Cheryl Houston

Improving dietary behavior in African Americans: the Parents As Teachers High 5, Low Fat Program

BACKGROUND The High 5, Low Fat Program (H5LF) for African American parents was developed in partnership with the Parents As Teachers program, and was designed to test a dietary intervention appropriate for national adoption. METHODS H5LF used a group randomized, nested cohort design with 738 parents. Consistent with organizational goals and methods, parent educators delivered a dietary change program via personal visits, newsletters, and group meetings. Primary outcomes were reducing percentage calories from fat and increasing fruit and vegetable consumption among participating parents; intermediate aims included improving in nutrition-related skills and parental modeling of dietary behaviors. RESULTS H5LF parents achieved a 0.53 increase in fruit and vegetable consumption (P = 0.03), and a higher proportion of H5LF parents reduced their intake to less than 30% calories from fat (chi(2) = 4.8, P < 0.03; -1.7% calories from fat, p = 0.07) and improved performance of dietary behaviors (F = 14.2, P = 0.004). Improvements in parental modeling were not statistically significant. CONCLUSIONS H5LF is an effective intervention that is appropriate for national adoption by over 2000 Parents As Teachers sites with the potential to impact dietary intake of African American parents nationwide.

Relationships among Social Support, Diabetes Outcomes, and Morale for Older Men and Women

The present study examined (a) whether a diabetes-specific measure of social support is more highly related to diabetes outcomes than is a general measure of social support, (b) if the relationship between social support and diabetes outcomes is different for men and women, and (c) if self-care behavior and metabolic control influences morale among older adults with diabetes. Study participants were 191 community-dwelling volunteers (81 men, 110 women) over the age of 60 with non-insulin-dependent diabetes mellitus. For men, social support specific to ones regimen affected metabolic control indirectly by increasing self-care behavior. For women, neither diabetes-specific nor general support was related to self-care behavior nor was self-care behavior related to metabolic control. For women, only high levels of overall support were associated with higher levels of morale. For men, higher levels of morale were found for those who were married and perceived high levels of available support, and for those who were in better metabolic control. These latter findings suggest that reciprocal relationships between psychosocial variables and health outcomes should be considered.

Cultural Relevancy of a Diabetes Prevention Nutrition Program for African American Women

Diabetes among African American women is a pressing health concern, yet there are few evaluated culturally relevant prevention programs for this population. This article describes a case study of the Eat Well Live Well Nutrition Program, a community-based, culturally specific diabetes prevention nutrition program for African American women. The stages of change theory and principles from community organization guided the development of the program. Health education strategies, including participatory development and program delivery by peer educators, were applied to promote cultural relevance. Results indicated that overall participants (90%) believed the program to be culturally relevant and were very satisfied with the program (82%). Cultural relevancy was significantly associated with greater program satisfaction and changes in dietary patterns when controlling for the number of sessions attended. Conclusions suggest that participatory strategies can be effective in designing culturally specific prevention programs for African American women.

African American Family Structure: Are There Differences in Social, Psychological, and Economic Well-Being?

This study addresses the following research questions: (a) What are the various types of family structures that exist in urban African American households? and (b) to what extent do differences in family structure influence social, psychological, and economic well-being as reported by urban African American women? The authors present findings from 301 African American women who participated in a community-based nutrition prevention program in a large Midwestern urban center. This studys results indicate that family structure has more influence on African American womens economic well-being than do social and psycho-logical factors. Implications of these findings for intervention are presented.

The Short-Term Impact of a Health Promotion Program For Low-Income African American Women

Objective: The purpose of this study is to describe the results of a process and outcome evaluation of a culturally specific, peer-led, dietary change program designed to reduce the risk of noninsulin-dependent diabetes mellitus (NIDDM) among low-income African American women. Method: Using an experimental, control-group design, 239 African American women completed pretest and posttest interviews that included measures of nutrition-related knowledge, attitudes, behaviors, fat intake, and weight. Results: Significant reductions in fat intake were found among women in the treatment condition. Participants significantly increased low-fat dietary patterns and showed higher levels of nutrition-related knowledge. Examination of physical data indicates that no significant weight differences were found between the treatment and control groups. Conclusions: This model of health promotion, which individually tailors the intervention content through staging and used community organization strategies, has potential for reducing the risk of diet-related diseases among African American women.

