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Halladay JR, Lenhart KC, Robasky K, Jones W, Homan WF, Cummings DM, Cené CW, Hinderliter AL, Miller CL, Donahue KE, Garcia BA, Keyserling TC, Ammerman AS, Patterson C, DeWalt DA, Johnston LF, Willis MS, Schisler JC. Applicability of Precision Medicine Approaches to Managing Hypertension in Rural Populations. J Pers Med 2018; 8:E16. [PMID: 29710874 PMCID: PMC6023309 DOI: 10.3390/jpm8020016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/23/2018] [Accepted: 04/23/2018] [Indexed: 12/28/2022] Open
Abstract
As part of the Heart Healthy Lenoir Project, we developed a practice level intervention to improve blood pressure control. The goal of this study was: (i) to determine if single nucleotide polymorphisms (SNPs) that associate with blood pressure variation, identified in large studies, are applicable to blood pressure control in subjects from a rural population; (ii) to measure the association of these SNPs with subjects' responsiveness to the hypertension intervention; and (iii) to identify other SNPs that may help understand patient-specific responses to an intervention. We used a combination of candidate SNPs and genome-wide analyses to test associations with either baseline systolic blood pressure (SBP) or change in systolic blood pressure one year after the intervention in two genetically defined ancestral groups: African Americans (AA) and Caucasian Americans (CAU). Of the 48 candidate SNPs, 13 SNPs associated with baseline SBP in our study; however, one candidate SNP, rs592582, also associated with a change in SBP after one year. Using our study data, we identified 4 and 15 additional loci that associated with a change in SBP in the AA and CAU groups, respectively. Our analysis of gene-age interactions identified genotypes associated with SBP improvement within different age groups of our populations. Moreover, our integrative analysis identified AQP4-AS1 and PADI2 as genes whose expression levels may contribute to the pleiotropy of complex traits involved in cardiovascular health and blood pressure regulation in response to an intervention targeting hypertension. In conclusion, the identification of SNPs associated with the success of a hypertension treatment intervention suggests that genetic factors in combination with age may contribute to an individual's success in lowering SBP. If these findings prove to be applicable to other populations, the use of this genetic variation in making patient-specific interventions may help providers with making decisions to improve patient outcomes. Further investigation is required to determine the role of this genetic variance with respect to the management of hypertension such that more precise treatment recommendations may be made in the future as part of personalized medicine.
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Affiliation(s)
- Jacqueline R Halladay
- Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Kaitlin C Lenhart
- McAllister Heart Institute at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Kimberly Robasky
- Q2 Solutions|EA Genomics, Morrisville, North Carolina. 27560, USA.
| | - Wendell Jones
- Q2 Solutions|EA Genomics, Morrisville, North Carolina. 27560, USA.
| | - Wayne F Homan
- Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Doyle M Cummings
- Department of Family Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Crystal W Cené
- Cecil R. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Alan L Hinderliter
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Cassandra L Miller
- Center for Health Promotion and Disease Prevention at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Katrina E Donahue
- Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Cecil R. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Beverly A Garcia
- Center for Health Promotion and Disease Prevention at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Thomas C Keyserling
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Nutrition, Gillings School of Global Public Health at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Nutrition, Gillings School of Global Public Health at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Cam Patterson
- Presbyterian Hospital/Weill-Cornell Medical Center, New York, NY 10065, USA.
| | - Darren A DeWalt
- Cecil R. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Larry F Johnston
- Center for Health Promotion and Disease Prevention at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Monte S Willis
- McAllister Heart Institute at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Pharmacology and Department of Pathology and Lab Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Jonathan C Schisler
- McAllister Heart Institute at The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
- Department of Pharmacology and Department of Pathology and Lab Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Jilcott Pitts SB, Keyserling TC, Johnston LF, Evenson KR, McGuirt JT, Gizlice Z, Whitt OR, Ammerman AS. Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults. J Acad Nutr Diet 2017; 117:1618-1627. [PMID: 28606554 PMCID: PMC5623155 DOI: 10.1016/j.jand.2017.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have been conducted in rural areas assessing the influence of community-level environmental factors on residents' success improving lifestyle behaviors. OBJECTIVE Our aim was to examine whether 6-month changes in diet, physical activity, and weight were moderated by the food and physical activity environment in a rural adult population receiving an intervention designed to improve diet and physical activity. DESIGN We examined associations between self-reported and objectively measured changes in diet, physical activity, and weight, and perceived and objectively measured food and physical activity environments. Participants were followed for 6 months. PARTICIPANTS/SETTING Participants were enrolled in the Heart Healthy Lenoir Project, a lifestyle intervention study conducted in Lenoir County, located in rural southeastern North Carolina. Sample sizes ranged from 132 to 249, depending on the availability of the data. INTERVENTION Participants received four counseling sessions that focused on healthy eating (adapted Mediterranean diet pattern) and increasing physical activity. POTENTIAL MODERATING FACTORS Density of and distance to food and physical activity venues, modified food environment index, Walk Score, crime, and perceived nutrition and physical activity neighborhood barriers were the potential mediating factors. OUTCOME MEASURES Diet quality, physical activity, and weight loss were the outcomes measured. STATISTICAL ANALYSES Statistical analyses included correlation and linear regression and controlling for potential confounders (baseline values of the dependent variables, age, race, education, and sex). RESULTS In adjusted analysis, there was an inverse association between weight change and the food environment, suggesting that participants who lived in a less-healthy food environment lost more weight during the 6-month intervention period (P=0.01). Also, there was a positive association between self-reported physical activity and distance to private gyms (P=0.04) and an inverse association between private gym density and pedometer-measured steps (P=0.03), indicating that those who lived farther from gyms and in areas with lower density of gyms had greater increases in physical activity and steps, respectively. CONCLUSIONS Contrary to our hypotheses, results indicated that those living in less-favorable food and physical activity environments had greater improvements in diet, physical activity, and weight, compared to those living in more favorable environments. Additional research should be undertaken to address these paradoxical findings and, if confirmed, to better understand them.
