Disparities in obesity among rural and urban residents in a health disparate region

BACKGROUND: The burden of obesity and obesity-related conditions is not borne equally and disparities in prevalence are well documented for low-income, minority and rural adults in the United States. The current literature on rural versus urban disparities is largely derived from national surveillance data which may not reflect regional nuances. There is little practical research that supports the reality of local service providers such as county health departments that may serve both urban and rural residents in a given area. Conducted through a community-academic partnership, the primary aim of this study is to quantify the current levels of obesity (BMI), fruit and vegetable (FV) intake and physical activity (PA) in a predominately rural health disparate region. Secondary aims are to determine if a gradient exists within the region in which rural residents have poorer outcomes on these indicators compared to urban residents. METHODS: Conducted as part of a larger ongoing community-based participatory research (CBPR) initiative, data were gathered through a random digit dial telephone survey using previously validated measures (n = 784). Linear, logistic and quantile regression models are used to determine if residency (i.e. rural, urban) predicts outcomes of FV intake, PA and BMI. RESULTS: The majority (72%) of respondents were overweight (BMI = 29 ± 6 kg/m(2)), with 29% being obese. Only 9% of residents met recommendations for FV intake and 38% met recommendations for PA. Statistically significant gradients between urban and rural and race exist at the upper end of the BMI distribution. In other words, the severity of obesity is worse among black compared to white and for urban residents compared to rural residents. CONCLUSIONS: These results will be used by the community-academic partnership to guide the development of culturally relevant and sustainable interventions to increase PA, increase FV intake and reduce obesity within this health disparate region. In particular, local stakeholders may wish to address disparities in BMI by allocating resources to the vulnerable groups identified

A health/media literacy intervention improves adults’ interpretations of sugar-sweetened beverage advertising

Although excessive sugar-sweetened beverages (SSB) intake is linked to numerous adverse health consequences, media literacy interventions rarely address the influences of food and beverage marketing with a specific focus on adults. This randomized controlled trial study investigated (1) whether media literacy education modifies adults’ perceptions of SSB advertising and (2) whether changes are moderated by health literacy. Results from the multilevel mixed-effects regression analyses with the intention-to-treat last-observation-carried-forward method showed that compared to MoveMore (a matched-contact comparison condition), SIPsmartER (an intervention condition) participants significantly enhanced their skillsets across media literacy domains (i.e., authors/audiences, messages/meanings, representation/reality) between baseline and 6-month follow-up. Baseline health literacy status did not moderate media literacy outcomes. Both low and high health literate participants improved their outcomes, suggesting that this media literacy intervention benefited adults regardless of their health literacy level. Results demonstrate the importance of cultivating critical analyses and strengthening adults’ resistance toward SSB advertising

A health/media literacy intervention improves adults’ interpretations of sugar-sweetened beverage advertising

Although excessive sugar-sweetened beverages (SSB) intake is linked to numerous adverse health consequences, media literacy interventions rarely address the influences of food and beverage marketing with a specific focus on adults. This randomized controlled trial study investigated (1) whether media literacy education modifies adults’ perceptions of SSB advertising and (2) whether changes are moderated by health literacy. Results from the multilevel mixed-effects regression analyses with the intention-to-treat last-observation-carried-forward method showed that compared to MoveMore (a matched-contact comparison condition), SIPsmartER (an intervention condition) participants significantly enhanced their skillsets across media literacy domains (i.e., authors/audiences, messages/meanings, representation/reality) between baseline and 6-month follow-up. Baseline health literacy status did not moderate media literacy outcomes. Both low and high health literate participants improved their outcomes, suggesting that this media literacy intervention benefited adults regardless of their health literacy level. Results demonstrate the importance of cultivating critical analyses and strengthening adults’ resistance toward SSB advertising

Evaluating the Feasibility of a Gardening and Nutrition Intervention with a Matched Contact-Control Physical Activity Intervention Targeting Youth

