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

Published:February 16, 2014DOI:https://doi.org/10.1016/j.jand.2013.11.020

      Abstract

      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<0.0001). Sugar intake also decreased significantly as compared with baseline (by approximately 3 tsp; P<0.0001). Time differences were not apparent for any other measures. Results from this study suggest that CBPR efforts are a viable and effective strategy for implementing nonpharmacologic, multicomponent, lifestyle interventions that can help address the persistent racial and ethnic disparities in hypertension treatment and control. Outcome findings help fill gaps in the literature for effectively translating lifestyle interventions to reach and engage African-American communities to reduce the burden of hypertension.

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      References

        • Wang T.J.
        • Vasan R.S.
        Epidemiology of uncontrolled hypertension in the United States.
        Circulation. 2005; 112: 1651-1662
        • Roger V.L.
        • Go A.S.
        • Lloyd-Jones D.M.
        • et al.
        Heart disease and stroke statistics—2012 update.
        Circulation. 2012; 125: e2-e220
        • Centers for Disease Control and Prevention
        Racial/Ethnic Disparities in the Awareness, Treatment, and Control of Hypertension—United States, 2003–2010.
        Morbidity and Mortality Weekly Report (MMWR). 2013; 62: 351-355
        • Cutler J.A.
        • Sorlie P.D.
        • Wolz M.
        • Thom T.
        • Fields L.E.
        • Roccella E.J.
        Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004.
        Hypertension. Nov 2008; 52: 818-827
        • Appel L.J.
        • Champagne C.M.
        • Harsha D.W.
        • et al.
        Effects of comprehensive lifestyle modification on blood pressure control: Main results of the PREMIER clinical trial.
        JAMA. 2003; 289: 2083-2093
        • Appel L.J.
        • Moore T.J.
        • Obarzanek E.
        • et al.
        A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group.
        N Engl J Med. 1997; 336: 1117-1124
        • Elmer P.J.
        • Obarzanek E.
        • Vollmer W.M.
        • et al.
        Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial.
        Ann Intern Med. 2006; 144: 485-495
        • Schoenthaler A.
        • Luerassi L.
        • Teresi J.A.
        • et al.
        A practice-based trial of blood pressure control in African Americans (TLC-Clinic): Study protocol for a randomized controlled trial.
        Trials. 2011; 12: 265
        • Fernandez S.
        • Tobin J.N.
        • Cassells A.
        • Diaz-Gloster M.
        • Kalida C.
        • Ogedegbe G.
        The counseling african americans to control hypertension (caatch) trial: Baseline demographic, clinical, psychosocial, and behavioral characteristics.
        Implement Sci. 2011;
        • DeHaven M.J.
        • Ramos-Roman M.A.
        • Gimpel N.
        • et al.
        The GoodNEWS (Genes, Nutrition, Exercise, Wellness, and Spiritual Growth) Trial: A community-based participatory research (CBPR) trial with African-American church congregations for reducing cardiovascular disease risk factors –recruitment, measurement, and randomization.
        Contemp Clin Trials. 2011; 32: 630-640
        • Wilcox S.
        • Laken M.
        • Parrott A.W.
        • et al.
        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.
        Contemp Clin Trials. 2010; 31: 323-335
        • Moore T.J.
        • Alsabeeh N.
        • Apovian C.M.
        • et al.
        Weight, blood pressure, and dietary benefits after 12 months of a web-based nutrition education program (DASH for Health): Longitudinal observational study.
        J Med Internet Res. 2008; 10
        • Dekkers J.C.
        • van Wier M.F.
        • Ariens G.A.M.
        • et al.
        Comparative effectiveness of lifestyle interventions on cardiovascular risk factors among a Dutch overweight working population: A randomized controlled trial.
        BMC Public Health. 2011;
        • Cleland C.L.
        • Tully M.A.
        • Kee F.
        • Cupples M.E.
        The effectiveness of physical activity interventions in socio-economically disadvantaged communities: A systematic review.
        Prev Med. 2012; 54: 371-380
        • Stuart-Shor E.M.
        • Berra K.A.
        • Kamau M.W.
        • Kumanyika S.K.
        Behavioral strategies for cardiovascular risk reduction in diverse and underserved racial/ethnic groups.
        Circulation. 2012; 125: 171-184
        • Kumanyika S.
        • Whitt-Glover M.
        • Gary T.
        • et al.
        Expanding the obesity research paradigm to reach African American communities.
        Prev Chronic Dis. 2007; 4
        • Kumanyika S.K.
        • Gary T.L.
        • Lancasster K.J.
        • et al.
        Achieving healthy weight in African-American communities: Research perspectives and priorities.
        Obes Res. 2005; 13: 2037-2047
      1. Community Based Participatory Research: Assessing the Evidence. Agency for Healthcare Research and Quality, Rockville, MD2004
        • Cargo M.
        • Mercer S.
        The value and challenges of participatory research: Strengthening its practice.
        Annu Rev Public Health. 2008; 29: 325-350
        • Wallerstein N.
        • Duran B.
        Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity.
        Am J Public Health. 2010; 100: S40-S46
      2. US Census Bureau. American Factfinder: US Census Bureau. http://www.census.gov. Accessed August 4, 2012.

