1
|
Brown KL, Wang NY, Bennett WL, Gudzune KA, Daumit G, Dalcin A, Jerome GJ, Coughlin JW, Appel LJ, Clark JM. Differences in weight-loss outcomes among race-gender subgroups by behavioural intervention delivery mode: An analysis of the POWER trial. Clin Obes 2024:e12670. [PMID: 38741385 DOI: 10.1111/cob.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/18/2024] [Accepted: 03/30/2024] [Indexed: 05/16/2024]
Abstract
Prior in-person behavioural intervention studies have documented differential weight loss between men and women and by race, with Black women receiving the least benefit. Remotely delivered interventions are now commonplace, but few studies have compared outcomes by race-gender groups and delivery modality. We conducted a secondary analysis of POWER, a randomized trial (NCT00783315) designed to determine the effectiveness of 2 active, lifestyle-based, weight loss interventions (remote vs. in-person) compared to a control group. Participants with obesity and at least one cardiovascular disease risk factor (N = 415) were recruited in the Baltimore, MD area. Data from 233 white and 170 Black individuals were used for this analysis. Following an intention-to-treat approach, we compared the mean percent weight loss at 24 months by race-gender subgroups using repeated-measures, mixed-effects models. Everyone lost weight in the active interventions however, weight loss differed by race and gender. white and Black men had similar results for both interventions (white: in-person (-7.6%) remote (-7.4%); Black: in-person (-4.7%) remote (-4.4%)). In contrast, white women lost more weight with the in-person intervention (in-person (-7.2%) compared to the remote (-4.4%)), whereas Black women lost less weight in the in-person group compared to the remote intervention at 24 months (-2.0% vs. -3.0%, respectively; p for interaction <.001). We found differences between the effectiveness of the 2 weight loss interventions-in-person or remote-in white and Black women at 24 months. Future studies should consider intervention modality when designing weight loss interventions for women.
Collapse
Affiliation(s)
- Kristal L Brown
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Department of Creative Arts Therapies, Drexel University, College of Nursing and Health Professions, Philadelphia, Pennsylvania, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Gail Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Arlene Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Gerald J Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Department of Kinesiology, Towson University, Baltimore, Maryland, USA
| | - Janelle W Coughlin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| |
Collapse
|
2
|
Kuo A, Yazji I, Abbass N, Chong DD, Fane L, Örge FH. Lack of racial and ethnic diversity in pediatric ophthalmology clinical trials from 2000 to 2022. J AAPOS 2024; 28:103870. [PMID: 38460595 DOI: 10.1016/j.jaapos.2024.103870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024]
Abstract
PURPOSE To examine the prevalence of and factors associated with racial and ethnic reporting and trends in such reporting and to assess whether categories of race and ethnicity have been under- or over-represented in pediatric ophthalmology randomized control trials (RCTs) in the United States. METHODS We systematically searched the literature on pediatric ophthalmology RCTs in high-impact factor ophthalmology journals published between 2000 and 2022. Logistic regression was used to assess parameters linked to race/ethnicity reporting; linear regression, to gauge the relationship between publication year and race/ethnicity reporting. The racial and ethnic composition of RCTs was contrasted with 2010 US census data by calculating percentage difference. RESULTS Of 170 eligible articles, 89 (52.4%) included race/ethnicity data. Multivariable analysis showed that academic (OR = 12.19; 95% CI, 3.34-44.44) and government (OR = 3.91; 95% CI, 1.20-12.72) funding was linked to data reporting. During the study period, publication year and race/ethnicity reporting had a nonstatistically significant 1.0% annual increase (r = 0.29, P = 0.18). White participants were over-represented, with a percentage difference of 16.7% (95% CI, 11.8%-21.7%), whereas Hispanic individuals were under-represented, with a percentage difference of -7.6% (95% CI, -11.2% to -4.1%) compared to the 2010 US census data. CONCLUSIONS Our results indicate a gradual rise in reported race and/or ethnicity in published pediatric ophthalmology RCTs, though not statistically significant, both in the United States and globally. Notably, under-representation of Hispanic, over-representation of White, and proportional representation of Black and Asian individuals were observed in US-based studies.
Collapse
Affiliation(s)
- Andy Kuo
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Isabella Yazji
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nadia Abbass
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David D Chong
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Lauren Fane
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Faruk H Örge
- Case Western Reserve University School of Medicine, Cleveland, Ohio; Center for Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| |
Collapse
|
3
|
Wippold GM, Frary SG. Predictors of Health-Related Quality of Life Among African American Men. J Racial Ethn Health Disparities 2022; 9:2131-2138. [PMID: 34533780 PMCID: PMC8926934 DOI: 10.1007/s40615-021-01151-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022]
Abstract
African American men have the lowest life expectancy of any ethnic gender group in the USA. Furthermore, these men endorse having a lower health-related quality of life (HRQoL) than any other group. There have been recent calls from national organizations to improve HRQoL-a multidimensional indicator of health strongly associated with mortality and morbidity. Following these calls, there have been widespread efforts implemented to improve HRQoL among the US population, though no known effort has been implemented that is tailored to the unique experiences of African American men. Health promotion efforts that are not tailored to the unique preferences and experiences of these men are likely to produce limited results. Formative research conducted among African American men is needed in order to design and implement an effective HRQoL-promoting intervention for African American men. The present study constitutes such formative research and was conducted with a sample of 211 African American men. Hierarchical regressions were performed to understand the role of literature-derived predictors of HRQoL among these men. Results found that depression, stress, and physical activity were found to be significant predictors of HRQoL among these men. This is the first known study to examine predictors of HRQoL among African American men-a group that disproportionately experiences health disparities and low HRQoL, though for who few successful health promotions exist. The findings from this study have implications for those seeking to design and implement HRQoL-promoting interventions among African American men.
Collapse
Affiliation(s)
- Guillermo M Wippold
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA.
| | - Sarah Grace Frary
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| |
Collapse
|
4
|
Wippold GM, Frary SG, Abshire DA, Wilson DK. Improving Recruitment, Retention, and Cultural Saliency of Health Promotion Efforts Targeting African American Men: A Scoping Review. Ann Behav Med 2022; 56:605-619. [PMID: 34473823 PMCID: PMC9242543 DOI: 10.1093/abm/kaab079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND When health promotion efforts intend to include African American men, they experience challenges with recruitment and retention, in addition to limited cultural saliency-interventions that do not align the cultural preferences and experiences of the target population produce less effective results. PURPOSE This scoping review provides an understanding of (a) how health promotion efforts among African American men are developed and implemented, in addition to the (b) main outcomes, (c) retention rates, and (d) methodological rigor of those efforts. METHODS The following databases were used: PubMed, EMBASE (Ovid), PsycINFO (EBSCO), CINAHL (EBSCO), Web of Science (Clarivate), and ProQuest. Included studies were restricted to those: (a) conducted among African American men and (b) reported the effects of a health promotion intervention. Interventions using single-group pre-post study, post-test-only study, non-randomized controlled trial, and randomized controlled trial (RCT) study designs were included. RESULTS The results indicate that varying degrees of customization in the design and implementation of health promotion efforts targeting African American can improve recruitment, retention, and health-related outcomes. Results draw attention to the need for community input when designing and implementing efforts targeting these men. CONCLUSIONS These results indicate that opportunities exist to innovate health promotion efforts among African American men, such as the intentional incorporation of the community's values, perspectives, and preferences in the effort (i.e., cultural saliency) and explicitly indicating how the efforts were culturally tailored to improve saliency. Opportunities also exist to innovate health promotion efforts among African American men based on literature-derived best practices.
Collapse
Affiliation(s)
- Guillermo M Wippold
- Department of Psychology, University of South Carolina, Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, USA
| | - Sarah Grace Frary
- Department of Psychology, University of South Carolina, Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, USA
| | | | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, USA
| |
Collapse
|
5
|
Tsenoli M, Khan MAB, Östlundh L, Arora T, Omar O. Complementary feeding practices and the associated risk of childhood obesity among ethnic minority groups living in high-income countries: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e053821. [PMID: 35273047 PMCID: PMC8915298 DOI: 10.1136/bmjopen-2021-053821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/12/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Complementary feeding (CF) is defined as the period from when exclusive breast milk and formula are no longer sufficient for meeting the infant's nutritional needs. The CF period occurs from birth to 23 months of age. Though the recommended guidelines for introducing CF is from around 6 months of age, data indicates that some infants are introduced to food earlier than 6 months which can predispose children to obesity and overweight. Obesity in ethnic minority groups (EMG) is higher than their native counterparts and often tracks into adulthood. Hence, our aim was to conduct a systematic review and meta-analysis on the available literature to identify the risk of childhood overweight/obesity associated with CF practices concerning their timing, as well as the frequency and type of CF food introduced. We focused specifically on EMG children living in high-income countries. METHODS AND ANALYSIS A methodological literature search surrounding childhood obesity and overweight (COO) risk associated with CF practices will be conducted in May 2021 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The following academic databases will be methodologically searched: PubMed, EMBASE, PsycINFO, CINAHL, SCOPUS, Cochrane Library and the WHO Global Index Medicus. Three independent researchers will be involved in independent screening and review the included articles based on the predefined inclusion and exclusion criteria. Where conflicts arise during the screening process, it will be resolved through discourse until a consensus is reached. Information on CF practices and anthropometric measurements will be extracted to ascertain the risk of COO. For this study, WHO body mass index for age and sex percentiles, Centers for Disease Control and Prevention classification and other recognised country-specific classifications will be utilised for the outcome. ETHICS AND DISSEMINATION Formal ethical approval is not needed as the results will be drawn from currently available published literature. Outcomes of the review will be shared through peer-reviewed publications. PROSPERO REGISTRATION NUMBER CRD42021246029.
Collapse
Affiliation(s)
- Maido Tsenoli
- University of South Wales, Pontypridd, UK
- Birmingham Community Healthcare NHS Foundation Trust, Aston, UK
| | - Moien A B Khan
- Nutrition Studies Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
- Primary Care, NHS North West London Local Area Team, London, UK
| | - Linda Östlundh
- National Medical Library, United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, UAE
| | - Teresa Arora
- College of Natural & Health Sciences, Zayed University, Dubai, UAE
| | - Omar Omar
- College of Health Sciences, Qatar University, Doha, Ad Dawhah, Qatar
| |
Collapse
|
6
|
Voils CI, Pendergast J, Hale SL, Gierisch JM, Strawbridge EM, Levine E, McVay MA, Reed SD, Yancy WS, Shaw RJ. A randomized feasibility pilot trial of a financial incentives intervention for dietary self-monitoring and weight loss in adults with obesity. Transl Behav Med 2021; 11:954-969. [PMID: 33245118 DOI: 10.1093/tbm/ibaa102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Financial incentives could be used to improve adherence to behavioral weight loss interventions, increasing their effectiveness. This Phase IIb randomized pilot study evaluated the feasibility and acceptability of a study protocol for providing financial incentives for dietary self-monitoring and/or weight loss. Community-dwelling adults with obesity were enrolled in a 24 week, group-based weight loss program. Participants were randomized in a 2 × 2 factorial design to receive financial incentives for both dietary self-monitoring and weekly weight loss, just one, or neither. Participants could earn up to $300, evolving from fixed weekly payments to intermittent, variable payments. The notice of reward was provided by text message. The study was conducted in three successive cohorts to evaluate study procedure changes, including dietary approach, recruitment and retention strategies, text messaging, and incentives. Descriptive statistics calculated separately for each cohort described study performance relative to predefined targets for recruitment, including minority representation; retention; adherence; and weight loss. Acceptability was assessed via postintervention qualitative interviews. In Cohort 1 (n = 34), a low-carbohydrate diet was used. Recruitment, retention, adherence, and weight loss were adequate, but minority representation was not. For Cohort 2 (n = 31), employing an additional recruitment method and switching to a reduced-calorie diet yielded adequate recruitment, minority representation, retention, and adherence but less weight loss. Returning to a low-carbohydrate diet in Cohort 3 (n = 28) yielded recruitment, minority representation, retention, adherence, and weight loss similar to Cohort 2. Participant feedback informed changes to text message timing and content and incentive amount. Through successive cohorts, we optimized recruitment and retention strategies and text messaging. An adequately powered trial is warranted to evaluate the efficacy of these incentive structures for reducing weight. The trial registration number is NCT02691260.
