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Gobin R, Thomas T, Goberdhan S, Sharma M, Nasiiro R, Emmanuel R, Rambaran M, McFarlane S, Elia C, Van-Veen D, Govia I, Palmer T, Read U, Cruickshank JK, Samuels TA, Wilks R, Harding S. Readiness of primary care centres for a community-based intervention to prevent and control noncommunicable diseases in the Caribbean: A participatory, mixed-methods study. PLoS One 2024; 19:e0301503. [PMID: 38683831 PMCID: PMC11057736 DOI: 10.1371/journal.pone.0301503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention. METHODS Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers. RESULTS Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs. CONCLUSION Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.
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Affiliation(s)
- Reeta Gobin
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | - Troy Thomas
- Faculty of Natural Sciences, University of Guyana, Georgetown, Guyana
| | | | - Manoj Sharma
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | | | - Rosana Emmanuel
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Madan Rambaran
- Institute of Health Science Education, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Shelly McFarlane
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | | | - Davon Van-Veen
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | - Ishtar Govia
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Tiffany Palmer
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | | | - J. Kennedy Cruickshank
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - T. Alafia Samuels
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Rainford Wilks
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Seeromanie Harding
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
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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.
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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
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3
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Abbey EL, Rigg Q. A Qualitative Study of the Meaning of Food and Religious Identity. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024:S1499-4046(24)00047-2. [PMID: 38583161 DOI: 10.1016/j.jneb.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To identify common themes of the meaning of food among people who identify with a specific religious tradition, particularly focusing on potential applications for nutrition education and professional practice at multiple levels of the Social-Ecological Model. DESIGN Virtual and in-person focus groups were used to collect qualitative data. SETTING A midsized city in eastern Washington State. PARTICIPANTS Nine focus groups (n = 35), each representing a distinct religious congregation. PHENOMENON OF INTEREST Meaning of food in the context of religion. ANALYSIS Qualitative, reflexive thematic analysis using web-based software to organize data. RESULTS Four key themes were identified that applied to both of the overarching focus group topic areas (general and religious): (1) food fosters connection, (2) food influences health, (3) relationships with food are complicated, and (4) food choices reflect values. Subthemes were specific to topic areas. In religious contexts, the meaning of food was more likely understood at a community level in addition to individual and relational levels of the Social-Ecological Model. CONCLUSIONS AND IMPLICATIONS Acknowledgment and consideration of the religious identities of patients and clients may provide greater opportunities for community connection, which may have potential implications for community-level nutrition interventions.
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Affiliation(s)
| | - Quincy Rigg
- Department of Health Sciences, Whitworth University, Spokane, WA
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4
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Arena R, Pronk NP, Woodard C. Novel Approaches to Addressing the US Physical Inactivity and Obesity Pandemics: An Opportunity for Religious Organizations. Am J Med 2024; 137:240-248. [PMID: 38042243 DOI: 10.1016/j.amjmed.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Physical inactivity and obesity crises persist in the United States despite substantial mitigation efforts. The primary goal of this analysis is to determine whether the geographic concentration of religious institutions overlaps with geographic patterns for physical inactivity and obesity prevalence. METHODS We obtained 2021 county-level, age-adjusted physical inactivity ("no leisure time physical activity") and obesity prevalence from the 2023 Centers for Disease Control and Prevention PLACES database. Data on number of congregations per 100,000 individuals and adherents as a percentage of the population were obtained from the 2020 US Religion Census. The American Nations regional cultures model was obtained from the Nationhood Lab. RESULTS On a national level, all correlations were statistically significant between health factors and religious infrastructure-higher physical inactivity and obesity were related to more congregations per 100,000 population on a county level. The strength of correlations between congregations per 100,000 county population and both physical inactivity and obesity prevalence was greatest in the American Nations model's Deep South and Tidewater regions. CONCLUSIONS Approaches to addressing the pandemics of unhealthy lifestyle-related health factors of physical inactivity and obesity in the United States have, in large part, been unsuccessful. Church-based healthy lifestyle programs, particularly in areas where a high concentration of congregations align with high physical inactivity and obesity, may offer a novel and effective approach to addressing this issue.
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Affiliation(s)
- Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL.
