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ASSOCIATIONS OF PERCEIVED STRESS, STRESS MANAGEMENT, AND HEALTHY
EATING WITH WEIGHT IN A SAMPLE OF BLACK CHURCHGOING WOMEN
By
VICTORIA A. RODRÍGUEZ
A THESIS PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE
UNIVERSITY OF FLORIDA
2017
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© 2017 Victoria A. Rodríguez
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ACKNOWLEDGEMENTS
This would not have been possible without the unconditional support of my mentor, Dr.
Carolyn Tucker. Thank you for investing your time, energy, wisdom, love, and compassion into
my development. Thank you for the many opportunities you have provided me to grow
professionally and for the example you provide as a researcher, scholar, psychologist, teacher
and woman. Thank you for taking the time to celebrate my strengths, for your encouragement,
and for making me feel like family.
Thank you to the members of my thesis committee, Dr. Nicole Whitehead, for
contributing to my professional and academic development and Dr. Laurie Mintz, for
additionally supporting me as a writer and therapist-in-training. I feel lucky to be working with
such distinguished women. Also, thank you to Dr. Michael Marsiske for his continued support
and for taking the time to review my work.
Thank you to my parents, Mami y Papi, who have always encouraged me, believed in my
potential, and lifted me up. I still maintain that I won the parent lottery. To the rest of my family,
especially Manolo, Maylin, Eduardo, Kelly, Manuel Andres, Marcos, William, Mimi, and Lily,
thank you for bringing me a unique and irreplaceable joy. I feel blessed to have such a brilliant
group of people in my corner.
There are a number of other special individuals who have supported me in large and
small ways throughout this process. Thank you to Jessica England for her example and lovely
friendship, to Shuchang Kang for being an extraordinary person to me and one of the main
reasons I chose to attend the University of Florida, to Austin Folger for all of the logistical
support and encouraging conversations, to Tessa Wimberley for being an incredible supervisor
and for believing in me, to John Conway for the sacrifice of his time and teaching, to Zoya
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Shakeel for her great help during the research process, and to Catalina Gonzalez-Marques and
Cristina Rabaza for their sisterhood. ¡Muchísimas gracias!
Lastly, thank you to Rob Taylor for showing me a rare and inimitable support through
kind words and kinder actions. You are singular.
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TABLE OF CONTENTS
page
ACKNOWLEDGEMENTS .............................................................................................................3
LIST OF TABLES ...........................................................................................................................6
ABSTRACT .....................................................................................................................................7
CHAPTER
1 INTRODUCTION ....................................................................................................................9
2 METHOD ...............................................................................................................................14
Participants .............................................................................................................................14
Measures .................................................................................................................................14 Procedure ................................................................................................................................16
3 RESULTS ...............................................................................................................................19
Preliminary Analyses ..............................................................................................................19 Research Question 1 ...............................................................................................................19
Research Question 2 ...............................................................................................................20
4 DISCUSSION .........................................................................................................................24
Summary of Findings .............................................................................................................24 Limitations ..............................................................................................................................26
Strengths .................................................................................................................................27 Implications ............................................................................................................................28
APPENDIX
A PERCEIVED STRESS SCALE (PSS) ...................................................................................30
B THE HEALTH PROMOTING LIFESTYLE PROFILE (HPLP-II) ......................................31
C HEALTH SMART BEHAVIOR FREQUENCY SCALE (HSB) ..........................................33
D DEMOGRAPHIC AND HEALTH INFORMATION QUESTIONNAIRE ..........................34
E INFORMED CONSENT FORM ............................................................................................41
LIST OF REFERENCES ...............................................................................................................48
BIOGRAPHICAL SKETCH .........................................................................................................56
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LIST OF TABLES
Table page
2-1 Participant Demographic Information. ..............................................................................18
3-1 Skewness and Kurtosis for the Variables of Interest .........................................................22
3-2 Descriptive Mean Statistics and Cronbach’s Alphas for the Variables of Interest ............22
3-3 Pearson Correlations for the Variables of Interest .............................................................23
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Abstract of Thesis Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Master of Science
ASSOCIATIONS OF PERCEIVED STRESS, STRESS MANAGEMENT, AND HEALTHY
EATING WITH WEIGHT IN A SAMPLE OF BLACK CHURCHGOING WOMEN
By
Victoria A. Rodríguez
August 2017
Chair: Carolyn M. Tucker
Major: Psychology
Obesity and overweight place individuals at higher risk for serious health complications
including cardiovascular disease, Type 2 Diabetes, and some cancers. Black women have the
highest incidence of obesity compared to other demographic groups in the United States.
The goals of the present study are to (1) examine the associations of perceived stress,
stress management and frequency of healthy eating with weight in a sample of black
Churchgoing women and (2) determine whether these health variables differ in association with
certain demographic variables. Participants were 208 Black churchgoing women from 21 African
Methodist Episcopal Churches throughout Florida.
Multiple regressions were used to examine the research questions. The results from these
analyses indicate that the regression model including perceived stress, stress management, and
frequency of healthy eating as criterion variables was not significant. The regression model was
then re-tested with the two positive health promoting behaviors (i.e., stress management and
healthy eating). The reduced model was significant; however, stress management and frequency
of healthy eating were not significant individual predictors of weight. Age and income were
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found to be negative predictors of perceived stress. Age was also found to be a positive predictor
of frequency of healthy eating.
This study supports the need for counseling psychologists to conduct more community-
based research focused health disparities. Counseling psychologists are perfectly positioned for
such research because of their valuing of health promotion, training in viewing clients through a
multicultural lens, and commitment to the inclusion of minorities in research to reduce health
disparities.
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CHAPTER 1
INTRODUCTION
Obesity and weight-related morbidities are currently among the top health concerns in the
United States. Obesity is a multifactorial, chronic disease that develops from the interaction of
“social, behavioral, cultural, physiological, metabolic, and genetic factors” (NIH, 1998, p. 5;
NIH, 2013; NRC, 1989). It is characterized by an unhealthy, excess amount of body fat (NIH,
1998; NIH, 2013). Overweight is a term used to describe an “excess amount of body weight that
may come from muscles, bone, fat, and water” (NIH, 1998, p. 1; NIH, 2013). Obesity and
overweight have been described as any weight that is higher than what is considered a healthy
weight for a given height (CDC, 2016). Both of these health problems place individuals at higher
risk for serious health complications including hypertension, high cholesterol, Type 2 Diabetes,
coronary heart disease, stroke, osteoarthritis, and some cancers, such as breast, colon, kidney,
and liver cancer (CDC, 2016; NIH, 2013; Bhaskaran et al., 2014).