Collapse
Affiliation(s)
- Corrine I Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Research Service, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | | | - Sarah L Hale
- School of Medicine, Duke University, Durham, NC, USA
| | - Jennifer M Gierisch
- School of Medicine, Duke University, Durham, NC, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | | | | | - Megan A McVay
- College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Shelby D Reed
- School of Medicine, Duke University, Durham, NC, USA
| | - William S Yancy
- School of Medicine, Duke University, Durham, NC, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Ryan J Shaw
- School of Nursing, Duke University, Durham, NC, USA
| |
Collapse
|
7
|
Wippold GM, Frary SG, Abshire D, Wilson DK. Peer-to-peer health promotion interventions among African American men: a scoping review protocol. Syst Rev 2021; 10:184. [PMID: 34154638 PMCID: PMC8218504 DOI: 10.1186/s13643-021-01737-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health promotion efforts among African American men have been met with significant challenges and have produced limited results. Interventions that do not align with the values, perspectives, and preferences of African American men often produce less effective results. Research among African American men has provided compelling evidence that these men prefer informal networks of health support. Recent successful health promotion efforts among these men have benefited from peer-to-peer models of implementation. To date, no known scoping or systematic review of peer-to-peer health promotion interventions among African American men has been conducted. The goal of this scoping review is to understand the extent of, design, implementation, and use of peer-to-peer interventions to promote health, improve quality of life, and prevent disease among African American men. METHODS A review of the literature will be performed in PubMED, EMBASE, PsycInfo, CINAHL, and Web of Science. The development of this protocol was guided by the work of Arksey and O'Malley and the PICOS statement. Reporting will be guided by the PRISMA-ScR checklist. Eligible studies include those testing the effects of a peer-to-peer health promotion intervention targeting African American men. A comparison group will not be required. For the purposes of the current review, "peers" will be limited to other African American men. An initial screening of the titles and abstracts of potentially eligible studies will be completed by two independent reviewers. The full text of records that appear to meet the eligibility criteria will be accessed and further screened. Data will then be extracted and collected using a custom Microsoft Excel spreadsheet. Extracted data will include authors' name and publication year, target health issue(s), design of the intervention, components of the intervention, peer-led components of the intervention, peer role, length and type of training for peer leaders, intervention duration, frequency of the intervention, study design and number of participants, and main outcomes. Finally, results will be presented in table format and summarized in text format. DISCUSSION Results will have implications for the design, implementation, and evaluation of health promotion interventions among African American men. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020198664.
Collapse
Affiliation(s)
- Guillermo M. Wippold
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, South Carolina 29208 USA
| | - Sarah Grace Frary
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, South Carolina 29208 USA
| | | | - Dawn K. Wilson
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, South Carolina 29208 USA
| |
Collapse
|
8
|
Yang Q, Mitchell ES, Ho AS, DeLuca L, Behr H, Michaelides A. Cross-National Outcomes of a Digital Weight Loss Intervention in the United States, Canada, United Kingdom and Ireland, and Australia and New Zealand: A Retrospective Analysis. Front Public Health 2021; 9:604937. [PMID: 34178911 PMCID: PMC8222510 DOI: 10.3389/fpubh.2021.604937] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
Mobile health (mHealth) interventions are ubiquitous and effective treatment options for obesity. There is a widespread assumption that the mHealth interventions will be equally effective in other locations. In an initial test of this assumption, this retrospective study assesses weight loss and engagement with an mHealth behavior change weight loss intervention developed in the United States (US) in four English-speaking regions: the US, Australia and New Zealand (AU/NZ), Canada (CA), and the United Kingdom and Ireland (UK/IE). Data for 18,459 participants were extracted from the database of Noom's Healthy Weight Program. Self-reported weight was collected every week until program end (week 16). Engagement was measured using user-logged and automatically recorded actions. Linear mixed models were used to evaluate change in weight over time, and ANOVAs evaluated differences in engagement. In all regions, 27.2–33.2% of participants achieved at least 5% weight loss by week 16, with an average of 3–3.7% weight loss. Linear mixed models revealed similar weight outcomes in each region compared to the US, with a few differences. Engagement, however, significantly differed across regions (P < 0.001 on 5 of 6 factors). Depending on the level of engagement, the rate of weight loss over time differed for AU/NZ and UK/IE compared to the US. Our findings have important implications for the use and understanding of digital weight loss interventions worldwide. Future research should investigate the determinants of cross-country engagement differences and their long-term effects on intervention outcomes.
Collapse
Affiliation(s)
| | | | | | - Laura DeLuca
- Noom Inc., New York, NY, United States.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, United States
| | - Heather Behr
- Noom Inc., New York, NY, United States.,Department of Integrative Health, Saybrook University, Pasadena, CA, United States
| | | |
Collapse
|
9
|
Crane MM, Seburg EM, Levy RL, Jeffery RW, Sherwood NE. Using targeting to recruit men and women of color into a behavioral weight loss trial. Trials 2020; 21:537. [PMID: 32546253 PMCID: PMC7298816 DOI: 10.1186/s13063-020-04500-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/10/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The majority of participants in weight loss trials are non-Hispanic White women, while men and women of color are underrepresented. This study presents data obtained from non-targeted and targeted recruitment approaches in a trial of behavioral weight loss programs to (1) describe the yields from each approach and (2) compare the demographics, weight control histories, and study involvement of samples recruited by each approach. METHODS Data for this observational study include source of recruitment, demographic information, weight loss experiences (e.g., lifetime weight loss, current weight loss behaviors), and completion of the 6-month assessment visit. RESULTS Men comprised 14.2% of participants who responded to non-targeted recruitment efforts, while targeted efforts yielded 50.4% men. Similarly, people of color comprised 12.8% of those who responded to non-targeted approaches, whereas targeted recruitment methods yielded 47.2% people of color. Men recruited through targeted methods were younger (p = 0.01) than men recruited through non-targeted means but were otherwise similar. Women of color recruited through targeted methods reported use of fewer weight loss strategies relative to women of color recruited through non-targeted means (p = 0.006) but were otherwise similar. There were no differences by recruitment method on retention to the study. CONCLUSIONS Using targeted recruitment methods increased the ethnic and gender diversity of the recruited sample without reducing study retention. This targeting also increased the enrollment of women with less weight loss experience who may not have otherwise sought out a weight loss program. Developing and implementing a targeted recruitment plan should be considered early in the clinical trial development process. TRIAL REGISTRATION Clinicaltrials.gov, NCT02368002. Registered on 20 February 2015.
Collapse
Affiliation(s)
- Melissa M Crane
- Department of Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren St., Suite 470, Chicago, IL, 60612, USA.
| | - Elisabeth M Seburg
- HealthPartners Institute, 8170 33rd Ave South, Minneapolis, MN, 55440-1524, USA
| | - Rona L Levy
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105-6250, USA
| | - Robert W Jeffery
- Division of Epidemiology and Community Health, University of Minnesota, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, University of Minnesota, 300 West Bank Office Building, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| |
Collapse
|
10
|
Sayer J, Paniagua D, Ballentine S, Sheehan L, Carson M, Nieweglowski K, Corrigan P. Perspectives on diet and physical activity among urban African Americans with serious mental illness. SOCIAL WORK IN HEALTH CARE 2019; 58:509-525. [PMID: 30907271 PMCID: PMC6658098 DOI: 10.1080/00981389.2019.1587662] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/22/2019] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
African Americans are burdened by high rates of obesity that contribute to chronic disease and early mortality. To tailor a weight loss intervention to meet the needs of African Americans with serious mental illness, a community-based participatory research (CBPR) team comprised primarily of African Americans with serious mental illness guided qualitative research to understand factors that affect weight and interventions that may diminish obesity. Data from five focus groups (n = 55) were analyzed to better understand this group's needs. Participants voiced individual, social, and structural barriers to maintaining and achieving a healthy weight and provided perspectives on potential solutions.
Collapse
Affiliation(s)
- Janis Sayer
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
| | - Deysi Paniagua
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
| | - Sonya Ballentine
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
| | - Lindsay Sheehan
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
| | - Margaret Carson
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
| | | | - Patrick Corrigan
- a Department of Psychology , Illinois Institute of Technology , Chicago , IL , USA
| |
Collapse
|
11
|
Dodgen L, Spence-Almaguer E, Cantu Anguiano K, Hooker A, White S. Partnership Processes to Develop SHE Tribe: A Healthy Lifestyle Intervention. Health Promot Pract 2018; 21:591-600. [PMID: 30458648 DOI: 10.1177/1524839918812428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic diseases, like diabetes and heart disease, disproportionately impact women of color as compared to White women. Community-engaged and participatory approaches are proposed as a means to address chronic disease health disparities in minority communities, as they allow for tailoring and customization of strategies that align with community needs, interests, and priorities. While community-based participatory research (CBPR) is a framework that offers a clear set of principles to guide intervention design and development, the complexity and diversity of community contexts make it challenging to anticipate all of the possible pathways to implementation. This article describes the application of CBPR principles in the design and development of SHE Tribe (She's Healthy and Empowered), a social network-based healthy lifestyle intervention intended to promote the adoption of sustainable health behaviors in underserved communities. Practical and specific strategies are described to aid practitioners, researchers, and community partners as they engage in community-academic partnerships. These strategies uncover some of the inner workings of this partnership to promote trust and collaboration and maximize partner strengths, with the aim to aid others with key elements and practical steps in the application of participatory methods.
Collapse
Affiliation(s)
- Leilani Dodgen
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | | | | | | |
Collapse
|
12
|
Kaholokula JK, Ing CT, Look MA, Delafield R, Sinclair K. Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders. Ann Hum Biol 2018; 45:249-263. [PMID: 29843522 PMCID: PMC6002761 DOI: 10.1080/03014460.2018.1465593] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
CONTEXT Obesity, diabetes and cardiovascular disease (CVD) have reached epidemic proportions among Native Hawaiians/Pacific Islanders (NHPI). Culturally responsive interventions that account for their interpersonal, sociocultural and socioeconomic realities are a public health priority. OBJECTIVE To describe cultural adaptation and culturally grounded approaches to developing health interventions for NHPI and to review the culturally responsive approaches used by, and outcomes from, two long-standing community-based participatory research projects (CBPR) in Hawai'i: PILI 'Ohana and KāHOLO Projects. METHODS A literature review of 14 studies from these two projects was done to exemplify the methods applied to culturally adapting existing evidence-based interventions and to developing novel interventions from the 'ground up' to address health disparities in NHPI. Of the 14 studies reviewed, 11 were studies of the clinical and behavioural outcomes of both types of interventions. RESULTS Both culturally adapted and culturally grounded approaches using community-based assets and NHPI cultural values/practices led to establishing sustainable and scalable interventions that significantly improved clinical measures of obesity, diabetes and hypertension. CONCLUSION Several recommendations are provided based on the lessons learned from the PILI 'Ohana and KāHOLO Projects. Multidisciplinary and transdisciplinary research using CBPR approaches are needed to elucidate how human biology is impacted by societal, environmental and psychological factors that increase the risk for cardiometabolic diseases among NHPI to develop more effective health promotion interventions and public health policies.
