Abstract
Evidence of the effectiveness of community-based lifestyle behavior change interventions among African-American adults is mixed. We implemented a behavioral lifestyle change intervention, Heart Matters, in two rural counties in North Carolina with African-American adults. Our aim was to evaluate the effect of Heart Matters on dietary and physical activity behaviors, self-efficacy, and social support. We used a cluster randomized controlled trial to compare Heart Matters to a delayed intervention control group after 6 months. A total of 143 African-American participants were recruited and 108 completed 6-month follow-up assessments (75.5%). We used mixed regression models to evaluate changes in outcomes from baseline to 6-month follow-up. The intervention had a significant positive effect on self-reported scores of encouragement of healthy eating, resulting in an increase in social support from family of 6.11 units (95% CI [1.99, 10.22]) (p < .01). However, intervention participants also had an increase in discouragement of healthy eating compared to controls of 5.59 units (95% CI [1.46, 9.73]) among family (p < .01). There were no significant differences in changes in dietary behaviors. Intervention participants had increased odds (OR = 2.86, 95% CI [1.18, 6.93]) of increased frequency of vigorous activity for at least 20 min per week compared to control participants (p < .05). Individual and group lifestyle behavior counseling can have a role in promoting physical activity levels among rural African-American adults, but more research is needed to identify the best strategies to bolster effectiveness and influence dietary change. Trial Registration: Clinical Trials, NCT02707432. Registered 13 March 2016.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allicock, M., Campbell, M. K., Valle, C. G., Carr, C., Resnicow, K., & Gizlice, Z. (2012). Evaluating the dissemination of Body & Soul, an evidence-based fruit and vegetable intake intervention: Challenges for dissemination and implementation research. Journal of Nutrition Education and Behavior, 44, 530–538. https://doi.org/10.1016/j.jneb.2011.09.002.
Appel, L. J., Champagne, C. M., Harsha, D. W., Cooper, L. S., Obarzanek, E., Elmer, P. J., et al. (2003). Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER clinical trial. JAMA, 289, 2083–2093. https://doi.org/10.1001/jama.289.16.2083.
Bess, K., Young, T., Carthron, D., Cene, C., Davis, K., Frerichs, L., … Corbie-Smith, G. (2017). Integrating intervention mapping and CBPR principles to adapt a multi-component EBI in a rural African American community. Paper presented at the American Public Health Association Annual Meeting, Atlanta, GA.
Bland, V., & Sharma, M. (2017). Physical activity interventions in African American women: A systematic review. Health Promotion Perspective, 7, 52–59. https://doi.org/10.15171/hpp.2017.11.
Bopp, M., Wilcox, S., Laken, M., Hooker, S. P., Parra-Medina, D., Saunders, R., et al. (2009). 8 steps to fitness: A faith-based, behavior change physical activity intervention for African Americans. Journal of Physical Activity & Health, 6, 568–577.
Campbell, M. K., Demark-Wahnefried, W., Symons, M., Kalsbeek, W. D., Dodds, J., Cowan, A., et al. (1999). Fruit and vegetable consumption and prevention of cancer: The Black Churches United for Better Health project. American Journal of Public Health, 89, 1390–1396. https://doi.org/10.2105/ajph.89.9.1390.
Campbell, M. K., Hudson, M. A., Resnicow, K., Blakeney, N., Paxton, A., & Baskin, M. (2007). Church-based health promotion interventions: Evidence and lessons learned. Annual Review of Public Health, 28, 213–234. https://doi.org/10.1146/annurev.publhealth.28.021406.144016.
Cockerham, W. C., Bauldry, S., Hamby, B. W., Shikany, J. M., & Bae, S. (2017). A Comparison of Black and White Racial Differences in Health Lifestyles and Cardiovascular Disease. American Journal of Preventive Medicine, 52, S56–S62. https://doi.org/10.1016/j.amepre.2016.09.019.
Corbie-Smith, G., Wiley-Cene, C., Bess, K., Young, T., Dave, G., Ellis, K., et al. (2018). Heart Matters: A study protocol for a community based randomized trial aimed at reducing cardiovascular risk in a rural, African American community. BMC Public Health, 18, 938. https://doi.org/10.1186/s12889-018-5802-1.
