1
|
Vivian EM, Chewning BA, Voils CI, Brown RL. Healthy Outcomes through Peer Educators: Feasibility of a peer support diabetes prevention programme for African-American grandmother caregivers. Diabetes Obes Metab 2024; 26:2598-2605. [PMID: 38567410 DOI: 10.1111/dom.15574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
AIM To assess the protocol feasibility and intervention acceptability of a community-based, peer support diabetes prevention programme (DPP) for African-American (AA) grandmother caregivers at risk for diabetes. MATERIALS AND METHODS Grandmother caregivers were randomized in a 2:1 ratio to DPP (active comparator) or DPP plus HOPE (Healthy Outcomes through Peer Educators; intervention). DPP + HOPE incorporated support from a peer educator who met with participants in person or by telephone every week during the 1-year intervention. Outcomes included: (1) recruitment rates, outcome assessment, and participation adherence rates assessed quantitatively; and (2) acceptability of the programme assessed through end-of-programme focus groups. RESULTS We successfully consented and enrolled 78% (n = 35) of the 45 AA grandmothers screened for eligibility. Eighty percent of participants (aged 64.4 ± 5.7 years) were retained up to Week 48 (74% for DPP [n = 17] and 92% for DPP + HOPE [n = 11]). All grandmothers identified social support, neighbourhood safety, and access to grocery stores as influences on their health behaviours. At Month 12, the active comparator (DPP) group and the intervention group (DPP + HOPE) had a mean change in body weight from baseline of -3.5 ± 5.5 (-0.68, -6.29) kg and - 4.4 ± 5.7 (-0.59, -8.2) kg, respectively. CONCLUSIONS This viable study met the aim of educating and equipping AA grandmothers with the practical and sustained support needed to work toward better health for themselves and their grandchildren, who may be at risk for diabetes. The intervention was both feasible and acceptable to participating grandmothers and their organizations.
Collapse
Affiliation(s)
- Eva M Vivian
- University of Wisconsin Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Betty A Chewning
- University of Wisconsin Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Corrine I Voils
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Roger L Brown
- University of Wisconsin School of Nursing and School of Medicine and Public Health, Madison, Wisconsin, USA
| |
Collapse
|
2
|
Chao AM, Moore M, Wadden TA. The past, present, and future of behavioral obesity treatment. Int J Obes (Lond) 2024:10.1038/s41366-024-01525-3. [PMID: 38678143 DOI: 10.1038/s41366-024-01525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
Over the last century, hundreds of evaluations have been conducted to examine weight-management interventions related to diet, physical activity, and behavior therapy. These investigations have contributed to a growing body of knowledge that has consistently advanced the field of obesity treatment, while also revealing some persistent challenges. This narrative review summarizes key findings from randomized controlled trials conducted in adults that have combined diet, physical activity, and behavior therapy, an approach variously referred to as behavioral treatment, comprehensive lifestyle modification, or intensive lifestyle intervention. The review shows that current behavioral approaches induce average reductions in baseline body weight of 5 to 10% at 6 to 12 months. Such losses have proven effective in reducing the risk of type 2 diabetes in persons with impaired glucose tolerance and in improving other obesity-related complications. These benefits have also been associated with reductions in healthcare costs. Despite these advances, behavioral treatment is challenged by the need for larger losses to achieve optimal improvements in health, by difficulties associated with maintaining weight loss, and by barriers limiting access to treatment. New anti-obesity medications, when combined with behavioral obesity treatment, hold promise of addressing the first two issues.
Collapse
Affiliation(s)
- Ariana M Chao
- Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | - Molly Moore
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
3
|
Bauer AG, Shah B, Johnson N, Aduloju-Ajijola N, Bowe-Thompson C, Christensen K, Berkley-Patton JY. Feasibility and Acceptability of the Project Faith Influencing Transformation Intervention in Faith-Based Settings. HEALTH EDUCATION & BEHAVIOR 2024; 51:291-301. [PMID: 37978814 DOI: 10.1177/10901981231211538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
African Americans (AAs) are disproportionately burdened with diabetes and prediabetes. Predominately AA churches may be optimal settings for reaching AAs at greatest diabetes risk, along with related morbidities and mortalities. The current study used the RE-AIM framework to qualitatively examine the feasibility, acceptability, and satisfaction with the Project Faith Influencing Transformation (FIT) intervention, a diabetes risk reduction intervention in AA churches. Participants were (N = 21) church and community members who also participated in the larger Project FIT intervention and were primarily female, with an average age of 60 years (SD = 11.1). Participants completed a brief survey and focus group discussion. Participants discussed intervention effectiveness in changing health behaviors and outcomes, with high rates of adoption, acceptability, and satisfaction across churches that conducted the intervention. Participants also discussed outreach to members of the broader community, the role of the pastor, and challenges to intervention implementation and maintenance-tailored strategies to improve intervention effectiveness are discussed. Given the significant diabetes disparities that exist for AAs, it is imperative to continue to investigate best practices for reaching communities served by churches with sustainable, relevant health programming. This study has the potential to inform more effective, tailored diabetes prevention interventions for high-risk AAs in faith-based settings.
Collapse
Affiliation(s)
- Alexandria G Bauer
- Rutgers University-New Brunswick, Piscataway, NJ, USA
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Binoy Shah
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nia Johnson
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | | | | | | |
Collapse
|
4
|
Alick CL, Braxton D, Skinner H, Alexander R, Ammerman AS, Keyserling TC, Samuel-Hodge CD. Rural African American Women With Severe Obesity: A Cross-Sectional Analysis of Lifestyle Behaviors and Psychosocial Characteristics. Am J Health Promot 2023; 37:1060-1069. [PMID: 37505193 PMCID: PMC10631280 DOI: 10.1177/08901171231190597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
PURPOSE To examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity. DESIGN Cross-sectional study. SETTING Rural Southeastern United States. SUBJECTS Participants included 289 African American women with a mean age of 56 years, 66% with a high school education or less, and a mean body mass index (BMI) of 38.6 kg/m2; 35% (n = 102) were classified with Class 3 obesity. MEASURES We objectively measured height, weight, and physical activity steps/day. Self-reported dietary and physical activity behaviors, general health-related quality of life, mental health, and social support were measured with validated surveys. ANALYSIS Chi-Square analysis for categorical variables and analysis of variance (ANOVA) - via multiple linear regression - for continuous variables. RESULTS There were no significant demographic differences between BMI groups, except for age, where women with Class 3 obesity were on average younger (51 vs 58 y, P < .001). Although dietary behaviors did not differ significantly between groups, we observed significant group differences in self-reported and objective measures of physical activity. The age-adjusted difference in means for self-reported total physical activity minutes/wk. was 91 minutes, with women categorized with Class 3 obesity reporting significantly fewer weekly minutes than those with overweight/Class 1-2 obesity (64.3 vs 156.4 min/wk. respectively, P < .01). Among psychosocial variables, only in the physical component scores of health-related quality of life did we find significant group differences - lower physical well-being among women with Class 3 obesity compared to those with overweight/Class 1-2 obesity (P = .02). CONCLUSION For African American women with Class 3 obesity living in rural setting, these findings suggest behavioral weight loss interventions may need to target physical activity strategies that address physical, psychosocial, and environmental barriers.
Collapse
Affiliation(s)
- Candice L. Alick
- Center for Health Promotion & Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Danielle Braxton
- Department of Health Promotion, North Carolina Wesleyan College, Rocky Mount, NC, USA
| | - Harlyn Skinner
- Department of Biological Science, Center for Human Health and the Environment, North Carolina State University, Chapel Hill, NC, USA
| | - Ramine Alexander
- Department of Family and Consumer Sciences, Food and Nutritional Sciences, North Carolina Agricultural & Technical State University, Greensboro, NC, USA
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C. Keyserling
- Internal Medicine, UNC School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Carmen D. Samuel-Hodge
- Department of Nutrition, Gillings School of Global Public Health, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
5
|
Dodgen L, Kitzman H, Spence E, Mamun A, Walters ST, Cervantes D. What's theory got to do with it: measuring effects of theory on lifestyle behaviors and weight in the Better Me Within Randomized Trial. AMERICAN JOURNAL OF HEALTH EDUCATION 2023; 54:86-98. [PMID: 37396565 PMCID: PMC10311983 DOI: 10.1080/19325037.2022.2163007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/08/2022] [Indexed: 02/19/2023]
Abstract
Background Knowing which theoretical constructs work best to design effective interventions is essential for populations with increased disease burden. African American women (AAW) experience greater prevalence of chronic diseases and fewer benefits from weight loss interventions compared to White women. Purpose To examine how theoretical constructs were associated with lifestyle behaviors and weight outcomes in the Better Me Within (BMW) Randomized Trial. Methods BMW used a tailored diabetes prevention program implemented in churches among AAW with BMI ≥ 25. Regression models assessed relationships between constructs (self-efficacy, social support and motivation), and outcomes (physical activity (PA), calories, and weight). Results Among 221 AAW (mean (SD) age 48.8 years (11.2); mean weight 215.1 pounds (50.5), several significant relationships were found including an association between change in motivation for activity and change in PA (p=.003), and change in motivation for diet and weight at follow-up (p=<.001). Discussion The clearest relationships emerged for PA with motivation for activity and weight management social support demonstrating significance in all models. Translation to Practice Self-efficacy, motivation and social support show promise to promote changes in PA and weight among church-going AAW. Opportunities to keep engaging AAW in research are essential for eliminating health inequities in this population.
Collapse
Affiliation(s)
- Leilani Dodgen
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
- Research, Baylor Scott & White Health and Wellness Center, Dallas, TX, USA
| | - Heather Kitzman
- Research, Baylor Scott & White Health and Wellness Center, Dallas, TX, USA
- Robbins Institute for Health Policy & Leadership, Baylor University, Waco, TX, USA
| | - Emily Spence
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Abdullah Mamun
- Research, Baylor Scott & White Health and Wellness Center, Dallas, TX, USA
- Ethicon, Raritan, NJ, USA
| | - Scott T. Walters
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Diana Cervantes
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| |
Collapse
|
6
|
Goedecke JH, Mendham AE. Pathophysiology of type 2 diabetes in sub-Saharan Africans. Diabetologia 2022; 65:1967-1980. [PMID: 36166072 PMCID: PMC9630207 DOI: 10.1007/s00125-022-05795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/12/2022] [Indexed: 01/11/2023]
Abstract
Sub-Saharan Africa (SSA) is the region with the highest projected rates of increase in type 2 diabetes (129% by 2045), which will exacerbate the already high prevalence of type 2 diabetes complications and comorbidities in SSA. In addition, SSA is grappling with poverty-related health problems and infectious diseases and is also undergoing the most rapid rates of urbanisation globally. These socioenvironmental and lifestyle factors may interact with genetic factors to alter the pathophysiological sequence leading to type 2 diabetes in sub-Saharan African populations. Indeed, current evidence from SSA and the diaspora suggests that the pathophysiology of type 2 diabetes in Black Africans is different from that in their European counterparts. Studies from the diaspora suggest that insulin clearance is the primary defect underlying the development of type 2 diabetes. We propose that, among Black Africans from SSA, hyperinsulinaemia due to a combination of both increased insulin secretion and reduced hepatic insulin clearance is the primary defect, which promotes obesity and insulin resistance, exacerbating the hyperinsulinaemia and eventually leading to beta cell failure and type 2 diabetes. Nonetheless, the current understanding of the pathogenesis of type 2 diabetes and the clinical guidelines for preventing and managing the disease are largely based on studies including participants of predominately White European ancestry. In this review, we summarise the existing knowledge base and data from the only non-pharmacological intervention that explores the pathophysiology of type 2 diabetes in SSA. We also highlight factors that may influence the pathogenesis of type 2 diabetes in SSA, such as social determinants, infectious diseases and genetic and epigenetic influences.