Collapse
Affiliation(s)
| | - Claire Townsend Ing
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Mele A. Look
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Rebecca Delafield
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Ka‘imi Sinclair
- Initiative for Research and Education to Advance Community Health (IREACH), Washington State University
| |
Collapse
|
13
|
Joseph RP, Coe K, Ainsworth BE, Hooker SP, Mathis L, Keller C. Hair As a Barrier to Physical Activity among African American Women: A Qualitative Exploration. Front Public Health 2018; 5:367. [PMID: 29404317 PMCID: PMC5777534 DOI: 10.3389/fpubh.2017.00367] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/26/2017] [Indexed: 11/28/2022] Open
Abstract
Background African American (AA) women face unique sociocultural barriers to physical activity (PA) engagement. Such barriers may contribute to their low PA levels and high cardiometabolic disease burden. One particular barrier reported among AA women in recent research is that being physically active can have an undesirable effect on the hairstyles and hair maintenance of many AA women. However, the underlying mechanisms contributing to this barrier have not been fully elucidated. The purpose of this study is to explore hairstyle maintenance as a barrier to PA among AA women and to identify effective strategies to overcome this barrier in the design of a culturally relevant PA intervention. Methods A qualitative study design was used. Data were collected from the focus groups comprising 23 sedentary and obese AA women (median age = 38.1 years, median body mass index = 39.8 kg/m2). Content analysis was used to analyze these focus group data. Results Three key themes emerged from the qualitative narratives of participants: (1) impact of perspiration on hair and hairstyle maintenance, (2) image and social comparisons, and (3) solutions to overcome hair-related barriers to PA. For impact of perspiration and hairstyle maintenance, participants described how perspiring while engaging in PA negatively impacts many of their hairstyles. Participants further discussed how time and monetary burdens associated with PA-related hairstyle maintenance further contributed to this issue. Findings for the theme of image and social comparison focused on how an AA woman’s hairstyle is an important part of the image and the social comparisons made by non-AAs regarding the hairstyles and maintenance practices of AA women. For solutions to hairstyle maintenance barriers, participant described a variety of potential styling techniques that may help alleviate PA-related maintenance concerns, including braids, locks, and natural hairstyles. However, no styling technique was uniformly endorsed by all study participants. Conclusion Findings highlight the significance of hair in the AA community and provide further insight on appropriate intervention design strategies to overcome this sociocultural barrier to PA. Future research is needed to corroborate and further expand on our findings.
Collapse
Affiliation(s)
- Rodney P Joseph
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Kathryn Coe
- Social and Behavioral Sciences Department, Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Barbara E Ainsworth
- Exercise Science and Health Promotion Program, School of Nutrition and Health Promotion, College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Steven P Hooker
- Exercise Science and Health Promotion Program, School of Nutrition and Health Promotion, College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - LaTanya Mathis
- Previously Affiliated with Arizona State University, Phoenix, AZ, United States
| | - Colleen Keller
- Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| |
Collapse
|
14
|
Sheats JL, Petrin C, Darensbourg RM, Wheeler CS. A Theoretically-Grounded Investigation of Perceptions About Healthy Eating and mHealth Support Among African American Men and Women in New Orleans, Louisiana. FAMILY & COMMUNITY HEALTH 2018; 41 Suppl 2 Suppl, Food Insecurity and Obesity:S15-S24. [PMID: 29461312 PMCID: PMC5987535 DOI: 10.1097/fch.0000000000000177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There has been a surge in diet-related mobile health (mHealth) interventions. However, diet-related mHealth research targeted toward racial/ethnic populations has been relatively limited. Focus groups with African American men and women from New Orleans, Louisiana, were conducted to (1) describe perceptions about healthy eating, (2) determine the acceptability of mHealth interventions, and (3) identify preferred mHealth intervention features. Descriptive statistics and thematic content analyses were performed. Qualitative data were organized within the context of the Theory of Planned Behavior and Social Cognitive Theory's theoretical components. Results may inform the development of mHealth research to improve eating behaviors among the target population.
Collapse
Affiliation(s)
- Jylana L Sheats
- Global Community Health and Behavioral Sciences Department (Dr Sheats and Ms Wheeler) and Tulane Prevention Research Center (Ms Darensbourg), School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; and School of Medicine, Tulane University, New Orleans, Louisiana (Mrs Petrin)
| | | | | | | |
Collapse
|
15
|
Auerbach BJ, Katz R, Tucker K, Boyko EJ, Drewnowski A, Bertoni A, Dubbert P, Hickson DA, Correa A, Young BA. Factors associated with maintenance of body mass index in the Jackson Heart Study: A prospective cohort study secondary analysis. Prev Med 2017; 100:95-100. [PMID: 28414066 PMCID: PMC5511791 DOI: 10.1016/j.ypmed.2017.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 04/04/2017] [Accepted: 04/09/2017] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to compare the relationship of diet quality, physical activity, and environmental factors with body mass index (BMI) maintenance in African American adults. We analyzed data from 4041 participants in the Jackson Heart Study, a prospective cohort study based in Jackson, Mississippi. Exposures were baseline American Heart Association diet quality score, American Heart Association physical activity categories, the built environment, the food environment, and neighborhood safety. The outcome was weight maintenance or loss (no BMI increase ≥1.0kg/m2) versus weight gain (BMI increased ≥1.0kg/m2) over a mean of 5.0years. We found that 63% of participants maintained or lost weight and 37% gained weight. In multivariable analyses, ideal diet quality was associated with a 6% greater likelihood of BMI maintenance (incidence rate ratio [IRR] 1.06, 95% confidence interval [CI]: 1.03, 1.10). Living in an unsafe neighborhood was associated with a 2% lower likelihood of BMI maintenance (IRR 0.98, 95% CI: 0.96, 0.99), as was poor built environment (IRR 0.98, 95% CI: 0.97, 0.998). Physical activity and poor food environment were not associated with BMI maintenance. In conclusion, among African American adults in Jackson, Mississippi, high quality diet was the strongest factor associated with BMI maintenance.
Collapse
Affiliation(s)
- Brandon J Auerbach
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States.
| | - Ronit Katz
- Kidney Research Institute, University of Washington, Seattle, WA, United States
| | - Katherine Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Edward J Boyko
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States; Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| | - Adam Drewnowski
- Nutritional Sciences Program, Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, United States
| | - Alain Bertoni
- Wake Forrest School of Medicine, Winston-Salem, NC, United States
| | - Patricia Dubbert
- Division of Health Services Research, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Adolfo Correa
- University of Mississippi Medical Center & Jackson Heart Study, Jackson, MS, United States
| | - Bessie A Young
- Division of Nephrology, Department of Medicine, University of Washington School of Medicine, United States; Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
| |
Collapse
|
16
|
Rosenbaum DL, Piers AD, Schumacher LM, Kase CA, Butryn ML. Racial and ethnic minority enrollment in randomized clinical trials of behavioural weight loss utilizing technology: a systematic review. Obes Rev 2017; 18:808-817. [PMID: 28524643 DOI: 10.1111/obr.12545] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/04/2017] [Accepted: 03/07/2017] [Indexed: 01/04/2023]
Abstract
Many racial and ethnic minority groups (minorities) are disproportionately affected by overweight and obesity; however, minorities are often under-represented in clinical trials of behavioural weight loss (BWL) treatment, potentially limiting the generalizability of these trials' conclusions. Interventions involving technology may be particularly well suited to overcoming the barriers to minority enrollment in BWL trials, such as demanding or unpredictable work schedules, caregiving responsibilities and travel burdens. Thus, this systematic review aimed to describe minority enrollment in trials utilizing technology in interventions, as well as to identify which form(s) of technology yield the highest minority enrollment. Results indicated relatively low enrollment of minorities. Trials integrating smartphone use exhibited significantly greater racial minority enrollment than trials that did not; trials with both smartphone and in-person components exhibited the highest racial minority enrollment. This review is the first to explore how the inclusion of technology in BWL trials relates to minority enrollment and can help address the need to improve minority enrollment in weight loss research.
Collapse
Affiliation(s)
- D L Rosenbaum
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - A D Piers
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - L M Schumacher
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - C A Kase
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - M L Butryn
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
17
|
Goode RW, Styn MA, Mendez DD, Gary-Webb TL. African Americans in Standard Behavioral Treatment for Obesity, 2001-2015: What Have We Learned? West J Nurs Res 2017; 39:1045-1069. [PMID: 28322668 DOI: 10.1177/0193945917692115] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
African Americans (AAs) bear a disproportionate burden of the obesity epidemic, yet have historically been underrepresented in weight loss research. We conducted a narrative review of large ( N > 75) randomized prospective clinical trials of standard behavioral treatment for weight loss that reported results in the past 15 years (2001-2015) to (a) determine the rates of inclusion and reported results for AAs and (b) further identify strategies that may result in improved outcomes. Of the 23 trials reviewed, 69.6% of the studies met or exceeded population estimates for AAs in the United States. However, only 10 reported outcomes and/or considered race in the analytic approach. At 6 months, AA participants consistently lost less weight than White participants. The use of culturally tailored intervention materials and monthly personal telephone calls were reported as factors that may have enhanced treatment response. Future behavioral weight loss trials should also increase reporting of outcomes by race.
Collapse
|
18
|
Cohen A, Perozich A, Rajan R, Persky S, Parisi J, Bowie J, Fahle J, Cho J, Krishnan A, Cohen Z, Ezike A, Schulte C, Taylor J, Storey D, Ahmed RS, Cheskin LJ. Framed, Interactive Theory-Driven Texting: Effects of Message Framing on Health Behavior Change for Weight Loss. FAMILY & COMMUNITY HEALTH 2017; 40:43-51. [PMID: 27870754 DOI: 10.1097/fch.0000000000000128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
More approaches to support weight control are needed, especially among racial minorities who shoulder a disproportionate obesity burden. Using an approach influenced by regulatory fit theory, we conducted a 28-day, 4-arm experimental trial with 89 obese adults recruited from urban, predominantly African American churches to ascertain the efficacy of framed text messages to motivate behaviors conducive to weight loss. Participants were assigned to receive message framing that was matched versus mismatched to their motivational orientation. Results were mixed overall; however, matched texts elicited greater motivation to change eating and exercise behavior, suggesting promise in using motivational approaches to tailor messages.
