Iris Young-Clark

Reducing cardiovascular disease risk in mid-life and older African Americans: A church-based longitudinal intervention project at baseline

INTRODUCTION African Americans (AAs) experience higher age-adjusted morbidity and mortality than Whites for cardiovascular disease (CVD). Church-based health programs can reduce risk factors for CVD, including elevated blood pressure [BP], excess body weight, sedentary lifestyle and diet. Yet few studies have incorporated older adults and longitudinal designs. PURPOSES The aims of this study are to: a) describe a theory-driven longitudinal intervention study to reduce CVD risk in mid-life and older AAs; b) compare selected dietary (fruit and vegetable servings/day, fat consumption), physical activity (PA) and clinical variables (BMI, girth circumferences, systolic and diastolic BP, LDL, HDL, total cholesterol [CHOL] and HDL/CHOL) between treatment and comparison churches at baseline; c) identify selected background characteristics (life satisfaction, social support, age, gender, educational level, marital status, living arrangement and medication use) at baseline that may confound results; and d) share the lessons learned. METHODS This study incorporated a longitudinal pre/post with comparison group quasi-experimental design. Community-based participatory research (CBPR) was used to discover ideas for the study, identify community advisors, recruit churches (three treatment, three comparison) in two-counties in North Florida, and randomly select 221 mid-life and older AAs (45+) (n=104 in clinical subsample), stratifying for age and gender. Data were collected through self-report questionnaires and clinical assessments. RESULTS AND CONCLUSIONS Dietary, PA and clinical results were similar to the literature. Treatment and comparison groups were similar in background characteristics and health behaviors but differed in selected clinical factors. For the total sample, relationships were noted for most of the background characteristics. Lessons learned focused on community relationships and participant recruitment.

Life dissatisfaction and eating behaviors among older African Americans: The protective role of social support

ObjectivesTo examine (a) the influences of life dissatisfaction and dietary social support on eating behaviors (a high-fat diet and fruit/vegetable consumption) of older African Americans and (b) the moderating role of perceived dietary social support on the association between their life dissatisfaction and unhealthy eating behaviors.DesignBaseline data from a larger intervention study of mid-life and older African Americans. The study incorporated a quasi-experimental design with random selection of participants, stratifying for age and gender.SettingSix churches in North Florida.ParticipantsOne hundred and seventy-eight (132 females and 46 males with a median age of 60) older African Americans.MeasurementsA structured questionnaire elicited personal data as well as information on eating behaviors, life dissatisfaction, and perceived dietary social support.ResultsOlder African Americans with more cumulative life adversity, as reflected by high life dissatisfaction, had significantly poorer eating behaviors including the consumption of a high-fat diet and low intake of fruits and vegetables. Older African Americans’ dietary choices were also associated with their perceived social support. More importantly, perceived social support acted as a buffer to mitigate the influence of life dissatisfaction on older African Americans’ eating behaviors.ConclusionLife dissatisfaction places older African Americans at risk for unhealthy eating behaviors. However, high levels of dietary social support can protect older African Americans from the influence of life dissatisfaction on unhealthy eating behaviors. There are practical implications of this research for health interventions and programming.

The Development of Health for Hearts United: A Longitudinal Church-based Intervention to Reduce Cardiovascular Risk in Mid-life and Older African Americans

This article describes Health for Hearts United, a longitudinal church-based intervention to reduce cardiovascular disease (CVD) risk in mid-life and older African Americans. Using community-based participatory research (CBPR) approaches and undergirded by both the Socio-ecological Theory and the Transtheoretical Model of Behavior Change, the 18-month intervention was developed in six north Florida churches, randomly assigned as treatment or comparison. The intervention was framed around three conceptual components: awareness building (individual knowledge development); clinical learning (individual and small group educational sessions); and efficacy development (recognition and sustainability). We identified three lessons learned: providing consistency in programming even during participant absences; providing structured activities to assist health ministries in sustainability; and addressing changes at the church level. Recommendations include church-based approaches that reflect multi-level CBPR and the collaborative faith model.

Establishing health ministries: leaders' perceptions of process and effectiveness.

Church-based health interventions are one mechanism to address health issues of African Americans. This study determines the perceptions of health leaders regarding the development process for and the effectiveness of church health ministries, using the Precede/Proceed model. Ten health leaders from six medium-sized churches in a North Florida county participated in a 10-month breast health intervention. Data were collected using two methods. A brief questionnaire was administered that included items related to knowledge about breast health, perceptions of and processes for health ministry development, and perceptions of resources used during the intervention. In addition, a focus group was conducted with the health leaders, using a trained moderator, which included questions about their health behaviors prior to and after the project, biggest successes and challenges in establishing their health ministries, and plans for sustaining the health ministry after the project. Questionnaire data were analyzed using descriptive statistics and paired t-tests. Focus group data and open-ended questionnaire responses were transcribed and analyzed using code-based analytic procedures where data were organized into thinking units, categories, and then broader themes. Findings indicate that health leaders perceived that health ministry development focused on a series of steps, including: a) predisposing: health leaders background (personal characteristics, education/profession, health behaviors); b) enabling: support and participation from the pastor; and c) reinforcing: start-up processes (personal contact, public relations, materials and church member involvement) and outputs (activities and partnerships). This study demonstrates that health ministry development involves a sequential process that fits within a broad organizational framework for health behavior change.

