Lovoria B. Williams

Design of a cluster-randomized controlled trial of a diabetes prevention program within African–American churches: The Fit Body and Soul study

Evidence from varied community settings has shown that the Group Lifestyle Balance (GLB) Program and other adaptations of the Diabetes Prevention Program (DPP) intervention are effective in lowering diabetes risk. Most DPP data originated from studies of pre-diabetic whites, with only sparse evidence of the effect of DPP in African Americans (AAs) in community settings. This paper describes the design, methods, baseline characteristics and cost effective measures, of a single-blinded, cluster-randomized trial of a faith-based adaptation of the GLB program, Fit Body and Soul (FBAS). The major aims are to test efficacy and cost utility of FBAS in twenty AA churches. Randomization occurred at the church level and 604 AA overweight/obese (BMI≥25kg/m(2)) adults with fasting plasma glucose range from normal to pre-diabetic received either FBAS or a health-education comparison program. FBAS is a group-based, multi-level intervention delivered by trained church health advisors (health professionals from within the church), with the goal of ≥7% weight loss, achieved through increasing physical activity, healthy eating and behavior modification. The primary outcome is weight change at 12weeks post intervention. Secondary outcomes include hemoglobin A1C, fasting plasma glucose, waist circumference, blood pressure, physical activity level, quality of life measures, and cost-effectiveness. FBAS is the largest known cohort of AAs enrolled in a faith-based DPP translation. Reliance on health professionals from within the church for program implementation and the cost analysis are unique aspects of this trial. The design provides a model for faith-based DPPs and holds promise for program sustainability and widespread dissemination.

Community-based participatory research and smoking cessation interventions: a review of the evidence.

This article reviews the evidence of the use of community-based participatory research (CBPR) and smoking cessation interventions. An overview of CBPR is provided, along with a description of the search methods and quality scoring. Research questions are explored to determine if CBPR improves the quality of research methods and community involvement in cessation intervention studies and cessation outcomes when using CBPR approaches. Results of the review are provided along with a comprehensive table summarizing all the included studies. Strengths and challenges of the CBPR approach are presented with recommendations for future research.

Percent weight reduction required to achieve minimal clinically important improvements in health-related quality of life among African Americans: A secondary analysis of the fit body and soul study

Objective To calculate the percent weight reduction required to achieve minimal clinically important improvement (MCII) in health-related quality of life (HRQOL) Design Secondary data analysis from the longitudinal cohort of a single-blinded, cluster-randomized community trial to test the efficacy of the faith-based adaptation of the Diabetes Prevention Program Setting African-American churches Participants This study included 472 congregants with a body mass index of ≥ 25 and fasting plasma glucose<126 mg/dl. Main Outcome Measure Percent weight reduction required to achieve the MCII in HRQOL measured by two instruments, SF-12 and EQ-5D, one year following baseline Analysis The percent weight reduction required to achieve established MCII in SF-12 Physical Component Summary (PCS), SF-12 Mental Component Summary (MCS), and EQ-5D Health Status (HS) at one-year follow-up were calculated using fitted linear regression models. In addition to models for the total sample, we generated models, stratified by baseline BMI, PCS, and HS, to calculate the percent weight reduction required to achieve MCII in HRQOL for those most in need of weight reduction and those in need of improved HRQOL. Results The percent weight reduction was a significant predictor of improvement in the SF-12PCS and the EQ-5DHS but not SF-12MCS. To achieve a MCII in SF-12PCS and EQ-5DHS, 18% and 30% weight reductions were required, respectively. A smaller percent weight reduction was required when the baseline BMI was ≥ 40. Conclusions and Implications Improvements in HRQOL among African-American congregants seeking weight reduction required more than the 3–5% weight reduction associated with improvements in physical health.

Increasing Stroke Recognition and Behavioral Intent to Call Emergency Management Services in a Vietnamese American Population

Objective: Serious complications of stroke, one of the leading causes of morbidity and mortality in the United States can be mitigated if treated in a timely manner. Stroke outcome disparity in Vietnamese Americans (VAs) is attributable to pre-hospital delay. To increase acute stroke recognition and behavior intent to call Emergency Management Services (EMS) among VAs and their families, an evidence-based, culturally and linguisticallyappropriate educational intervention was pilot-tested. Methods: A convenience sample of 38 Vietnamese-speaking adults recruited from a free community clinic participated in a one-hour educational session. Pre and post intervention surveys were administered to assess knowledge and intent. Results: Differences in pre-test and post-test means were large for stroke knowledge (Cohens D=2.39), associated emergency action (Cohens D=2.57) and behavioral intent to call EMS (Cohens D=0.94). Conclusion: A linguistically and culturally appropriate community-based education intervention may be effective in increasing stroke recognition and behavior intent to call EMS among VAs.

Cost-effectiveness of a faith-based lifestyle intervention for diabetes prevention among African Americans: A within-trial analysis

AIMS We assessed costs and cost-effectiveness of implementing Fit Body and Soul (FBAS), a church-based 18-session lifestyle education intervention for African Americans. METHODS We calculated incremental cost-effectiveness ratios (ICER) using data from a cluster randomized controlled trial comparing FBAS with health education (HE) among 604 overweight participants in 20 churches. The ICER was the adjusted difference in costs to deliver FBAS versus HE over the difference in weight change (kilograms [kg]) at one-year follow-up. Costs included those incurred for participant identification and program implementation. We fitted linear mixed-effects regression models, accounting for clustering of participants within churches and for age, sex, and educational attainment. We repeated these analyses for secondary outcomes (waist circumference [cm], physical activity [MET], glucose, blood pressure, and quality of life). RESULTS Per-person intervention cost of FBAS was

Abstract B62: Tailored parental cessation delivered concurrently with tobacco prevention in children enrolled in urban and rural southern elementary schools

50.39 more than HE (

Abstract A35: Reducing lung cancer mortality in disparate populations through cancer-Community Awareness Access Research and Education (c-CARE)

442.22 vs.

Fit body and soul: a church-based behavioral lifestyle program for diabetes prevention in African Americans.

391.83 per-person), and adjusted differences in weight change (1.9 kg [95% CI: 1.0 to 2.8]) and waist circumference (2.4 cm [95% CI: 1.3 to 3.4]) were both significant. FBAS did not result in statistically significant differences in physical activity, glucose, blood pressures, or quality of life. We estimated that compared to HE, FBAS costs an additional

Community Trial of a Faith-Based Lifestyle Intervention to Prevent Diabetes Among African-Americans

26.52 per kg weight lost and

Effects on Weight of a Cluster-Randomized, Controlled Trial of a Faith-based Adaption of the Diabetes Prevention Program within African-American Churches

21.00 per cm reduction in waist circumference. CONCLUSIONS For a modest increase in cost, FBAS led to greater weight and waist reductions among African Americans in a church setting. ClinicalTrials.gov Identifier NCT01730196.