African Americans are one of the largest ethnic minority groups in the United States (U.S. Census Bureau, 2008). African Americans in the United States suffer from many health disparities related to chronic diseases. For example, the rate of obesity is higher among African Americans compared to white Americans (National Center for Health Statistics, 2008). Also, African Americans have higher rates of obesity-related co-morbidities such as diabetes, hypertension, cerebrovascular disease, and some cancers than the white population (Satia et al., 2004).

North Carolina has the 17^th highest rate of obesity in the nation among adults and 5^th highest among teens. It is ranked 9^th highest for rates of diabetes and 10^th highest for hypertension (Trust for America's Health, 2008). In 1999-2002, the rate of death from heart disease among black North Carolinians was more than 20 percent higher than in whites (Center for Disease Control and Prevention, 2008; North Carolina Department of Health and Human Services, 2008). Additionally, while the cancer mortality rate in the nation declined over the last decade, cancer mortality remains high in North Carolina, and in Edgecombe County, NC where blacks comprise the majority of the population, it is the number one cause of death (North Carolina State Center for Health Statistics, 2008).

Lifestyle factors including diet and physical activity play an important role in prevention of these health conditions. Diets that include daily consumption of a variety of fruits and vegetables, whole grains, limited or moderate use of low fat meats and dairy products have been found to assist in the prevention of many chronic diseases (Office of Disease Prevention and Health Promotion U.S. Department of Health and Human Services, 2008). The National Cancer Institute recommends that black men eat 9 servings of fruits and vegetables a day as part of an active lifestyle to promote good health and protect against diet-related diseases (National Cancer Institute, 2008). Additionally, an objective of Healthy People 2010 is to increase the proportion of people consuming at least two servings of fruits and three servings of vegetables. In addition, objectives of Healthy People 2010 include increasing the proportion of people who consume at least three servings of whole grains, and who consume less than 10 percent of total calories from saturated fat. Unfortunately, many Americans do not meet recommendations. According to Healthy People 2010, food consumption patterns of citizens 2 years of age and older in the United States reflect insufficient daily consumption of whole grains (7% meeting recommendations), vegetables (3%), and fruits (28%) (Healthy People 2010, 2008).

The traditional cuisine of African Americans in the southern U.S. is often called "soul food." Although soul foods include a variety of healthful foods such as collards, okra, rice, legumes, and sweet potatoes, soul foods also include high intakes of fat from a variety of meats, especially pork, seasoned with lard or other animal fats. According to a recently published study with African Americans living in North Carolina, fat intake comprised close to 50% of calories which far exceeds the current recommendation of 20 to 35% of calories from total fat (Kim et al., 2008). Also, intake of fruits and vegetables among black North Carolinians is particularly low. Satia et al. (2004) reported that the mean daily intake of fruits and vegetables was 0.88 and 1.64 servings, respectively, among African Americans living in North Carolina.

The objectives of this research project were to 1) assess participants' nutrition knowledge and knowledge of food and disease prevention linkages, 2) assess perceived benefits of and barriers to eating a healthy diet, 3) assess self-efficacy associated with eating a healthy diet, 4) assess beliefs about healthfulness, appropriate consumption, and protective aspect of specific foods including fruits, vegetables, and whole grains, and 5) identify self-efficacy of shopping for foods such as whole grains, foods low in fat or sodium among members of two African American churches located in two eastern North Carolina counties.

People living in the eastern region of North Carolina have higher rate of obesity, diabetes, cancer and other health problems compared to the rest of the state and to national statistics. Many of these health conditions are a result of unhealthy eating habits that may include high intake of saturated and trans fats, and low intake of fruits, vegetables, whole grains and other healthy foods. The goal of the current study was to assess beliefs, barriers and self-efficacy of eating a healthy diet and self-efficacy of shopping for foods such as whole grains or foods designated as low fat or low sodium. Additionally, assessment of beliefs about healthfulness, appropriate consumption, and protective aspect of specific foods including fruits, vegetables, and whole grains was made.

Participants gave relative low scores for all statements regarding barriers to eating healthy foods except for a statement about the price for buying healthy foods. These scores were also lower than scores regarding perceived benefits. The high value of benefits and somewhat lower value of barriers in this sample were consistent with those reported by Henry et al. (2006) regarding decisional balance scores for fruits and vegetables. Perceived benefits have also been reported as important factors to consider in consumption of fruits and vegetables by people from other studies. Moser et al. (2005) for example, found that intrinsic benefits such as living longer, losing or maintaining weight and having more energy were the best predictors of intakes of fruits. The results of the current study showed that beliefs that the intrinsic benefits of eating a healthy diet such as feeling better or being healthier received the highest scores from all benefits statements. The low scores for barrier statements and relatively high scores for benefits indicate that they saw few obstacles and many benefits to eat healthy. Also, only the cost of healthy foods was considered a significant barrier to eat healthy. Moser et al. (2005) suggested that such intrinsic factors may be helpful in the efforts to increase intakes of fruits among African American males. However, the self-reported perceived intake reported in the current study shows that these beliefs did not translate into perceived increased intakes (Table 4).

Contrary to previously published studies, participants of the current study did not consider dietary preferences of significant individuals such as family members or friends to be significant barriers to eat healthy. Participants included in a sample in the Airhihenbuwa and Kumanyika (1996) study, perceived those with whom food is eaten as a very relevant factor for food preferences. Moser et al. (2005) suggested based on their results that significant individuals such as family or peers would have a significant impact on intake of fruits among African American men.

