Dissemination Trial For Health For Hearts United: Model Development, Preliminary Outcomes and Lessons Learned

BACKGROUND: Cardiovascular disease CVD), the leading cause of death in the U.S., is a particular problem for African Americans (AAs). Church-based health interventions are effective in reducing CVD risk, yet few have been successfully disseminated. This paper describes the model development, preliminary health outcomes, and lessons learned from the Health for Hearts United (HHU) dissemination trial which evolved from the longitudinal Reducing CVD Risk Study in a two-county area in North Florida. Community-based participatory research approaches and the socio-ecological model guided the study. METHODS: Data for this paper were from health leaders (n = 25) in the first six churches investigated, and the outreach participants (n = 86) they engaged. Health leaders completed survey items (daily servings of fruits/vegetables [F/V], fat consumption [FAT], and daily minutes of physical activity [PA]) and clinical measures (body mass index [BMI]; waist, hip and abdomen circumferences; and systolic and diastolic blood pressure [BP]). For outreach participants, a brief CVD Awareness Quiz was administered. Data were analyzed using description statistics, Pearson correlations, and repeated measures analysis of variance. RESULTS: Findings showed that the dissemination model was implemented by 100% of the churches, and resulted in health outcomes changes for health leaders (significant increases between pre- and post-test in F/V; significant decreases in FAT, BMI, abdomen circumference, with educational level and marital status as selected significant covariates) and in a significant increase in CVD awareness for outreach participants. Lessons learned are discussed. Although preliminary, the results suggest that the HHU dissemination model has promise for reducing CVD risk in AA's

Health Insurance Status, Psychological Processes, and Older African Americans\u27 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\u27 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\u27 psychological competency and/or vulnerability. Policies and interventions to increase older African Americans\u27 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

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

Stressful Life Events, Marital Satisfaction, and Marital Management Skills of Taiwanese Couples

The association between stressful life events and marital satisfaction for 372 Taiwanese couples was examined, as was the moderating effects of three marital management skills (e.g., tolerance/sacrifice, empathy/consideration, soothing/alleviation) on that association. Multilevel modeling analysis showed that stressful life events reduced husbands’ and wives’ marital satisfaction. Spouses’ marital management skills were associated with an increase in their marital satisfaction (actor effects) except for husbands’ soothing and alleviation skills. Husbands’ tolerance and empathy were also related to an increase in the wife’s marital satisfaction (partner effects) and had significant interactions with the relationship between the wife’s stress and her marital satisfaction. Husbands’ and wives’ soothing skills also had significant interactions with the association between stressful life events and their own satisfaction. These results are discussed in relation to the life course, stress process, coping theories, and Chinese cultural values as well as their clinical implications of working with Chinese population

Marital Enqing and Depression in Taiwanese Couples: The Mediating Role of Active and Passive Sacrifice

Using social exchange and identity theory, the authors examined the association between marital enqing and depression in 372 Taiwanese couples, and the mediating effects of active and passive sacrifice on that association. Marital enqing is a unique form of affection toward the partner in Taiwanese couples. Data was analyzed by using the actor-partner interdependence model to test for actor and partner effects among study variables. Results indicated that husbands, who reported more marital enqing, tended to have lower levels of depression. Partner effects revealed that couples’ marital enqing decreased their spouse’s depressive symptoms. Husbands’ sacrifice behaviors mediated the association between his marital enqing and depression. However, Taiwanese wives’ sacrifice behavior did not mediate the association between her marital enqing and depression. Chinese cultural principles indeed impacted how couples in Taiwan conceptualized marital affection differently from couples in western cultures, and it provided insights into its relationships with couples’ sacrifices and relational and individual wellbeing

Pathways of the family stress model in midlife on physical health in later adulthood.