      3. Mississippi Department of Health. Vital Statistics Mississippi: Summary Statistics by City. 2007. http://msdh.ms.gov/phs/stat2007.htm. Accessed August 4, 2012.

        • Anderson-Lewis C.
        • Cuy-Castellanos D.
        • Byrd A.
        • et al.
        Utilizing mixed methods to measure the perception of community capacity in an academic-community partnership for a walking intervention.
        Health Promot Pract. 2012; 13: 788-796
        • Zoellner J.
        • Connell C.
        • Madson M.
        • et al.
        H.U.B City Steps: Methods and early findings from a community-based participatory research trial to reduce blood pressure among African Americans.
        Int J Behav Nutr Phys Act. 2011; 8
        • Zoellner J.
        • Hill J.
        • Zynda K.
        • Sample A.
        • Yadrick K.
        Environmental perceptions and objective walking trail audits inform a community-based participatory research walking intervention.
        Int J Behav Nutr Phys Act. 2012; 9
        • Zoellner J.
        • Connell C.
        • Powers A.
        • Williams-Avis A.
        • Yadrick K.
        • Bogle M.
        Does a 6-month pedometer intervention improve physical activity and health among vulnerable African Americans? A feasibility study.
        J Phys Act Health. 2010; 7: 224-231
        • Zoellner J.
        • Connell C.
        • Santell R.
        • et al.
        Fit for Life Steps: Results of a community walking intervention in the rural Mississippi Delta.
        Prog Community Health Partnersh. 2007; 1: 49-60
        • Zoellner J.
        • Powers A.
        • Avis-Williams A.
        • Ndirangu M.
        • Strickland E.
        • Yadrick K.
        Compliance and acceptability of maintaining a 6-month pedometer diary in a rural, African American community-based walking intervention.
        J Phys Act Health. 2009; 6: 475-482
        • Heaney C.
        • Israel B.
        Social Networks and Social Support.
        in: Glanz K. Rimer B. Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice. 4th ed. Jossey-Bass, San Francisco, CA2008: 189-210
        • Israel B.
        Social networks and social support: Implications for natural helper and community-level interventions.
        Health Educ Q. 1985; 12: 65-80
        • Deci E.
        • Ryan R.
        Intrinsic Motivation and Self-Determination in Human Behavior.
        Plenum Press, New York, NY1985
        • Ryan R.
        • Deci E.
        Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.
        Am Psychol. 2000; 55: 68-78
        • Prochaska J.
        • Velicer W.
        The transtheoretical model of health behavior change.
        Am J Health Promot. 1997; 12: 38-48
        • Miller W.R.
        • Rollnick S.
        Motivational Interviewing: Preparing People for Change.
        3rd edition. Guilford Press, New York, NY2013
        • Miller W.
        • Zweben A.
        • DiClemente C.
        • Rychtarik R.
        Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence.
        (Project MATCH Monograph Series, Vol. 2. NIH Pub. No.94-3723) National Institute on Alcohol Abuse and Alcoholism, Rockville, MD1992
        • Rollnick S.
        • Allison J.
        • Ballasiotes S.
        Variations on theme: Motivational interviewing and its adaptations.
        in: Miller W.R. Rollnick S. Motivational interviewing: Preparing people for change. Guilford Press, New York2002: 270-283
        • Madson M.B.
        • Loignon A.C.
        • Lane C.
        Training in motivational interviewing: A systematic review.
        J Subst Abuse Treat. 2009; 36: 101-109
      4. Madson M, Landry A, Molaison E, Schumacher J, Yadrick K. Training MI interventionists across disciplines: A descriptive project. Motivational Interviewing: Theory, Research, Implementation and Practice. 2014. In press.