Collapse
Affiliation(s)
- Julia H Goedecke
- Biomedical Research and Innovation Platform and Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Amy E Mendham
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit (DPHRU), Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health through Physical Activity, Lifestyle and Sport Research Centre (HPALS), FIMS International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
7
|
Saju R, Castellon-Lopez Y, Turk N, Moin T, Mangione CM, Norris KC, Vu A, Maranon R, Fu J, Cheng F, Duru OK. Differences in Weight Loss by Race and Ethnicity in the PRIDE Trial: a Qualitative Analysis of Participant Perspectives. J Gen Intern Med 2022; 37:3715-3722. [PMID: 35469358 PMCID: PMC9037581 DOI: 10.1007/s11606-022-07521-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many Diabetes Prevention Program (DPP) translation efforts have been less effective for underresourced populations. In the cluster-randomized Prediabetes Informed Decision and Education (PRIDE) trial, which evaluated a shared decision-making (SDM) intervention for diabetes prevention, Hispanic and non-Hispanic Black participants lost less weight than non-Hispanic White participants at 12-month follow-up. OBJECTIVE To explore perspectives about weight loss from PRIDE participants of different racial and ethnic groups. PARTICIPANTS Sample of participants with prediabetes who were randomized to the PRIDE intervention arm (n=24). APPROACH We conducted semi-structured interviews within three groups stratified by DPP participation and % weight loss at 12 months: (DPP+/WL+, enrolled in DPP and lost >5% weight; DPP+/WL-, enrolled in DPP and lost <3% weight; DPP-/WL-, did not enroll in DPP and lost <3% weight). Each group was further subdivided on race and ethnicity (non-Hispanic Black (NHB), non-Hispanic White (NHW), Hispanic). Interviews were conducted on Zoom and transcripts were coded and analyzed with Dedoose. KEY RESULTS Compared to NHW participants, Hispanic and NHB participants more often endorsed weight loss barriers of limited time to make lifestyle changes due to long work and commute hours, inconvenient DPP class locations and offerings, and limited disposable income for extra weight loss activities. Conversely, facilitators of weight loss regardless of race and ethnicity included retirement or having flexible work schedules; being able to identify convenient DPP classes; having a strong, positive support system; and purchasing supplementary resources to support lifestyle change (e.g., gym memberships, one-on-one activity classes). CONCLUSIONS We found that NHB and Hispanic SDM participants report certain barriers to weight loss more commonly than NHW participants, particularly barriers related to limited disposable income and/or time constraints. Our findings suggest that increased lifestyle change support and flexible program delivery options may be needed to ensure equity in DPP reach, participant engagement, and outcomes.
Collapse
Affiliation(s)
- Rintu Saju
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yelba Castellon-Lopez
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - Norman Turk
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Health System and HSR&D Center for Study of Healthcare Innovation, Implementation & Policy, University of California, Los Angeles, CA, USA
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Amanda Vu
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Richard Maranon
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Jeffery Fu
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Felicia Cheng
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - O Kenrik Duru
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
| |
Collapse
|
8
|
LaRose JG, Reading JM, Lanoye A, Brown KL. Recruitment and retention of emerging adults in lifestyle interventions: Findings from the REACH trial. Contemp Clin Trials 2022; 121:106904. [PMID: 36055582 PMCID: PMC10430794 DOI: 10.1016/j.cct.2022.106904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Emerging adulthood (EA) is a critical time to promote cardiometabolic health, but EAs are underrepresented in lifestyle intervention trials. Knowledge gaps exist regarding how best to recruit and retain sociodemographically diverse EAs. Our goal was to begin to address these gaps using data from the Richmond Emerging Adults Choosing Health (REACH) Trial. METHODS REACH was a comparative efficacy trial for EAs, age 18-25, with a body mass index of 25-45 kg/m2. Enrollment goals were: N = 381, ≥40% underrepresented race/ethnicity, ≥30% men, ≥85% retention at 6 months. We translated formative work into a recruitment and retention plan, examined yield for recruitment and retention overall, and by gender and race/ethnicity, as well as cost data. Descriptive statistics and chi square tests were used. RESULTS Enrollment benchmarks were met overall (N = 382) and for participants from underrepresented race/ethnic backgrounds (58.0%), but not men (17.3%). The most common recruitment sources were email (26.9%), radio (22.2%), and online radio (15.4%); this pattern largely held true across gender and race/ethnic groups, though word of mouth and participant referral together accounted for nearly a quarter of enrolled men. Costs averaged $155 per randomized participant. Retention was 89% at 3-months, 84% at 6-months (primary endpoint) and 80% at 12-months (follow-up), with no significant differences by gender or race/ethnicity (all p's > 0.05). Retention did not differ by recruitment method (p = .69). CONCLUSIONS Grounding our approach in formative data and embracing participants as partners in research contributed to the recruitment and retention of sociodemographically diverse EAs. Additional efforts are needed to enroll EA men.
Collapse
Affiliation(s)
| | - Jean M Reading
- Virginia Commonwealth University School of Medicine, USA
| | - Autumn Lanoye
- Virginia Commonwealth University School of Medicine, USA; VCU Massey Cancer Center, USA
| | - Kristal Lyn Brown
- Virginia Commonwealth University School of Medicine, USA; The Johns Hopkins University School of Medicine, USA
| |
Collapse
|
9
|
Kinsey AW, Phillips J, Desmond R, Gowey M, Jones C, Ard J, Clark JM, Lewis CE, Dutton GR. Factors Associated with Weight Loss Maintenance and Weight Regain Among African American and White Adults Initially Successful at Weight Loss. J Racial Ethn Health Disparities 2022; 9:546-565. [PMID: 33544328 PMCID: PMC8339173 DOI: 10.1007/s40615-021-00985-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Providing ongoing treatment through extended care programs can improve weight loss maintenance (WLM), but the effectiveness of these programs for African Americans (AA) are mixed and may be due to unique cultural factors. PURPOSE To identify, prioritize, and organize factors associated with WLM as experienced by AA and White adults initially successful with weight loss. METHODS Adults identified their greatest amount of lifetime weight loss, and those achieving ≥5% weight loss were classified as maintainers (continued >5% weight reduction for ≥1 year) or regainers (≤5% weight reduction) based on current weight. The nominal group technique was conducted to identify and rank WLM facilitators and barriers. Online card sorting tasks and hierarchical clustering were performed to illustrate conceptual relationships between facilitators (maintainers only) and barriers (regainers only). RESULTS Participants (maintainers, n = 46; regainers, n = 58; 81.7% women, 48.1% AA) identified known factors associated with successful weight management (daily weighing, self-monitoring, regular physical activity, mindful eating). However, the perceived importance of these factors differed between groups (maintainer vs. regainers; AA vs. Whites). Unique factors affecting WLM were also identified (refresher groups recommended by White maintainers and regainers; self-accountability identified by AA maintainers). Salient facilitators and barriers were best represented in 2-3 clusters; each group had ≥1 unique cluster(s) revealing group-specific higher-order domains associated with successful WLM. CONCLUSIONS As lifestyle interventions for WLM (particularly for AA) are developed, attention to the preferences, and lived experiences of these groups is recommended. Strategies targeting physical activity maintenance and autonomy-supportive approaches may improve WLM among AA.
Collapse
Affiliation(s)
- Amber W Kinsey
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Janice Phillips
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Renee Desmond
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA
| | - Marissa Gowey
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Catherine Jones
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jamy Ard
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Jeanne M Clark
- Division of General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Medical Towers 615, Birmingham, AL, 35205, USA.
| |
Collapse
|
10
|
Peers empowering peers-feasibility of a peer educator training program to prevent diabetes. BMC Womens Health 2022; 22:65. [PMID: 35260142 PMCID: PMC8905906 DOI: 10.1186/s12905-022-01645-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study assessed the feasibility and acceptability of the Healthy Outcomes through Peer Educators (HOPE) training program designed to train African American (AA) grandmothers to serve as peer educators for other AA grandmothers who are at risk for diabetes. The newly trained peer educators will provide the needed encouragement and positive reinforcement essential for successful sustainable health behaviors to grandmothers enrolled in a subsequent Diabetes Prevention Program. Methods Thirty AA women between the ages of 49–72 were enrolled in the pre-post single group study. The participants were required to attend a 2-h Diabetes Prevention Program session every week for 16 weeks. The sessions covered the role of the peer educator and encouraged participants to increase their physical activity and consume more servings of fruits and vegetables daily. We noted the number of participants who successfully completed the training and solicited their perspective regarding the strengths of the program and suggestions to improve the program. The Wilcoxon Signed Ranks Test was performed to evaluate changes in body weight, self-reported physical activity, and fruit and vegetable intake from baseline to week 16. Results Ninety three percent (n = 28) of enrollees completed the training program. All (n = 28) the peer educator trainees indicated that they would recommend the program to a friend and 93% (n = 26) reported that the program met their needs. The participants (n = 28) felt that the training prepared them to offer support to other grandmothers in their community. A Wilcoxon Signed Ranks Test revealed that participants body weights were significantly lower after completion of the 16 week training program (median = 156.5 lbs., n = 28) compared to baseline (median = 163.0, n = 28), Z = − 4.43, p < 0.05. Fruit and vegetable intake increased significantly (median = 5, n = 28) at week 16 compared to week one, (median = 2, n = 28) Z = 4.46, p < 0.05. Participants were more physically active at week 16 (median = 150 min per week, n = 28) compared to week 1, (median = 30 min per week, n = 28) Z = 4.62, p < 0.05. Conclusions The peer educator training component of HOPE was found to be feasible and acceptable as evidenced by our successful recruitment and retention of participants. Participation in the peer educator training program also resulted in improvement in health behaviors.
Collapse
|
11
|
Buro AW, Baskin M, Miller D, Ward T, West DS, Gore LR, Gwede CK, Epel E, Carson TL. Rationale and study protocol for a randomized controlled trial to determine the effectiveness of a culturally relevant, stress management enhanced behavioral weight loss intervention on weight loss outcomes of black women. BMC Public Health 2022; 22:193. [PMID: 35090433 PMCID: PMC8795937 DOI: 10.1186/s12889-022-12519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Obesity is a persistent public health concern and a risk factor for many chronic diseases including at least 13 different cancers. Adult Black females have the highest prevalence of obesity (57%) compared to other racial/gender groups in the U.S. Although behavioral weight loss (BWL) interventions have demonstrated effectiveness, Black females tend to lose less weight than White counterparts. The higher prevalence of chronic psychological stress reported by Black females may contribute to their disproportionate prevalence of obesity and observed suboptimal weight loss. This study will examine the effectiveness of a 12-month culturally-targeted, stress management-enhanced BWL intervention on weight loss and stress reduction among Black females in a fully-powered randomized, controlled trial. METHODS Adult Black females with obesity (n = 340) will be randomized to either a culturally targeted stress management-enhanced BWL intervention (BWL-Stress) or the same BWL intervention alone (BWL-alone). The primary outcome is weight change at month 6. Secondary outcomes will include changes in stress measures (e.g., perceived stress, cortisol), energy intake, and physical activity at month 6. We will also assess process measures (e.g., treatment adherence, treatment burden). Each outcome will also be evaluated at month 12 to assess longer-term effects of the intervention. DISCUSSION This novel approach for enhancing an evidence-based BWL program with culturally-targeted stress management strategies for Black females addresses an understudied barrier to effective weight management among a population at high risk for obesity and obesity-related chronic diseases. This study will potentially elucidate psychological or behavioral mechanisms linking our novel intervention to study outcomes. If the intervention is proven to be effective, this study will have significant clinical and public health implications for weight management among Black females. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov , identifier NCT04335799t , on April 6, 2020.
