Evaluating the implementation of peer counseling in a church-based dietary intervention for African Americans

Objective

Body & Soul, an evidence-based nutrition program for African Americans churches, is currently being disseminated nationally and free of charge by the National Cancer Institute. For dissemination feasibility, the peer counseling training is done via DVD rather than by live trainers. We describe implementation and process evaluation of the peer counseling component under real world conditions.

Methods

The study sample included 11 churches (6 early intervention, 5 delayed intervention) in 6 states. Data sources included training observations, post-training debriefing sessions, coordinator interviews, and church participant surveys. Survey data analysis examined associations between exposure to peer counseling and change in dietary intake. Qualitative data were analyzed using the constant comparative method.

Results

Eight of 11 churches initiated the peer counseling program. Recall of talking with a peer counselor was associated with significantly (p < .02) greater fruit and vegetable intake. Data indicate sub-optimal program execution after peer counselor training.

Conclusion

Inconsistent implementation of the peer counseling intervention is likely to dilute program effectiveness in changing nutrition behaviors.

Practice implications

Disseminating evidence-based programs may require added resources, training, quality control, and technical assistance for improving program uptake. Similar to earlier research phases, systematic efforts at the dissemination phase are needed for program success.     

Adequate nutrient intake can reduce cardiovascular disease risk in African Americans

Cardiovascular disease kills nearly as many Americans each year as the next seven leading causes of death combined. The prevalence of cardiovascular disease and most of its associated risk factors is markedly higher and increasing more rapidly among African Americans than in any other racial or ethnic group. Improving these statistics may be simply a matter of improving diet quality. In recent years, a substantial and growing body of evidence has revealed that dietary patterns complete in all food groups, including nutrient-rich dairy products, are essential for preventing and reducing cardiovascular disease and the conditions that contribute to it. Several cardiovascular risk factors, including hypertension, insulin resistance syndrome, and obesity, have been shown to be positively influenced by dietary patterns that include adequate intake of dairy products. The benefits of nutrient-rich dietary patterns have been specifically tested in randomized, controlled trials emphasizing African American populations. These studies demonstrated proportionally greater benefits for African Americans without evidence of adverse effects such as symptoms of lactose intolerance. As currently promoted for the prevention of certain cancers and osteoporosis, regular consumption of diets that meet recommended nutrient intake levels might also be the most effective approach for reducing cardiovascular disease risk in African Americans.     

Increasing knowledge of cardiovascular risk factors among African Americans by use of community health workers: the ABCD community intervention pilot project

African Americans have higher rates of cardiovascular disease (CVD) and poorer outcomes compared to others. The American Diabetes Association and the National Diabetes Education Program have promoted use of the ABC approach (glycated hemoglobin A1c, blood pressure, cholesterol) for identifying and controlling the leading indicators of CVD risk. In the present study, researchers added a D factor, for depression, because this disorder is common and also predictive of CVD risk and of control of diabetes. Particularly among low-income African Americans, depression is frequently not targeted or treated. The current study tests the effectiveness of recruiting African Americans in churches and training community health workers (CHWs) to educate their peers about CVD and risk reduction. For the intervention group, CHWs participated in a 16-hour training session and delivered a 6-week tailored educational program with counseling sessions and demonstrations. The control group received a weekly lecture by clinical experts. The CHW active-learning intervention was more effective than lectures by clinical experts in increasing the knowledge of CVD risk. The only significant difference in clinical measures reflected a worsening of HbA1c levels in the control group; the CHW intervention group showed a slight improvement. Participants also learned self-management skills, such as taking blood pressure, measuring glucose, and reading labels. Nevertheless, more longitudinal research and a larger sample size are needed to confirm the impact of CHWs in community settings to change factors associated with CVD risk.     

Incidence and risk factors for cardiovascular disease in African Americans with diabetes: the Atherosclerosis Risk in Communities (ARIC) study

To determine the incidence rate of cardiovascular disease (CVD) and its association with conventional and less well-established risk factors in African Americans with diabetes, we studied 741 African Americans aged 45 to 64 years with diabetes, in the Atherosclerosis Risk in Communities (ARIC) study. Risk factors were measured from 1987 to 1989, and incident CVD (n = 143 coronary heart disease (CHD) or stroke events) was ascertained through 1998. The crude incidence rate (per 1000 person-years) of CVD was 22.5 (11.9 for CHD and 12.0 for stroke). After multivariate adjustments, total cholesterol, prevalent hypertension and current smoking were significantly and positively associated with incident CVD among these African Americans with diabetes. Among the non-conventional risk factors, serum creatinine, factor VIII, von Willebrand factor, and white blood cell count were positively and serum albumin negatively and independently associated with CVD incidence. Adjusted relative risks for highest versus lowest tertiles of these risk factors ranged from 1.77 to 2.13. This study confirms that the major risk factors (hypercholesterolemia, hypertension and smoking) are important determinants of CVD in African Americans with diabetes. In addition, several blood markers of hemostasis or inflammatory response and elevated serum creatinine also proved to be CVD risk factors in African Americans with diabetes.     

