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Title:   Author  item
                                            NICKLAS, THERESA - US Department Of Agriculture (USDA)item
                                            JAHNS, LISA - US Department Of Agriculture (USDA)item
                                            BOGLE, MARGARET - US Department Of Agriculture (USDA)item
                                            CHESTER, DIEDRA - US Department Of Agriculture (USDA)item
                                            GIOVANNI, MARIA - US Department Of Agriculture (USDA)item
                                            KLURFELD, DAVID - US Department Of Agriculture (USDA)item
                                            Laugero, Kevinitem
                                            LIU, YAN - US Department Of Agriculture (USDA)item
                                            PETERSON, STEPHANIE - US Department Of Agriculture (USDA)item
                                            TUCKER, KATHERINE - US Department Of Agriculture (USDA)
  Submitted to: Journal of the Academy of Nutrition and Dietetics
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 5/2/2013
                                    Publication  Date: 7/16/2013
                                    Citation: Nicklas, T.A., Jahns, L., Bogle, M.L., Chester, D.N., Giovanni, M., Klurfeld, D., Laugero, K.D., Liu, Y., Peterson, S.J., Tucker, K.L. 2013. Barriers and facilitators for consumer adherence to the dietary guidelines for Americans:  The health study. Journal of the Academy of Nutrition and Dietetics. pii: S2212-2672(13)00527-3.Interpretive Summary: Poor diet is associated with disease risk, yet few adopt and adhere to dietary recommendations, such as those in the U.S. Dietary Guidelines for Americans (DG).  Although studies have been conducted to ascertain factors (barriers) that hinder the consumption of specific foods or nutrients, there is actually little known about the barriers to DG adherence as a whole.  This is particularly true for children.  The present multi-site study used a type of focus group, called nominal group technique (NGT), to determine in 5th grade children and their caregivers (e.g., parent) the primary barriers to following the DG.  NGT is a method of data collection which enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice.  Separate NGTs were conducted in different children and caregivers to assess the types of factors, called facilitators, that help DG adherence.  Specific barriers for children (e.g., availability of competing “junk” foods) and adults (lack of meal preparation skills) were identified, as were barriers (e.g., poor palatability) common to both children and adults.  Identified facilitators of DG adherence coincided with barriers.  Overall, results suggest some modifiable conditions that may aid in the development of interventions aimed at helping persons follow the DG.
                                Technical Abstract: The majority of the U.S. population does not meet recommendations for consumption of dairy (D), whole grain (WG), fruit (F), and vegetables (V).  The goal of this study was to understand barriers and facilitators to adherence to the Dietary Guidelines (DG) for Americans for four nutrient-rich food groups in fifth grade children and adults across six sites in a multi-state study.
A total of 281 adults (32% African-American [AA]; 33% European-American [EA]; 35% Hispanic-American [HA]) and 321 children (33% AA; 33% EA; 34% HA) participated in 97 Nominal Group Technique (NGT) sessions.  NGT is a qualitative method of data collection which enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. The core barriers specific to adults were lack of meal preparation skills or recipes (WG, D, V); did not grow up eating the foods (D, F, V); spoilage/ripeness and cost (WG, F, V); cultural issues (WG); and health reasons, e.g. lactose intolerance (D). Specific to children, the core barriers were competing foods, i.e. junk foods/fast foods (WG, D, F, V) and lack of exposure (V) or availability (F). The core barriers common to both children and adults included disliking the taste (D, WG, V) and lack of knowledge on food sources/health benefits/portion sizes (WG).  For both adults and children, reported facilitators closely coincided with the barriers and highlighted modifiable conditions that could help individuals to meet the DG.


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