| | - Nicolaas P Pronk
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; HealthPartners Institute, Minneapolis, MN; Department of Health Policy and Management, University of Minnesota, Minneapolis, MN
| | - Colin Woodard
- Nationhood Lab, Pell Center for International Relations and Public Policy, Salve Regina University, Newport, RI
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Yip JLY, Poduval S, de Souza-Thomas L, Carter S, Fenton K. Anti-racist interventions to reduce ethnic disparities in healthcare in the UK: an umbrella review and findings from healthcare, education and criminal justice. BMJ Open 2024; 14:e075711. [PMID: 38418232 PMCID: PMC10910548 DOI: 10.1136/bmjopen-2023-075711] [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: 05/16/2023] [Accepted: 02/07/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To assess the evidence for anti-racist interventions which aim to reduce ethnic disparities in healthcare, with a focus on implementation in the UK healthcare system. DESIGN Umbrella review. DATA SOURCES Embase, Medline, Social Policy and Practice, Social Care Online and Web of Science were searched for publications from the year 2000 up to November 2023. ELIGIBILITY CRITERIA Only systematic and scoping reviews of anti-racist interventions reported in English were included. Reviews were excluded if no interventions were reported, no comparator interventions were reported or the study was primarily descriptive. DATA EXTRACTION AND SYNTHESIS A narrative synthesis approach was used to integrate and categorise the evidence on anti-racist interventions for healthcare. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool. RESULTS A total of 29 reviews are included in the final review. 26 are from the healthcare sector and three are from education and criminal justice. The most promising interventions targeting individuals include group-based health education and providing culturally tailored interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority communities may provide an effective approach to reducing ethnic health disparities. Interventions to improve quality of care for conditions with disproportionately worse outcomes in ethnic minority communities show promise. At a policy level, structural interventions including minimum wage policies and integrating non-medical interventions such as housing support in clinical care has some evidence for improving outcomes in ethnic minority communities. CONCLUSIONS Many of the included studies were low or critically low quality due to methodological or reporting limitations. For programme delivery, different types of pathway integration, and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on individual behaviour change and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multilevel approach.
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Affiliation(s)
| | - Shoba Poduval
- Institute of Health Informatics, University College London, London, UK
| | | | - Sophie Carter
- Office for Health Improvement and Disparities, London, UK
- Health Innovation Manchester, Manchester, UK
| | - Kevin Fenton
- Office for Health Improvement and Disparities, London, UK
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Perez LG, Flόrez KR, Seelam R, Williams MV, Derose KP. Effects of a Faith-Based Obesity Intervention on African American and Latino Adults' Children. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241235992. [PMID: 38406923 DOI: 10.1177/2752535x241235992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Faith-based interventions are promising for promoting healthy behaviors among adults, but their ripple effects on participants' children are unknown. This study is one of the first to assess the effects of a faith-based multilevel obesity intervention on adult participants' children. METHODS We analyzed quantitative data from a cluster randomized controlled trial with two African American and two Latino churches in South Los Angeles, California, which invited adult participants to enroll one child (5-17 years) in a sub-study. At baseline and 6-7 months follow-up, parents completed a child health survey, which included the family nutrition and physical activity screening tool, and child height and weight were measured (n = 50). RESULTS Results from linear regression models showed children of intervention participants, compared to control, had significantly better dietary patterns at follow-up. CONCLUSIONS Findings suggest the health benefits of a faith-based multilevel obesity intervention for adults can extend to children and may help address obesity disparities.
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Affiliation(s)
| | - Karen R Flόrez
- Center for Systems and Community Design, Graduate School of Public Health and Heath Policy, City University of New York, New York, NY, USA
| | | | | | - Kathryn P Derose
- RAND Corporation, Santa Monica, CA, USA
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amhers, Amherst, MA, USA
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7
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Maroney K, Laurent J, Alvarado F, Gabor A, Bell C, Ferdinand K, He J, Mills KT. Systematic review and meta-analysis of church-based interventions to improve cardiovascular disease risk factors. Am J Med Sci 2023; 366:199-208. [PMID: 37244637 DOI: 10.1016/j.amjms.2023.05.010] [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] [Received: 07/28/2022] [Revised: 04/18/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Church-based interventions have been shown to reduce cardiovascular disease (CVD) risk factors and could reduce health disparities in groups with a high burden of CVD. We aim to conduct a systematic review and meta-analysis to determine the effectiveness of church-based interventions for CVD risk factor improvement and to examine the types of interventions that are effective. METHODS Systematic searches of MEDLINE, Embase, and manual reference searches were conducted through November 2021. Study inclusion criteria were church-based interventions delivered in the United States to address CVD risk factors. Interventions targeted barriers to improving blood pressure, weight, diabetes, physical activity, cholesterol, diet, or smoking. Two investigators independently extracted study data. Random effects meta-analyses were conducted. RESULTS A total of 81 studies with 17,275 participants were included. The most common interventions included increasing physical activity (n = 69), improving diet (n = 67), stress management (n = 20), medication adherence (n = 9), and smoking cessation (n = 7). Commonly used approaches for implementation included cultural tailoring of the intervention, health coaching, group education sessions, inclusion of spiritual components in the intervention, and home health monitoring. Church-based interventions were associated with significant reductions in body weight (-3.1 lb, [95% CI, -5.8, -1.2], N = 15), waist circumference (-0.8 in, [CI, -1.4, -0.1], N = 6), and systolic blood pressure (-2.3 mm Hg, [CI, -4.3, -0.3], N = 13). CONCLUSIONS Church-based interventions targeting CVD risk factors are effective for reducing CVD risk factors, particularly in populations with health disparities. These findings can be used to design future church-based studies and programs to improve cardiovascular health.
