Purpose-To examine the efficacy of an intervention based on the transtheoretical model (TTM) for increasing fruit and vegetable consumption among economically disadvantaged AfricanAmerican adolescents. Design-Pretest-posttest quasi-experimental study.Setting-Youth services agencies located in New York, New Jersey, and Pennsylvania. Agencies were assigned to computer intervention (CIN) and nonintervention control study arms.Subjects-A total of 507 African-American adolescents ages 11 to 14 years.Intervention-Youths in the CIN arm completed four 30-minute intervention sessions tailored on TTM stages and processes of change.Measures-Self-reported fruit and vegetable consumption and stages, pros, cons, and self-efficacy for consumption.Analysis-Intervention effects were examined with analysis of covariance models that were controlled for demographic variables and baseline measures of each outcome. Chi-square analyses were used to examine between-arm differences in youths' stage progressions.Results-After adjustment by covariates, pros (p < .025) and fruit and vegetable consumption (p < .001) varied significantly with study arm. Youths in the CIN arm had higher pro scores and fruit and vegetable consumption than controls. More youths in the CIN arm than in the control arm progressed to later stages and maintained recommended intake levels (p < .05).Conclusions-A TTM-based intervention can increase fruit and vegetable intake and effect positive changes in TTM variables related to intake among economically disadvantaged AfricanAmerican adolescents.Send reprint requests to Jennifer Di Noia, PhD, Columbia University School of Social Work, 1255 Amsterdam Ave., New York, NY 10027; jd201@columbia.edu. NIH Public Access PURPOSESubstantial epidemiologic evidence supports the protective role of fruits and vegetables in the prevention of cancer. 1 Despite the health benefits of a diet rich in fruits and vegetables, fewer than one fourth of African-American adolescents consume the minimum five recommended daily servings and, like U.S. adolescents from other racial/ethnic groups, their average intake decreases with income. 2 Although African-Americans comprise a modest 13% of the U.S. population, cancer incidence and mortality rates are higher among African-Americans than they are among members of any other U.S. racial and ethnic group. 3,4 Their low fruit and vegetable intake and high cancer incidence suggest that economically disadvantaged AfricanAmerican adolescents would benefit from intervention to increase fruit and vegetable consumption.The transtheoretical model (TTM) provides a theoretical framework for developing interventions to modify a variety of health behaviors. 5 The model comprises four constructs: (1) stages of change, the temporal readiness to modify health behavior; (2) decisional balance, the relative importance of the perceived pros and cons of change; (3) situational selfefficacy, confidence in one's ability to modify the behavior across positive social, negative affect, and difficult situations; a...

Although low-income youth are likely to have low or less frequent fruit and vegetable intake, current understanding of the influences on intake in youth is limited. A systematic review of quantitative research on determinants of fruit and vegetable intake among low-income youth (i.e., persons aged <20 years) was conducted. The aims were to identify which determinants have been studied and which are consistently associated with intake. Fifty-eight papers published between 2003 and August 2013 were included. Across studies, 85 unique determinants were identified. Those best supported by evidence were race/ethnicity (with intake consistently higher among Hispanic as compared with African American and white youth), fruit and vegetable preferences, and maternal fruit and vegetable intake. For many potential determinants, the consistency of evidence could not be examined because of a lack of studies. Findings highlight racial/ethnic differences in fruit and vegetable intake and influences on intake that should be considered when designing dietary interventions for low-income youth. Further research on intake determinants in this at-risk population is needed to establish an evidence base to guide interventions.

Observed differences in TTM variables and fruit and vegetable consumption by stage of change in this sample of economically disadvantaged African-American adolescents were consistent with theory and previous applications of the model to fruit and vegetable consumption in adults. With replication studies, the TTM may be appropriate for designing interventions to increase fruit and vegetable consumption among this population.