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Embree GGR, Samuel-Hodge CD, Johnston LF, Garcia BA, Gizlice Z, Evenson KR, DeWalt DA, Ammerman AS, Keyserling TC. Successful long-term weight loss among participants with diabetes receiving an intervention promoting an adapted Mediterranean-style dietary pattern: the Heart Healthy Lenoir Project. BMJ Open Diabetes Res Care 2017; 5:e000339. [PMID: 28405344 PMCID: PMC5372065 DOI: 10.1136/bmjdrc-2016-000339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/02/2017] [Accepted: 02/20/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To examine weight change by diabetes status among participants receiving a Mediterranean-style diet, physical activity, and weight loss intervention adapted for delivery in the southeastern USA, where rates of cardiovascular disease (CVD) are disproportionately high. RESEARCH DESIGN AND METHODS The intervention included: Phase I (months 1-6), an 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/m2 offered as 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 intervention for those losing ≥8 pounds with all others receiving a lifestyle maintenance intervention. Weight change was assessed at 6, 12, and 24-month follow-up. RESULTS Baseline characteristics (n=339): mean age 56, 77% female, 65% African-American, 124 (37%) with diabetes; mean weight 103 kg for those with diabetes and 95 kg for those without. Among participants with diabetes, average weight change was -1.2 kg (95% CI -2.1 to -0.4) at 6 months (n=92), -1.5 kg (95% CI -2.9 to -0.2) at 12 months (n=96), and -3.7 kg (95% CI -5.2 to -2.1) at 24 months (n=93). Among those without diabetes, weight change was -0.4 kg (95% CI -1.4 to 0.6) at 24 months (n=154). CONCLUSIONS Participants with diabetes experienced sustained weight loss at 24-month follow-up. High-risk US populations with diabetes may experience clinically important weight loss from this type of lifestyle intervention. TRIAL REGISTRATION NUMBER NCT01433484.
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Affiliation(s)
- Genevieve G R Embree
- Ambulatory Care Physician, Durham VA Medical Center, Durham, North Carolina, USA
| | - Carmen D Samuel-Hodge
- Department of Nutrition, Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Larry F Johnston
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Beverly A Garcia
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Kelly R Evenson
- Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Darren A DeWalt
- Division of General Medicine and Clinical Epidemiology , School of Medicine, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Alice S Ammerman
- Department of Nutrition, Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas C Keyserling
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA; Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Thayer LM, Pimentel DC, Smith JC, Garcia BA, Lee Sylvester L, Kelly T, Johnston LF, Ammerman AS, Keyserling TC. Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items. Am J Health Educ 2016; 48:11-21. [PMID: 28947925 DOI: 10.1080/19325037.2016.1250688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As Americans commonly consume restaurant foods with poor dietary quality, effective interventions are needed to improve food choices at restaurants. PURPOSE To design and evaluate a restaurant-based intervention to help customers select and restaurants promote heart healthy menu items with healthful fats and high quality carbohydrates. METHODS The intervention included table tents outlining 10 heart healthy eating tips, coupons promoting healthy menu items, an information brochure, and link to study website. Pre and post intervention surveys were completed by restaurant managers and customers completed a brief "intercept" survey. RESULTS Managers (n = 10) reported the table tents and coupons were well received, and several noted improved personal nutrition knowledge. Overall, 4214 coupons were distributed with 1244 (30%) redeemed. Of 300 customers surveyed, 126 (42%) noticed the table tents and of these, 115 (91%) considered the nutrition information helpful, 42 (33%) indicated the information influenced menu items purchased, and 91 (72%) reported the information will influence what they order in the future. DISCUSSION The intervention was well-received by restaurant managers and positively influenced menu item selection by many customers. TRANSLATION TO HEALTH EDUCATION PRACTICE Further research is needed to assess effective strategies for scaling up and sustaining this intervention approach.
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Affiliation(s)
- Linden M Thayer
- Duke University - Center for Advanced Hindsight; 334 Blackwell Street, Suite 320, Durham, NC 27701-3971
| | - Daniela C Pimentel
- University of North Carolina - Chapel Hill, Department of Nutrition; 135 Dauer Drive 2200 McGavran-Greenberg Hall, CB #7461, Chapel Hill, NC 27599-7461
| | - Janice C Smith
- University of North Carolina - Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Beverly A Garcia
- University of North Carolina - Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Laura Lee Sylvester
- Lenoir County Cooperative Extension; 1791 NC Highway 11 55, Kinston, NC 28504
| | - Tammy Kelly
- Kinston-Lenoir Chamber of Commerce; 301 N. Queen St, Kinston, NC 28501
| | - Larry F Johnston
- University of North Carolina - Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Alice S Ammerman
- University of North Carolina - Chapel Hill, Department of Nutrition; 135 Dauer Drive 2200 McGavran-Greenberg Hall, CB #7461, Chapel Hill, NC 27599-7461.,University of North Carolina - Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Thomas C Keyserling
- University of North Carolina - Chapel Hill, Department of Medicine; 125 MacNider Hall, CB #7005 Chapel Hill NC 27599-7005
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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: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Cavallo DN, Sisneros JA, Ronay AA, Robbins CL, Jilcott Pitts SB, Keyserling TC, Ni A, Morrow J, Vu MB, Johnston LF, Samuel-Hodge CD. Assessing the Feasibility of a Web-Based Weight Loss Intervention for Low-Income Women of Reproductive Age: A Pilot Study. JMIR Res Protoc 2016; 5:e30. [PMID: 26920252 PMCID: PMC4788741 DOI: 10.2196/resprot.4865] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/04/2015] [Accepted: 11/14/2015] [Indexed: 11/20/2022] Open
Abstract
Background Low-income women of reproductive age are at increased risk for obesity and resulting increases in the risk of maternal/fetal complications and mortality and morbidity. Very few weight-loss interventions, however, have been targeted to this high-risk group. Based on the high prevalence of social media use among young and low-income individuals and previous successes using group formats for weight-loss interventions, the use of social media as a platform for weight-loss intervention delivery may benefit low-income women of reproductive age. Objective Examine the feasibility of delivering group-based weight-loss interventions to low-income women of reproductive age using face-to-face meetings and Web-based modalities including social media. Methods Participants attended a family planning clinic in eastern North Carolina and received a 5-month, group- and Web-based, face-to-face weight-loss intervention. Measures were assessed at baseline and 20 weeks. Results Forty participants enrolled, including 29 (73%) African American women. The mean body mass index of enrollees was 39 kg/m2. Among the 12 women who completed follow-up, mean weight change was -1.3 kg. Participation in the intervention was modest and retention at 5 months was 30%. Returnees suggested sending reminders to improve participation and adding activities to increase familiarity among participants. Conclusions Engagement with the intervention was limited and attrition was high. Additional formative work on the barriers and facilitators to participation may improve the intervention’s feasibility with low-income women of reproductive age.