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Affiliation(s)
- Kieran Maroney
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Jodie Laurent
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Flor Alvarado
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Alexandra Gabor
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Caryn Bell
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Sciences Institute, New Orleans, LA, USA
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Sciences Institute, New Orleans, LA, USA
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8
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Sklar RP, Goldman RE. "The First Person They Call is Their Pastor": The Role of New York City Faith Leaders in Supporting Their Congregation's Health and Well-Being During COVID-19. JOURNAL OF RELIGION AND HEALTH 2023:1-20. [PMID: 36917363 PMCID: PMC10011784 DOI: 10.1007/s10943-023-01789-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
This article reports findings from a qualitative study of New York City faith leaders' efforts to mitigate the effects of the COVID-19 pandemic on their communities during the first two years of the pandemic. Faith leaders were recruited via reputational case sampling to participate in individual, key informant interviews. This study used a social-contextual approach to health promotion by exploring the influence of faith leaders and religious communities on health behaviors. Results suggest that engaged faith leaders worked individually and collaboratively to support the changing physical, emotional, and spiritual needs of their religious communities and those in the surrounding area. This study highlights the importance of faith leaders as supporters, communicators, and advocates, and provides directions for future research on the impact of faith leaders on individuals' experiences and health behaviors during a pandemic.
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Affiliation(s)
- Rachel P Sklar
- Division of Biology and Medicine, Brown University, Providence, RI, USA.
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Derose KP, Cohen DA, Han B, Arredondo EM, Perez LG, Larson A, Loy S, Mata MA, Castro G, De Guttry R, Rodríguez C, Seelam R, Whitley MD, Perez S. Linking churches and parks to promote physical activity among Latinos: Rationale and design of the Parishes & Parks cluster randomized trial. Contemp Clin Trials 2022; 123:106954. [PMID: 36206951 PMCID: PMC9783594 DOI: 10.1016/j.cct.2022.106954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Regular physical activity (PA) contributes to positive health outcomes, but a minority of US adults meet minimum guidelines for moderate-to-vigorous PA (MVPA) and muscle-strengthening, and Latinos are less likely than whites to meet these guidelines. Public parks can be leveraged for community PA but tend to be underutilized, while churches have reach within Latino communities and can influence parishioners' health. METHODS We are conducting a cluster randomized controlled trial to examine the impact of a multilevel, faith-based intervention linking Catholic parishes (n = 14) to their local parks on adult Latino parishioners' (n = 1204) MVPA and health-related outcomes. Our approach targets multiple levels (individual, group, church, and neighborhood-park) to promote health-enhancing PA through park-based exercise classes led by kinesiology students, peer leader-led walking groups, park-based church events, church-based PA support activities, and environmental advocacy. Data are collected at churches by trained bilingual/bicultural research assistants using accelerometry, surveys, and biometric procedures. We will implement a set of hierarchical repeated-measure linear models to examine effects on the primary outcome (MVPA) and secondary outcomes (self-reported PA, heart rate/fitness, waist circumference, waist-to-hip ratio, body fat, mental health, and perceived social support for PA). We will also conduct a process evaluation. CONCLUSION To our knowledge, this will be the first study examining efficacy of an integrated church and park-based intervention on Latino adults' PA and represents a scalable model of PA programming for low-income communities. The intervention makes use of innovative partnerships within and across sectors - faith-based, local parks/city government, and local universities - further facilitating sustainability. CLINICALTRIALS govID: NCT03858868.
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Affiliation(s)
- Kathryn P Derose
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA; University of Massachusetts Amherst, Department of Health Promotion & Policy, 705 N. Pleasant St, Amherst, MA 01003, USA.
| | - Deborah A Cohen
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA; Kaiser Permanente Southern California, Department of Research and Evaluation, 100 S Los Robles, Pasadena, CA 91101, USA.
| | - Bing Han
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA; Kaiser Permanente Southern California, Department of Research and Evaluation, 100 S Los Robles, Pasadena, CA 91101, USA.
| | - Elva M Arredondo
- San Diego State University, Psychology Department and Institute for Behavioral and Community Health Studies, 9245 Sky Park Ct, #221, San Diego, CA 92123, USA.
| | - Lilian G Perez
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA.
| | - Anne Larson
- California State University, Los Angeles, School of Kinesiology, 5151 State University Drive, Los Angeles, CA 90032, USA.
| | - Steven Loy
- California State University, Northridge, Department of Kinesiology, 18111 Nordhoff Street, Northridge, CA 91330, USA.
| | - Michael A Mata
- Los Angeles First Church of the Nazarene, 3401 W. Third St., Los Angeles, CA 90020, USA
| | - Gabriela Castro
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA.
| | - Rebecca De Guttry
- Pardee RAND Graduate School, 1776 Main St, Santa Monica, CA 90401, USA.
| | - Claudia Rodríguez
- Pardee RAND Graduate School, 1776 Main St, Santa Monica, CA 90401, USA.
| | - Rachana Seelam
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA.
| | | | - Sergio Perez
- Archdiocese of Los Angeles, San Gabriel Pastoral Region, 16009 E Cypress, Irwindale, CA 91706, USA.
