Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study

Full-Text HTML XML Download Download as PDF (Size:467KB) PP. 96-114
DOI: 10.4236/ojepi.2017.72009    502 Downloads   607 Views  


Objective: The pilot study was intended to test the feasibility of a multiple-component lifestyle intervention targeting African American adults in a weight control and cardiometabolic risk reduction program on diet, activity, and stress, using community-engagement principles. Methods: Applying mixed qualitative and quantitative measures, the intervention had a two-part sequential study design consisting of 12 weekly small group sessions that provided individual and group counseling in nutrition, exercise, and mindfulness, while incorporating focus group and interactive techniques to learn about barriers and acceptable practices for this population. The program was implemented at an African-American church in Nashville, Tennessee. Results: Thirty-four participants (aged 56.1 ± 11 years, body mass index (BMI) 36.7 ± 6.6 kg/m2) completed the intervention. Lifestyle changes after the 12 weekly sessions showed some positive trends including reduced sodium intake (from 2725.3 ± 326.5 to 2132 ± 330, mg/day, P = 0.008), increased walking steps (from 4392.1 ± 497.2 to 4895.3 ± 497.9, steps/day, not significant), and slightly decreased Perceived Stress Scale (PSS) scores (from 13.7 ± 1.4 to 12.4 ± 1.5, not significant). Body fat % among male participants decreased significantly (from 33.8 ± 2.6 to 28 ± 2.6, %, P = 0.043). Among cardiometabolic risk biomarkers, hemoglobin A1c (HbA1c) decreased significantly (from 6.6 ± 0.2 to 6.1 ± 0.2, %, P < 0.001). The baseline PSS score was positively associated with baseline adiposity levels (e.g., weight, β = 2.4, P = 0.006). Twenty-one participants took part in focus groups during the program to identify barriers to healthy lifestyle changes. Primary barriers reported were price, time for preparing healthy meals, unfamiliarity with mindfulness activities, their health condition, and daily schedule available for physical activities. Conclusions: This church-based pilot intervention was proven feasible by showing modest progress in reducing adiposity and decreasing HbA1c levels. The focus group and interactive methods facilitated program direction. Future full-scale studies are warranted to identify key strategies that provide more personalized approaches and supportive environments to sustain a healthy lifestyle among these at risk minorities with limited resources.

Cite this paper

Zhou, Y. , Jackson, C. , Oates, V. , Davis, G. , Davis, C. , Takizala, Z. , Akatue, R. , Williams, K. , Liu, J. , Hébert, J. , Patel, K. , Buchowski, M. , Schlundt, D. and Hargreaves, M. (2017) Refining a Church-Based Lifestyle Intervention Targeting African-American Adults at Risk for Cardiometabolic Diseases: A Pilot Study. Open Journal of Epidemiology, 7, 96-114. doi: 10.4236/ojepi.2017.72009.


[1] Center for Disease Control and Prevention (2014) Health of Black or African American Non-Hispanic Population.
[2] Marshall, S.J., Jones, D.A., Ainsworth, B.E., Reis, J.P., Levy, S.S. and Macera, C.A. (2007) Race/Ethnicity, Social Class and Leisure-Time Physical Inactivity. Medicine and Science in Sports and Exercise, 39, 44-51.
[3] Colditz, G.A., Willett, W.C., Stampfer, M.J., Manson, J.E., Hennekens, C.H., Arky, R.A. and Speizer, F.E. (1990) Weight as a Risk Factor for Clinical Diabetes in Women. American Journal of Epidemiology, 132, 501-513.
[4] Chan, J.M., Rimm, E.B., Colditz, G.A., Stampfer, M.J. and Willett, W.C. (1994) Obesity, Fat Distribution and Weight Gain as Risk Factors for Clinical Diabetes in Men. Diabetes Care, 17, 961-969.