The study reported here involved Cooperative Extension as a key research partner and was guided by a community-based participatory research approach and a feasibility study framework. The research objective was to assess four indicators of feasibility (i.e., acceptability, demand, implementation, and limited-effectiveness) of a gardening and nutrition program delivered at three youth community sites as compared to a matched contact-control physical activity intervention delivered at three different youth community sites. Conducted in a medically underserved region, the mixed-methods, quasi-experimental study revealed numerous opportunities for and barriers to increasing youths\u27 willingness to try fruits and vegetables and increasing physical activity among youths

HUB City Steps: Methods and Early Findings From a Community-Based Participatory Research Trial to Reduce Blood Pressure Among African Americans

Background: Community-based participatory research (CBPR) has been recognized as an important approach to develop and execute health interventions among marginalized populations, and a key strategy to translate research into practice to help reduce health disparities. Despite growing interest in the CBPR approach, CBPR initiatives rarely use experimental or other rigorous research designs to evaluate health outcomes. This behavioral study describes the conceptual frameworks, methods, and early findings related to the reach, adoption, implementation, and effectiveness on primary blood pressure outcomes. Methods: The CBPR, social support, and motivational interviewing frameworks are applied to test treatment effects of a two-phased CBPR walking intervention, including a 6-month active intervention quasi experimental phase and 12-month maintenance randomized controlled trial phase to test dose effects of motivational interviewing. A community advisory board helped develop and execute the culturally-appropriate intervention components which included social support walking groups led by peer coaches, pedometer diary selfmonitoring, monthly diet and physical activity education sessions, and individualized motivational interviewing sessions. Although the study is on-going, three month data is available and reported. Analyses include descriptive statistics and paired t tests. Results: Of 269 enrolled participants, most were African American (94%) females (85%) with a mean age of 43.8 (SD = 12.1) years. Across the 3 months, 90% of all possible pedometer diaries were submitted. Attendance at the monthly education sessions was approximately 33%. At the 3-month follow-up 227 (84%) participants were retained. From baseline to 3-months, systolic BP [126.0 (SD = 19.1) to 120.3 (SD = 17.9) mmHg; p \u3c 0.001] and diastolic BP [83. 2 (SD = 12.3) to 80.2 (SD = 11.6) mmHg; p \u3c 0.001] were significantly reduced. Conclusions: This CBPR study highlights implementation factors and signifies the community’s active participation in the development and execution of this study. Reach and representativeness of enrolled participants are discussed. Adherence to pedometer diary self-monitoring was better than education session participation. Significant decreases in the primary blood pressure outcomes demonstrate early effectiveness. Importantly, future analyses will evaluate long-term effectiveness of this CBPR behavioral intervention on health outcomes, and help inform the translational capabilities of CBPR efforts

Improvements in Blood Pressure Among Undiagnosed Hypertensive Participants in a Community-Based Lifestyle Intervention, Mississippi, 2010

Introduction Effective strategies are needed to reach and treat people who lack awareness of or have uncontrolled hypertension. We used data from a community-based participatory research initiative, Hub City Steps, to quantify the prevalence of undiagnosed hypertension and determine the relationship between hypertension status at baseline and postintervention improvements in blood pressure and health-related quality of life. Methods Hub City Steps was a 6-month preintervention–postintervention lifestyle intervention targeting hypertension risk factors. Outcome measures were collected at baseline, 3 months, and 6 months. Generalized linear mixed models were used to test for effects by time and hypertension status. Results Of the enrolled sample (N = 269), most were overweight or obese (91%), African American (94%), and women (85%). When considering hypertension status, 42% had self-reported diagnosis of hypertension (self-reported subgroup; 84% with antihypertensive medication use); 36% had no self-reported medical history of hypertension, but when blood pressure was measured they had a clinical diagnosis of prehypertension or hypertension (undiagnosed subgroup); and 22% had no self-reported or clinical hypertension diagnosis (no hypertension subgroup). From baseline to 6 months, systolic blood pressure significantly improved for participants with self-reported hypertension [8.2 (SD, 18.2) mm Hg] and undiagnosed hypertension [12.3 (SD, 16.3) mm Hg], with undiagnosed participants experiencing the greatest improvements (P \u3c .001). Effects remained significant after controlling for covariates. Health-related quality of life significantly improved for all 3 hypertension subgroups, with no apparent subgroup differences. Conclusion This study reveals advantages of a culturally appropriate community-based participatory research initiative to reach those with undetected hypertension and effectively improve blood pressure status and health-related quality of life

