This Is AuburnElectronic Theses and Dissertations

The Mediterranean diet in the Stroke Belt: a cross-sectional study on adherence and perceived knowledge, barriers, and benefits




Knight, Caroline

Type of Degree

Master's Thesis


Nutrition, Dietetics and Hospitality Management


The Mediterranean diet (MD) is recommended by the current Dietary Guidelines for Americans, yet little is known about the diet in the Stroke Belt. Thus, we investigated MD adherence and perceived benefits and barriers to consumption of the MD in the US Stroke Belt. A survey containing MD knowledge, barriers, and benefits (KBB) questions, a MD adherence screener (MEDAS), questions based on the Precaution Adoption Model, and demographic/anthropometric questions was distributed to US residents. Responses from the Stroke Belt (SB; n = 305), California (CA; n = 489), and all other US states (OtherUS; n = 435) were obtained. The CA group served as the reference group. A linear model was used to assess KBB question scores, adjust for sex and age, and all other demographic variables. Multivariable linear regression analysis was used to assess the differences in total MEDAS adjusted for all covariates. Barriers on MD convenience, sensory factors, and health were significantly greater in the SB group, but not the OtherUS group, in all models (p < 0.05). Ethics & feasibility was found to be a significantly less of a benefit in the SB group in all models (p < 0.05). For each point increase in MEDAS, a reduction in 0.43 and 0.51 points (p < 0.05) was observed in the SB and otherUS groups, respectively. There were no significant differences in MEDAS by sex, age, or ethnicity. Our results identify key barriers and benefits of the MD in the SB which can inform targeted MD intervention studies.