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Affiliation(s)
- David N Cavallo
- Case Western Reserve University, Department of Nutrition, Cleveland, OH, United States.
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Jilcott Pitts SB, Keyserling TC, Johnston LF, Smith TW, McGuirt JT, Evenson KR, Rafferty AP, Gizlice Z, Garcia BA, Ammerman AS. Associations between neighborhood-level factors related to a healthful lifestyle and dietary intake, physical activity, and support for obesity prevention polices among rural adults. J Community Health 2015; 40:276-84. [PMID: 25096764 DOI: 10.1007/s10900-014-9927-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We examined cross-sectional associations among neighborhood- and individual-level factors related to a healthful lifestyle and dietary intake, physical activity (PA), and support for obesity prevention polices in rural eastern North Carolina adults. We examined perceived neighborhood barriers to a healthful lifestyle, and associations between neighborhood barriers to healthy eating and PA, participants' support for seven obesity prevention policies, and dependent variables of self-reported dietary and PA behaviors, and measured body mass index (BMI) (n = 366 study participants). We then used participants' residential addresses and Geographic Information Systems (GIS) software to assess neighborhood-level factors related to access to healthy food and PA opportunities. Correlational analyses and adjusted linear regression models were used to examine associations between neighborhood-level factors related to a healthful lifestyle and dietary and PA behaviors, BMI, and obesity prevention policy support. The most commonly reported neighborhood barriers (from a list of 18 potential barriers) perceived by participants included: not enough bicycle lanes and sidewalks, not enough affordable exercise places, too much crime, and no place to buy a quick, healthy meal to go. Higher diet quality was inversely related to perceived and GIS-assessed neighborhood nutrition barriers. There were no significant associations between neighborhood barriers and PA. More perceived neighborhood barriers were positively associated with BMI. Support for obesity prevention policy change was positively associated with perceptions of more neighborhood barriers. Neighborhood factors that promote a healthful lifestyle were associated with higher diet quality and lower BMI. Individuals who perceived more neighborhood-level barriers to healthy eating and PA usually supported policies to address those barriers. Future studies should examine mechanisms to garner such support for health-promoting neighborhood changes.
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Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, East Carolina University, Lakeside Annex 8, 600 Moye Blvd, MS 660, Greenville, NC, 27834, USA,
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Robbins CL, Keyserling TC, Jilcott Pitts S, Morrow J, Moos MK, Johnston LF, Farr SL. Outcomes of cardiovascular disease risk factor screening and referrals in a family planning clinic. J Womens Health (Larchmt) 2014; 24:131-7. [PMID: 25517351 DOI: 10.1089/jwh.2014.4938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) screening in Title X settings can identify low-income women at risk of future chronic disease. This study examines follow-up related to newly identified CVD risk factors in a Title X setting. METHODS Female patients at a North Carolina Title X clinic were screened for CVD risk factors (n=462) and 167/462 (36.1%) were rescreened one year later. Clinical staff made protocol-driven referrals for women identified with newly diagnosed CVD risk factors. We used paired t-tests and chi square tests to compare screening and rescreening results (two-tailed, p<0.05). RESULTS Among 11 women in need of referrals for newly diagnosed hypertension or diabetes, 9 out of 11 (81.8%) were referred, and 2 of 11 (18.2%) completed referrals. Among hypertensive women who were rescreened (n=21), systolic blood pressure decreased (139 to 132 mmHg, p=0.001) and diastolic blood pressure decreased (90 to 83 mmHg, p=0.006). Hemoglobin A1c did not improve among rescreened diabetic women (n=5, p=0.640). Among women who reported smoking at enrollment, 129 of 148 (87.2%) received cessation counseling and 8 of 148 (5.4%) accepted tobacco quitline referrals. Among smokers, 53 out of 148 (35.8%) were rescreened and 11 of 53 (20.8%) reported nonsmoking at that time. Among 188 women identified as obese at enrollment, 22 (11.7%) scheduled nutrition appointments, but only one attended. Mean weight increased from 221 to 225 pounds (p 0<.05) among 70 out of 188 (37.2%) obese women who were rescreened. CONCLUSIONS The majority of women in need of referrals for CVD risk factors received them. Few women completed referrals. Future research should examine barriers and facilitators of referral care among low-income women.