Simulated reductions in consumption of sugar-sweetened beverages improves diet quality in Lower Mississippi Delta adults

Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality.To simulate the effects of replacing SSBs with tap water on diet quality and total energy intake of Lower Mississippi Delta (LMD) adults.Retrospective analysis of cross-sectional dietary intake data using a representative sample of LMD adults (n=1,689). Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005) scores that were computed using the population ratio method. The effects of substituting SSBs with water on diet quality were simulated by replacing the targeted items’ nutrient profile with tap water's profile.Simulating the replacement of SSBs with tap water at 25, 50, and 100% levels resulted in 1-, 2.3-, and 3.8-point increases, respectively, in the HEI-2005 total score. Based on a mean daily intake of 2,011 kcal, 100% substitution of SSBs with tap water would result in 11% reduction in energy intake.Replacing SSBs with water could substantially improve the diet quality of the LMD adult population and potentially lead to significant weight loss overtime. Prioritizing intervention efforts to focus on the replacement of SSBs with energy-free drinks may be the most efficacious approach for conveying potentially substantial health benefits in this and similar disadvantaged populations

Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: Findings from a randomized control trial

This work is licensed under a Creative Commons Attribution 4.0 International License.Background Although reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6–18 month and 0–18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported. Methods Following completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures. Results Of 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0–18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6–18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6–18 month maintenance phase, compared to the IVR control participants (− 98 SSB kcals/day, 95% CI = − 196, − 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = − 69, 125) or IVR control condition (− 70 SSB kcals/day, 95% CI = − 209, 64). Call completion rates were similar across maintenance conditions (4.2–4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or$38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ. Conclusion Overall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption.National Institutes of Health, National Cancer Institute (R01CA154364

HUB City Steps: A 6-Month Lifestyle Intervention Improves Blood Pressure among a Primarily African-American Community

The effectiveness of community-based participatory research (CBPR) efforts to address the disproportionate burden of hypertension among African Americans remains largely untested. The objective of this 6-month, noncontrolled, pre-/post-experimental intervention was to examine the effectiveness of a CBPR intervention in achieving improvements in blood pressure, anthropometric measures, biological measures, and diet. Conducted in 2010, this multicomponent lifestyle intervention included motivational enhancement, social support provided by peer coaches, pedometer diary self-monitoring, and monthly nutrition and physical activity education sessions. Of 269 enrolled participants, 94% were African American and 85% were female. Statistical analysis included generalized linear mixed models using maximum likelihood estimation. From baseline to 6 months, blood pressure decreased significantly: mean (±standard deviation) systolic blood pressure decreased from 126.0±19.1 to 119.6±15.8 mm Hg, P=0.0002; mean diastolic blood pressure decreased from 83.2±12.3 to 78.6±11.1 mm Hg, P

HUB City Steps: A 6-Month Lifestyle Intervention Improves Blood Pressure among a Primarily African-American Community

The effectiveness of community-based participatory research (CBPR) efforts to address the disproportionate burden of hypertension among African Americans remains largely untested. The objective of this 6-month, noncontrolled, pre-/post-experimental intervention was to examine the effectiveness of a CBPR intervention in achieving improvements in blood pressure, anthropometric measures, biological measures, and diet. Conducted in 2010, this multicomponent lifestyle intervention included motivational enhancement, social support provided by peer coaches, pedometer diary self-monitoring, and monthly nutrition and physical activity education sessions. Of 269 enrolled participants, 94% were African American and 85% were female. Statistical analysis included generalized linear mixed models using maximum likelihood estimation. From baseline to 6 months, blood pressure decreased significantly: mean (±standard deviation) systolic blood pressure decreased from 126.0±19.1 to 119.6±15.8 mm Hg, P=0.0002; mean diastolic blood pressure decreased from 83.2±12.3 to 78.6±11.1 mm Hg, P