Collapse
Affiliation(s)
- Anne Cohen
- Johns Hopkins University, Johns Hopkins Weight Management Center, Baltimore, Maryland (Mss Cohen, Perozich, Fahle, Ezike, Cohen, and Schulte, Messrs Cho, Krishnan, Taylor, and Syed, and Dr Cheskin); Departments of Health, Behavior & Society (Ms Rajan, Drs Bowie, Storey, and Cheskin, and Mr Ahmed) and Mental Health (Dr Parisi), Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland Global Obesity Prevention Center at Johns Hopkins Baltimore, Maryland (Dr Cheskin); and National Institutes of Health, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland (Dr Persky)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Jay M, Gutnick D, Squires A, Tagliaferro B, Gerchow L, Savarimuthu S, Chintapalli S, Shedlin MG, Kalet A. In our country tortilla doesn't make us fat: cultural factors influencing lifestyle goal-setting for overweight and obese Urban, Latina patients. J Health Care Poor Underserved 2016; 25:1603-22. [PMID: 25418230 DOI: 10.1353/hpu.2014.0165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Obesity disproportionately affects Latina adults, and goal-setting is a technique often used to promote lifestyle behavior change and weight loss. To explore the meanings and dimensions of goal-setting in immigrant Latinas, we conducted four focus groups arranged by language ability and country of origin in an urban, public, primary care clinic. We used a narrative analytic approach to identify the following themes: the immigrant experience, family dynamics, and health care. Support was a common sub-theme that threaded throughout, with participants relying on the immigrant community, family, and the health care system to support their goals. Participants derived satisfaction from setting and achieving goals and emphasized personal willpower as crucial for success. These findings should inform future research on how goal-setting can be used to foster lifestyle behavior change and illustrate the importance of exploring the needs of Latino sub-groups in order to improve lifestyle behaviors in diverse Latino populations.
Collapse
|
20
|
Kim S, Macaskill P, Baur LA, Hodson EM, Daylight J, Williams R, Kearns R, Vukasin N, Lyle DM, Craig JC. The differential effect of socio-economic status, birth weight and gender on body mass index in Australian Aboriginal Children. Int J Obes (Lond) 2016; 40:1089-95. [PMID: 27121249 DOI: 10.1038/ijo.2016.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 04/04/2016] [Accepted: 04/18/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Adult Aboriginal Australians have 1.5-fold higher risk of obesity, but the trajectory of body mass index (BMI) through childhood and adolescence and the contribution of socio-economic factors remain unclear. Our objective was to determine the changes in BMI in Australian Aboriginal children relative to non-Aboriginal children as they move through adolescence into young adulthood, and to identify risk factors for higher BMI. METHODS A prospective cohort study of Aboriginal and non-Aboriginal school children commenced in 2002 across 15 different screening areas across urban, regional and remote New South Wales, Australia. Socio-economic status was recorded at study enrolment and participants' BMI was measured every 2 years. We fitted a series of mixed linear regression models adjusting for age, birth weight and socio-economic status for boys and girls. RESULTS In all, 3418 (1949 Aboriginal) participants were screened over a total of 11 387 participant years of follow-up. The prevalence of obesity was higher among Aboriginal children from mean age 11 years at baseline (11.6 vs 7.6%) to 16 years at 8 years follow-up (18.6 vs 12.3%). The mean BMI increased with age and was significantly higher among Aboriginal girls compared with non-Aboriginal girls (P<0.01). Girls born of low birth weight had a lower BMI than girls born of normal birth weight (P<0.001). Socio-economic status and low birth weight had a differential effect on BMI for Aboriginal boys compared with non-Aboriginal boys (P for interaction=0.01). Aboriginal boys of highest socio-economic status, unlike those of lower socio-economic status, had a higher BMI compared with non-Aboriginal boys. Non-Aboriginal boys of low birth weight were heavier than Aboriginal boys. CONCLUSIONS Socio-economic status and birth weight have differential effects on BMI among Aboriginal boys, and Aboriginal girls had a higher mean BMI than non-Aboriginal girls through childhood and adolescence. Intervention programs need to recognise the differential risk for obesity for Aboriginal and non-Aboriginal boys and girls to maximise their impact.
Collapse
Affiliation(s)
- S Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - P Macaskill
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - L A Baur
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - E M Hodson
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - J Daylight
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - R Williams
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - R Kearns
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - N Vukasin
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - D M Lyle
- Department of Rural Health, University of Sydney, Camperdown, New South Wales, Australia
| | - J C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
21
|
Stolley MR, Sharp LK, Fantuzzi G, Arroyo C, Sheean P, Schiffer L, Campbell R, Gerber B. Study design and protocol for moving forward: a weight loss intervention trial for African-American breast cancer survivors. BMC Cancer 2015; 15:1018. [PMID: 26715447 PMCID: PMC4696142 DOI: 10.1186/s12885-015-2004-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 12/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Breast cancer survival rates are significantly lower among African-American women compared to white women. In addition, African-American women with breast cancer are more likely than white women to die from co-morbid conditions. Obesity is common among African-American women, and it contributes to breast cancer progression and the development and exacerbation of many weight-related conditions. Intervening upon obesity may decrease breast cancer and all-cause mortality among African-American breast cancer survivors. METHODS/DESIGN Moving Forward is a weight loss intervention being evaluated in a randomized trial with a projected sample of 240 African American breast cancer survivors. Outcomes include body mass index, body composition, waist:hip ratio, and behavioral, psychosocial and physiological measures. Survivors are randomized to either a 6-month guided weight loss intervention that involves twice weekly classes and text messaging or a self-guided weight loss intervention based on the same materials offered in the guided program. The guided intervention is being conducted in partnership with the Chicago Park District at park facilities in predominantly African-American neighborhoods in Chicago. Recruitment strategies include direct contact to women identified in hospital cancer registries, as well as community-based efforts. Data collection occurs at baseline, post-intervention (6 months) and at a 12-month follow-up. DISCUSSION This study evaluates a community-based, guided lifestyle intervention designed to improve the health of African-American breast cancer survivors. Few studies have addressed behavioral interventions in this high-risk population. If successful, the intervention may help reduce the risk for breast cancer recurrence, secondary cancers, and co-morbid conditions, as well as improve quality of life. TRIAL REGISTRATION U.S. Clinicaltrials.gov number: NCT02482506, April 2015.
Collapse
Affiliation(s)
- Melinda R Stolley
- Cancer Center and Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3548, USA.
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.
| | - Lisa K Sharp
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.
- Department of Pharmacy Systems, Outcome & Policy, UIC, College of Pharmacy, Chicago, IL, USA.
| | - Giamila Fantuzzi
- Department of Kinesiology and Nutrition, UIC, College of Applied Health Sciences, Chicago, IL, USA.
| | - Claudia Arroyo
- Cancer Center and Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3548, USA.
| | - Patricia Sheean
- School of Nursing, Loyola University, Maywood, IL, 60153, USA.
| | - Linda Schiffer
- Cancer Center and Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3548, USA.
| | - Richard Campbell
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.
| | - Ben Gerber
- Cancer Center and Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226-3548, USA.
- Institute for Health Research and Policy, University of Illinois at Chicago (UIC), Chicago, IL, USA.
| |
Collapse
|
22
|
Eldridge JD, Devine CM, Wethington E, Aceves L, Phillips-Caesar E, Wansink B, Charlson ME. Environmental influences on small eating behavior change to promote weight loss among Black and Hispanic populations. Appetite 2015; 96:129-137. [PMID: 26368577 DOI: 10.1016/j.appet.2015.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/24/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
Small eating behavior changes are proposed as more feasible to achieve and maintain than larger changes used in traditional behavioral weight loss studies. However, it is unclear whether overweight Black and Hispanic adults in a low-income urban setting experience small changes as feasible and what might influence feasibility. Participants' experiences in a 12-week pilot weight loss intervention were explored qualitatively to determine the feasibility of making small eating behavior changes in this population. After the intervention (69% retention), semi-structured interviews with 46 men and women (mean age 51, 50% Non-Hispanic Black, 43% Hispanic) revealed that making small eating changes was a process shaped by participants' intrapersonal and interpersonal eating environments. Participants responded to intrapersonal and interpersonal eating environmental challenges by adapting small change strategies, navigating eating environments, and negotiating household eating practices. Findings highlight how even small eating behavior changes called for adaptation, navigation, and negotiation of complex eating environments in daily life. These findings were used to improve the trial that followed and underline the importance of feasibility studies to inform community trials. Findings also add to understanding of contextual challenges and the skills needed to implement small changes in a low income, ethnic minority population.
Collapse
Affiliation(s)
- Johanna D Eldridge
- Division of Nutritional Sciences, Savage Hall, Cornell University, Ithaca, NY 14853, USA.
| | - Carol M Devine
- Division of Nutritional Sciences, Savage Hall, Cornell University, Ithaca, NY 14853, USA.
| | - Elaine Wethington
- Department of Human Development, College of Human Ecology, Martha Van Rensselaer Hall, Cornell University, Ithaca, NY 14853, USA.
| | - Luz Aceves
- Division of Nutritional Sciences, Savage Hall, Cornell University, Ithaca, NY 14853, USA.
| | - Erica Phillips-Caesar
- Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medical College, 338 East 66th Street, New York, NY 10065, USA.
| | - Brian Wansink
- Dyson School of Applied Economics and Management, Warren Hall, Cornell University, Ithaca, NY 14853, USA.
| | - Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Sciences Research, Department of Medicine, Weill Cornell Medical College, 338 East 66th Street, New York, NY 10065, USA.
| |
Collapse
|
23
|
Applying the Pragmatic-Explanatory Continuum Indicator Summary Model in a Primary Care-Based Lifestyle Intervention Trial. Am J Prev Med 2015; 49:S208-14. [PMID: 26296556 DOI: 10.1016/j.amepre.2015.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/24/2015] [Accepted: 05/13/2015] [Indexed: 11/22/2022]
Abstract
The majority of adults in the U.S. can be classified as overweight or obese (68%), putting them at risk for Type 2 diabetes, cardiovascular diseases, and other adverse health outcomes. The U.S. Preventive Services Task Force recommends that providers offer or refer obese adults to intensive, multicomponent lifestyle interventions. However, there is a critical need for interventions that have been shown to be pragmatic and effective among diverse populations, scalable across different clinical settings and systems, and sustainable over time. The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool can be used to assess the degree to which trials of behavioral lifestyle interventions provide evidence to support this need. We used our recently completed trial, Evaluation of Lifestyle Interventions to Treat Elevated Cardiometabolic Risk in Primary Care (E-LITE), as a case study and assessed the domains of PRECIS to explore the degree to which we felt it achieved its intended pragmatic design (completed in December 2014). Overall, the systematic assessment using the PRECIS tool revealed that the E-LITE trial design was very pragmatic in nature. Its results and the subsequent adoption of the intervention into actual practice also suggest high potential for implementation of primary care interventions.
Collapse
|
24
|
Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, Davey-Smith G, Dennison-Himmelfarb CR, Lauer MS, Lockwood DW, Rosal M, Yancy CW. Social Determinants of Risk and Outcomes for Cardiovascular Disease. Circulation 2015; 132:873-98. [DOI: 10.1161/cir.0000000000000228] [Citation(s) in RCA: 738] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
25
|
Mesman GR, Magness JM, Ward WL. Educational handouts for Latino youth who are obese. J Pediatr Health Care 2015; 29:222-32. [PMID: 25532698 DOI: 10.1016/j.pedhc.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 11/04/2014] [Accepted: 11/08/2014] [Indexed: 11/28/2022]
Abstract
Although obesity is a significant problem for many children in the United States, youth who are ethnic minorities, especially Latinos, are at an even great risk than their White counterparts. This ethnic disparity suggests that it is important to target Latino youth with prevention and intervention efforts if there is to be a meaningful decline in pediatric obesity rates. Unfortunately, children, including Latino youth, often do not receive specific recommendations at their primary care visits regarding proper nutrition and exercise. With this in mind, we summarized literature related to pediatric obesity in Latino youth and translated four educational handouts that were previously published in English. The handouts are designed to be used by a variety of different professionals who work in pediatric obesity clinics and are an efficient way to share detailed information with patients.