Sixty-nine percent of American adults are overweight or obese (Ogden et al., 2014). The
rate of obesity among American adults significantly increased from 30.5% in 2000 to 37.7% in
2014 (Ogden et al., 2014). While obesity affects a wide range of individuals, racial and ethnic
minority groups are unduly burdened by weight-related morbidities such as diabetes, heart
disease, and cancer (Bandera, Maskarinec, Romieu, & John, 2015; Ard, 2015; Braveman,
Cubbin, Egerter, Williams, & Pamuk, 2010; Sharma, Melarcher, Giles, & Myers, 2004).
Furthermore, women are disproportionately affected by overweight and obesity (Chang Nitzke,
Brown & Reniscow, 2014). African American and Black women have the highest incidence of
obesity compared to other demographic groups in the United States (Ard, 2015). Specifically, the
prevalence of obesity among African American/Black women (56.6%) is higher than the rate
among Hispanic women (44.4%) and Caucasian women (32.8%; Ard, 2015; Tucker, Bilello, &
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Gautam, 2016). Black women also experience higher rates of overweight and obesity than Black
men (Ogden et al., 2014). In Florida, 78.2% of Black women are overweight or obese
(USDHHS, 2010; Lopez et al., 2014).
Not only do African American women have the highest prevalence of obesity in the
United States, but they are also less likely to participate in weight loss programs and tend to have
a lower success rate when they do participate in weight loss programs (Jones et al., 2014). It is
also noteworthy that while weight gain is common over the lifespan for all individuals, black
women experience the largest magnitude of weight gain (Turk et al., 2012).
When examining weight-related risk factors in minority populations, it is useful to
include a focus on healthy eating behaviors and nutritional knowledge. There is substantial
evidence linking healthy eating practices with reduced cardiovascular disease as well as reduced
risk of Type 2 Diabetes, some cancers, overweight, and obesity (USDHHS, 2015). Current
dietary guidelines recommend increased consumption of fruits, vegetables, and whole grains and
decreased consumption of fats, processed meats, sugar-sweetened foods, and refined grains
(USDHHS, 2015). African Americans tend to consume a higher percentage of energy from
dietary fat than their White counterparts (Watters & Sattia, 2009). Qualitative research focused
on urban, low-income, African American adults has also demonstrated that while these
individuals may be able to generally identify nutritional guidelines related to healthy eating,
many still lack knowledge of nutritional content of specific foods and endorse unhealthy dietary
choices (Lucan, Barg, Karasz, Palmer, & Long, 2012).
Barriers to engaging in health-promoting behaviors such as healthy eating are varied and
span economic, psychological, and sociocultural domains. Obstacles to healthy eating and
physical activity, especially among African American families, include hopelessness with regard
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to changing one’s health situation, conflicting messages from trusted health care providers,
limited access to low calorie and low fat foods, guilt and self-blame (Jones et al., 2014).
Additional barriers to healthy eating include limited access to fresh produce and inability to find
healthy substitutes for traditional meals (Bramble, Cornelius, & Simpson, 2009) as well as lack
of knowledge of healthy foods, lack of energy to cook and plan healthy foods, and cost (Baruth,
Sharpe, Parra-Medina, & Wilcox, 2014). Impediments to family communication, including
ubiquity of electronics, generational differences, and financial problems have also been found to
be significant barriers to healthy eating (Fruh et al., 2013). Lastly, lack of social support and role
models, family expectations related to eating traditional foods, emotional stress, and health
conditions have all been found to negatively impact weight loss maintenance in Black
communities (Seale et al., 2013).
There is much research linking stress and stress management to eating and weight. Stress
has been linked to weight gain, problematic eating behaviors, and poor diet as well as increased
cortisol, a hormone that promotes fat production in the body (Richardson, Arsenault, Cates, &
Muth, 2015; Block, He, Zaslavsky, Ding, & Ayanian, 2009; De Vriendt et al., 2012; Ferranti et
al., 2013; Lee & Fried, 2014; Rosmond, 2003). Conversely, weight loss has been found to be
maintained by stress management and positive coping skills (Turk et al., 2012; Elfhag, 2005).
Longitudinal research with American women has also shown associations among higher
BMI, higher perceived psychosocial and family stress, and higher weight gain (Block et al,
2009). Research with ethnically diverse American women has also determined that perceived
stress is positively associated with obesity and unhealthy eating behaviors (Richardson et al.,
2015).
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A biopsychosocial approach to stress suggests that “stress leads to weight gain not only
through behavioral pathways such as increased food consumption and sedentariness but also
directly through prolonged exposure to biological stress mediators such as cortisol” (Tomiyama,
Puterman, Epel, Rehkopf, & Laraia, 2013, p. 4; Dallman, 2010). Moreover, psychosocial
stressors such as low socioeconomic status and racism may affect stress reactivity, which results
in physiological manifestations such as higher blood pressure, an outcome that is also positively
associated with weight (Bermudez-Millan, 2016). Black women appear to be particularly
vulnerable to chronic stress (Cox et al., 2012) and, interestingly, in this population behavioral
stress has been found to be negatively associated with healthy eating whereas physical stress has
been found to be positively associated with healthy eating (Jones, Tucker, & Herman, 2009).
Behavioral stress refers to psychological indicators of stress such as poor coping skills (e.g.
smoking; Jones, Tucker, & Herman, 2009). Physical stress refers to physiological stress
symptoms and responses such as muscle tensions and body aches (Jones, Tucker, & Herman,
2009).
Black churches are appropriate sites for conducting health promotion focused research
due to their mental, physical, and spiritual health promotion legacy and widespread influence in
Black communities (Austin & Harris, 2011; Resincow et al., 2001). Conducting health-focused
research in churches and involving church members and spirituality in interventions to promote
healthy eating are increasing in occurrence. For example, it has been shown that church-based
health promotion interventions increase dietary health behaviors such as consumption of fruits
and vegetables (Nolan, Tucker, Flenar, Arthur, & Smith, 2016; Thompson, Goodman, &
Tussing-Humphreys, 2015; Wilcox et al., 2013; Campbell et al, 2007). Additionally,
incorporating religious themes into weight-loss and maintenance programs has resulted in
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decreases in negative thoughts associated with food and eating (Patel, Lycett, Coufopoulos, &
Turner, 2017) and in improved maintenance of health behavior changes (Seale et al., 2013).
Social support from fellow church members has been shown to have a positive effect on
motivation to adopt a healthy lifestyle, specifically in populations that also experience a sense of
belonging to their religious community (Krause, Shaw, & Liang, 2011).
In one study of Black church members, women were found to have a higher interest than
men in health information on healthy foods and exercising. This finding suggests that sex roles
exist with regard to healthy meal preparation and engaging in healthy eating and physical
activity (Austin & Harris, 2011). It has been shown in another study that African American
women churchgoers are more likely to take concrete actions to serve healthy foods at church
events (Kegler et al., 2012) and to engage in general food shopping and preparation (Lucan et
al., 2012).
