Tiffany L. Cox

Measuring parental support for children's physical activity in white and African American parents: the Activity Support Scale for Multiple Groups (ACTS-MG).

OBJECTIVES The Activity Support Scale (ACTS) was expanded for use with African American families. Its factorial invariance and internal reliability were examined for non-Hispanic white and African American parents. METHODS The ACTS was modified to improve its applicability to African American families based on information from five focus groups with 27 African American parents of elementary school-aged children. Between 2006 and 2008, the revised scale was administered to 119 African American and 117 non-Hispanic white parents in northeastern NY and Alabama. Its factorial invariance across race/ethnicity and internal consistency were examined. RESULTS Factor analysis of the revised scale, the Activity Support Scale for Multiple Groups (ACTS-MG), identified four parenting factors in white and African American parents including logistic support, modeling, use of community resources to promote physical activity (PA), and restriction of sedentary behaviors. Results supported the scales internal reliability and factorial invariance across race/ethnicity. CONCLUSION The ACTS-MG is appropriate for use with non-Hispanic white and African American families and will enable the extension of current research with white families to the examination of strategies supporting PA in African American families. Additional psychometric work with the ACTS-MG is encouraged.

Stress Management–Augmented Behavioral Weight Loss Intervention for African American Women A Pilot, Randomized Controlled Trial

The relationship between chronic stress and weight management efforts may be a concern for African American (AA) women, who have a high prevalence of obesity, high stress levels, and modest response to obesity treatment. This pilot study randomly assigned 44 overweight/obese AA women with moderate to high stress levels to either a 12-week adaptation of the Diabetes Prevention Program Lifestyle Balance intervention augmented with stress management strategies (Lifestyle + Stress) or Lifestyle Alone. A trend toward greater percentage of baseline weight loss at 3-month data collection was observed in Lifestyle + Stress (−2.7 ± 3.6%) compared with Lifestyle Alone (−1.4 ± 2.3%; p = .17) and a greater reduction in salivary cortisol (Lifestyle + Stress: −0.2461 ± 0.3985 ng/mL; Lifestyle Alone: −0.0002 ± 0.6275 ng/mL; p = .20). These promising results suggest that augmenting a behavioral weight control intervention with stress management components may be beneficial for overweight/obese AA women with moderate to high stress levels and merit further investigation with an adequately powered trial.

Using Formative Research to Develop a Worksite Health Promotion Program for African American Women

ABSTRACT Objectives: To describe the development of a culturally appropriate worksite health promotion program (WHPP) designed to promote increased physical activity and improved nutrition in a high risk group of African American women. Methods: The program was based on EatRight, which is a lifestyle-oriented weight control program that focuses on food volume, rather than calories. Formative research included four nominal group technique (NGT) sessions conducted with 14 African American women from the selected worksite to gather input on job factors that affected their weight and daily life factors that affected their amount of physical activity. Their responses were used to adapt existing EatRight materials to target areas of special need for this unique group. Results: Themes emerged from the NGT sessions that indicated stress at work and an environment of unhealthy eating, in addition to social eating and lack of social support for healthy eating added to unhealthy eating patterns at work. In response to physical activity, the primary themes included lack of time to exercise, stress of multiple family roles and responsibilities, and perceived physical barriers to physical activity. Discussion: Based on the NGT themes, EatRight materials were adapted and additional topics (e.g., increasing social support, overcoming limitations, and time management) were included to develop a WHPP that addressed issues that the participants identified as relevant for their work and home lives. Conducting the NGT sessions and EatRight classes in the work environment, we were able to provide a convenient, familiar environment which fostered social support among participants. We believe that a culturally appropriate modification of EatRight holds great promise in addressing health disparities seen among African American women by offering education on lifestyle changes that will decrease weight through nutrition and physical activity.

