Changes in dietary behaviors of Greeks and Greek-Americans living in Tarpon Springs, Florida

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Title:
Changes in dietary behaviors of Greeks and Greek-Americans living in Tarpon Springs, Florida
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Creator:
Kurtz, Cora Sweigart
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Subjects / Keywords:
Greeks -- Nutrition -- Florida -- Tarpon Springs   ( lcsh )
Greek Americans -- Nutrition -- Florida -- Tarpon Springs   ( lcsh )
Diet in disease   ( lcsh )
Anthropology thesis Ph. D
Dissertations, Academic -- Anthropology -- UF
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bibliography   ( marcgt )
non-fiction   ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1990.
Bibliography:
Includes bibliographical references (leaves 182-190)
Statement of Responsibility:
by Cora Sweigart Kurtz.
General Note:
Typescript.
General Note:
Vita.

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University of Florida
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All applicable rights reserved by the source institution and holding location.
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aleph - 001556847
oclc - 22579235
notis - AHH0478
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CHANGES IN DIETARY
GREEK-AMERICANS LIVING


BEHAVIORS
IN TARPON


OF GREEKS
SPRINGS,


AND
FLORIDA


CORA


SWEIGART


KURTZ


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
* THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT














ACKNOWLEDGEMENTS


Thanks


to Dr.


Leslie


Sue


Lieberman,


committee


chairperson,


whose


understanding,


patience,


support,


critiques


and


guidance


led


me through


the


maze


of higher


education


and


learning


so that


I could


realize


this


accomplishment.


Thanks


also


the


other


members


committee:


H.R.


Bernard,


Dean


Spring


(through


the


qualifying


exams),


Armelagos,


(for


the


dissertation


review),


Shireman


and


Crandall


who


each


added


a unique


dimension


learning


experiences.


Without


the


enthusiasm


and


time


devoted


members


the


Tarpon


Springs


community,


this


study


could


not


have


been


a reality.


am deeply


indebted


to Father


Tryfon


Theophilopoulos


and


Zula


Hourdas,


the


secretary,


the


Saint


Nicholas


Greek


Orthodox


Church


for


their


cooperation


supporting


the


purposes


the


study


making


public


announcements


the


church


services


and


publishing


the


Greek


and


English


versions


the


study


summary


the


church


bulletin;


to Naomi


Patterson


for


recruiting


Greeks


and


Greek-Americans


participate


the


study;


Maria









Greek


Orthodox


Church;


Chryse


Flowers,


who


introduced


the


editor


the


local


weekly


newspaper


so that


I could


submit


data


a copy


collection


and


study


summary


helping


for


publication


me collect


names


prior


persons


participate


the


study


following


a church


service;


the


Helen


Ellis


Hospital


administration,


especially


to Jerry


Touchton,

Emmerson,


Director


Coordinator


Community


Relations,


Volunteers,


for


and


Ruby


their moral


support


and


assistance


with


lending


me the


Reflotron


machine,


allowing


me to participate


the


Cholesterol


Screening


and


Health


Fair


recruit


participants


the


study


and


collect


data,


assigning


a bilingual


phone


operator


the


switchboard


make


calls


potential


participants


and


for


assigning


volunteer


retired


nurses


to help


with


the


finger


sticks


and


running


the


Reflotron


machine


for


the


cholesterol


analysis;


and


to all


the


others


from


the


Tarpon


Springs


community


who


helped


with


the


coordination


the


study


and


participated


the


study.


Thanks


are


also


appropriate


Jeff


Glor,


for


his


assistance


with


the


computer


data


analysis;


to Elias


Stassinos


for


the


back


translation


the


Greek


translation


the


questionnaire


to English;


and


friend,


Don


Higler,


for


his


encouragement


throughout


this


endeavor.











TABLE OF CONTENTS


page


ACKNOWLEDGEMENTS.IN...................................

LIST OF ABBREVIATIONS.................................


vii


ABSTRACTS .......... .. ........................ ...

CHAPTERS


INTRODUCTION..


Diet and Heart Disease....................

Ethnicity.o.............................****

Research Goals..............................


REVIEW OF THE LITERATURE....................


Ethnicity..................................

The Greek and Greek-American Diet...........

Diet and Risk of CHD........................

Nutrition Intervention......................


Pilot Study.................................

The Research Site...........................

Sample......................................

Data Collection.............................

Data Analysis..............................

Variables....................................


- ----I -


METHODSr








Demographic Characteristics................


Eating Preferences Affecting Food Use.......

Frequency of Food Intakes...................


The 24-Hour Recall......................... 103

Risk Factors for CHD........................ 113

5 DISCUSSION.................................. 127

Adaptive Pressures on Food Use.............. 128

Ethnic Change....... ... ................ 129

Eating Preferences and Diet Changes......... 132

Dietary Changes and CHD Risk Factor Status.. 134

Implications for Nutrition Intervention..... 140

6 CONCLUSIONS........ ...................... 142

APPENDICES............................................ 145

A NEWSPAPER ADVERTISEMENT OF STUDY............ 146

B QUESTIONNAIRE............................... 147

C EATING PREFERENCES OF ETHNIC GROUPS......... 168

D FOOD FREQUENCIES............................ 175

REFERENCES. ............... ... ...... ...... .. .. 182

BIOGRAPHICAL SKETCH................................... 191


Ethnicity....,....,...,.,..,














List


Abbreviations


BMI = body
BP = blood
CA = cancer
Ca/Phos = c


mas
pre


index
sure


alcium


phosphorus


ratio


Card
CHD
chol
CSI
Cult
Diab
GA =
GR =-
gms
HBP
HDL
ht =
K =
kg
kcal
LDL
MANO
max-
mg -
mg/d
am =
N =
Na =
Nati
NG =


NHAN
pk =
Pro
PUFA
Reli
RNA/
SAS
SES
SFA
TV -


= cardiac (heart) medi
= carbohydrate
= cholesterol
= cholesterol-saturated
= culture
I diabetes
Greek-American
Greek
= grams
= high blood pressure m
= high density lipoprot
height
potassium
Kilograms


= 1
)VA
EPA
: mi
1l =


31


cation


index


education
ein


Calories
ow density lipoprotein
= multi-variate analysis
= maximum-ecosapentanoic
lligram
milligrams per deciliter


millimeters
umber
sodium
= national
non-Greek


naennutP.


ES = National Health an
cigarette pack
- protein
= polyunsaturated fatt
= religion
DNA = ribonucleic acid
= Statistical Analysis
= socioeconomic status
= saturated fatty acids
* television


d


y


of variance
acid


(cholesterol


blood


pressure


Examination


values)
reading)


Survey


acid


/ deoxyribonucleic
Systems


acid














Abstract


of the


Dissertation


University


Requirements


Presented


of Florida


for


the


Degree


the


Partial


Doctor


Graduate


Fulfillment


School


the


Philosophy


CHANGES


IN DIETARY


GREEK-AMERICANS


LIVING


BEHAVIORS


TARPON


OF GREEKS
SPRINGS,


AND
FLORIDA


Cora


Sweigart


Kurtz


May


1990


Chairperson:


Leslie


Sue


Lieberman,


Ph.D.


Major


Department:


Anthropology


A cultural


ecological


model


was


used


analyze


infrastructural,


structural


and


demographic


factors


that


influence


dietary


behaviors


and


subsequent


coronary


heart


disease


(CHD)


risk


status


Greek


immigrants,


25-74


years,


the


United


States.


Greeks


were


chosen


because


they


provide


a natural


experiment


persons


who


migrated


from


country


with


a low


a high


mortality


rate


CHD.


the


diet


becomes


more


"Americanized,


" previous


studies


showed


that


the


risk


OlD


increased


among


Greek


immigrants.


Subj ects


were


recruited


a community-wide


cholesterol


screening,


a health


fair,


a Greek


church


and


Greek


organizations


during


the


Fall


1988


and


Spring


1989.








weighed


and


measured,


had


blood


pressures


checked


and


had


finger


stick


for


blood


that


was


analyzed


cholesterol.


The


self-administered


questionnaire


elicited


demographic


and


CHD

and


risk


factor


cooking


information,


preferences,


ethnic


a food


attitudes,


frequency


and


restaurant

24-hour


recall.


Results


indicated


that


Greek-Americans


had


significantly


lower


(p=less


than


.05)


cholesterol


values


(f=205


mg/dl)


than


non-Greeks


(R=220


mg/dl).


Age


had


positive


relationship


(p=.04)


with


blood


cholesterol


for


the


Greeks


and


non-Greeks.


Structural


factors


that


were


operationalized


measure


commercial


influences,


e.g.,


purchasing


foods


and


drinks


advertised


on TV,


using


newspaper


coupons


for


food


purchases


and


using


recipes


from


popular


magazines


were


strong


predictors


(p=.024)


increasing


cholesterol


values


the


Greeks.


Non-Greek


cholesterol


values


were


not


significantly


influenced


infrastructural


and


structural


factors.


sedentary


lifestyle


was


predictive


higher


(R-square=10,


p=.0007)


cholesterols


among


the


non-Greeks


and


the


absence


a chronic


disease


diagnosis


was


predictive


low


(R-square=11,


p=.0017)


cholesterol


levels.


Nutrition


educators


would


benefit


from


considering


the


varying


infrastructural


and


structural


influences


on food








populations


who


have


increased


their


risk


for


CHD


and


other


chronic


diseases.














CHAPTER


INTRODUCTION


Diet


and


Heart


Disease


Since


the


mid-1960s,


epidemiological


evidence


has


accumulated,


explanatory


pointing


variables


dietary


the


behaviors


increased


risk


as one


the


coronary


heart


disease


(CHD).


In 1980


and


1985,


the


United


States


government


published


dietary


goals


recommending


reduced


intakes


(especially


saturated


fat),


sugar,


and


salt,


with


increased


intakes


complex


carbohydrates


and


fiber


protect


against


CHD


risk.


1988,


the


Surgeon


General's


Report


research


on Nutrition


on the


and


role


Health


diet


(DHHS


health


1988)


summarized


promotion


and


the


disease


prevention.


For


the


two


out


three


adult


Americans


who


not


smoke


or drink


excessively,


the


choice


what


eat


seems


to influence


long-term


health


prospects


more


than


any


other


behavior.


The


relationship


dietary


and


cholesterol


CUD


supported


clinical,


epidemio-


logical,


metabolic,


and


animal


evidence.


These


studies


strongly


indicate


that


the


formation


of atherosclerotic


lesions


coronary


arteries,


which


contribute


the


risk










and


LDL


cholesterol,


turn,


are


increased


diets


high


total


and


saturated


fat


but


decreased


diets


containing


polyunsaturated


and/or


monounsaturated


fat.


I chose


to systematically


describe


changes


dietary


behaviors


among


Greek


immigrants


and


Greek-Americans


living


Tarpon


Springs,


Florida,


for


this


study


because


the


population


standardized


Greece


death


has


rate


a low-risk


CHD


for


229.8


CHD.


per


The


age-


100,000


the


Unite<

Keys


States


(1980)


and


found


85.1

the


per 100,000

CHD mortality


Greece


rate


(WHO


1986)


a United


States


male


cohort


40-59


years


to be


5.69 times


higher


than


that


a matched


Greek


cohort.


Greek


immigrants


the


United


States


are


adopting


traditional


American


dietary


practices,


thus


increasing


their


CHD


risk


status


(Christakis


1981).


Preservation


the


traditional


diet


has


been


identified


with


lowered


risk


coronary


heart


disease


for


Greek-Americans


(Christakis


et al.


1965


and


Keys


1980)


and


other


ethnic-Americans,


e.g.


, Japanese


(Robertson


et al.


1977).


However,


there


are


few


systematic


studies


the


natural


dietary


changes


which


occur


among


individuals


response


situational,


economic,


technological,


and


media


influences.











Acculturation


and


assimilation


into


an industrialized


host


society


that


promotes


consumption


mass-produced


foods


alters


health


specific


practices.


dietary


The


components,


multiple


life


forces


styles,


that


and


work


related


hold


consumption


channels


predictable


enough


to maintain


food-industry


profits


paradoxically


narrow


human


choice


and


the


opportunity


resist


the


trend


the


guise


increasing


convenience,


ease,


and


"freedom"


(Mintz


1985:211)


Acculturation


research


provides


a means


for


observing


how


immigrants,


when


confronted


with


altered


food


consumption


environments


, utilize


adaptive


strategies


cope


with


the


new


conditions.


the


process


adaptation,


new


food


behaviors


and


concepts


about


food


emerge


(Bennett


1976).


Identification


with


ethnic


origins


individuals


who


place


a high


importance


on ethnic


cohesiveness


and


dietary


practices


may


advantageous


the


maintenance


and


adoption


of health


promoting


food


behaviors.


Ethnicity


and


other


factors


lead


intracultural


variation


human


food


patterns


and


nutritional


status


within


populations


with


ostensibly


similar


sociocultural


environments.


The


key


understanding


diet


and


nutritional


status


an ethnic


community


to delimit


dietary


heterogeneity


and


address


the


alternative


ways


which










Dietary


differences


this


study


were


not


treated


random


and


idiosyncratic


phenomena,


but


rather


characteristics


broad


patterns


food


use


which


Bennett


(1976)


terms


a cultural


instrumental

ecological


behavior.

analysis


" Bennett


incorporate


a framework

es three


domains:


thought,


the


mental


rules


thinking


that


develop


via


the


process


experience


and


thinking


about


experience,


e.g.,


attitudes,


values,


logic


and


structures;


interhuman


activity,


the


observed


individual


and


group


rules


of behavior


that


govern


relationships,


e.g


interaction,


consensus,


conflict,


affiliation,


individualism,


and


reciprocity;


adaptation,


the


patterns


and


rules


individual


and


group


social


adjustment


and


behavioral change

maintaining status


the


quo,


course


e.g


of realizing


., coping,


goals


adjustment,


adaptation,


adaptive


strategies,


achievement,


compromise


and


fulfillment


The


distinction


between


interhuman


activity,


adaptation,


primarily


descripti


analytic.

ve while


Interhuman


adaptation


activity


explanatory


Adaptive


behavior


further


divides


into


two


levels


analysis:


microsocial,


which


views


behavior


specific


contexts


purpose,


e.g.,


innovative,


manipulative,


coping,


characterized


both


a formal,










social

culture


system


or institution.


manifest


level


Pareto


as "residues"


(1916)

that i


referred


includedd


artifacts,


language,


stories,


rites,


rituals


and


ceremonies.


He called


the


latent


level


operation,


"derivations"


the


hidden


code


concepts)


behind


statements.


A cultural


ecological


framework


was


used


identify


underlying


conditions


and


factors


which


were


adaptive


maladaptive


dietary


behaviors


terms


of health


consequences.


Dietary


behaviors


this


study


were


viewed


as the


result


a conscious


or unconscious


decision-making


process


within


a specific


context


which


offered


alternatives


and


imposed


constraints


on choice.


A feedback


system


further


supported


or modified


this


decision


process


(Bennett


1976).


In this


research,


I addressed


the


diet-health


status


Greek


immigrants


and


Greek-Americans


(especially


relation


CHD


risk)


stemming


from


dietary


changes


that


accompany


assimilation


into


the


American


society.