The current research regarding the intersection of gender, stress, healthy eating, and
weight in church settings is limited. The present study seeks to gain greater understanding of the
associations of stress, stress management and frequency of healthy eating over the previous week
(henceforth referred to as frequency of healthy eating) with weight among Black churchgoing
women. Specifically, in this study the following research questions will be examined:
1. Are perceived stress, stress management, and frequency of healthy eating significant
predictors of weight among Black churchgoing women?
2. Are there significant differences in perceived stress, stress management, frequency of
healthy eating, and weight in association with age, income level, and education level?
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CHAPTER 2
METHOD
Participants
The participants for this study were the Black women churchgoers (N=208) among the
321 churchgoers enrolled in a broader obesity reduction intervention study known as African
Methodist Episcopal Health-Smart Church Model Program (called Health-Smart AME). All of
the participants in the larger study were recruited from among 21 AME churches throughout
rural, suburban, and urban areas of Florida. For the present study, only the baseline data of the
208 Black churchgoing women were used. These participants’ ages ranged from 18 to 83 years
old (M = 54.7, SD = 15.9). Additional participant demographic information including
employment, level of education, and household income are presented in Table 2-1.
Inclusion criteria for participating in this study were (a) being at least 18 years old, (b)
giving written consent to participate in the research study, and (c) ability to read English at a 6th-
grade reading level. Exclusion criteria for participating in this study were: (a) current
involvement in a medical treatment with major side effects, such as chemotherapy, radiation, or
hemodialysis and (b) having a blood pressure reading of 160/100 mmHg or higher or a heart rate
of 100 beats per minute of higher—indicating that the participant was at risk for a health problem
such as a stroke as a result of participating in the broader obesity reduction intervention study in
which the participants in the present study were enrolled.
Measures
All participants completed an assessment battery that included 7 measures. The following
4 measures will be used to explore the research questions in this study: (1) The Perceived Stress
Scale, (2) The Health Promoting Lifestyle Profile-II, (3) The Health Smart Behavior Frequency
Scale, and (4) a Demographic Health Information Questionnaire.
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The Perceived Stress Scale (PSS; Cohen, Kamarck, and Mermelstein, 1983). The
PSS is a 10-item questionnaire to assess respondents’ perception of stress in their lives. All items
are assessed using a five-point Likert scale with scores ranging from 0 to 4 where 0 = Never, 1 =
Almost Never, 2 = Sometimes, 3 = Fairly Often, and 4 = Very Often. In the original study to
develop the PSS, the Cronbach’s alpha was 0.85. For this study, the Cronbach’s alpha was 0.88.
An example statement from the PSS is “In the last month, how often have you been upset
because of something that happened unexpectedly?” A total score on the PSS is calculated by
reverse scoring the four positively stated items on the measure and taking the sum across items.
The mean score on the PSS for the participants in this study is 24.45 (SD = 6.74).
The Health Promoting Lifestyle Profile-II (HPLP-II; Walker, Sechrist, & Pender,
1987). The HPLP-II is a 52-item scale used to assess engagement in the following 6 areas, which
comprise the measure’s 6 subscales: (1) Self-Actualization, (2) Health Responsibility, (3)
Exercise Consistency, (4) Nutrition, (5) Interpersonal Support, and (6) Stress Management.
Response choices on this measure are based on a four-point Likert scale with scores ranging
from 1 to 4 where 1 = Never, 2 = Sometimes, 3 = Often, and 4 = Routinely. In the original study
to develop the HPLP-II, the Cronbach’s alphas for the subscales ranged from 0.70 to 0.90. Only
the Stress Management subscale was used in the present study. For this study, the Cronbach’s
alpha for the Stress Management subscale was 0.81. An example statement from this subscale is
“Take some time for relaxation each day.” A subscale score is calculated by taking the mean
across only relevant subscale items. The mean score on the Stress Management subscale for the
participants in this study is 2.32 (SD = 0.57).
The Health Smart Behavior Frequency Scale (HSB). The HSB is a 10-item
questionnaire that was prepared by the Primary Investigator (PI) for the larger intervention study
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for which the participants in the present study were enrolled. The HSB was used in the present
study to assess the number of days over the previous week in which the respondent engaged in
healthy eating behaviors and physical activity behaviors. The HSB has 5 subscales: (1) Healthy
Eating Frequency, (2) Healthy Drinking Frequency, (3) Physical Activity, (4) Healthy Walking,
and (5) Screen Time. Only the Healthy Eating Frequency subscale was used in the present study.
An example statement from this subscale is “On how many days of the past week did you eat a
healthy breakfast?” In the original study to develop the HSB, the Cronbach’s alpha was 0.81..
For this study, the Cronbach’s alpha was 0.83.
Demographic and Health Information Questionnaire (DHIQ). The DHIQ is a 34-item
questionnaire that was also prepared by the PI of the aforementioned intervention study. The
DHIQ was used to collect basic demographic information including race, ethnicity, employment,
education, income, and health history.
Procedure
This study was approved by the Institutional Review Board at the institution where the
researchers for the larger intervention study and the present study are based. The participants in
the present study were recruited to participate in the larger intervention study called Health-
Smart AME—a study launched to examine the effectiveness of a culturally-sensitive health
promotion intervention aimed at increasing healthy eating behaviors and health literacy and
reducing Body Mass Index in African American churchgoers. Church leaders from each of the
21 participating AME churches were trained by the researchers to recruit study participants,
collect the baseline and post-intervention data on these participants, and implement the
intervention. These church leaders were called health empowerment coaches (HECs).
Participants were recruited by these HECs through multiple methods including distributing flyers
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about the study at their respective churches, making announcements during church events,
sending out newsletters and/or emails, and word of mouth.
The various recruitment methods included (a) the instruction to contact one of the HECs
about enrolling in the study if interested in participating in it and (b) the inclusion criteria for
study participation as well as the exclusion criteria that made one ineligible for study
participation. The study enrollment process began for the adult churchgoers at each church who
were interested in participating in the larger intervention study, who met the inclusion criteria for
participation in the study, and did not meet exclusion criteria for participation in the study. The
enrollment process consisted of completing an Informed Consent Form and providing baseline
data for the study. Providing the baseline data, which included the data used in the present study,
involved completing study-related questionnaires and having height, weight, blood pressure, and
heart rate measured by the trained HECs with supervision by a retired nurse or physician. Study
participants were compensated $30 for their involvement in the baseline and post-intervention
data collections.
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Table 2-1. Participant Demographic Information.
n % .