Coughlin, S. S., & Smith, S. A. (2017). Community-Based Participatory Research to Promote Healthy Diet and Nutrition and Prevent and Control Obesity Among African-Americans: a Literature Review. Journal of Racial and Ethnic Health Disparities, 4, 259–268. https://doi.org/10.1007/s40615-016-0225-0.
Darmon, N., & Drewnowski, A. (2015). Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: A systematic review and analysis. Nutrition Reviews, 73, 643–660. https://doi.org/10.1093/nutrit/nuv027.
Duru, O. K., Sarkisian, C. A., Leng, M., & Mangione, C. M. (2010). Sisters in motion: a randomized controlled trial of a faith-based physical activity intervention. Journal of the American Geriatrics Society, 58, 1863–1869. https://doi.org/10.1111/j.1532-5415.2010.03082.x.
Elmer, P. J., Obarzanek, E., Vollmer, W. M., Simons-Morton, D., Stevens, V. J., Young, D. R., et al. (2006). Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Annals of Internal Medicine, 144, 485–495.
Faridi, Z., Shuval, K., Njike, V. Y., Katz, J. A., Jennings, G., Williams, M., et al. (2010). Partners reducing effects of diabetes (PREDICT): A diabetes prevention physical activity and dietary intervention through African-American churches. Health Education Research, 25, 306–315. https://doi.org/10.1093/her/cyp005.
Geller, K., Harmon, B., Burse, N., & Strayhorn, S. (2019). Church-based social support’s impact on African-Americans’ physical activity and diet varies by support type and source. Journal of Religion and Health, 58, 977–991. https://doi.org/10.1007/s10943-018-0576-4.
Gorin, S. S., Badr, H., Krebs, P., & Prabhu Das, I. (2012). Multilevel interventions and racial/ethnic health disparities. Journal of the National Cancer Institute. Monographs, 2012, 100–111. https://doi.org/10.1093/jncimonographs/lgs015.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42, 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.
Hooker, S. P., Hutto, B., Zhu, W., Blair, S. N., Colabianchi, N., Vena, J. E., et al. (2016). Accelerometer measured sedentary behavior and physical activity in white and black adults: The REGARDS study. Journal of Science and Medicine in Sport, 19, 336–341. https://doi.org/10.1016/j.jsams.2015.04.006.
Howard, V. J., Kleindorfer, D. O., Judd, S. E., McClure, L. A., Safford, M. M., Rhodes, J. D., et al. (2011). Disparities in stroke incidence contributing to disparities in stroke mortality. Annals of Neurology, 69, 619–627. https://doi.org/10.1002/ana.22385.
Judd, S. E., Gutierrez, O. M., Newby, P. K., Howard, G., Howard, V. J., Locher, J. L., et al. (2013). Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in black Americans. Stroke, 44, 3305–3311. https://doi.org/10.1161/STROKEAHA.113.002636.
Kaiser Permanente Center for Health Research. (2018). PREMIER: A trial of lifestyle interventions for blood pressure control. Retrieved from https://research.kpchr.org/Research/Research-Areas/Cardiovascular-Disease/PREMIER. Accessed 17 Dec 2019
Kaplan, M., Crago, N., Herzog, F., Jame, L., Kiernan, N., Middlemiss, W., … Weinreb-Welch, L. (2018). Food-related intergenerational discussion group experiences. Retrieved from https://aese.psu.edu/extension/intergenerational/program-areas/nutrition-health/fridge. Accessed 17 Dec 2019
Kittler, P., & Sucher, K. (2001). Food and Culture. Stamford: Wadsworth.
Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., Walker, E. A., et al. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346, 393–403. https://doi.org/10.1056/NEJMoa012512.
Kumanyika, S. K., Espeland, M. A., Bahnson, J. L., Bottom, J. B., Charleston, J. B., Folmar, S., et al. (2002). Ethnic comparison of weight loss in the Trial of Nonpharmacologic Interventions in the Elderly. Obesity Research, 10, 96–106. https://doi.org/10.1038/oby.2002.16.
Lancaster, K., Carter-Edwards, L., Grilo, S., Shen, C., & Schoenthaler, A. (2014). Obesity interventions in African American faith-based organizations: A systematic review. Obesity Reviews, 15, 159–176.