Collapse
Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Monica Baskin
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Darci Miller
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Tayler Ward
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Delia Smith West
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - L Robert Gore
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Clement K Gwede
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA
| | - Elissa Epel
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4117 E Fowler Ave, Tampa, FL, 33617, USA.
| |
Collapse
|
12
|
Yeary KHCK, Ounpraseuth S, Wan F, Graetz I, Fagan P, Huff-Davis A, Kaplan C, Johnson K, Hutchins E. Assessing the Feasibility of an Online Training Designed to Enable Community Health Workers to Deliver a Comprehensive, Evidence-Based Weight Loss Intervention for Rural African Americans of Faith. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1277-1284. [PMID: 32441002 PMCID: PMC7679277 DOI: 10.1007/s13187-020-01764-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Obesity is a critical modifiable risk factor in cancer prevention, control, and survivorship. Comprehensive weight loss interventions (e.g., Diabetes Prevention Program (DPP)) have been recommended by governmental agencies to treat obesity. However, their high implementation costs limit their reach, especially in underserved African American (AA) communities. Community health workers (CHWs) or trusted community members can help increase access to obesity interventions in underserved regions facing provider shortages. CHW-led interventions have increased weight loss. However, in-person CHW training can be costly to deliver and often requires extensive travel to implement. Web-based trainings have become common to increase reach at reduced cost. However, the feasibility of an online CHW training to deliver the DPP in AAs is unknown. The feasibility of an online CHW training to deliver the DPP adapted for AAs was assessed. The online training was compared to an in-person DPP training with established effectiveness. CHW effectiveness and satisfaction were assessed at baseline and 6 weeks. Nineteen participants (in-person n = 10; online n = 9) were recruited. At post-training, all scored higher than the 80% on a knowledge test required to deliver the intervention. All participants reported high levels of training satisfaction (88.9% of online participants and 90% of in-person participants rated the training as at least 6 on a 1-7 scale) and comfort to complete intervention tasks (78% of online participants and 60% of in-person participants scored at least 6 on a 1-7 scale). There were no significant differences in outcomes by arm. An online CHW training to deliver the DPP adapted for AAs faith communities produced comparable effectiveness and satisfaction to an evidence-based in-person CHW training. Further research is needed to assess the cost-effectiveness of different CHW training modalities to reduce obesity.
Collapse
Affiliation(s)
- Karen Hye-Cheon Kim Yeary
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carton Streets, Buffalo, NY, 14263, USA.
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Fei Wan
- Department of Surgery, Washington University School of Medicine in St. Louis, 660 Euclid Avenue, St. Louis, MO, 63110, USA
| | - Ilana Graetz
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Suite 636, Atlanta, GA, 30322, USA
| | - Pebbles Fagan
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Anna Huff-Davis
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Cameron Kaplan
- The Gehr Center for Health Systems Science & Innovation, Keck School of Medicine of USC, 2020 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Kemmian Johnson
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| | - Ellen Hutchins
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, 72205, USA
| |
Collapse
|
13
|
Devaraj SM, Napoleone JM, Miller RG, Rockette-Wagner B, Arena VC, Mitchell-Miland C, Saad MB, Kriska AM. The role of Sociodemographic factors on goal achievement in a community-based diabetes prevention program behavioral lifestyle intervention. BMC Public Health 2021; 21:1783. [PMID: 34600527 PMCID: PMC8487523 DOI: 10.1186/s12889-021-11844-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/29/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The Diabetes Prevention Program (DPP) behavioral lifestyle intervention was effective among a diverse sample of adults with prediabetes. Demonstrated effectiveness in translated versions of the DPP lifestyle intervention (such as Group Lifestyle Balance, DPP-GLB) led to widescale usage with national program oversight and reimbursement. However, little is known about the success of these DPP-translation programs across subgroups of sociodemographic factors. This current effort investigated potential disparities in DPP-translation program primary goal achievement (physical activity and weight) by key sociodemographic factors. METHODS Data were combined from two 12-month community-based DPP-GLB trials among overweight/obese individuals with prediabetes and/or metabolic syndrome. We evaluated change in weight (kilograms and percent) and activity (MET-hrs/week) and goal achievement (yes/no; ≥5% weight loss and 150 min per week activity) after 6 and 12 months of intervention within and across subgroups of race/ethnicity (non-Hispanic white, non-Hispanic black), employment status, education, income, and gender. RESULTS Among 240 participants (85%) with complete data, most sociodemographic subgroups demonstrated significant weight loss. However, non-Hispanic white lost more weight at both 6 and 12 months compared to non-Hispanic black participants [median weight loss (IQR), 6 months: 5.7% (2.7-9.0) vs. 1.5% (1.2-7.5) p = .01 and 12 months: 4.8% (1.1-9.6) vs. 1.1% (- 2.0-3.7) p = .01, respectively]. In addition, a larger percentage of non-Hispanic white demonstrated a 5% weight loss at 6 and 12 months. Employment was significantly related to 12-month weight loss, with retired participants being the most successful. Men, participants with graduate degrees, and those with higher income were most likely to meet the activity goal at baseline and 12 months. Differences in physical activity goal achievement across gender, education, and income groups were significant at baseline, attenuated after 6 months, then re-emerged at 12 months. CONCLUSIONS The DPP-GLB was effective in promoting weight loss and helped to alleviate disparities in physical activity levels after 6 months. Despite overall program success, differences in weight loss achievement by race/ethnicity were found and disparities in activity re-emerged after 12 months of intervention. These results support the need for intervention modification providing more tailored approaches to marginalized groups to maximize the achievement and maintenance of DPP-GLB behavioral goals. TRIAL REGISTRATION NCT01050205 , NCT02467881 .
Collapse
Affiliation(s)
- Susan M Devaraj
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Jenna M Napoleone
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Rachel G Miller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Bonny Rockette-Wagner
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Chantele Mitchell-Miland
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Mohammed Bu Saad
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Andrea M Kriska
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 5135 Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| |
Collapse
|
14
|
DeHaven MJ, Gimpel NA, Kitzman H. Working with communities: Meeting the health needs of those living in vulnerable communities when Primary Health Care and Universal Health Care are not available. J Eval Clin Pract 2021; 27:1056-1065. [PMID: 33051956 DOI: 10.1111/jep.13495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/10/2020] [Accepted: 09/21/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The health care delivery model in the United States does not work; it perpetuates unequal access to care, favours treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are low-income minorities (Native Americans, Hispanics, and African-Americans) who live in high risk and vulnerable communities. The historical lack of support in the United States for Universal Health Care (UHC) and Primary Health Care (PHC)-with their emphasis on health care for all, population health, and social determinants of health-requires community health scientists to develop innovative local solutions for addressing unmet community health needs. METHODS We developed a model community health science approach for improving health in fragile communities, by combining community-oriented primary care (COPC), community-based participatory research (CBPR), asset-based community development, and service learning principles. During the past two decades, our team has collaborated with community residents, local leaders, and many different types of organizations, to address the health needs of vulnerable patients. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action. RESULTS From 2000 to 2020, we established a federally funded research programme for testing interventions to improve health outcomes in vulnerable communities, by working in partnership with community organizations and other stakeholders. The partnership goals were reducing chronic disease risk and multimorbidity, by stimulating lifestyle changes, increasing healthy behaviours and health knowledge, improving care seeking and patient self-management, and addressing the social determinants of health and population health. Our programmes have also provided structured community health science training in high-risk communities for hundreds of doctors in training. CONCLUSION Our community health science approach demonstrates that the factors contributing to health can only be addressed by working directly with and in affected communities to co-develop health care solutions across the broad range of causal factors. As the United States begins to consider expanding health care options consistent with PHC and UHC principles, our community health science experience provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest assets US health care systems have for better addressing population health and the social determinants of health are the important health-related initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for improving health outcomes and reducing health disparities. This has been the greatest lesson we have learned the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved.
Collapse
Affiliation(s)
- Mark J DeHaven
- Academy for Research on Community Health, Engagement, and Services (ARCHES), University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Nora A Gimpel
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heather Kitzman
- Robbins Institute for Health Policy & Leadership, Baylor Scott & White Health and Wellness, Dallas, Texas, USA
| |
Collapse
|
15
|
Woods-Giscombe CL, Gaylord SA, Faurot KR, Lynch C, Phillips P. It Is Not Just About Enrollment: Recognizing the Impact of RCT Recruitment Approaches on Prediabetes Awareness, Screening, and Capacity Building in African American Communities. J Urban Health 2021; 98:123-128. [PMID: 34142348 PMCID: PMC8501166 DOI: 10.1007/s11524-021-00543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Cheryl L. Woods-Giscombe
- School of Nursing, University of North Carolina at Chapel Hill, C.B.# 7460, 4103 Carrington Hall, Chapel Hill, NC USA
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Keturah R. Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Pamela Phillips
- Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| |
Collapse
|
16
|
Formagini T, Brooks JV, Jacobson LT, Roberts AW. Reimbursement Policies for Diabetes Prevention Program (DPP): Implications for Racial and Ethnic Health Disparities. Kans J Med 2021; 14:234-237. [PMID: 34540140 PMCID: PMC8415384 DOI: 10.17161/kjm.vol1415125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Taynara Formagini
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
| | - Joanna V Brooks
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
- University of Kansas Cancer Center, Kansas City, KS
| | - Lisette T Jacobson
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Andrew W Roberts
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS
- University of Kansas Cancer Center, Kansas City, KS
- Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, KS
| |
Collapse
|
17
|
Abstract
The global diabetes burden is staggering, and prevention efforts are needed to reduce the impact on individuals and populations. There is strong evidence from efficacy trials showing that lifestyle interventions promoting increased physical activity, improvements in diet, and/or weight loss significantly reduce diabetes incidence and improve cardiometabolic risk factors. Implementation research assessing the feasibility, effectiveness, and cost-effectiveness of delivering these proven programs at the community level has shown success, but more research is needed to overcome barriers to implementation in different settings globally. New avenues of research should be considered to combat this public health issue.
Collapse
Affiliation(s)
- Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
| | - Saria Hassan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA; Department of Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Rakale Quarells
- Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Drive, SW NCPC-318, Atlanta, GA 30310, USA
| | - Megha Shah
- Department of Family and Preventive Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| |
Collapse
|
18
|
LaRose JG, Lanoye A, Ferrell D, Lu J, Mosavel M. Translating evidence-based behavioral weight loss into a multi-level, community intervention within a community-based participatory research framework: the Wellness Engagement (WE) Project. Transl Behav Med 2021; 11:1235-1243. [PMID: 33823050 DOI: 10.1093/tbm/ibaa140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Black Americans and individuals from economically disadvantaged backgrounds are at disproportionate risk for obesity, yet are underrepresented in behavioral weight loss (BWL) trials and experience less benefit from traditional programs. The Wellness Engagement (WE) Project sought to translate evidence-based BWL within a CBPR framework to promote change across multiple domains of influence in an under-resourced, predominantly Black community. The purpose of this paper is to describe the efforts we undertook to translate data from our extensive formative phase into programming well suited to meet the needs of the Petersburg community. In addition, we present data from our pilot work on feasibility and acceptability. Formative data were collected using a variety of methods including a community-wide survey, asset mapping, house chats, focus groups, and key informant interviews. In collaboration with key stakeholders and community members, evidence-based approaches to weight loss were adapted to meet the needs of the community with respect to both content and delivery modality. Materials were adapted to focus on small, realistic changes appropriate for the specific context. Behavioral groups, experiential nutrition and exercise sessions, and walking groups leveraged existing assets and were open to all community members. Feasibility and acceptability ratings were promising. Furthermore, the WE Project appeared to contribute to a culture of wellness. CBPR might be a viable approach for engaging under-resourced Black communities in behavioral weight management; larger scale implementation and evaluation efforts are needed.
