Jacquelyn W. McClelland

Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health project.

OBJECTIVES This study assessed the effects of the Black Churches United for Better Health project on increasing fruit and vegetable consumption among rural African American church members in North Carolina. METHODS Ten counties comprising 50 churches were pair matched and randomly assigned to either intervention or delayed intervention (no program until after the follow-up survey) conditions. A multicomponent intervention was conducted over approximately 20 months. A total of 2519 adults (77.3% response rate) completed both the baseline and 2-year follow-up interviews. RESULTS The 2 study groups consumed similar amounts of fruits and vegetables at baseline. AT the 2-year follow-up, the intervention group consumed 0.85 (SE = 0.12) servings more than the delayed intervention group (P < .0001). The largest increases were observed among people 66 years or older (1 serving), those with education beyond high school (0.92 servings), those widowed or divorced (0.96 servings), and those attending church frequently (1.3 servings). The last improvement occurred among those aged 18 to 37 years and those who were single. CONCLUSIONS The project was a successful model for achieving dietary change among rural African Americans.

The North Carolina Black Churches United for Better Health Project: Intervention and Process Evaluation

The North Carolina Black Churches United for Better Health project was a 4-year intervention trial that successfully increased fruit and vegetable (F&V) consumption among rural African American adults, for cancer and chronic disease prevention. The multicomponent intervention was based on an ecological model of change. A process evaluation that included participant surveys, church reports, and qualitative interviews was conducted to assess exposure to, and relative impact of, interventions. Participants were 1,198 members of 24 intervention churches who responded to the 2-year follow-up survey. In addition, reports and interviews were obtained from 23 and 22 churches, respectively. Serving more F&V at church functions was the most frequently reported activity and had the highest perceived impact, followed by the personalized tailored bulletins, pastor sermons, and printed materials. Women, older individuals, and members of smaller churches reported higher impact of certain activities. Exposure to interventions was associated with greater F&V intake. A major limitation was reliance on church volunteers to collect process data.

Baseline Fruit and Vegetable Intake among Adults in Seven 5 A Day Study Centers Located in Diverse Geographic Areas

OBJECTIVE To examine baseline rates of fruit and vegetable consumption among adults in the 5 A Day research trials in order to identify any regional and sociodemographic differences associated with daily servings. DESIGN The main outcome measure was the frequency of fruits and vegetables consumed within 1 month of the baseline survey as assessed by a 7-item food frequency questionnaire (FFQ). SUBJECTS/SETTING Participants (N = 15,060) were from 7 study centers. Study centers included schools (N = 48), worksites (N = 60), churches (N = 50), or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (N = 15) in interventions to increase fruit and vegetable consumption. STATISTICAL ANALYSES Means and standard errors, adjusting for clusters, were calculated. A mixed linear model analyzed relationships between fruit and vegetable consumption and regional center, gender, age, race, education, income, marital status, food-shopping responsibility, and whether one lives with children. RESULTS Results indicate an overall mean intake of 3.6 daily servings of fruits and vegetables. Significant differences in mean daily servings were found among the regional study centers (low of 3.0 to high of 4.1). There were significant differences in mean daily consumption by age (< 30 years = 3.7 servings per day; 30 to 49 years = 3.4; > or = 50 years = 3.7), education (> high school = 3.4 servings per day; high school graduate = 3.4; some college = 3.5; college graduate = 3.9), race (black = 3.7 servings per day; Hispanic = 3.0; white = 3.6; other = 3.7), marital status (married = 3.6 servings per day; single = 3.5), and food-shopping responsibilities (little = 3.2 servings per day; about half = 3.6; most = 3.8). Only 17% of respondents ate 5 or more servings of fruits and vegetables per day. CONCLUSIONS The 7 regions showed significant variability in daily fruit and vegetable consumption, suggesting that a single national message to increase fruit and vegetable consumption may not reach the population segments most in need of changing. It is advisable to spend more time understanding the food consumption habits of the population under investigation to develop messages to foster behavior change.