The


direction


and


extent


an immigrant


s assimilation,


a large


extent,


believed


result


from


forces


attraction


(positive


and


negative)


generated


the


social


organization


ethnic


communities


and


their


capacity


to attract


and


hold


members


within


their


social


boundaries


(Breton


1964).










descendants


of the


cultural


behavior--language,


norms,


customs--of


the


new


society.


Assimilation,


his


definition,


implies


the


entrance


the


ethnics


into


the


very


fabric--social


cliques,


business


life,


civic


associations,


and,


eventually,


the


families--of


the


society.


While


acculturation


usually


proceeds


faster


than


assimilation,


believes


that


acculturation


has


probably


lagged


behind


the


Greek-American


population.


If his


assumption


true,


then


dietary


practices


Greek-Americans


Tarpon


Springs


have


changed


more


slowly


than


their


macrosocial


adaptation


the


American


social,


business


and


civic


institutions.


Research


Goals


The


key


goals


this


study


are


a description


dietary


patterns


emphasizing


determined


inter-ethnic


and


a complex


intra-ethnic


set


variables


heterogeneity


and


a cultural


ecological


framework


that


stresses


the


importance


the


social


as well


as the


material


environment;


and


delineation


variations


diet


as adaptive


strategies


among


Greeks,


Greek-Americans


and


non-Greeks.


(Figure


page


(DeWalt


1983,


DeWalt


and


Pelto


1976,


Goode


1984).


A related


objective


emphasize


the


multifactorial











U- -UD


IrMnASrUCTUZu n ACTO -^.


LIKE it FO


OOD USPAT


Figure 1
Food


-1:
and


Ecological Influences on


Diet-Related


Disease


INHERENT INDIVIDUAL
RISK FACTORS


LIFESTYLE
RISK FACTORS


Health Status/
CHD Risk


IIPlOeC


m0










life


style


factors


that


may


make


the


occurrence


CHD


more


probable


(Figure


page


(Beaton,


1976).


Dietary


patterns


and


other


CHD


risk


factors


are


analyzed


technological


indicative


identify


interactions


influences.

adaptive or


These


between

observed


maladaptive


ethnic


and


patterns


behaviors


are


that


affect


CHD


risk


factor


status.


The


observed


systematic


trends


dietary


pattern


changes


among


aggregates


Greek


and


Greek-American


individuals,


compared


non-Greeks,


are


useful


predicting


future


dietary


changes.


Such


predictions


could


serve


as a marketing


tool


for


designing


nutrition


intervention


program


Greeks


and


Greek-Americans,


identifying char

to incorporating


who


are


acteristics

directed d


increased


persons


dietary


risk


who


changes


for


are

into


CHD,


most amenable

their food


behaviors.


Health


planners


may


find


this


study


useful


when


developing


guidelines


for


health-related


behavior


changes


that


deal


with


a complexity


of food


consumption


behaviors


among


ethnic


populations


that


have


also


increased


their


risk


CHD


and


other


chronic


diseases.














CHAPTER


REVIEW


OF THE


LITERATURE


American


anthropologists


the


first


half


the


twentieth


century


viewed


culture


as an ideational,


superorganic


construct.


They


were


less


concerned


with


material


technical


culture


and


focused


more


on values,


social


structure,


and


ideational


data


(Bernard


and


Pelto


1987)


Humans


were


thought


have


distinctive


idea


systems


and


cultural


definitions


things


like


food


which


influenced


their


behaviors.


Behavioral


differences


among


distinct


social


groups


and


communities


were


believed


result


from


differences


culturally-based


idea


systems.


Extension of this

conclusion (which


notion

became


cultural


causality


an assumption


our


was


the


culture)


that


order


change


behavior,


including


food


consumption


behavior,


culture


(that


ways


thinking


about


things


like


food)


had


to change.


Mead


(1955)


supported


this


educational


model


behavioral


change,


and


this


model


continues


to be supported


among


nutrition


educators


today


(Pelto


1981)










technological


influences


on human


behavior.


Harris


(1979)


example,


described


his


view


how


ideational


and


material


variables


interact


to influence


human


behavior.


contrast


to the


idealist


approach


which


defines


social


and


cultural


phenomena


from


an in-group


(emic)


perspective,


Harris


focuses


on access


resources,


biological


determinants,


and


technological,


and


energy


factors


causal


influences


on both


human


behavior


and


culture.


Bernard


and


Pelto


(1987),


the


book


Technoloav


and


Social


Change,


collected


essays


which


lent


support


the


technoenvironmental


theory


how


human


lifeways


are


shaped.


Anthropologists


and


other


social


scientists


continue


describe


the


relationship


of technological


changes


changes


social


relations,


cultural


values,


attitudes,


and


psychological


functioning.


This


reorientation


culture


change


raises


two


important


concerns:


What


the


role


the


individual


social


change?


and


Is technology


necessarily


"good


for"


people


(Bernard


and


Pelto


1987)?


Mintz


(1985:13)


recognized


that


the


precise


ways


which


culture


change


occurs


are


not


fully


understood.


hypothesized


earlier


that


recurrent


historical

sequences.


changes r

Profound


epeat


or re-enact


changes


dietary










relationships


between


separate


cultures.


Cultural


"meaning"


, in


his


view,


arises


from


cultural


applications


uses.


Thus,


symbolic


meaning


emerges


as a consequence


interacting


external


factors,


e.g


, economic,


political


and


material,


that


give


relevance


or meaning


to the


symbol.


In this


context,


observed


behaviors


are


viewed


explanatory


codes


within


an environmental


milieu


that


can


read


(decoded)


as a "product


the


production.


Ethnicity


Definition


Ethnic


studies


prior


the


1970s


focused


on external


observations


an ethnic


group.


Ethnic


groups


were


seen


minority


cultures


that


had


temporary


differences


with


the


larger


society.


With


time,


the


process


linear


assimilation


would


cumulatively


completed


(Newman


1978)


and


the


ethnic


group


would


integrated


into


the


host


society.


More


recently,


investigators


have


defined


ethnic


groups


as liasoned


individuals


who


share


common


cultural


and


social


affiliations


within


a multicultural,


multiethnic


context (Cohen

inclusion and


1978).

exclusion


Ethnic


group


criteria


for


members


determine


themselves


and


significant


others.


This


broader


definition


of ethnicity


suggests


that


ethnic


groups


can


live


symbiotic


adaptation










Ethnicity


and


Culture


Harwood


(1981)


views


ethnicity


as a broader


phenomenon


than


culture.


standards,


the


While

range


ethnicity


social


marked


situations


certain


and


cultural


cultural


expressions


for


the


ethnic


group


more


varied.


Ethnic


groups


are


not


limited


one


culture


context


but


interact


multiple


alliances


within


their


environments


(Wolfe


1966)


For


example,


Isajiw


(1978)


described


a culture


layer


that


shared


widely


numerous


ethnic


groups


within


Canadian


society


(this


example


could


apply


the


United


States,


as well)


The


technological


culture


shared


many


communities


and


individual


There


a value


placed


on the


products


technology,


the


people


who


have


access


them


and


the


use


new


technologies.


Technology's


common


language


spoken


less


as a symbol


of identity


than


as a


practical


means


of attaining


the


products


of the


technologi-


culture.


This


culture


layer


either


works


together


with


other


culture


layers


or it


contradictory


and


conflicts


with


the


ethnic


group's


values.


Ethnic


group


members


determine


whether


include


or exclude


from


their


ranks.


Criteria


for


Ethnic


MembershiD


Ethnic


membership


criteria


may


perceived


differently


members


than


non-members.


To non-members,


group










(Dreidger


1978).


Discarding


these


sible


ethnic


practices


referred


Moskos


(1989)


as acculturation.


From


an internal


perspective,


ethnic


group


members


are


aware


different


coalitions


and


social


ties


among


the


membership.


Social


ties,


such


as friendships,


marriages,


and


business


relationships


not


form


via


a single


focus


alliance


with


fellow members,


but


incorporate


multiple


dimensions


interaction


with


individuals


from


inside


and


outside


the


ethnic


boundary


(Wolfe


1966)


Breton


(1978:61)


described


these


ethnic


ties


as partially


overlapping


"intersecting


circles"


which


individuals


belong.


One


circle


may


include


kinship


and


friendship


ties


and


another


circle


may


represent


occupational,


religious


and


political


affiliations.


A small


number


group


members


may


share


liasions


both


circles,


but


the


maj ority


members


share


these


ties


with


either


different


fellow


ethnics


or with


individuals


from


outside


the


ethnic


group.


Moskos


(1989)


describes

business


the

and


trend


toward


political


ties


the establishment

with individuals


of social,

and


organizations


outside


the


ethnic


group


as assimilation


into


a host


society.


Acculturation


usually


precedes


assimilation


into


a host


society.


For


Greek


immigrants,


however,


Moskos


(1989)


observed


that


assimilation


generally


has


preceded










The


Ethnic


Boundary


A major


aspect


the


ethnic


group


the


creation


and


maintenance


boundary.


Goode


(1984)


described


the


boundary


as permeable


(open


outside


influence)


closed

members


(socially

relate t


impenetrable).


o significant


Within


objects


the


and


boundary,


according


ascriptive


behaviors.


The


social


bond


that


shared


members

to the


provides

alienation


a sense


experienced


peoplehood


when


that


immigrants


an antidote


arrive


new


culture.


While


local


communities,


families,


clubs


and


unions


offer


membership


ties,


they


not


provide


the


continuum


of identity


with


an individual's


cultural


and


social


roots


that


the


immigrant


desires.


The


degree


boundary


permeability


determines


the


number


outside


alliances


the


ethnic


group


will


tolerate.


For


political


and


economic


purposes,


ethnic


boundaries


are


often


permeable.


Moskos


(1989)


believes


that


motivation


toward


assimilation


Greeks


into


United


States


society


linked


with


a desire


economic


ascendancy


and


political


representation.


Newman


(1978)


described


relationships


among


ethnic


members


as subgroup


and


segments


fluctuating


with


assimilative


inter-group


and


alliances,


divergent


coalitions,


relationships


within


the


larger


ethnic


boundary.


These


ethnic


segments










Ways


Ethnicity


Cohen


(1978)


suggested


that


situational


ethnicity


may


operationalized


represent


the


interaction


two


more


people


from


separate


groups


which


labels


are


used


signify


sociocultural


differences


between


them.


the


emergence


and


persistence


ethnic


differences


believed


to be non-random,


determine

Goode


then


qualities


et al.


questions


and


(1984) ,


about


variations


utilized


the


factors


can


concept


which


examined.


cultural


ecological


influences


on intra-group


diversity


for


studying


persistence


and


change


an immigrant


ethnic


group's


definition


and


food


practices.


They


identified


differences


the


processes


boundary


strengthening


(social


closure)


and


boundary


permeability


(open


outside


influence),


relation


to rules


for


food


use


among


Italian-Americans


Philadelphia.


They


observed


that


contact


with


supermarkets,


communication

industrial wo


media,


rkplaces


restaurants,

tended to d


school


decrease


lunches,


the


and


importance


ethnic


food


usage


and


increased


the


importance


the


American


structure


of meal


formats


(menus)


and


meal


cycles


(patterning


the


use


different


meal


formats


over


time--day,


week,


week-end,


annual


holiday


cycle


and


life


cycle).


Household


differences


dietary


behaviors


were


Studvina










indicator


ethnic


continuity


was


household


ranking


roles


and


the


rights


of members


to negotiate


menu


selections.


These


decision-making


actions


were


mediated


shared


rules,


situational


pressures,


and


personal


preferences.


Greek


and


Greek-American


Ethnic


Identity


Scourby

foreign-born


(1979)

Greeks


observed


New


that


York


United


City


States


maintained


and

strong


religious


and


national


ties,


as observed


affiliations


with


the


Greek


Orthodox


Church


and


social


organizations


which


promoted


dance,


music


and


cuisine.


her


study


three


generations


Greek


immigrants,


she


observed


generational


differences


internal


perceptions


ethnic


identity.


Study


respondents,


when


asked


to identify


themselves


with


ethnic


labels,


indicated


weakening


identities


with


being


Greek.


First


generation


Greeks


tended


identify


with


Greek


or Greek


Orthodox


labels.


Second


generation


respondents


thought


themselves


Greek-American,


while


a discernible


trend


called


American


was


evident


the


third


generation


respondents.


The


number


inconsistencies


observed


with


individual


ethnic


identity


underscored


the


notion


that,


from


the


perception


an ethnic


member,


much


of ethnic


identity i


- a a


1










however,


the


majority


of Greeks


New


York


City


maintained


relatively


strong


attachment


ties


to their


ethnic


religion


and


nationality,


despite


their


identification


with


being


American.


Moskos


(1989


reported


that


the


Greek


Church


America


the


serves


"prime


both


definer


a religious


of Greek


and


social


ethnicity


function


this


and


country


" He


observed


that


the


American


generations


Greek-Americans


are


many


ways


more


Greek


Orthodox


than


their middle-class


Greek


contemporaries


Greece.


While


these


differences


create


social


distances


between


Greek-Americans


and


newly


arrived


Greeks


(Greeks


who


arrived


the


United


States


within


the


past


five


years),


there


are


shared


similarities


their


continuing


conservative


views


about


family


and


personal


matters.


While


adapting


where


necessary


order


accommodate


the


achievement


standards


the


larger


society,


the


approximate


one


million


Greek-Americans


(Moskos


1989


have


maintained


a remarkable


degree


communal


and


family


cohesiveness.


The


ethnic


anchor


for


Greek


immigrant


families


has


been


the


promotion


the


Greek


language


among


their


children


(Moskos


1989).


Greek-Americans,


however,


have


been


less


concerned


with


promoting


the


Greek


language


and


have










Greece.


An estimated


majority


American-born


Greeks


have


visited


their


ancestral


homeland


at least


once.


Moskos


(1989)


identified


three


subgroups


of Greeks


the


United


States:


an older


immigrant


group


who


came


America


before


World


War


or in


the


years


immediately


following;


a more


recent


wave


of immigrants


who


came


to the


United


States


since


the


lifting


of the


immigrant


restrictions


1966;


and


the


children


and


grandchildren


Greek


immigrant


parents


who


constitute


the


Greek-American


communities.


While


each


these


groups


claim


varying


degrees


allegance


Greece,


the


majority


estimated


four


out


five;


Moskos


1989


share


an ethnic


commitment


a common


Hellenic


heritage


and


affiliation


with


the


Greek


Orthodox


Church.


Ethnic


ties


among


Greeks


and


Greek-Americans


can


viewed


as primary


and


secondary


relationships.


Primary


ties


are


informal


and


intimate.


They


involve


networks


among


individuals


and


families.


Secondary


ties


describe


more


formal


or casual


relationships


that


deal,


often


bureaucratically,

Greek-Americans,


with

ethnic


segmented a

activities


alliances. Among

frequently involve


segmented


or secondary


ties:


church


attendance,


voluntary


association


membership,


eating


Greek-cui sine


restaurants,










actively


involved


the


Greek-American


community.


Secondary


group


affiliation


can


define


Greek


ethnic


identity


as much


as primary


group


affiliations.


As generations


become


more


removed


(e.g


third


and


fourth


generations)


from


the


Greek


homeland,


Greek


ethnicity


not


so much


matter


cultural


transmission,


but


one


voluntary


participation


Greek-American


institutional


life.