Process Evaluation Methods of a Peer-Delivered Health Promotion Program for African American Women:

The Eat Well, Live Well (EWLW) Nutrition Program was a community-based, dietary change program delivered by peer educators to low-income African American women. To ensure that the program was delivered as intended, a process evaluation was conducted to determine the extent to which the content was accurate and comprehensive. The methodology included developing checklists for each of the intervention sessions, audiotaping randomly selected sessions, and independently rating the audiotapes. Overall comprehensiveness of the content delivered by the peer educators was 91.42%. Cohen’s kappa () for each data collection interval ranged from 0.95 to 0.97. Overall accuracy of information delivered was 88.52%. A process evaluation as described for the EWLW program is essential for peer-led health promotion programs and necessary to ensure program integrity. Practice implications are discussed.

Obesity in Inner‐city African Americans

OBJECTIVE Obesity, a risk factor for chronic diseases, has a high prevalence in African Americans and low-income individuals. However, little is known about perceptions of overweight, attempts to lose weight, and strategies used to lose weight among African Americans in inner cities. DESIGN A 1990 cross-sectional telephone survey (n = 1445) of north St Louis and central Kansas City, USA. RESULTS Obesity was common (44%) in this sample of inner-city African Americans. The obese perceived themselves as overweight (70%) and were trying to lose weight (66%). The majority of the obese (68%) were both dieting and exercising to lose weight. Smoking prevalence was not higher among the obese or those trying to lose weight. Many of the obese had received medical advice recently on low-fat diets (51%) and had been advised to lose weight (40%). Factors independently associated with perception, attempts to lose weight and medical advice differed, but included degree of obesity. CONCLUSIONS These results corroborate US national data that obesity is a public health problem in this population and that obese inner-city African Americans perceive themselves as overweight and are trying to lose weight, especially as degree of obesity increases. It also appears that smoking is not being used as a weight loss strategy and that the obese, as a group, are receiving some medical advice on low-fat diets. This information is critical for designing culturally sensitive weight-control programmes.

Staging of Dietary Patterns among African American Women

This article describes the development of a behavioral staging algorithm for use in the Eat Well, Live Well Nutrition Program, a peer-delivered community-based program for African American women (N = 301). The authors examined whether increased frequency in performing low-fat eating behaviors and lower percentage calories from fat intake resulted as a participant moved through five stages of readiness to change each of five low-fat dietary patterns. Frequency of performing low-fat dietary behaviors was significantly different (p < .05) between four stages for the pattern of avoid fried foods, three stages for modify meats, and two stages for the patterns of substitution, avoid fat as seasoning, replacement. Percentage calories from fat were significantly different (p < .05) between four stages for the pattern of replacement, three stages for avoid fried foods and modify meats, and two stages for substitution and avoid fat as seasoning. Implications of these findings for the tailoring of community-based dietary programs are presented.

A community research partnership to improve the diet of African Americans.

OBJECTIVE To describe a community research partnership in which a national parent education organization collaborated with academic institutions to develop a dietary change program for underserved African American parents. METHODS Qualitative methods were used to characterize issues that impacted partnership operations. RESULTS Data are reported on partnership activities including program development and implementation with African American parents. Lessons learned and strategies for improving the partnership are presented. CONCLUSIONS Ongoing assessment and evaluation of how a partnership operates, especially in the context of multiple sites, are important to sustaining successful functioning.

The Feasibility of Recruiting Hospitalized Patients With Diabetes for a Smoking Cessation Program

The aims of this study were to identify hospitalized smokers with diabetes, assess the severity of their physical condition, and determine their willingness to participate in a postdischarge smoking cessation program. Hospitalized smokers with diabetes were identified through referrals from the Dietetics Department. Smoking status was determined via medical charts, healthcare staff, and patient self-report. Among all patients with diabetes who were identified (n=314), smoking status was routinely recorded only for those with a primary cardiac diagnosis (41%). Smokers (n=59) were significantly younger and reported multiple but fewer concomitant diagnoses than nonsmokers. Ninety-one percent of the smokers who were contacted refused to participate in a postdischarge smoking cessation program. We conclude that accurate methods are needed for identifying all smokers to facilitate cessation efforts. The severity and chronicity of the physical condition of hospitalized smokers with diabetes may limit willingness to participate in a postdischarge smoking cessation intervention.