Collapse
|
26
|
Phillips-Caesar EG, Winston G, Peterson JC, Wansink B, Devine CM, Kanna B, Michelin W, Wethington E, Wells M, Hollenberg J, Charlson ME. Small Changes and Lasting Effects (SCALE) Trial: the formation of a weight loss behavioral intervention using EVOLVE. Contemp Clin Trials 2015; 41:118-28. [PMID: 25633208 PMCID: PMC4492122 DOI: 10.1016/j.cct.2015.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/29/2022]
Abstract
Background Obesity is a major health problem that disproportionately affects Black and Hispanic adults. This paper presents the rationale and innovative design of a small change eating and physical activity intervention (SC) combined with a positive affect and self-affirmation (PA/SA) intervention versus the SC intervention alone for weight loss. Methods Using a mixed methods translational model (EVOLVE), we designed and tested a SC approach intervention in overweight and/ or obese African American and Hispanic adults. In Phase I, we explored participant’s values and beliefs about the small change approach. In Phase II, we tested and refined the intervention and then, in Phase III we conducted a RCT. Participants were randomized to the SC approach with PA/SA intervention vs. a SC approach alone for 12 months. The primary outcome was clinically significant weight loss at 12 months. Results Over 4.5 years a total of 574 participants (67 in Phase I, 102 in Phase II and 405 in Phase III) were enrolled. Phase I findings were used to create a workbook based on real life experiences about weight loss and to refine the small change eating strategies. Phase II results shaped the recruitment and retention strategy for the RCT, as well as the final intervention. The RCT results are currently under analysis. Conclusion The present study seeks to determine if a SC approach combined with a PA/SA intervention will result in greater weight loss at 12 months in Black and Hispanic adults compared to a SC approach alone.
Collapse
Affiliation(s)
- Erica G Phillips-Caesar
- Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medical College 338 East 66th Street New York, NY 10065; School of Applied Economics and Management, Cornell University 201 Warren Hall Cornell University, Ithaca, NY 14853-7801.
| | - Ginger Winston
- George Washington University, Department of Medicine, Foggy Bottom South Pavilion, 22nd & I Street, NW Washington DC 20037
| | - Janey C Peterson
- Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medical College 338 East 66th Street New York, NY 10065; School of Applied Economics and Management, Cornell University 201 Warren Hall Cornell University, Ithaca, NY 14853-7801
| | - Brian Wansink
- Department of Human Development, Cornell University G96 Martha Van Rensselaer Hall Ithaca, NY 14853-4401
| | - Carol M Devine
- Division of Nutritional Sciences, Cornell University 405 Savage Hall Cornell University Ithaca, NY 14853-4401
| | - Balavanketsh Kanna
- Lincoln Medical and Mental Health Center for Collaborative Community Research
| | - Walid Michelin
- Lincoln Medical and Mental Health Center for Collaborative Community Research
| | - Elaine Wethington
- Department of Human Development, Cornell University G96 Martha Van Rensselaer Hall Ithaca, NY 14853-4401
| | - Martin Wells
- Cornell University Department of Statistical Science 301 Malott Hall Ithaca, NY 14853
| | - James Hollenberg
- Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medical College 338 East 66th Street New York, NY 10065; School of Applied Economics and Management, Cornell University 201 Warren Hall Cornell University, Ithaca, NY 14853-7801
| | - Mary E Charlson
- Division of Clinical Epidemiology and Evaluative Science Research, Weill Cornell Medical College 338 East 66th Street New York, NY 10065; School of Applied Economics and Management, Cornell University 201 Warren Hall Cornell University, Ithaca, NY 14853-7801
| |
Collapse
|
27
|
Rosas LG, Thiyagarajan S, Goldstein BA, Drieling RL, Romero PP, Ma J, Yank V, Stafford RS. The effectiveness of two community-based weight loss strategies among obese, low-income US Latinos. J Acad Nutr Diet 2015; 115:537-50.e2. [PMID: 25578925 DOI: 10.1016/j.jand.2014.10.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 09/23/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Latino immigrants have high rates of obesity and face barriers to weight loss. OBJECTIVE To evaluate the effectiveness of a case-management (CM) intervention with and without community health workers (CHWs) for weight loss. DESIGN This was a 2-year, randomized controlled trial comparing two interventions with each other and with usual care (UC). PARTICIPANTS/SETTING Eligible participants included Latinos with a body mass index of 30 to 60 and one or more heart disease risk factors. The 207 participants recruited during 2009-2010 had a mean age of 47 years and were mostly women (77%). At 24 months, 86% of the sample was assessed. INTERVENTION The CM+CHW (n=82) and CM (n=84) interventions were compared with each other and with UC (n=41). Both included an intensive 12-month phase followed by 12 months of maintenance. The CM+CHW group received home visits. MAIN OUTCOME MEASURES Weight change at 24 months. STATISTICAL ANALYSES Generalized estimating equations using intent-to-treat. RESULTS At 6 months, mean weight loss in the CM+CHW arm was -2.1 kg (95% CI -2.8 to -1.3) or -2% of baseline weight (95% CI -1% to -2%) compared with -1.6 kg (95% CI -2.4 to -0.7; % weight change, -2%, -1%, and -3%) in CM and -0.9 kg (95% CI -1.8 to 0.1; % weight change, -1%, 0%, and -2%) in UC. By 12 and 24 months, differences narrowed and CM+CHW was no longer statistically distinct. Men achieved greater weight loss than women in all groups at each time point (P<0.05). At 6 months, men in the CM+CHW arm lost more weight (-4.4 kg; 95% CI -6.0 to -2.7) compared with UC (-0.4 kg; 95% CI -2.4 to 1.5), but by 12 and 24 months differences were not significant. CONCLUSIONS This study demonstrated that incorporation of CHWs may help promote initial weight loss, especially among men, but not weight maintenance. Additional strategies to address social and environmental influences may be needed for Latino immigrant populations.
Collapse
|
28
|
Johnson ER, Carson TL, Affuso O, Hardy CM, Baskin ML. Relationship between social support and body mass index among overweight and obese African American women in the rural deep South, 2011-2013. Prev Chronic Dis 2014; 11:E224. [PMID: 25539128 PMCID: PMC4279865 DOI: 10.5888/pcd11.140340] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION African American women in the Deep South of the United States are disproportionately obese, a condition strongly influenced by their social environment. The objective of this study was to characterize the prevalence of social support from family and friends for healthy eating and exercise in rural communities. METHODS This study is an analysis of a subgroup (N = 195) of overweight and obese African American women from a larger ongoing weight loss trial (N = 409) in rural communities of the Alabama Black Belt and Mississippi Delta. The Social Support and Eating Habits Survey and Social Support and Exercise Survey were used to measure support from family and friends for healthy eating and exercise, respectively. Linear regression was conducted to determine the association between social support factors and body mass index (BMI). RESULTS Concurrently prevalent in our sample were encouraging support for healthy eating (family, median,14.0; range, 5.0-25.0; friends, median, 13.0; range 5.0-25.0) and discouraging support for healthy eating (family, median, 12.0; range, 5.0-25.0; friends, median, 11.0; range, 5.0-25.0). Median scores for support for exercise received in the form of participation from family and friends were 24.0 (range 10.0-48.0) and 24.0 (range 10.0-50.0), respectively. The median score for support for exercise in the form of rewards and punishment from family was 3.0 (range, 3.0-11.0). Social support factors were not associated with BMI. CONCLUSION Overweight and obese African American women in the rural Deep South experience minimal social support from family and friends for healthy eating and exercise. Given the evidence that social support promotes healthy behaviors, additional research on ways to increase support from family and friends is warranted.
Collapse
Affiliation(s)
| | | | - Olivia Affuso
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Monica L Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave S, MT 618, Birmingham, AL 35294-4410. E mail:
| |
Collapse
|
29
|
Harvey JR, Ogden DE. Obesity treatment in disadvantaged population groups: where do we stand and what can we do? Prev Med 2014; 68:71-5. [PMID: 24878585 PMCID: PMC4452994 DOI: 10.1016/j.ypmed.2014.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 01/14/2023]
Abstract
Obesity is now the second leading cause of death and disease in the United States leading to health care expenditures exceeding $147 billion dollars. The socioeconomically disadvantaged and racial/ethnic minority groups are at significantly increased risk for obesity. Despite this, low income and minority individuals are underrepresented in the current obesity treatment literature. Additionally, weight loss outcomes for these high risk groups are well below what is typically produced in standard, well-controlled behavioral interventions and reach and access to treatment is often limited. The use of telecommunications technology may provide a solution to this dilemma by expanding dissemination and allowing for dynamic tailoring. Further gains may be achieved with the use of material incentives to enhance uptake of new behaviors. Regardless of what novel strategies are deployed, the need for further research to improve the health disparities associated with obesity in disadvantaged groups is critical. The purpose of this manuscript is to review the weight loss intervention literature that has targeted socioeconomically disadvantaged and racial/ethnic minority populations with an eye toward understanding outcomes, current limitations, areas for improvement and need for further research.
Collapse
Affiliation(s)
- Jean R Harvey
- University of Vermont, Department of Nutrition and Food Sciences, USA; University of Vermont, Vermont Center on Behavior and Health, USA.
| | - Doris E Ogden
- University of Vermont, Department of Nutrition and Food Sciences, USA
| |
Collapse
|
30
|
Kumanyika SK, Swank M, Stachecki J, Whitt-Glover MC, Brennan LK. Examining the evidence for policy and environmental strategies to prevent childhood obesity in black communities: new directions and next steps. Obes Rev 2014; 15 Suppl 4:177-203. [PMID: 25196413 DOI: 10.1111/obr.12206] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/27/2022]
Abstract
Exposure to physical and policy environments that limit availability, affordability and appeal of healthy eating and active living options is higher for U.S. blacks than whites. This may contribute to high risk of obesity in black communities and limit effectiveness of preventive interventions. Here, we assess applicability to black Americans of findings from a prior evidence review system designed to accelerate the discovery and application of policy and environmental strategies for childhood obesity prevention and assess external validity. The database included 600 peer-reviewed articles reporting data from 396 sets of studies (study groupings) published from January 2000 through May 2009 and pertained to 24 types of policy and environmental strategies. Only 33 study groupings (~8%) included ≥ 50% black Americans or reported subgroup analyses. Of 10 evaluation studies for interventions rated as effective for all populations in the primary review, 8 suggested effectiveness of child-focused interventions in school or child care settings for obesity- or physical activity-related outcomes in black Americans. Overall findings highlight the need for rigorous evaluations of interventions that reach black children in community or institutional settings, and conceptual frameworks and research designs geared to identifying ethnic or ethnicity-income group differences in intervention effects.
