Marilyn Laken

The Faith, Activity, and Nutrition (FAN) Program: Design of a participatory research intervention to increase physical activity and improve dietary habits in African American churches

BACKGROUND African Americans are at increased risk for cardiovascular disease and cancer morbidity and mortality. Physical activity and healthy dietary practices can reduce this risk. The church is a promising setting to address health disparities, and community-based participatory research is a preferred approach. OBJECTIVES Using a community-based participatory approach and the social ecologic model, the FAN trial aims to increase self-reported moderate-intensity physical activity and fruit and vegetable consumption and reduce blood pressure in African American church members. Secondary aims are to increase objectively measured moderate-intensity physical activity and fiber/whole grain consumption and reduce fat consumption. DESIGN FAN is a group randomized trial (GRT) with two levels of clustering: participants (N=1279; n=316 accelerometer subgroup) within church and church within church cluster. In the first wave, seven clusters including 23 churches were randomized to an immediate intervention or delayed intervention. In subsequent waves, 51 churches were randomized to an immediate or delayed intervention. METHODS Church committee members, pastors, and cooks participate in full-day trainings to learn how to implement physical activity and dietary changes in the church. Monthly mailings and technical assistance calls are delivered over the 15-month intervention. Members complete measurements at baseline and 15 months. A detailed process evaluation is included. SUMMARY FAN focuses on modifying the social, cultural, and policy environment in a faith-based setting. The use of a community-based participatory research approach, engagement of church leaders, inclusion of a detailed process evaluation, and a formal plan for sustainability and dissemination make FAN unique.

The Faith, Activity, and Nutrition Program: A Randomized Controlled Trial in African-American Churches

BACKGROUND Faith-based interventions hold promise for promoting health in ethnic minority populations. To date, however, few of these interventions have used a community-based participatory research (CBPR) approach, have targeted both physical activity and healthy eating, and have focused on structural changes in the church. PURPOSE To report the results of a group randomized CBPR intervention targeting physical activity and healthy eating in African-American churches. DESIGN Group RCT. Data were collected from 2007 to 2011. Statistical analyses were conducted in 2012. SETTING/PARTICIPANTS Seventy-four African Methodist Episcopal (AME) churches in South Carolina and 1257 members within them participated in the study. INTERVENTION Churches were randomized to an immediate (intervention) or delayed (control) 15-month intervention that targeted organizational and environmental changes consistent with the structural ecologic model. A CBPR approach guided intervention development. Intervention churches attended a full-day committee training and a full-day cook training. They also received a stipend and 15 months of mailings and technical assistance calls to support intervention implementation. MAIN OUTCOME MEASURES Primary outcomes were self-reported moderate- to vigorous-intensity physical activity (MVPA), self-reported fruit and vegetable consumption, and measured blood pressure. Secondary outcomes were self-reported fat- and fiber-related behaviors. Measurements were taken at baseline and 15 months. Intent-to-treat repeated measures ANOVA tested group X time interactions, controlling for church clustering, wave, and size, and participant age, gender, and education. Post hoc ANCOVAs were conducted with measurement completers. RESULTS There was a significant effect favoring the intervention group in self-reported leisure-time MVPA (d=0.18, p=0.02), but no effect for other outcomes. ANCOVA analyses showed an intervention effect for self-reported leisure-time MVPA (d=0.17, p=0.03) and self-reported fruit and vegetable consumption (d=0.17, p=0.03). Trainings were evaluated very positively (training evaluation item means of 4.2-4.8 on a 5-point scale). CONCLUSIONS This faith-based structural intervention using a CBPR framework showed small but significant increases in self-reported leisure-time MVPA. This program has potential for broad-based dissemination and reach. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00379925.

The health-e-AME faith-based physical activity initiative: Description and baseline findings.

This article provides an overview of the development, implementation, and baseline findings from a statewide faith-based physical activity (PA) initiative. The 3-year program is training African Methodist Episcopal volunteers across South Carolina to implement programs to increase PA in their congregations. To date, 98 churches have been trained. Interviews done with a random sample (n = 39) indicated that 54% are implementing at least one PA program. The baseline telephone survey (N = 571) estimates that 27.8% of the population is regularly active, 54.9% underactive, and 17.3% sedentary. Baseline rates of regular PA were higher in those who were younger, healthier, and nonsmokers. Challenges to date have included obtaining rosters and implementing a large-scale program with limited resources. Interest in the program has been strong and supported by church leaders. Current efforts are on training additional churches and working with those already trained to support sustainability.

Does Dark Chocolate Have a Role in the Prevention and Management of Hypertension?: Commentary on the Evidence

The notion that eating chocolate would prevent or treat hypertension is appealing to many who produce and enjoy chocolate. Several studies have documented beneficial effects of dark chocolate on insulin action and endothelial function. However, the published studies on chocolate and blood pressure include a relatively small number of subjects, and results are conflicting. In addition, because of secrecy surrounding the production of chocolate and the unique sociocultural context of this popular food, research on efficacy and effectiveness is complex. This commentary summarizes 13 peer-reviewed studies on dark chocolate and blood pressure and raises questions relevant to its future as an evidence-based lifestyle intervention.