Coronary heart disease risk factors and cigarette smoking among rural African Americans.

Cigarette smoking has been reported to worsen high-density lipoprotein (HDL) cholesterol and other cardiac risk factors, yet no studies have examined this issue among rural African Americans. This study examines the association between cigarette smoking and cardiac risk factors among rural African Americans. A population-based sample of 403 African-American adults from two rural Virginia counties underwent total cholesterol (TC), HDL, systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), serum glucose, and glycosylated hemoglobin (GlyHb) measurements. Cross-sectional multivariate analyses were used to compare risk factors across categories of cigarette use. Age, BMI, alcohol consumption, and the use of antihypertensive medications were covariates in the analysis. Results indicated that female light smokers had significantly lower SBP and DBP, and lower HDL. Female heavy smokers had significantly lower HDL and BMI and significantly higher TC/HDL ratios. Male heavy smokers had significantly higher SBP. More than 33% of males and more than 50% of females were overweight, and increasing BMI was associated with significantly or nearly significantly worsening of all other risk factor levels. Both cigarette smoking and obesity adversely affect other cardiac risk factors. Novel approaches are needed to decrease both smoking and obesity in this difficult to reach population.     

Life satisfaction and cardiovascular disease risk in Poland

Introduction

Cardiovascular disease is the most common cause of death. Life satisfaction is a predictor of morbidity and mortality, irrespectively of objective measures of health status. The aim of the study was to evaluate the relationship between life satisfaction (LS) and cardiovascular disease risk (CVD) assessed with the Framingham Risk Score (FRS) in Polish adults.

Material and methods

Past, present and projected LS were estimated. The FRS reflecting 10-year CVD risk was calculated from health indices and lifestyle parameters. Relationships between LS and FRS were tested by two-way analysis of variance in 489 men and 591 women, 40–50 years of age.

Results

Subjects with a reduction in LS over time had a higher FRS compared to peers with an improvement in LS. The relationship between current LS and FRS had a J-shape in men; FRS was lowest in men with an LS of 5–7 (average LS), slightly higher in men with an LS of 8–10 (highest LS), and highest in men with an LS of 1–4 (lowest LS). Among women, there was an inverse linear relationship between LS and FRS: the higher the LS, the lower FRS. There was a strong linear relationship between predicted LS and CVD risk. Highest risk was evident in subjects with low LS in whom low LS was predicted over the next five years.

Conclusions

Low LS (dissatisfaction) thus has a long-term negative effect on CVD risk in Polish adults of both sexes.     

Sleep in older African Americans and Caucasians at risk for sleep-disordered breathing

This study explored differences in sleep between older African Americans (AA) and Caucasians (CA) at risk for sleep-disordered breathing. Seventy AA and 70 CA were compared on ambulatory monitoring sleep variables and on self-reports on health and socioeconomic status (SES). After controlling for SES and health covariates, CA woke up significantly more often than AA (p = .018), but there were no other differences in sleep variables between the two groups. Time awake at night was related to being male, more depression, less walking, and lower income, whereas having more awakenings during the night was related to being CA, higher apnea-hypopnea index, and higher periodic leg movement index. Importance of inclusion of SES, health, and other covariates in studies exploring racial differences in sleep are discussed.     

Pilot study to assess HIV knowledge, spirituality, and risk behaviors among older African Americans

A pilot study was conducted in anticipation of implementation of a larger project to assess human immunodeficiency virus (HIV) risk behaviors among older African Americans. A cross-sectional methodology was employed, including 33 African Americans aged more than 50 years in the metropolitan Washington, DC, area. The average age of the participants was 66 years old, with an age range from 51 to 86 years. Data were collected utilizing previously validated instruments that were administered using an audio computer-assisted survey instrument. There was relatively high knowledge regarding HIV, with female participants scoring significantly higher compared to male participants (p=.003). Another specific finding of the preliminary study was the association between higher levels of spirituality and lower levels of HIV sexual risk behaviors (Spearman's correlation=-0.369, p=.035). Results of this pilot study suggest that older African American females may be more knowledgeable regarding HIV than older African American males. This may suggest that educational and behavioral interventions developedfor this group may need to be structured based upon the targeted gender of the audience. The association between increased spirituality and decreased risk behaviors may suggest that spiritually-based interventions may provide some benefit regarding reduction of HIV risk behaviors in this population. However, the small sample size in this study warrants caution in the conclusions and highlights the need for further research in this population.     