Look, A. R. G., & Wing, R. R. (2010). Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the Look AHEAD trial. Archives of Internal Medicine, 170, 1566–1575. https://doi.org/10.1001/archinternmed.2010.334.
Look, A. R. G., Pi-Sunyer, X., Blackburn, G., Brancati, F. L., Bray, G. A., Bright, R., et al. (2007). Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: One-year results of the look AHEAD trial. Diabetes Care, 30, 1374–1383. https://doi.org/10.2337/dc07-0048.
McNabb, W., Quinn, M., Kerver, J., Cook, S., & Karrison, T. (1997). The PATHWAYS church-based weight loss program for urban African-American women at risk for diabetes. Diabetes Care, 20, 1518–1523. https://doi.org/10.2337/diacare.20.10.1518.
Melvin, C. L., Corbie-Smith, G., Kumanyika, S. K., Pratt, C. A., Nelson, C., Walker, E. R., et al. (2013). Developing a research agenda for cardiovascular disease prevention in high-risk rural communities. American Journal of Public Health, 103, 1011–1021. https://doi.org/10.2105/AJPH.2012.300984.
National Cancer Institute Division of Cancer Control & Population Sciences. (n.d.) Dietary Screener Questionnaire (DSQ) in the NHANES 2009-10: Dietary factors, food items asked, and testing status for DSQ. Retrieved from https://epi.grants.cancer.gov/nhanes/dietscreen/evaluation.html#pub. Accessed 17 Dec 2019
Peterson, J. A., Yates, B. C., & Hertzog, M. (2008). Heart and soul physical activity program: Social support outcomes. American Journal of Health Behavior, 32, 525–537. https://doi.org/10.5555/ajhb.2008.32.5.525.
Rauh, M. J., Hovell, M. F., Hofstetter, C. R., Sallis, J. F., & Gleghorn, A. (1992). Reliability and validity of self-reported physical activity in Latinos. International Journal of Epidemiology, 21, 966–971. https://doi.org/10.1093/ije/21.5.966.
Resnicow, K., Jackson, A., Wang, T., De, A. K., McCarty, F., Dudley, W. N., & Baranowski, T. (2001). A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: Results of the Eat for Life trial. American Journal of Public Health, 91, 1686–1693. https://doi.org/10.2105/ajph.91.10.1686.
Resnicow, K., Campbell, M., Carr, C., McCarty, F., Wang, T., Periasamy, S., et al. (2004). Body and soul. A dietary intervention conducted through African-American churches. American Journal of Preventive Medicine, 27, 97–105. https://doi.org/10.1016/j.amepre.2004.04.009.
Resnicow, K., Jackson, A., Blissett, D., Wang, T., McCarty, F., Rahotep, S., & Periasamy, S. (2005a). Results of the healthy body healthy spirit trial. Health Psychology, 24, 339–348. https://doi.org/10.1037/0278-6133.24.4.339.
Resnicow, K., Taylor, R., Baskin, M., & McCarty, F. (2005b). Results of go girls: A weight control program for overweight African-American adolescent females. Obesity Research, 13, 1739–1748. https://doi.org/10.1038/oby.2005.212.
Sallis, J., Haskell, W., Wood, P., Fortmann, S., Rogers, T., Blair, S., & Paffenbarger, R. (1985). Physical activity assessment methodology in the Five-City Project. American Journal of Epidemiology, 121, 91–106.
Sallis, J., Grossman, R., Pinski, R., Patterson, T., & Nader, P. (1987). The development of scales to measure social support for diet and exercise behaviors. Preventive Medicine, 16, 825–836.
Sallis, J., Pinski, R., Grossman, R., Patterson, T., & Nader, P. (1988). The developmetn of self-efficacy scales for ehatlh-related diet and exercise behaviors. Health Education Research, 3, 283–292.
Sallis, J. F., Hovell, M. F., Hofstetter, C. R., Faucher, P., Elder, J. P., Blanchard, J., et al. (1989). A multivariate study of determinants of vigorous exercise in a community sample. Preventive Medicine, 18, 20–34.