Collapse
Affiliation(s)
- S K Kumanyika
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | |
Collapse
|
31
|
Whitt-Glover MC, Kumanyika SK, Haire-Joshu D. Introduction to the special issue on achieving healthy weight in black American communities. Obes Rev 2014; 15 Suppl 4:1-4. [PMID: 25196403 DOI: 10.1111/obr.12210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 12/17/2022]
Abstract
The prevalence of obesity is high in the United States, and highest among racial and ethnic minority groups. This special issue of Obesity Reviews is based upon evidence reviews prepared for and presented at a national invited workshop convened by the African American Collaborative Obesity Research Network (AACORN) in August of 2012. A set of potential topics was developed, a priori, and AACORN network members and colleagues with relevant expertise were invited to lead evidence reviews. The result is 10 articles focused on providing a comprehensive picture of what is known and unknown about interventions to prevent and treat obesity or improve weight-related behaviours in African American adults and children. Evidence reviews included in this special issue focus on children and adolescents (n=2); adults from various perspectives (n=5); eHealth interventions (n=1); interventions within faith organizations (n=1); and environmental and policy change interventions (n=1). Overall, the reviews show a small evidence base for research on African Americans and call for additional prioritization of funding to include studies that can inform action and bring progress in obesity prevention and treatment in African Americans on par with the scope and seriousness of the problem.
Collapse
|
32
|
Cabassa LJ, Siantz E, Nicasio A, Guarnaccia P, Lewis-Fernández R. Contextual Factors in the Health of People With Serious Mental Illness. QUALITATIVE HEALTH RESEARCH 2014; 24:1126-1137. [PMID: 24966198 PMCID: PMC4276729 DOI: 10.1177/1049732314541681] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
People living with serious mental illness (SMI) have shorter life expectancies than the general population. We examined how contextual factors influence the physical health of this population. We conducted interviews, focus groups, and participant observations with stakeholders from six behavioral health organizations. We found that consumers' avoidance of overt disagreement during medical visits, their mistrust of medical institutions, and cultural variations in body image influenced the clinical encounter. Mental health providers' ambivalence about intervening in consumers' physical health, primary care providers' misattribution of physical symptoms to mental disorders, and providers' stigmatization of consumers shaped clinical encounters. Consumers' diets were shaped by food environments and social norms associated with traditional diets. Internal and external factors impacted consumers' physical activity. In this article, we illustrate the importance of considering contextual factors in the development and implementation of interventions aimed at improving the physical health of people with SMI.
Collapse
Affiliation(s)
| | | | - Andel Nicasio
- New York State Psychiatric Institute, New York, New York, USA
| | - Peter Guarnaccia
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | | |
Collapse
|
33
|
Bersamin A, Wolsko C, Luick B, Boyer B, Lardon C, Hopkins S, Stern JS, Zidenberg-Cherr S. Enculturation, perceived stress, and physical activity: implications for metabolic risk among the Yup'ik--the Center for Alaska Native Health Research Study. ETHNICITY & HEALTH 2014; 19:255-69. [PMID: 23297688 PMCID: PMC3644025 DOI: 10.1080/13557858.2012.758691] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES American Indians and Alaska Natives (ANs) report among the lowest levels of physical activity in the USA, but there is very little systematic research examining the determinants of physical activity patterns in these populations. This study investigated the relationships between enculturation (or cultural traditionality), psychosocial stress, and physical activity in a community-based sample of Yup'ik women and men living in rural AN communities. Associations between these variables and several metabolic risk factors were also examined. DESIGN A sample of 488 Yup'ik participants (284 women and 204 men) from six villages in the Yukon-Kuskokwim Delta region completed a wellness survey and an array of physiological assessments [e.g., body mass index (BMI), blood pressure]. A subset of 179 participants also completed a 3-day pedometer assessment of physical activity. RESULTS Multivariate linear regression models indicated that participants who were more enculturated (i.e., living more of a traditional lifestyle) and who experienced lower levels of psychosocial stress were significantly more physically active. In turn, both lower levels of psychosocial stress and higher levels of physical activity were associated with lower BMI, lower percent body fat, and lower waist circumference. CONCLUSIONS Findings underscore the importance of gaining a culturally specific understanding of physical activity patterns in indigenous groups in order to inform effective health promotion strategies.
Collapse
Affiliation(s)
- Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | | | - Bret Luick
- Natural Resource Management, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Bert Boyer
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Cecile Lardon
- Psychology Department, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Scarlett Hopkins
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, Alaska
| | - Judith S. Stern
- Department of Nutrition, University of California, Davis, Davis, California
| | | |
Collapse
|
34
|
Rolland C, Johnston KL, Lula S, Macdonald I, Broom J. Long-term weight loss maintenance and management following a VLCD: a 3-year outcome. Int J Clin Pract 2014; 68:379-87. [PMID: 24372837 DOI: 10.1111/ijcp.12300] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Effective weight loss treatment is important as obesity has severe health and socioeconomic repercussions. Emerging evidence suggests that rapid initial weight loss results in better long-term weight loss maintenance. This remains controversial and contradicts current recommendations for slower weight loss. AIM To determine the effect of a very low calorie diet (VLCD) with group-based behaviour therapy on weight loss and long-term weight management by means of a retrospective database analysis. METHODS Data for this retrospective analysis included participants who embarked on the LighterLife Total VLCD programme between 2007 and 2010, and whose weights at baseline and at least 12 months were available (n = 5965). RESULTS Data were available for 5965 individuals at 1 year, 2044 at 2 years and 580 at 3 years. At baseline, the majority of individuals were Caucasian (n = 5155), female (n = 5419), ≥ 40 years old (n = 4272), 49% were within the body mass index (BMI) range of 30-35 kg/m(2) while 51% had a BMI > 35 kg/m(2) . The average initial weight of the whole cohort was 99.1 kg (SD 16.6). Initial weight and BMI at entry onto programme, as well as numbers of weeks of weight loss were all significantly associated with weight loss achieved on the first weight loss attempt. Weight lost during the initial weight loss phase was the only factor, which was significantly associated with percentage weight loss maintenance for years 1, 2, and 3. CONCLUSION The findings of this retrospective analysis suggest that provided a longer term weight loss management programme is adhered to, large amounts of initial weight loss can result in important longer term weight loss maintenance in motivated individuals.
Collapse
Affiliation(s)
- C Rolland
- Centre for Obesity Research and Epidemiology, Robert Gordon University, Aberdeen, UK
| | | | | | | | | |
Collapse
|
35
|
Mitchell NS, Polsky S. Innovative care delivery model to address obesity in older African-American women: Senior Wellness Initiative and Take Off Pounds Sensibly collaboration for health (SWITCH). J Am Geriatr Soc 2014; 61:1971-5. [PMID: 24219198 DOI: 10.1111/jgs.12444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the feasibility and acceptability of integrating Take Off Pounds Sensibly (TOPS), a national nonprofit weight-loss program through which people have lost a clinically significant amount of weight, into a community program that serves African Americans (AAs) and to determine weight change. DESIGN Single-group pilot design. SETTING Denver, Colorado. PARTICIPANTS Community-dwelling participants aged 51 to 85. INTERVENTION Participants were recruited through a program that serves AAs, and new TOPS chapters were started at a church, senior center, and senior residence for independent living. MEASUREMENTS Feasibility was measured by determining the ease of recruitment and acceptability was measured according to retention. The secondary outcome was weight change. RESULTS Sixty-four percent of people who were referred to the program or attended an information session participated in the study. The retention rate at 52 weeks was 79%. At 52 weeks, 16 of 48 participants had lost 5% or more of their initial weight, and 23 had lost 0% to 4.9% of their initial weight. CONCLUSIONS Recruiting AA women through the Center for African American Health was feasible, and the program was acceptable. One-third of participants lost a clinically significant amount of weight. TOPS may be one way to combat the health disparity of obesity in AA women.
Collapse
Affiliation(s)
- Nia S Mitchell
- Division of General Internal Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; Anschutz Health and Wellness Center, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; Colorado Health Outcomes, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | | |
Collapse
|
36
|
Bruce MA, Beech BM, Crook ED, Sims M, Griffith DM, Simpson SL, Ard J, Norris KC. Sex, weight status, and chronic kidney disease among African Americans: the Jackson Heart Study. J Investig Med 2013; 61:701-7. [PMID: 23524947 DOI: 10.2310/jim.0b013e3182880bf5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Obesity has been shown to have implications for chronic kidney disease (CKD); however, it has received minimal attention from scientists studying CKD among African Americans. OBJECTIVES The purpose of this study was to examine the manner in which weight status has implications for CKD among this group through analysis of data drawn from the Jackson Heart Study (JHS). DESIGN Cross-sectional analysis of a single-site longitudinal population-based cohort. PARTICIPANTS The data for this study were drawn from the baseline examination of the Jackson Heart Study (JHS). The analytic cohort consisted of 3430 African American men and women (21-84 years of age) living in the tricounty area of the Jackson, Mississippi metropolitan areas with complete data to determine CKD status. MAIN MEASUREMENTS The primary dependent variable was CKD (defined as the presence of albuminuria or reduced estimated glomerular filtration rate <60 mL/min per 1.73 m(2)). Weight status, the primary predictor, was a 4-category measure based on body mass index. RESULTS Associations were explored through bivariable analyses and multivariable logistic regression analyses adjusting for CKD, weight status, diabetes, hypertension, and cardiovascular disease risk factors as well as demographic factors. The prevalence of CKD in the JHS was 20%. The proportion of overweight, class I, and class II obese individuals was 32.5%, 26.9%, and 26.2% respectively. In the pooled model, weight status was not found to be associated with CKD; however, subgroup analysis revealed that class II obesity was associated with CKD among men (odds ratio, 2.37; confidence interval, 1.34-4.19) but not among women (odds ratio, 1.32; confidence interval, 0.88-1.98). The relationship between CKD prevalence and diabetes and CKD prevalence and hypertension varied by sex and differed across weight categories. CONCLUSIONS Weight status has implications for CKD among the JHS participants, and this study underscores the need for additional research investigating the relationship between weight status, sex, and CKD among African Americans.
Collapse
Affiliation(s)
- Marino A Bruce
- Mississippi Institute for the Improvement of Geographic Minority Health, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Samuel-Hodge CD, Johnston LF, Gizlice Z, Garcia BA, Lindsley SC, Gold AD, Braxton DF, Keyserling TC. A pilot study comparing two weight loss maintenance interventions among low-income, mid-life women. BMC Public Health 2013; 13:653. [PMID: 23855318 PMCID: PMC3717028 DOI: 10.1186/1471-2458-13-653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 06/25/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Despite high obesity prevalence rates, few low-income midlife women participate in weight loss maintenance trials. This pilot study aims to assess the effectiveness of two weight loss maintenance interventions in this under-represented population. METHODS Low-income midlife women who completed a 16-week weight loss intervention and lost ≥ 8 lbs (3.6 kg) were eligible to enroll in one of two 12-month maintenance programs. The programs were similar in content and had the same number of total contacts, but were different in the contact modality (Phone + Face-to-Face vs. Face-to-Face Only). Two criteria were used to assess successful weight loss maintenance at 12 months: (1) retaining a loss of ≥ 5% of body weight from the start of the weight loss phase and (2) a change in body weight of < 3%, from the start to the end of the maintenance program. Outcome measures of changes in physiologic and psychosocial factors, and evaluations of process measures and program acceptability (measured at 12 months) are also reported. For categorical variables, likelihood ratio or Fisher's Exact (for small samples) tests were used to evaluate statistically significant relationships; for continuous variables, t-tests or their equivalents were used to assess differences between means and also to identify correlates of weight loss maintenance. RESULTS Overall, during the 12-month maintenance period, 41% (24/58) of participants maintained a loss of ≥ 5% of initial weight and 43% (25/58) had a <3% change in weight. None of the comparisons between the two maintenance programs were statistically significant. However, improvements in blood pressure and dietary behaviors remained significant at the end of the 12-month maintenance period for participants in both programs. Participant attendance and acceptability were high for both programs. CONCLUSIONS The effectiveness of two pilot 12-month maintenance interventions provides support for further research in weight loss maintenance among high-risk, low-income women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00288301.