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Affiliation(s)
- Cheryl L Robbins
- 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion , Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Keyserling TC, Sheridan SL, Draeger LB, Finkelstein EA, Gizlice Z, Kruger E, Johnston LF, Sloane PD, Samuel-Hodge C, Evenson KR, Gross MD, Donahue KE, Pignone MP, Vu MB, Steinbacher EA, Weiner BJ, Bangdiwala SI, Ammerman AS. A comparison of live counseling with a web-based lifestyle and medication intervention to reduce coronary heart disease risk: a randomized clinical trial. JAMA Intern Med 2014; 174:1144-57. [PMID: 24861959 PMCID: PMC4142754 DOI: 10.1001/jamainternmed.2014.1984] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Most primary care clinicians lack the skills and resources to offer effective lifestyle and medication (L&M) counseling to reduce coronary heart disease (CHD) risk. Thus, effective and feasible CHD prevention programs are needed for typical practice settings. OBJECTIVE To assess the effectiveness, acceptability, and cost-effectiveness of a combined L&M intervention to reduce CHD risk offered in counselor-delivered and web-based formats. DESIGN, SETTING, AND PARTICIPANTS A comparative effectiveness trial in 5 diverse family medicine practices in North Carolina. Participants were established patients, aged 35 to 79 years, with no known cardiovascular disease, and at moderate to high risk for CHD (10-year Framingham Risk Score [FRS], ≥10%). INTERVENTIONS Participants were randomized to counselor-delivered or web-based format, each including 4 intensive and 3 maintenance sessions. After randomization, both formats used a web-based decision aid showing potential CHD risk reduction associated with L&M risk-reducing strategies. Participants chose the risk-reducing strategies they wished to follow. MAIN OUTCOMES AND MEASURES The primary outcome was within-group change in FRS at 4-month follow-up. Other measures included standardized assessments of blood pressure, blood lipid levels, lifestyle behaviors, and medication adherence. Acceptability and cost-effectiveness were also assessed. Outcomes were assessed at 4 and 12 months. RESULTS Of 2274 screened patients, 385 were randomized (192 counselor; 193 web): mean age, 62 years; 24% African American; and mean FRS, 16.9%. Follow-up at 4 and 12 months included 91% and 87% of the randomized participants, respectively. There was a sustained reduction in FRS at both 4 months (primary outcome) and 12 months for both counselor-based (-2.3% [95% CI, -3.0% to -1.6%] and -1.9% [95% CI, -2.8% to -1.1%], respectively) and web-based groups (-1.5% [95% CI, -2.2% to -0.9%] and -1.7% [95% CI, -2.6% to -0.8%] respectively). At 4 months, the adjusted difference in FRS between groups was -1.0% (95% CI, -1.8% to -0.1%) (P = .03), and at 12 months, it was -0.6% (95% CI, -1.7% to 0.5%) (P = .30). The 12-month costs from the payer perspective were $207 and $110 per person for the counselor- and web-based interventions, respectively. CONCLUSIONS AND RELEVANCE Both intervention formats reduced CHD risk through 12-month follow-up. The web format was less expensive. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01245686.
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Affiliation(s)
- Thomas C Keyserling
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill2Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Stacey L Sheridan
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill2Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill3Cecil G. Sheps Center for Health Services R
| | - Lindy B Draeger
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Eric A Finkelstein
- Health Services and Systems Research Program, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Eliza Kruger
- Health Services and Systems Research Program, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Larry F Johnston
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill5Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Carmen Samuel-Hodge
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill6Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Myron D Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Katrina E Donahue
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill5Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Michael P Pignone
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill3Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | - Maihan B Vu
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill
| | | | - Bryan J Weiner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Shrikant I Bangdiwala
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill11Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill5Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill6Department of Nutrition, Gillings School of Global Public Health, Un
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Samuel-Hodge CD, Garcia BA, Johnston LF, Gizlice Z, Ni A, Cai J, Kraschnewski JL, Gustafson AA, Norwood AF, Glasgow RE, Gold AD, Graham JW, Evenson KR, Trost S, Keyserling TC. Translation of a behavioral weight loss intervention for mid-life, low-income women in local health departments. Obesity (Silver Spring) 2013; 21:1764-73. [PMID: 23408464 DOI: 10.1002/oby.20317] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 11/23/2012] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To translate a behavioral weight loss intervention for mid-life, low-income women in real world settings. DESIGN AND METHODS In this pragmatic clinical trial, we randomly selected six North Carolina county health departments and trained their current staff to deliver a 16-session evidence-based behavioral weight loss intervention (special intervention, SI). SI weight loss outcomes were compared to a delayed intervention (DI) control group. RESULTS Of 432 women expressing interest, 189 completed baseline measures and were randomized within health departments to SI (N = 126) or DI (N = 63). At baseline, average age was 51 years, 53% were African American, mean weight was 100 kg, and BMI averaged 37 kg/m2 . A total of 96 (76%) SI and 55 (87%) DI participants returned for 5-month follow-up measures. The crude weight change was -3.1 kg in the SI and -0.4 kg in the DI group, for a difference of 2.8 kg (95% CI 1.4 to 4.1, p = 0.0001). Diet quality and physical activity improved significantly more in the SI group, and estimated intervention costs were $327 per participant. CONCLUSION This pragmatic short-term weight loss intervention targeted to low-income mid-life women yielded meaningful weight loss when translated to the county health department setting.
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Affiliation(s)
- Carmen D Samuel-Hodge
- Department of Nutrition, Gillings School of Public Health and School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; UNC Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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Samuel-Hodge CD, Johnston LF, Gizlice Z, Garcia BA, Lindsley SC, Gold AD, Braxton DF, Keyserling TC. A pilot study comparing two weight loss maintenance interventions among low-income, mid-life women. BMC Public Health 2013; 13:653. [PMID: 23855318 PMCID: PMC3717028 DOI: 10.1186/1471-2458-13-653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 06/25/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Despite high obesity prevalence rates, few low-income midlife women participate in weight loss maintenance trials. This pilot study aims to assess the effectiveness of two weight loss maintenance interventions in this under-represented population. METHODS Low-income midlife women who completed a 16-week weight loss intervention and lost ≥ 8 lbs (3.6 kg) were eligible to enroll in one of two 12-month maintenance programs. The programs were similar in content and had the same number of total contacts, but were different in the contact modality (Phone + Face-to-Face vs. Face-to-Face Only). Two criteria were used to assess successful weight loss maintenance at 12 months: (1) retaining a loss of ≥ 5% of body weight from the start of the weight loss phase and (2) a change in body weight of < 3%, from the start to the end of the maintenance program. Outcome measures of changes in physiologic and psychosocial factors, and evaluations of process measures and program acceptability (measured at 12 months) are also reported. For categorical variables, likelihood ratio or Fisher's Exact (for small samples) tests were used to evaluate statistically significant relationships; for continuous variables, t-tests or their equivalents were used to assess differences between means and also to identify correlates of weight loss maintenance. RESULTS Overall, during the 12-month maintenance period, 41% (24/58) of participants maintained a loss of ≥ 5% of initial weight and 43% (25/58) had a <3% change in weight. None of the comparisons between the two maintenance programs were statistically significant. However, improvements in blood pressure and dietary behaviors remained significant at the end of the 12-month maintenance period for participants in both programs. Participant attendance and acceptability were high for both programs. CONCLUSIONS The effectiveness of two pilot 12-month maintenance interventions provides support for further research in weight loss maintenance among high-risk, low-income women. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00288301.