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Seguin-Fowler RA, Eldridge GD, Rethorst CD, Graham ML, Demment M, Strogatz D, Folta SC, Maddock JE, Nelson ME, Ha S. Improvements and Maintenance of Clinical and Functional Measures Among Rural Women: Strong Hearts, Healthy Communities-2. 0 Cluster Randomized Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e009333. [PMID: 36378768 PMCID: PMC9665948 DOI: 10.1161/circoutcomes.122.009333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in the United States; however, women and rural residents face notable health disparities compared with male and urban counterparts. Community-engaged programs hold promise to help address disparities through health behavior change and maintenance, the latter of which is critical to achieving clinical improvements and public health impact. METHODS A cluster-randomized controlled trial of Strong Hearts, Healthy Communities-2.0 conducted in medically underserved rural communities examined health outcomes and maintenance among women aged ≥40 years, who had a body mass index >30 or body mass index 25 to 30 and also sedentary. The multilevel intervention provided 24 weeks of twice-weekly classes with strength training, aerobic exercise, and skill-based nutrition education (individual and social levels), and civic engagement components related to healthy food and physical activity environments (community, environment, and policy levels). The primary outcome was change in weight; additional clinical and functional fitness measures were secondary outcomes. Mixed linear models were used to compare between-group changes at intervention end (24 weeks); subgroup analyses among women aged ≥60 years were also conducted. Following a 24-week no-contact period, data were collected among intervention participants only to evaluate maintenance. RESULTS Five communities were randomized to the intervention and 6 to the control (87 and 95 women, respectively). Significant improvements were observed for intervention versus controls in body weight (mean difference: -3.15 kg [95% CI, -4.98 to -1.32]; P=0.008) and several secondary clinical (eg, waist circumference: -3.02 cm [-5.31 to -0.73], P=0.010; systolic blood pressure: -6.64 mmHg [-12.67 to -0.62], P=0.031; percent body fat: -2.32% [-3.40 to -1.24]; P<0.001) and functional fitness outcomes; results were similar for women aged ≥60 years. The within-group analysis strongly suggests maintenance or further improvement in outcomes at 48 weeks. CONCLUSIONS This cardiovascular disease prevention intervention demonstrated significant, clinically meaningful improvements and maintenance among rural, at-risk older women. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03059472.
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Affiliation(s)
- Rebecca A. Seguin-Fowler
- Institute for Advancing Health through Agriculture, Texas A&M AgriLife, College Station (R.A.S-F.)
| | - Galen D. Eldridge
- Texas A&M AgriLife Research and Extension Center, Dallas (G.D.E., C.D.R., M.L.G., M.D.)
| | - Chad D. Rethorst
- Texas A&M AgriLife Research and Extension Center, Dallas (G.D.E., C.D.R., M.L.G., M.D.)
| | - Meredith L. Graham
- Texas A&M AgriLife Research and Extension Center, Dallas (G.D.E., C.D.R., M.L.G., M.D.)
| | - Margaret Demment
- Texas A&M AgriLife Research and Extension Center, Dallas (G.D.E., C.D.R., M.L.G., M.D.)
| | | | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston (S.C.F., M.E.N.).,Texas A&M University, College Station (S.C.F., M.E.N.)
| | - Jay E. Maddock
- Statistical Collaboration Center, Texas A&M University, College Station (J.E.M., S.H.)
| | - Miriam E. Nelson
- Friedman School of Nutrition Science and Policy, Tufts University, Boston (S.C.F., M.E.N.).,Texas A&M University, College Station (S.C.F., M.E.N.)
| | - Seungyeon Ha
- Statistical Collaboration Center, Texas A&M University, College Station (J.E.M., S.H.)
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Ralston PA, Young-Clark I, Wickrama K(A, Coccia C, Lemacks JL, Battle AM, Hart C, Ilich JZ. Dissemination trial for Health for Hearts United: Model development, preliminary outcomes and lessons learned. Contemp Clin Trials Commun 2022; 29:100979. [PMID: 36052174 PMCID: PMC9424356 DOI: 10.1016/j.conctc.2022.100979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Cardiovascular disease CVD), the leading cause of death in the U.S., is a particular problem for African Americans (AAs). Church-based health interventions are effective in reducing CVD risk, yet few have been successfully disseminated. This paper describes the model development, preliminary health outcomes, and lessons learned from the Health for Hearts United (HHU) dissemination trial which evolved from the longitudinal Reducing CVD Risk Study in a two-county area in North Florida. Community-based participatory research approaches and the socio-ecological model guided the study. Methods Data for this paper were from health leaders (n = 25) in the first six churches investigated, and the outreach participants (n = 86) they engaged. Health leaders completed survey items (daily servings of fruits/vegetables [F/V], fat consumption [FAT], and daily minutes of physical activity [PA]) and clinical measures (body mass index [BMI]; waist, hip and abdomen circumferences; and systolic and diastolic blood pressure [BP]). For outreach participants, a brief CVD Awareness Quiz was administered. Data were analyzed using description statistics, Pearson correlations, and repeated measures analysis of variance. Results Findings showed that the dissemination model was implemented by 100% of the churches, and resulted in health outcomes changes for health leaders (significant increases between pre- and post-test in F/V; significant decreases in FAT, BMI, abdomen circumference, with educational level and marital status as selected significant covariates) and in a significant increase in CVD awareness for outreach participants. Lessons learned are discussed. Although preliminary, the results suggest that the HHU dissemination model has promise for reducing CVD risk in AA's.