In spite of the high evaluation of benefits and relatively low score value for barriers most participants indicated that they consumed inadequate intake of foods they indicated as healthy while indicating too high consumption of foods believed to be unhealthful. In the light of the above, the question must be asked why the knowledge and beliefs as well as low value of perceived barriers to eat healthy and high value of perceived benefits do not coincide with the indicated behavior? Ard et al. (2005) found that acculturations are important factors in consumption of fruits, vegetables and the amount of fat. They found that African Americans who were more traditional in their religious beliefs, had preferences for things African American, interracial attitudes, health beliefs and practices, racial segregation, and family values ate fewer servings of fruits and vegetables and more fat. Findings reported by Airhihenbuwa and Kumanyika (1996) also seem to support the influence of culture on food preferences among African Americans. Although participants in that study stated that being black has nothing to do with food preferences, they did state that "Food practices are handed down from generation to generation. Once your body gets used to a particular type of food, it is not easy to switch to another type." They also stated that "I noticed that anywhere Black people go, they do tend to go where the more spicier type food is." Although acculturation was not found to be a significant predictor of fat intake in a sample included in a study by Evans (2007), most research on food preferences of African Americans strongly suggests acculturation to be a very important factor. It is safe to assume that the current results may be explained by the idea that cultural beliefs and attitudes may influence dietary pattern regardless of awareness of disease prevention or beliefs regarding healthfulness of foods. Cultural beliefs are believed to be particularly strong in the southern region of the U.S. and the eastern part of North Carolina which was the setting for the current study and is a part of the U.S. south.

Taste and food preferences were reported in other studies as important predictors of intake of vegetables. Moser et al. (2005) found that preference for foods such as candy, cookies, or ice cream was an important determinant of limited intake of vegetables. The results of Moser et al.'s study were consistent with similar studies that reported taste as a barrier to eating vegetables but not fruits. The results of the previous studies would indicate that taste would be a stronger factor in food selection than awareness of health issues and other perceived benefits or barriers. However, barrier statements related to taste included in our survey did not receive very high scores indicating that they were not very important in food selection (Table 1).

Participants in the current study indicated that both red and processed meats are not healthy and that they should consume less of them. This finding is consistent with the findings reported by Airhihenbuwa and Kumanyika (1996) who interviewed groups of African Americans in a focus group setting. Fourteen participants in that study believed that foods high in fat and saturated fat should be modified or replaced by foods lower in fat. The perceived high consumption of meats reported by the participants of the current study was consistent with other reports. According to Gans et al. (2003), black participants from their sample were less likely to eat meatless meals and modify meats to make them lower in fat. They were also less likely to modify other dietary behavior related to fat intake such as consuming low fat cookies or milk.

Based on ethnicity and weight status the participants included in this study were at high risk for many chronic health conditions. The results showed that overall participants had adequate knowledge about the association of specific foods such as fruits, vegetables, whole grains or processed meats with disease prevention and the nutrient content of specific foods (Table 5). However, only a small percentage of respondents correctly answered questions about recommended intakes of fruits or vegetables. The low rate of awareness about the recommendation for produce is consistent with those reported by Stables et al. (2002). According to their report which was based on a nationally represented sample, just 5.36% and 13.82% of African American respondents surveyed in 1991 and 1997, respectively, were aware of the recommendations for fruit and vegetable intake.

Generally speaking participants gave high scores for perceived benefits (considered them to be important) to eat healthy while barriers of eating healthy received much lower values (considered to be less important factors). Also, participants expressed relatively high self-efficacy of eating healthy foods and purchasing foods that could help them to improve their diets. Additionally, participants showed high awareness of foods that are associated with disease prevention including fruits, vegetables, and whole grains. They also had a good understanding of nutrient content in selected foods. Based on these results, future programs designed to improve diets for this population should not be focused on increasing awareness of benefits of, addressing barriers of healthy eating or to seek to increase self-efficacy of eating or purchasing healthy foods. However, participants did indicate that they do not eat enough of the foods perceived to be healthy and that they eat too much of foods that are known to be unhealthy. Diet plays a very important part of disease prevention and development. Since African Americans are disproportionately affected by many diet related diseases, it is essential that further research be conducted to understand why African Americans have the dietary behaviors they have. One possibility that needs further exploration is the factor of cultural identification on dietary behaviors in this population. In order for interventions to be successful, they must include honest conversations regarding cultural aspects of dietary preferences. Interventions should also focus not only on individuals but entire families and communities at large. In recent years, faith-based health programs have become increasingly popular because of acceptability and positive outcomes especially in African American populations. Church and church leaders can play a very important role in making some desirable changes in food habits of church members. Church based nutrition interventions that include changes in policies regarding healthy foods offered at events, finding opportunities to introduce new healthy foods, and teaching alternative ways of food preparation may be more effective at making lasting dietary changes. Additionally church-based interventions may be even more successful if they include a Biblical foundation for the recommended healthy dietary changes. The Bible plays an important place in the lives of many African American members of Protestant denominations and contains a number of texts, stories and characters that center around food or attitudes of people toward food. For example, Biblical texts can be used to teach about grains, legumes, fruits and vegetables, nuts, flax seeds, honey and olive oil. Additionally, concepts such as variety, moderation, temperance, and self-control can be supported by the scriptures and may be especially important considering that overeating and over nutrition is a primary issue in the development of obesity and thus subsequent chronic health disease. The results of this study could be incorporated into future church-based nutrition interventions with the African American community in the southeast region of North Carolina.