Total 208
Age
18-30 20 9.6
31-40 22 10.6
41-50 41 19.7
51-60 40 19.2
61-70 43 20.7
71-83 37 17.8
Missing 5 2.4
Employment
Work full-time 88 42.3
Work part-time 28 13.5
Unemployed but looking for a job 13 6.3
Do not work 79 38.0
Highest Level of Education
Elementary School 1 0.5
Junior High/Middle School 4 1.9
High School or GED 48 23.1
Trade/Technical School 28 13.5
2-Year College 35 16.8
4-Year College/University 50 24.0
Professional/Graduate School 39 18.8
Missing 3 1.4
Annual Household Income
Less than $10,000 23 11.1
$10,000 to $19,999 18 8.7
$20,000 to $29,999 28 13.5
$30,000 to $39,999 14 6.7
$40,000 to $49,999 17 8.2
$50,000 to $59,999 18 8.7
$60,000 to $69,999 17 8.2
$70,000 to $79,999 12 5.8
$80,000 to $89,999 9 4.3
$90,000 to $99,999 8 3.8
$100,000 or more 13 6.3
Missing 31 14.9
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CHAPTER 3
RESULTS
Preliminary Analyses
Prior to running the main analyses, skewness and kurtosis values for the variables of
interest (e.g. perceived stress, stress management, healthy eating, weight, age, income and
education level) were examined (Table 3-1). Z-scores for skewness and kurtosis were calculated
by dividing the skewness and kurtosis coefficient by their standard errors. For the medium
sample size used in the present study (N=208), z-scores for skewness and kurtosis greater than
the absolute value of 3.29 are considered non-normal (Kim, 2013). The Blom method is used to
normalize skewed and kurtotic data (Blom, 1958). Stress management, weight, and education
level all had z-scores for either skewness or kurtosis that exceeded the absolute value of 3.29
and, thus, were transformed using the Blom method. This method reorganizes individual data
points and assigns them a new rank that fits a normal distribution (Blom, 1958). Additionally, the
descriptive mean statistics and Cronbach’s alphas for the variables of interest were calculated
(Table 3-2). Lastly, the Pearson correlations for the variables of interest were determined (Table
3-3).
Research Question 1
Research Question 1 states: “Are perceived stress, stress management, and frequency of
healthy eating significant predictors of weight among Black churchgoing women?” A multiple
regression analysis was used to examine whether perceived stress (M = 24.25, SD = 6.74), stress
management (M = 2.32, SD = 0.57), and frequency of healthy eating (M = 3.58, SD = 1.68) were
significant predictors of weight (M = 200.83, SD = 45.10). The predictor variables (PVs) in this
regression were perceived stress, stress management, and frequency of healthy eating. The
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criterion variable (CV) in this regression was weight. The results indicated that this regression
model was not significant, R2 = .041, F(3, 175) = 2.486, p > .05.
Because perceived stress was not originally correlated with weight, it was removed from
the regression model. The regression model was then re-tested with just the two positive health
promoting behaviors (i.e., stress management and healthy eating). The PVs in this regression
were stress management and frequency of healthy eating and the CV in this regression was
weight. The results indicated that this regression model was significant, R2 = .045, F(2, 182) =
4.273, p < .05. Stress management and frequency of healthy eating together explained 4.4% of
the variance in weight. However, stress management, β= -.117, t(184) = -1.381, p > .05, and
frequency of healthy eating, β= -.081, t(184) = -1.682, p > .05, were not significant individual
predictors of weight.
A simple regression analysis was run using stress management as a predictor of weight.
The PV in this regression was stress management and the CV was weight. Results indicated that
this regression model was significant, R2 = .024, F(1, 186) = 4.532, p < .05. Stress management
explained 2.4% of the variance in weight. As stress management increased, weight decreased, β=
-.161, t(187) = -2.129, p < .05.
A second simple regression analysis was run using healthy eating as a predictor of
weight. The PV in this regression was frequency of healthy eating and the CV was weight. The
results of this regression indicated that this regression model was significant, R2 = .031, F(1,
187) = 6.010, p < .05. Frequency of healthy eating explained 3.0% of the variance in weight. As
frequency of healthy eating increased weight decreased, β= -.104, t(188) = -2.452, p < .05.
Research Question 2
Research Question 2 states: “Are there significant differences in perceived stress, stress
management, frequency of healthy eating, and weight in association with age, income level, and
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education level?” To address this question, four multiple regressions were run. Either perceived
stress, stress management, frequency of healthy eating, and weight was a CV in each of these
multiple regressions. Age, income level and education level were all entered as PVs in each of
these multiple regressions.
Results of the multiple regression for perceived stress showed that the demographic
predictor variables explained a significant amount of variance in level of perceived stress, R2 =
.122, F(3,157) = 7.298, p = .000. In terms of individual predictors, age, β= -.089, t(160) = -2.714,
p < .01, and income, β= -.446, t(160) = -2.145, p < .05, were both significant, negative predictors
of perceived stress. Education level was not a significant predictor of perceived stress.
Results of the multiple regression for frequency of healthy eating showed that the
demographic predictor variables explained a significant amount of variance in frequency of
healthy eating, R2 = .071, F(3,160) = 4.105, p < .01. In terms of individual predictors, age, β =
.020, t(163) = 2.503, p < .05, was a significant, positive predictors of frequency of healthy
eating. Income and education level were not significant predictors of frequency of healthy eating.
Results of the multiple regression for stress management and weight showed that the
demographic predictor variables were not significant predictors of stress management or weight.
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Table 3-1. Skewness and Kurtosis for the Variables of Interest
Variable Skewness SE Kurtosis SE Skewness/
SE
Kurtosis/
SE
Perceived Stress .006 .173 .513 .344 .035 1.49
Stress Management .569 .172 .257 .343 3.308 .749
Healthy Eating .066 .172 -.724 .342 .384 2.117
Weight .861 .173 .878 .345 4.977 2.445
Age -.220 .171 -.797 .340 -1.287 -2.344
Education Level -.191 .170 -1.193 .338 -1.123 3.430
Income .384 .183 -.941 .363 2.099 2.592
Note. Z-score of skewness and kurtosis values greater than the absolute value of 3.29 were
deemed non-normal.
Table 3-2. Descriptive Mean Statistics and Cronbach’s Alphas for the Variables of Interest
Variable M Range SD α n
Perceived Stress
24.25 0 44 6.74 0.88 198
Stress Management
2.32 1.20 4 0.57 0.81 199
Healthy Eating
3.58 0 7 1.68 0.83 200
Weight 200.83 111 344 45.10 197
Note. Higher scores indicate higher levels of the construct assessed.
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Table 3-3. Pearson Correlations for the Variables of Interest
Variable 1 2 3 4
1. Perceived Stress –
2. Stress Management -.282*** –
3. Healthy Eating -.213** .467*** –
4. Weight .023 -.147* -.165* –
Note. * p < .05, ** p < .01, ***p < .001.