Collapse
Affiliation(s)
- Jessica Gokee LaRose
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA, USA
| | - Autumn Lanoye
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA, USA.,Virginia Commonwealth University, Massey Cancer Center, Richmond, VA, USA
| | | | - Juan Lu
- Virginia Commonwealth University School of Medicine, Department of Family Medicine, Division of Epidemiology, Richmond, VA, USA
| | - Maghboeba Mosavel
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, VA, USA
| |
Collapse
|
19
|
Kinsey AW, Gowey MA, Tan F, Zhou D, Ard J, Affuso O, Dutton GR. Similar weight loss and maintenance in African American and White women in the Improving Weight Loss (ImWeL) trial. ETHNICITY & HEALTH 2021; 26:251-263. [PMID: 29966428 PMCID: PMC6314901 DOI: 10.1080/13557858.2018.1493435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Abstract
Objective: African Americans (AA) are often underrepresented and tend to lose less weight than White participants during the intensive phase of behavioral obesity treatment. Some evidence suggests that AA women experience better maintenance of lost weight than White women, however, additional research on the efficacy of extended care programs (i.e. continued contacts to support the maintenance of lost weight) is necessary to better understand these differences.Methods: The influence of race on initial weight loss, the likelihood of achieving ≥5% weight reduction (i.e. extended care eligibility), the maintenance of lost weight and extended care program efficacy was examined in 269 AA and White women (62.1% AA) participating in a 16-month group-based weight management program. Participants achieving ≥5% weight reduction during the intensive phase (16 weekly sessions) were randomized to a clustered campaign extended care program (12 sessions delivered in three, 4-week clusters) or self-directed control.Results: In adjusted models, race was not associated with initial weight loss (p = 0.22) or the likelihood of achieving extended care eligibility (odds ratio 0.64, 95% CI [0.29, 1.38]). AA and White women lost -7.13 ± 0.39 kg and -7.62 ± 0.43 kg, respectively, during initial treatment. There were no significant differences in weight regain between AA and White women (p = 0.64) after adjusting for covariates. Clustered campaign program participants (AA: -6.74 ± 0.99 kg, White: -6.89 ± 1.10 kg) regained less weight than control (AA: -5.15 ± 0.99 kg, White: -4.37 ± 1.04 kg), equating to a 2.12 kg (p = 0.03) between-group difference after covariate adjustments.Conclusions: Weight changes and extended care eligibility were comparable among all participants. The clustered campaign program was efficacious for AA and White women. The high representation and retention of AA participants may have contributed to these findings.
Collapse
Affiliation(s)
- Amber W. Kinsey
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marissa A. Gowey
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fei Tan
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Dali Zhou
- Department of Mathematical Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jamy Ard
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Olivia Affuso
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gareth R. Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
20
|
Berkley-Patton J, Bowe Thompson C, Bauer AG, Berman M, Bradley-Ewing A, Goggin K, Catley D, Allsworth JE. A Multilevel Diabetes and CVD Risk Reduction Intervention in African American Churches: Project Faith Influencing Transformation (FIT) Feasibility and Outcomes. J Racial Ethn Health Disparities 2020; 7:1160-1171. [PMID: 32329033 PMCID: PMC7581562 DOI: 10.1007/s40615-020-00740-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/30/2022]
Abstract
Wide-reaching health promotion interventions are needed in influential, accessible community settings to address African American (AA) diabetes and CVD disparities. Most AAs are overweight/obese, which is a primary clinical risk factor for diabetes/CVD. Using a faith-community-engaged approach, this study examined feasibility and outcomes of Project Faith Influencing Transformation (FIT), a diabetes/CVD screening, prevention, and linkage to care pilot intervention to increase weight loss in AA church-populations at 8 months. Six churches were matched and randomized to multilevel FIT intervention or standard education control arms. Key multilevel religiously tailored FIT intervention components included: (a) individual self-help materials (e.g., risk checklists, pledge cards); (b) YMCA-facilitated weekly group Diabetes Prevention Program (DPP) weight loss classes; (c) church service activities (e.g., sermons, responsive readings); and (d) church-community text/voice messages to promote healthy eating and physical activity. Health screenings (e.g., weight, blood pressure, blood glucose) were held during church services to identify participants with diabetes/CVD risks and refer them to their church's DPP class and linkage to care services. Participants (N = 352 church members and community members using churches' outreach ministries) were primarily female (67%) and overweight/obese (87%). Overall, FIT intervention participants were significantly more likely to achieve a > 5 lb weight loss (OR = 1.6; CI = 1.24, 2.01) than controls. Odds of intervention FIT-DPP participants achieving a > 5 lb weight loss were 3.6 times more than controls (p < .07). Exposure to sermons, text/email messages, brochures, commitment cards, and posters was significantly related to > 5 lb. weight loss. AA churches can feasibly assist in increasing reach and impact of diabetes/CVD risk reduction interventions with intensive weight loss components among at risk AA church-populations.
Collapse
Affiliation(s)
- Jannette Berkley-Patton
- Department of Biomedical and Health Informatics, School of Medicine, and Psychology Department, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO, 64108, USA.
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Alexandria G Bauer
- Department of Biomedical and Health Informatics, School of Medicine, and Psychology Department, University of Missouri-Kansas City, 2411 Holmes Street, Kansas City, MO, 64108, USA
| | - Marcie Berman
- The Institute for Community Research, Hartford, CT, USA
| | - Andrea Bradley-Ewing
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City; Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City; Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jenifer E Allsworth
- Department of Biomedical and Health Informatics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| |
Collapse
|
21
|
Hurt TR, Francis SL, Seawell AH, Krisco MP, Flynn MH, O'Connor MC, Rudolph CS, Hill A. Revising Diabetes Programming for Black Men and Their Families. Glob Qual Nurs Res 2020; 7:2333393620960183. [PMID: 33088849 PMCID: PMC7545759 DOI: 10.1177/2333393620960183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
Type-2 diabetes has increased 160% for African American males in the United States. This two-part study's purpose was to apply social marketing theory to understand the Type-2 diabetes education needs of men in Iowa. Study One was a preference assessment of Type-2 diabetes education strategies. Four African American men participated in a series of four focus groups and indicated that they were interested in diabetes prevention programming with their families but not in having it labeled as diabetes education. Participating men would rather increase their physical activity as opposed to tracking their food intake. As a follow-up to this study, nine other African American males took part in Study Two, which used cooking demonstrations and recipe taste-testing with the men to examine their relationship to food in the context of managing their Type-2 diabetes. The findings of both studies, which provided insight into these African American men's lifestyle as related to their Type-2 diabetes, could be useful for nursing professionals who have a critical role in navigating cultural, gender, and family norms while developing care plans, offering patient education, and promoting quality of life.
Collapse
|
22
|
Kitzman H, Mamun A, Dodgen L, Slater D, King G, King A, Slater JL, DeHaven M. Better Me Within Randomized Trial: Faith-Based Diabetes Prevention Program for Weight Loss in African American Women. Am J Health Promot 2020; 35:202-213. [PMID: 32945175 PMCID: PMC8177484 DOI: 10.1177/0890117120958545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Previous DPP translations in African American women have been suboptimal. This trial evaluated a community-based participatory research developed faith-based diabetes prevention program (DPP) to improve weight loss in African American women. DESIGN This cluster randomized trial allocated churches to faith-based (FDPP) or standard (SDPP) DPP interventions. Setting. African American churches. Subjects. Eleven churches with 221 African American women (aged 48.8 ± 11.2 years, BMI = 36.7 ± 8.4) received the FDPP (n = 6) or SDPP (n = 5) intervention. INTERVENTION FDPP incorporated 5 faith-based components, including pastor involvement, into the standard DPP curriculum. The SDPP used the standard DPP curriculum. Lay health leaders facilitated interventions at church sites. MEASURES Weight and biometrics were collected by blinded staff at baseline, 4- and 10-months. ANALYSIS A multilevel hierarchical regression model compared the FDPP and SDPP groups on outcomes. RESULTS FDPP and SDPP churches significantly lost weight at 10-months (overall -2.6%, p < .01). Women in FDPP churches who attended at least 15 sessions lost an additional 6.1 pounds at 4-months compared to SDPP corresponding to a 5.8% reduction at 10-months (p < .05). Both groups had significant improvements in health behaviors and biometrics. CONCLUSIONS Faith-based and standard DPP interventions led by lay health leaders successfully improved weight, health behaviors, and chronic disease risk. However, the faith-based DPP when fully implemented met the CDC's recommendation for weight loss for diabetes prevention in African American women.
Collapse
Affiliation(s)
- Heather Kitzman
- Baylor Scott & White Health and Wellness Center, 10616Baylor Scott & White Health, Dallas, TX, USA.,Robbins Institute for Health Policy & Leadership, Hankamer School of Business, Baylor University, Waco, TX, USA
| | - Abdullah Mamun
- Baylor Scott & White Health and Wellness Center, 10616Baylor Scott & White Health, Dallas, TX, USA
| | - Leilani Dodgen
- Baylor Scott & White Health and Wellness Center, 10616Baylor Scott & White Health, Dallas, TX, USA
| | - Donna Slater
- Better Me Within Community Advisory Board, New Millennium Bible Fellowship Praise Center, Dallas, TX, USA
| | - George King
- Better Me Within Community Advisory Board, New Millennium Bible Fellowship Praise Center, Dallas, TX, USA
| | - Alene King
- Better Me Within Community Advisory Board, New Millennium Bible Fellowship Praise Center, Dallas, TX, USA
| | - J Lee Slater
- Better Me Within Community Advisory Board, New Millennium Bible Fellowship Praise Center, Dallas, TX, USA
| | - Mark DeHaven
- Department of Public Health Science, 14727University of North Carolina, Charlotte, NC, USA
| |
Collapse
|
23
|
Yeary KHK, Kaplan CM, Hutchins E. Implementation costs of a community health worker delivered weight loss intervention in black churches serving underserved communities. Prev Med Rep 2020; 18:101084. [PMID: 32309114 PMCID: PMC7155228 DOI: 10.1016/j.pmedr.2020.101084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/15/2020] [Accepted: 03/30/2020] [Indexed: 12/30/2022] Open
Abstract
Black adults bear a disproportionate burden of the obesity epidemic but are underrepresented in weight loss research and lose less weight than their white counterparts in weight loss interventions. Comprehensive behavioral weight loss interventions cause weight loss, but their high cost have stymied their implementation in black and other underserved communities. Recent translations of evidence-based weight loss interventions for black communities have been designed to increase intervention reach. However, the costs of implementing such interventions have seldom been reported in the context of a randomized controlled trial. Thus, the costs of implementing a community-health worker delivered Diabetes Prevention Program (DPP) adaptated for rural black adults of faith (The WORD) are reported. Data from a randomized controlled effectiveness trial conducted in 31 churches (n = 440) were used to calculate implementation costs. All participants received the 16-session core weight loss intervention and weight loss data was collected at baseline and 6 months. Participants lost an average of 2.53 kg at 6 months. Total implementation costs were $340.95 per participant. Thus, the implementation cost was $138 per kg. This is one of the few comprehensive examinations of costs for a DPP translation for black adults of faith and provide initial data from which practitioners and policy makers can use to determine the engagement of churches to disseminate the DPP through churches. Future studies are needed to confirm the extent churches are a cost-effective strategy to cause weight loss in black communities.
