The Effect of 9/11 on the Personal Values of Dietetics Students

This research evaluated how the terrorist attacks of 9/11 affected the personal values of a group of dietetics students. Each student ranked 20 personal values in order of importance before and at three time points after 9/11. Statistical comparisons of the responses demonstrated that the terrorist attacks changed the relative importance of several of the values. When personal values are used as motivating tools in nutritional counseling, the impact of major events on personal values must be considered for both the counselor and patient.

The terrorist attacks of 9/11 have had an extraordinary, though still evolving, impact on our society (Schuster et al., 2001). An assignment in a college nutrition counseling class conducted before and after 9/11 offers insight into how the events affected the values of a group of dietetics students. The assignment was not designed as a research instrument or intended as such, and the timing of the assignment just before 9/11 was coincidental. However, due to the opportune scheduling of the exercises, important lessons for teachers of dietetics students were garnered.

Dietitians need to consider how their own personal values may have an impact on their performance as nutrition counselors and thus affect their capacity to develop empathy. Understanding and tolerating the values of others are also essential components of developing rapport and persuading individuals (Helm & Klawitter, 1995).

Dietitians must be concerned with the values of patients. During nutritional counseling sessions, dietitians not only educate, but they also motivate patients to manage their own nutrition and health (Holli & Calabrese, 1997). Dietitians can enhance the success of their own motivational efforts by determining, considering, and responding to what is most important to patients, including their values at a particular time (Snetselaar, 1997).

This study evaluated the continuity of and changes in students' personal values before and after 9/11. Implications for teachers of dietetics students regarding the importance of values in their professional careers are explored.

The authors wish to thank Kara Gaetke, B. S. Candidate, 2004, Yale University, for her editorial help.

METHODS
This study included 31 dietetic students enrolled in "Nutrition Counseling," a required course for the major at the University of Kentucky during the fall 2001 semester. Twenty-nine students were female; the mean age was 22 ± 4 (SD) years. Twenty-four students were in their third year and seven were in their fourth year of the Dietetics Didactic Program. The University of Kentucky's Institutional Review Board approved the study, retroactively.

The classroom assignment has been given annually for the last 10 years to help students consider their own values and to reinforce the importance that values will play in their future work. Early in the semester, each student ranked 20 personal values in order of importance (Bianchi, Butler, & Richey, 1990). The same assignment was given a total of four times during the 2001 fall semester on these dates: August 29, September 12 (the day after the terrorist attacks), September 19, and October 10.

Data were analyzed using the SPSS for Windows (Version 10). Mean rankings for each personal value were compared using a repeated measures analysis of variance (ANOVA) followed by pair wise comparison tests for time within each value. Statistical significance was set at p < 0.05. All results are expressed as the mean ± SEM.

RESULTS
The students' rankings of the importance of their personal values at the four points of the semester (Table 1) indicated both stability and change in the face of 9/11 and its aftermath. Statistically significant changes occurred in the relative importance of a number of values, although the mean rankings of certain values indicated that they remained most important to the students even after the momentous events.

Notably, in the September 12 assignment, there were statistically significant changes in the mean rankings of 11 of the 20 listed values when compared to the rankings from August 29. Three values ranked higher in importance. "National security" rose from 13th in importance on August 29 to 8th the day after the attacks. "A world at peace" was ranked 14th before the attacks and 10th on September 12. The students ranked "freedom" 12th before and 7th after 9/11.

Eight personal values decreased in importance to the students after 9/11: "a comfortable life," "an exciting life," "happiness," "mature love," "self-respect," "social recognition," "wisdom," and "knowledge." One week after the terrorist attacks, fewer significant changes were noted in the students' mean rankings of the 20 values as compared to the results recorded for the assignment on September 12. Two values, "mature love" and "knowledge," regained some of the importance lost immediately in the wake of 9/11, while the value characterized as "family security" slipped in importance.

One month after 9/11, only two values showed significant changes from the values indicated on the September 19 assignment. Both "an exciting life" and "social recognition" dropped in the immediate aftermath of the attacks and showed significant increases in importance on September 19.