Examining change in social support and fruit and vegetable consumption in African American adults

ObjectiveTo examine (a) inter-individual variation in African Americans’ fruit and vegetable social support, behavior, and consumption trajectories by estimating latent growth curves (LGCs) and (b) the associations between these trajectories over time.DesignAs part of a larger intervention study, data were collected from mid-life and older African Americans yearly for three years. The study incorporated a quasi-experimental design with random selection of participants, stratifying for age and gender.SettingSix churches in North Florida.ParticipantsTwo hundred and thirty one (73% women; median age range of 57–63) older African Americans.MeasurementsA structured questionnaire elicited personal data as well as information on dietary social support, eating-related behaviors, and fruit and vegetable dietary intake.ResultsAge was positively associated with initial social support but negatively associated with the rate of change in social support. More important, the rate of change in dietary social support predicted eating-related behavior trajectories, which influenced the rate of change in fruit and vegetable consumption over time after controlling for the intervention.ConclusionThese findings illustrate the mediating role of eating-related behaviors and the inter-locking nature of social support, behavior and consumption trajectories. This research has implications for future research as well as community interventions and programs.

Linking Life Dissatisfaction to Health Behaviors of Older African Americans Through Psychological Competency and Vulnerability

The objective of this study was to examine the influence of life dissatisfaction on health behaviors of older African Americans and the linking role of psychological competency (e.g., control and agency) and psychological vulnerability (e.g., negative affect). A structural equation model using baseline data from a larger intervention study of older African Americans was examined. Respondents included 207 (153 females and 54 males with a median age of 60) older African Americans. Life dissatisfaction was directly associated with respondents’ daily fat consumption and sleep and indirectly associated with receiving regular physical exams, physical activity, and fruit and vegetable consumption through their psychological processes. The association between life dissatisfaction and respondents’ health behaviors varied depending on the behavior under consideration. Programs and services designed to improve older African Americans’ health behaviors should address their psychological processes, as this research suggests these psychological processes are associated with different health behaviors.

Antioxidant intake in relation to serum C-reactive protein in mid-life and older African Americans

ABSTRACT Objective: African Americans (AAs) experience greater prevalence of cardiovascular disease (CVD) compared to other ethnic/racial groups. Low-grade chronic inflammation (often quantified by serum C-reactive protein CRP) is a well-documented risk factor for CVD. A healthy diet is plentiful in antioxidant nutrients and is associated with a lower inflammatory status and CVD risk. Our objective was to examine the relationship between dietary intake of antioxidants (carotenoids, vitamins A, C, E, and selenium) and serum CRP concentrations in mid-life and older AAs, while controlling for confounders. Methods: Data were from the baseline phase of a longitudinal church-based intervention study to reduce CVD risk in AAs. Anthropometrics were measured in a standard manner. Fasting serum samples were analyzed with ELISA for CRP. Multiple-pass 24-hour dietary recalls were used to assess intake; self-reported questionnaires were used to collect demographics. Statistical analyses were performed using SPSS Statistics 21 with the level of significance set at p < 0.05. Results: A total of n = 73 participants (n = 51 females) were included in the analyses. The females and males, respectively were 58.9 ± 10.3 and 59.4 ± 9.7 years old, with BMI of 34.6 ± 8.3 and 35.6 ± 9.3 kg/m2 (Mean ± SD). The mean serum CRP was above 0.6 mg/dL, although slightly lower in males. Males consumed more energy (kcal) and met RDA for selenium, whereas females met RDA for vitamin C. Both groups met RDA for vitamin A. All other dietary variables fell below the RDA or had no RDA established. Results from the binary logistic regression did not show significant association between dietary antioxidants and serum CRP in males or females. However, among females, for every unit increase in BMI, there was a 15% increase in serum CRP (OR = 1.15, p = 0.04). Conclusions: Our study does not support the inverse relationship between antioxidants intake and CRP, but does support the evidence for obesity-induced inflammation and suggests the association can be applied to AA women.

Health insurance status, psychological processes, and older African Americans’ use of preventive care

The current study examined the influence of health insurance, psychological processes (i.e. psychological competency and vulnerability), and the interaction of these two constructs on older African Americans’ utilization of five preventive care services (e.g. cholesterol screening and mammogram/prostate examination) using data from 211 older African Americans (median age = 60). In addition to direct effects, the influence of health insurance sometimes varied depending on respondents’ psychological competency and/or vulnerability. Policies and interventions to increase older African Americans’ use of preventive health services should consider structural (e.g. health insurance) and psychological (e.g. psychological competency and vulnerability) factors along with the interaction between these factors.

The Development of a Tracking Tool to Improve Health Behaviors in African American Adults

Although African Americans (AAs) have high risk for cardiovascular disease, few individual tailored interventions are available to improve healthy lifestyles in this population. The purpose of this study was to develop and pilot-test a tracking tool for AA adults to examine the extent to which participants initiated health goals and were ready for change, improved health behaviors (increased fruit/vegetables and physical activity, decreased fat), and perceived the tool was useful in tracking and improving health behaviors. AA adults (n=11, 40 years or older) were recruited and completed for one week the Health Check Report Card (HCRC), a tracking tool that measures types of food eaten and physical activity using a pre-determined point system. Findings showed that the participants at post-test significantly increased fruit/vegetable consumption. The HCRC was perceived as helpful in tracking health behaviors. This study suggests that the HCRC may be a tool to explore in improving health behaviors of AAs.