
their preference for fresh F&V over frozen or
canned and noted that they steam their vegetables or eat them raw because cooking longer
wastes a lot of vitamins (Hispanic, NC).
Among African Americans, family physicians
were perceived as the most important source of
information on diet and healthy lifestyle: We
know what we are supposed to eat, but we just
dont do it until we go to the doctor and he tells
us (African American, NC). My doctor told
me my cholesterol was borderline, and I never
thought Id hear that and that I would have to
change my diet (African American, CT).
African Americans described their church
communities as a good setting for educating
and motivating healthy eating, despite many of
the unhealthy traditional foods that are served
at these functions. One North Carolina woman
remarked: Just trying different things too,
because at this church we have feedings from
time to time, well a whole lot, (laughter) and
we could try some different things at those
times, but I guarantee you that most of the time
it is basically the same thing, because a lot of
people like the greens and peas and they are
highly seasoned and that is just tradition . . . but
to try different things like fruits and salad in the
place of some of the other things . . . it probably
wouldnt get eaten (African American, NC).
General determinants
Familial influence was a central determinant
reported by all three ethnic groups. In general,
women served as the nutritional gatekeepers for
their families. One North Carolina man noted:

Understanding barriers and facilitators of F&V consumption

My wife cooks differently than my mother . . .

She dont use the seasoning my mother did
cause I try to eat healthier and stay in shape
(African American, NC). This mans wife (also
a focus group participant) went on to talk about
her adherence to a healthier cooking style: I
really made the decision that I was going to
change when the doctor told me that he had
high blood pressure. Matter of fact, the doctor
told him that he had to change, so by him changing I changed along with him (African
American, NC).
Negative influences of spouses and families
were also reported. One male participant from
North Carolina noted: My son and my wife
dont like vegetables, so she doesnt cook them,
and I dont cook, so I just dont get them. I eat
what she cooks (Caucasian, NC). An African
American mother from North Carolina
described her husband as a negative influence
on the familys diet: In my home that is why I
do not invest in a lot of fruits, because cost wise
they are as expensive as meats and other things,
and my children would waste them, and I would
be the only one-not even my husband . . . it isnt
because he is not informed, it is because of his
desires and tastes. And it has trickled right
down to the children (African American, NC).

Age
Barriers
While both age groups identified cost as a
major barrier, the under 50 group simply noted
that F&V cost more than other food items,
while the 50 group witnessed a transition
from free, homegrown F&V to high-priced
produce in the supermarkets: When I go to the
grocery store and I see the price tags on certain
things, I cannot gear myself up to get a grocery
bag full of them because of the cost, what I
would love to buy would cost half of what my
groceries cost in a week (African American,
NC, 50).
The under 50 age group identified fast food
as a more prominent barrier than their older
counterparts: I think people in my generation
were raised in an era of convenience (African
American, CT, ,50). The younger group identified fatigue after a long day of work as a
barrier to preparing F&V. They noted that if
vegetables came with a meal at a restaurant,
they would be more likely to eat them than if

47

vegetables were offered a la carte. Furthermore,

only the under 50 group mentioned that a lack
of cooking skills hindered their ability to
prepare vegetable dishes.
Facilitators
While both age groups recognized the health
benefits of F&V, the 50 group cited more
proximal health reasons for consumption. For
instance, a female participant recalled, In my
family, we have a lot of heart disease on my
mothers side . . . . As a result Ive changed the
way I eat . . . I cut a lot of the grease out of my
diet and I eat lots of vegetables (Caucasian,
NC, 50). The younger generation demonstrated a more distal concern over health and
change in dietary habits: If I want to lose
weight, I would probably stick more to fruits,
salads, and things like that. I wouldnt change
. . . til I was forced to.. . but my body doesnt
ask for it, so I kind of get into what I want, but
Im not saying thats good. If I wanted to watch
my weight for a while, I would do that. I would
commit to it.
Yet some members of the younger generation
made a conscious effort to develop healthier
dietary habits than their parents: Im becoming
the opposite of the way my mom cooked. When
we were growing up it was a lot of butter, but
now I dont cook that way . . . (Caucasian, CT,
,50). The presence of children in the younger
groups household had a positive influence on
the purchasing and consumption of F&V: Now
that I have kids Im a lot more careful about
what I eat . . . I want to set a good example so I
buy a lot more fruits now (Caucasian, CT,
,50); For me, my childrens health is the most
important thing in the world. I believe plenty of
vegetables are really important for them
(Hispanic, NC, acculturated).
General determinants
Both upbringing and family influence were
described by older and younger participants
alike as having a paramount impact on their
F&V consumption: In my case I keep on reproducing the salads, and almost the same vegetables that my mom used . . . as a habit
(Hispanic, CT, non-acculturated). Another participant added: I think my cooking is probably
very similar to my mothers. Now, do I like new
recipes? Yes, but when push comes to shove
and I got to get a meal on the table quick I fall