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Affiliation(s)
- Penny A. Ralston
- , Center on Better Health and Life for Underserved Populations, Florida State University, P.O. Box 3064191, Tallahassee, FL, 32306-1491, USA
| | - Iris Young-Clark
- , Center on Better Health and Life for Underserved Populations, Florida State University, USA
| | - Kandauda (A.S.) Wickrama
- Georgia Athletic Association Endowed Professor of Human Development and Family Science Research, University of Georgia, USA
| | - Catherine Coccia
- , Department of Dietetics & Nutrition, Florida International University, USA
| | - Jennifer L. Lemacks
- College of Nursing and Health Professions, University of Southern Mississippi, USA
| | | | | | - Jasminka Z. Ilich
- , Institute for Successful Longevity, Consulting Faculty, Center on Better Health and Life for Underserved Populations, Florida State University, USA
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12
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Abstract
Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: (a) give equity issues higher priority, (b) adopt a health equity lens, (c) strengthen approaches by using health equity frameworks, (d) broaden the types of policies considered, and (e) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.
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Affiliation(s)
- Shiriki K Kumanyika
- Dornsife School of Public Health, Drexel University, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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13
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Lloyd-Jones DM, Allen NB, Anderson CAM, Black T, Brewer LC, Foraker RE, Grandner MA, Lavretsky H, Perak AM, Sharma G, Rosamond W. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation 2022; 146:e18-e43. [PMID: 35766027 PMCID: PMC10503546 DOI: 10.1161/cir.0000000000001078] [Citation(s) in RCA: 543] [Impact Index Per Article: 271.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In 2010, the American Heart Association defined a novel construct of cardiovascular health to promote a paradigm shift from a focus solely on disease treatment to one inclusive of positive health promotion and preservation across the life course in populations and individuals. Extensive subsequent evidence has provided insights into strengths and limitations of the original approach to defining and quantifying cardiovascular health. In response, the American Heart Association convened a writing group to recommend enhancements and updates. The definition and quantification of each of the original metrics (Life's Simple 7) were evaluated for responsiveness to interindividual variation and intraindividual change. New metrics were considered, and the age spectrum was expanded to include the entire life course. The foundational contexts of social determinants of health and psychological health were addressed as crucial factors in optimizing and preserving cardiovascular health. This presidential advisory introduces an enhanced approach to assessing cardiovascular health: Life's Essential 8. The components of Life's Essential 8 include diet (updated), physical activity, nicotine exposure (updated), sleep health (new), body mass index, blood lipids (updated), blood glucose (updated), and blood pressure. Each metric has a new scoring algorithm ranging from 0 to 100 points, allowing generation of a new composite cardiovascular health score (the unweighted average of all components) that also varies from 0 to 100 points. Methods for implementing cardiovascular health assessment and longitudinal monitoring are discussed, as are potential data sources and tools to promote widespread adoption in policy, public health, clinical, institutional, and community settings.
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14
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Brewer LC, Jenkins S, Hayes SN, Kumbamu A, Jones C, Burke LE, Cooper LA, Patten CA. Community-Based, Cluster-Randomized Pilot Trial of a Cardiovascular Mobile Health Intervention: Preliminary Findings of the FAITH! Trial. Circulation 2022; 146:175-190. [PMID: 35861762 PMCID: PMC9287100 DOI: 10.1161/circulationaha.122.059046] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND African Americans continue to have suboptimal cardiovascular health (CVH) based on the American Heart Association Life's Simple 7 (LS7), 7 health-promoting behaviors and biological risk factors (eg, physical activity, blood pressure). Innovative, community-level interventions in partnership with trusted institutions such as African American churches are potential means to improve CVH in this population. METHODS Using a community-based participatory research approach, the FAITH! Trial (Fostering African American Improvement in Total Health) rigorously assessed the feasibility and preliminary efficacy of a refined, community-informed, mobile health intervention (FAITH! App) for promoting CVH among African Americans in faith communities using a cluster randomized controlled trial. Participants from 16 churches in Rochester and Minneapolis-St Paul, MN, were randomized to receive the FAITH! App (immediate intervention) or were assigned to a delayed intervention comparator group. The 10-week intervention core features included culturally relevant and LS7-focused education modules, diet/physical activity self-monitoring, and a group sharing board. Data were collected via electronic surveys and health assessments. Primary outcomes were average change in mean LS7 score (continuous measure of CVH ranging from poor to ideal [0-14 points]) from baseline to 6 months post-intervention (using generalized estimating equations) and app engagement/usability (by the Health Information Technology Usability Evaluation Scale; range, 0-5). RESULTS Of 85 enrolled participants (randomized to immediate [N=41] and delayed [control] intervention [N=44] groups), 76 and 68 completed surveys/health assessments at baseline and 6 months post-intervention, respectively (80% retention rate with assessments at both baseline and 6-month time points); immediate intervention [N=30] and control [N=38] groups). At baseline, the majority of participants (mean age [SD], 54.2 [12.3] years, 71% female) had <4-year college education level (39/66, 59%) and poor CVH (44% in poor category; mean LS7 score [SD], 6.8 [1.9]). The mean LS7 score of the intervention group increased by 1.9 (SD 1.9) points compared with 0.7 (SD 1.7) point in the control group (both P<0.0001) at 6 months. The estimated difference of this increase between the groups was 1.1 (95% CI, 0.6-1.7; P<0.0001). App engagement/usability was overall high (100% connection to app; >75% completed weekly diet/physical activity tracking; Health Information Technology Usability Evaluation Scale, mean [SD], 4.2 [0.7]). CONCLUSIONS On the basis of preliminary findings, the refined FAITH! App appears to be an efficacious mobile health tool to promote ideal CVH among African Americans. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03777709.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular Medicine (L.C.B., S.N.H.), Mayo Clinic College of Medicine, Rochester, MN
- Center for Health Equity and Community Engagement Research (L.C.B.), Mayo Clinic, Rochester, MN
| | - Sarah Jenkins
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences (S.J.), Mayo Clinic, Rochester, MN
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine (L.C.B., S.N.H.), Mayo Clinic College of Medicine, Rochester, MN
| | - Ashok Kumbamu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (A.K.), Mayo Clinic, Rochester, MN
| | | | - Lora E. Burke
- School of Nursing, Department of Health and Community Systems, University of Pittsburgh, PA (L.E.B.)