Greek


culture


among


the


two


or more


generations


removed


may


new


emergent


brand


of Hellenism


in America.


Yet,


certain


forms


of Greek


ethnic


identity--a


Greek


Orthodoxy


within


the


framework


American


religious


pluralism,


attachments


old


country


foods


and


dances,


ungrammatical


Greek,


the


whole


system


kinship


life--continue.


The


Greek


and


Greek-American


Diet


Bread,


olives,


olive


oil,


fruits,


nuts,


and


legumes


are


staples


the


Greek


diet.


Vegetables


are


common


and


meats


are


used


less


frequently


than


the


American


diet.


Milk


rarely


drunk


but


used


instead


dairy


products


such


yogurt


and


feta


cheese.


Desserts


are


very


sweet


and


are


consumed


as snacks


or with


lunch


and


dinner.


Greek


coffee


strong


and


laced


with


sugar.


Religious


and


social


occasions


which


are


include


marked


or exclude


special,


the


traditional


serving


food


certain


practices


foods










masquerading


and


kite-flying


known


as apokria--the


equivalent


the


western


carnival


and


"farewell


to meat"


(Nickles


1969)


During


the


forty


day


Lenten


fast,


no red


meat,


chicken,


fish,


cheese,


dairy


products


or eggs


are


eaten.


eliminated


during


Holy


Week,


the


week


prior


to the


Orthodox


Easter


(personal


communication


1982


and


1989).


Protein


intake


among


Greeks


appears


to be


adequate


with


no observed


significant


deficiencies.


Mineral


intakes


for


iron


and


calcium


are


below


the


United


States


Recommended


Dietary


Allowances


both


before


and


after


immigration


to the


United


States


(Newman


1986)


Valassi


(1962)


studied


food


habits


and


food


practices


Greek


immigrants


to the


United


States


as compared


to the


habits


and


practices


non-migrants


their


respective


regions


origin


Greece.


She


also


studied


the


food


behavior


of Greek-Americans


as a group


the


United


States


Valassi


observed


differences


between


Greek


immigrants


and


younger


generation


Greek-American


food


preferences.


Meal


composition


Greeks


followed


the


traditional


patterns


and


timing


meal


practices


Greece.


Greek-Americans


conformed


more


to the


meal


patterns


of Americans.


American-born


Greeks


preferred


less


time-consuming


recipes










Greek-Americans


tended


"Americanize"


the


cooking


methods,


ingredients,


and


seasonings


Greek


recipes.


Freedman


and


Grivetti


(1984)


observed


similar


trends


among


reported


Greek-American


significant


women


Sacramento,


covariations


among


California.


items


They


such


respondent


generation,


composition


meals,


and


timing


food


intake.


They


identified


a strong


trend


abandonment


traditional


Greek


dietary


patterns


and


the


adoption


American


food


practices


third


generation


Greek-Americans.


Moskos


(1989)


noted


that


food


central


importance


among


dishes,


Greeks


and


olive


Greek-Americans.


and


vinegar


Greek


salads,


foods,


cheese


e.g.,


pie,


lamb


and


variety


Greek


pastries,


are


used


for


social


gestures


hospitality


as well


as nourishment.


survey


Costantakos


(1987)


found


that,


even


among


third


generation


Greek-Americans,


four


out


five


individuals


still


regard


Greek


food


as being


very


much


part


their


diet.


Adaptation


the


American


diet


involves


Thanksgiving


compromises


stuffed


For

turkey


example,


will


the t

found


traditional


on the


American


table


beside


a dish


feta


cheese


and


kalamata


olives.


Greek


immigrants,


however,


have


adopted


the


"American


highball" in


preference


ouzo


or Greek


whiskies


(Moskos











Thus,


while


some


studies


suggest


that


intra-group


variations


dietary


behaviors


follow


a linear


acculturation


model


for


Greek


immigrants


the


United


States


which


ethnic


food


patterns


weaken


with


generations,


this


characteristic


does


not


appear


apparent


Greek


immigrants


general.


On the


contrary,


Goode


(1984)


showed


that


situational


and


structural


factors


may


influence


individual


behavior


Mediterranean


immigrants


the


United


States,


but


may


not


weaken


the


shared


sociocultural


rules


or break


down


the


old


system


entirely.


Interpreting


intra-group


variation


and


the


structural


factors


that


determine


can


help


to explain


the


cultural


traditions.


dynamic


Viewed


both

from


continuity


this


and


change


perspective,


ethnic


ethnic

food


systems


are


eating


patterns


which


are


socially


mediated,


transmitted,


and


reinforced.


an ethnic


group


remains


relatively


closed,


then


the


structure


the


food


system


continues


transmitted


and


reinforced


through


social


interactions


and


social


sanctions.


Diet


and


Risk


of CHD


Epidemiological


studies


(Christakis


1981


and


Kurtz


1982)


suggest


that,


as the


Greek


diet


becomes


more


westernized,


risk


factor


status


for


OlD)


increases


among










lipoprotein


(HDL)


cholesterol


and


increased


triglycerides


were


observed


Greek-American


boys


aged


14-16


years


compared w

generation


ith


Greek


Greek


cohorts


boys


the


the


United


same


age.


States


Second


more


nearly


resembled


the


age-matched


American


boys'


LDL


and


triglyceride


patterns


than


did


the


serum


profiles


Greek


boys


who


immigrated


to the


United


States


with


their


families.


Ferro-Luzzi


(1984)


demonstrated


a similar


increase


CHD


risk


factors


with


an experimental


westernization


Experimentally


of the


increased


Mediterranean


dietary


diet


content,


southern


and


Italy.


altered


saturated-to-polyunsaturated


ratio,


increased


total


serum


cholesterol


and


LDL


both


men


and


women,


and


reduced


HDL


values


women.


The

Research


Surgeon

Council


General


s Report


s Report

(1989)


(1988)

on diet


and

and


the


National


health


found


the


association


between


dietary


fat,


especially


saturated


fat,


and


cholesterol


with


CHD


highly


supported


scientific


evidence.


Grundy


(1989)


further


elucidated


this


relationship


describing


the


effects


monounsaturated


fatty


acids


plasma


lipids


and


lipoproteins.


The


"active"


nutrient











cholesterol-lowering


may


"neutral.


" Its


observed


beneficial


lowering


effect


LDL


cholesterol


may


attributed


the


low


dietary


saturated


fat,


since


saturated


has


been


shown


animal


studies


suppress


the


receptor-mediated


clearance


LDL.


Stearic


acid,


a saturated


fat,


does


not


raise


total


cholesterol


or LDL


(Bonanome


and


Grundy


1988).


In contrast,


palmitic

converted


acid


(another


to oleic


acid


saturated


more


fat),


slowly


which


than


appears


stearic


to be


acid,


raises


certain


LDL


levels.


foods


which


While


are


this


high


observation


stearic


may


acid


suggest


(e.g


that


beef


cocoa


butter)


are


acceptable


for


a cholesterol-lowering


diet,


most


foods


containing


stearic


acid


also


contain


relatively

containing


large


quantities


saturated


fats,


palmitic

general,


acid.


are


Thus,


reduced


foods


for


cholesterol-lowering


effect


(Grundy


1989).


Linoleic


acid


has


been


shown


previous


equations


(Keys


et al.


1965


and


Hegsted


1965)


have


a greater


cholesterol-lowering


effect


than


monounsaturates.


High


intakes


polyunsaturated


fatty


acids,


however,


will


also


reduce


HDL


cholesterol


levels.


HDL


lowering,


contrast,


was


not


observed


with


oleic


acid


diets


(Mattson


and


Grundy


1985).










LDL


cholesterol


(Spady


and


Dietscky


1988).


This


action


similar


to the


described


effects


Grundy


dietary


(1989)


saturated


Decreasing


the


fats,


dietary


cholesterol

receptor ac


and


saturated


tivity


liver


fats,

cells


therefore,


and


increases


conversely


the


lowers


LDL


the


LDL


concentration


the


blood


(Connor


1989).


Connor


. (1989)


devised


a cholesterol-saturated


index


(CSI)


as a means


predicting


the


potential


food


or a diet


raise


the


total


and


LDL


cholesterol.


low


indicates


low


cholesterol


and


saturated


fat


content


a food


or diet


and


a decreased


risk


of CHD.


A high


suggests


an increased


potential


risk


for


CHD.


The


traditional


Mediterranean


diet


approximately


35-40%


and


rich


monounsaturated


(primarily


oleic)


fatty


acids


(Grundy


1989).


Whether


this


diet


or the


United


States


recommended


diet


(DHHS


1988


and


NRC


1989)


and


approximately


oleic


acid


preferable


for


decreasing


risk


CHD


not


known.


The


current


American


diet,


which


contribute


calories


an increased


from


risk


fat,


CHD


known


because


high


ratio


saturated


fats


(DHHS


1988).


the


saturated


and


cholesterol


contents


the


diet


have


a greater


cholesterol-lowering


effect


than










lowest


also


cholesterol


more


values.


indicative


Lower

lowered


total

CHD


fat

risk


intakes


than


would


a higher


diet


that


contains


predominantly


monounsaturated


fatty


acids.


Nutrition


Intervention


Ethnic


Populations


Research


methods


used


to describe


dietary


behaviors


ethnic


groups


may


also


useful


the


analysis


transactions


among


any


socially


bounded


group


whose


social


network


includes


the


sharing


a food


system.


Community


nutrition


research


would


benefit


from


studying


the


cultural


dynamics


food


behavior


continuity


and


change


before


designing


intervention


strategies


for


decreasing


dietary


risk


factors


CHD


and


other


chronic


diseases.


Pelto


(1981)


suggested


that


the


application


approaches


from


anthropology


nutrition


education


research


can


provide


the


following


components:


Participant
ethnographic
community ne
social units
The collect
data.


observation to establish the
context--the characteristics
ighborhood, school, and other


on


qualitative


and


of the
relevant


quantitative


The development of a broad data base, with
collection of information on a wide range of
variables.
The use of observational (intrusive or reactive)
and unobtrusive measures as well as data
collection techniques that rely on interviews.
The development of new data collection tools not
Anr 1 tv1 ott waan aS Sajt 4aan bC -nA ir tn.4 at 1 a










design


levels of analysis:
and beyond to the b
The use of methods
preserve the express
community and avoid
inherent in the use


The


use


that


includes


data


or


individual, family,
roader society.
of statistical analy


sion
the
of


multivariate


elucidate the interact
affect people's dietary


I several
community,

rsis which


of variability within
assumptions of homogen
averages.
statistical techniques
ons among factors that
behavior.


the
eity

to


The


long-term


goal


of such


research


would


produce


information


and


analyses


about


the


effect


technological,


material,

behaviors


health


and


ideological


which,


policy


turn,


influences


would


development.


on community


contribute


integrating


dietary


effective


data


on ethnic


food


patterns


and


disease


morbidity/mortality


with


nutrition


education,


government


guidelines


could


translated


into


dietary


recommendations


for


various


ethnic-American


populations.


research














CHAPTER

METHODS


Pilot


Study


Introduction


A pilot


study


was


conducted


on a small


sample


of Greeks


and


Greek-Americans


living


Gainesville,


Florida,


during


late


Spring


and


early


Summer


1986.


The


purposes


the


pilot


study


were


to test


Parts


'-III


a questionnaire


which


were


devised


collect


data


that


describe


demographic


characteristics,


dietary


practices,


and


frequencies


food


use


among


study


subjects,


and


test


whether


the


instrument


was


sensitive


enough


register


trends


aggregate


groupings


the


study


population.


Methods


Subjects


were


enlisted


community


group


functions


and


individual


contacts.


Group


participants


were


recruited


from


a Sunday


morning


Greek


Orthodox


Church


service,


from


joint


business


meeting


the


Greek


Student


Club


and


the


Greek-American


Student


Club


the


University


Florida,


and


from


a meeting


the


Gainesville


Greek


Women's


Auxiliary.


Individuals


were


recruited


at their


place










frequented


Greeks


and


Greek-Americans


who


live


Gainesville.


Subjects


willingly


filled


out


the


study


questionnaire.


Only


two


females


refused


participate


the


study


Ten


male


and


ten


female


Greek


(n=7)


and


Greek-Americans


(n=13)


participated


the


pilot


study


Ages


ranged


from


20-79


years.


Arrangements


attending


the


group


meetings


Gainesville


were


facilitated


through


the


suggestions


and


invitation

University


of a Visiting


Florida.


Greek


Professor


I attended


the


Classics


community


at the


functions


and


gave


a questionnaire


and


pencil


Greeks


and


Greek-Americans


attendance.


Questionnaire


directions


were


self-explanatory.


No coaching


was


volunteered.


A few


questions


were


asked


the


subjects


clarify


some


the


written


questions.


Subjects


took


between


20-30


minutes


each


answer


the


questionnaire


and


handed


upon


completion.

Results


Greeks,


States


Greece


who


between


more


were


17-32


recently,


family

years.


members,

Greek si


between


lived


.ngles


years


ago.


the


emigrate


Greek


United

d from


family


members


lived


Gainesville


an average


16.5


years,


while


singles


averaged


years


Gainesville.


Previous










Families


averaged


persons


and


singles


persons


per


household


unit.


Family


households


were


composed


average


of 1.2 students,


ranging


from


preschool


through


university


Singles


were


university


students


and


only


two


single


subjects


had


full


or part-time


employment.


Years


education


completed


ranged


from


a Ph.D.


degree.


Neither


age


nor


gender


appeared


influence


Greek


Greek-American


eating


practices


and


food


preferences.


Socioeconomic


status


comparisons,


as reflected


type


employment


and


years


education


completed,


showed


distinguishing


trends


either.


The


majority


subjects


observed


yearly


religious


fasts


and


commemorated


Greek


holidays


with


special


Greek


foods.


One


Greek-American


and


one


Greek


male


reported


never


observing


religious


fasts.


Likewise,


one


Greek-American


female


and


one


Greek


female


did


not


practice


this


religious


observance.


These


individuals,


except


for


one


person,


did


observe


the


Greek


holidays


some


way,


however.


Whether


this


represents


individual


preference


or would


indicative


a trend


a larger


study


population


could


not


determined.


The


most


obvious


differences


eating


practices


and


food


preference


became


apparent


when


Greeks


and










vending


machines.


The


majority


Greek-American


families


preferred


the


alternative


choices


eating


out.


This


trend


was


less


pronounced


with


the


Greek


and


Greek-American


singles.


home,


Greeks


prepared


more


their


dishes


with


Greek


ingredients


and


fewer


with


convenience


foods


than


did


the


Greek-Americans.


Greek


families


showed


a greater


preference


for


feta


cheese,


white


bread,


olive


oil,


olives,


Greek


peppers,


spinach-cheese


pie,


Greek


pastries,


yogurt,


and


Greek


coffee


than


did


their


Greek-American


counterparts.


Greek-American


families,


on the


other


hand,


exhibited


stronger


preferences


cheeses


other


than


feta,


peanut


butter,


meat,


potatoes,


rice


and


pastas,


mayonnaise


or salad


dressing,


milkshakes,


doughnuts,


danish,


coffee


cake


and


other


American


pastries,


potato


chips,


whole


milk


(some


preferred


skim


milk),


chocolate


milk,


koolade


or soft


drinks.