Collapse
|
38
|
Latino church leaders' perspectives on childhood obesity prevention. Am J Prev Med 2013; 44:S232-9. [PMID: 23415188 DOI: 10.1016/j.amepre.2012.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/20/2012] [Accepted: 11/28/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prevalence of obesity among Latino children is an increasing concern. Churches are settings that a majority of Latino families frequent on a regular basis. In addition to religious worship, churches supply social, emotional, and material support. Therefore, churches may be promising venues for obesity-prevention interventions engaging families and communities. PURPOSE To qualitatively examine Latino church leaders' perspectives on childhood obesity and insights on obesity-prevention programming in faith-based community settings in South Texas. METHODS In-depth interviews were conducted between 2009 and 2011 with a purposive sample of 35 Latino church leaders from 18 churches in San Antonio, Texas. Interviews were audiotaped and transcribed verbatim. Inductive analysis was performed to identify themes. RESULTS The results revealed that participants were knowledgeable about the severity and health consequences of childhood obesity, and the extent to which it was affecting members of their congregations. Participants discussed the interconnection between one's faith and health (i.e., one's body as "God's Temple"). They suggested that churches could serve as a conduit for obesity-prevention programs that offer faith-oriented health education, cooking classes, and fun physical activity opportunities for both parents and children. CONCLUSIONS This study reveals the strong potential of faith-based communities to serve as an intervention setting with the needed infrastructure for implementing effective obesity-prevention strategies.
Collapse
|
39
|
Tussing-Humphreys LM, Fitzgibbon ML, Kong A, Odoms-Young A. Weight loss maintenance in African American women: a systematic review of the behavioral lifestyle intervention literature. J Obes 2013; 2013:437369. [PMID: 23691286 PMCID: PMC3649225 DOI: 10.1155/2013/437369] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 01/08/2013] [Accepted: 01/28/2013] [Indexed: 02/02/2023] Open
Abstract
We performed a systematic review of the behavioral lifestyle intervention trials conducted in the United States published between 1990 and 2011 that included a maintenance phase of at least six months, to identify intervention features that promote weight loss maintenance in African American women. Seventeen studies met the inclusion criteria. Generally, African American women lost less weight during the intensive weight loss phase and maintained a lower % of their weight loss compared to Caucasian women. The majority of studies failed to describe the specific strategies used in the delivery of the maintenance intervention, adherence to those strategies, and did not incorporate a maintenance phase process evaluation making it difficult to identify intervention characteristics associated with better weight loss maintenance. However, the inclusion of cultural adaptations, particularly in studies with a mixed ethnicity/race sample, resulted in less % weight regain for African American women. Studies with a formal maintenance intervention and weight management as the primary intervention focus reported more positive weight maintenance outcomes for African American women. Nonetheless, our results present both the difficulty in weight loss and maintenance experienced by African American women in behavioral lifestyle interventions.
Collapse
|
40
|
Seale JP, Fifield J, Davis-Smith YM, Satterfield R, Thomas JG, Cole B, Atkinson MJ, Boltri JM. Developing culturally congruent weight maintenance programs for African American church members. ETHNICITY & HEALTH 2012; 18:152-167. [PMID: 22943791 DOI: 10.1080/13557858.2012.708914] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Developing community-based and culturally congruent weight loss maintenance programs is an important component of weight reduction interventions in high-risk populations. This qualitative investigation was conducted to guide development of faith-based weight maintenance programs for African American church members. DESIGN Twenty African American church members who previously participated in a church-based group weight loss program were recruited to participate in focus groups. This qualitative inquiry focused on the role of faith in maintaining healthy lifestyle behaviors, such as healthy eating and regular physical activity. Within these groups, a nominal group process was used to identify activities and language to be included within a faith-based maintenance program. RESULTS Content analysis identified seven conceptual domains that participants thought were important aspects of a faith-based weight maintenance program: (1) accountability for change targets, (2) programmatic tools, (3) group benefits and support, (4) keys to successful behavior change, (5) keys to church and programmatic level success, (6) addressing barriers, and (7) faith. The faith sub-domains included faith in the Lord, using the body for God, and a spiritual focus. The nominal group process resulted in 11 recommended components for a faith-based weight maintenance program. The top four included scriptures and prayers are 'walk of faith,' healthy diet, exercise, and focusing on God. CONCLUSIONS The results suggest that integrating faith themes into a weight loss maintenance program may increase its long-term impact on participants' health behavior change.
Collapse
Affiliation(s)
- J Paul Seale
- Department of Family Medicine, Mercer University School of Medicine and the Medical Center of Central Georgia, Macon, GA, USA
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Svetkey LP, Ard JD, Stevens VJ, Loria CM, Young DY, Hollis JF, Appel LJ, Brantley PJ, Kennedy BM, Kumanyika SK, Batch BC, Corsino L, Lien LF, Vollmer WM. Predictors of long-term weight loss in adults with modest initial weight loss, by sex and race. Obesity (Silver Spring) 2012; 20:1820-8. [PMID: 21527896 PMCID: PMC3830958 DOI: 10.1038/oby.2011.88] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Effective weight management interventions could reduce race-sex disparities in cardiovascular disease (CVD), yet little is known about factors associated with successful weight loss maintenance in race-sex subgroups. In the Weight Loss Maintenance trial (WLM), overweight/obese (BMI 25-45 kg/m(2)) adults who lost ≥4 kg in a 6-month behavioral weight loss intervention (phase I) were randomized into one of three 30-month maintenance interventions (phase II). To investigate predictors in subgroups, randomized groups were combined for this analysis. Of 1,685 phase I participants, 1,032 (61%) entered phase II, including 12% black men (BM), 26% black women (BW), 25% white men (WM), and 37% white women (WW). Weight change over the 36-month study ranged from -2.3% (95% confidence interval = -3.1 to -1.5%) in BW to -4.5% (95% confidence interval = -5.7 to -4.0%) in WM, the result of differential weight loss during phase I. Within race, men lost significantly more weight than women, but within sex group, weight loss did not differ significantly between races. Although participants regained weight during phase II, regain did not differ by race-sex group, and mean weight at the end of the study was significantly lower than phase I entry weight for each subgroup. In regression models, phase I weight loss predicted overall 36-month weight loss in all race-sex groups. Healthy dietary pattern at entry, improvement in dietary pattern, or both were predictive in three of four race-sex groups. Few other variables other than initial weight loss and dietary pattern were predictive. Future research should identify additional modifiable influences on long-term maintenance after a modest weight loss.
Collapse
Affiliation(s)
- Laura P Svetkey
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Archer E, Groessl EJ, Sui X, McClain AC, Wilcox S, Hand GA, Meriwether RA, Blair SN. An economic analysis of traditional and technology-based approaches to weight loss. Am J Prev Med 2012; 43:176-82. [PMID: 22813682 DOI: 10.1016/j.amepre.2012.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 02/20/2012] [Accepted: 04/06/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The financial burden and human losses associated with noncommunicable diseases necessitate cost-effective and efficacious interventions. PURPOSE An economic analysis of the Lifestyle Education for Activity and Nutrition (LEAN) Study; an RCT that examined the efficacy of traditional and technology-based approaches to weight loss. METHODS Economic analyses from an organizational perspective were conducted for four approaches: standard care control (SC); group weight-loss education (GWL); a multisensor armband (SWA); and the armband in combination with group weight-loss education (GWL+SWA). Data were collected in 2008-2009. Weight loss was the primary outcome. Total costs, costs per participant, costs per kilogram lost, and incremental cost-effectiveness ratios (ICERs) were calculated in 2010-2011. All costs are the actual expenses (i.e., staff time and materials) incurred by the LEAN study (except where noted) and reported in 2010 U.S. dollars. RESULTS In the sample population of 197 sedentary, overweight, and obese adults (mean [±SD] age=46.9 ± 0.8 years, BMI=33.3 ± 5.2, weight=92.8 ± 18.4 kg), the GWL+SWA was the most expensive intervention in costs/participant ($365/partic) while yielding the greatest weight loss/partic (6.59 kg). The GWL was next in cost/partic ($240), but the SWA was less expensive in cost/partic ($183) and more efficacious (3.55 vs 1.86 kg/partic). The SC did not achieve significant weight loss. The SWA was the most cost effective ($51/partic/kg lost), followed by the GWL+SWA ($55) and GWL alone ($129). The ICER suggests that for each additional kilogram lost, the GWL+SWA cost $60 more than the SWA alone. CONCLUSIONS The SWA was the most cost-effective intervention ($51/partic/kg lost). The addition of the GWL increased the efficacy of the SWA intervention but increased costs by $60/partic for each additional kilogram lost. The technology-based approaches were more cost effective and efficacious than traditional approaches in promoting weight loss via lifestyle changes in sedentary, overweight, and obese adults.
Collapse
Affiliation(s)
- Edward Archer
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, 29201-3937, USA.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Pagoto SL, Schneider KL, Oleski JL, Luciani JM, Bodenlos JS, Whited MC. Male inclusion in randomized controlled trials of lifestyle weight loss interventions. Obesity (Silver Spring) 2012; 20:1234-9. [PMID: 21633403 DOI: 10.1038/oby.2011.140] [Citation(s) in RCA: 289] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prevalence of obesity is similar for men (32.2%) and women (35.5%). It has been assumed that lifestyle weight loss interventions have been developed and tested in predominately female samples, but this has not been systematically investigated. The aim of this review was to investigate total and ethnic male inclusion in randomized controlled trials of lifestyle interventions. PUBMED, MEDLINE, and PSYCHINFO were searched for randomized controlled trials of lifestyle weight loss interventions (N = 244 studies with a total of 95,207 participants) published in the last 10 years (1999-2009). A trial must be in English, included weight loss as an outcome, and tested a dietary, exercise, and/or other behavioral intervention for weight loss. Results revealed samples were on average 27% male vs. 73% female (P < 0.001). Trials recruiting a diseased sample included a larger proportion of males than those not targeting a disease (35% vs. 21%; P < 0.001). About 32% of trials used exclusively female samples, whereas only 5% used exclusively male samples (P < 0.001). No studies in the past 10 years specifically targeted minority males. Ethnic males identified composed 1.8% of total participants in US studies. Only 24% of studies that underrepresented males provided a reason. Males, especially ethnic males, are underrepresented in lifestyle weight loss trials.