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (L.A.C.)
| | - Christi A. Patten
- Department of Psychiatry and Psychology (C.A.P.), Mayo Clinic College of Medicine, Rochester, MN
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15
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Perez LG, Cohen DA, Seelam R, Han B, Arredondo EM, Castro G, Rodriguez C, Mata MA, Larson A, Derose KP. Church Contextual Factors Associated With Latinx Physical Activity and Park Use. FAMILY & COMMUNITY HEALTH 2022; 45:163-173. [PMID: 35536714 PMCID: PMC9156548 DOI: 10.1097/fch.0000000000000328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Churches can be important settings for promoting physical activity (PA) among Latinx populations. Little is known about what factors across the church context-social, organizational, and physical (outdoor spaces)-are associated with Latinx PA to inform faith-based PA interventions. This study investigated associations of church contextual factors with Latinx PA. We used cross-sectional data from a Latinx adult sample recruited from 6 churches that each had a nearby park in Los Angeles, California (n = 373). Linear or logistic regression models examined associations of church PA social support, PA social norms, perceived quality and concerns about the park near one's church, and church PA programming with 4 outcomes: accelerometer-based moderate-to-vigorous PA (MVPA) and self-reported adherence to PA recommendations, use of the park near one's church, and park-based PA. Park quality and concerns were positively associated with using the park near one's church. Church PA programming was positively associated with park-based PA. None of the factors were related to accelerometer-based MVPA or meeting PA recommendations. Findings suggest targeting church PA programming and nearby parks may be key to improving Latinx park use. Church and local parks department partnerships may help enhance park conditions to support churchgoing Latinx PA and health.
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Affiliation(s)
- Lilian G Perez
- Behavioral and Policy Sciences Department (Drs Perez and Derose and Ms Castro) and Research Programming (Ms Seelam), RAND Corporation, Santa Monica, California; Divisions of Behavioral Health (Dr Cohen) and Biostatistics Research (Dr Han), Kaiser Permanente, Pasadena, California; Division of Health Promotion and Behavioral Sciences, San Diego State University, San Diego, California (Dr Arredondo); Pardee RAND Graduate School, Santa Monica, California (Ms Rodriguez); Nazarene Theological Seminary, Kansas City, Missouri (Rev Mata); Department of Kinesiology & Nutritional Science, California State University, Los Angeles (Dr Larson); and Department of Health Promotion and Policy, University of Massachusetts, Amherst (Dr Derose)
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16
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Gandara E, Harvey IS, Foster M, Luo W, McKyer L, Burdine J, Martinez D. Facilitators and Barriers When Conducting Adult Health Programs Within the African American Church: A Systematic Review. JOURNAL OF RELIGION AND HEALTH 2022:10.1007/s10943-022-01532-6. [PMID: 35303242 DOI: 10.1007/s10943-022-01532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 06/14/2023]
Abstract
Despite the success of health programs conducted within African American (AA) churches, research has been limited in understanding facilitators and barriers that exist when conducting adult health programs within AA churches. Thus, the objective of this study was to systematically review the literature to identify these facilitators and barriers. A comprehensive literature search was conducted and studies that met the eligibility criteria were divided based on their focus: disease topic or behavior, health promotion activities, or church readiness. Facilitators and barriers were also stratified using the socioecological model. Out of 288 articles initially identified, only 29 were included. Facilitators and barriers were predominantly found at the intrapersonal and organizational level for disease topic or behavior studies, and at the organizational level for studies focused on health promotion activities and church readiness. None of the articles identified facilitators and barriers at the policy level.
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Affiliation(s)
- Eduardo Gandara
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA.