The current study examined economic adversity and physical health outcomes in line with the family stress model (FSM) for husbands and wives in enduring marriages. Data came from 243 husbands and wives who participated from early middle to later adulthood. Assessments included observational and self-report measures. Economic hardship and economic pressure were assessed in early middle adulthood. Feelings of hostility and observed harsh couple interaction were examined in middle adulthood, and physical impairment was assessed in later adulthood. Results indicated that economic hardship related to economic pressure. In addition, economic pressure indirectly related to physical impairment via hostility and harsh couple interaction. For husbands, economic pressure was also directly associated with their own physical impairment in later adulthood. Finally, economic pressure was indirectly associated with husband to wife harsh couple interaction through wife hostility. Similarly, economic pressure was indirectly associated with wife to husband harsh couple interaction through husband hostility. Results suggest that economic adversity as experienced in early middle adulthood has long-term health consequences into later adulthood.This accepted article is published as Neppl, T. K., Diggs, O. N., Wickrama, K. A. S., & Walker O'Neal, C. (2021). Pathways of the family stress model in midlife on physical health in later adulthood. Journal of Family Psychology, 35(1), 22–32. https://doi.org/10.1037/fam0000714. Posted with permission

Identifying diverse life transition patterns from adolescence to young adulthood: The influence of early socioeconomic context

The purposes of the present study are to investigate: (1) the heterogeneity in life transition patterns of youth from adolescence to young adulthood (ages 18-30) involving the timing and sequence of four transition events (college graduation, full-time employment, marriage, and parenthood), (2) the influence of early socioeconomic adversity on life transition patterns from adolescence to young adulthood, and (3) the influence of gender and race/ethnicity on these transition patterns. Using a multivariate discrete-time mixture survival model with a sample of 14,503 adolescents from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the study identified four life transition patterns and found that early socioeconomic adversity shapes disrupted life transition patterns from adolescence to young adulthood. Gender and race/ethnicity differences are discussed. These results highlight the need for prevention and intervention programs that selectively target at-risk youth beginning in adolescence and continuing through subsequent transition periods

Health for Hearts United Longitudinal Trial: Improving Dietary Behaviors in Older African Americans

Introduction Church-based interventions have been shown to improve the dietary health of underserved populations, yet few studies have examined sustainability of health behavior change over time. This paper examines dietary outcomes over a 24-month period (baseline and 6, 18, and 24 months) for fruit and vegetable and fat consumption behaviors of African-American participants in the Health for Hearts United church-based intervention in North Florida. Study design This quasi-experimental, longitudinal trial was conducted from 2009 to 2012. Data were analyzed in 2018. Setting/participants Six churches in a 2-county area (3 treatment, 3 comparison) were selected for the study using community-based participatory research approaches. Participants were African-American adults (aged ≥45 years; n=211 at baseline) randomly selected from the churches, stratified by age and sex. Intervention Health for Hearts United intervention was developed by the 3 treatment churches. The 18-month intervention was implemented in 3 6-month phases, framed around 3 conceptual components, which included 4 types of programs and 4 key messages. Main outcome measures Fruit and vegetable consumption was assessed using a single item (fruit and vegetable intake) and the National Cancer Institute Fruit and Vegetable Screener. Fat consumption was determined using a single item (fat intake) and the National Cancer Institute Fat Screener. Background characteristics included age, sex, educational level, and marital status. Results Significant time effects only were found for daily fruit and vegetable intake ( p\u3c0.001), fat intake ( p\u3c0.001), and the Fat Screener ( p\u3c0.001) with dietary improvements in both treatment and comparison groups across the intervention phases. Fruit and Vegetable Screener results showed that time ( p\u3c0.001) and the interaction between time and treatment ( p\u3c0.01) were significant, with increases in fruit and vegetable consumption over time for both the treatment and comparison groups and with the increase differing between groups. Post hoc analysis revealed that the treatment group had greater increases in fruit and vegetable consumption than the comparison group between Phases 1 and 3 ( p=0.03). Conclusions Dietary behaviors of mid-life and older African Americans can be improved and sustained over 24 months using a church-based heart health intervention, with similar improvements noted for both comparison and treatment participants. Trial registration This study is registered at www.clinicaltrials.gov NCT03339050

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\u27 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\u27 psychological competency and/or vulnerability. Policies and interventions to increase older African Americans\u27 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