[5] Hu, F.B., Manson, J.E., Stampfer, M.J., Colditz, G., Liu, S., Solomon, C.G. and Willett, W.C. (2001) Diet, Lifestyle and the Risk of Type 2 Diabetes Mellitus in Women. The New England Journal of Medicine, 345, 790-797.
[6] Wienpahl, J., Ragland, D.R. and Sidney, S. (1990) Body Mass Index and 15-Year Mortality in a Cohort of Black Men and Women. Journal of Clinical Epidemiology, 43, 949-960.
[7] Stevens, J., Plankey, M.W., Williamson, D.F., Thun, M.J., Rust, P.F., Palesch, Y. and O’Neil, P.M. (1998) The Body Mass Index-Mortality Relationship in White and African American Women. Obesity Research, 6, 268-277.
[8] Owen, C.G., Kapetanakis, V.V., Rudnicka, A.R., Wathern, A.K., Lennon, L., Papacosta, O., Cook, D.G., Wannamethee, S.G. and Whincup, P.H. (2015) Body Mass Index in Early and Middle Adult Life: Prospective Associations with Myocardial Infarction, Stroke and Diabetes over a 30-Year Period: The British Regional Heart Study. BMJ Open, 5, e008105.
[9] Avenell, A., Broom, J., Brown, T.J., Poobalan, A., Aucott, L., Stearns, S.C., Smith, W.C., Jung, R.T., Campbell, M.K. and Grant, A.M. (2004) Systematic Review of the Long-Term Effects and Economic Consequences of Treatments for Obesity and Implications for Health Improvement. Health Technology Assessment, 8, 1-182.
[10] Lynch, J., Helmrich, S.P., Lakka, T.A., Kaplan, G.A., Cohen, R.D., Salonen, R. and Salonen, J.T. (1996) Moderately Intense Physical Activities and High Levels of Cardiorespiratory Fitness Reduce the Risk of Non-Insulin-Dependent Diabetes Mellitus in Middle-Aged Men. Archives of Internal Medicine, 156, 1307-1314.
[11] Hu, F.B., Sigal, R.J., Rich-Edwards, J.W., Colditz, G.A., Solomon, C.G., Willett, W.C., Speizer, F.E. and Manson, J.E. (1999) Walking Compared with Vigorous Physical Activity and Risk of Type 2 Diabetes in Women: A Prospective Study. Journal of American Medical Association, 282, 1433-1439.
[12] Hu, F.B., Li, T.Y., Colditz, G.A., Willett, W.C. and Manson, J.E. (2003) Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women. Journal of American Medical Association, 289, 1785-1791.
[13] Chastin, S.F., Palarea-Albaladejo, J., Dontje, M.L. and Skelton, D.A. (2015) Combined Effects of Time Spent in Physical Activity, Sedentary Behaviors and Sleep on Obesity and Cardio-Metabolic Health Markers: A Novel Compositional Data Analysis Approach. PLoS ONE, 10, e0139984.
[14] Ekelund, U., Luan, J., Sherar, L.B., Esliger, D.W., Griew, P. and Cooper, A. (2012) Moderate to Vigorous Physical Activity and Sedentary Time and Cardiometabolic Risk Factors in Children and Adolescents. Journal of American Medical Association, 307, 704-712.
[15] Fryar, C.D., Hirsch, R., Eberhardt, M.S., Yoon, S.S. and Wright, J.D. (2010) Hypertension, High Serum Total Cholesterol and Diabetes: Racial and Ethnic Prevalence Differences in U.S. Adults, 1999-2006. NCHS Data Brief, 36, 1-8.
[16] Lancaster, K.J., Carter-Edwards, L., Grilo, S., Shen, C. and Schoenthaler, A.M. (2014) Obesity Interventions in African American Faith-Based Organizations: A Systematic Review. Obesity Reviews, 15, 159-176.
