Can Interventions that Strengthen Couples’ Relationships Confer Additional Benefits for their Health? A Randomized Controlled Trial with African American Couples

Abstract

This study examined the effects of the Protecting Strong African American Families (ProSAAF) prevention program on adults’ self-reported health outcomes 25 months after enrollment. ProSAAF is a couple-focused prevention program specifically designed to meet the needs of African-American families residing in the rural South. African-American couples (N = 346) with an early adolescent child participated in a randomized controlled trial of the program. Dyadic data analyses indicated significant direct effects on changes in couple functioning post-intervention as well as significant indirect effects of ProSAAF on changes in health through post-intervention improvements in couple functioning. These benefits were documented for men’s and women’s general health, depressive symptoms, and problematic sleep. There were no significant direct effects of ProSAAF participation on changes in health. Findings provide tempered optimism regarding the potential benefits of couple-focused programming for adults’ physical, mental, and behavioral health.

This is a preview of subscription content, access via your institution.

Fig. 1

Notes

  1. 1.

    To be eligible, the target child to be African-American, but not both parents. Ethnicity was not assessed in surveys completed by participants. Notes from research staff indicated that two caregivers (from different families) were not African-American. All participants were comfortable being identified as part of an African American family

  2. 2.

    These two couples were excluded from analyses because data analytic techniques required dyads to be distinguishable by sex, and this subsample size precluded group comparisons

  3. 3.

    Analyses comparing constrained models to the unconstrained model indicted no significant deterioration in model fit by imposing these equality constraints

References

  1. Barton, A. W., Beach, S. R. H., Hurt, T. R., Fincham, F. D., Stanley, S. M., Kogan, S. M., & Brody, G. H. (2016). Determinants and long-term effects of attendance levels in a marital enrichment program for African American couples. Journal of Marital and Family Therapy, 42, 272–287. https://doi.org/10.1111/jmft.12126.

    Article  PubMed  Google Scholar 

  2. Barton, A. W., Beach, S. R. H., Lavner, J. A., Bryant, C. M., Kogan, S. M., & Brody, G. H. (2017). Is communication a mechanism of relationship education effects among rural African Americans? Journal of Marriage and Family, 79, 1450–1461. https://doi.org/10.1111/jomf.12416.

    Article  PubMed  Google Scholar 

  3. Barton, A. W., Beach, S. R. H., Bryant, C. M., Lavner, J. A., & Brody, G. H. (2018a). Stress spillover, African Americans’ couple and health outcomes, and the stress-buffering effect of family-centered prevention. Journal of Family Psychology, 32, 186–196. https://doi.org/10.1037/fam0000376.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Barton, A. W., Beach, S. R. H., Wells, A. C., Ingels, J. B., Corso, P. S., Sperr, M. C., et al. (2018b). The Protecting Strong African American Families program: A randomized controlled trial with rural African American couples. Prevention Science, 19, 904–913. https://doi.org/10.1007/s11121-018-0895-4.

  5. Barton, A. W., Lavner, J. A., Stanley, S. M., Johnson, M. D., & Rhoades, G. K. (2020). “Will you complete this survey too?” differences between individual versus dyadic samples in relationship research. Journal of Family Psychology, 34, 196–203. https://doi.org/10.1037/fam0000583.

    Article  PubMed  Google Scholar 

  6. Choi, H., Yorgason, J. B., & Johnson, D. R. (2015). Marital quality and health in middle and later adulthood: Dyadic associations. The Journals of Gerontology: Series B, 71, 154–164. https://doi.org/10.1093/geronb/gbu222.

    Article  Google Scholar 

  7. Cowan, P. A., & Cowan, C. P. (2014). Controversies in couple relationship education (CRE): Overlooked evidence and implications for research and policy. Psychology, Public Policy, and Law, 20, 361–383. https://doi.org/10.1037/law0000025.

    Article  Google Scholar 

  8. Culp, L. N., & Beach, S. R. H. (1998). Marriage and depressive symptoms. Psychology of Women Quarterly, 22, 647–663. https://doi.org/10.1111/j.1471-6402.1998.tb00183.x.