Six of the 20 values showed significant changes from their pre-September 11 importance to that shown by the assignment one month later. On the October 10 rankings, four values, "equality," "happiness," "a sense of accomplishment," and "wisdom" registered significant decreases, and two values, "national security" and "a world at peace," showed significant increases in the importance assigned to them by the students when compared to the August 29 rankings.

The continuing aspect of the crisis and its possible lasting effect on the students' ranking of values were reflected in the findings that there were no significant decreases in the students' rankings of "national security," "a world at peace," or "freedom" either at one week or at one month after the 9/11 attacks.

Personal values-"family security," "happiness," "relationship with God," and "self-respect"-were ranked as the most important to students all four times. Although the rankings of each of these values within the top four varied, and "happiness" showed a significant decrease in importance across the four time points, all of these personal values remained highly ranked each time.

DISCUSSION
The effect of the 9/11 attacks on the students' rankings provides insights for teachers of dietetics students on the subject of personal values of the nutrition counselor and the patient. The results of the four assignments underscore the impact of significant events on personal values.

The 9/11 attacks were extraordinary events; the horrific and tragic nature of the attacks is reflected in the impact they had on the students' ranking of the 20 values. One lesson learned is that major events can cause significant changes in the relative importance an individual assigns to personal values. In counseling patients, dietitians must recognize that extraordinary events may affect what patients value most. Significant events such as the death or serious illness of a loved one, the loss of a job, or a divorce might well have an impact, perhaps even greater than that of 9/11. Dietitians also should recognize that their own values are subject to change following significant events. This may necessitate reassessment of the dietitian's own self-awareness in order to promote tolerance and empathy for others.

A second lesson is that not all values are constant and immutable. Not only did the events of 9/11 cause significant changes to the importance assigned to a listing of values, as might be expected, but in the aftermath of those events, movement-though more limited-continued. Although one month does not necessarily suggest long-term effects on the students' values, it does indicate that students were notably affected by 9/11. For dietitians providing nutrition counseling to the same patients over time, some re-ordering of priorities is relatively constant and is to be expected.

A third lesson is that certain values are more durable and constant than others. The values of "family security," "happiness," "relationship with God," and "self-respect," consistently ranked high, representing values most fundamental to the students. A dietitian providing nutrition counseling might be mindful that patients hold certain values dear even in the face of a calamity. Appeals to patients' interests in pleasure, excitement in life, love affairs, and other more superficial values might be less successful in motivating them than would efforts to connect their nutritional success with its meaning for the patient's family, self-respect, religious faith, and overall happiness.

Data from this class assignment were analyzed for the first time in 2001. As a means of comparison, data were collected from the same assignment in another Nutrition Counseling class of dietetics students (22 students, all female, mean age of 21 ± 1 (SD) years) during the fall semester of 2002 (data not shown). The 2002 students ranked the same 20 personal values in order of importance at the beginning of the semester (September 4), approximately the middle of the semester (October 30), and at the end of the semester (December 11). During this time period, there were no significant national events comparable to 9/11. Mean rankings for each personal value were compared using a repeated measures ANOVA followed by pair wise comparison tests for time within each value, using the same version of SPSS that was used in 2001. In 2002, there were no statistically significant changes in the ranking of personal values over the three time points in the semester. The students' ranking of personal values did not change over the course of the 2002 semester.

This study was limited in its sample size, content, and duration. The survey instrument only allowed ranking of personal values relative to each other and did not permit the student to rank values of equal importance to them. However, this study does provide important information for nutrition education. The results underscore the stability of certain fundamental values and the changeability of others.

CONCLUSIONS
A college classroom assignment taught dietetics students about their personal values and the impact significant events can have on those values. This assignment reinforced the importance personal values play in motivating patients. During nutritional counseling, it's important for dietitians to remember that 1) a part of motivating patients or clients is determining and responding to what is most important, including the patient's personal values at a given time, 2) major events can cause significant changes in the relative importance an individual assigns to personal values, 3) not all values remain constant, and 4) some values are more enduring than others.