[17] DeHaven, M.J., Hunter, I.B., Wilder, L., Walton, J.W. and Berry, J. (2004) Health Programs in Faith-Based Organizations: Are They Effective? American Journal of Public Health, 94, 1030-1036.
[18] Newton, R.L., Griffith, D.M., Kearney, W.B. and Bennett, G.G. (2014) A Systematic Review of Weight Loss, Physical Activity and Dietary Interventions Involving African American Men. Obesity Reviews, 15, 93-106.
[19] Kong, A., Tussing-Humphreys, L.M., Odoms-Young, A.M., Stolley, M.R. and Fitzgibbon, M.L. (2014) Systematic Review of Behavioural Interventions with Culturally Adapted Strategies to Improve Diet and Weight Outcomes in African American Women. Obesity Reviews, 15, 62-92.
[20] O’Reilly, G.A., Cook, L., Spruijt-Metz, D. and Black, D.S. (2014) Mindfulness-Based Interventions for Obesity-Related Eating Behaviours: A Literature Review. Obesity Reviews, 15, 453-461.
[21] Baer, R.A. (2003) Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. Clinical Psychology: Science and Practice, 10, 125-143.
[22] Abbott, R.A., Whear, R., Rodgers, L.R., Bethel, A., Thompson Coon, J., Kuyken, W., Stein, K. and Dickens, C. (2014) Effectiveness of Mindfulness-Based Stress Reduction and Mindfulness Based Cognitive Therapy in Vascular Disease: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Journal of Psychosomatic Research, 76, 341-351.
[23] Puhl, R. and Suh, Y. (2015) Stigma and Eating and Weight Disorders. Current Psychiatry Reports, 17, 552.
[24] Martinez, D.J., Turner, M.M., Pratt-Chapman, M., Kashima, K., Hargreaves, M.K., Dignan, M.B. and Hébert, J.R. (2016) The Effect of Changes in Health Beliefs among African-American and Rural White Church Congregants Enrolled in an Obesity Intervention: A Qualitative Evaluation. Journal of Community Health, 41, 518-525.
[25] Cohen, S. and Williamson, G. (1988) Perceived Stress in a Probability Sample of the United States. In: Spacapan, S. and Oskamp, S., Eds., The Social Psychology of Health, Sage, Newbury Park.
[26] Tudor-Locke C. and Bassett D.R. Jr. (2004) How Many Steps/Day Are Enough? Preliminary Pedometer Indices for Public Health. Sports Medicine, 34, 1-8.
[27] Tudor-Locke, C., Craig, C.L., Thyfault, J.P. and Spence, J.C. (2013) A Step-Defined Sedentary Lifestyle Index: <5000 Steps/Day. Applied Physiology, Nutrition and Metabolism, 38, 100-114.
[28] Sisson, S.B., Camhi, S.M., Tudor-Locke, C., Johnson, W.D. and Katzmarzyk, P.T. (2012) Characteristics of Step-Defined Physical Activity Categories in U.S. Adults. American Journal of Health Promotion, 26, 152-159.
[29] Thomas, G.N., Macfarlane, D.J., Guo, B., Cheung, B.M., McGhee, S.M., Chou, K.L., Deeks, J.J., Lam, T.H. and Tomlinson, B. (2012) Health Promotion in Older Chinese: A 12-Month Cluster Randomized Controlled Trial of Pedometry and “Peer Support”. Medicine and Science in Sports and Exercise, 44, 1157-1166.
[30] Oguma, Y. and Shinoda-Tagawa, T. (2004) Physical Activity Decreases Cardiovascular Disease Risk in Women: Review and Meta-Analysis. American Journal of Preventive Medicine, 26, 407-418.
[31] Khoury, B., Sharma, M., Rush, S.E. and Fournier, C. (2015) Mindfulness-Based Stress Reduction for Healthy Individuals: A Meta-Analysis. Journal of Psychosomatic Research, 78, 519-528.