    Article  Google Scholar 

  9. DeNavas-Walt, C., & Proctor, B. D. (2014). Income and poverty in the United States: 2013 (current population reports P60–249). Washington, DC: U.S. Census Bureau.

    Google Scholar 

  10. Ditzen, B., Hahlweg, K., Fehm-Wolfsdorf, G., & Baucom, D. (2011). Assisting couples to develop healthy relationships: Effects of couples relationship education on cortisol. Psychoneuroendocrinology, 36, 597–607. https://doi.org/10.1016/j.psyneuen.2010.07.019.

    Article  PubMed  Google Scholar 

  11. Doss, B. D., Cicila, L. N., Georgia, E. J., Roddy, M. K., Nowlan, K. M., Benson, L. A., & Christensen, A. (2016). A randomized controlled trial of the web-based OurRelationship program: Effects on relationship and individual functioning. Journal of Consulting and Clinical Psychology, 84, 285–296. https://doi.org/10.1037/ccp0000063.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Doss, B. D., Roddy, M. K., Nowlan, K. M., Rothman, K., & Christensen, A. (2019). Maintenance of gains in relationship and individual functioning following the online OurRelationship program. Behavior Therapy, 50, 73–86. https://doi.org/10.1016/j.beth.2018.03.011.

    Article  PubMed  Google Scholar 

  13. Fawcett, E. B., Hawkins, A. J., Blanchard, V. L., & Carroll, J. S. (2010). Do premarital education programs really work? A meta-analytic study. Family Relations, 59, 232–239. https://doi.org/10.1111/j.1741-3729.2010.00598.x.

    Article  Google Scholar 

  14. Feinberg, M. E., Jones, D. E., Kan, M. L., & Goslin, M. C. (2010). Effects of family foundations on parents and children: 3.5 years after baseline. Journal of Family Psychology, 24, 532–542. https://doi.org/10.1037/a0020837.

    Article  PubMed  Google Scholar 

  15. Fincham, F. D., Ajayi, C., & Beach, S. R. H. (2011). Spirituality and marital satisfaction in African American couples. Psychology of Religion and Spirituality, 3, 259–268. https://doi.org/10.1037/a0023909.

    Article  Google Scholar 

  16. Gupta, S. K. (2011). Intention-to-treat concept: A review. Perspectives in Clinical Research, 2, 109–112. https://doi.org/10.4103/2229-3485.83221.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hahlweg, K., Markman, H. J., Thurmaier, F., Engl, J., & Eckert, V. (1998). Prevention of marital distress: Results of a German prospective longitudinal study. Journal of Family Psychology, 12, 543–556. https://doi.org/10.1037/0893-3200.12.4.543.

    Article  Google Scholar 

  18. Halford, W. K., Rahimullah, R. H., Wilson, K. L., Occhipinti, S., Busby, D. M., & Larson, J. (2017). Four year effects of couple relationship education on low and high satisfaction couples: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 85, 495–507. https://doi.org/10.1037/ccp0000181.

    Article  PubMed  Google Scholar 

  19. Harrison, P. A., Fulkerson, J. A., & Beebe, T. J. (1998). DSM-IV substance use disorder criteria for adolescents: A critical examination based on a statewide school survey. American Journal of Psychiatry, 155, 486–492. https://doi.org/10.1176/ajp.155.4.486.

    CAS  Article  Google Scholar 

  20. Hawkins, A. J., Blanchard, V. L., Baldwin, S. A., & Fawcett, E. B. (2008). Does marriage and relationship education work? A meta-analytic study. Journal of Consulting and Clinical Psychology, 76, 723–734. https://doi.org/10.1037/a0012584.

    Article  PubMed  Google Scholar 

  21. Hayes, A. F. (2009). Beyond baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76, 408–420. https://doi.org/10.1080/03637750903310360.

    Article  Google Scholar 

  22. Hays, R. D., Sherbourne, C. D., & Mazel, R. M. (1993). The RAND 36-item health survey 1.0. Health Economics, 2, 217–227. https://doi.org/10.1002/hec.4730020305.

    CAS  Article  PubMed  Google Scholar 

  23. Jenkins, N. H., & Saiz, C. C. (1995). The communication skills test. Denver: Unpublished manuscript, University of Denver.

    Google Scholar 

  24. Kiecolt-Glaser, J. K., & Wilson, S. J. (2017). Lovesick: How couples’ relationships influence health. Annual Review of Clinical Psychology, 13, 421–443. https://doi.org/10.1146/annurev-clinpsy-032816-045111.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lavner, J. A., Barton, A. W., & Beach, S. R. H. (2019). Improving couples’ relationship functioning leads to improved coparenting: A randomized controlled trial with rural African American couples. Behavior Therapy, 50, 1016–1029. https://doi.org/10.1016/j.beth.2018.12.006.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lavner, J. A., Barton, A. W., & Beach, S. R. H. (2020). Direct and indirect effects of a couple-focused preventive intervention on children’s outcomes: A randomized controlled trial with African American families. Journal of Consulting and Clinical Psychology, 88, 696–707. https://doi.org/10.1037/ccp0000589.

    Article  PubMed  Google Scholar 

  27. Loew, B. A. (2016). Internet delivery of PREP-based relationship education for older couples. Denver University.

  28. MacKinnon, D. P., & Fairchild, A. J. (2009). Current directions in mediation analysis. Current Directions in Psychological Science, 18, 16–20. https://doi.org/10.1111/j.1467-8721.2009.01598.x.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Markman, H. J., & Rhoades, G. K. (2012). Relationship education research: Current status and future directions. Journal of Marital and Family Therapy, 38, 169–200. https://doi.org/10.1111/j.1752-0606.2011.00247.x.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Markman, H. J., Renick, M. J., Floyd, F. J., Stanley, S. M., & Clements, M. (1993). Preventing marital distress through communication and conflict management training: A 4- and 5-year follow-up. Journal of Consulting and Clinical Psychology, 61, 70–77. https://doi.org/10.1037/0022-006X.61.1.70.

    CAS  Article  PubMed  Google Scholar 

  31. Markman, H. J., Stanley, S. M., Blumberg, S., Jenkins, N. H., & Whaley, C. (2004). Twelve hours to a great marriage. San Francisco: Jossey-Bass.

    Google Scholar 

  32. Marsh, H. W., Hau, K.-T., & Wen, Z. (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling: A Multidisciplinary Journal, 11, 320–341. https://doi.org/10.1207/s15328007sem1103_2.

    Article  Google Scholar 

  33. Muthén, B., & Asparouhov, T. (2015). Causal effects in mediation modeling: An introduction with applications to latent variables. Structural Equation Modeling: A Multidisciplinary Journal, 22, 12–23. https://doi.org/10.1080/10705511.2014.935843.

    Article  Google Scholar 

  34. Muthén, L. K., & Muthén, B. O. (2017). Mplus User’s Guide (8th ed.). Los Angeles: Muthén & Muthén.

    Google Scholar 

  35. Myrick, M., Ooms, T., & Patterson, P. (2009). Healthy Marriage and Relationship Programs: A Promising Strategy for Strengthening Families. Retrieved from https://www.healthymarriageinfo.org/wp-content/uploads/2017/12/Healthy-Marriage-and-Relationship.pdf.

  36. National Center for Health Statistics. (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville, MD.

  37. Norton, R. (1983). Measuring marital quality: A critical look at the dependent variable. Journal of Marriage and Family, 45, 141–151 Retrieved from http://www.jstor.org/stable/351302.

    Article  Google Scholar 

  38. Owen, J., Quirk, K., Bergen, C., Inch, L. J., & France, T. (2012). The effectiveness of PREP with lower-income racial/ethnic minority couples. Journal of Marital and Family Therapy, 38, 296–307. https://doi.org/10.1111/j.1752-0606.2012.00294.x.

    Article  PubMed  Google Scholar 

  39. Pihet, S., Bodenmann, G., Cina, A., Widmer, K., & Shantinath, S. (2007). Can prevention of marital distress improve well-being? A 1 year longitudinal study. Clinical Psychology & Psychotherapy, 14, 79–88. https://doi.org/10.1002/cpp.522.

    Article  Google Scholar 

  40. Pinquart, M., & Teubert, D. (2010). Effects of parenting education with expectant and new parents: A meta-analysis. Journal of Family Psychology, 24, 316–327. https://doi.org/10.1037/a0019691.

    Article  PubMed  Google Scholar 

  41. Proulx, C. M., Helms, H. M., & Buehler, C. (2007). Marital quality and personal well-being: A meta-analysis. Journal of Marriage and Family, 69, 576–593. https://doi.org/10.1111/j.1741-3737.2007.00393.x.

    Article  Google Scholar 

  42. Radloff, L. S. (1977). The CES–D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. https://doi.org/10.1177/014662167700100306.

    Article  Google Scholar 

  43. Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin, 140, 140–187. https://doi.org/10.1037/a0031859.

    Article  PubMed  Google Scholar 

  44. Roddy, M. K., Rhoades, G. K., & Doss, B. D. (2020). Effects of ePREP and OurRelationship on low-income couples’ mental health and health behaviors: A randomized controlled trial. Prevention Science, 21, 861–871. https://doi.org/10.1007/s11121-020-01100-y.

    Article  PubMed  Google Scholar 

  45. Sansone, R. A., & Sansone, L. A. (2012). Rumination: Relationships with physical health. Innovations in Clinical Neuroscience, 9(2), 29–34 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22468242.

    PubMed  PubMed Central  Google Scholar 

  46. Spritzer, K. L., & Hays, R. D. (2003). MOS sleep scale: A manual for use and scoring, version 1.0. Los Angeles, CA.

  47. Stanley, S. M., Hoyer, L., & Trathen, D. W. (1994). The confidence scale. In Unpublished manuscript. Denver: University of Denver.

    Google Scholar 

  48. Stanley, S. M., Markman, H. J., Prado, L. M., Olmos-Gallo, P. A., Tonelli, L., St. Peters, M., et al. (2001). Community-based premarital prevention: Clergy and lay leaders on the front lines*. Family Relations, 50, 67–76. https://doi.org/10.1111/j.1741-3729.2001.00067.x.

    Article  Google Scholar 

  49. Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52, 145–161. https://doi.org/10.1177/0022146510395592.

    Article  PubMed  Google Scholar 

  50. Whisman, M. A., Robustelli, B. L., & Labrecque, L. T. (2018). Specificity of the association between marital discord and longitudinal changes in symptoms of depression and generalized anxiety disorder in the Irish longitudinal study on ageing. Family Process, 57, 649–661. https://doi.org/10.1111/famp.12351.

    Article  PubMed  Google Scholar 

  51. Whitton, S. W., Rhoades, G. K., & Whisman, M. A. (2014). Fluctuation in relationship quality over time and individual well-being: Main, mediated, and moderated effects. Personality and Social Psychology Bulletin, 40, 858–871. https://doi.org/10.1177/0146167214528988.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by Award Numbers R01 HD069439 from the National Institute of Child Health and Human Development and R01 AG059260 from the National Institute on Aging to Steven R. H. Beach as well as P50 DA051361 from the National Institute on Drug Abuse to Gene H. Brody. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

This research was supported by Award Number R01 HD069439 from NICHD, Award Number R01 AG059260 from NIA, and Award Number P50 DA051361 from NIDA.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Allen W. Barton.

Ethics declarations

Disclosure of Potential Conflicts of Interest

The authors report no conflicts of interest.

Research Involving Human Participants

All procedures were approved by the Institutional Review Board of the university at which the research was conducted and complied with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all couples prior to data collection and program participation.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Data is available for review upon request to the first author.

Electronic supplementary material

ESM 1

(DOCX 76 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Barton, A.W., Lavner, J.A. & Beach, S.R.H. Can Interventions that Strengthen Couples’ Relationships Confer Additional Benefits for their Health? A Randomized Controlled Trial with African American Couples. Prev Sci 22, 386–396 (2021). https://doi.org/10.1007/s11121-020-01175-7

Download citation

Keywords

  • African Americans
  • Couples
  • Health
  • Prevention
  • Relationship satisfaction