Utilizing the Multi-Theory Model to Explain the Fruits and Vegetables Consumption of Asian American, Native Hawaiian, and Pacific Islander College Student

The benefits of fruits and vegetables have been well documented. Studies show that adequate consumption of fruits and vegetables can reduce the risk of many chronic diseases. However, many adults are consuming well below the recommended levels of fruits and vegetables (F&V) (< 5 cups daily). The transitional period from adolescence to young adulthood is an important time for the promotion of maintaining healthy dietary habits and lifestyles, as most health behaviors learned during this time may persist into later life. While there are numerous studies on the dietary behaviors in other populations, the existing literature on dietary behaviors among Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) is limited. Therefore, this study aimed to utilize the Multi-Theory Model (MTM) for health behavior change to explain the intention of initiating and sustaining fruits and vegetables among AANHPI college students in the U.S. that express and do not express consuming the daily cups of fruits and vegetables. Using a quantitative cross-sectional survey, data was collected from AANHPI college students over the age of 18 who are currently enrolled at a college or university in the U.S., using a 43-item questionnaire. Multiple regression models were used to analyze data. Of the 436 participants, 54.4% (n=237) reported not consuming the recommended daily five cups of F&V. Two MTM initiation constructs, behavioral confidence (b=0.119, p<0.01), and changes in the physical environment (b=0.061, p=0.004) were shown to be significantly associated with the intent to initiate F&V consumption. This model explained 33.7% of the variance. Furthermore, three MTM sustenance constructs, emotional transformation (b=0.110, p<0.001), practice for change (b=0.070, p=0.012), and changes in the social environment (b=0.065, p=0.005) were shown to be significantly associated with the intent to sustain F&V consumption behaviors and accounted for 31.1% of the variance. Approximately 45.6% (n=199) of participants reported consuming five or more cups of F&V. Of the three sustenance constructs examined, only emotional transformation (b=0.122, p<0.001) and practice for change (b=0.139, p<0.001) were significantly associated with sustaining F&V consumption behaviors and accounted for 32.6% of the variance. It was also found that females had a 76.5% increase in odds of consuming five or more cups of F&V (OR: 1.765, 95% CI, 0.460, 1.173, p=0.013) compared with males. Interestingly, participants who lived on campus had an 82% increase in odds of consumption of F&V (OR: 1.82, 95% CI: 1.098, 3.017 p=0.020) compared with students living off campus. Lastly, those who expressed higher behavioral confidence had a 1.33 times higher likelihood of consuming adequate cups of F&V. Findings from this study show that the MTM of health behavior change is useful in predicting fruit and vegetable consumption behaviors among AANHPI college students and should be considered when designing culturally tailored theory-based interventions to encourage healthy eating behaviors.