Body Image as a Mediator of the Relationship Between Body Mass Index and Weight-Related Quality of Life in Black Women

BACKGROUND Body image (BI) may be important in understanding weight-related attitudes and behaviors in black women. Specifically, body dissatisfaction may mediate the relationship between body mass index (BMI) and weight-related quality of life (QOL) in black women. We examined the relationship between BMI and weight-related QOL in black women and tested for mediation by body dissatisfaction. METHODS The sample included 149 black women recruited from Birmingham, Alabama, for a one-time clinic visit. BIs were self-reported using the Pulvers figure rating scale. Body discrepancy (BD), a surrogate measure of body dissatisfaction, was calculated as perceived current image minus ideal image. QOL was self-reported using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). Baron and Kennys test for mediation was conducted where BMI was the predictor, IWQOL-Lite score was the outcome, and BD was the mediator under investigation. RESULTS Mean age was 40.5 years, and mean BMI was 36.1 kg/m(2). The mean IWQOL-Lite score was 81.1±15.8 out of 100. Participants had a BD score of 2.3, indicating a desire to be two figure sizes smaller than their current perceived body size. Tests for mediation revealed that BD partially mediated the relationship between BMI and IWQOL-Lite scores in this sample. CONCLUSIONS BD was in the pathway of the association between BMI and IWQOL-Lite scores. BI dissatisfaction may contribute to explaining more about black womens weight-related QOL beyond actual BMI alone. Additional research is needed to better understand black womens perception of weight and subsequent weight-related behaviors.

Physical Activity Patterns During Weight Maintenance Following a Low-energy Density Dietary Intervention

Objective: The objective was to determine the role of physical activity (PA) and energy intake on weight maintenance among former University of Alabama at Birmingham EatRight Weight Management Program participants.

A study of a culturally enhanced EatRight dietary intervention in a predominately African American workplace.

CONTEXT The workplace may be an ideal venue for engaging African American women in behavioral interventions for weight reduction. OBJECTIVE To examine the effectiveness of a culturally enhanced EatRight dietary intervention among a group of predominately African American women in a workplace setting. DESIGN Crossover design study. SETTING Workplace. PARTICIPANTS A total of 39 women volunteered for this study, of whom 27 completed it. INTERVENTION The control period involved observation of participants for 22 weeks after receiving standard counseling on lifestyle methods to achieve a healthy weight; following the control period, participants crossed over to the 22-week intervention period. The intervention was culturally enhanced using feedback derived from formative assessment and delivered as 15 group sessions. MAIN OUTCOME MEASURES The primary outcome measure was the difference in weight change between the control and intervention periods; changes in waist circumference and quality of life were secondary outcomes. RESULTS Most participants were obese, with a mean baseline body mass index of 36 kg/m², weight of 97.9 kg, and waist circumference of 111 cm. Weight increased during the control period by 0.7 kg but decreased by 2.6 kg during the intervention (net difference = -3.4 kg, P <.001), with 30% of participants losing 5% or more of body weight. Compared to the control period, there was a significant decrease in waist circumference (-3.6 cm, P =.006) and improvement in weight-related quality of life (5.7, P =.03). CONCLUSIONS This pilot study demonstrated the feasibility of a culturally enhanced behavioral weight loss intervention in a predominately African American workplace setting. The workplace may be conducive for targeting African American women who are disproportionately affected by obesity.

Cultural Perceptions of Weight in African American and Caucasian Women

OBJECTIVE To determine if African American (AA) and Caucasian women grouped variables related to race and weight into discrete clusters and if there were discernable response patterns with unique subgroup characteristics. METHODS Women (N=277, 48% AA) completed a card sorting task, ranking 28 variables. We used multidimensional scaling to determine perceived similarities and differences between variables, and latent class analysis to identify subgroups responding similarly. RESULTS We identified 5 clusters of variables and 4 response patterns, which were demographically and anthropometrically distinct. CONCLUSIONS These results can be used for empirical cultural tailoring of behavioral weight loss interventions.