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M.-C. Yeh et al.

back on what I learned from my mother

(Caucasian, NC, 50).
Early family eating patterns were described
as having a major influence on dietary practices
later in life: Ill never eat broccoli, we ate cornbread and beef . . . . Thats what Im used to
(Caucasian, CT, 50).; Some kids have never
been exposed (to fruit and vegetables) . . . .
They get frozen food and fast food all of the
time. They dont never eat it and dont really
like it (African American, CT, ,50).
DISCUSSION
Although the health benefits of a diet rich in
F&V are well known, most of the US population does not integrate a sufficient amount of
fruit and vegetables (at least 5 a day) into their
daily diet (Serdula et al., 2004; Guenther et al.,
2006; Casagrande et al., 2007; Larson et al.,
2007; Vitolins et al., 2007). Most studies thus far
have primary focused on barriers to F&V consumption among children (Hill et al., 1998;
Campbell et al., 1999; Cullen et al., 2003). The
present study examines barriers and enablers to
F&V consumption among a multi-ethnic,
multi-age-group population from two regions in
the USA (urban Northeast vs. rural South). The
results of the study might provide insight for
program planners when attempting to ameliorate diets in the adult population.
Findings from the focus groups indicate that
most participants, regardless of ethnicity, associated a diet rich in F&V with positive health
benefits. However, most admitted not adhering
to the Department of Health and Human
Services and USDAs recommendations regarding F&V intake. The primary individual impediment was a perceived lack of time due to long
working hours and extensive preparation time
required for cooking vegetables. This barrier
was more prevalent among the younger (,50)
age group. Additionally, the high-cost and highspoilage rates of F&V deterred many participants from consuming F&V on a daily basis.
Darmon et al. (Darmon et al., 2002), Pollard
et al. (Pollard et al., 2002), Dibsdall et al.
(Dibsdall et al., 2002) findings are consistent
with the present study emphasizing that the
high cost of F&V is an impediment to sufficient
consumption. Additional barriers common to
all ethnicities were the convenience of purchasing pre-packaged foods and the adverse impact