Controversies in Hypertension: Does Dark Chocolate Have a Role in the Prevention and Management of Hypertension? Commentary on the Evidence

The notion that eating chocolate would prevent or treat hypertension is appealing to many who produce and enjoy chocolate. Several studies have documented beneficial effects of dark chocolate on insulin action and endothelial function. However, the published studies on chocolate and blood pressure include a relatively small number of subjects, and results are conflicting. In addition, because of secrecy surrounding the production of chocolate and the unique sociocultural context of this popular food, research on efficacy and effectiveness is complex. This commentary summarizes 13 peer-reviewed studies on dark chocolate and blood pressure and raises questions relevant to its future as an evidence-based lifestyle intervention.

The influence of attitudes about unintended pregnancy on use of prenatal and postpartum care.

OBJECTIVE: The purpose of this study was to examine the effects of feelings about pregnancy and consideration of abortion on late initiation of prenatal care and postpartum appointment.STUDY DESIGN: A descriptive study was conducted in a tertiary clinic in Detroit using a convenience sample comprised of 518 low-income pregnant and postpartum women with a large number of unintended pregnancies. A series of χ-squared analyses and logistic regression models were conducted to identify variables predictive of these outcomes.RESULTS: Teenagers were 1.8 times more likely to initiate late prenatal care versus early care (p=0.05), and women who considered an abortion were 3.7 times more likely to initiate late prenatal care (p=0.01). Having considered abortion but deciding against it due to psychologic/moral reasons was protective against late initiation of prenatal care (OR=0.23; p=0.01). Multiparity was the only predictor of a missed postpartum appointment. Multiparous women were three times more likely to miss the appointment (p=0.05).CONCLUSIONS: Success in improving early access to prenatal care will involve addressing the issue of unintended pregnancy. This challenge will require that health care providers assess feelings and values related to a pregnancy. Understanding womens feelings and values about the pregnancy will allow providers to more effectively assist with decision-making and positive pregnancy behaviors. In addition, community-based education related to family planning and the value of prenatal and postpartum care is needed to involve womens partners, family, and friends, because social support systems influence decisions regarding pregnancy behaviors.

Contraceptive Decision Making Among Medicaid-Eligible Women

The purpose of this study was to examine the influence of sociodemographic factors, attitudes, knowledge, and experiences regarding the use of various contraceptive methods, future plans prenatally, and actual use postpartum among a population of low income pregnant women. Women were interviewed prenatally and during the postpartum period in a large, urban academic health center serving primarily an indigent population. The primary analytic method employed was logistic regression. The key finding in this study is that women are not consistently using the method of contraception postpartum that they planned during the prenatal period. Only 54.7% of the women planning to use oral contraceptive pills were using them postpartum, and only 31.3% of the women planning to use condoms were actually using them postpartum. Expanding contraceptive education and counseling throughout the perinatal period may assist womens decision making.

Is blood pressure control to less than 140/less than 90 mmHg in 50% of all hypertensive patients as good as we can do in the USA: or is this as good as it gets?

Purpose of review This review assesses whether controlling hypertension in 50% of all patients is the best we can do. Recent findings NHANES 2007–2008 data show that blood pressure was controlled to less than 140/less than 90 mmHg in 50% of all hypertensive patients, an increase from 27% in 1988–1994. The 50% control rate reflects the product of 72.5% of all patients treated and 69% of all treated patients controlled. However, there are opportunities for improvement, as 27.5% of all hypertensives, or 55% of uncontrolled patients, were untreated in 2007–2008. These individuals are disproportionately younger, men, and Hispanic. Moreover, 31% of all treated hypertensives, or 45% of uncontrolled patients, have blood pressure of at least 140/at least 90 mmHg. They are disproportionately older, women, and black. Summary Initiatives to raise hypertension treatment from 72.5% in 2007–2008 to 87.5% in the future are conceivable by targeting unaware and untreated patient groups and engaging them in ongoing healthcare. This could improve hypertension control by an absolute 10% of all patients. Reducing therapeutic inertia and increasing therapeutic efficiency could raise the proportion of patients on treatment who are controlled from 69 to 80% and could increase hypertension control by 8%. Combining these approaches could raise hypertension control to 70% of all hypertensive adults in the USA.

IMPACTING POPULATION CARDIOVASCULAR HEALTH THROUGH A COMMUNITY-BASED PRACTICE NETWORK: UPDATE ON AN ASH-SUPPORTED COLLABORATIVE

J Clin Hypertens (Greenwich). 2011;13:543–550. ©2011 Wiley Periodicals, Inc.

Factors influencing hospital admissions and emergency department visits among children with complex chronic conditions: a qualitative study of parents' and providers' perspectives.

Children with complex chronic conditions (CCC) have greater health care needs and use rates than children in general. Elevated health care use includes more frequent hospital admissions, longer hospital stays, and greater health care expenses. Prior studies have examined population characteristics associated with increased hospital admissions, emergency department (ED) use, and general healthcare use, yet few studies have investigated these events from the parents’ or health care providers’ point of view. The purpose of this study was to explore parents/caregivers’ and health care providers’ perceptions of the factors placing infants and young children with CCC at risk for or protecting them against hospital admissions and ED visits. Parents or primary caregivers participated in interviews, and health care providers in pediatric acute care, pediatric primary care, and emergency care participated in focus groups. Interview and focus group data were analyzed using directed content analysis and an ecological risk and protective factors model. The analysis revealed that parents/caregivers and health care providers described risk factors and protective factors on multiple ecological levels surrounding the child with CCC. This article presents these findings, which add to current knowledge of factors influencing hospital admissions and ED visits and may be used to inform interventions addressing high health care utilization in this population. This article concludes with the implications of the findings for future research and nursing practice.