Collapse
Affiliation(s)
- Sherry L Pagoto
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Kumanyika SK, Fassbender JE, Sarwer DB, Phipps E, Allison KC, Localio R, Morales KH, Wesby L, Harralson T, Kessler R, Tan-Torres S, Han X, Tsai AG, Wadden TA. One-year results of the Think Health! study of weight management in primary care practices. Obesity (Silver Spring) 2012; 20:1249-57. [PMID: 22051940 DOI: 10.1038/oby.2011.329] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Think Health! study evaluated a behavioral weight loss program adapted from the Diabetes Prevention Program (DPP) lifestyle intervention to assist primary care providers (PCPs) and auxiliary staff acting as lifestyle coaches (LCs) in offering weight loss counseling to their patients. In a randomized trial conducted at five clinical sites, study participants were randomly assigned in a 1:1 ratio within each site to either "Basic Plus" (n = 137), which offered PCP counseling every 4 months plus monthly LC visits during the first year of treatment, or "Basic" (n = 124), which offered only PCP counseling every 4 months. Participants were primarily (84%) female, 65% African American, 16% Hispanic American, and 19% white. In the 72% of participants in each treatment group with a 12-month weight measurement, mean (95% CI) 1-year weight changes (kg) were -1.61 (-2.68, -0.53) in Basic Plus and -0.62 (-1.45, 0.20) in Basic (difference: 0.98 (-0.36, 2.33); P = 0.15). Results were similar in model-based estimates using all available weight data for randomized participants, adjusting for potential confounders. More Basic Plus (22.5%) than Basic (10.2%) participants lost ≥ 5% of their baseline weight (P = 0.022). In a descriptive, nonrandomized analysis that also considered incomplete visit attendance, mean weight change was -3.3 kg in Basic Plus participants who attended ≥ 5 LC visits vs. + 0.53 kg in those attending <5 LC visits. We conclude that the Basic Plus approach of moderate-intensity counseling by PCPs and their staff can facilitate modest weight loss, with clinically significant weight loss in high program attenders.
Collapse
Affiliation(s)
- Shiriki K Kumanyika
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Comparison of the Block Kid's Food Frequency Questionnaire with a 24 h dietary recall methodology among Hmong-American children, 9-18 years of age. Br J Nutr 2012; 109:346-52. [PMID: 22716765 DOI: 10.1017/s0007114512001043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hmong are one of the immigrant Asian subgroups with increasing rates of obesity, type 2 diabetes and CVD. Despite their population growth in the USA and declining health status, no research has investigated the appropriateness of dietary assessment measures, including FFQ and 24 h dietary recalls among Hmong. The present study compared the nutrient information obtained through a 24 h dietary recall method with that collected using the Block Kid's Food Frequency Questionnaire (Block FFQ) among Hmong-American children (n 335) of 9-18 years of age. For this purpose, two 24 h dietary recalls were collected during non-consecutive days and averaged for comparison. The Block FFQ was administered on the day of the second 24 h recall and the two methodologies were also compared using t tests. Among all children, Block FFQ nutrient estimates for vitamin A, vitamin C and food group servings for vegetables and fruits were significantly higher than those assessed through the 24 h dietary recalls (P< 0.001). Nutrient estimates for protein and food group servings for grains and meat and beans were significantly higher among all participants when assessed through the 24 h dietary recalls than through the Block FFQ (P< 0.05). The results suggest that the Block FFQ does not appear to be a good measure of protein, grain, and meat and bean intake among Hmong children of 9-18 years of age, and the 24 h dietary recall offers a better account of the Hmong diet and is inclusive of ethnic food options otherwise missed in the Block FFQ. We recommend the modification of the current Block FFQ to appropriately reflect cultural food/beverage items of the population in interest.
Collapse
|
46
|
Brown SD, Lee K, Schoffman DE, King AC, Crawley LM, Kiernan M. Minority recruitment into clinical trials: experimental findings and practical implications. Contemp Clin Trials 2012; 33:620-3. [PMID: 22449836 DOI: 10.1016/j.cct.2012.03.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 01/31/2012] [Accepted: 03/07/2012] [Indexed: 11/19/2022]
Abstract
Racial and ethnic minorities in the US suffer disproportionately from obesity and related comorbidities, yet remain underrepresented in health research. To date, research on practical strategies to improve minority reach and recruitment into clinical trials is primarily descriptive rather than experimental. Within a randomized behavioral weight management trial for obese women, this recruitment experiment examined whether two characteristics of direct mail letters, an ethnically-targeted statement and personalization, increased the response rate among minority women. The ethnically-targeted statement noted ethnic-specific information about health risks of obesity. Personalized letters included recipients' names/addresses in the salutation and a handwritten signature on high-quality letterhead. Of women sent direct mail letters (N=30,000), those sent letters with the ethnically-targeted statement were more likely to respond than women sent letters with the generic statement, 0.8% (n=121) vs. 0.6% (n=90) respectively, p=.03, a 34.4% increase. Women sent personalized letters were no more likely to respond than women sent non-personalized letters, p=.53. In the weight management trial itself, of 267 women randomized into the trial, 33.7% (n=90) were minorities. Of minority women randomized into the trial, 68.9% (n=62) were recruited by direct mail letters: 75.8% (n=47) of those were sent a letter and 24.2% (n=15) were referred by friends/family who were sent a letter. The results indicate that a simple modification to a standard recruitment letter can have a meaningful impact on minority reach and recruitment rates. Practical implications include using ethnically-targeted, non-personalized direct mail letters and recruiting through friends/family at no additional cost.
Collapse
Affiliation(s)
- Susan D Brown
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA.
| | | | | | | | | | | |
Collapse
|
47
|
Turk MW, Sereika SM, Yang K, Ewing LJ, Hravnak M, Burke LE. Psychosocial correlates of weight maintenance among black & white adults. Am J Health Behav 2012; 36:395-407. [PMID: 22370440 DOI: 10.5993/ajhb.36.3.10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To investigate (1) weight maintenance among black and white participants and (2) psychosocial correlates (eg, healthy eating barriers, self-efficacy, stress) of weight maintenance 18 months after behavioral weight-loss treatment. METHODS Linear and logistic regression examined weight change and unsuccessful weight maintenance (>5% weight gain) among 107 black and white adults. RESULTS After controlling for socio-demographics, differences in weight maintenance between ethnicities were not generally noted. Healthy eating barriers and stressful life events were associated with weight gain, P<.04. CONCLUSIONS Strategies to cope with stressful events and overcome barriers to eating healthfully are needed for weight maintenance among both ethnicities.
Collapse
|
48
|
Magnusson MB, Sjöberg A, Kjellgren KI, Lissner L. Childhood obesity and prevention in different socio-economic contexts. Prev Med 2011; 53:402-7. [PMID: 22001687 DOI: 10.1016/j.ypmed.2011.09.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 09/15/2011] [Accepted: 09/21/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess recent trends in obesity, health beliefs, and lifestyles in Swedish schoolchildren, with focus on socioeconomic disparities. METHOD The study was conducted in two areas with high and low socioeconomic status (SES). 340 11-12 year olds participated in three cross-sectional surveys assessing food-related behaviours, physical activity and health beliefs, together with anthropometric examinations. Comparisons were made before and after a community-based intervention (2003 versus 2008) within the low-SES school, and between the low and high-SES school (2008 only). RESULTS In the low-SES school BMI z-score decreased over 5 years (0.80 vs 0.46) as did the percentage of children frequently consuming sweet drinks (43.5 vs 26.8%), statistically significant in girls only (p<0.05). Children increasingly perceived benefits of healthy life-styles (37 vs 55%). In 2008, consumption of breakfast, vegetables, sweets and sweet drinks differed between schools, as did screen-time and physical activity, all in favour of the high SES-school where the obesity-prevalence was significantly lower (0.8 vs 6.7%). CONCLUSION Positive changes in diet and weight status were observed, especially in girls, within a low-income multi-ethnic community undergoing a health promotion intervention. Our results underscore the multifactorial etiology of childhood obesity and the importance of continuing tailored, gender-sensitive prevention efforts.
Collapse
Affiliation(s)
- Maria B Magnusson
- Department of Public Health and Community Medicine, Public Health Epidemiology Unit, The Sahlgrenska Academy at the University of Gothenburg, Sweden.
| | | | | | | |
Collapse
|
49
|
Abstract
In 2010, the White House Task Force on Childhood Obesity provided benchmark goals for reducing childhood obesity. We evaluated the balance of prevention and treatment required for achieving Task Force goals in benchmark years 2015, 2020, and 2030. We created a simulation of US birth cohorts (2-19 years) born 2008-2030. For each year, we assumed "old" birth cohorts (part of previous benchmark obesity estimates) would benefit from obesity treatment strategies, and "new" birth cohorts would benefit from obesity prevention strategies. We assessed obesity prevalence that must be achieved through prevention strategies, under varying assumptions of treatment effectiveness. When we assumed a 1% absolute reduction in prevalence through treatment, we found that prevention strategies would need to achieve an obesity prevalence of 12% by 2015, 8% by 2020, and 0.3% by 2030. Because of higher obesity prevalence among minority children, prevention strategies would need to achieve a negative prevalence by 2030, which is implausible. Under more generous assumptions of treatment effectiveness, estimates became positive but remained low. Task Force goals are more difficult to achieve with each benchmark year. Policies must focus on obesity treatment interventions, particularly targeted to racial/ethnic minority children, to make progress in stemming the epidemic.
Collapse
Affiliation(s)
- Joyce M Lee
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, Michigan, USA.
| | | |
Collapse
|
50
|
Wilcox S, Sharpe PA, Parra-Medina D, Granner M, Hutto B. A randomized trial of a diet and exercise intervention for overweight and obese women from economically disadvantaged neighborhoods: Sisters Taking Action for Real Success (STARS). Contemp Clin Trials 2011; 32:931-45. [PMID: 21864718 DOI: 10.1016/j.cct.2011.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 06/23/2011] [Accepted: 08/09/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lower socioeconomic status at both the individual and neighborhood level is associated with increased health risks. Weight loss can reduce this risk, but few high quality weight-loss studies target this population. OBJECTIVES STARS tests a culturally appropriate, group-based behavioral and social support intervention on body weight and waist circumference in women from financially disadvantaged neighborhoods. DESIGN A stratified (by BMI) randomized trial. Randomization to group was generated by a random numbers table with allocation concealment by opaque envelopes. METHODS Participants 25-50 years who had a BMI ≥ 25 kg/m(2) and a waist circumference ≥ 88 cm were recruited from 18 census tracts in Columbia, SC with high rates of poverty between November 2008 and November 2010. All participants received a dietary and exercise counseling session. Intervention participants then receive 16 theoretically-based and tailored weekly group sessions followed by 8 weeks of telephone maintenance counseling. Control participants receive 16 weekly health education mailings. Measurements correspond to baseline, post-group intervention, and post-telephone counseling, and for intervention participants, after a 12-week no-contact period. Measurement staff was blinded to group assignment. RESULTS Participants (N=155; n=80 intervention, n=75 minimal intervention control) were primarily African American (86.5%) and averaged 38.9 years with a mean BMI of 40.1 kg/m(2) and waist circumference of 115.4 cm. Food insecurity was reported by 43% of participants. SUMMARY STARS targets an underserved population with an innovative, tailored, and theoretically-grounded, group-based intervention followed by telephone maintenance. If effective, the approach has the potential to be feasible and cost-effective for community delivery.
Collapse
Affiliation(s)
- Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | | | | | | | | |
Collapse
|