Values and diet among colorectal cancer survivors and non-affected individuals in North Carolina

Individual core values may be important to understanding and predicting behavioral decisions. This dissertation, presented in two manuscripts, examined the relationship between values and fruit and vegetable (FV) intake for colorectal cancer (CRC) survivors and non-affected persons. Hypotheses were tested using data from the North Carolina Strategies for Improving Diet, Exercise, and Screening (NC STRIDES) project, a population-based study of CRC risk prevention. Manuscript One describes the results of logistic regression analyses to evaluate whether values promote FV intake for 234 participants. Manuscript Two describes the results of case-comparison techniques to analyze counseling transcripts from 24 participants doing a values self-confrontation exercise. Findings include: Manuscript One: All participants selected family, health, and God's will as the most frequently endorsed values. Compared to CRC survivors, non-affected persons were more likely to choose the values responsibility and friendship. Race, sex, baseline FV intake, and intervention group were not statistically associated with endorsing a particular value. Being a survivor did not predict selection of health as a value or selection of value type (instrumental values vs. terminal values). Being a nonsurvivor did predict increased FV intake at follow-up. Neither selecting instrumental values nor health predicted increased FV consumption. Selecting instrumental values was not predictive for reporting higher importance or self-efficacy for FV intake. Manuscript Two: The value health functioned to influence diet as: (1) a necessary component for other values, (2) a manifestation of God's will, and (3) a co-requisite value with responsibility for being in good health. Values functioned in both health promoting and limiting ways. For FV adherence, beliefs were more suggestive than categorizing participants based on values, sex, race, and CRC status. While logistic analyses provided no evidence supporting relationships between values and FV intake, case-comparison analyses underscore that values do influence diet. The values self-confrontation served to raise participants' awareness about their value hierarchies and helped establish how values influence diet choices. Future research should explore ascribed meanings to values in tandem with how values relate to the health behavior of interest. Understanding how and which values influence health behavior practices can impact intervention design for cancer preventive behaviors