[32] Demarzo, M.M. Andreoni, S., Sanches, N., Perez, S., Fortes, S. and Garcia-Campayo, J. (2014) Mindfulness-Based Stress Reduction (MBSR) in Perceived Stress and Quality of Life: An Open, Uncontrolled Study in a Brazilian Healthy Sample. Explore, 10, 118-120.
[33] Geary, C. and Rosenthal, S.L. (2011) Sustained Impact of MBSR on Stress, Well-Being and Daily Spiritual Experiences for 1 Year in Academic Health Care Employees. Journal of Alternative and Complementary Medicine, 17, 939-944.
[34] Carlson, K.J., Silva, S.G., Langley, J. and Johnson, C. (2013) Mindful-Veteran: The Implementation of a Brief Stress Reduction Course. Complementary Therapies in Clinical Practice, 19, 89-96.
[35] Daubenmier, J., Moran, P.J., Kristeller, J., Acree, M., Bacchetti, P., Kemeny, M.E., Dallman, M., Lustig, R.H., Grunfeld, C., Nixon, D.F., Milush, J.M., Goldman, V., Laraia, B., Laugero, K.D., Woodhouse, L., Epel, E.S. and Hecht, F.M. (2016) Effects of a Mindfulness-Based Weight Loss Intervention in Adults with Obesity: A Randomized Clinical Trial. Obesity, 24, 794-804.
[36] Bjorntorp, P. (2001) Do Stress Reactions Cause Abdominal Obesity and Comorbidities? Obesity Reviews, 2, 73-86.
[37] Torres, S.J. and Nowson, C.A. (2007) Relationship between Stress, Eating Behavior and Obesity. Nutrition, 23, 887-894.
[38] Brantley, P.J., Stewart, D.W., Myers, V.H., Matthews-Ewald, M.R., Ard, J.D., Coughlin, J.W., Jerome, G.J., Samuel-Hodge, C., Lien, L.F., Gullion, C.M., Hollis, J.F., Svetkey, L.P. and Stevens, V.J. (2014) Psychosocial Predictors of Weight Regain in the Weight Loss Maintenance Trial. Journal of Behavioral Medicine, 37, 1155-1168.
[39] Sarlio-Lahteenkorva, S., Rissanen, A. and Kaprio, J. (2002) A Descriptive Study of Weight Loss Maintenance: 6 and 15 Year Follow-Up of Initially Overweight Adults. International Journal of Obesity and Related Metabolic Disorders, 24, 116-125.
[40] Center for Disease Control and Prevention (2014) Measuring Blood Pressure.
[41] Hall, W.D., Ferrario, C.M., Moore, MA, Hall, J.E., Flack, J.M., Cooper, W., Simmons, J.D., Egan, B.M., Lackland, D.T., Perry, M. and Roccella, E.J. (1997) Hypertension-Related Morbidity and Mortality in the Southeastern United States. The American Journal of the Medical Sciences, 313, 195-209.
[42] Ajala, O., English, P. and Pinkney, J. (2013) Systematic Review and Meta-Analysis of Different Dietary Approaches to the Management of Type 2 Diabetes. The American Journal of Clinical Nutrition, 97, 505-516.
[43] Nordmann, A.J., Nordmann, A., Briel, M., Keller, U., Yancy, W.S., Brehm, B.J. and Bucher, H.C. (2006) Effects of Low-Carbohydrate vs. Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors: A Meta-Analysis of Randomized Controlled Trials. Archives of Internal Medicine, 166, 285-293.
[44] Bradlee, M.L., Singer, M.R. and Moore, L.L. (2014) Lean Red Meat Consumption and Lipid Profiles in Adolescent Girls. Journal of Human Nutrition and Dietetics, 27, 292-300.
[45] Schaefer, E.J., Levy, R.I., Ernst, N.D., Van Sant, F.D. and Brewer, H.B. (1981) The Effects of Low Cholesterol, High Polyunsaturated Fat and Low Fat Diets on Plasma Lipid and Lipoprotein Cholesterol Levels in Normal and Hypercholesterolemic Subjects. The American Journal of Clinical Nutrition, 34, 1758-1763.