of the media on F&V intake by promoting

fast-food. These results are consistent with the
literature (French et al., 2001; Katz, 2003).
Moreover, the findings of the study indicate that
the home food environment has a paramount
effect on F&V consumption later in life.
Children who grew up consuming abundant
F&V at home continue this practice in adulthood. Similarly, studies by Kratt et al. (Kratt
et al., 2000) and Campbell et al. (Campbell
et al., 2007a,b) have found that the home food
environment impacted what the family unit
(i.e., parents, children or adolescents) ate.
Though many barriers were prevalent among
all ethnic groups, others were ethnic-specific.
For example, African American participants
reported limited access to fresh produce which
consequently inhibited their F&V intake.
Numerous studies have shown that predominately minority and racially mixed neighborhoods had significantly less supermarkets and
more grocery stores than Caucasian neighborhoods, thus limiting F&V intake among low
income populations (Zenk et al., 2005; Algert
et al., 2006; Moore and Diez Roux, 2006).
African American participants saw their church
communities as a good setting for health education, yet the nutritional practices at gatherings
consisted of foods rich in saturated fats. The
African American church community has been
previously explored as a setting for health behavior interventions (Campbell et al., 2000;
Resnicow et al., 2001, 2005; Ammerman et al.,
2003). The cultural influence of the church
should be utilized in future interventions to
further promote a process of positive dietary
change among its members. Additionally,
African American participants discussed the
role primary care physicians play in facilitating
behavioral change. Specific interventions should
be tailored utilizing the primary care physicians
impact to increase this populations F&V
consumption.
Hispanic focus group participants, mostly
immigrants, noted the negative effects of the
US culture on their health: a busy and stressful
work environment, persuasive and prevalent
advertising for unhealthy foods and a reduction
in the quality coupled with an increase in the
price of fresh F&V. Therefore, there is a need
to improve the availability and access to fresh
F&V that are commonly available in the native
countries of Hispanic immigrants. Consistent
with the findings of the present study,

Understanding barriers and facilitators of F&V consumption

Larsen et al. (Larsen et al., 2003) found that

second generation American Hispanics F&V
consumption is significantly lower than first generation American Hispanics, in part because of
TV-viewing and poor dietary habits acquired in
the USA.
The risk of developing lifestyle-related
chronic diseases among most focus group participants of the younger generation did not
appear to be a strong motivator for dietary
change. Diseases were perceived as events that
might occur later in life; hence many younger
participants did not consider a low intake of
F&V a health threat. The combination of low
perceived threat and low perceived benefit
coupled with high perceived barriers (e.g., high
cost of V&F), as conceptualized by the Health
Belief Model (Janz and Becker, 1984), could
explain why younger participants in this study
did not think eating more F&V was a priority
for them now. Therefore, a combination of
strategies aimed at enhancing individual awareness (Cues to Action) of the health benefits of
F&V consumption together with increasing selfefficacy and decreasing perceived barriers might
have a positive impact on the younger segment
of the population.
There are limitations to this study. The
Spanish-speaking groups were likely to have
different ethnic origins across region as most
Hispanics in North Carolina were from Mexico
or other Central/South American countries,
whereas most Hispanics in Connecticut were
from Puerto Rico or Dominican Republic. Our
study contained two focus groups from each
study site, and may have insufficient variability
to draw in-depth comparisons between the
many different Hispanic groups in the USA.
Furthermore, Hispanic groups were divided by
acculturation status rather than by age. This
made the direct comparisons of findings among
Hispanic, Caucasian and African American difficult. Additionally, it is possible that some of
the questions in the focus groups guide might
have led participants to conceive of perceived
barriers and facilitators to F&V consumption
they would not have otherwise thought of.
FUNDING
This study was funded by a grant from the
Centers for Disease Control and Prevention
(CDC),
grant number
U48-CCU115802.

49

This CDC funded study is a joint collaboration

between the Yale Prevention Research Center
and the Center for Health Promotion and
Disease Prevention of the University of North
Carolina at Chapel Hill (UNC).

ACKNOWLEDGMENTS
We acknowledge the important contribution of
the following expert panellists to this project:
Ms Mary Adams (Connecticut Department of
Health), Dr Desiree Backman (California
Department of Health Services, Public Health
Institute), Ms Diane Beth (Physical Activity
and Nutrition Branch, North Carolina Division
of Public Health), Dr Kelly Brownell (Yale
University), Dr Marci Campbell (University of
North Carolina-Chapel Hill), Ms Melinda
Colindres (University of North Carolina-Chapel
Hill),
Dr
Isobel
Contento
(Columbia
University), Dr Alan Kristal (Fred Hutchinson
Cancer Research Center), Dr Susan Mayne
(Yale University), Dr Kim Pham (Yale
University), Dr Peter Salovey (Yale University)
and Dr Carmen Samuel-Hodge (University of
North Carolina-Chapel Hill). Additionally, we
thank focus group participants both in North
Carolina and in Connecticut for participating in
this study.

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