Development and Validation of the Dietary Habits and Colon Cancer Beliefs Survey (DHCCBS): An Instrument Assessing Health Beliefs Related to Red Meat and Green Leafy Vegetable Consumption

Dietary patterns characterized by higher red meat (RM) consumption are associated with increased colon cancer (CC) risk. Preclinical and epidemiological evidence suggest higher green leafy vegetable (GLV) consumption may mitigate these risks. Determining the relationship between dietary habits and expected health outcomes is needed. Methods. The Health Belief Model (HBM) was used to assess perceived CC susceptibility and severity, and related dietary benefits, barriers, and motivators. RM and GLV consumption were quantified using select DHQII items (n=15) capturing the previous 30 days' intake. A 34-item Qualtrics survey was provided to a convenience sample of 1,075 adults residing throughout the US Confirmatory factor analysis measured fitness with HBM, and Cronbach's alpha assessed subscale reliability. A subsample (n=47) completed a 2-week follow-up for test-retest reliability. Independent sample t-tests were used to compare RM and GLV intake and DHCCBS responses between genders. Individual barrier questions and RM and GLV consumption were compared using ANOVA for each gender; post hoc analyses between barrier question responses were assessed with Bonferroni correction. Results were considered significant with a p value of less than 0.05. Results. 990 US adults (52.7% female, 79.1% white, 50.8% aged 35+ years) completed valid surveys. Factor analysis with varimax rotation validated the construct of HBM subscales; only one question had a loading less than 0.745. Subscale Cronbach's alphas ranged within 0.478-0.845. Overall test-retest reliability was acceptable (r=0.697, p=5.22x10(−8)). Participant BMI was (mean±SD) 26.7±6.6 kg/m(2). Participants consumed (median, IQR) 2.3, 0.9-4.7 cooked cup equivalents GLV/week and 12.2, 5.8-21.5 ounces RM/week. Over half of respondents agreed or strongly agreed with the statement “I can't imagine never eating red meat,” while less than one eighth of respondents agreed or strongly agreed with the statement “I don't like the taste of green leafy vegetables.” Conclusion. The DHCCBS is a valid instrument for measuring health beliefs related to red meat, green leafy vegetables, and perceived colon cancer risk. Additionally, these findings suggest increasing GLV may be more feasible than reducing RM for CC risk reduction in meat eaters.