Stages of change and psychosocial correlates of fruit and vegetable consumption among rural African-American church members

Purpose. This study examined the relationship between stages of change, other psychosocial factors, and fruit and vegetable (F&V) consumption among rural African-Americans participating in a 5 a Day study. Design. The cross-sectional design assessed associations between F&V intake, stage of change, self-efficacy, beliefs, barriers, and social support. Setting. Participants were surveyed by telephone. Subjects. Subjects were 3557 adult church members (response rate, 79.1%), aged 18 and over from 10 North Carolina counties. Measures. A seven-item food frequency measured F&V intake. Stage of change was measured using four items; other psychosocial variables were measured using Likert scales. Chi-square tests and analysis of variance were used in statistical analyses. Results. The majority of participants (65 %) were in the preparation stage of change. Individuals in action/maintenance consumed an average of 6.5 daily F&V servings compared to 3.3 to 3.5 servings for those in precontemplation, contemplation, and preparation. Self-efficacy, social support, and belief about how many daily F&V servings are needed, were positively associated with stage. Barriers were most prevalent among precontemplators. Conclusions. The findings support the applicability of the stages-of-change model to dietary change among rural African-Americans. The relationship between stage, self-efficacy, social support, and barriers supports using a multicomponent intervention strategy.

Translating Weight Loss and Physical Activity Programs Into the Community to Preserve Mobility in Older, Obese Adults in Poor Cardiovascular Health

BACKGROUND Limitations in mobility are common among older adults with cardiovascular and cardiometabolic disorders and have profound effects on health and well-being. With the growing population of older adults in the United States, effective and scalable public health approaches are needed to address this problem. Our goal was to determine the effects of a physical activity and weight loss intervention on 18-month change in mobility among overweight or obese older adults in poor cardiovascular health. METHODS The study design was a translational, randomized controlled trial of physical activity (PA) and weight loss (WL) on mobility in overweight or obese older adults with cardiovascular disease (CVD) or at risk for CVD. The study was conducted within the community infrastructure of Cooperative Extension Centers. Participants were randomized to 1 of 3 interventions: PA, WL + PA, or a successful aging (SA) education control arm. The primary outcome was time to complete a 400-m walk in seconds (400MWT). RESULTS A significant treatment effect (P = .002) and follow-up testing revealed that the WL + PA group improved their 400MWT (adjusted mean [SE], 323.3 [3.7] seconds) compared with both PA (336.3 [3.9] seconds; P = .02) and SA (341.3 [3.9] seconds; P < .001). Participants with poorer mobility at baseline benefited the most (P < .001). CONCLUSION Existing community infrastructures can be effective in delivering lifestyle interventions to enhance mobility in older adults in poor cardiovascular health with deficits in mobility; attention should be given to intervening on both weight and sedentary behavior since weight loss is critical to long-term improvement in mobility. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00119795.

Fruit and vegetable consumption of rural african americans : Baseline survey results of the black churches united for better health 5 A Day project

The objective of this study was to determine baseline fruit and vegetable consumption (total and specific) among rural African Americans participating in a 5 A Day intervention study and factors associated with this dietary intake. A telephone survey was administered to 3,737 adult members of 50 black churches from 10 rural counties in North Carolina. The survey measured demographic characteristics, knowledge and beliefs regarding cancer and nutrition, and food-frequency data related specifically to fruit and vegetable consumption. Associations between fruit and vegetable consumption and income, education, age, gender, marital status, the presence of children within the household, and awareness of the 5 A Day program were explored using descriptive and regression analyses. Food-frequency data showed a mean intake of 3.7 +/- 2.4 daily servings of fruits and vegetables within this population of rural African Americans. Twenty-three percent of the participants reported eating five or more daily servings of fruits and vegetables. Significant associations were found between fruit and vegetable intake and both age and gender (p < 0.001), with older females consuming the most and younger males consuming the least fruits and vegetables. Findings from this rural African American population parallel national studies showing that US intake of fruits and vegetables falls short of the 5 A Day guidelines. Female gender and advancing age were positively associated with fruit and vegetable intake. Study results reinforce the need to promote the 5 A Day message. Such messages may prove most beneficial if targeted toward younger adult males, whose fruit and vegetable intakes are especially low.

