to relatively uncontrollable factors will lead to low community efficacy, with adverse effects on personal efficacy.

Problems controlling diet were pronounced and common to all groups. One problem was lack of knowledge. For example, group members lacked the knowledge to accurately identify foods that were free of salt or sugar and to prepare healthy yet tasty meals (Hispanic participants in the Minnesota program). Another problem was social issues, such as the effect of diabetic dietary restrictions on family relationships (Hmong community participants in the Minnesota program) because (1) culturally valued foods were not among recommended healthy foods (Native Americans: Parker, 1994) and (2) adhering to “proper” diets interfered with social relationships that required sharing traditional foods (Lang, 1995). Avoiding traditional foods was seen as a sign of disrespect to those offering them (Pacific Islanders: Wang et al., 1999). Barriers to dietary adherence also existed in a variety of contextual factors, ranging from the difficulty of preparing two menus to the availability and greater cost of healthy foods (Hispanic communities: Hunt, Valenzuela, and Pugh, 1998). Many of the variations on the diet/food/obesity theme are not ethnically specific, and the absence of data from specific ethnic communities likely reflects the focus of the investigator or the special circumstances of the respondents.

A few studies reported data suggesting that latent cultural and individual values may play a critical role in dietary practices. Liburd and colleagues (1999) examined perceptions of preferred body size among African-American women with Type 2 diabetes. As these women “understood” the relationship of weight to diabetes, two-thirds of them expressed a desire to lose weight. However, when confronted with images of thin, mid-sized, and large bodies, they rejected “thin” bodies as unhealthy and perceived mid-sized to large bodies as signs of good health. African-American women living in less safe, low-income areas also appeared to see large body size as a safety factor; a large person appeared more formidable and less likely to be attacked. Implicit beliefs such as



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement