Intersection of identities: food, role, and the African-American pastor

A Scoping Review of Self-Care Within the Context of Obesity-Related Outcomes Among Faith Leaders

OBJECTIVE

Faith leaders often serve as health-related role models yet many struggle with obesity and self-care engagement. The purpose of this scoping review was to examine how the faith leader literature has defined self-care and examined obesity and obesity-related chronic disease.

DATA SOURCE

Studies were identified through database (eg, PubMed, CINAHL, PsycINFO), backward, and grey literature (eg, dissertations) searches.

INCLUSION/EXCLUSION CRITERIA

Studies published in English with participants who were 18 years or older and examined leaders across all faiths. Studies also included an examination of self-care behaviors among faith leaders within the context of obesity or obesity-related chronic diseases.

DATA EXTRACTION/SYNTHESIS

Data synthesis was qualitative and informed by the six-step framework developed by Arksey and O'Malley (2005) as well as updated recommendations by Daudt et al (2013). Of the 418 studies identified and screened, 20 met the eligibility criteria.

RESULTS

Studies were primarily cross-sectional and participants Christian faith-leaders in the US. Most studies did not define self-care or incorporate theory, but focused on vegetarian diets and physical activity engagement. Other self-care related behaviors (eg, sleep, days off), some unique to faith leaders (eg, sabbatical), were included but not systematically.

CONCLUSIONS

Research with more diverse faith leaders and that uses theory is needed to guide development of strategies for engaging this population in self-care to reduce obesity and related chronic diseases.

Perceived Religious Influence on Health Is Associated with Beneficial Health Behaviors in Members of Predominantly Black Churches

Background

Cardiovascular disease is the leading cause of death in the United States, and Black populations are disproportionately affected. Black populations also have high rates of religiosity, which may be an important health motivator, but mechanisms are unclear.

Objective

We examined the relationship between perceived religious influence on health and cardiovascular health behaviors, risk factors, and confidence participating in medical care in Black church congregants.

Methods

We surveyed 302 members of 13 churches with predominantly Black congregations in New Orleans, Louisiana. Participants reported if religious beliefs had an influence on their health and if they avoided harmful behaviors because of religion. Fruit and vegetable intake, physical activity, smoking status, confidence asking questions to health care providers, understanding treatment plans and self-reported hypertension, hypercholesterolemia, and diabetes were assessed. Logistic regression was used adjusting for age, sex, and education.

Results

Survey respondents were 77% female with a median age of 66 years, and 72%, 56%, and 37% reported hypertension, hypercholesterolemia, and diabetes, respectively. Perceived religious influence on health was positively associated with fruit and vegetable intake, physical activity, and confidence asking questions to health care providers. Avoiding harmful behaviors because of religion was positively associated with physical activity. There was no association between perceived religious influence on health and smoking, hypertension, hypercholesterolemia, or diabetes.

Conclusion

Perceived religious influence on health was associated with beneficial cardiovascular health behaviors and confidence participating in medical care. These findings can inform the design and delivery of interventions to reduce cardiovascular disease among Black religious communities.

Fit with Faith: An Exploratory Study Examining a Behavior Change Intervention for African-American Clergy and Their Spouses

Fit with Faith is a 10-week, diet, physical activity, and stress reduction intervention for African-American clergy and spouses, which included: meetings, phone calls, a behavior tracking app. Survey, 24-h recall, accelerometer, anthropometric, and blood pressure data were collected. Wilcoxon signed ranked tests were used for analyses. In this one-arm study, clergy and spouses (n = 20) attended most meetings and calls, but only half posted daily goals or tracked behaviors using the app. Spouses' body mass index (BMI) decreased and physical activity self-regulation cognitive scores increased pre-post intervention. Statistically significant changes in BMI, systolic blood pressure, and self-regulations scores also were seen among younger (< 51 years) participants (n = 8). As positive changes were seen mostly among women and younger participants, more research is needed on how to engage all clergy in behavior change programs.

Examination of Associations between Physical Activity and Eating Identities among College-aged Adults Living in Hawai'i

While physical activity and diet behaviors are correlated, mechanisms underlying associations have rarely been examined. This study examined associations between physical activity identity and eating identity among college-aged adults in Hawai'i to provide guidance for future multiple behavior change interventions. This study was a cross-sectional analysis of data collected between September 2013 and January 2014. Participants were 40 college students attending 4-year and 2-year institutions within the University of Hawai'i system. Total physical activity identity score and dimensions were measured using the Athlete Identity Questionnaire. Eating identity subtypes were measured using the Eating Identity Type Inventory. Associations between physical activity identity total score, 4 physical activity identity dimensions (appearance, importance, competence, and encouragement), and 4 eating identity subtypes (healthy, emotional, meat, and picky) were examined using multiple linear regressions. A significant positive association was found between total physical activity identity score and the healthy eating subtype and a negative association with the picky eating subtype. The physical activity dimension importance had a significant positive association with the healthy eating subtype, appearance a negative association with the emotional eating subtype, and competence a positive association with the meat eating subtype but a negative association with the picky eating subtype. The findings suggest important overlap in identities for physical activity and diet. Measurement of physical activity identity and eating identity as well as tailored intervention strategies should be incorporated into more behavior change research.

Prevalence of Cardiovascular Disease Risk Factors by Key Demographic Variables Among Mid-South Church Leaders from 2012 to 2017

Cardiovascular disease (CVD) risk factors were examined among church leaders (n = 2309) who attended Mid-South United Methodist Church annual meetings between 2012 and 2017 using repeated cross-sectional data. There was a significant increase in body mass index (BMI) (b = 0.24, p = 0.001) and significant decreases in blood pressure (systolic: b = - 1.08, p < 0.001; diastolic: b = - 0.41, p = 0.002), total cholesterol (b = - 1.76, p = 0.001), and blood sugar (b = - 1.78, p = 0.001) over time. Compared to Whites, a significant increase was seen in BMI (b = 1.14, p = 0.008) among participants who self-identified as "Other," and a significant increase was seen in blood pressure (systolic: b = 1.36, p = 0.010; diastolic: b = 1.01, p = 0.004) among African Americans over time. Results indicate BMI and blood pressure are important CVD risk factors to monitor and address among church leaders, especially among race/ethnic minority church leaders.

Strategies for Designing Clergy and Spouse Obesity-Related Programs

PURPOSE

Clergy have influence on the health of congregations and communities yet struggle with health behaviors. Interventions tailored to their occupation-specific demands and unique needs may provide a solution. Qualitative methods were used to identify opportunities and resources for the development of an effective obesity-related program for clergy.

APPROACH

Ninety-minute focus groups were held with clergy (3 groups) and spouses (3 separate groups). Discussion explored: Program target(s); Opportunities and barriers that influence diet, physical activity, and stress-reduction practices; Empowering and culturally relevant health promotion strategies.

SETTING

All study activities took place in Memphis, TN.

PARTICIPANTS

Eighteen clergy and fourteen spouses participated. All clergy were male, all spouses were female.

METHOD

Previous research with clergy informed the interview guide and the PEN-3 framework aided in organizing the coding of clergy and spouse focus groups. Focus groups were audio recorded and transcripts analyzed using NVivo® 12.

RESULTS

Themes included: 1) Intervention targets-clergy, spouses, congregations; 2) Opportunities and barriers-making time, establishing boundaries, church traditions, individuals who support and hinder behavior change; 3) Intervention strategies-tools for healthy eating, goal setting, camaraderie, combining face-to-face with eHealth modalities.

CONCLUSION

The relationship between clergy, spouse, and congregation make it important for obesity-related programs to target the unique needs of both clergy and spouses. Strategies should focus on healthy eating and personal connections no matter the modality used.

Church Leaders' Views of Obesity Prevention Efforts for Children and Youth

OBJECTIVE

To examine church leaders' views on the role of faith-based organizations in promoting healthy eating and physical activity in children.

DESIGN

Qualitative research using semi-structured in-depth interviews.

SETTING

South Carolina.

PARTICIPANTS

Leaders (n = 26) from United Methodist churches (n = 20).

PHENOMENON OF INTEREST

Perceptions of health promotion efforts for children in faith-based settings, including primary health concerns, perceived opportunities, partnerships, and the relationship of these efforts to the overall church mission.

ANALYSIS

Interviews were transcribed verbatim and coded using a constant comparative method.

RESULTS

Five themes emerged related to (1) multiple concerns about health issues facing children; (2) existing church structures influencing health behaviors; (3) potential partnerships to address children's health; (4) importance of role models; and (5) the need for a tailored approach.

CONCLUSIONS AND IMPLICATIONS

Church leaders viewed childhood health behaviors as an important area of concern for the church and identified links between physical and spiritual health. They identified multiple existing and potential organizational and community structures as important in improving healthy eating and physical activity. Faith-based organizations can play an important role in developing and delivering health programming for children but desired assistance through partnerships with subject matter experts.

The Local Food Environment and Food Security: The Health Behavior Role of Social Capital

Food politics and economic forces may determine the macro conditions for food supply, but the local environment has the most substantial impact on population health. Food security is determined not only by the basic availability of food, but also by social, economic, and cultural factors influencing dietary behaviors. This paper investigates the role of social institutions, specifically social capital, in affecting food security by proposing a theoretical linkage between social capital and health behavior, and an illustrative case is provided. Social capital, defined as the value of the bonding, bridging, and linking relationships between people, is well demonstrated to be related to health. Many mechanisms link social capital to health, including shared access to food and nutritional behaviors. Further, social capital influences health through social status and race. This paper further investigates the links between minority status, food security, social capital, and health. The analysis draws on empirical work in North Carolina with community gardens, faith communities, the local food environment, and other social capital-related variables. By investigating the nature of local food security, particularly for minority populations, this analysis allows for better integration of local conditions with global food politics.

Hypertension in the Faith Community: A Four-Week, Nurse Led, Diet/Exercise Intervention

Inadequate blood pressure (BP) control in hypertension carries a major financial and public health burden. This study examined the efficacy of behavioral and lifestyle changes on BP control among African American adults, aged 55 years and older in a faith-based setting. The study was supported by clergy who helped to engage participants in interventions. Nurse-led diet and exercise teaching with BP monitoring led to lower BP readings over a 4-week intervention.

Church-Based Social Support's Impact on African-Americans' Physical Activity and Diet Varies by Support Type and Source

The objective of this study was to examine sources (friends, family, church members, and pastors) and type (positive or negative) of social support and their association with eating and physical activity behaviors. Study participants consisted of 41 African-American adults (78% female), with an average age of 43.5 years (standard deviation = 15.7). Participants were recruited from churches in southwest, Ohio. Mean comparisons showed family members, and friends had the highest positive and negative social support scores for healthy eating and physical activity. Pastors and church members received the lowest social support scores related to these behaviors. Using a linear regression analysis, social support in the form of physical activity rewards from family members was positively associated with fruit and vegetable consumption after adjusting for gender, age, education level, and church location. Based on these findings, future research should continue examining how different social support sources and types influence physical activity and healthy eating behaviors among African-Americans.

Health Behaviors and Preventive Healthcare Utilization Among African-American Attendees at a Faith-Based Public Health Conference: Healthy Churches 2020

Unhealthy eating habits and physical inactivity along with lack of access to quality healthcare contribute to the marked health disparities in chronic diseases among African-Americans. Faith-based public health conferences offer a potential opportunity to improve health literacy and change health behaviors through health promotion within this population, thereby reducing health disparities. This study examined the self-reported health behaviors and preventive healthcare utilization patterns of 77 participants at a predominantly African-American faith-based public health conference, Healthy Churches 2020. A self-administered questionnaire was distributed to a sample of attendees to assess their health behaviors (diet and physical activity), preventive healthcare utilization (annual healthcare provider visits), and health-promoting activities at their places of worship. The results indicate that attendees of a faith-based public health conference have adequate preventive healthcare utilization, but suboptimal healthy behaviors. Our findings support the need for ongoing health-promoting activities with an emphasis on diet and physical activity among this population.

Leading God's People: Perceptions of Influence Among African-American Pastors

Religious leaders, particularly African-American pastors, are believed to play a key role in addressing health disparities. Despite the role African-American pastors may play in improving health, there is limited research on pastoral influence. The purpose of this study was to examine African-American pastors' perceptions of their influence in their churches and communities. In-depth interviews were conducted with 30 African-American pastors and analyzed using a grounded theory approach. Three themes emerged: the historical role of the church; influence as contextual, with pastors using comparisons with other pastors to describe their ability to be influential; and a reciprocal relationship existing such that pastors are influenced by factors such as God and their community while these factors also aid them in influencing others. A conceptual model of pastoral influence was created using data from this study and others to highlight factors that influence pastors, potential outcomes and moderators as well as the reciprocal nature of pastoral influence.

What does a person's eating identity add to environmental influences on fruit and vegetable intake?

OBJECTIVE

To evaluate whether knowledge of a person's eating identity (EI) can explain any additional variation in fruit and vegetable intake above and beyond that explained by food environment characteristics, perceptions of the food environment, and shopping behaviors.

DESIGN

Cross-sectional study.

SETTING

A total of 968 adults were recruited for a telephone survey by the Survey Research Laboratory in an eight-county region in South Carolina.

SUBJECTS

The survey queried information on shopping behaviors, perceptions of the food environment, demographic and address information, fruit and vegetable intake, and EI. EI was assessed using the Eating Identity Type Inventory, a 12-item instrument that differentiates four eating identity types: healthy, emotional, meat, and picky. Statistical analyses were restricted to 819 participants with complete data.

RESULTS

Healthy EI and picky EI were significantly and directly related to fruit and vegetable intake, with coefficients of 0.31 (p-value<0.001) for healthy EI and -0.16 (p-value<0.001) for picky EI, whereas emotional EI (β = 0.00, p-value = 0.905) and meat EI (β = -0.04, p-value = 0.258) showed no association. Shopping frequency also directly and significantly influenced fruit and vegetable intake (β = 0.13, p-value = 0.033). With the inclusion of EI, 16.3% of the variation in fruit and vegetable intake was explained.

CONCLUSIONS

Perceptions and GIS-based measures of environmental factors alone do not explain a substantial amount of variation in fruit and vegetable intake. EI, especially healthy EI and picky EI, is an important, independent predictor of fruit and vegetable intake and contributes significantly to explaining the variation in fruit and vegetable intake.

"As a Community, We Need to be More Health Conscious": Pastors' Perceptions on the Health Status of the Black Church and African-American Communities

BACKGROUND

Churches are recognized for their potential capacity to provide health services and interventions to address health disparities in African-Americans (blacks). Since pastors are central community leaders, their support and involvement can influence both implementation and outcomes for church-based health programs. The purpose of this qualitative study was to explore pastors' perceptions of congregant health status within the black church.

METHODS

Semi-structured interviews were conducted with 11 pastors whose female congregants participated in a physical activity intervention. Thematic analysis techniques were used to analyze interview data.

RESULTS

Three major themes emerged: (1) health risks in the African-American community, (2) health promotion in the black church, and (3) the importance of women in the black family and the church. Pastors noted numerous health disparities affecting their congregants and the African-American community at large, including obesity and infant mortality. They viewed health holistically and included faith in their perspectives. According to pastors, holistic health was promoted through health ministry programming in black churches. Women were described as the cornerstone of the black church, yet faced unique health concerns from their roles as family caretakers and congregants.

DISCUSSION

Pastors shared their major concerns for congregant health status and the African-American community. Health interventions focusing on African-Americans in church settings should include pastor involvement and should incorporate holistic approaches to address health risks.

