Skip to main content
SpringerLink
Log in

Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Few trials have tested physical-activity interventions among sexual minorities, including African American men who have sex with men (MSM).

Purpose

We examined the efficacy and mediation of the Being Responsible for Ourselves (BRO) physical-activity intervention among African American MSM.

Method

African American MSM were randomized to the physical-activity intervention consisting of three 90-min one-on-one sessions or an attention-matched control intervention and completed pre-intervention, immediately post-intervention, and 6- and 12-month post-intervention audio computer-based surveys.

Results

Of the 595 participants, 503 completed the 12-month follow-up. Generalized estimating equation models revealed that the intervention increased self-reported physical activity compared with the control intervention, adjusted for pre-intervention physical activity. Mediation analyses suggested that the intervention increased reasoned action approach variables, subjective norm and self-efficacy, increasing intention immediately post-intervention, which increased physical activity during the follow-up period.

Conclusions

Interventions targeting reasoned action approach variables may contribute to efforts to increase African American MSM’s physical activity.

Clinical trial registration

The trial was registered with the ClinicalTrials.gov Identifier NCT02561286.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. National Center for Health Statistics: Health, United States, 2013: With special feature on prescription drugs. Hyattville, MD: National Center for Health Statistics, 2014.

  2. Centers for Disease Control and Prevention. HIV surveillance report, 2011. Atlanta: Centers for Disease Control and Prevention; 2013.

    Google Scholar 

  3. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2014 update: A report from the American Heart Association. Circulation. 2014; 129: e28-e29.

    Article  PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention. National diabetes statistics report: Estimates of diabetes and its burden in the United States. Atlanta: Centers for Disease Control and Prevention; 2014: 2014.

    Google Scholar 

  5. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: The National Academy Press; 2011.

    Google Scholar 

  6. Wolitski RJ, Stall R, Valdiserri RO (eds): Unequal opportunity: Health disparities affect gay and bisexual men in the United States. New York: Oxford University Press, 2008.

  7. Department of Health and Human Services: 2008 physical activity guidelines for Americans. from http://www.health.gov/PAGuidelines/pdf/paguide.pdf.

  8. Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity—A systematic review. Am J Prev Med. 2002; 22: 73-108.

    Article  PubMed  Google Scholar 

  9. Greaves CJ, Sheppard KE, Abraham C, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health. 2011; 11.

  10. Waters LA, Galichet B, Owen N, Eakin E. Who participates in physical activity intervention trials? J Phys Act Health. 2011; 8: 85-103.

    Article  PubMed  Google Scholar 

  11. Newton RL Jr, Griffith DM, Kearney WB, Bennett GG. A systematic review of weight loss, physical activity and dietary interventions involving African American men. Obes Rev. 2014; 15(Suppl 4): 93-106.

    Article  PubMed  Google Scholar 

  12. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.

    Google Scholar 

  13. Fishbein M, Ajzen I. Predicting and changing behavior: The reasoned action approach. New York: Taylor and Francis Group; 2010.

    Google Scholar 

  14. Wainberg ML, Gonzalez MA, McKinnon K, et al. Targeted ethnography as a critical step to inform cultural adaptations of HIV prevention interventions for adults with severe mental illness. Soc Sci Med. 2007; 65: 296-308.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Heeren GA, Jemmott JB 3rd, Sidloyi L, Ngwane Z. Disclosure of HIV diagnosis to HIV-infected children in South Africa: Focus groups for intervention development. Vulnerable Child Youth Stud. 2012; 7: 47-54.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Darker CD, French DP, Eves FF, Sniehotta FF. An intervention to promote walking amongst the general population based on an ‘extended’ theory of planned behaviour: A waiting list randomised controlled trial. Psychol Health. 2010; 25: 71-88.

    Article  CAS  PubMed  Google Scholar 

  17. Dishman RK, Motl RW, Saunders R, et al. Self-efficacy partially mediates the effect of a school-based physical-activity intervention among adolescent girls. Prev Med. 2004; 38: 628-636.

    Article  PubMed  Google Scholar 

  18. El-Bassel N, Jemmott JB 3rd, Landis JR, et al. Intervention to influence behaviors linked to risk of chronic diseases: a multisite randomized controlled trial with African-American HIV-serodiscordant heterosexual couples. Arch Intern Med. 2011; 171: 728-736.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fjeldsoe BS, Miller YD, Marshall AL. MobileMums: A randomized controlled trial of an SMS-based physical activity intervention. Ann Behav Med. 2010; 39: 101-111.

    Article  PubMed  Google Scholar 

  20. Jemmott JB 3rd, Jemmott LS, O’Leary A, et al. Cognitive-behavioural health-promotion intervention increases fruit and vegetable consumption and physical activity among South African adolescents: A cluster-randomised controlled trial. Psychol Health. 2011; 26: 167-185.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jemmott JB 3rd, Jemmott LS, Ngwane Z, et al. Theory-based behavioral intervention increases physical activity in South African men: A cluster-randomized controlled trial. Prev Med. 2014; 64: 114-120.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Montanaro EA, Bryan AD. Comparing theory-based condom interventions: Health belief model versus theory of planned behavior. Health Psychol. 2014; 33: 1251-1260.