        • Sacks F.M.
        • Svetkey L.P.
        • Vollmer W.M.
        • et al.
        Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet.
        N Engl J Med. 2001; 344: 3-10
        • American Thoracic Society
        ATS Statement: Guidelines for the six-minute walk test.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Solway S.
        • Brooks D.
        • Lacasse Y.
        • Thomas S.
        A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain.
        Chest. 2001; 119: 256-270
        • Thompson F.
        • Midthune D.
        • Subar A.
        • Kahle L.
        • Schatzkin A.
        • Kipnis V.
        Performance of a short tool to assess dietary intakes of fruits and vegetables, percentage energy from fat and fiber.
        Public Health Nutr. 2004; 7: 1097-1105
      5. National Cancer Institute. Multifactor screener: Scoring procedures. 2007. http://appliedresearch.cancer.gov/surveys/nhis/multifactor. Accessed August 4, 2012.

        • Dempster A.
        • Laird N.
        • Rubin B.
        Maximum likelihood from incomplete data via the EM algorithm.
        J Royal Stat Soc. 1977; (Series B (Methodological),39(1):1-39)
        • Thomas A.J.
        • Eberly L.E.
        • Smith G.D.
        • Neaton J.D.
        • Stamler J.
        Race/ethnicity, income, major risk factors, and cardiovascular disease mortality.
        Am J Public Health. 2005; 95: 1417-1423
        • Whelton P.K.
        • He J.
        • Appel L.J.
        • et al.
        Primary prevention of hypertension: Clinical and public health advisory from the National High Blood Pressure Education Program.
        JAMA. 2002; 288: 1882-1888
        • Pazoki R.
        • Nabipour I.
        • Seyednezami N.
        • Imami S.R.
        Effects of a community-based healthy heart program on increasing healthy women's physical activity: A randomized controlled trial guided by Community-based Participatory Research (CBPR).
        BMC Public Health. Aug 2007;
        • Farag N.H.
        • Moore W.E.
        • Thompson D.M.
        • Kobza C.E.
        • Abbott K.
        • Eichner J.E.
        Evaluation of a community-based participatory physical activity promotion project: Effect on cardiovascular disease risk profiles of school employees.
        BMC Public Health. 2010;
        • Rankin P.
        • Morton D.P.
        • Diehl H.
        • Gobble J.
        • Morey P.
        • Chang E.
        Effectiveness of a volunteer-delivered lifestyle modification program for reducing cardiovascular disease risk factors.
        Am J Cardiol. 2012; 109: 82-86
        • Dickinson H.O.
        • Mason J.M.
        • Nicolson D.J.
        • et al.
        Lifestyle interventions to reduce raised blood pressure: A systematic review of randomized controlled trials.
        J Hypertens. 2006; 24: 215-233
        • Mertens I.L.
        • Van Gaal L.F.
        Overweight, obesity, and blood pressure: The effects of modest weight reduction.
        Obes Res. 2000; 8: 270-278
        • Straznicky N.
        • Grassi G.
        • Esler M.
        • et al.
        European Society of Hypertension Working Group on Obesity Antihypertensive effects of weight loss: Myth or reality?.
        J Hypertens. 2010; 28: 637-643
        • Neter J.E.
        • Stam B.E.
        • Kok F.J.
        • Grobbee D.E.
        • Geleijnse J.M.
        Influence of weight reduction on blood pressure: A meta-analysis of randomized controlled trials.
        Hypertension. 2003; 42: 878-884
        • Atienza A.A.
        • King A.C.
        Community-based health intervention trials: An overview of methodological issues.
        Epidemiol Rev. 2002; 24: 72-79

      Biography

      J. Zoellner is an associate professor, Department of Human Nutrition, Foods and Exercise, Virginia Polytechnic Institute and State University, Blacksburg.

      Biography

      C. Connell is a professor, Department of Nutrition & Food Systems, The University of Southern Mississippi, Hattiesburg.

      Biography

      A. S. Landry is an assistant professor, Department of Nutrition & Food Systems, The University of Southern Mississippi, Hattiesburg.

      Biography

      E. Fontenot Molaison is a professor and dietetic internship director, Department of Nutrition & Food Systems, The University of Southern Mississippi, Hattiesburg.

      Biography

      K. Yadrick is chair and professor, Department of Nutrition & Food Systems, The University of Southern Mississippi, Hattiesburg.

      Biography

      M. B. Madson is an associate professor, Department of Psychology, The University of Southern Mississippi, Hattiesburg.

      Biography

      V. Blakely Reed is graduate coordinator, Department of Public Health, The University of Southern Mississippi, Hattiesburg.

      Biography

      J. L. Thomson is a research epidemiologist, US Department of Agriculture, Agricultural Research Service, Human Nutrition and Food, Louisiana State University, Baton Rouge.