Partnering with African American churches to achieve better health: Lessons learned during the black churches united for better health 5 a day project

African Americans (AAs) are at increased risk for many diseases, including cancer, but health promotion efforts often fail to reach them. Effective partnerships can be established with African American churches to deliver health-based interventions. In an NCI-funded study aimed at increasing fruit and vegetable consumption among rural AAs, investigators at three academic institutions and the North Carolina State Health Department partnered successfully with 50 churches to promote dietary change. This study adds to the increasing body of research in support of the African American church as an able partner in delivering health-based interventions. In conducting interventions and research through this channel, the health professional should gain support from regional secular associations; respect the power of the pastor; incorporate the strengths of the congregation; respect the mission of the church; establish open communication and develop trust; provide ample support and training to assure fidelity to interventions and integrity of data; and be patient and persevere.

Weight Loss and Self-Regulatory Eating Efficacy in Older Adults: The Cooperative Lifestyle Intervention Program

Objectives. Using the weight efficacy lifestyle questionnaire (WEL), we examined whether a group-mediated intervention for weight loss among older, obese adults resulted in changes in self-regulatory self-efficacy for eating behavior and whether these changes mediated weight loss. Methods. This was a randomized controlled design, and 288 older adults received 1 of 3 treatments for 6 months: physical activity only (PA), weight loss + physical activity (WL + PA), or a successful aging (SA) health education program. The WEL was administered prior to randomization and again at the 6-month follow-up visit. Results. A significant treatment effect was observed for the WEL, F (2,249) = 15.11, p < .0001, partial eta2 = .11, showing that improvement occurred only in the WL + PA group as compared with PA and SA. Changes in WEL scores partially mediated the effects of the WL + PA intervention on weight loss. Discussion. These results illustrate that WL + PA can be effective in improving older adults’ self-efficacy for the self-regulation of eating behavior and that these changes are prospectively related to the amount of weight loss. Further research is warranted on an expanded concept of self-efficacy as well as controlled experimental studies on eating behavior in older adults.

Review of evaluation tools used to assess the impact of nutrition education on dietary intake and quality, weight management practices, and physical activity of low-income audiences:

Nutrition education programs and social marketing campaigns frequently focus on low-income audiences with the goal of improving dietary intake and quality, weight management practices, and physical activity. The impact of nutrition education can be assessed by measuring change in relation to any or all of these broad variables. Unfortunately, little information is available concerning the reliability, validity, and sensitivity to change of measures used to assess these constructs with low-income audiences of adults and adolescents. This article reviews the literature and discusses the types of available measures that have been used and evaluated for the above audiences. It describes specific measures used to assess total diet, consumption of food groups from the Food Guide Pyramid, and behaviors related to weight management and physical activity. Overall, this review suggests that there is a critical need for additional development and evaluation of dietary quality measurement tools for low-income and minority audiences.

Reaching Older Adults with Nutrition Education: Lessons Learned During the Partners in Wellness Pilot Project

Abstract Older Americans are at increased risk for malnutrition. Yet, health promotion efforts often fail to reach them. Studies suggest that existing channels (e.g., organized sites/systems such as churches, clubs, or schools) might be used to reach a hard-to-reach audience with information. Partners in Wellness: A Pilot Program Using a Holistic Approach to Improve the Nutritional Status of Older Adults at Congregate Nutrition Sitesused congregate nutrition sites as channels to deliver nutrition education programming to decrease the risk of malnutrition among food-stamp eligible or food-stamp recipient older adults. This paper identifies issues, both facilitating factors and barriers, in designing and conducting effective educational programming for older adults.