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CHAPTER 4
DISCUSSION
Summary of Findings
The purpose of the present study was to examine the associations of stress, stress
management, and healthy eating with weight among a sample of Black churchgoing women.
Specifically, the following research questions were examined: (1) Are perceived stress, stress
management, and frequency of healthy eating significant predictors of weight among Black
churchgoing women? and (2) Are there significant differences in perceived stress, stress
management, frequency of healthy eating, and weight in association with age, income level, and
education level? Multiple regressions were used to examine these research questions.
Together, perceived stress, stress management, and frequency of healthy eating were not
found to be significant predictors of weight among the Black churchgoing women participants in
this study. Once perceived stress was removed from the model, however, stress management,
and frequency of healthy eating, together, were significant predictors of weight among these
participants. This finding is supported by current research reporting the negative association
between both stress management and frequency of healthy eating and weight (Turk et al., 2012;
Elfhag, 2005; USDHHS, 2015).
Interestingly, in this study, perceived stress was neither found to be correlated with nor
predictive of weight among the study participants. This finding is contradicted by research
showing a positive association between stress and BMI (Moore-Green, Gross, Silver, & Perrino,
2012; Armstead, Hebert, Griffin, & Prince, 2014; Turk et al., 2012). More specifically, research
with racially diverse American women has found a positive association between perceived stress
and obesity (Richardson et al., 2015). Other studies do not find associations between stress and
weight (Kim et al., 2008; Strickland, Giger, Nelson, & Davis, 2007; Walcott-McQuigg, 1995).
25
One explanation for the aforementioned inconsistent findings regarding the relationship
between perceived stress and weight lies in the method by which perceived stress is assessed. For
example, the PSS measure may not have captured an accurate stress profile in the participating
Black women churchgoers. The reliability and validity data for the PSS is strong, however, the
mean value in this study (M = 24.25) is higher than the mean value from the normed measure in
Black populations (M = 14.7) (Cohen, Kamarck, & Mermelstein, 1983). This suggests that while
perceived stress is exhibited in high levels in this sample, and more generally in the population
of Black women (Turner & Avison, 2003; Schulz et al., 2000; Moore-Greene et al., 2012; Hatch
& Dohrenwend, 2007; Carson et al., 2015), it may differentially influence other behavioral and
physiological predictors of weight gain such as increased eating behavior and cortisol
production.
Analyses of the differences in the target variables (i.e., perceived stress, stress
management, frequency of healthy eating, and weight) in association with demographic variables
of age, income, and education level also yielded noteworthy findings. In this sample, income was
a significant, negative predictor of perceived stress. This is consistent with the literature
regarding socioeconomic status and stress (Richardson et al., 2015; Manuel, Martinson, Bledsoe-
Mansori, & Bellamy, 2012; Campbell-Grossman et al., 2016). Age was also a significant,
negative predictor of perceived stress and a significant, positive predictor of frequency of healthy
eating in this sample. The literature regarding the relationship between age and stress is mixed.
Evidence postulates that age does not negatively predict stress and that increased use of coping
skills over the life span acts as a stress buffer (Sherman, Cheng, Fingerman, & Schyner, 2016).
Conversely, it is also documented that older adults experience higher levels of stress (Fiske
Wetherell, & Gatz, 2009; Ezzati et al., 2013). It is important to note, however, that there is a
26
paucity of research regarding the relationship between age and perceived stress in African
American women. Evidence supporting the positive predictive relationship between age and
healthy eating also appears to be inconsistent (Sylvie, Jiang, & Cohen, 2013; Xu, Houston,
Locher, & Zizza, 2012; Hiza, Casavale, Guenther, & Davis, 2013). Education level was not
found to be a predictor of frequency of healthy eating, which is contradicted by current research
(Hiza et al., 2013; Friel, Hattersley, Ford, & O’Rourke, 2015).
Weight has been shown to have a significant relationship with age (Apostolopoulou et al,
2012; Yakusheva, Kapinos, & Weiss, 2017) and income (Leung, Rimm, Nguyen, Shuval, &
Yaroch, 2015; Cawley, Moran, & Simon, 2010). Similarly, stress management has been shown
to have a significant relationship with age (Lavretsky, 2010) and has been studied in low-income
populations (van der Waerden, Hoefnagels, Hosman, & Souren, 2013; Bloom, Glass, Curry,
Hernandez, & Houck, 2012; Dutton, Bermudez, Matas, Majid, & Myers, 2013). Surprisingly, the
demographic variables did not have significant, predictive relationships with weight or stress
management in this study. This may be partially explained by the limited research regarding
these variables in populations similar to the present study sample.
Limitations
There are some limitations in this study. First, the instruments assessing perceived stress,
stress management, and frequency of healthy eating were self-report measures. Self-report
measures, while shown to be reliable in health research (DiMatteo, Giordani, Lepper, &
Croghan, 2002), are subject to social desirability bias when measuring health behaviors
(Mossavar-Rahmani et al., 2012; Prince et al., 2008; Klesges, Baranowski, & Beech, 2004).
Future similar studies to the present study should consider using daily monitoring forms or
digital monitoring methods to obtain health behavior data. Such monitoring is more appropriate
than asking study participants to recall health behaviors from several days prior (e.g., frequency
27
of healthy eating over the course of seven days) and helps eliminate under or over reporting of
such behaviors. This study could have also benefited from the inclusion of physiological
measures of stress such as salivary cortisol level.
Second, the PSS measure may not be sensitive enough to capture differences in perceived
stress in diverse populations. As previously stated, the mean score for the PSS in the present
study sample (M = 24.25) was higher than the mean score from the normed measure in Black
populations (M = 14.7; Cohen et al., 1983). This may suggest that either the present study
sample experiences higher levels of perceived stress than the general population of Black
individuals or, more likely, that the PSS questionably elevates perceived stress scores or does not
accurately measure this construct in Black women like those in the presents study.
Third, demographic characteristics of the study sample, including the race/ethnicity and
gender composition of the sample, limit the generalizability of the findings in the present study
findings. The majority of studies related to obesity prevention, healthy eating, and physical
activity recruit mostly female study participants (Kumanyika et al., 2008). Because this study
focuses on women, the results are not generalizable to men or transgender and gender non-
conforming individuals. Similarly, because the study sample was comprised of only Black
participants, the results are not generalizable to other racial or ethnic groups.
Finally, the study participants were not randomly sampled, but were instead volunteers
from among churches across the state of Florida. Consequently, the sample is likely not
representative of Black women churchgoers and thus may not be generalized to them.
Strengths
Despite the aforementioned limitations, this study also includes some noteworthy
strengths. First, the medium sample size (N=208) in this study provides sufficient power for the
selected statistical analyses (Field, 2009).