Role of religious social support in longitudinal relationships between religiosity and health-related outcomes in African Americans

This study tested a longitudinal model of religious social support as a potential mediator of the relationship between religious beliefs and behaviors, and multiple health-related outcomes (e.g., depressive symptoms, functioning, diet, alcohol use, cancer screening). A national probability sample of African Americans enrolled in the religion and health in African Americans study completed three waves of telephone interviews over a 5-year period (N = 766). Longitudinal structural equation models indicated that religious behaviors, but not beliefs, predicted the slowing of a modest overall decline in positive religious social support, while negative interactions with congregational members were stable. Positive religious support was associated with lower depressive symptoms and heavy drinking over time, while negative interaction predicted increases in depressive symptoms and decreases in emotional functioning. Positive religious support mediated the relationship between religious behaviors and depressive symptoms and heavy drinking. Findings have implications for mental health interventions in faith-based settings.     

Menopause, insulin resistance, and risk factors for cardiovascular disease

OBJECTIVE: In this retrospective analysis of the European Group for the Study of Insulin Resistance database, a clamp data pooling project, a cardiovascular risk score (CVS) was assessed to verify whether hyperinsulinemia and/or insulin resistance were independent cardiovascular risk factors and to investigate how menopause affected CVS and insulin resistance. DESIGN: Information was obtained on whole-body glucose uptake (M), determined by the euglycemic hyperinsulinemic clamp technique, normalized by fat-free mass (FFM), and insulin concentration (I) at a steady state. Body composition was estimated using a labeled water technique or bioimpedance. Other parameters measured included blood pressure, lipid levels, and waist-to-hip ratio. CVS was computed using a structural equation model that included age, body mass index, blood lipids, and blood pressure. The study population included 523 normal and overweight patients. Women were grouped according to fertility status, and men, according to age (cutoff 50 y). RESULTS: M/kg(FFM)/I significantly decreased after menopause (12.41 +/- 3.40 vs 10.96 +/- 3.68; P < 0.01) and in men 50 years and older (11.39 +/- 3.47 vs 10.32 +/- 3.77 micromol x min(-1) x kg(-1) x microUI/mL; P < 0.02). CVS was lowest in fertile women (-0.414 +/- 0.57 vs 0.107 +/- 0.43; P < 0.0001) and highest in men 50 years and older (0.045 +/- 0.455 vs 0.257 +/- 0.51; P < 0.001). CVS significantly correlated with M/kg(FFM)/I in men 49 years and younger (r(o) = -0.27, P < 0.0001) and 50 years and older (r(o) = -0.38, P < 0.0001) and with fasting insulin in fertile women (r(o) = -0.29, P < 0.01) and in the other groups (r(o) ranging from 0.37 to 0.45, P < 0.0001). CONCLUSIONS: Menopause does not seem to strictly relate to a decrease in insulin sensitivity as postmenopausal women had the same insulin sensitivity as age-matched men. In the population studied, the best predictor of CVS was fasting insulin rather than insulin sensitivity.     

Hypertension, hypercoagulability and the metabolic syndrome: a cluster of risk factors for cardiovascular disease

Cardiovascular disease (CVD) is one of the main causes of mortality in the world representing around 30% of all deaths. It constitutes also an important factor in morbidity and incapacity. There are several related CVD risk factors such as hypertension, metabolic syndrome (MetS) and hypercoagulability. The exact mechanisms that underlie the relation between those factors and CVD are not sufficiently known yet; pathogenic explanations are lacking also for the mechanisms relating metabolic factors to insulin resistance (IR) and the association with the development of atherosclerosis and thrombosis. The possible links between hypertension, hemostasis alterations and MetS are examined in this report.     

Sleep disorders in African Americans and Caucasian Americans: a meta-analysis

Previous research suggests that ethnic groups differ in the prevalence and severity of disordered sleep symptoms. This study used meta-analysis to determine the magnitude of ethnic differences between African Americans (AAs) and Caucasian Americans (CAs) in insomnia symptoms and sleep-disordered breathing (SDB). It also used moderator analyses to explore the variability in these effect sizes. Thirteen studies measuring insomnia symptoms and 10 studies measuring SDB met inclusion criteria and represented thousands of adult AAs and CAs. Results indicate AAs have a higher prevalence and greater severity of SDB, but CAs report more insomnia symptoms. These results indicate a need for a multi-ethnic approach to the assessment and treatment of sleep disorders.     

Coronary artery disease risk factors in Yaqui Indians and Mexican Americans.

The prevalence of coronary artery disease risk factors in adults was studied in Yaqui Indians and Mexican Americans. The risk factors studied included hypertension, diabetes, hypercholesterolemia, smoking, and sedentary life-style. Subjects included 94 Mexican Americans, 44 Yaqui Indians, and 12 of mixed or other ancestry. Mexican Americans had higher rates of smoking (21.3% versus 11.4%) and hypercholesterolemia (9.4% versus 4.8%) than did Yaqui Indians although neither comparison was statistically significant. Yaqui Indians had twice the risk of diabetes (40.5% versus 19.8%, P less than .05). When looking at both races combined, men smoked at six times the rate of women (36.4% versus 6.3%, P less than .05). Of all those tested, only 6% had no risk factors, and 88% were classified as having a sedentary life-style. Achieving increased levels of exercise in the population studied would appear to hold the most promise for reducing coronary artery disease risks.