Collapse
Affiliation(s)
- Karen H. Kim Yeary
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, United States
| | - Cameron M. Kaplan
- University of Southern California, Los Angeles, CA 90033, United States
| | - Ellen Hutchins
- University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| |
Collapse
|
24
|
Kim Yeary KH, Cornell CE, Moore PC, Gauss CH, Prewitt TE, Turner J. The WORD: Outcomes of a Behavioral Weight Loss Maintenance Effectiveness Trial in Rural Black Adults of Faith. Obesity (Silver Spring) 2020; 28:510-520. [PMID: 31984668 PMCID: PMC7042080 DOI: 10.1002/oby.22717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/21/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Rural black communities bear a disproportionate burden of obesity. To increase reach among underserved groups, community-based weight loss and maintenance interventions are crucial. METHODS The Diabetes Prevention Program (DPP) was adapted for rural black adults of faith to create The Wholeness, Oneness, Righteousness, Deliverance (WORD) trial, a group-based, community health worker-delivered weight loss intervention. A Weight Loss Only arm (16 sessions) was compared with a Weight Loss + Maintenance arm (16 + 12 sessions) in a cluster randomized controlled trial of 31 churches (n = 440). Weight and related behaviors were assessed at 0, 6, 12, and 18 months. RESULTS The WORD produced weight loss from baseline to 6 months (percentage body weight change -2.47 [-3.13 to -1.80]). Among those who lost 5% of their baseline weight, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance arm compared with control. Maintenance arm participants reported higher activity at 12 months. There were no between-arm differences at 18 months. CONCLUSIONS The WORD produced weight loss from baseline to 6 months on par with that produced by other DPP adaptations for black communities, including adaptations using health professionals. Weight regain was also consistent with that reported in prior literature. Continuing sessions as part of the church's mission may foster adoption of DPP-based weight loss programs.
Collapse
Affiliation(s)
| | - Carol E. Cornell
- University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | | | - C. Heath Gauss
- University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | | | - Jerome Turner
- Boys, Girls, Adults Community Development Center (BGACDC), Marvell, AR 72366
| |
Collapse
|
25
|
Blackman Carr LT, Samuel-Hodge CD, Ward DS, Evenson KR, Bangdiwala SI, Tate DF. Comparative effectiveness of a standard behavioral and physical activity enhanced behavioral weight loss intervention in Black women. Women Health 2019; 60:676-691. [PMID: 31814531 DOI: 10.1080/03630242.2019.1700585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Black women typically lose small amounts of weight in behavioral weight loss interventions, partially due to low engagement in physical activity. Culturally relevant enhancement of the physical activity component may improve weight loss. This study compared the effectiveness of a culturally-relevant, physical activity-enhanced behavioral weight loss intervention to a standard behavioral weight loss intervention in Black women (n = 85) over 6 months. The study was conducted in two cohorts from March 2016 to February 2017 at the University of North Carolina at Chapel Hill. Participants had an average age of 48.30 ± 11.02 years with an average body mass index of 36.46 ± 4.50 kg/m2. Standard and enhanced groups' weight change (-2.83 kg and -2.08 kg, respectively) and change in physical activity (43.93 min/ week and 15.29 min/week, respectively) did not differ between groups. Significantly more standard group participants lost 5% of baseline weight compared to enhanced group participants. This study produced typical weight loss results in Black women. Behavioral weight loss treatment remains moderately effective for Black women. Strategies to increase attendance and self-monitoring, and the inclusion of cultural contexts to weight-related behaviors are needed to improve outcomes.
Collapse
Affiliation(s)
- Loneke T Blackman Carr
- Department of Nutritional Sciences, University of Connecticut , Storrs, Connecticut, USA.,Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Carmen D Samuel-Hodge
- Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Dianne S Ward
- Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Kelly R Evenson
- Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University , Hamilton, Ontario, Canada
| | - Deborah F Tate
- Department of Health Behavior, Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
| |
Collapse
|
26
|
Rosenbaum DL, Clark MH, Convertino AD, Call CC, Forman EM, Butryn ML. Examination of Nutrition Literacy and Quality of Self-monitoring in Behavioral Weight Loss. Ann Behav Med 2019; 52:809-816. [PMID: 30124757 DOI: 10.1093/abm/kax052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Few have examined nutrition literacy (i.e., capacity to process and make informed nutritional decisions) in behavioral weight loss. Nutrition literacy (NL) may impact necessary skills for weight loss, contributing to outcome disparities. Purpose The study sets out to identify correlates of NL; evaluate whether NL predicted weight loss, food record completion and quality, and session attendance; and investigate whether the relations of race and education to weight loss were mediated by NL and self-monitoring. Methods This is a secondary analysis of 6-month behavioral weight loss program in which overweight/obese adults (N = 320) completed a baseline measure of NL (i.e., Newest Vital Sign). Participants self-monitored caloric intake via food records. Results NL was lower for black participants (p < .001) and participants with less education (p = .002). Better NL predicted better 6-month weight loss (b = -.63, p = .04) and food record quality (r = .37, p < .001), but not food record completion or attendance (ps > 0.05). Black participants had lower NL, which was associated with poorer food record quality, which adversely affected weight loss. There was no indirect effect of education on weight loss through NL and food record quality. Conclusions Overall, results suggest that lower NL is problematic for weight loss. For black participants, NL may indirectly impact weight loss through quality of self-monitoring. This might be one explanation for poorer behavioral weight loss outcomes among black participants. Additional research should investigate whether addressing these skills through enhanced treatment improves outcomes. Clinical trial information NCT02363010.
Collapse
Affiliation(s)
- Diane L Rosenbaum
- Department of Psychology, Drexel University, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Margaret H Clark
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Christine C Call
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Meghan L Butryn
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
27
|
AuYoung M, Moin T, Richardson CR, Damschroder LJ. The Diabetes Prevention Program for Underserved Populations: A Brief Review of Strategies in the Real World. Diabetes Spectr 2019; 32:312-317. [PMID: 31798288 PMCID: PMC6858084 DOI: 10.2337/ds19-0007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
IN BRIEF This review highlights examples of the translation of the Diabetes Prevention Program (DPP) to underserved populations. Here, underserved populations are defined as groups whose members are at greater risk for health conditions such as diabetes but often face barriers accessing treatment. Strategies to develop and evaluate future DPP translations are discussed.
Collapse
Affiliation(s)
- Mona AuYoung
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | - Tannaz Moin
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
- VA Health Services Research and Development Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Laura J. Damschroder
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI
| |
Collapse
|
28
|
Fine A, Gallaway MS, Dukate A. Prevention in Prison: The Diabetes Prevention Program in a Correctional Setting. Diabetes Spectr 2019; 32:331-337. [PMID: 31798291 PMCID: PMC6858081 DOI: 10.2337/ds18-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to determine whether an adaptation of the Diabetes Prevention Program (DPP) could be successfully implemented in a correctional environment to promote weight loss, lower A1C, and improve other cardiometabolic outcomes. METHODS A quasi-experimental, staggered-start control study was conducted in a female and male federal correctional institution. Twenty-six male and 21 female incarcerated, overweight individuals with prediabetes or at high risk for developing diabetes were randomly assigned to two groups. Data were measured at 6-month intervals starting at baseline for 18 months. Group 1 participated in the 12-month Group Lifestyle Balance intervention program from baseline to 12 months. Group 2 served as a control group from baseline for 6 months and then completed the intervention program from months 6 to 18. RESULTS Participants were ethnically diverse and mostly >44 years of age. At baseline, members of the two study groups were not significantly different with regard to sex, race/ethnicity, age, or prediabetes status. About half of participants (51%) completed the program, with participants in group 1 significantly more likely to be completers (P <0.05). At 6 months, participants in the intervention group had significantly more weight loss on average (12 lb) than those in the control/delayed-start group (5 lb) (P <0.001). However, both groups (active intervention and control) experienced significant decreases in weight, BMI, triglycerides, and A1C levels after 6 months. In combined analysis, after the 12-month intervention, participants in both groups demonstrated significant decreases in BMI (P <0.001) and A1C (P <0.001) from baseline. CONCLUSION The DPP may be an effective method for reducing the impact of diabetes in the correctional environment addressed. Larger studies should be conducted to confirm these outcomes. Study findings were affected by high attrition rates, primarily due to transfers and releases from the institution.
Collapse
Affiliation(s)
- Alyssa Fine
- Wellness and Diabetes Program, Cowlitz Indian Tribe, Longview, WA
| | - M. Shayne Gallaway
- U.S. Department of Health and Human Services, U.S. Public Health Service Commissioned Corps, Washington, DC
| | - Angela Dukate
- Federal Correctional Institution of the Federal Bureau of Prisons, Danbury, CT
| |
Collapse
|
29
|
Woods-Giscombe CL, Gaylord SA, Li Y, Brintz CE, Bangdiwala SI, Buse JB, Mann JD, Lynch C, Phillips P, Smith S, Leniek K, Young L, Al-Barwani S, Yoo J, Faurot K. A Mixed-Methods, Randomized Clinical Trial to Examine Feasibility of a Mindfulness-Based Stress Management and Diabetes Risk Reduction Intervention for African Americans with Prediabetes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:3962623. [PMID: 31511777 PMCID: PMC6710811 DOI: 10.1155/2019/3962623] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/21/2019] [Indexed: 12/29/2022]
Abstract
African Americans have disproportionately high rates of stress-related conditions, including diabetes and diabetes-related morbidity. Psychological stress may negatively influence engagement in risk-reducing lifestyle changes (physical activity and healthy eating) and stress-related physiology that increase diabetes risk. This study examined the feasibility of conducting a randomized trial comparing a novel mindfulness-based stress management program combined with diabetes risk-reduction education versus a conventional diabetes risk-reduction education program among African American adults with prediabetes and self-reported life stress. Participants were recruited in collaboration with community partners and randomized to the mindfulness-based diabetes risk-reduction education program for prediabetes (MPD; n = 38) or the conventional diabetes risk-reduction education program for prediabetes (CPD; n = 30). The mindfulness components were adapted from the Mindfulness-based Stress Reduction Program. The diabetes risk-reduction components were adapted from the Power to Prevent Program and the Diabetes Prevention Program. Groups met for eight weeks for 2.5 hours, with a half-day retreat and six-monthly boosters. Mixed-methods strategies were used to assess feasibility. Psychological, behavioral, and metabolic data were collected before the intervention and at three and six months postintervention to examine within-group change and feasibility of collecting such data in future clinical efficacy research. Participants reported acceptability, credibility, and cultural relevance of the intervention components. Enrollment of eligible participants (79%), intervention session attendance (76.5%), retention (90%), and postintervention data collection attendance (83%, 82%, and 78%, respectively) demonstrated feasibility, and qualitative data provided information to further enhance feasibility in future studies. Both groups exhibited an A1C reduction. MPD participants had reductions in perceived stress, BMI, calorie, carbohydrate and fat intake, and increases in spiritual well-being. Considering the high prevalence of diabetes and diabetes-related complications in African Americans, these novel findings provide promising guidance to develop a larger trial powered to examine efficacy of a mindfulness-based stress management and diabetes risk-reduction education program for African Americans with prediabetes.
Collapse
Affiliation(s)
| | - Susan A. Gaylord
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Carrie E. Brintz
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Shrikant I. Bangdiwala
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - John B. Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - John D Mann
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
- Department of Neurology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Chanee Lynch
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Pamela Phillips
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| | - Sunyata Smith
- Lehman College, City University of New York, New York, NY, USA
| | - Karyn Leniek
- Health Partners Central Minnesota Clinics, Sartell, MN, USA
| | - Laura Young
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Saada Al-Barwani
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeena Yoo
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keturah Faurot
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
30
|
Abstract
Type 2 diabetes is a major UK public health priority. Among minority ethnic communities, the prevalence is alarmingly high, approximately three to five times higher than in the white British population. Particularly striking is the earlier onset of Type 2 diabetes, which occurs some 10-12 years younger, with a significant proportion of cases being diagnosed before the age of 40 years. This review focuses on the UK context and Type 2 diabetes in adult populations, exploring the available evidence regarding the complex interplay of biological, lifestyle, social, clinical and healthcare system factors that are known to drive these disparities.