- Psychiatry, Texas A&M University, College Station, TX, USA.
| | | | - Margaret Foster
- University Libraries, Texas A&M University, College Station, TX, USA
| | - Wen Luo
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Lisako McKyer
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA
| | - Jim Burdine
- Department of Health Promotion and Community Health Sciences, Texas A&M School of Public Health, College Station, TX, USA
| | - Denise Martinez
- Center for Community Health Development, Texas A&M School of Public Health, College Station, TX, USA
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17
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Langford AT, Orellana KT, Buderer N. Correlates of knowledge of clinical trials among U.S. adults: Findings from the 2020 Health Information National Trends Survey. Contemp Clin Trials 2022; 114:106676. [PMID: 35026434 DOI: 10.1016/j.cct.2022.106676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge about clinical trials affects efficient and equitable clinical trial recruitment and retention. This study explored correlates of clinical trial knowledge in a nationally representative sample of US adults. METHODS Cross-sectional data from the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4) were evaluated. There were 3,865 responses in the full dataset; 2,648 remained after eliminating respondents without complete data for all covariates of interest. Participants were asked, "How would you describe your level of knowledge about clinical trials?" The response options "know a little bit" and "know a lot" were combined and compared to the response option "don't know anything." Covariates of interest included patient-provider communication, history of medical conditions, eHealth use, knowledge of clinicaltrials.gov, prior invitation to join a clinical trial, and socio-demographic factors. RESULTS Participants with a history of cancer were 1.6 times more likely [CI 1.2, 2.2] to have knowledge of clinical trials. Participants who used electronic means to look for health information were 1.7 times more likely [CI 1.2, 2.4] to have knowledge of clinical trials. Participants who had heard of the website clinicaltrials.gov had 5.1 times greater odds of knowing about clinical trials [CI 2.6, 10.3] and 4.5 greater odds if they had been invited to participate in a clinical trial [CI 2.0, 9.8]. College graduates had higher odds than others. CONCLUSION Several factors affect clinical trial knowledge in US adults. Findings from this study may inform interventions to raise awareness about clinical trials and thereby, potentially improve enrollment.
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Affiliation(s)
- Aisha T Langford
- Department of Population Health, NYU Langone Health, 227 East 30th Street, New York, NY 10016, USA.
| | - Kerli T Orellana
- Department of Population Health, NYU Langone Health, 227 East 30th Street, New York, NY 10016, USA.
| | - Nancy Buderer
- Nancy Buderer Consulting, LLC, Biostatistician, 230 S. Gordon Dr., Oak Harbor, OH 43449, USA.
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18
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Payán DD, Flórez KR, Williams MV, Oden CW, Mata MA, Branch CA, Whitley MD, Derose KP. Sermons to Address Obesity in Partnership With African American and Latino Churches. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:811-815. [PMID: 34120832 PMCID: PMC8440423 DOI: 10.1016/j.jneb.2021.04.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Denise D Payán
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, Merced, CA.
| | - Karen R Flórez
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | | | - Clyde W Oden
- Bethel African Methodist Episcopal Church, Oxnard, CA
| | | | | | | | - Kathryn P Derose
- RAND Corporation, Santa Monica, CA; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
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19
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Okobi OE, Ajayi OO, Okobi TJ, Anaya IC, Fasehun OO, Diala CS, Evbayekha EO, Ajibowo AO, Olateju IV, Ekabua JJ, Nkongho MB, Amanze IO, Taiwo A, Okorare O, Ojinnaka US, Ogbeifun OE, Chukwuma N, Nebuwa EJ, Omole JA, Udoete IO, Okobi RK. The Burden of Obesity in the Rural Adult Population of America. Cureus 2021; 13:e15770. [PMID: 34295580 PMCID: PMC8290986 DOI: 10.7759/cureus.15770] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 12/14/2022] Open
Abstract
There is an epidemic of obesity in adults in rural America. It is estimated that about 19% of the population resides in rural areas, which encompasses 97% of America's total landmass. Although rural America makes up a fraction of America's total population, it has been estimated that the prevalence of obesity is approximately 6.2 times higher than in urban America. This illustrates an apparent disparity that exists between the rural population and urban populations that needs to be examined. The prevalence of obesity, especially in rural America, is a growing concern in the medical community in recent years. Obesity has been identified as a significant risk factor for cardiovascular disease, cancer, and type 2 diabetes mellitus, which are leading causes of morbidity and mortality in the US. To better understand the disparity in the prevalence of adult obesity between rural and urban America, researchers have identified risk factors that are associated with the high incidence and prevalence of obesity in the rural American adult population. Low income and lack of physical activity have been identified as factors that predispose rural Americans to increased risk of obesity, arguing that low-income Americans may not have access to the resources available to assist them in weight reduction. With rural Americans being at an income disadvantage, it creates a risk for obesity, which further predisposes them to chronic diseases such as hypertension, obstructive sleep apnea (OSA), diabetes, and coronary artery disease. As obesity continues to rise among the American population, the burden on the rural population is incredibly evident. Despite ongoing efforts by the US government and strategies implemented by the Common Community Measures for Obesity Prevention, there is still much to be done to tackle the epidemic. With an existing strategy in place, such as the 12 Common Community Measures for Obesity Prevention (COCOMO) strategies to fight obesity with physical activity, Americans are a step closer to conquering this epidemic. However, until other disparities such as income are addressed, rural Americans may continue to be severely impacted by the rising incidence of obesity and subsequent higher mortality rates from associated diseases.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Olamide O Ajayi
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA
| | | | - Ifeoma C Anaya
- Pathology and Laboratory Medicine, Faculty of Medicine, Ahmadu Bello University, Zaria, NGA
| | | | | | | | | | - Iyanu V Olateju
- Internal Medicine, Washington Adventist University, Takoma Park, USA
| | - Joanna J Ekabua
- Infectious Disease, University of Louisville, Louisville, USA
| | - Mireille B Nkongho
- Hematology, University of Virginia, Charlottesville, USA
- Psychiatry, Saint James School of Medicine, Saint Vincent, VCT
| | | | | | - Ovie Okorare
- Internal Medicine, Delta State University, Abraka, NGA
| | | | | | - Nnenna Chukwuma
- Internal Medicine, Advocate Christ Medical Center, Oak Lawn, USA
| | - Emmanuel J Nebuwa
- Internal Medicine, Rockville Ambulatory Surgery Center, Silver Spring, USA
| | - Janet A Omole
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Iboro O Udoete
- Public Health, Central Michigan University, Mount Pleasant, USA
| | - Rita K Okobi
- Research and Development, University of Maryland, Laurel, USA
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20
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Payán DD, Derose KP, Flórez KR, Branch CA, Williams MV. The Food Environment in 3 Neighborhoods in South Los Angeles, California: Access, Availability, Quality, and Marketing Practices. Prev Chronic Dis 2020; 17:E61. [PMID: 32678063 PMCID: PMC7380293 DOI: 10.5888/pcd17.200028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Denise D Payán
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 N Lake Rd, Merced, CA 95343.
