An Importance influence on what people eat is their understanding of the relationship between the foods they consume and potential health risks. Improved understanding of how diet relates to cancer has resulted in dietary guidelines for reducing the risk of cancer. A major challenge is determining strategies for implementing these guidelines. Nutrition communication theory suggests that effective communication of nutrition knowledge and health issues requires understanding individuals' current practices, attitudes, understanding, and knowledge about diet and health i.e., receiver inputs or predispositions.
A naturalistic or ethnographic approach using intensive-depth interviews of both spouses illuminated dual- earner families' (n=18 interviews) perceptions and constructions of meaning(predispositions) towards the diet -cancer connection, a topic about which little is known. These constructions are theorized to influence families' responses to diet and cancer education programs.
A number of themes and underlying issues emerged using Strauss' (1987)" grounded theory" approach to qualitative data analysis. The strongest barrier to positive dietary change is a perceived lack of time for food planning, shopping, and preparation. Other barriers include increased perceived food costs, and children's food preferences.
Another theme that emerged is that some people just "feel good" about eating healthfully, something attributed to both psychological and physiological influences. This emergent theme supports the importance of providing positive messages instead of a negative ones( i.e., Don't avoid, eliminate)
Diet or positively changing your eating habits was viewed collectively as "one thing you can do" to lower your changes of getting cancer, as "one aspect of a system." A healthy balanced diet emerged as related and therefore preventive. Participants claimed they related what they heard or read not just to cancer, but to the" ...larger health issue." In their own words,"...I don't usually separate the cancer part out from the overall health issue." Families seemed more interested in the whole health context, rather than being focused on one specific disease, referring to them as 'health recommendations" Since participants seem to favor the health guidance approach, we ought to orient our messages to how to diet and cancer prevention fit into the larger health issue.
Some families hard a very high level of understanding about current eating recommendations across chronic diseases. They were cognizant of the “one diet” or “total diet” concept to reduce cancer, heart disease and other chronic disease risk. Families felt the one diet message for overall health”…would sell me faster,” than messages only focused on cancer. This is consistent with participants favoring a full complete picture of diet in relation to chronic diseases.
Interviewees seemed well versed with heart healthy education issues reflecting exposure to lots of heart healthy education. They often expressed not being able to remember about the specifics of a dietary recommendation due to the numerous messages on heart and cancer. Participants often commented that they felt more familiar with heart messages than cancer messages.
Reduction of fat and increase in fiber intake were perceived as the “biggies” in terms of cancer prevention dietary guidelines that families were “…becoming convinced on.” The significant majority of participants identified increasing fiber intake in connection with cancer risk, whereas reducing fat was not as strongly or unanimously associated. A theme that cut across participants was the identification of cured meats such as hotdogs and bacon in connection to cancer. Charcoal broiling had the same widespread identification among families.
A major theme among this group of families was their belief and concern related to the cancer risk associated with: chemicals, pesticides and their residues, insecticides, fertilizers. Contaminants in meats from their food also emerged as belief. Peanuts were also perceived to be carcinogenic by several families.
Participants tended to still view diet and cancer recommendations from an “avoid” or “cause” point of view. Diet and cancer prevention education has tried to overcome this by emphasizing positive messages, such as ‘eat more often’ and ‘eat loss often’ instead of ‘avoid,’ ‘cut out’ or ‘don’t eat’. We still have work to do in this area to overcome the old perspective of everything causes cancer.
The interviews indicated that participants made dietary changes to reduce their risk of getting cancer in different ways and to varying extents. When asked about what they have done to reduce their cancer risk, some found that they have experienced all of their energy on “survival.” Leaving little time for much else. The more common reaction, however, was the perception that it was “second nature.” Diet and health issues have always been a concern to most of these families.
An important concept families pointed out was that the dietary change process is a gradual evolving one. This phenomenon sometimes made it difficult for them to tease out a conscious dietary decision for reducing the risk of cancer or for any other chronic disease for that matter.
The news media emerged as a primary source of health news and cancer nutrition information for this group of families (magazines, newspapers, TV, radio). Personal sources of cancer information, such as relatives, friends, co-workers were also discovered to be significant and important to participants. The multiple channels seemed to have reinforced each other by promoting message/content acceptance and some impressive dietary changes. Use of professional sources of cancer nutrition information such as, nutrition educators or involvement in nutrition education programs, was noticeably lacking and not sought out.
This naturalistic inquiry uncovered the salient issues affecting dual-earner young families’ understanding of the diet-cancer connection and developed a vocabulary of terms and phrases meaningful to this audience. The passages reported illustrate how the connection took hold in the minds and lives of these families. Theoretically based implications of the findings for planning nutrition education and communication programs to reduce cancer risk are discussed.
 

Greenberg, Marlene (January 1990). The Diet-Cancer connection: assessing receiver inputs (predispositions) of dual-earner families