Collapse
Affiliation(s)
- L M Goff
- Diabetes Research Group, Departments of Diabetes and Nutritional Sciences, King's College London, London, UK
| |
Collapse
|
31
|
Maxwell AE, Santifer R, Chang LC, Gatson J, Crespi CM, Lucas-Wright A. Organizational readiness for wellness promotion - a survey of 100 African American church leaders in South Los Angeles. BMC Public Health 2019; 19:593. [PMID: 31101096 PMCID: PMC6525409 DOI: 10.1186/s12889-019-6895-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/25/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Churches are an important asset and a trusted resource in the African American community. We needed a better understanding of their readiness to engage in health promotion before launching a large-scale health promotion effort in partnership with South Los Angeles churches. METHODS In 2017, we conducted surveys with leaders of 100 churches. Surveys were conducted face-to-face (32%) or by telephone (68%) with senior pastors (one per church) and lasted on average 48 min. We compared small (less than 50 active members), medium (50-99 active members) and large churches (at least 100 active members), and assessed which church characteristics were associated with the implementation of wellness activities. RESULTS Medium and large churches conducted significantly more wellness activities than small churches and were more likely to have wellness champions and health policies. Regardless of church size, insufficient budget was the most commonly cited barrier to implement wellness activities (85%). A substantial proportion of churches was not sure how to implement wellness activities (61%) and lacked volunteers (58%). Forty-five percent of the variation in the number of wellness activities in the last 12 months was explained by church characteristics, such as size of congregation, number of paid staff, leadership engagement, having a wellness ministry and barriers. CONCLUSIONS Many churches in South Los Angeles are actively engaged in health promotion activities, despite a general lack of resources. We recommend a comprehensive assessment of church characteristics in intervention studies to enable the use of strategies (e.g., stratification by size) that reduce imbalances that could mask or magnify study outcomes. Our data provide empirical support for the inner settings construct of the Consolidated Framework for Implementation Research in the context of health promotion in African American churches.
Collapse
Affiliation(s)
- Annette E Maxwell
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center; UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Rhonda Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - L Cindy Chang
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center; UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.,Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Juana Gatson
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Catherine M Crespi
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center; UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| |
Collapse
|
32
|
Emmons KM, Gandelman E. Translating behavioral medicine evidence to public policy. J Behav Med 2019; 42:84-94. [PMID: 30825091 DOI: 10.1007/s10865-018-9979-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/05/2018] [Indexed: 12/12/2022]
Abstract
Behavioral medicine has made significant contributions to our understanding of how to prevent disease and improve health. However, social and environmental factors continue to have a major influence on health in ways that will be difficult to combat on a population level without concerted efforts to scale interventions and translate the evidence into public health policies. Now is also the right time to increase our efforts to produce policy relevant research and partnerships that will maximize the chances that our evidence is taken to scale in ways that can influence population health broadly, and perhaps contribute to the reduction of the recalcitrant health disparities that plague virtually every area of behavioral medicine focus. As a field we must take an active role in policy translation, learning from the public policy and political science disciplines, and our own pioneers in policy translation. This article discusses importance of accelerating evidence translation to policy, and suggests several factors that could enhance our translation efforts, including embracing policy translation as a key goal in behavioral medicine, increasing our understanding in variability of evidence-based policy adoption across and within states, improving our understanding of how to most effectively communicate our findings to policy makers, conducting research that is responsive to policy makers' needs, and considering the important role of local policy partnerships.
Collapse
Affiliation(s)
- Karen M Emmons
- Department of Social and Behavioral Science, Harvard TH Chan School of Public Health, Room 601, 677 Huntington Ave, Boston, MA, 02115, USA.
| | | |
Collapse
|
33
|
Abstract
PURPOSE OF REVIEW This article discusses the state of type 2 diabetes (T2D) self-management research on non-Hispanic Black men with a focus on their knowledge of diabetes, factors that impact T2D self-management and intervention research that specifically targets non-Hispanic Black men with T2D. RECENT FINDINGS Studies on T2D knowledge and barriers and facilitators to T2D self-management in non-Hispanic Black men are limited to small qualitative focus group and in-depth interviews. To date, few T2D interventions for non-Hispanic Black men have been developed and tested. Research shows that non-Hispanic Black men's knowledge of T2D may be less than optimal compared to non-Hispanic white men. Factors that influence T2D self-management in non-Hispanic Black men include gender-related values and beliefs, and a range of other psychosocial (e.g., social support) and structural (e.g., access to health care) factors. Interventions with gender-specific programming may show promise. More studies with larger sample sizes and longitudinal designs are needed to develop programming to effectively target this at-risk population.
Collapse
Affiliation(s)
- Jaclynn M Hawkins
- School of Social Work, University of Michigan, 1080 S. University Ave, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
34
|
Yeary KHK, Moore PC, Gauss CH, Cornell C, Prewitt TE, Shakya S, Turner J, Scarbrough C, Porter G, Estabrooks PA. Reach and Adoption of a Randomized Weight Loss Maintenance Trial in Rural African Americans of Faith: The WORD (Wholeness, Oneness, Righteousness, Deliverance). Am J Health Promot 2018; 33:549-557. [PMID: 30309257 DOI: 10.1177/0890117118805065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE There is minimal information regarding the Reach and Adoption of evidence-based weight loss maintenance interventions for African Americans of faith. DESIGN The WORD (Wholeness, Oneness, Righteousness, Deliverance) was an 18-month, cluster randomized trial designed to reduce and maintain weight loss in African American adults of faith. Participants received the Diabetes Prevention Program adapted core weight loss program for 6 months, and churches were subsequently randomized to 12-month maintenance treatment or control. All participants underwent body weight and associated behavioral and psychosocial assessments at baseline, 6, 12, and 18 months. The current article focuses on assessing Reach and Adoption at baseline and 6 months using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. SETTING Lower Mississippi Delta. PARTICIPANTS Thirty churches, 61 WORD Leaders (WLs), and 426 participants. INTERVENTION Group delivered by trained community members (WLs). MEASURES Body mass index and percentage weight lost from baseline to 6-month follow-up were measured. Reach was assessed at participant, WL, and church levels through calculating participation rates and sociodemographics of each level. Adoption was assessed at church and WL levels. ANALYSIS Descriptive statistics summarized baseline characteristics of each level. Continuous and categorical end point comparisons were made. RESULTS Participants' participation rate was 0.84 (n = 437 agreed to participate, n = 519 eligible invited to participate); they were predominantly female, employed, and had a mean age of 49.8. Dropouts by 6 months were younger, had differential marital status, and religious attendance compared with retained participants. Church participation rate was 0.63 (n = 30 enrolled, n = 48 eligible approached) and the majority reported ≤100 active members. The WL participation rate was 0.61 (n = 61 implemented intervention, n = 100 eligible approached); they were primarily female and aged 53.9 (mean). CONCLUSION Recruitment, engagement, and delivery strategies employed by the WORD show promise of sustained engagement and adoption in other faith-based behavioral weight management programs for African Americans.
Collapse
Affiliation(s)
- Karen H Kim Yeary
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Page C Moore
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Heath Gauss
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Carol Cornell
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - T Elaine Prewitt
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Samjhana Shakya
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jerome Turner
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Catherine Scarbrough
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gwenndolyn Porter
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paul A Estabrooks
- 1 Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
35
|
Kumanyika SK, Morales KH, Allison KC, Localio AR, Sarwer DB, Phipps E, Fassbender JE, Tsai AG, Wadden TA. Two-Year Results of Think Health! ¡Vive Saludable!: A Primary Care Weight-Management Trial. Obesity (Silver Spring) 2018; 26:1412-1421. [PMID: 30160061 PMCID: PMC6143399 DOI: 10.1002/oby.22258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 10/31/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Think Health! ¡Vive Saludable! evaluated a moderate-intensity, lifestyle behavior-change weight-loss program in primary care over 2 years of treatment. Final analyses examined weight-change trajectories by treatment group and attendance. METHODS Adult primary care patients (n = 261; 84% female; 65% black; 16% Hispanic) were randomly assigned to Basic Plus (moderate intensity; counseling by primary care clinician and a lifestyle coach) or Basic (clinician counseling only). Intention-to-treat analyses used all available weight measurements from data collection, treatment, and routine clinical visits. Linear mixed-effects regression models adjusted for treatment site, gender, and age, and sensitivity analyses evaluated treatment attendance and the impact of loss to follow-up. RESULTS Model-based estimates for 24-month mean (95% CI) weight change from baseline were -1.34 kg (-2.92 to 0.24) in Basic Plus and -1.16 kg (-2.70 to 0.37) in Basic (net difference -0.18 kg [-2.38 to 2.03]; P = 0.874). Larger initial weight loss in Basic Plus was attenuated by a ~0.5-kg rebound at 12 to 16 months. Each additional coaching visit was associated with a 0.37-kg greater estimated 24-month weight loss (P = 0.01). CONCLUSIONS These findings in mostly black and Hispanic female primary care patients suggest that strategies to improve treatment attendance may improve weight loss resulting from moderate-intensity counseling.
Collapse
Affiliation(s)
- Shiriki K. Kumanyika
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Knashawn H. Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kelly C. Allison
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - A. Russell Localio
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David B. Sarwer
- Center for Obesity Research and Education, Temple University College of Public Health, Philadelphia, PA, USA
| | - Etienne Phipps
- Center for Urban Health Policy and Research, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
- Public health consultant, Philadelphia, Pennsylvania, USA
| | - Jennifer E. Fassbender
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adam G. Tsai
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Thomas A. Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
36
|
McElfish PA, Long CR, Kaholokula JK, Aitaoto N, Bursac Z, Capelle L, Laelan M, Bing WI, Riklon S, Rowland B, Ayers BL, Wilmoth RO, Langston KN, Schootman M, Selig JP, Yeary KHCK. Design of a comparative effectiveness randomized controlled trial testing a faith-based Diabetes Prevention Program (WORD DPP) vs. a Pacific culturally adapted Diabetes Prevention Program (PILI DPP) for Marshallese in the United States. Medicine (Baltimore) 2018; 97:e0677. [PMID: 29742712 PMCID: PMC5959435 DOI: 10.1097/md.0000000000010677] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pacific Islander populations, including Marshallese, face a disproportionately high burden of health disparities relative to the general population. OBJECTIVES A community-based participatory research (CBPR) approach was utilized to engage Marshallese participants in a comparative effectiveness trial testing 2 Diabetes Prevention Program (DPP) interventions designed to reduce participant's weight, lower HbA1c, encourage healthy eating, and increase physical activity. DESIGN To compare the effectiveness of the faith-based (WORD) DPP to the culturally adapted (Pacific Culturally Adapted Diabetes Prevention Program [PILI]) DPP, a clustered randomized controlled trial (RCT) with 384 Marshallese participants will be implemented in 32 churches located in Arkansas, Kansas, Missouri, and Oklahoma. Churches will be randomly assigned to WORD DPP arm or to PILI DPP arm. METHODS WORD DPP focuses on connecting faith and health to attain a healthy weight, eat healthy, and be more physically active. In contrast, PILI DPP is a family and community focused DPP curriculum specifically adapted for implementation in Pacific Islander communities. PILI focuses on engaging social support networks to maintain a healthy weight, eat healthy, and be more physically active. All participants are assessed at baseline, immediate post intervention, and 12 months post intervention. SUMMARY Both interventions aim to cause weight loss through improving physical activity and healthy eating, with the goal of preventing the development of T2D. The clustered RCT will determine which intervention is most effective with the Marshallese population. The utilization of a CBPR approach that involves local stakeholders and engages faith-based institutions in Marshallese communities will increase the potential for success and sustainability. This study is registered at clinicaltrials.gov (NCT03270436).