| | | | - Karen R Flórez
- City University of New York, Graduate School of Public Health and Health Policy, New York, New York
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21
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Wilcox S, Saunders RP, Jake-Schoffman D, Hutto B. The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study: 24-Month Organizational Maintenance in a Countywide Initiative. Front Public Health 2020; 8:171. [PMID: 32528919 PMCID: PMC7247868 DOI: 10.3389/fpubh.2020.00171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/20/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction: Despite the important role that faith-based organizations can play in eliminating health disparities, few studies have focused on organizational change and maintenance of interventions in this setting, making their long-term impact unknown. This study reports 24-month maintenance of the Faith, Activity, and Nutrition (FAN) program in a southeastern county. Previously reported findings of reach, adoption, implementation, and effectiveness are also summarized. Methods: Church coordinators from 35 intervention churches (97% predominantly African American) located in a rural, medically underserved county in South Carolina were interviewed at baseline (2015), and 12- and 24-months post-training regarding implementation of physical activity (PA) and healthy eating (HE) components of the FAN program. Guided by the RE-AIM framework, organizational maintenance was defined as church coordinator-reported 24-month implementation of the four FAN components (providing opportunities, setting guidelines/policies, sharing messages, engaging pastor). Repeated measures analyses (mixed models) examined change in implementation over time. Churches were also classified as maintainers, non-sustained implementers, and low implementers for each FAN component. Statistical analyses were conducted in 2019. Results: Church coordinators reported significantly greater implementation of both PA and HE FAN components at 12 and 24 months compared to baseline (medium to large effects). The percentage of churches classified as maintainers ranged from 21 to 42 and 27 to 94% across PA and HE components, respectively. Most churches (58% for PA, 97% for HE) were maintaining at least one FAN component at 24 months. Conclusions: These promising findings position FAN well for the national implementation study now underway. Trial Registration: This study is registered at www.clinicaltrials.gov NCT02868866.
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Affiliation(s)
- Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Ruth P Saunders
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Danielle Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, United States
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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22
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Williams RM, Zhang J, Woodard N, Slade J, Santos SLZ, Knott CL. Development and validation of an instrument to assess institutionalization of health promotion in faith-based organizations. EVALUATION AND PROGRAM PLANNING 2020; 79:101781. [PMID: 31991309 DOI: 10.1016/j.evalprogplan.2020.101781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
Institutionalization of health promotion interventions occurs when the organization makes changes to support the program as a component of its routine operations. To date there has not been a way to systematically measure institutionalization of health promotion interventions outside of healthcare settings. The purpose of the present study was to develop and evaluate the initial psychometric properties of an instrument to assess institutionalization (i.e., integration) of health activities into faith-based organizations (i.e., churches). This process was informed by previous institutionalization models led by a team of experts and a community-based advisory panel. We recruited African American church leaders (N = 91) to complete a 22-item instrument. An exploratory factor analysis revealed four factors: 1) Organizational Structures (e.g., existing health ministry, health team), 2) Organizational Processes (e.g., records on health activities; instituted health policy), 3) Organizational Resources (e.g., health promotion budget; space for health activities), and 4) Organizational Communication (e.g., health content in church bulletins, discussion of health within sermons) that explained 62.3 % of the variance. The measure, the Faith-Based Organization Health Integration Inventory (FBO-HII), had excellent internal consistency reliability (α = .89) including the subscales (α = .90, .82, .81, and .87). This measure has promising initial psychometric properties for assessing institutionalization of health promotion interventions in faith-based settings.
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Affiliation(s)
- Randi M Williams
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Jing Zhang
- University of Maryland, School of Public Health, Department of Epidemiology and Biostatistics, United States.
| | - Nathaniel Woodard
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Jimmie Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, United States.
| | - Sherie Lou Zara Santos
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Cheryl L Knott
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
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