28
Second, the examination of psychosocial correlates of weight in this study significantly
contributes to the current psychological literature. Successfully examining and addressing
emotional and mental processes (e.g. stress and stress management) that relate to weight supports
the idea that holistic interventions are needed to address the multifactorial nature of obesity.
Third, this study focuses on Black churchgoing women—a group that is underrepresented
in health promotion research similar to the present study and in research in general (Yancey,
Ortega, & Kumanyika, 2006; Cole, 2009; Martin, Negron, Balbierz, Bickell, & Howell, 2013).
The inclusion of such individuals in the present study addresses the need for health research and
health promotion interventions that can help reduce the obesity disparities that disproportionately
impact Black women.
Implications
Because of the increasing focus in counseling psychology on health disparities and the
associations of psychological variables with physical health behaviors and outcomes, the present
study has implications for counseling psychologists. These results may inform future studies by
counseling psychologists that aim to examine the relationships between psychosocial variables
and physical health behaviors and outcomes. The investigation of stress and stress management
as they relate to physical health is a particularly relevant research area for Counseling
Psychologists to be involved in because of their training in the multifaceted components of
health and wellbeing. Specifically, this study supports the need for counseling psychologists to
conduct more community-based/engaged research focused on the links between both stress
management levels and health and weight or weight concerns of their clients. The present study
also suggests that intervention research and interventions to reduce stress and improve health
eating among black women clients are needed.
29
Furthermore, the values of the field of Counseling Psychology, including attending to
individuals’ emotional, social, health-related, and health-related system concerns (APA, 2017)
are bolstered by mental and physical health research involving minorities such as those in the
present study. Future health research focused on obesity necessitates the involvement of
Counseling Psychologists as these professionals are trained in using holistic and culturally-
sensitive research methods and perspectives that are needed in such research. Counseling
psychologists are perfectly positioned for such research because of their training in and valuing
of health promotion, their training in conducting research and viewing clients through a
multicultural lens, and their commitment to the inclusion of minorities in research to reduce
health disparities such as obesity disparities.
30
APPENDIX A
PERCEIVED STRESS SCALE (PSS)
The questions in this scale ask you about your feelings and thoughts during the last month. In
each case, you will be asked to indicate by circling how often you felt or thought a certain way.
Name ____________________________________________________________
Date ______________ Age ________ Gender (Circle): M F Other ______________
0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often
1. In the last month, how often have you been upset
because of something that happened unexpectedly?
2. In the last month, how often have you felt that you
were unable to control the important things in your
life?
3. In the last month, how often have you felt nervous
and “stressed”?
4. In the last month, how often have you felt confident
about your ability to handle your personal
problems?
5. In the last month, how often have you felt that
things were going your way?
6. In the last month, how often have you found that
you could not cope with all the things that you had
to do?
7. In the last month, how often have you been able to
control irritations in your life?
8. In the last month, how often have you felt that you
were on top of things?
9. In the last month, how often have you been angered
because of things that were outside of your control?
10. In the last month, how often have you felt
difficulties were piling up so high that you could
not overcome them?
The PSS Scale is reprinted with permission of the American Sociological Association, from
Cohen, S., Kamarck, T., and Mermelstein, R. (1983). A global measure of perceived stress.
Journal of Health and Social Behavior, 24, 386-396. Cohen, S. and Williamson, G. Perceived
Stress in a Probability Sample of the United States. Spacapan, S. and Oskamp, S. (Eds.) The
Social Psychology of Health. Newbury Park, CA: Sage, 1988.
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
0 1 2 3 4
31
APPENDIX B
THE HEALTH PROMOTING LIFESTYLE PROFILE (HPLP-II)
32
33
APPENDIX C
HEALTH SMART BEHAVIOR FREQUENCY SCALE (HSB)
34
APPENDIX D
DEMOGRAPHIC AND HEALTH INFORMATION QUESTIONNAIRE
Demographic and Health Information Questionnaire
Directions: Please answer all questions that apply to you. Your answers will be kept
confidential. For questions with bubbles (O), completely fill in the bubbles, like this:
Do you consider yourself to be Hispanic or Latino?
O No, not Hispanic or Latino
O Yes, Puerto Rican
O Yes, Dominican
O Yes, Mexican or Mexican American
O Yes, Cuban
O Yes, another Hispanic or Latino origin (please specify below):
______________________________________________
Do you consider yourself to be African American or Black?
(Note: Even if you consider yourself to be Hispanic/Latino, you may also consider yourself to
be African American or Black)
O No, not African American or Black
O Yes, African-American of American origin (born and grew up in America)
O Yes, African-American of African origin (born in Africa but now an American citizen)
O Yes, African-American of Caribbean origin (born in one of the Caribbean Islands but
now an American citizen)
O Yes, African
O Yes, Caribbean
O Yes, another African American or Black origin (Please print origin below)
_____________________________________________
Do you consider yourself to be any of the following races? (bubble-in all that apply)
(Note: Even if you consider yourself to be Hispanic/Latino and/or African American or
Black, you may also consider yourself to be one or more of the following races)
O American Indian or Alaska Native
O Asian or Asian American
O Caucasian/White/European American
O Native Hawaiian or other Pacific Islander
O Other (please specify): ______________________________________
35
What is your sex? O Female O Male
What is your age? _________
What is your current relationship status?
O I do not have a spouse or partner
O I am living with my spouse or partner
O I am not living with my spouse or partner
What is your employment status?
O I work part-time
O I work full-time
O I am currently unemployed but looking for a job
O I do not work (stay-at-home parent, retired, on disability, etc.)
What is the highest level of education that you have completed?
O elementary school
O junior high/middle school
O high school or GED
O 2-year college
O 4-year college/university
O professional/graduate school
O trade/technical school
How many adults currently live in your household (including yourself)?
O 1 O 2 O 3 O 4 O 5 O 6 or more
How many children (17 years old or younger) currently live in your household?
O 1 O 2 O 3
O 4 O 5 O 6
O 7 O 8 O 9 or more
36
What is your yearly household income (the total combined income that is made yearly by
all working members of your household)?
O Less than $10,000
O $10,000 to $19,999
O $20,000 to $29,999
O $30,000 to $39,999
O $40,000 to $49,999
O $50,000 to $59,999
O $60,000 to $69,999
O $70,000 to $79,999
O $80,000 to $89,999
O $90,000 to $99,999
O $100,000 or more
How tall are you? ________ feet, _________ inches
How much do you weigh? _________ pounds
Are you currently trying to lose weight?
O Yes
O No
Has your doctor or other health care provider told you that you need to lose weight?
O Yes
O No
How important is it for you to lose weight?
O Not at all important
O Only a little important
O Moderately important
O Very important
37
Please bubble in all of the following that apply to you.