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Kraschnewski JL, Gold AD, Gizlice Z, Johnston LF, Garcia BA, Samuel-Hodge CD, Keyserling TC. Development and evaluation of a brief questionnaire to assess dietary fat quality in low-income overweight women in the southern United States. J Nutr Educ Behav 2013; 45:355-361. [PMID: 23340242 DOI: 10.1016/j.jneb.2012.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 10/08/2012] [Accepted: 10/29/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To develop a brief questionnaire to assess dietary fat quality, the Dietary Fat Quality Assessment (DFQA), for use in dietary counseling to reduce heart disease risk. METHODS A subsample of 120 underserved, midlife women enrolled in a randomized, controlled weight loss trial completed baseline and follow-up telephone surveys. Main outcome measures included dietary fat components (total fat, saturated fat, polyunsaturated fat, monounsaturated fat, omega-3 fatty acids, and cholesterol). RESULTS Assessments of major dietary fat components using the DFQA and a food frequency questionnaire were significantly correlated, with correlation coefficients of 0.54-0.66 (P < .001). Intra-class correlation coefficients to assess reliability ranged from 0.48 to 0.59 for each of the fat components studied. CONCLUSIONS AND IMPLICATIONS The DFQA provides a reasonable assessment of dietary fat quality associated with coronary heart disease risk and may prove useful as a brief assessment tool to guide dietary counseling given to reduce heart disease risk.
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Affiliation(s)
- Jennifer L Kraschnewski
- Department of Medicine and Public Health Sciences, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
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Samuel-Hodge CD, Garcia BA, Johnston LF, Kraschnewski JL, Gustafson AA, Norwood AF, Glasgow RE, Gold AD, Graham JW, Evenson KR, Stearns SC, Gizlice Z, Keyserling TC. Rationale, design, and sample characteristics of a practical randomized trial to assess a weight loss intervention for low-income women: the Weight-Wise II Program. Contemp Clin Trials 2011; 33:93-103. [PMID: 21930244 DOI: 10.1016/j.cct.2011.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 08/22/2011] [Accepted: 08/30/2011] [Indexed: 11/30/2022]
Abstract
Obesity is common among low-income mid-life women, yet most published weight loss studies have not focused on this population and have been highly resourced efficacy trials. Thus, practical type 2 translational studies are needed to evaluate weight loss interventions for low-income women. In this paper, we present the rationale, study design, and baseline characteristics of a type 2 translational study that evaluates both the processes and outcomes of a weight loss intervention for low-income women given at 6 county health departments in North Carolina. Key features of this study include random selection of study sites, intervention delivery by current staff at study sites, efforts to integrate the intervention with local community resources, a focus on evaluating the processes of translation using the RE-AIM framework, use of an evidence-based weight loss intervention, a detailed description of participant recruitment and representativeness, and a practical randomized trial designed to assess the effectiveness of the intervention. Of 81 health departments invited to participate, 30 (37%) were eligible and willing, and 6 were selected at random to deliver the intervention. Of 432 potential participants screened by phone, 213 (49%) were eligible and of these, 189 (89%) completed baseline measures and were randomized to receive a 5-month weight loss intervention or a delayed intervention. The mean age was 51, mean BMI 37 kg/m(2), 53% were African American, and 43% had no health insurance. The results of this study should be informative to key stakeholders interested in real world weight loss interventions for low-income mid-life women.
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Affiliation(s)
- Carmen D Samuel-Hodge
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health and School of Medicine, Department of Nutrition, Chapel Hill, NC 27599-7426, United States.
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Samuel-Hodge CD, Kraschnewski JL, Keyserling TC, Bangdiwala SI, Gizlice Z, Garcia BA, Johnston LF, Gustafson A, Petrovic L, Glasgow RE. Optimized probability sampling of study sites to improve generalizability in a multisite intervention trial. Prev Chronic Dis 2009; 7:A10. [PMID: 20040225 PMCID: PMC2811505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Studies of type 2 translation, the adaption of evidence-based interventions to real-world settings, should include representative study sites and staff to improve external validity. Sites for such studies are, however, often selected by convenience sampling, which limits generalizability. We used an optimized probability sampling protocol to select an unbiased, representative sample of study sites to prepare for a randomized trial of a weight loss intervention. METHODS We invited North Carolina health departments within 200 miles of the research center to participate (N = 81). Of the 43 health departments that were eligible, 30 were interested in participating. To select a representative and feasible sample of 6 health departments that met inclusion criteria, we generated all combinations of 6 from the 30 health departments that were eligible and interested. From the subset of combinations that met inclusion criteria, we selected 1 at random. RESULTS Of 593,775 possible combinations of 6 counties, 15,177 (3%) met inclusion criteria. Sites in the selected subset were similar to all eligible sites in terms of health department characteristics and county demographics. CONCLUSION Optimized probability sampling improved generalizability by ensuring an unbiased and representative sample of study sites.