Greek


singles


reported


never


eating


french


toast,


pancakes,


or waffles


and


preferred


eggs


more


frequently


than


did


the


Greek-American


singles.


They


however,


prefer


doughnuts,


danish,


and


coffee


cake


more


frequently


than


both


Greek


singles


family


prefer


members


yellow


and


Greek-American


vegetables,


singles.


cream


and


Greek


yogurt,


contrast


the


preference


Greek-American


singles.










rice,


potato


chips,


and


American


pastries.


In addition,


they


consumed


the


following


foods


more


frequently


than


did


the


Greek


singles:


fish,


poultry,


olives,


low-fat


milk,


herbal


teas


and


diet


drinks.


Conclusions


The


observed


technological


and


comparisons


convenience


suggest


the


factors


influence


determining


dietary


behaviors,


the


and


comparison


also


suggest


groups.


Greek


varying


families


degrees


showed


change


the


among


greatest


ethnic


preferences


the


dietary


pattern.


Greek


singles,


while


still


showing


a preference


for


Greek


foods,


made


some


changes


the


direction


a more


Americanized


diet.


Greek-American


family


members


had


accepted


American


dietary


practices.


Greek-American


singles,


while


choosing


American-type


foods,


showed


evidence


attempting


limit


their


intake


accordance


with


the


United


States


government


dietary


goals


for


a lower


fat


intake.


Except


for


the


Greek-American


observations


singles'


represent


dietary


a trend


patterns,


Greek


dietary


these


behaviors


the


direction


acceptance


the


American


practices


associated


with


increased


risk


CHD.


A larger


sample


will


test


whether


this


apparent


trend


dietary


change


significant.










Greek-Americans


substituting


the


reference


Greek


versus


Italian,


as used


Roches


(1984)


modification


Sandberg's


group


cohesiveness


scale.


In order


adapt


the


statements


to a non-ethnic


population


(the


non-Greek


cohort),


statements


were


broadened


to include


attitudes


about


ethnic


behaviors


and


feelings


general.


For


example,


the


statement


"Jokes


about


Greeks


bother


me"


was


changed


to "Jokes


about


ethnic


people


bother


me.


Subjects

a printed


to pilot-test

announcement p


the


questionnaire


osted


the


were


Information


solicited

Desk,


Alachua


General


Gainesville,


Hospital

during


Center


the


Health


summer


and


1988.


Fitness,


Twelve


the


fifteen


subjects,


who


volunteered


to test


the


questionnaire,


returned


their


completed


questionnaires.


Respondents


were


also


asked


report


the


length


time


required


to complete


the


entire


questionnaire


and


comment


regarding


any


ambiguously-worded


questions


Subjects


represented


a diversity


health-conscious,


middle-class,


Gainesville


residents.


Three


subj ects


were


students


the


University


Florida


and


three


were


employed


there.


One


subj ect


was


a restaurant


owner,


one


worked


a hospital,


one


subj ect


was


an elementary


art


teacher,


another


was


a homemaker,


and


two


were










The


time


required


complete


the


entire


questionnaire


ranged


from


15-90


minutes,


with


an average


of 38 minutes


per


subject.


Comments


about


question


ambiguity


focused


most


the


Ethnic


Culture


Questionnaire.


The


comments


predominantly


addressed


a dislike


for


the


forced-choice


scale.


only


They


other


order


preferred


consistency


which


the


have


among


smoking


a "no


the


opinion"


comments


questions


were


category


referred


addressed.


The


to the


These


situations


were


remedied


using


a score


3.5 when


statements


the


Ethnic


Culture


Questionnaire


were


not


answered


a subject.


A "no


opinion"


category


was


not


added


because


the


scale


was


originally


designed


as a


forced-choice


response.


I chose


the


scale


because


was


previously


tested


with


other


ethnic


groups


(Roche


1984)


Questions


referring


smoking


behaviors


were


rearranged


accommodate


subjects'


suggestions.


The


Research


Site


Tarpon


Springs


located


on the


West


Coast


Florida,


Pinellas


County,


along


the


Gulf


Mexico.


It's


first


settlers


were


A.W.


Ormond


and


his


daughter,


Mary,


1876.


was


founded


1882


Anson


P.K.


Safford


and


promoted


a resort.


In 1890,


John


Cheney


started


the


sponge


industry


the


waters


the


Gulf


Mexico


(Tarpon


Springs










Florida.


More


than


2,000


Greeks


(mostly


men)


had


established


themselves


the


colony


the


beginning


World


War


Tarpon


Springs


became


the


world's


largest


sponge


producer


until


the


end


World


War


During


this


thirty


year


period,


Greek


culture


prospered


American


flourished


setting


the


Greek


wealth


the


coffeehouses


sponge


and


industry.


nightclubs

The


population


majority


Tarpon


Springs


was


Greek.


Unlike


any


other


Greek


enclave


the


United


States,


became


immigrant

Nicholas


Greek

(named


Town.


the


The


Greek


patron


Orthodox


saint


Church,


seafarers)


Saint

, was


established


1907


(Moskos


1989).


Two


decline


factors


after


caused


World


the


War


sponge


the


industry's


discovery


prosperity


a method,


1939,


to convert


wood


waste


pulp


into


synthetic


sponge


reduced


the


demand


for


natural


sponges;


and


a major


outbreak


of a disease,


known


as "red


tide"


which


struck


the


west


coast


Florida


1947,


decimated


the


sponge


beds.


In the


1960s,


the


Tarpon


Springs


sponge


industry


began


a comeback.


Once


again,


Kalymnos


divers


began


migrating


Tarpon


Springs


(Bernard,


1987)


the


late


1970s,


Greeks


and


Greek-Americans


represented


approximately


one-third


the


total


population


Tarpon


Springs.


While


the


non-Greek










The


majority


Greek


immigrants,


however,


were


more


likely


to find


employment


the


local


Greek


restaurants


or shops


(Moskos


1989).


Small


numbers


Greek-American


retirees


from


the


north


(several


score


a year,


Moskos


1989:26)


also


entered


the


Greek


community


the


Tarpon


Springs


area.


The


original


Greek


settlement


was


concentrated


area


known


as "fishtown,


(Moskos


1989:26)


bordered


Pinellas


and


Tarpon


Avenues


and


Dodecanese


Boulevard


This


area


remains


predominantly


Greek


today.


Newer


Greek


arrivals,


Greek


retirees


from


the


North,


and


more


affluent


Greeks


live


the


surrounding


suburbs


Tarpon


Springs


and


surrounding


towns


(personal


observation


and


verbal


communication


with


personnel


the


Chamber


of Commerce)


The


largest


age


group


the


estimated


population


Pinellas


County


1989


was


the


over-65


age


group


whites


(University


Florida


Bulletin


89-90,


1989).


Twenty-eight


per


cent


the


white


population


years


age


or older.


Retirees


from


the


upper


mid-West


and


middle


Atlantic


States


account


the


majority


persons


this


age


group.


Blacks


compose


only


the


estimated


total


population.


The


estimated


population


Tarpon


Springs


18,000


the


(Polk


white


Directory


population


1987).


The


estimates.


Th


Greeks

e most


are


included


recently


published










the


Greek


population


(according


personal


communication


with


the


Church


Secretary)


because


there


are


several


Greek


Churches


the


surrounding


towns


where


Greeks


from


Tarpon


Springs


are


members.


Thus,


the


membership


roll


for


one


church


would


underrepresent


the


actual


number


Greeks


who


live


Tarpon


Springs.


Samole


The


study


sample


was


obtained


from


the


Greek


population


Tarpon


Springs


and


the


surrounding


areas.


A comparison


group


of non-Greeks,


from


the


same


geographic


area,


was


also


studied.

adults,

Greeks,


The

aged

who w


sample


25-7

ere


was


years


Greek


divided


age.


into t

Group


immigrants


three


groups


was


Group


a sample


was


a sample


53 Greek-Americans


(born


the


United


States


Greek


descent)


Group


was


composed


a sample


non-Greeks.

a Greek or


Any


non-Greek,


Greek-American


who


was


married


excluded


from


or living


the


with


non-Greek


group.


An attempt


was


made


obtain


a random


sample


from


Tarpon


Springs.


"fishtown"


area


Streets


and


were


surrounding


randomly

a suburbs


selected

SNames


from

and


the

phone


numbers


for


persons


living


on the


selected


streets


were


obtained


from


the


Polk


Directory


(1987).


A Greek-American










briefly


described


the


study


and


asked


persons


within


the


selected


age


ranges


to participate


the


study


making


appointment


come


the


Walk-In


Care,


Holiday,


Florida


(the


out-patient


Springs)


on one


clinic


two


Helen


Ellis


week-ends.


Hospital,


the


eighteen


Tarpon


persons


who


scheduled


an appointment


time


and


date


to participate


the


study,


only


five


actually


came


the


study


collection


site.


None


the


participants


were


Greek


Greek-Americans.


Reminder


calls


were


made


the


remaining


persons


but


they


were


unable


participate.


participated


a live


talk


show


at the


local


Greek


radio


station


the


day


before


calls


were


being


made,


an attempt


stimulate


interest


the


study


and


participation


among


the


Greeks.


Greek


callers


to the


radio


station


during


the


talk


show


spoke


enthusiastically


about


the


study


and


inquired


about


how


and


where


they


could


participate.


Alternate


arrangements


for


recruiting


study


participants


were


negotiated


with


the


Administrator


and


Director


Community


Relations


at the


Helen


Ellis


Hospital,


Tarpon


Springs.


They


permitted


me to


attend


community-wide


cholesterol


screening


and


a health


fair,


which


they


were


sponsoring,


recruit


subj ects


and


collect


data


for


the


study


Special


arrangements


were


made


with










Greek


community


attend


these


events


and


participate


the


study.


The


cholesterol


screening


was


held


a large


corridor


the


Tarpon


Springs


Mall,


October


12-16,


1988.


The


health


fair


was


held


the


Ignatius


Church's


social


hall,


Tarpon


Springs,


March


1989.


A data


collection


site


was


also


set


the


community


hall


Saint


Nicholas


Greek


Orthodox


Church


on Sunday,


April


1989.


Greeks


and


Greek-Americans,


who


attended


the


church


service


on that


day,


were


asked


to participate


the


study


following


the


morning


service.


The


persons


study


who


sample


are


was


more


probably


biased


health-conscious


being


than


the


composed


average


person


the


total


population


or had


been


told


on a


previous


occasion


that


their


cholesterol


value


was


elevated.


To test


representativeness


the


sample,


data


from


the


study


were


compared


with


a similar


age


group


persons


from


NHAINES


II(DHHS


1986-87),


a large


representative


sample


the


United


States


population.


Table


describes


these


comparisons


40).


The


significant


difference


the


cholesterol


values


for


the


total


samples


and


between


the


males


Tarpon


Springs


and


NHANES


may


be explained


the


significant


differences


observed


between


the


Greek-Americans


and











Table


Data


comparisons


with


NHANES


Ages 25-74 years


N Greek Study Range N NHANES Range
Cholesterol mg/dl mg/dl mg/dl ag/dl


Total


-369


9096


135-330


Males


-306


Femal


118-369


4302


4794


219


-307


225


135-330


Blood


Pressure


Total


Systolic
Diastoli


79.0


90-176
49-106


9096
9096


-186


72-103


Males


Systolic
Diastolic


-175


56-106


4302
4302


-183


75-105


Females
Systolic
Diastoli


76.5


90-176
49-105


4794
4794


111-188


71-10


Wt(kg)/Ht(meters-squared)


Total
Males
Femal


28.1
28.2


18.2-44


.0-44


18.2-44


9045
4302
4743


19.2-43


25.9*


28.4


.2-33


19.8-43


*=significance


at 1


significance


ess
ess


than
than


Tarpon


Springs


sample


had


a health-conscious


bias


because


subjects


were


recruited


health


screening


events


. They


may


have


decreased


their


cholesterol


levels


because


previous


elevated


l vel.-


+ns










a regular


schedule.


The


significantly


lower


diastolic


level


and


the


lower


values


the


range


for


women


may


suggestive


these


the


exercise


positive


practices.


consequences


Males,


that


however,


result


had


from


higher


Tarpon


Springs.


Data


Collection


Four


primary


methods


were


used


for


data


collection.


First


a period


of participant


observation


was


used


develop


an appropriately


worded


questionnaire


and


provide


context


for


interpreting


the


data


from


the


survey.


Initial


introductions


key


people


within


the


Greek


community


were


facilitated


a recently


retired


nurse


supervisor


from


the


local


Health


Department.


During


a two


day


visit


to Tarpon


Springs,


March


1988,


she


arranged


meetings


and


introductions


with


the


local


priest,


a Greek


physician,


a Greek


restaurant


owner,


an influential


business


man,


who


associated


with


the


sponge-diving


industry,


and


women,


who


could


the


Greek


translation


of the


questionnaire


and


help


with


the


data


collection.


Continuing


contacts


were


maintained


with


these


persons


throughout


the


data


collection


period.


Publicity


and


advertisement


contacts


regarding


the


data


collection


times


were


made


with


presidents


the


men's


and


women's


Helenic


Benevolent


Associations,


local


Greek










elicit


participation


study


from


those


attending.


Naomi


Patterson


recruited


subjects


from


the


organization


for


younger
member.


Greeks,

A study


the


Philoptohos


summary


and


Society,


which


announcements


both


she


English


and


Greek


were


added


as supplements


the


Church


Bulletin


prior


to data


gathering


events.


The


priest,


Father


Tryfon,


made


verbal


announcements


at the


respective


services.


was


introduced


the


editor


a local


weekly


newspaper,


The


Leader


Today,


Chryse


Flowers,


a Greek-American


some


prominence


the


community.


A description


study


appeared


1988


morning


on the


(Appendix


service


front


page


Mrs.


with


the


Flowers


me at Saint


paper Sa

attended


Nicholas


turday,


the


Greek


October


Sunday


Orthodox


Church,


October


1988,


to help


recruit


subjects


and


ask


them


attend


the


cholesterol


screening


and


participate


the


study


the


Tarpon


Springs


Mall,


October


12-16.


Greek


physician,


was


contacted


prior


the


data


collection


times


and


asked


to lend


his


influence


encouraging


Greeks


and


Greek-Americans


participate


the


study.


The


second


data


collection


method


was


self-administered


questionnaire


(Appendix


The


questionnaire


wasr


composed


five


parts


and


was


given


each


subj ect


the


data


collection


site.


Each


subj ect


was










fill


out


at home


for


later


pick-up


or return


an agreed


upon


location.


Of the


total


number


subjects,


who


participated


the


study,


returned


the


completed


questionnaire.


Greeks


had


the


lowest


questionnaire


completion


rate


(27%).


The


self-administered


questionnaire


provided


data


concerning:


Demographic


Smoking
Health


and


information


exercise


history


Frequency


Greek-American


Social


Eating, f
A food fr
A 24-hour


visits


cohesion


ood


eque


behaviors


Greece,


Greek


scale


purchasing, an
ncv check-list


food r


d


food


use


preferences


ecall


Third,


individual


height


and


weight


measurements


were


obtained.