O I am on a special diet (if so, what type of diet?): ______________________________
_____________________________________________________________________
O I have undergone surgery (e.g., gastric bypass) that causes me to lose weight.
O I have undergone surgery that causes me to gain weight.
O I have a medical condition that causes me to lose weight.
O I have a medical condition that causes me to gain weight.
O I participate in a weight-loss program (if so, what program?): ____________________
_____________________________________________________________________
O I participate in the following exercise program: _______________________________
O I am pregnant.
O I am breast feeding or nursing a child.
In general, how would you describe your health?
O Excellent
O Very good
O Good
O Fair
O Poor
Do you currently have any of the following health conditions?
Overweight/obesity .......................... O Yes O No
High cholesterol ............................... O Yes O No
High blood pressure (hypertension) O Yes O No
Type 2 diabetes ................................ O Yes O No
Heart disease .................................... O Yes O No
Have you ever been diagnosed with any of the following types of cancer?
Lung cancer O Yes O No
Breast cancer O Yes O No
Prostate cancer O Yes O No
Colon or rectal cancer O Yes O No
Oral/Throat cancer O Yes O No
Are you currently undergoing cancer treatment?
O Yes
O No, my cancer treatment is completed
O No, I have never been diagnosed with cancer
38
How many unplanned health care visits have you had in the past year? _________
On average, over a 24-hour period, how many hours do you sleep?
O 2 or less O 3 O 4
O 5 O 6 O 7
O 8 O 9 O 10 or more
Do you think that you get enough sleep each day? O Yes O No
How often do you smoke cigarettes, cigars, cigarillos, or little cigars?
O Never
O Sometimes
O Often
O Very often
How often do you use chewing tobacco, snuff, or dip?
O Never
O Sometimes
O Often
O Very often
Note: Please answer the following questions regarding your child who is also taking part in this
study. (If two or more of your children are taking part in this study, you will be asked to answer
these questions for your other children after this section.)
Is the child or adolescent Hispanic or Latino?
O No, not Hispanic or Latino
O Yes, Puerto Rican
O Yes, Dominican
O Yes, Mexican or Mexican American
O Yes, Cuban
O Yes, another Hispanic or Latino origin
(Please print origin below—for example, Colombian, Venezuelan, Spanish, and so on)
_____________________________________________
39
Is the child or adolescent African American or Black?
(Note: Even if the child or adolescent is Hispanic/Latino, he or she may also be African
American or Black)
O No, not African American or Black
O Yes, African-American of American origin (born and grew up in America)
O Yes, African-American of African origin (born in Africa but now an American citizen)
O Yes, African-American of Caribbean origin (born in one of the Caribbean Islands but
now an American citizen)
O Yes, African
O Yes, Caribbean
O Yes, another African American or Black origin (Please print origin below)
_____________________________________________
Is the child or adolescent any of the following races? (bubble-in all that apply)
(Note: Even if the child or adolescent is Hispanic/Latino and/or African American or Black,
he or she may also be one or more of the following races)
O American Indian or Alaska Native
O Asian or Asian American
O Caucasian/White/European American
O Native Hawaiian or other Pacific Islander
O Other: _____________________________________________
(Please write in your child’s race if it is not listed)
What is the child’s/adolescent’s sex?
O Female
O Male
What is the child’s/adolescent’s birthdate?
___ ___ / ___ ___ / ___ ___ ___ ___
(Month) (Day) (Year)
Is the child currently trying to lose weight?
O Yes
O No
40
In general, how would you describe the child’s/adolescent’s health?
O Excellent
O Very good
O Good
O Fair
O Poor
Does the child or adolescent currently have any of the following health conditions? (Please
bubble-in all that apply.)
O Overweight/obesity
O High cholesterol
O High blood pressure (hypertension)
O Type 2 diabetes
O Cancer (type): ___________________________________________________
O Heart disease
O Other (please list): ______________________________________________________
O The child or adolescent does not have any of these health condition
41
APPENDIX E
INFORMED CONSENT FORM
INFORMED CONSENT FORM
to Participate in Research, and
AUTHORIZATION
to Collect, Use, and Disclose Protected Health
Information (PHI)
Title of this study:
The African Methodist Episcopal (AME) Health-Smart Church Model Program
Researchers:
Principal Investigator: Carolyn M. Tucker, PhD
Other research staff: Tya M. Arthur, PhD, MPH; Frederic F. Desmond, PhD
Telephone Number: 352-273-2167 or 1-866-290-5770 (toll-free)
Information about this study:
You are being asked to participate in a research study.
Before you agree to take part in this study, please read this form which describes the study. A
member of the research team will describe this study to you and answer all of your questions.
Why is the study being done and what will happen to you if you take part in the study?
The study is being done by Dr. Carolyn M. Tucker and her research team at the University of
Florida in Gainesville, FL. The researchers want to see if a church-based health promotion
program (called the AME Health-Smart Church Model Program) can help AME church
members eat healthier, become more physically active, and feel better emotionally, and also
reduce their weight, blood pressure, and heart rate as appropriate. Moreover, the researchers
want to see if teaching parents with children taking part in the program to be “health
empowerment coaches” for their children helps these children reduce their weight, blood
pressure, and heart rate as appropriate.
42
If you are an adult and you agree to take part in this study, you will:
Complete some questionnaires three different times during the study. These
questionnaires deal with issues such as eating and physical activity behaviors, health
motivation, depression, stress, and other health-related topics. It takes most people
about 90 minutes to complete these questionnaires each time they are completed.
However, you are encouraged to complete them in several, shorter (e.g., 15- to 20-
minute) sessions at home prior to each data collection event at your church. The first
time you will complete these questionnaires will be soon after you begin taking part in
the study. The second time you will complete these questionnaires will be about three-
and-a-half months after the first time you complete the questionnaires. The third time
you will complete these questionnaires will be about three-and-a-half months after the
second time you complete the questionnaires.
Have your height, weight, blood pressure, and heart rate measured three different
times during the study. These measurements will be taken each of the three times you
will complete the questionnaires. Trained retired or non-retired health professionals
(e.g., nurses) will take these measurements.
Meet individually (for about 30 minutes) with a church leader who has been
trained as a Health Empowerment Coach to implement the AME Health-Smart
Church Model Program. If you do not have a child participating in the study, the
Health Empowerment Coach will help you set one or two healthy eating- or physical
activity-related health-smart goals to work toward while you are in the program. If you
have one or more children participating in the study, the Health Empowerment Coach
will (a) help you set one healthy eating-related health-smart goal, (b) teach you how to
help your participating child (or children) set one eating-related health-smart goal, and
(c) ask that you have your entire household collectively agree on one physical activity-
related health-smart goal to work toward while you are in the program.