[46] Lewis, B., Hammett, F., Katan, M., Kay, R.M., Merkx, I., Nobels, A., Miller, N.E. and Swan, A.V. (1981) Towards an Improved Lipid-Lowering Diet: Additive Effects of Changes in Nutrient Intake. The Lancet, 2, 1310-1313.
[47] Zanni, E.E., Zannis, V.I., Blum, C.B., Herbert, P.N. and Breslow, J.L. (1987) Effect of Egg Cholesterol and Dietary Fats on Plasma Lipids, Lipoproteins and Apoproteins of Normal Women Consuming Natural Diets. Journal of Lipid Research, 28, 518- 527.
[48] Brinton, E.A., Eisenberg, S. and Breslow, J.L. (1990) A Low-Fat Diet Decreases High Density Lipoprotein (HDL) Cholesterol Levels by Decreasing HDL Apolipoprotein Transport Rates. The Journal of Clinical Investigation, 85, 144-151.
[49] Dirks, R.T. and Duran, N. (2001) African American Dietary Patterns at the Beginning of the 20th Century. The Journal of Nutrition, 131, 1881-1889.
[50] Hargreaves, M.K., Schlundt, D.G. and Buchowski, M.S. (2002) Contextual Factors Influencing the Eating Behaviours of African American Women: A Focus Group Investigation. Ethnicity & Health, 7, 133-147.
[51] Airhihenbuwa, C.O., Kumanyika, S., Agurs, T.D., Lowe, A., Saunders, D. and Morssink, C.B. (1996) Cultural Aspects of African American Eating Patterns. Ethnicity & Health, 1, 245-260.
[52] Kumanyika, S.K., Whitt-Glover, M.C. and Haire-Joshu, D. (2014) What Works for Obesity Prevention and Treatment in Black Americans? Research Directions. Obesity Reviews, 15, 204-212.
[53] Young, D.R. and Stewart, K.J. (2006) A Church-Based Physical Activity Intervention for African American Women. Family & Community Health, 29, 103-117.
[54] Peterson, J.A. and Cheng, A.L. (2011) Heart and Soul Physical Activity Program for African American Women. Western Journal of Nursing Research, 33, 652-670.
[55] Whitt-Glover, M.C., Hogan, P.E., Lang, W. and Heil, D.P. (2008) Pilot Study of a Faith-Based Physical Activity Program among Sedentary Blacks. Preventing Chronic Disease, 5, A51.
[56] Thabane, L., Ma, J., Chu, R., Cheng, J., Ismaila, A., Rios, L.P., Robson, R., Thabane, M., Giangregorio, L. and Goldsmith, C.H. (2010) A Tutorial on Pilot Studies: The What, Why and How. BMC Medical Research Methodology, 10, 1.
[57] Leon, A.C., Davis, L.L. and Kraemer, H.C. (2011) The Role and Interpretation of Pilot Studies in Clinical Research. Journal of Psychiatric Research, 45, 626-629.
[58] Macdiarmid, J. and Blundell, J. (1998) Assessing Dietary Intake: Who, What and Why of Under-Reporting. Nutrition Research Reviews, 11, 231-253.
[59] Black, D.R., Gleser, L.J. and Kooyers, K.J. (1990) A Meta-Analytic Evaluation of Couples Weight-Loss Programs. Health Psychology, 9, 330-347.
[60] McLean, N., Griffin, S., Toney, K. and Hardeman, W. (2003) Family Involvement in Weight Control, Weight Maintenance and Weight-Loss Interventions: A Systematic Review of Randomised Trials. International Journal of Obesity and Related Metabolic Disorders, 27, 987-1005.

comments powered by Disqus

Copyright © 2017 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.