    Article  PubMed  Google Scholar 

  23. Plotnikoff RC, Lubans DR, Penfold CM, Courneya KS. Testing mediator variables in a physical activity intervention for women with type 2 diabetes. Psychol Sport Exerc. 2014; 15: 1-8.

    Article  Google Scholar 

  24. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991; 50: 179-211.

    Article  Google Scholar 

  25. Fishbein M, Ajzen I. Belief, attitude, intention and behavior. Boston: Addison-Wesley; 1975.

    Google Scholar 

  26. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods. 2002; 7: 83-104.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Baruth M, Wilcox S, Blair S, et al. Psychosocial mediators of a faith-based physical activity intervention: Implications and lessons learned from null findings. Health Educ Res. 2010; 25: 645-655.

    Article  PubMed  Google Scholar 

  28. Jemmott JB 3rd, Jemmott LS, O’Leary A, et al. On the efficacy and mediation of a social cognitive one-on-one HIV risk-reduction intervention for African American men who have sex with men: A randomized controlled trial. AIDS Behav. 2014; 19: 1247-1262.

    Article  PubMed Central  Google Scholar 

  29. Michie S, Ashford S, Sniehotta FF, et al. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychol Health. 2011; 26: 1479-1498.

    Article  PubMed  Google Scholar 

  30. Cook T, Campbell D. Quasi-experimentation: Design and analysis for field settings. Chicago: Houghton Mifflin; 1979.

    Google Scholar 

  31. Metzger DS, Koblin B, Turner C, et al. Randomized controlled trial of audio computer-assisted self-interviewing: Utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team. Am J Epidemiol. 2000; 152: 99-106.

    Article  CAS  PubMed  Google Scholar 

  32. Centers for Disease Control and Prevention: 2001 national school-based youth risk behavior survey. Public-use data documentation. Retrieved August 2003, from ftp.cdc.gov/pub/data/yrbs/2001/YRBS_2001_National_User_Guide.pdf

  33. Zhang J, Jemmott JB 3rd. Effects of an online social network intervention on physical activity in young African American women. Philadelphia: University of Pennsylvania; 2016.

    Google Scholar 

  34. Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health. 1998; 13: 623-649.

    Article  Google Scholar 

  35. Jemmott JB, 3rd, Heeren GA: Prospective study of theory of planned behavior predictors of health behaviors in African American men over three months. Annenberg School for Communication, University of Pennsylvania, 2009.

  36. Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986; 73: 13-22.

    Article  Google Scholar 

  37. Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. New York: Wiley; 2004.

    Google Scholar 

  38. Muthén LK, Muthén BO. Mplus user’s guide. 7th ed. Los Angeles: Muthén & Muthén; 2012.

    Google Scholar 

  39. Muthen BO, Satorra A. Complex sample data in structural equation modeling. Sociol Methodol. 1995; 25: 267-316.

    Article  Google Scholar 

  40. Little RJA, Rubin DB. Statistical analysis with missing data. 2nd ed. Hoboken: Wiley; 2002.

    Google Scholar 

  41. Bryant FB, Satorra A. Principles and practice of scaled difference chi-square testing. Struct Equ Model Multidiscip J. 2012; 19: 372-398.

    Article  Google Scholar 

  42. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivar Behav Res. 2004; 39: 99-128.

    Article  Google Scholar 

  43. Olsson UH, Foss T, Troye SV, Howell RD. The performance of ML, GLS, and WLS estimation in structural equation modeling under conditions of misspecification and nonnormality. Struct Equ Model Multidiscip J. 2000; 7: 557-595.

    Article  Google Scholar 

  44. Kenny DA, McCoach DB. Effect of the number of variables on measures of fit in structural equation modeling. Struct Equ Model. 2003; 10: 333-351.

    Article  Google Scholar 

  45. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model Multidiscip J. 1999; 6: 1-55.

    Article  Google Scholar 

  46. Rucker DD, Preacher KJ, Tormala ZL, Petty RE. Mediation analysis in social psychology: Current practices and new recommendations. Soc Personal Psychol Compass. 2011; 5: 359-371.

    Article  Google Scholar 

  47. Kraft C, Robinson BE, Nordstrom DL, Bockting WO, Rosser BRS. Obesity, body image, and unsafe sex in men who have sex with men. Arch Sex Behav. 2006; 35: 587-595.

    Article  PubMed  Google Scholar 

  48. Resnicow K, Jackson A, Blissett D, et al. Results of the healthy body healthy spirit trial. Health Psychol. 2005; 24: 339-348.