Samuel-Hodge, C. D., Keyserling, T. C., Park, S., Johnston, L. F., Gizlice, Z., & Bangdiwala, S. I. (2009). A randomized trial of a church-based diabetes self-management program for African Americans with type 2 diabetes. The Diabetes Educator, 35, 439–454. https://doi.org/10.1177/0145721709333270.
Smith, T., Calloway, E., Pinard, C., Hennessey, E., Oh, A., Nebeling, L., & Yaroch, A. (2017). Using secondary 24-hour dietary recall data to estimate daily dietary factor intake from the FLASHE study dietary screener. American Journal of Preventive Medicine, 52, 856–862. https://doi.org/10.1016/j.amepre.2017.01.015.
Stevens, V. J., Obarzanek, E., Cook, N. R., Lee, I. M., Appel, L. J., Smith West, D., et al. (2001). Long-term weight loss and changes in blood pressure: Results of the Trials of Hypertension Prevention. Annals of Internal Medicine, 134, 1–11.
Sylvia, L. G., Bernstein, E. E., Hubbard, J. L., Keating, L., & Anderson, E. J. (2014). Practical guide to measuring physical activity. Journal of the Academy of Nutrition and Dietetics, 114, 199–208. https://doi.org/10.1016/j.jand.2013.09.018.
Taplin, S. H., Anhang Price, R., Edwards, H. M., Foster, M. K., Breslau, E. S., Chollette, V., et al. (2012). Introduction: Understanding and influencing multilevel factors across the cancer care continuum. Journal of the National Cancer Institute. Monographs, 2012, 2–10. https://doi.org/10.1093/jncimonographs/lgs008.
Thomson, J. L., Tussing-Humphreys, L. M., Zoellner, J. M., & Goodman, M. H. (2016). Psychosocial constructs were not mediators of intervention effects for dietary and physical activity outcomes in a church-based lifestyle intervention: Delta Body and Soul III. Public Health Nutrition, 19, 2060–2069. https://doi.org/10.1017/S1368980015003602.
Vaughan, A. S., Quick, H., Pathak, E. B., Kramer, M. R., & Casper, M. (2015). Disparities in Temporal and geographic patterns of declining heart disease mortality by race and sex in the United States, 1973-2010. Journal of the American Heart Association, 4. https://doi.org/10.1161/JAHA.115.002567.
Wilcox, S., Laken, M., Bopp, M., Gethers, O., Huang, P., McClorin, L., et al. (2007). Increasing physical activity among church members: Community-based participatory research. American Journal of Preventive Medicine, 32, 131–138. https://doi.org/10.1016/j.amepre.2006.10.009.
Wingo, B., Carson, T., & Ard, J. (2014). Differences in weight loss and health outcomes among African Americans and whites in multicentre trials. Obesity Reviews, 15, 46–61.
Yanek, L. R., Becker, D. M., Moy, T. F., Gittelsohn, J., & Koffman, D. M. (2001). Project Joy: faith based cardiovascular health promotion for African American women. Public Health Reports, 116, 68–81. https://doi.org/10.1093/phr/116.S1.68.
Yeary, K. H., Cornell, C. E., Turner, J., Moore, P., Bursac, Z., Prewitt, T. E., & West, D. S. (2011). Feasibility of an evidence-based weight loss intervention for a faith-based, rural, African American population. Preventing Chronic Disease, 8, A146.
Funding
This study was funded by the National Heart Lung and Blood Institute (Grant Numbers R01HL120690 & K24HL105493-09; PI Giselle Corbie-Smith). This project was also supported by NIH/NCRR Colorado CTSI Grant Number UL1 RR025780 and University of North Carolina CTSI Grant Number UL1TR002489. Dr. Frerichs was supported by the National Heart Lung and Blood Institute (Grant Number 5K01HL138159; PI Frerichs). The funding bodies had no role in the design, collection, analysis, interpretation, nor writing of the study. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH views.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Frerichs, L., Bess, K., Young, T.L. et al. A Cluster Randomized Trial of a Community-Based Intervention Among African-American Adults: Effects on Dietary and Physical Activity Outcomes. Prev Sci 21, 344–354 (2020). https://doi.org/10.1007/s11121-019-01067-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-019-01067-5