Collapse
Affiliation(s)
- Pearl Anna McElfish
- College of Medicine, University of Arkansas for Medical Sci10-1ences Northwest, 1125 N. College Avenue, Fayetteville, AR
| | - Christopher R. Long
- College of Medicine, University of Arkansas for Medical Sci10-1ences Northwest, 1125 N. College Avenue, Fayetteville, AR
| | | | - Nia Aitaoto
- Center for Pacific Islander Health, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Zoran Bursac
- Division of Biostatistics, Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, TN
| | - Lucy Capelle
- Arkansas Coalition of Marshallese, Springdale, AR
| | | | - Williamina Ioanna Bing
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Sheldon Riklon
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Brett Rowland
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Britni L. Ayers
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Ralph O. Wilmoth
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Krista N. Langston
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, Fayetteville
| | - Mario Schootman
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO; Department of Biostatistics
| | - James P. Selig
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Karen Hye-cheon Kim Yeary
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, AR
| |
Collapse
|
37
|
Blackman Carr LT, Samuel-Hodge C, Ward DS, Evenson KR, Bangdiwala SI, Tate DF. Racial Differences in Weight Loss Mediated by Engagement and Behavior Change. Ethn Dis 2018; 28:43-48. [PMID: 29467565 DOI: 10.18865/ed.28.1.43] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective We set out to determine if a primarily Internet-delivered behavioral weight loss intervention produced differential weight loss in African American and non-Hispanic White women, and to identify possible mediators. Design Data for this analysis were from a randomized controlled trial, collected at baseline and 4-months. Setting The intervention included monthly face-to-face group sessions and an Internet component that participants were recommended to use at least once weekly. Participants We included overweight or obese African American and non-Hispanic White women (n=170), with at least weekly Internet access, who were able to attend group sessions. Intervention Monthly face-to-face group sessions were delivered in large or small groups. The Internet component included automated tailored feedback, self-monitoring tools, written lessons, video resources, problem solving, exercise action planning tools, and social support through message boards. Main Outcome Measure Multiple linear regression was used to evaluate race group differences in weight change. Results Non-Hispanic White women lost more weight than African American women (-5.03% vs.-2.39%, P=.0002). Greater website log-ins and higher change in Eating Behavior Inventory score in non-Hispanic White women partially mediated the race-weight loss relationship. Conclusions The weight loss disparity may be addressed through improved website engagement and adoption of weight control behaviors.
Collapse
Affiliation(s)
- Loneke T Blackman Carr
- The Samuel Dubois Cook Center on Social Equity at Duke University, Durham, North Carolina
| | - Carmen Samuel-Hodge
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dianne Stanton Ward
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kelly R Evenson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Deborah F Tate
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
38
|
Joseph JJ, Echouffo-Tcheugui JB, Talegawkar SA, Effoe VS, Okhomina V, Carnethon MR, Hsueh WA, Golden SH. Modifiable Lifestyle Risk Factors and Incident Diabetes in African Americans. Am J Prev Med 2017; 53:e165-e174. [PMID: 28818415 PMCID: PMC5704929 DOI: 10.1016/j.amepre.2017.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/17/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The associations of modifiable lifestyle risk factors with incident diabetes are not well investigated in African Americans (AAs). This study investigated the association of modifiable lifestyle risk factors (exercise, diet, smoking, TV watching, and sleep-disordered breathing burden) with incident diabetes among AAs. METHODS Modifiable lifestyle risk factors were characterized among 3,252 AAs in the Jackson Heart Study who were free of diabetes at baseline (2000-2004) using baseline questionnaires and combined into risk factor categories: poor (0-3 points), average (4-7 points), and optimal (8-11 points). Incidence rate ratios (IRR) for diabetes (fasting glucose ≥126 mg/dL, physician diagnosis, use of diabetes drugs, or glycosylated hemoglobin A1c ≥6.5%) were estimated using Poisson regression modeling adjusting for age, sex, education, occupation, systolic blood pressure, and BMI. Outcomes were collected 2005-2012 and data analyzed in 2016. RESULTS Over 7.6 years, there were 560 incident diabetes cases (mean age=53.3 years, 64% female). An average or optimal compared to poor risk factor categorization was associated with a 21% (IRR=0.79, 95% CI=0.62, 0.99) and 31% (IRR=0.69, 95% CI=0.48, 1.01) lower risk of diabetes. Among participants with BMI <30, IRRs for average or optimal compared to poor categorization were 0.60 (95% CI=0.40, 0.91) and 0.53 (95% CI=0.29, 0.97) versus 0.90 (95% CI=0.67, 1.21) and 0.83 (95% CI=0.51, 1.34) among participants with BMI ≥30. CONCLUSIONS A combination of modifiable lifestyle factors are associated with a lower risk of diabetes among AAs, particularly among those without obesity.
Collapse
Affiliation(s)
- Joshua J Joseph
- Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio; Johns Hopkins University, School of Medicine, Baltimore, Maryland.
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sameera A Talegawkar
- Sumner M. Redstone Global Center for Prevention and Wellness, Milken Institute School of Public Health at the George Washington University, Washington, District of Columbia
| | - Valery S Effoe
- Division of Public Health Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | | | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Willa A Hsueh
- Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Sherita H Golden
- Johns Hopkins University, School of Medicine, Baltimore, Maryland
| |
Collapse
|
39
|
Abstract
Prevention of diabetes poses significant challenges; especially when applied as public health intervention. While several trials, most importantly Diabetes Prevention Program, show that intensive lifestyle modification leading to weight loss is the most important intervention, many individuals and some populations may show resistance to these interventions. Roadblocks to lifestyle intervention alone or in combination include: age, some ethnic groups (e.g., south Asians), genetic make-up, and some characteristics of body phenotype. Recent data show that non-alcoholic fatty liver disease along with insulin resistance may constitute 'metabolically unhealthy phenotype'. These subgroups would need more intensive interventions to convert prediabetes to normal glucose regulation. Whether 'fatty pancreas' and sarcopenia, latter more often seen in Asian Indians and with advancing age, are other phenotypes requiring intensive and different interventions (e.g., more resistance exercise in latter) remains to be researched. Further, variations in dietary quality (Mediterranean diet enriched with extra virgin olive oil, high-protein diets) without changing much of calories, provide attractive options for intervention. Many of such innovations require more research. Translation of lessons from diabetes prevention studies to general population is daunting but possible. However, such community-based interventions need substantial human and material resources, which pose hurdles in underserved populations and developing countries. In such situations, low-cost modalities, for example, use of trained community educators and digital and social media, constitute attractive approaches.
Collapse
Affiliation(s)
- Anoop Misra
- Fortis C-DOC Centre for Excellence for Diabetes, Metabolic Diseases and Endocrinology; National Diabetes, Obesity and Cholesterol Diseases Foundation; and Diabetes Foundation (India), New Delhi, India
| |
Collapse
|
40
|
Townsend CKM, Miyamoto RES, Antonio M, Zhang G, Paloma D, Basques D, Braun KL, Kaholokula JK. The PILI@Work Program: a translation of the diabetes prevention program to Native Hawaiian-serving worksites in Hawai'i. Transl Behav Med 2017; 6:190-201. [PMID: 27356989 PMCID: PMC4927448 DOI: 10.1007/s13142-015-0383-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A previously translated Diabetes Prevention Program Lifestyle Intervention (DPP-LI) was adapted for delivery as a worksite-based intervention, called PILI@Work, to address obesity disparities in Native Hawaiians/Pacific Islanders. This study examined the effectiveness of PILI@Work and factors associated with weight loss at post-intervention. Overweight/obese employees of 15 Native Hawaiian-serving organizations received the 3-month component of PILI@Work. Assessments included weight, systolic/diastolic blood pressure, physical activity and functioning, fat intake, locus of weight control, social support, and self-efficacy. Weight, systolic/diastolic blood pressure, physical functioning, physical activity frequency, fat intake, family support, and eating self-efficacy improved from pre- to post-intervention. Regression analysis indicated that worksite type, decreased diastolic blood pressure, increased physical activity, and more internalized locus of weight control were significantly associated with 3-month weight loss. PILI@Work initiated weight loss in Native Hawaiians/Pacific Islanders. DPP-LI translated to worksite settings and tailored for specific populations can be effective for addressing obesity.
Collapse
Affiliation(s)
- Claire K M Townsend
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA.
| | - Robin E S Miyamoto
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
| | - Mapuana Antonio
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
| | - Guangxing Zhang
- Office of Biostatistics & Quantitative Health Sciences John A Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Diane Paloma
- Native Hawaiian Health Program, Queen's Health Systems, Honolulu, HI, USA
| | - DeAnna Basques
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
| | - Kathryn L Braun
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Joseph Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A Burns School of Medicine, University of Hawai'i at Mānoa, 677 Ala Moana Blvd, Suite 1016, Honolulu, HI, 96813, USA
| |
Collapse
|
41
|
Venditti EM. Behavioral lifestyle interventions for the primary prevention of type 2 diabetes and translation to Hispanic/Latino communities in the United States and Mexico. Nutr Rev 2017; 75:85-93. [PMID: 28049753 DOI: 10.1093/nutrit/nuw041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lifestyle behaviors in overweight and obese individuals are closely linked to the development, course, and outcomes of type 2 diabetes and multiple comorbid health conditions. Behavior change theory and many randomized controlled studies offer strong support for screening and identifying adults at increased cardiometabolic risk and for providing early intervention to mitigate risk factors to prevent or delay the onset of disease. The current article reviews key lifestyle intervention efficacy and dissemination trials conducted with individuals deemed to be at increased risk for diabetes and describes the rationale for training teams of professionals and community health workers (e.g., promotores [in Spanish]) to implement comprehensive programs, with fidelity, in a variety of medical care and community settings. This evidence-based road map may be used to facilitate the design and implementation of strategies for structured behavioral diabetes risk reduction programs in the public and private healthcare sectors and other relevant community-based platforms serving individuals of Hispanic/Latino origin in the United States and Mexico.
Collapse
Affiliation(s)
- Elizabeth M Venditti
- E.M. Venditti is with the Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
42
|
Kitzman H, Dodgen L, Mamun A, Slater JL, King G, Slater D, King A, Mandapati S, DeHaven M. Community-based participatory research to design a faith-enhanced diabetes prevention program: The Better Me Within randomized trial. Contemp Clin Trials 2017; 62:77-90. [PMID: 28807739 DOI: 10.1016/j.cct.2017.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 01/02/2023]
Abstract
Reducing obesity positively impacts diabetes and cardiovascular risk; however, evidence-based lifestyle programs, such as the diabetes prevention program (DPP), show reduced effectiveness in African American (AA) women. In addition to an attenuated response to lifestyle programs, AA women also demonstrate high rates of obesity, diabetes, and cardiovascular disease. To address these disparities, enhancements to evidence-based lifestyle programs for AA women need to be developed and evaluated with culturally relevant and rigorous study designs. This study describes a community-based participatory research (CBPR) approach to design a novel faith-enhancement to the DPP for AA women. A long-standing CBPR partnership designed the faith-enhancement from focus group data (N=64 AA adults) integrating five components: a brief pastor led sermon, memory verse, in class or take-home faith activity, promises to remember, and scripture and prayer integrated into participant curriculum and facilitator materials. The faith components were specifically linked to weekly DPP learning objectives to strategically emphasize behavioral skills with religious principles. Using a CBPR approach, the Better Me Within trial was able to enroll 12 churches, screen 333 AA women, and randomize 221 (Mage=48.8±11.2; MBMI=36.7±8.4; 52% technical or high school) after collection of objective eligibility measures. A prospective, randomized, nested by church, design will be used to evaluate the faith-enhanced DPP as compared to a standard DPP on weight, diabetes and cardiovascular risk, over a 16-week intervention and 10-month follow up. This study will provide essential data to guide enhancements to evidence-based lifestyle programs for AA women who are at high risk for chronic disease.