Height


was


measured


inches


having


the


participant


stand,


without


shoes,


on a specially-designed


platform


attached


to a portable


Accustat


Stadiometer,


marketed


Genentech,


Inc.


Weights


were


obtained


having


the


participants


stand,


without


shoes,


on a Sears


Electronic


Bath


Scale,


Model


6414


The


scale


weighs


to the


nearest


half


pound


Two


5-pound


dumb


bells


were


used


test


the


accuracy


the


scale


weight


before


and


between


data


collection


events.


The


dumb


bells


consistently


weighed


9.5


pounds


at each


weighing.


Height


inches


was


converted










(kg)/height


(meters-squared)


was


used


compute


body


mass


index


(BMI).


The

blood


fourth method

pressure and


assessed


total


the


blood


physiological


cholesterol.


parameters


Subjects


reported


information


about


hypertension


and


cardiac


disease,


with


any


respective


medications


taken,


Part


I of


the


questionnaire.


Questions


relating


a family


history


hypertens ion,


cardiac


disease,


diabetes


and


cancer


were


addressed


the


questionnaire


relation


their


parents


and


children


s medical


historic


es.


Blood


pressures


were


obtained


use


an automatic


sphygmomanometer


with


a digital


print-out


(Biomega


423b,


marketed


Biomega


Corporation),


which


was


loaned


me for


the


study


the


director


the


Alachua


General


Hospital


Center


Health


and


Fitness,


where


was


employed


part-time.


The


digitally-read


numbers


were


advantageous


reducing


subjectivity


associated


with


human


hearing


and


interpretation.


Visually-read


numbers


can


also


transcribed


with


greater


reliability


than


verbal


data.


Participants


were


seated


with


the


right


arm


cuffed


and


positioned


a right


angle.


The


right


forearm


rested


on a


stable


surface


appropriate


height.


Blood


cholesterol


values


were


obtained


from


a digital










Relations,


Helen


Ellis


Hospital,


Tarpon


Springs.


Volunteer


retired


nurses


assisted


with


the


blood


drawing


the


cholesterol


screening


and


health


fair.


I hired


a dietitian


from


Gainesville


assist


with


the


blood


drawing


and


trained

Orthodox


her


run


Church


the


data


cholesterol


collection


analysis


site,


April


the G

1989.


;reek

The


State


Florida


issued


a regulation,


effective


January


1989,


stating


that


only


trained,


licensed


medical


technologists


may


blood


drawings


and


run


the


analysis


cholesterol


at cholesterol


screenings.


Laura


Phillips,


the


MRS


Licensure


Office,


Jacksonville,


Florida,


assured


phone


that


research


would


exempt


under


Regulation


483031


I did


not


collect


money


from


the


subjects


give


them


information


about


their


cholesterol


values


writing.


Drops


of blood


were


obtained


from


a finger


stick


and


absorbed

analyzed


onto


a calibrated


the


chemistry


chem

unit.


strip,

Chem


which

strips


was machine

were compared


with


standards


validate


the


machine


analysis.


Cholesterol


values


obtained


this


method


were


reported


previous


studies


vary


within


the


true


value


the


standard


sample


(Brown


1988


and


Sedor


et al.


1987).


This


range


similar


to the


daily


variation


3-5%


that


has











greater


than


140/90


mm and


to have


cholesterol


values


re-evaluated


the


blood


cholesterol


level


was


greater


than


mg/dl.


They


were


instructed


see


a physician


the


level


was


greater


than


mg/dl


(NIH


Consensus


Conference


on Cholesterol


1985).


Sources


error


data


collection


technicrues


Ethnicity


measurement


problems


common


problem


with


ethnicity


measures


the


paucity


standardized


instruments


which


measure


degrees


which


members


an ethnic


group


are


committed


to the


group


and


traditions


(Roche


1984).


More


frequently,


studies


(e.g.


Sassen-Koob


1979;


Woodrum


et al.


1980;


Cheung


1981)


use


descriptive


analyses


based


on observed


presence


absence


characteristics,


investigator,


classify


determined


individuals


the


into


respective


ethnic


categories.


Another

standardized


problem with

measures that


ethnicity

allow cr


scales


oss-ethnic


a lack


comparisons.


For


example,


studies,


like


that


Burnam


(1987),


employed


analytical


techniques


check


internal


validity


their


acculturation


scale.


It's


use,


however,


has


been


limited


Mexican-Americans


and


has


not


been


tested


cross-ethnic


studies.










Italian-Americans


(Crispino


1980


and


Roche


1984).


Cross-comparisons


among


findings


from


the


three


studies


suggest


good


external


validity


the


scale;


and


Questions


addressed


on Sandberg


s group


cohesiveness


scale


are


similar


to those


addressed


Scourby


(1979)


her


study


ethnicity


among


three


generations


Greek-Americans


New


York


City.


Thus,


the


Sandberg


group


cohesiveness


scale


provides


data


that


are


comparable


cross-culturally


with


other


ethnic-Americans


and


comparable


with


findings


from


a similar


Greek-American


ethnicity


study


The


scale


(Appendix


Part


II of


the


study


questionnaire)


consists


thirty


statements


that


measure


participant


attitudes


toward


various


aspects


the


ethnic


group.


Three


subscales


(cultural,


national,


and


religious)


identify

cultural


intergroup

subscale e


similarities


licits


and


attitudes


differences.


about


The


traditions,


language,


music,


and


history


the


group.


The


national


subscale


focuses


on the


sense


peoplehood


shared


group


members


with


questions


about


the


ethnic


neighborhood,


being


comfortable


with


fellow-ethnics,


not


changing


one's


name,


being


able


someone


count


the


same


on ethnic


peers


nationality,


and


for


help,


voting


marrying


for


candidates


the


same


ethnic


background.


The


religious


subscale










Dietary


measurement


problems


A major


problem


with


the


development


dietary


instruments


population


studies


the


need


for


tools


that


can


readily


and


inexpensively


used


with


large


numbers


subjects


and


which


yield


accurate


information


about


usual


dietary


patterns


(James


et al.


1981;


Block


1982;


Gray


1984).


Sources


error


can


potentially


introduced


during


data


collection,


quantitative


processing,


and


interpretation


(Algert


and


Stumbo


1986).


The


24-hour


recall


method


one


the


most


widely


used


techniques


for


collecting


dietary


information


average


group


dietary


intakes


(Block,


1982)


has


also


been


criticized


being


unrepresentative


of usual


intake.


Beaton


et al.


(1983)


for


example,


found


the


major


source


variance


between


and


within


subj ect


differences


from


day


day.


As part


the


Seven


Countries


Study


(Keys


1980),


systematic


comparisons


dietary


surveys


were


examined.


Increasing


the


number


24-hour


measurements


was


not


found


reduce


intra-individual


variation,


but


rather,


provided


more


reliable


estimation


an individual's


preferences,


validity

their co


the


mparison


data

s was


was

tha


assumed.

t the in


An important


itra-individual


finding


variation,


- a -


A










an attempt


to further


define


reliability


reported


intakes,


Jeor


(1983),


demonstrated


similar


intra-


and


inter-subject


variability


reported


foods


but


insignificant


differences


mean


daily


nutrient


intake


when


compared


with


the


nutrient


analysis


one-week


and


three-week


food


logs.


Protein


was


the


only


nutrient


change


when


days


the


week


were


compared.


The


interaction


between


nutrient


intakes


for


weeks


and


days


the


week


was


significant


only


calories


and


fat.


Thus,


would


appear


that


24-hour


nutrient


data


can


representative


a group's


intake.


as Young


(1960)


concluded

sampling


after


studying


techniques


variation


(24-hour


recall


between t

, dietary


three


dietary


history,


and


7-day


record),


the


24-hour


recall


provided


the


same


values


as the


seven-day


record


when


used


with


groups


least


fifty


persons


and


when


a 10%


error


rate


was


acceptable.


A confounding


measurement


error


with


24-hour


recalls


the


conversion


of foods


nutrients.


There


inherent


error


any


nutrient


data


base.


Climate,


harvesting,


handling,


values


food

given


processing


foods


and


preparation


(Witschi


affect


1981)


nutrient


At present,


standard


data


base


containing


USDA


food


composition


data


and


manufacturers'


data


provide


the


best


values


on which


to base










populations


residing


outside


the


United


States


(Adelman


. 1985)


The


food


frequency


questionnaire


an easier


and


quicker


method


than


the


24-hour


recall.


While


does


not


assess


actual


quantities


consumed,


may


achieve


a more


representative


pattern


usual


intake


foods


(Chu


1984)


Karinpaa


and


Seppanen


(1983)


demonstrated


that


agreement


between


a food


frequency


questionnaire


and


24-hour


recall


foods


was


were


high


reported


foods


more


commonly


frequently


eaten


during


a meal.


the


Snack


24-hour


recall


the


interview.


checklist


Mullen


or frequency


(1984)


method


also


produced


observed


greater


that


agreement


with


observations


of foods


eaten


at a meal


than


for


meal


accompaniments


(e.g.,


nuts


and


seeds).


Used


together,


the


food


frequency


questionnaire


and


the


24-hour


with


recall


additional


provide


a cross-check


information


on dietary


foods

pattern


reported


and


along


food


practices


(Christakis


1978).


general,


descriptions


usual


dietary


intakes


are


more


reliable


when


the


dietary


questionnaire


used


with


a 24-hour


recall


(Alford


and


Ekvall


1984).


The


problem


informant


inaccuracy


a critical










behaviors


being


measured.


Bernard


et al.


(1984)


observed


that


comparisons


between


what


people


say


they


do and


observations


what


they


do bear


little


resemblance


Bradburn


(1983)


refers


the


types


bias


which


affect


how


subjects


respond


interviews


as "response


effects,


" of


which


there


are


three


classes:


deliberate
information
divulging c


memory


errors
for t
certain


embellishment


h


errors,


communication


e purpose o
information


or omission


impress
to the i


ing


or not


interviewer,


errors.


Variation


response


effects


may


influenced


the


data


gathering


perceived


role


task,


the


the


interviewer's


community,


and


performance


characteristics


the


research


subject.


Bradburn


(1983)


noted


that


the


empirical


literature


suggests


that


characteristics


the


data


gathering


task


are


the


major


influence


on response


effects.


Bradburn


(1983)


further


described


comparisons


instrument


administration


methods.


Face-to-face


interviews,


telephone,


and


self-administered


questionnaires


have


high


variance


with


no consistent


direction


their


biases.


Self-administered


forms


appear


to be slightly


superior


for


items


requiring


definite


information,


questions


requiring










Face-to-face


interviewing


allows


for


use


cue


cards


visual


aids


to improve


recall.


Increased


motivation


may


also


come


from


the


interviewer


being


with


the


respondents


person


encourage


them


take


time


consider


the


questions


carefully.


The


time


"window"


involved


recall


reported


affect


the


size


memory


errors


(Bradburn


1983


and


Bernard


et al.


1984) .


The


more


recent


the


recall


period


-g.,


24-hours

Bernard


informant


vs a week),


et al.


the


(1984),


accuracy


more


however,


could


accurate


the


observed


accounted


information.


that


for


only


this


factor


their


data


on recall


of communications.


Can


validity


dietary


information


improved


obtaining


weighed


samples


foods


eaten


when


compared


with


estimates


of dietary


recall?


Studies


from


the


Seven


Countries


Study


(Keys,


1980)


and


Todd


(1983)


conclude


that


the


weighed


sample


method


does


not


significantly


improve


one-day


subj ect


group


reporting


dietary


accuracy.


record


Todd


a reasonable


found


estimate


(within


15%)


the


weighed


intake.


Both


methods


had


considerable


inter-


and


intra-subject


variability.


Keys


concluded


that


the


difficulty


and


expensiveness


collecting


replicates


all


meals


eaten,


compared


with


the










Household


refuse


analysis


(Rathj e


1984)


and


biochemical


markers


(Christakis,


1981


and


Willett


1983)


have


been


used


test


the


validity


reported


dietary


intakes.


The


increasing


percentage


the


food


dollar


on away-from-home


food


consumption


the


United


States


(greater


than


40%;


Morgan


and


Goungetas


1986)


limits


the


usefulness


household


refuse


analysis


verifying


informant


accuracy


While


certain


biochemical


markers


(e.g. ,


adipose


tissue


and


erythrocyte


fatty


acids


, plasma


carotene


and


alpha-tocopherol


level


have


been


shown


confirm


reported


dietary


estimates


of these


respective


dietary


nutrients,


analysis


biochemical


parameters


not


exist


for


nutrients.


Blood


cholesterol


levels,


while


not


a direct


measure


of dietary


or cholesterol


intakes,


are


a useful


clinical


parameter


for


identifying


persons


who


may


ingesting


high


saturated


and


cholesterol


foods.


Thus,


best,


recall


data


can


only


interpreted


estimates


group


trends


and


patterns.


Because


the


goal


this


research


focus


on dietary


patterns


of aggregate


subgroups


that


may


suggestive


increased


risk


CHD,


averages


dietary


intakes


saturated


fat,


cholesterol,


calories,


and


fiber


will


compared


with


the


subgroups


who


have


elevated


cholesterol


values


as a validity


check.










per


subject.


Food


models


were


available


for


memory


prompting


and


standardize


serving


sizes.


This


one


quantitative

differences


measurement


between


several


limited


dec


dietary


visions about

information


measurement

gathering


times.


Prototypes


of Greek


and


American


diets


were


a proxy


for


time


this


cross-sectional


study.


Greek


and


American


diet


prototypes


were


built


from


nutrition


surveys


and


food


consumption


studies


from


the


1960s


the


present.


(Studies


Greek


et al.


dietary


1965;


practices


include:


Ashton-Vouyoucalos


1975


Valassi

; Keys


1962;

1980;


Christakis

Lieberman


and


Gardner


1980;


Kurtz


et al.


1982;


Freedman


and


Grivetti


1984.


Studies


American


dietary


practices


include:


Ten-State


Nutrition


Survey


1968-1970;


HANES


1971-73


and


1979;


Nationwide


Food


Consumption


Surveys


1977-78,


1985-86;


Food


and


Nutrition


Board


1986).


A Greek


version


the


questionnaire


was


available


for


those


subjects


who


cannot


read


English.


Back


translation


the


study


questionnaire


was


performed


two


Greek-speaking


translators.


The


Greek


version


was


translated


from


the


English


version


Maria


Pantelis,


a Greek


immigrant


who


lives


Tarpon


Springs.


She


also


owns


a Greek-type


typewriter


so that


the


questionnaire


could


typed


with


Greek


alphabet


characters.


The


back


translation


English










words


or the


questions.


His


comment,


however,


was


that


the


Greek


language


constantly


changing


and


for


that


reason


assumed

mother'


the


age


original

, because


translation


of the


was


phrasing


done


used.


someone


His


his


observation


was


true,


but


since


most


the


subjects


would


also


the


age


of the


original


translator,


the


translation


was


kept


originally


interpreted.


Some


Greeks


Group


1 could


not


read


either


Greek


or English.


A family


member


verbally


translated


the


questionnaire


them


from


the


English


version.


Back


translation


minimizes


errors


associated


with


assymetrical


intrepretations


a source


language


into


target


language.