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Affiliation(s)
| | | | | | | | - Ziya Gizlice
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Beverly A. Garcia
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Larry F. Johnston
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison Gustafson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsay Petrovic
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Samuel-Hodge CD, Johnston LF, Gizlice Z, Garcia BA, Lindsley SC, Bramble KP, Hardy TE, Ammerman AS, Poindexter PA, Will JC, Keyserling TC. Randomized trial of a behavioral weight loss intervention for low-income women: the Weight Wise Program. Obesity (Silver Spring) 2009; 17:1891-9. [PMID: 19407810 DOI: 10.1038/oby.2009.128] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Low-income women in the United States have the highest rates of obesity, yet they are seldom included in weight loss trials. To address this research gap, components of two evidence-based weight loss interventions were adapted to create a 16-week intervention for low-income women (Weight Wise Program), which was evaluated in a randomized trial with the primary outcome of weight loss at 5-month follow-up. Participants were low-income women (40-64 years) with a BMI of 25-45. Of 143 participants, 72 were randomized to the Weight Wise Program (WWP) and 71 to the Control Group (CG). Five-month follow-up data were obtained from 64 (89%) WWP and 62 (87%) CG participants. With baseline values carried forward for missing data, WWP participants had a weight change of -3.7 kg compared to 0.7 kg in the CG (4.4 kg difference, 95% confidence interval (CI), 3.2-5.5, P<0.001). For systolic blood pressure (SBP), change in the WWP was -6.5 mm Hg compared to -0.4 mm Hg among controls (6.2 mm Hg difference, 95% CI, 1.7-10.6, P=0.007); for diastolic BP (DBP), changes were -4.1 mm Hg for WWP compared to -1.3 mm Hg for controls (2.8 mm Hg difference, 95% CI, 0.0-5.5, P=0.05). Of the 72 WWP participants, 64, 47, and 19% lost at least 3, 5, and 7% of their initial body weight, respectively. In conclusion, the WWP was associated with statistically significant and clinically important short-term weight loss.
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Affiliation(s)
- Carmen D Samuel-Hodge
- Department of Nutrition, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
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Samuel-Hodge CD, Keyserling TC, Park S, Johnston LF, Gizlice Z, Bangdiwala SI. A randomized trial of a church-based diabetes self-management program for African Americans with type 2 diabetes. Diabetes Educ 2009; 35:439-54. [PMID: 19383882 DOI: 10.1177/0145721709333270] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study developed and tested a culturally appropriate, church-based intervention to improve diabetes self-management. Research Design and Methods This was a randomized trial conducted at 24 African American churches in central North Carolina. Churches were randomized to receive the special intervention (SI; 13 churches, 117 participants) or the minimal intervention (MI; 11 churches, 84 participants). The SI included an 8-month intensive phase, consisting of 1 individual counseling visit, 12 group sessions, monthly phone contacts, and 3 encouragement postcards, followed by a 4-month reinforcement phase including monthly phone contacts. The MI received standard educational pamphlets by mail. Outcomes were assessed at 8 and 12 months; the primary outcome was comparison of 8-month A1C levels. RESULTS At baseline, the mean age was 59 years, A1C 7.8%, and body mass index 35.0 kg/m(2); 64% of participants were female. For the 174 (87%) participants returning for 8-month measures, mean A1C (adjusted for baseline and group randomization) was 7.4% for SI and 7.8% for MI, with a difference of 0.4% (95% confidence interval [CI], 0.1-0.6, P = .009). In a larger model adjusting for additional variables, the difference was 0.5% (95% CI, 0.2-0.7, P < .001). At 12 months, the difference between groups was not significant. Diabetes knowledge and diabetes-related quality of life significantly improved in the SI group compared with the MI group. Among SI participants completing an acceptability questionnaire, intervention components and materials were rated as highly acceptable. CONCLUSIONS The church-based intervention was well received by participants and improved short-term metabolic control.
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Affiliation(s)
- Carmen D Samuel-Hodge
- The Department of Nutrition, Schools of Public Health and Medicine and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Dr Samuel-Hodge)
| | - Thomas C Keyserling
- Department of Medicine, School of Medicine and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Dr Keyserling)
| | - Sola Park
- Department of Biostatistics, School of Public Health and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Dr Park), Dr Park is currently at Family Health International,
Research Triangle Park, North Carolina
| | - Larry F Johnston
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Mr Johnston, Dr Gizlice)
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Mr Johnston, Dr Gizlice)
| | - Shrikant I Bangdiwala
- Department of Biostatistics, School of Public Health and Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Dr Bangdiwala)
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Jilcott SB, Keyserling TC, Samuel-Hodge CD, Johnston LF, Gross MD, Ammerman AS. Validation of a Brief Dietary Assessment to Guide Counseling for Cardiovascular Disease Risk Reduction in an Underserved Population. ACTA ACUST UNITED AC 2007; 107:246-55. [PMID: 17258961 DOI: 10.1016/j.jada.2006.11.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Brief dietary assessment tools are needed to guide counseling in underserved populations to reduce cardiovascular disease (CVD) risk. The Dietary Risk Assessment is one such tool modified over time to reflect emerging evidence concerning diet and CVD risk. OBJECTIVE To examine the capacity of the modified Dietary Risk Assessment tool to measure aspects of diet quality in a sample of underserved, midlife (aged 40 to 64 years) women, by comparing Dietary Risk Assessment results to those of a longer food frequency questionnaire (FFQ) and with serum carotenoids. DESIGN This study used baseline data from women enrolled in a CVD risk reduction intervention trial. The Dietary Risk Assessment was administered to 236 women and results were compared to those from a longer FFQ administered to 104 women, and to serum carotenoids results from all participants. RESULTS Correlations between Dietary Risk Assessment indexes and corresponding measures from the FFQ were statistically significant: fruit and vegetable, r=-0.53 (P<0.0001, correlation is negative as a lower Dietary Risk Assessment score indicates greater fruit and vegetable intake); saturated fat, r=0.60 (P<0.0001). In linear regression models stratified by smoking and adjusted for body mass index, low-density lipoprotein cholesterol level, high-density lipoprotein cholesterol level, very-low-density lipoprotein cholesterol level, and age, the Dietary Risk Assessment fruit and vegetable index was significantly associated with serum carotenoids (parameter estimate for nonsmokers -0.22, P=0.01; smokers -0.45, P=0.003). Correlation coefficients between Dietary Risk Assessment total score and three diet quality index scores derived from FFQ variables were statistically significant, ranging in magnitude from 0.57 to 0.60. CONCLUSIONS The modified Dietary Risk Assessment provides a reasonable assessment of dietary factors associated with CVD risk; thus, it is appropriate for use to guide dietary counseling in CVD prevention programs for underserved, midlife, women.