Collapse
Affiliation(s)
- Heather Kitzman
- Baylor Scott & White Health and Wellness Center, Baylor Scott & White Health, 4500 Spring Ave, Dallas, TX 75210, United States.
| | - Leilani Dodgen
- School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, United States
| | - Abdullah Mamun
- School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, United States
| | - J Lee Slater
- Better Me Within Community Advisory Board, New Millennium Bible Fellowship Praise Center, 9026 Elam Rd, Dallas, TX 75217, United States
| | - George King
- Better Me Within Community Advisory Board, Cities of Refuge Church, 4801 Dolphin Rd, Dallas, TX 75223, United States
| | - Donna Slater
- Better Me Within Community Advisory Board, New Millennium Bible Fellowship Praise Center, 9026 Elam Rd, Dallas, TX 75217, United States
| | - Alene King
- Better Me Within Community Advisory Board, Cities of Refuge Church, 4801 Dolphin Rd, Dallas, TX 75223, United States
| | - Surendra Mandapati
- School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, United States
| | - Mark DeHaven
- Department of Public Health Science, University of North Carolina, 9201 University City Blvd, Charlotte, NC 28223, United States
| |
Collapse
|
43
|
Ard JD, Carson TL, Shikany JM, Li Y, Hardy CM, Robinson JC, Williams AG, Baskin ML. Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial. J Intern Med 2017; 282:102-113. [PMID: 28514081 PMCID: PMC6136898 DOI: 10.1111/joim.12622] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity is highly prevalent in African American women, especially those in the rural southern USA, resulting in persistent health disparities. OBJECTIVE To test the effectiveness of an evidence-based behavioural weight loss intervention delivered by community health advisors to African American women in the rural south. DESIGN AND METHODS Overweight or obese African American women (30-70 years) from eight counties in Mississippi and Alabama participated in a 24-month randomized controlled trial of an evidence-based behavioural weight loss programme augmented with community strategies to support healthy lifestyles (Weight Loss Plus, N = 154) compared to the weight loss programme alone (Weight Loss Only, N = 255). This study reports on 6-month outcomes on primary (weight change) and secondary (waist circumference, blood pressure, lipids, fasting blood glucose) outcomes, coinciding with the completion of the intensive weight loss phase. RESULTS Weight Loss Only participants lost an average of 2.2 kg (P < 0.001). Weight Loss Plus participants lost an average of 3.2 kg (P < 0.001). The proportion of the total sample that lost at least 5% of their body weight was 27.1% with no difference between treatment groups. Similarly, we observed statistically significant reductions in blood pressure, waist circumference and triglycerides in each treatment group, with no statistical differences between groups. CONCLUSION Trained lay health staff and volunteers from the rural southern USA were able to deliver a translation of a high-intensity behavioural intervention targeted to African American women, resulting in clinically meaningful weight loss and improvement in other metabolic outcomes in a significant proportion of participants.
Collapse
Affiliation(s)
- J D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - T L Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Y Li
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C M Hardy
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J C Robinson
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - A G Williams
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M L Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
44
|
Hurt TR, Seawell AH, Cutrona C, O'Connor MC, Camp RD, Duran R, Elderts R, Green C, Hara V, Pattee J. Black Women's Recommendations for Developing Effective Type 2 Diabetes Programming. Glob Qual Nurs Res 2017; 4:2333393617715335. [PMID: 28804746 PMCID: PMC5484429 DOI: 10.1177/2333393617715335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 05/13/2017] [Accepted: 05/22/2017] [Indexed: 01/28/2023] Open
Abstract
The purpose of this study was to learn from 29 Black women how to develop effective Type 2 diabetes programming. Three focus groups were held in Des Moines, Iowa, during fall 2012. Results highlighted themes related to diabetes knowledge, diabetes management and prevention, physical activity, diet, and diabetes management programming. Opinions were shared as to whether family members should be included in programs for supporting those diagnosed with diabetes. These results provided guidance and ideas to scholars and health care professionals aiming to improve effectiveness of diabetes programs for Black women and families.
Collapse
|
45
|
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
|
46
|
Samuel-Hodge CD, Holder-Cooper JC, Gizlice Z, Davis G, Steele SP, Keyserling TC, Kumanyika SK, Brantley PJ, Svetkey LP. Family PArtners in Lifestyle Support (PALS): Family-based weight loss for African American adults with type 2 diabetes. Obesity (Silver Spring) 2017; 25:45-55. [PMID: 27911049 PMCID: PMC5182111 DOI: 10.1002/oby.21700] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/30/2016] [Accepted: 09/19/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop and test a family-centered behavioral weight loss intervention for African American adults with type 2 diabetes. METHODS In this randomized trial, dyads consisting of an African American adult with overweight or obesity and type 2 diabetes (index participant) paired with a family partner with overweight or obesity but not diagnosed with diabetes were assigned in a 2:1 ratio to a 20-week special intervention (SI) or delayed intervention (DI) control group. The primary outcome was weight loss among index participants at the 20-week follow-up. RESULTS One hundred eight participants (54 dyads-36 (SI) and 18 (DI) dyads) were enrolled: 81% females; mean age, 51 years; mean weight,103 kg; and mean BMI, 37 kg/m2 . At post-intervention, 96 participants (89%) returned for follow-up measures. Among index participants, mean difference in weight loss between groups was -5.0 kg, P <0.0001 (-3.6 kg loss among SI; 1.4 kg gain in DI). SI index participants showed significantly greater improvements in hemoglobin A1c, depressive symptoms, family interactions, and dietary, physical activity, and diabetes self-care behaviors. SI family partners also had significant weight loss (-3.9 kg (SI) vs. -1.0 kg (DI), P = 0.02). CONCLUSIONS A family-centered, behavioral weight loss intervention led to clinically significant short-term weight loss among family dyads.
Collapse
Affiliation(s)
- Carmen D Samuel-Hodge
- Department of Nutrition, Gillings School of Global Public Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Judith C Holder-Cooper
- Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina, USA
- Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gwendolyn Davis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonia P Steele
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Thomas C Keyserling
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of General Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shiriki K Kumanyika
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Phillip J Brantley
- Behavioral Medicine Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Laura P Svetkey
- Department of Medicine, Division of Nephrology, Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
47
|
Keyserling TC, Samuel-Hodge CD, Pitts SJ, Garcia BA, Johnston LF, Gizlice Z, Miller CL, Braxton DF, Evenson KR, Smith JC, Davis GB, Quenum EL, Elliott NTM, Gross MD, Donahue KE, Halladay JR, Ammerman AS. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health 2016; 16:732. [PMID: 27495295 PMCID: PMC4975883 DOI: 10.1186/s12889-016-3370-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/23/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population. METHODS The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m(2) offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up. RESULTS Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m(2). In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar. CONCLUSIONS The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01433484.
Collapse
Affiliation(s)
- Thomas C. Keyserling
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, CB 7110, University of North Carolina, 5039 Old Clinic Building, Chapel Hill, NC 27599 USA
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Carmen D. Samuel-Hodge
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Stephanie Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Lakeside Annex 8, 600 Moye Blvd, MS 660, Greenville, NC 27834 USA
| | - Beverly A. Garcia
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Larry F. Johnston
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Cassandra L. Miller
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Danielle F. Braxton
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, CB 8050, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Janice C. Smith
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Gwen B. Davis
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Emmanuelle L. Quenum
- Greene County Health Department, 225 Kingold Blvd, Suite B, Snow Hill, North Carolina 28580 USA
| | - Nadya T. Majette Elliott
- Student Health Services, East Carolina University, 1000 East 5th St, MS 408, Greenville, NC 27858 USA
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455 USA
| | - Katrina E. Donahue
- Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Jacqueline R. Halladay
- Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC 27599 USA
- Cecil G. Sheps Center for Health Services Research, School of Medicine, CB 7590, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Alice S. Ammerman
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| |
Collapse
|
48
|
Abstract
Type two diabetes (T2D) is a challenging metabolic disorder for which a cure has not yet been found. Its etiology is associated with several phenomena, including significant loss of insulin-producing, beta cell (β cell) mass via progressive programmed cell death and disrupted cellular autophagy. In diabetes, the etiology of β cell death and the role of mitochondria are complex and involve several layers of mechanisms. Understanding the dynamics of those mechanisms could permit researchers to develop an intervention for the progressive loss of β cells. Currently, diabetes research has shifted toward rejuvenation and plasticity technology and away from the simplified approach of hormonal compensation. Diabetes research is currently challenged by questions such as how to enhance cell survival, decrease apoptosis and replenish β cell mass in diabetic patients. In this review, we discuss evidence that β cell development and mass formation are guided by specific signaling systems, particularly hormones, transcription factors, and growth factors, all of which could be manipulated to enhance mass growth. There is also strong evidence that β cells are dynamically active cells, which, under specific conditions such as obesity, can increase in size and subsequently increase insulin secretion. In certain cases of aggressive or advanced forms of T2D, β cells become markedly impaired, and the only alternatives for maintaining glucose homeostasis are through partial or complete cell grafting (the Edmonton protocol). In these cases, the harvesting of an enriched population of viable β cells is required for transplantation. This task necessitates a deep understanding of the pharmacological agents that affect β cell survival, mass, and function. The aim of this review is to initiate discussion about the important signals in pancreatic β cell development and mass formation and to highlight the process by which cell death occurs in diabetes. This review also examines the attempts that have been made to recover or increase cell mass in diabetic patients by using various pharmacological agents.
Collapse
Affiliation(s)
- Husnia I Marrif
- Department of Pharmacology, Faculty of Medicine, University of Benghazi Benghazi, Libya
| | - Salma I Al-Sunousi
- Department of Histology and Anatomy, Faculty of Medicine, University of Benghazi Benghazi, Libya
| |
Collapse
|
49
|
Personalized Weight Management Interventions for Cardiovascular Risk Reduction: A Viable Option for African-American Women. Prog Cardiovasc Dis 2016; 58:595-604. [PMID: 26908050 DOI: 10.1016/j.pcad.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/14/2016] [Indexed: 12/11/2022]
Abstract
Obesity is an independent contributor to cardiovascular disease (CVD) and a major driving force behind racial/ethnic and gender disparities in risk. Due to a multitude of interrelating factors (i.e., personal, social, cultural, economic and environmental), African-American (AA) women are disproportionately obese and twice as likely to succumb to CVD, yet they are significantly underrepresented in behavioral weight management interventions. In this selective review we highlight components of the limited interventions shown to enhance weight loss outcomes in this population and make a case for leveraging Web-based technology and artificial intelligence techniques to deliver personalized programs aimed at obesity treatment and CVD risk reduction. Although many of the approaches discussed are generally applicable across populations burdened by disparate rates of obesity and CVD, we specifically focus on AA women due to the disproportionate impact of these non-communicable diseases and the general paucity of interventions targeted to this high-risk group.
Collapse
|
50
|
Chirinos DA, Goldberg RB, Llabre MM, Gellman M, Gutt M, McCalla J, Mendez A, Schneiderman N. Lifestyle modification and weight reduction among low-income patients with the metabolic syndrome: the CHARMS randomized controlled trial. J Behav Med 2016; 39:483-92. [DOI: 10.1007/s10865-016-9721-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/29/2016] [Indexed: 01/23/2023]
|