Loyalty


one


language,


usually


the


source


language,


dominates


assymetrical


interpretations.


assume


that


two


languages


could


equivalent


fails


recognize

Back


the


fundamental


translation,


issue


while


not


culture


without


differences.


limitations,


method


identifying


translation


asymmetry


The


most


common


error


back


translation


results


from


dictionary-equivalent


redundancy


(Warner


and


Campbell


1970


and


Berkanovic


1980).


To test


the


validity


the


dietary


data,


market


trends


were


observed


through


informal


interviews.


A sample










managers,


grocery


shoppers


and


restaurant


patrons.


One


restaurant


manager


and


one


grocery


store


manager


would


not


allow


me to interview


their


patrons.


Grocery


managers


were


interviewed

frequently


about f

reported


requency


study


inventory


subjects.


turnover

Restaurant


items


managers


were


interviewed


about


type


patrons


and


popularity


menus


served.


Grocery


shoppers


and


restaurant


patrons


were


interviewed


their


about


respective


their


perceptions


communities.


Reported


food

food


behaviors


frequencies


were


grouped


into


the


food


groups


fruits


and


vegetables,


beverages,

comparing


grains,


mean


dairy,


frequencies


protein,

of the


fats

total


and sweets.

study sample


T-tests


food


group


and


mean


frequencies


the


validity


sample


food


group


indicated


no significant


differences


for


the


food


groups


except


the


protein


and


sweets


groups.


Mean


for


protein


the


study


sample


was


higher


(p=less


than


.05)


than


the


validity


sample.


The


reported


frequency


mean


for


sweets


was


lower


(p=less


than


.05)


the


study


sample


than


the


validity


sample.


Overweight


was


defined


terms


the


body


mass


index


(BMI),


as used


N HA N ES


(DHHS


1987).


Overweight


men


had


a BMI


equal


or exceeding


27.8;


and


were


severely


overweight


the


equaled


or was


greater


than


31.1.










overweight


as a BMI


equal


or greater


than


the


85th


percentiles


men


and


women


ages


20-29


years


as the


reference


population.


Nutrient


analysis


of foods


reported


on the


24-hour


recalls


were


performed


with


The


Nutritionist


Data


Base,


Version


4.5,


1989,


marketed


N-Squared


Computing,


Salem,


Oregon.


The


data


base


derived


from


a documented


USDA


data


base,


manufacturers


' data


and


recipes


that


are


frequently


updated.


Greek


foods


and


recipes


were


analyzed


using


either


similar


foods


and


recipes


or analyzing


recipes


individual


ingredients


contained


the


data


set.


Mortality


data


major


cardiovascular


diseases


Tarpon


Springs,


1987,


were


obtained


from


the


Florida


Department


Public


of Health


Health


and


Statistics


Rehabilitation


Section,


Services


Jacksonville,


(HRS),

Florida.


One


hundred,


fourteen


deaths


were


attributed


major


cardiovascular


diseases


during


1987,


with


them


from


heart


disease.


Forty-four


deaths


were


reported


from


chronic


ischemic


heart


disease


(CHD)


Tarpon


Springs.


Twenty


the


diD


deaths


were


among


white


males


and


twenty


were


white


females.


These


44:18,000


figures


or 240


per


would


account


100,000.


for


These


a mortality


data


are


rate


not


standardized


for


age.


Comparing


them


the










I attempted


to obtain


a mortality


breakdown


deaths


persons


from


Greek


descent,


but


found


the


task


to be


impossible


because


data


are


not


recorded


according


to ethnic


identity.


Morbidity


not


recorded


for


CHD


the


State


vital


records


or estimated


with


any


reliability


Tarpon


Springs


physicians.


Data


Analysis


Research


questions


addressed


this


study


include:


Are there systematic change
observed dietary behaviors
a. Gender (Male vs Female)
b. Age groups
c. Ethnicity (Greek, Greek
non-Greek)


patterns
among...


-American,


the


and


I compared with...
a. Number of year
Greek)
b. Socioeconomic
c. Marital status
to a Greek vs
Greek-American
d. Composition of
alone vs in a


s


living


the


status
and ethnicity
to a non-Greek,


United


mix,
if


the household, e
multigenerational


States


e.g.,
Greek


married
or


.g., living
family unit?


Is there an
processes, i
convenience,
cultural pre
practices in


observable
.e., which
and infra
ferences,
relation


pattern between structural
promote technology and
structural processes, i.e.,
social norms, and religious
to change adoption patterns?


Are the observed dietary behaviors associated with
a deviation from the traditional Greek diet and
indicative of increased risk of coronary heart
disease, as characterized by the American diet?

Variables


when


when


A










living


the


Tarpon


Springs


area.


Part


l of


the


questionnaire


provided


these


data.


Socioeconomic


status


was


determined


with


an SES


clustering


system


described


Schneider


(1986).


In contrast


the


Ho 1ingshead


scale


which


an ideologically


based


measure


the


status


level


the


working


members


a household,


the


SES


clustering


system


defines


class


as operationally


and


theoretically


different


from


status.


Inherent


the


Hollingshead


scale


the


concept


that


class


represents


the


economic


relationship


individuals


goods

Status


and


opportunities


groupings


are


for


thought


income


a market


to represent


economy


lifestyle


and


prestige


attributed


individuals


society


Schneider,


on the


other


hand,


utilizes


a Marxian


concept


class


which


views


class


as the


primary


element


influencing


individual'


role


place


an individual


the


fill


social


the


hierarchy.


production


The


process


particular


and


relationship


to others


the


economic


hierarchy


will


influence


his/her


access


the


social


product


society,


including


which


neighborhoods


they


live


and


schools


they


attend,


life


chances,


and


through


socialization


particular


social


place,


world


view"


(Schneider


1986


:211).


She


views


the


nature


a particular


class


society


within










SES


level,


clusters


occupation,


utilize

self r


variables


reported


which


ethnicity


include

. and r


education


elevance


ethnicity.


The


variable


statistically


derived


cluster


analysis.


Social


cohesion


scores


were


determined


according


each


of the


three


subgroups:


cultural,


national


and


religious


components


of ethnicity.


A total


score


the


thirty


items


were


referred


as the


attitudinal


ethnicity


score.


The


lower


the


score,


the


greater


indication


commitment


the


group.


Preference


American


foodways


was


operationalized


measure


preference


eating


American


steakhouses,


fast


food


restaurant


eating,


and


cooking


home


with


"American-style"


recipes.


Use


convenience


foods


and


microwave


oven,


preference


discontinuation


eating


individually,


the


family


eating


out


meal


deli's


specialty

behaviors


diners

which


or from


vending


represented


machines


convenience


reflected


and


technological


motivation.


Commercial


influences


were


measured


questions


regarding


the


frequency


food


purchases


because


coupon


use,


TV advertising,


or recipe


collection


from


popular


women


s magazines.


Continuity


Greek


dietary


practices


was










coffee

e.g.,


house,

olive c


and


Ii]-


preference


Greek


peppers,


cooking


feta


with


cheese


Greek


(all


foods,


are


available


grocery


stores


Tarpon


Springs)


Infrastructural


variables,


e.g.,


ethnicity,


included


data


about


frequency


observance


of religious


fasts


and


Greek/ethnic


holidays.


Parts


and


the


study


questionnaire


addressed


these


variables.


The


food


and


nutrient


patterns,


addition


eating


times


reported


Parts


IV and


V of


the


questionnaire,


were


compared


with


the


Greek


and


American


diet


prototypes


further


describe


abandonment


or persistence


Greek


dietary


behaviors

Springs.


among


Greeks


Variables,


and


e.g


Greek-Americans


., type


fat,


Tarpon


percentages


complex


carbohydrate


and


protein


consumed,


were


used


describe


the


degree


Americanization


the


dietary


patterns


and


adoption


dietary


practices


associated


with


increased


risk


coronary


heart


disease.


The


hypothesis


tested


whether


the


observed


dietary


patterns


demonstrate


persistence


ethnic


identity


and


food


practices


or change


relation


demographic,


technical/material,


and


infrastructural


influences.


Data


regarding


obesity,


elevated


blood


pressure,


and


elevated


serum


cholesterol


were


used


validate


and


explain


risk


S ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ .. -A e -ArS---


A


hl --


r I


I


-L L


..










interactions


among


the


study


variables


the


respective


ethnic


groups.


Significant


variance


between


and


among


aggregate


groups


of individuals


and


ethnic


groups


were


used


to describe


observed


differences


dietary


behaviors


and


risk


factor


status.














CHAPTER

RESULTS


Inference


Tests


Data


were


collected


between


October


1988


and


April


1989


from


Greeks,


Greek-Americans


and


non-Greeks


who


live


the


Tarpon


Springs


area.


Two


hundred,


twenty-six


persons,


aged


25-74


years,


participated


the


study.


One


hundred


and


twenty-eight


persons


(57%)


completed


the


entire


questionnaire,


thus


providing


explanatory


variables


the


study


Comparisons


between


the


two


groups


(Group


l=those


who


did


not


complete


the


questionnaire


and


Group


2=those


who


did


complete


the


questionnaire)


revealed


differences


between


their


body


mass


index


(BMI=weight


kgs/height


meters-squared),


blood


pressure


and


cholesterol


values


(Table


64).


There


were


no significant


differences


between


the


two


groups


Body


Mass


Index


(BMI)


or blood


cholesterol


levels


Differences


blood


pressure


values


were


highly


significant


the


.036


level


for


the


systolic


pressure


and


the


.005


level


the


diastolic


values.


Therefore,


data


for


the


two


groups


were


not


combined


for


further


analyses.


m












Table


4-1:


Comparisons


not


and


those


data


who


collected


did


answer


fro
the


ii


those


who


did


questionnaire


T-Test


Variable


Group


Group


p-values


28.9


0.077


kg/meters-squared


Blood


Pressure


Systolic
Diastolic


Hg)
4.8


*0.036
*0.005


79.0


Cholesterol


226.9


0.077


(ag/dl)


*=significant at less than .05
Group l=Those who did not complete the questionnaire
Group 2=Those who did complete the questionnaire


questionnaire,


did


not


fall


outside


the


ranges


of values


for


the


persons


who


completed


the


questionnaire


entirely


so their


data


were


included


with


the


group


persons


who


did


fill


out


the


questionnaire.


The


total


ethnicity


score


and


subscales


(culture,


religion,


national),


age,


cholesterol,


systolic


blood


pressure,


diastolic


blood


pressure


and


were


further


tested


see


whether


they


met


the


assumption


normality.


The


probability


that


each


these


variables


had


L normal










skewed


(1.04;


kurtosis


1.58)


the


opposite


direction,


however


both


had


p-values


less


than


and


could


accepted


under


the


normal


distribution


assumption.


Demoaraohic


Characteristics


of the


Sample


The


socioeconomic


(SES)


clustering


system


described


Schneider


(1986)


revealed


two


clusters


with


representative


groupings


persons


from


lower


and


higher


SES


categories.


These


groups


reflect


the


educational


level


achieved,


the


degree


skill,


autonomy,


supervision


and


type


employment


which


defines


an individual


s place


within


the


local


social


hierarchy.


Table


identifies


these


SES


groupings


ethnic


group.


Table


SES


cluster


ethnic


group


Ethnic


Group


Lower


Frequency


Row


SES


Higher


SES


Total


Percent


Greek


Greek-American


Non-Greek


54.4


45.6


Total


Persons with missing values were omitted from the
comparisons.


The


Chi-scuare


test


independence


had


a value


r.


ur











differences


SES.


Greeks


had


a higher


proportion


study


subjects


the


higher


SES


group.


Non-Greeks


had


a higher


percentage


persons


the


lower


SES


cluster.


The


clusters


revealed


a significant


(p-0.000)


relationship


with


age.


The


younger


age


group


(25-49


years)


contained


persons


from


the


lower


SES


group


and


from


the


higher


SES


cluster.


The


older


age


group


(50-74


years)


contained


a higher


proportion


persons


from


the


lower


SES


group


(30%


lower


SES


and


higher


SES).


Subjects


were


asked


report


age


decade


25-29,


30-39,


etc.)


Mean


age


for


Greeks


fell


within


the


fifties,


for


Greek-Americans


and


non-Greeks,


mean


age


fell


within


the


forties.


Because


the


small


cell


size


when


analyzing


age


with


other


variables


a multivariate


analysis,


age


was


subdivided


into


two


grouping.


Group


represented


those


persons


who


were


less


than


years


age.


Group


two


was


composed


persons


50-74


years


age.


Table


illustrates


the


age


groupings


ethnic


group.


The


Likelihood


Ratio


Chi-square


had


a value


6.155


with


2 degrees


freedom


and


a p-value


0.046,


indicating


that


ethnic


group


had


a significant


effect


age


grouping.


In later


analyses


where


age


had


a significant












Table 4-3: Ethnic group by age group

Ethnic Group Age Group
Frequency 25-49 50-74 Total
Row Percent years years

Greek 9 13 22


Greek-American


40.9


70.5


59.1


29.5


Non-Greek


Total


were


combined,


thus


allowing


a more


even


age


and


frequency


distribution


between


Greek


and


non-Greek


comparisons.


Each


age


group


had


a higher


proportion


females


than


males.


Table


describes


the


gender


composition


each


age


group


ethnic


group.


Study


subjects


had


lived


the


Tarpon


Springs


area


between


1-74


years.


Thirty-five


percent


reported


living


the


area


for


four


years


or less.


Half


them


were


new


the


area


within


the


past


years.


Sixty-two


the


study


participants


lived


Tarpon


Springs


for


or more


years.


Three-fourths


of the


Greek


subjects


were


born


Kalymnos,


the


island


home


the


original


divers


who


founded


--~~- -











Table 4-4: Gender by age and ethnic group

Gender Ethnic Group Age Group Total
Frequency 25-49 50-74
Row Percent years years

Female Greek 8 9 17
47.1 52.9

Male Greek 1 4 5
20.0 80.0

Female Greek-American 23 9 32
71.9 28.1

Male Greek-American 8 4 12
66.7 33.3

Female Non-Greek 20 15 35
57.1 42.9

Male Non-Greek 14 16 30
46.7 53.3

Total 74 57 131


five


years.


One


these


persons


lived


Tampa


prior


moving


to Tarpon


Springs.


The


other


person


immigrated


directly


from


Athens


and


living


with


a family


member


Tarpon


Springs.


Seventy-two


percent


of the


Greek


ethnic


group


lived


the


United


States


years


or longer


Ethnicity


Among


the


Greeks,


had


visited


Greece


within


the


past


five


years.


Twenty-eight


percent


reported


that


they


visited


Greece


more


than


three


times


during


that


period.










them


had


visited


Greece


more


than


once


or twice


during


that


time.


Greeks


and


Greek-Americans


differed


the


number


religious


fasting


occasions


that


they


kept.


Fifty-eight


percent


Greeks


compared


with


twenty-four


percent


Greek-Americans


reported


fasting


weekly.


Only


one


Greek


and


three


Greek-Americans


never


fast.


Three


non-Greek


persons


reported


fasting


weekly


and


69 percent


reported


never


fasting.


Yearly


holiday


festivities


were


celebrated


with


special


foods


67 percent


the


Greek


ethnic


group


and


95 percent


of the


Greek-Americans


contrast,


only


46 percent


of the


non-Greeks


used


special


holiday


foods


celebrate


yearly


festivities.