Pastoral perceptions of the learning and developing individual exercise skills (L.A.D.I.E.S.) intervention: a qualitative study

African-American women experience higher rates of obesity compared to other racial/ethnic groups. High levels of reported church attendance among African-Americans have led to the proliferation of faith-based health programs. Pastors can influence success for faith-based programs. The purpose of this study was to assess pastors' perceptions of the L.A.D.I.E.S. intervention, designed to increase physical activity levels in sedentary African-American women. For the L.A.D.I.E.S. intervention, 31 churches (n = 418 women) were randomized at the church level to a faith-based, non-faith-based or self-guided program. All 31 pastors were invited by telephone to participate in the current study. Using a qualitative design, semi-structured interviews were conducted with 11 pastors from participating churches. Thematic analysis and the ecological model were used to examine the findings. According to the pastors, women showed heightened awareness of the importance of health and physical activity, and increased levels of fellowship. L.A.D.I.E.S. also encouraged healthy church climates and new health ministries. Lessons learned included the need for an expanded participant base and curriculum. Pastors expressed appreciation for the culturally fitting approach of L.A.D.I.E.S. Findings have implications for faith-based and public agency partnerships.

Disease Messaging in Churches: Implications for Health in African-American Communities

Using the right messaging strategies, churches can help promote behavior change. Frequencies of disease-specific messages in 21 African-American churches were compared to overall and cancer-specific mortality and morbidity rates as well as church-level variables. Disease messages were found in 1025 of 2166 items. Frequently referenced topics included cancer (n = 316), mental health conditions (n = 253), heart disease (n = 246), and infectious diseases (n = 220). Messages for lung and colorectal cancers appeared at low frequency despite high mortality rates in African-American communities. Season, church size, and denomination showed significant associations with health messages. Next steps include testing messaging strategies aimed at improving the health of churchgoing communities.

Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers

BACKGROUND

Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality.

OBJECTIVE

We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations.

METHODS

This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians ('Imi Hale-Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities).

CONCLUSIONS

Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities.

Fulfilling Ethical Responsibility: Moving Beyond the Minimal Standards of Protecting Human Subjects from Research Harm

PROBLEM

Rules for protecting human subjects, in place federally since 1974, have focused primarily on guarding against placing research subjects at social, physical, or psychological risk or violating their privacy and confidentiality. Nevertheless, high-risk communities are routinely subjected to "sins of omission," which limit access to potentially significant research opportunities and result in the absence of studies that could confer high degree of community beneficence.

PURPOSE OF ARTICLE

To describe "sins of omission" and provide examples from the Community Networks Program Centers (CNPC) to illustrate how community-based participatory research (CBPR) can prevent them.

KEY POINTS

CBPR is an effective antidote to sins of omission. Activities undertaken by the CNPCs illustrate how adherence to CBPR principles can improve research access and outcomes.

CONCLUSIONS

By working with community members as partners, we expand the concept of beneficence to include "community beneficence," thus reducing the probability of "sins of omission."

The Eating Identity Type Inventory (EITI). Development and associations with diet

People with healthy eating identities report healthier diets and demonstrate greater receptivity to nutrition interventions, but other types of eating identity are likely important. We developed the Eating Identity Type Inventory (EITI) to assess affinity with four eating identity types; healthy, meat, picky, and emotional. This study assessed factorial validity, using confirmatory factor analysis (CFA) and established reliability and convergent validity of the EITI. In a telephone survey, 968 primary household food shoppers completed the EITI and a dietary questionnaire; 101 repeated the EITI approximately 1month later.CFA revealed that an 11-item model provided acceptable fit (χ(2)=206; df=38), CFI=.938, NNFI=.925, RMSEA=.070; SRMR=.059). The EITI demonstrated acceptable internal consistencies with Cronbach alpha's ranging from .61 to .82 and good test-retest reliability for healthy, emotional, and picky types (Pearson's correlations ranging from .78 to .84). Ordinary Least Squares (OLS) used to assess relationships between eating identity type and diet analyses demonstrated significant hypothesized relationships between healthy eating identity and healthier dietary intake and meat and picky eating identities and less healthy dietary intake. The EITI could facilitate behavioral and cognitive research to yield important insights for ways to more effectively design messages, interventions, and policies to promote healthy dietary behaviors.