    Article  PubMed  Google Scholar 

  49. Wilson DK, Van Horn ML, Kitzman-Ulrich H, et al. Results of the “Active by Choice Today” (ACT) randomized trial for increasing physical activity in low-income and minority adolescents. Health Psychol. 2011; 30: 463-471.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Jemmott JB 3rd, Stephens-Shields A, O’Leary A, et al. Mediation of effects of a theory-based intervention on self-reported physical activity in South African men. Prev Med. 2015; 72: 1-7.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Lewis BA, Williams DM, Martinson BC, Dunsiger S, Marcus BH. Healthy for life: A randomized trial examining physical activity outcomes and psychosocial mediators. Ann Behav Med. 2013; 45: 203-212.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Lubans DR, Foster C, Biddle SJH. A review of mediators of behavior in interventions to promote physical activity among children and adolescents. Prev Med. 2008; 47: 463-470.

    Article  PubMed  Google Scholar 

  53. Miller YD, Trost SG, Brown WJ. Mediators of physical activity behavior change among women with young children. Am J Prev Med. 2002; 23: 98-103.

    Article  PubMed  Google Scholar 

  54. Becofsky K, Baruth M, Wilcox S. Psychosocial mediators of two community-based physical activity programs. Ann Behav Med: Publ Soc Behav Med. 2014; 48: 125-129.

    Article  Google Scholar 

  55. Vallance JKH, Courneya KS, Plotnikoff RC, Mackey JR. Analyzing theoretical mechanisms of physical activity behavior change in breast cancer survivors: Results from the activity promotion (ACTION) trial. Ann Behav Med. 2008; 35: 150-158.

    Article  PubMed  Google Scholar 

  56. van Stralen MM, de Vries H, Mudde AN, Bolman C, Lechner L. The long-term efficacy of two computer-tailored physical activity interventions for older adults: Main effects and mediators. Health Psychol. 2011; 30: 442-452.

    Article  PubMed  Google Scholar 

  57. van Stralen MM, Yildirim M, Velde SJT, et al. What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms. Int J Obes. 2011; 35: 1251-1265.

    Article  Google Scholar 

  58. Williams DM, Dunsiger S. Suggestions for testing health behavior theories: Implications for mediator analysis. Ann Behav Med. 2007; 34: 223.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

John B. Jemmott III, Annenberg School for Communication and Department of Psychiatry Perelman School of Medicine, University of Pennsylvania; Jingwen Zhang, Annenberg School for Communication, University of Pennsylvania; Loretta S. Jemmott, School of Nursing, University of Pennsylvania; Ann O’Leary, Centers for Disease Control and Prevention; Larry D. Icard, College of Public Health, School of Social Work, Temple University; Robin Stevens, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Janet Hsu, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Scott Rutledge, College of Public Health, School of Social Work, Temple University. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This study was supported in part by the National Institute of Mental Health (R01 MH079736). We appreciate the contributions of Sonya Coombs, MS; Mikia Croom, MSEd; Lynette Gueits, MS; Janet Hsu, BA; Dionne Samuel, BA; Brian Taylor, BA; Pandora Woods, BA; and the late Dennis Clegg to the implementation of the research. The contributions of Christopher Coleman, PhD, and the late Thomas Ten Have, PhD, to the conception and design of the trial are gratefully acknowledged.

Author information

Authors and Affiliations

  1. Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, 3901 Walnut Street, Suite 503, Philadelphia, PA, 19104, USA

    Jingwen Zhang PhD, John B. Jemmott III PhD, Robin Stevens PhD, Loretta Sweet Jemmott PhD & Janet Hsu BA

  2. Centers for Disease Control and Prevention, Atlanta, GA, USA

    Ann O’Leary PhD

  3. Temple University, Philadelphia, PA, USA

    Larry D. Icard PhD & Scott E. Rutledge PhD

Authors
  1. Jingwen Zhang PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John B. Jemmott III PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ann O’Leary PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robin Stevens PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Loretta Sweet Jemmott PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Larry D. Icard PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Janet Hsu BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Scott E. Rutledge PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John B. Jemmott III PhD.

Ethics declarations

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Jingwen Zhang, John B. Jemmott, Ann O’Leary, Robin Stevens, Loretta Sweet Jemmott, Larry D. Icard, Janet Hsu, and Scott E. Rutledge declare that they have no conflict of interest. The manuscript represents valid work and neither this manuscript nor one with substantially similar content has been published or is being considered for publication elsewhere. The research reported in this manuscript was approved by the Institutional Review Board No. 8 of the University of Pennsylvania, Philadelphia, PA. Written informed consent from the men was required for the participation in this trial.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, J., Jemmott, J.B., O’Leary, A. et al. Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial. ann. behav. med. 51, 106–116 (2017). https://doi.org/10.1007/s12160-016-9832-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-016-9832-6

Keywords

Search

Navigation