Ethnic


group


cohesiveness


was


apparent


among


the


Greeks


and


Greek-Americans


from


their


ethnicity


scores.


The


lower


the


numerical


score


for


each


scale,


the


greater


the


commitment


to the


ethnic


group.


The


means


for


each


subscale


were


consistently


lower


the


Greeks


than


for


the


Greek-Americans.


Scores


for


the


non-Greeks


were


higher


than


either


the


Greek


ethnic


group


scores.


Scores


for


one


subscale


were


predictive


the


scores


on the


other


subscales


among


the


Greek


ethnic


groups


but


not


among


the










cohesiveness


scores.


The


exception


was


the


national


score


Greek-Americans.


While


Greek-Americans


reported


observing


holidays


with


special


foods


more


frequently


than


Greeks,


this


finding


may


reflect


a tendency


among


the


Greek-Americans


participate


both


Greek


and


American


holiday

holidays


festivities.


both


The


Greeks


use


and


special


foods


Greek-Americans


to celebrate


correlates


with


the


lower


national


scores


(greater


national


cohesiveness)


for


the


two


Greek


ethnic


groups.


During


the


time


of the


data


collection,


two


Greeks


were


running


elected


offices.


Governor


Dukakis


was


pre


sidential


candidate


and


United


States


Congressman


Bilirakis


was


campaigning


for


re-election.


While


a few


study


participants


showed


strong


agreement


or disagreement


with


the


question


inquiring


about


voting


for


candidates


the


same


ethnic


background,


no overall


election


opinion


bias


was


detected


among


the


majority


subjects'


responses


this


question.


Table


(p.71)


describes


the


ethnic


scoring


differences


between


the


study


groups


and


their


respective


score


correlation


coefficients.


Ethnicity


subscores


were


compared


to Roche's


(1984)


ethnicity


scores


obtained


from


two


samples


Italians


and











Table 4-5: Ethnicity scores by ethnic group

Correlation
Ethnic coefficients
Scale Group N Mean Range Cult Reli Nati

Culture GR 18 16.4 11.0-24.5 0.65 0.62
GA 40 19.7 10.0-35.0 0.78 0.58
NG 66 30.2 15.0-60.0 0.10 0.23

Religion GR 18 19.3 10.0-30.0 0.65 0.63
GA 40 23.0 10.0-43.0 0.78 0.69
NG 66 32.9 19.0-56.0 0.10 0.21

National GR 18 23.3 11.0-34.0 0.62 0.63
GA 40 30.1 14.0-45.0 0.58 0.69
NG 66 35.1 17.5-47.0 0.23 0.21

GR=Greek
Cult=Culture GA=Greek-American
Reli=Religion NG=Non-Greek
Natl=National



Table 4-6: Greek ethnic subscale comparisons with
Italian-American subscale scores

Greek Italian
Scale N Group Score N Group Score

Culture 18 GR 16.4 52 IT 27.6
40 GA 19.7 49 IA 28.2
66 NG 30.2 27 AM 35.4

Religion 18 GR 19.3 52 IT 35.1
40 GA 23.0 49 IA 36.1
66 NG 32.9 27 AM 41.5

National 18 GR 23.3 52 IT 32.4
40 GA 30.1 49 IA 32.0
66 NG 35.1 27 AM 39.7

GR=Greek IT=Italian
f>l=fTraalr-karT*I ran ThaT+al I jan-amarI{ r an










The


lower


scores


for


Greeks


and


Greek-Americans


Tarpon


Springs,


compared


to the


Italians


and


Italian-Americans


Providence,


not


surprising.


The


tourist


industry


Tarpon


Springs


promotes


the


Greek


culture


Greek


and


Greek-American


businesses


(e.g.,


sponge-diving,


curio


shops


and


Greek


restaurants)


are


obvious


throughout


the


town.


The


hourly


chimes


from


Saint


Nicholas


Greek


Orthodox


Church


a constant


reminder


the


Hellenic


influence


the


environment.


(The


ringing


hourly


chimes


the


local


church


a common


practice


Greece).


Identification


with


the


Greek


culture


has


economic


benefits


Tarpon


Springs.


Comparisons


between


the


two


studies


show


consistent


trends.


Italians


who


immigrated


the


United


States


scored


lower


on each


subscale


than


the


Italian-Americans.


Each


Italian


culture


group


score


scored


was


lower


lowest


than


the


both


American


Greeks


and


group.


Italians


The


and


the


national


score


was


highest.


Religion


appeared


less


influential


fostering


group


cohesiveness


among


the


Italian


groups


than


among


the


Greek


groups.


This


observation


consistent


with


Moskos'


(1989:34)


observation


that


the


Greek


Orthodox


Church


the


focus


the


immigrant


Greek


communities


the


United


States.


Scourby


(1979)


also










Eating


Preferences


A f fectinar


rood


Use


The


Greek


group


showed


a high


preference


for


eating


at Greek

individual


restaurants

Is almost n


(47%


ever


daily)


eat


. Only

a Greek


two


Greek


restaurant.


The


highest


percentage


(46%)


Greek-Americans


eat


a Greek


restaurant


only


monthly.


The


Greeks


reported


rarely


eating


at other


ethnic


restaurants


(58%


"almost


never")


or eating


an American


steakhouse


or fast


food


restaurant


(25%


- 33%


"infrequently").


Half


of the


Greek


sample


never


eat


fast


food


restaurant


and


never


eat


foods


purchased


from


a vending


machine


(Appendix


The


Greek-American


group's


restaurant


preferences


were


similar


to the


preferences


the


non-Greeks.


Approximately


half


the


persons


these


two


respective


ethnic


groups


an ethnic


or American


restaurant


monthly.


One-fourth


to one-third


persons


each


group


a fast


food


restaurant


either


weekly


or monthly


Greek-Americans


showed


a higher


preference


(35%


monthly)


for


eating


a deli


or submarine


sandwich


shop


compared


with


the


non-Greek


s preference


(25%


monthly).


Like


their


Greek


counterparts,


Greek-Americans


almost


never


ate


foods


purchased


from


a vending


machine


(92%)


contrast,


only


non-Greeks


never


ate


foods


purchased


from


a vending










home


daily


a common


household


meal.


A similar


percentage


these


persons


report


using


basic


ingredients


their


cooking.


Differences


food


preparation


patterns


were


apparent


from


the


use


convenience


foods.


Seventy-three


percent


the


Greeks


report


never


using


convenience


foods


and


only


them


use


a daily


combination


convenience


foods


and


basic


ingredients.


Half


the


non-Greeks


use


combination


convenience


foods


and


basic


ingredients


daily


compared


less


than


one-third


the


Greek-Americans


Non-Greeks


use


a microwave


oven


more


frequently


than


the


Greeks


or Greek-Americans.


Two-thirds


the


non-Greek


persons


reported


using


daily


or weekly


compared


the


Greek-Americans,


who


use


daily


or weekly


Eighty


percent


use


the


a microwave


Greeks

oven.


and


Only


the

of th


Greek-Americans

e non-Greeks re


never


ported


never


using


a microwave


oven


cook


home.


Type


meals


prepared


also


showed


differing


trends


between


the


ethnic


groups.


Greeks


use


"Greek


style"


recipes


(83%


daily)


and


Greek


ingredients


(75%


daily).


Slightly


greater


than


one-third


the


Greeks


never


eat


"American


style"


recipes


home.


As expected,


the


majority


non-Greeks


use


"American


style"


recipes


daily.


One-fourth










reported


never


eating


"Greek


style"


recipes


or using


Greek


ingredients


foods


prepared


home.


Greek-Americans


show


greater


diversity


how


meals


are


prepared


home.


Two-thirds


them


(40%


daily


and


weekly)


use


"Greek


style"


recipes


and


them


(28%


daily


and


weekly)


use


Greek


ingredients


the


foods


they


prepare


home.


While


still


maintaining


some


the


Greek


food


preparation


methods,


half


them


(28%


daily


and


weekly)


report


cooking


"American


style"


home.


Commerical


influences


(e.g.,


TV advertisements,


coupon


use


and


collection


recipes


from


magazines)


were


much


more


evident


among


non-Greeks


and


Greek-Americans


than


among


the


Greek

report


ethnic

never


group. Se

purchasing


venty-one


food


percent


or drinks


of the


advertise


Greeks

d on TV


collecting


magazine


recipes.


Half


(50%)


them


not


use


coupons


with


food


purchases.


contrast


the


non-Greeks


and


Greek-Americans


purchased


foods


that


were


advertised


on TV either


weekly


or monthly


(non-Greeks,


weekly


and


monthly;


Greek-Americans,


23%


weekly


and


monthly).


Forty-six


percent


non-Greeks


report


not


being


influenced


TV advertisements


their


food


purchases


and


Greek-Americans


not


purchase


foods


advertised


Two-thirds


the


non-Greeks


and


Greek-Americans,










the


non-Greeks


never


use


coupons


while


shopping


for


groceries.


Greek-Americans


and


non-Greeks


collect


recipes


from


popular


magazines.


Fifty-eight


percent


the


non-Greek


group


collect


recipes


from


popular


magazines


monthly


or more


often.


Fifty-four


percent


the


Greek-Americans


collect


recipes

magazine


either

recipe


monthly


or yearly.


learn


prepare


Greek-Americans


American


may


holiday


use

foods.


Operationalized


Comparisons


Dietary


Preferences


In order


operationalized


preferences,


elucidate

categories


convenience


these

of Gr


and


trends


eek


their


or American


commercial


dietary


influences,


the


questions


were


scored


assigning


the


categorical


responses


corresponding


scored


numbers.


monthly


Responses


persons


Daily


, yearly


within


was


and


each


given


almost


ethnic


a score


never


and


weekly


scored


numerical


grouping


were


totaled


and


averaged


so that


scores


fell


with


the


scoring


range


for


each


category.


Table


describes


these


scoring


comparisons


77).


The


aggregate


response


scores


within


the


ethnic


groups


suggest


differing


levels


of preference


for


Greek


or American


dietary


practices,


convenience


and


commercial


influences.


Trends


were


evident


between


the


two


Greek


groups


as well.











Table 4-7: Averaged eating preference responses by ethnic
group

Averaged Eating Preference Responses
Ethnic Group Almost
Frequency Daily Weekly Monthly Yearly Never
Percent

Greek Dietary Preference
Greek 1 11 1 0 0
8.3 74.9 8.3 0.0 0.0

Greek-American 2 24 12 00
5.3 63.3 31.6 0.0 0.0

Non-Greek 2 24 26 2 0
3.8 44.8 48.3 3.8 0.0

American Dietary Preference
Greek 1 3 6 2 0
8.3 25.0 49.9 16.7 0.0

Greek-American 7 19 9 1 2
18.5 50.0 23.8 2.6 5.3

Non-Greek 23 23 6 2 0
42.6 42.6 11.2 3.8 0.0

Convenience Preference
Greek 0 1 3 6 2
0.0 8.3 24.9 49.9 16.7

Greek-American 2 6 16 8 6
5.3 15.8 42.1 21.0 15.8

Non-Greek 0 13 26 13 2
0.0 24.3 48.2 24.2 3.7

Commercial Preference
Greek 0 0 6 2 4
0.0 0.0 50.0 16.6 33.3

Greek-American 0 9 19 10 0
0.0 23.7 50.0 26.3 0.0










preferences,


the


Greek-Americans


demonstrated


a slightly


greater


preference


Greek


than


for


American


foodways.


Non-Greeks

practices


revealed


a trend


occasionally


(the


toward pr

non-Greek


referring


group


Greek


was


dietary


composed


a variety


persons


from American,


Italian,


German


and


other


European


backgrounds).


The


trend


for


commercial


preference


was


higher


among


non-Greeks


when


compared


either


Greeks


Greek-Americans.


Greeks


were


least


influenced


convenience.


To determine

interrelationships


whether

among


these


the


trends


study


could


variables,


explain

a factor


analysis


(containing


the


eating


preference


variables


and


other


study


variables)


was


performed.


Three


factors


were


retained


because


they


met


the


prior


communality


estimate


1.0.

was


The initial

used because


factor


the


method,


rotated


with


varimax


principle


and


components,


standardized


scoring


coefficients


did


not


explain


any


additional


variance.


Factor


the


Ethnicity


Factor,


explained


6.34%


the


variance.


Variables


that


had


a loading


or greater


were


preference


for


"Greek


style"


recipes,


Greek


recipe


ingredients,


the


ethnicity


subscores


for


culture,


religion










Factor


the


Medical


Factor,


explained


.57%


the


variance.


This


factor


will


be described


later


the


section


pertaining


risk


factors


CHD


(page


121).


Factor


the


Commercial


Factor,


explained


3.57%


the


variance


and


had


a loading


on commercial


dining,


e.g


eating


ethnic


and


fast


food


restaurants,


a deli


submarine


sandwich


shop,


from


a vending


machine


and


purchasing


foods


which


are


advertised


on TV.


None


the


factors


explained


a high


proportion


of the


variance


.48%)


among


the


variables.


These


factors


were


tested


later


a multivariate


regression


analysis


determine


whether


they


could


explain


any


variance


the


blood


cholesterol


values.


These


findings


are


presented


the


section


on blood


cholesterol


(page


121).


Freauencv


Food


Intakes


Reported


monthly


frequencies


intakes


were


grouped


into


the


following


food


groups


and


compared


(Appendix


Quoted


percentages


refer


monthly


frequencies


unless


stated


otherwise.


Dairy


Food


Grou,


Within


the


dairy


food


group,


Greek-Americans


(54%)


and


Greeks


(47%


weekly,


monthly)


reported


consuming


whole


milk more


frequently


than


non-Greeks


(30%).


The


Greek










(63%)


compared


their


skim


milk


(42%)


and


whole


milk


(30%)


consumption


pattern.


Cheeses


were


the


most


frequently


consumed


food


within


the


dairy


food


group.


Greek-Americans


consumed


feta


cheese


(89%)


and


other


cheeses


(93%)


most


frequently


when


compared


with


the


Greeks


(72%


feta


and


other


cheeses)


and


non-Greeks


(34%


feta


and


other


chee


ses) .


Yogurt


was


consumed


more


frequently


Greeks


(72%)


than


Greek-Americans


(66%)


or non-Greeks


(41%)


Frozen


yogurt


was


eaten


less


frequently


A high


proportion


Greeks


(83%),


Greek-Americans


(84%)


and


non-Greeks


(79%)


almost


never


ate


frozen


yogurt.


Ice


cream


was


consumed


more


frequently


than


milk


ethnic


groups.


Greek-Americans


reported


the


highest


(78%)


cream


consumption,


followed


non-Greeks


(64%)


and


Greeks


(56%)


Comparisons


with


the


Greek


Diet


Greeks


previous


studies,


consumed


most


their


dairy


foods


the


form


yogurt


(Valassi


1962)


and


cheese


(Christakis

consumption


1965)


Greece


was


The


unpopularity


thought


Valassi


milk


(1962)


attributable


insufficient


quantities


before


the


war


and


poor


sanitation.


Lack


pasteurization,


except


large










customarily


boiled


and


drunk


hot


with


sugar


added,


consumed


more


frequently


than


cow's


milk


rural


areas


Greece.