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Samuel-Hodge CD, Keyserling TC, France R, Ingram AF, Johnston LF, Pullen Davis L, Davis G, Cole AS. A church-based diabetes self-management education program for African Americans with type 2 diabetes. Prev Chronic Dis 2006; 3:A93. [PMID: 16776894 PMCID: PMC1637801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diabetes self-management education interventions in community gathering places have been moderately effective, but very few studies of intervention effectiveness have been conducted among African Americans with type 2 diabetes. This paper describes a church-based diabetes self-management education intervention for African Americans, a randomized controlled trial to evaluate the intervention, and baseline characteristics of study participants. METHODS A New DAWN: Diabetes Awareness & Wellness Network was conducted among 24 churches of varying size in North Carolina. Each church recruited congregants with type 2 diabetes and designated a diabetes advisor, or peer counselor, to be part of the intervention team. Participants were enrolled at each church and randomized as a unit to either the special intervention or the minimal intervention. The special intervention included one individual counseling visit, twelve group sessions, three postcard messages from the participant's diabetes care provider, and twelve monthly telephone calls from a diabetes advisor. Baseline data included measures of weight, hemoglobin A1c, blood pressure, physical activity, dietary and diabetes self-care practices, and psychosocial factors. The study to evaluate the intervention (from enrollment visit to last follow-up) began in February 2001 and ended in August 2003. RESULTS Twenty-four churches (with 201 total participants) were randomized. Sixty-four percent of the participants were women. On average, the participants were aged 59 years and sedentary. They had an average of 12 years of education, had been diagnosed with diabetes for 9 years, had a body mass index of 35, had a hemoglobin A1c level of 7.8%, and had a reported dietary intake of 39% of calories from fat. CONCLUSION A New DAWN is a culturally sensitive, church-based diabetes self-management education program for African Americans with type 2 diabetes that is being evaluated for effectiveness in a randomized controlled trial. The outcomes of A New DAWN will contribute to the literature on community-based interventions for minority populations and help to inform the selection of approaches to improve diabetes care in this population.
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Affiliation(s)
- Carmen D Samuel-Hodge
- University of North Carolina at Chapel Hill, Department of Nutrition, Schools of Medicine and Public Health, CB #7426, 1700 Airport Rd, Room 246, Chapel Hill, NC 27599-8140, USA.
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Samuel-Hodge CD, Fernandez LM, Henríquez-Roldán CF, Johnston LF, Keyserling TC. A comparison of self-reported energy intake with total energy expenditure estimated by accelerometer and basal metabolic rate in African-American women with type 2 diabetes. Diabetes Care 2004; 27:663-9. [PMID: 14988282 DOI: 10.2337/diacare.27.3.663] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assesses the validity of dietary data from African-American women with type 2 diabetes by comparing reported energy intake (EI) with total energy expenditure (TEE) estimated by an accelerometer and basal metabolic rate (BMR). RESEARCH DESIGN AND METHODS EI of 200 African-American women was assessed by three telephone-administered 24-h diet recalls using a multiple-pass approach. Physical activity was measured over a 7-day period by accelerometer, which also provided an estimate of TEE. Underreporting of EI was determined by using cutoffs for EI-to-TEE and EI-to-BMR ratios. RESULTS Participants, on average, were 59 years of age, with a BMI of 35.7, 10.5 years of diagnosed diabetes, and 10.7 years of education. Mean EI was 1,299 kcal/day; mean EI-to-TEE and EI-to-BMR ratios were 0.65 and 0.88, respectively. Among the 185 subjects with complete dietary data, 81% (n=150) were classified as energy underreporters using the EI-to-TEE ratio cutoff; 58% (n=107) were classified as energy underreporters using the EI-to-BMR ratio. Energy underreporters had significantly lower reported fat, higher protein, but similar carbohydrate intakes compared with non-underreporters. The EI-to-TEE ratio was not significantly associated with any demographic variables or following a diet for diabetes, but it was inversely associated with BMI (r=-0.37, P<0.0001). In a multivariate model, demographic variables, BMI, and following a diet for diabetes explained 16% of the variance in the EI-to-TEE ratio, with the latter two variables being the only significant predictors (inversely associated). CONCLUSIONS Widespread energy underreporting among this group of overweight African-American women with type 2 diabetes severely compromised the validity of self-reported dietary data.
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Affiliation(s)
- Carmen D Samuel-Hodge
- Department of Nutrition, Schools of Public Health and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-8140, USA.
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Keyserling TC, Samuel-Hodge CD, Ammerman AS, Ainsworth BE, Henríquez-Roldán CF, Elasy TA, Skelly AH, Johnston LF, Bangdiwala SI. A randomized trial of an intervention to improve self-care behaviors of African-American women with type 2 diabetes: impact on physical activity. Diabetes Care 2002; 25:1576-83. [PMID: 12196430 DOI: 10.2337/diacare.25.9.1576] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether a culturally appropriate clinic- and community-based intervention for African-American women with type 2 diabetes will increase moderate-intensity physical activity (PA). RESEARCH DESIGN AND METHODS In this randomized controlled trial conducted at seven practices in central North Carolina, 200 African-American women, > or =40 years of age with type 2 diabetes, were randomized to one of three treatment conditions: clinic and community (group A), clinic only (group B), or minimal intervention (group C). The clinic-based intervention (groups A and B) consisted of four monthly visits with a nutritionist who provided counseling to enhance PA and dietary intake that was tailored to baseline practices and attitudes; the community-based intervention (group A) consisted of three group sessions and 12 monthly phone calls from a peer counselor and was designed to provide social support and reinforce behavior change goals; and the minimal intervention (group C) consisted of educational pamphlets mailed to participants. The primary study outcome was the comparison of PA levels between groups assessed at 6 and 12 months by accelerometer, which was worn while awake for 7 days. RESULTS Totals of 175 (88%) and 167 (84%) participants completed PA assessment at 6 and 12 months, respectively. For comparison of PA, the P value for overall group effect was 0.014. Comparing group A with C, the difference in the average adjusted mean for PA was 44.1 kcal/day (95% CI 13.1-75.1, P = 0.0055). Comparing group B with C, the difference in the average adjusted mean was 33.1 kcal/day (95% CI 3.3-62.8, P = 0.029). The intervention was acceptable to participants: 88% were very satisfied with clinic-based counseling to enhance PA, and 86% indicated that the peer counselor's role in the program was important. CONCLUSIONS The intervention was associated with a modest enhancement of PA and was acceptable to participants.