Greek-Americans


the


United


States


continued


prefer


yogurt


and


feta


cheese


(Valassi


1962


and


Costantakos


1987).


Vendors


sell


ice


cream


the


warmer


months


(April


September)


Greek


towns


and


rural


villages


(personal


observation


and


communication


1982)


Greek


immigrants


and


Greek-Americans


enjoy


ice


cream


the


United


States


throughout


the


year


(Valassi


1962).


Greeks


Tarpon


Springs


appear


to be


consuming


more


milk


than


Greeks


Greece


(Quantities


were


not


indicated


the


food


frequency,


so amounts


each


consumption


time


may


low)


The


24-hour


recall


indicates


that


Greeks


consume


most


their


milk


with


cereal


or coffee.


Like


Greeks


and


Greek-Americans


previous


studies,


preference


for


feta


cheese,


yogurt


and


cream


found


among


both


Greeks


and


Greek-Americans


Tarpon


Springs.


Comparisons


with


the


American


Diet


Nationwide


food


consumption


studies


(CSFII


1985)


indicate


that


whole


milk


consumption


decreased


among


United


States


men


between


1977


and


1985


and


among


United


States


women


(Popkin


1989)


during


the


same











low


who


or skim


consumed


milk


whole


(CSFII


milk


1985)


and


compared


who


with


preferred


44%


low


women


fat


skim


milk


one


of four


non-consecutive


days


(CSFII


1986).


Cheeses


were


consumed


United


States


women


(71%)


and


men


(33%)


more


frequently


than


yogurt


(12%women;


men)


per


individual


an average


day


(CSFII


1985


and


1986).


The


pattern


dairy


food


intake


among


the


non-Greek


group


Tarpon


Springs


similar


to reported


intakes


these


foods


the


nationwide


consumption


studies.


Sixteen


percent


the


non-Greeks


Tarpon


Springs


reported


consuming


whole


milk


daily,


while


reported


a daily


intake


Cheeses


of low


were


milk


consumed


and


less


preferred


frequently


skim


feta


milk


daily


and


other


cheeses


daily)


Five


percent


the


non-Greeks


reported


daily

Grain


consumption


Food


yogurt.


Grouo


Bread


Greek-Americans


consumed


than


more


frequently


non-Greeks.


Greeks


White


bread


and


used


most


frequently


the


Greeks


(71%


weekly


and


53%


daily).


Thirty-five


percent


the


Greeks


also


consume


brown


bread


daily.


Greek-Americans


and


non-Greeks


have


a greater


preference


for


brown


bread


(92%


Greek-American;


non-Greek)


Fifty-five


percent


Greek-Americans


and










Greek-Americans


(36%)


and


Greeks


(24%)


than


non-Greeks


(19%)


Specialty


breads,


e.g


doughnuts,


danish


and


coffee


cakes,


however,


are


preferred


more


frequently


Greek-Americans


(65%)


and


non-Greeks


(64%)


than


Greeks


(44%)


Two-thirds


(67%)


the


Greeks


eat


breakfast


cereals


but


non-Greeks


(89%)


and


Greek-Americans


(87%)


consume


cereal


more


frequently


Other


grains,


e.g.,


pasta


and


rice


are


also


consumed


more


frequently


Greek-Americans


(100%


pasta


and


rice)


and


non-Greeks


(97%


pasta;


92%


rice)


than


Greeks


(94%


pasta;


rice).


Comparisons


with


the


Greek


Diet


Greece,


bread


an indispensable


part


every


meal


(Valassi


1962)


Bread


usually


eaten


plain,


without


butter


or jelly,


and


used


to absorb


the


and


juices


from


salads


and


main


dishes


(personal


communication


and


observation


1982).


Specialty


breads,


e.g


., muffins,


biscuits


and


sweet


rolls


are


unknown


Greece


(Lieberman


and


Gardner


1980).


Pasta


eaten


plain


with


tomato


sauce


or in


combination


with


meat,


as in


pastitsio.


Rice


characteristically


prepared


as pilaf


or mixed


with


meat


and


seasonings


and


made


into


a stuffing


for


dolmathes


(Valassi


1962


and


Nickles










Greek-Americans,


however,


while


continuing


to have


a high


preference


bread,


have


also


adopted


the


consumption


doughnuts,


danish


and


coffee


cakes.


Pasta


and


rice


are


consumed


more


frequently


than


breakfast


cereals


Greeks.


Greek-American


consumption


patterns


of these


foods


more


nearly


resembles


the


non-Greek


preferences.


Connariaona


with


American


Diet


Consumption


yeast


breads


and


rolls


decreased


among


men,


aged


19-50,


between


1977


(82%


per


day)


and


1985


(74%


per


day).


Sixty-six


percent


women


reported


consuming


yeast


breads


and


rolls


on the


study


day


1985


(CSFII


1985


and


1986).


Other


baked


goods


were


consumed


a frequency


rate


of 52%


daily


men


(CSFII


1985)


and


women


(CSFII


1986)


Daily


cereal


and


pasta


intakes


were


reported


of the


19-50


year


old


men,


with


the


reported


intake


being


from


ready-to-eat


cereals


(CSFII


1985).


comparable


age


group


women


consumed


cereal


and


pasta


(66%)


at least


once


during


four


non-consecutive


days


with


them


consuming


ready-to-eat


cereals


(CSFII


1986).


Twenty-five


consisting


percent


mainly


men


grain


reported


(CSFII


consuming


1985)


mixed


and


dishes,


women


(CSFII


1986)


consumed


grain


dishes.


a


the










national


intakes.


Prior


to the


data


collection


periods


the


study


Tarpon


Springs,


news


was


released


regarding


the


benefit


oat


bran


reducing


serum


cholesterol


levels.


Informal


conversations


with


the


study


participants


indicated


that


they


had


increased


their


consumption


oatmeal,


other


oat


bran


cereals


and


oat


bran


baked


goods


This


increased


awareness


of oat


bran


a cholesterol-lowering


property


may


account


non-Greek


the


study


increased


intake


population


of cereal


Tarpon


Springs


among


when


the


compared


with


the


intake


cereals


reported


the


earlier


national


studies.


Fruits


and


Veaetables


Food


Grout


All


three


ethnic


groups


consumed


citrus


fruit


and


juices


frequently


(100%


non-Greek;


Greek-American;


monthly


and


weekly


Greek).


Only


a few


Greeks


(6%)


and


Greek-Americans


(5%)


never


consumed


citrus


fruits


or juices.


A high


proportion


of each


ethnic


group


also


consumed


other


fruits


and


juices


(97%


non-Greek;


Greek-American;


Greek)


Fruit


punch


or drink


was


consumed


most


frequently


Greek-Americans


(58%),


followed


non-Greeks


(46%)


and


Greeks


(41%).


Fifty-nine


percent


the


Greeks


almost


never


consumed


fruit


punch


or drink


compared


the


Greek-Americans


(31%),


who


had


the


smallest


proportion










Potatoes


were


unanimously


consumed


frequently


three


ethnic


groups.


persons


from


any


the


three


ethnic


groups


reported


never


consuming


potatoes.


Salty


snack


food


varieties,


e.g.,


potato


chips


and


corn


chips


were


consumed


most


frequently


non-Greeks


(67%).


Half


the


Greek-Americans


consumed


snack


food


varieties


monthly


compared


to 29%


Greeks,


who


consumed


these


foods.


Greeks


consumed


salad


frequently


(59%


daily


and


weekly).


Slightly


more


than


half


(55%)


the


Greek-Americans


consumed


green


salads


daily


and


almost


all


Greek-Americans


(95%)


consumed


green


salads


weekly.


Green


salad


consumption


was


reported


less


frequently


the


non-Greek


group


(44%


daily


and


weekly).


Eight


percent


the


non-Greeks


reported


never


having


green


salads


compared


no Greeks


or Greek-Americans


who


never


consumed


green


salads.


Greeks


preferred


yellow vegetables,


e.g.,


squash


and


carrots


(100%)


the


green


vegetables,


e.g.,


broccoli,


spinach,

more gre


and


sen


green


(100%)


beans

than v


(94%).


yellow


Greek


(91%)


-Americans


vegetables.


consumed

Non-Greeks


had


a high


preference


for


both


types


vegetables


(98%


green;


100%


yellow).


Intakes


olives


and


Greek


peppers


were


reported


more










preferences


these


foods


(49%


olives


and


Greek


peppers)


Twenty-eight


percent


the


Greeks


and


the


non-Greeks


compared


with


the


Greek-Americans


never


consumed


(56%)


olives.


never


Half


consumed


the


Greek


Greeks


peppers,


(50%)


while


and


only


non-Greeks


one-third


(34%)


of the


Greek-Americans


reported


never


having


Greek


peppers.


Comparisons


with


the


Greek


Diet


Consumption


of fruit


common


Greece.


Most


the


time,


fruit


(Valassi


1962;


sliced or

Lieberman


peeled


and


and


Gardner


eaten


raw


1980).


as a dessert


The


Greek


population


has


continued


enjoy


fruits,


especially


citrus


fruits,


Tarpon


Springs.


A greater


proportion


Greek-Americans


have


more


readily


adopted


fruit


punches


and


fruit


drinks.


Potatoes,


Greece,


are


characteristically


fried


with


olive


a frying


pan


and


eaten


mealtime,


rather


than


as a snack.


The


custom


having


potatoes


primarily


for


meals


has


continued


among


the


Greeks


Tarpon


Springs.


Greek-Americans


report


consuming


potato


chips


occasionally,


but


not


with


the


same


frequency


as the


non-Greeks.


In Greece,


Greeks


enjoy


a variety


raw


and


cooked


vegetables.


Raw


salads


are


served


daily


(Valassi


1962;










Greeks


and


Greek-Americans


not


as indispensable


an item


with


each


meal


as in


Greece.


Together


with


green


and


yellow


vegetable


consumption,


vegetable


intakes


are


greater


for


Greeks


and


Greek-Americans


Tarpon


Springs


than


for


non-Greeks


The


higher


preference


for


olives


and


Greek


peppers


Greek-Americans,


selective


compared


preference


with


type


Greeks,


olive


may


and


due


pepper


a more


consumed.


For


example,


Cretan


olives


not


look


or taste


the


same


olives


grown


on the


mainland


Greece


(personal


observation


and


communication


1982)


Greeks


Tarpon


Springs


may


prefer


only


the


type


olive


that


native


their


region


origin


Greece,


therefore


limiting


the


selection


olives


Tarpon


Springs.


Greek-Americans,


on the


other


hand,


may


enjoy


types


of olives


and


find


them


more


readily


available


Comparisons


with


any


the


grocery


American


store.


Diet


Fruit


intake


for


men


(CSFII


1985)


increased


eleven


percent


between


1977


and


1985.


For


women,


there


was


reported


increase


during


the


comparable


time


period


(Popkin


1989).


Twenty-three


percent


men


(CSFII


1985)


reported


women


daily


(CSFII


fruit


1986)


or fruit


reported


juice


consuming


consumption


fruit


and


on the


29%

study


A


A










compared


persons


the


national


studies,


may


associated


with


the


availability


fresh


fruits


and


the


promotion


orange


juice


Florida.


Fresh


fruits


grow


private


lawns


and


vine-ripened


produce


marketed


year


road-side


stands


Tarpon


Springs


and


the


surrounding


areas.


Vegetable


consumption


increased


for


men,


aged


19-50,


and


4.9%


women


between


1977


and


1985


(CSFII


1985


men


and


Popkin


consumed


1989).


vegetables


on the


Eighty


survey


-five


day


percent


1985.


the


Potatoes


were


consumed


and


tomatoes


42%.


Only


consumed


dark-green

vegetables.


vegetables


and


Sixty-nine


reported


percent


ate


eating


other


deep-yellow


vegetables.


Forty-one


percent


women,


aged


19-50,


consumed


potatoes


and


more


women


ate


dark-green


(11%)


and


deep-yellow


(11%)


vegetables


than


men.


Tomatoes


and


other


vegetables


were


and


consumed


respectively


women


(CSFII


1986).


Non-Greeks


Tarpon


Springs


demonstrated


a stronger


preference


vegetables


than


the


national


studies


indicate


(57%


green


vegetables


and


yellow vegetables


daily).


Potatoes


were


eaten


less


frequently


(22%


potatoes


and


potato


chips


daily)


The


availability


fresh


produce


Florida


may


account


for


the


increased


preference


for










indicative


a selection


bias


for


foods


associated


with


health


among


the


non-Greek


group


the


study


Protein


Food


GrouD


Fish


was


consumed


more


frequently


(100%)


than


poultry


(89%)


or meat


(83%)


the


Greek


group.


The


preference


Greek-Americans


for


fish


(100%


and


poultry


(98%)


was


nearly


equal.


The


frequency


meat


consumption,


Greek-Americans,


was


Non-Greeks


consumed


poultry


(97%)


preference


to fish


(94%)


and


meat


(91%)


Eleven


percent


the


Greeks


never


ate


meat


and


reported


never


eating


poultry.


contrast


no Greek-American


never


consumed


meat


or fish


and


only


never


consumed


poultry


Eight


percent


the


non-Greeks


never


eat


meat


and


reported


never


eating


fish


or poultry.


Seventy-seven


percent


the


Greeks


consumed


eggs


compared


to 85%


the


Greek-Americans


and


the


non-Greeks.


Lentils,


chickpeas


and


dried


beans


were


consumed


more


frequently


the


Greeks


(89%)


than


the


non-Greeks


(83%)


and


Greek-Americans


(78%).


Fourteen


percent


the


non-Greeks


reported


never


consuming


legumes


compared


the


Greek-Americans


appeared


who


interpre


never

t the


consumed

question


them.


Non-Greeks


as consumption


baked


beans


while


the


Greeks


and


Greek-Americans


responded










Greek-Americans


consumed


moderately


(59%)


Fifty-nine


percent


the


Greeks


never


consumed


peanut


butter


compared


the


non-Greeks


(25%)


and


Greek-Americans


(21%)


who


report


never


eating


Taramosalata,


called


"Greek


caviar,


" is


rarely


consumed


Greeks


(18%)


and


Greek-Americans


(11%).


Ninety-four


percent


the


non-Greeks


never


ate


Several


non-Greek


participants


asked


me what


this


food


was


while


they


were


answering


the


questionnaire.


Comparisons


with


the


Greek


Diet


Fish


well-liked


and


eaten


frequently


areas


Greece


which


are


bordered


water


(Valassi


1962).


Lamb


and


pork


are


meats


that


are


eaten


more


frequently


than


beef


Greece.


Poultry


and


eggs


are


used


soups


and


main


dishes.


The


quantities


meat


consumed


Greece


are


less


than


the


United


States


(Newman


1986).


Lentils


are


often


referred


as "the


meat


the


poor"


Greece.


Beans,


peas,


lentils


and


chickpeas


are


used


extensively


Greece


(Valassi


1962).


Greeks


and


Greek-Americans


Tarpon


Springs


reported


consuming


fish,


poultry


and


meat


more


frequently


than


lentils.


Simopoulos


(1989)


reports


that


eggs


Greece


contain


substantial


amounts


fatty


acids,


compared


eggs


4 ~ .


a


a. S


a


I -