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Affiliation(s)
- Thomas C Keyserling
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
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Stockerl-Goldstein KE, Reddy SA, Horning SF, Blume KG, Chao NF, Hu WW, Johnston LF, Long GD, Strober S, Wong RM, Feiner RH, Kobler S, Negrin RS. Favorable treatment outcome in non-Hodgkin's lymphoma patients with "poor" mobilization of peripheral blood progenitor cells. Biol Blood Marrow Transplant 2001; 6:506-12. [PMID: 11063379 DOI: 10.1016/s1083-8791(00)70021-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Our purpose was to evaluate the outcome and costs of high-dose chemotherapy and autologous peripheral blood progenitor cell (PBPC) transplantation in patients with the inability to mobilize sufficient numbers of PBPCs to allow rapid engraftment after PBPC transplantation. We treated 172 consecutive non-Hodgkin's lymphoma (NHL) patients with cyclophosphamide and granulocyte colony-stimulating factor followed by apheresis to collect PBPCs. The cells were separated on a Percoll gradient and purged with monoclonal antibodies and complement. The patients were categorized as "good" mobilizers if a collection of > or =2 x 10(6) CD34+ cells/kg was obtained (n = 138, 80%) or "poor" mobilizers if <2 x 10(6) CD34+ cells/kg were obtained (n = 34, 20%). With a median follow-up of 3.5 years, there is no statistically significant difference in actuarial event-free survival, overall survival, or relapse for good mobilizers compared with poor mobilizers. However, there was a trend toward increasing nonrelapse, transplantation-related mortality of 11.8% for poor mobilizers versus 3.6% for good mobilizers (P = .08) and early death from all causes including relapse within 120 days (poor 20.6% versus good 8.7%, P = .06). The total cost for bone marrow transplantation-related care was significantly higher, at $140,264 for poor mobilizers versus $80,833 for good mobilizers (P = .0001). The population of patients with NHL who mobilize PBPCs poorly into the circulation have a higher cost for posttransplant support. However, there is no significant difference in relapse, event-free survival, or overall survival for such patients compared with those who mobilize PBPCs easily.
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Affiliation(s)
- K E Stockerl-Goldstein
- Divisions of Bone Marrow Transplantation, Stanford University School of Medicine, California 94305-5623, USA.
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Keyserling TC, Ammerman AS, Samuel-Hodge CD, Ingram AF, Skelly AH, Elasy TA, Johnston LF, Cole AS, Henríquez-Roldán CF. A diabetes management program for African American women with type 2 diabetes. Diabetes Educ 2000; 26:796-805. [PMID: 11140007 DOI: 10.1177/014572170002600508] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This paper describes a clinic- and community-based diabetes intervention program designed to improve dietary, physical activity, and self-care behaviors of older African American women with type 2 diabetes. It also describes the study to evaluate this program and baseline characteristics of participants. METHODS The New Leaf ... Choices for Healthy Living With Diabetes program consists of 4 clinic-based health counselor visits, a community intervention with 12 monthly phone calls from peer counselors, and 3 group sessions. A randomized, controlled trial to evaluate the effectiveness of this intervention is described. RESULTS Seventeen focus groups of African American women were used to assessed the cultural relevance/acceptability of the intervention and measurement instruments. For the randomized trial, 200 African American women with type 2 diabetes were recruited from 7 practices in central North Carolina. Mean age was 59, mean diabetes duration was 10 years, and participants were markedly overweight and physically inactive. CONCLUSIONS Participants found this program to be culturally relevant and acceptable. Its effects on diet, physical activity, and self-care behaviors will be assessed in a randomized trial.
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Affiliation(s)
- T C Keyserling
- The Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill (Dr Keyserling)
| | - A S Ammerman
- Department of Nutrition, Schools of Medicine and Public Health, University of North Carolina at Chapel Hill (Dr Ammerman and Ms Samuel-Hodge)
| | - C D Samuel-Hodge
- Department of Nutrition, Schools of Medicine and Public Health, University of North Carolina at Chapel Hill (Dr Ammerman and Ms Samuel-Hodge)
| | - A F Ingram
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Mss Ingram and Cole and Mr Johnston)
| | - A H Skelly
- The School of Nursing, University of North Carolina at Chapel Hill (Dr Skelly)
| | | | - L F Johnston
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Mss Ingram and Cole and Mr Johnston)
| | - A S Cole
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill (Mss Ingram and Cole and Mr Johnston)
| | - C F Henríquez-Roldán
- Carlos F. Henriquez-Roldan is a PhD candidate at the University of North Carolina at Chapel Hill and is sponsored by a scholarship from Beca Presidente de la Republica de Chile
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Harrell JS, Johnston LF, Griggs TR, Schaefer P, Carr EG, McMurray RG, Meibohm AR, Munoz S, Raines BN, Williams OD. An occupation based physical activity intervention program: improving fitness and decreasing obesity. AAOHN J 1996; 44:377-84. [PMID: 8852235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this quasi-experimental study was to determine the effectiveness of an occupation based health and fitness program. Subjects were 1,504 police trainees (85% male, 15% female) with an ethnic distribution of 82% white, 16% African American, and 2% other. Data were collected at 25 sites across the state of North Carolina. The sites were randomly assigned to either the experimental group (implemented the intervention) or the control group (continued usual training). As compared with controls, subjects at the experimental sites improved significantly in cardiovascular fitness (aerobic power), general muscular strength (number of sit ups per minute), and flexibility, and lowered their body fat. The intervention required minimal equipment and was taught primarily by peers who received a 1 week training program. This occupational approach to improving health could be particularly useful in occupations with many workers who seldom engage in leisure time physical activity.
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