Attend six weekly 2-hour group sessions led by a Health Empowerment Coach.
During these sessions, you and other adult participants will (a) view a segment of the
Family Health Self-Empowerment DVD; (b) have small-group discussions focusing on
the viewed DVD segment, (c) participate in coach-guided group discussions focusing
on sections of the Health-Smart Behavior Resource Guide for Adults (you will receive
a free copy of this Guide); and (c) if applicable, receive instructions on how to teach
your child (or children) participating in the study age-appropriate program-related
activities using the Health-Smart Behavior Resource Guide for Children or the Health-
Smart Behavior Resource Guide for Adolescents (you will receive a free copy of an
age-appropriate Guide for each child participating in the study).
Complete weekly activities with your participating child (or children) that are
related to topics discussed during the weekly group sessions. If you have one or
more children participating in the study, you will be given family-based activities to
complete with your child (or children) at home each week. These activities will focus
on ways that your child (or children) can eat healthier, be more physically active, and
deal with stress, depression, anger, peer pressure, and bullying. All weekly activities
43
are described in a child or adolescent version of the Health-Smart Behavior Resource
Guide, which will be provided free of charge to each child and adolescent in your
household who also takes part in this study. A Health Empowerment Coach will teach
you how to engage your child and/or adolescent in these activities.
Will you be photographed, video- and/or audio-recorded?
Some photographs may be taken during program sessions to document the activities at your
church. Moreover, you may be asked (but not required) to participate in video-recorded or
audio-recorded interviews upon completion of the program. The purpose of the interviews is to
obtain qualitative data to help assess the effectiveness of the program. If you are willing to be
photographed during program sessions or to be video-recorded or audio-recorded during a
post-program interview, please sign the consent to be photographed, video and/or audio
recorded attached to this Informed Consent Form. If you choose not to sign the attached
consent document, you will not be photographed, video-recorded, or audio-recorded.
How long will you be in the study?
If you agree to take part in this study, you will be in this research study for about 8.5 months.
How many people will be in the study?
Participants in this study will include: (a) up to 600 adults from 30 AME churches across
Florida and (b) up to 300 children (6-17 years old) of adult participants who participate in the
study.
What are the possible foreseeable risks, discomforts, and benefits of this research?
Discomforts and Risks. We do not expect any risk to you as a result of taking part in
this study. However, you may feel a little uncomfortable during some of the discussion
groups because they deal with personal issues such as eating behaviors and being
overweight. Also, you may feel embarrassed when your height, weight, blood
pressure, and/or heart rate are measured and recorded by a trained health professional
(this data will be collected in a private area, and will be kept strictly confidential).
Finally, some of the study-related activities (e.g., exercising and eating a healthy diet)
may present a risk to you. For example, exercising without stretching properly first
may lead to injury, and some people may be allergic to some foods (even healthy
ones). Therefore, as with all exercise and nutrition programs, we strongly encourage
you to consult a physician before you change your physical exercise or eating
behaviors.
Benefits. You may or may not benefit from taking part in this research study. The
possible benefits of taking part in this study include improved overall health status due
to weight loss, lowered blood pressure, and/or better ability to deal with stress and
depression. If you achieve such health benefits while in the program, it will likely be
because the program helped you eat healthier, become more physically active, and feel
better emotionally.
What other choices do you have if you do not want to be in this study?
44
The alternative to taking part in this study is to do nothing. If you do not want to take part in
this study, do not sign this Informed Consent Form.
How will your study records be maintained and who will have access to them?
Study records will be stored in secure, locked filing cabinets, drawers, or closets, on
computer servers with secure passwords, or on encrypted electronic storage devices. The
study Principal Investigator, Dr. Carolyn M. Tucker, and her research staff, and the
University of Florida Institutional Review Board will have access to your study records.
Will it cost you anything to take part in this study?
It will not cost you anything to take part in this research study.
When may you be told about new findings which may affect your willingness to keep
taking part in this study?
Throughout the study, the researchers will notify you of new information that may become
available and might affect your decision to remain in the study.
If you agree to participate in this study, you will be given a signed copy of this document.
You may contact Dr. Carolyn M. Tucker at (352) 273-2167 or 1-866-290-5770 (toll-free) at any
time if you have questions about the research or if you think that you have been hurt by the
research.
You may contact the Institutional Review Board at the University of Florida Health Science
Center at (352) 273-9600 if you have questions about your rights as a research subject or what to
do if you are injured.
You may choose not to be in this study or you may quit being in the study at any time and there
will be no penalty and no loss of any benefits you are entitled to.
If you agree to participate in this study, the Principal Investigator will create, collect, and use
private information about you and your health. This information is called protected health
information or PHI. In order to do this, the Principal Investigator needs your authorization.
More specifically, the following information may be collected, used, and shared with others:
Demographic information, such as your first and last name, date of birth, marital status,
age, and gender.
Your responses to questions about what motivates and makes it harder for you to eat
healthy and engage in physical activity, your eating and physical activity behavior,
depressing and stressful events in your life, etc.
Your weight, height, blood pressure, and heart rate.
This information will be stored in locked filing cabinets or in secure computer servers with security
passwords.
45
Your PHI may be collected, used, and shared with others for the following study-related
purpose(s):
To evaluate the effectiveness of the AME Health-Smart Church Model Program in helping
AME church members eat healthier and become more physically active, lose weight, reduce
their blood pressure, and feel better emotionally. (Note, however, that any presentations or
publications to the general public regarding this study will only include data in aggregate
form—i.e., the data will be in a format such that individual study participants cannot be
identified.)
Once this information is collected, it becomes part of the research record for this study.
Only certain people have the legal right to collect, use and share your research records, and they
will protect the privacy and security of these records to the extent the law allows. These people
include:
the study Principal Investigator, Dr. Carolyn M. Tucker, and research staff associated with
this project.
other professionals at the University of Florida that provide study-related treatment or
procedures.
AME church leaders (i.e., Health Empowerment Coach Trainers) and retired or non-retired
health professionals (e.g., nurses) who are collaborating with Dr. Tucker and her research
team to implement this study.
The University of Florida Institutional Review Board (IRB; an IRB is a group of people
who are responsible for looking after the rights and welfare of people taking part in
research).
Your PHI may be shared with:
the study sponsor (Florida Blue Foundation).
United States and foreign governmental agencies who are responsible for overseeing
research, such as the Food and Drug Administration, the Department of Health and Human
Services, and the Office of Human Research Protections.
government agencies who are responsible for overseeing public health concerns such as the
Centers for Disease Control and federal, state and local health departments.
Otherwise, your research records will not be released without your permission unless required by
law or a court order. It is possible that once this information is shared with authorized persons, it
could be shared by the persons or agencies who receive it and it would no longer be protected by
the federal medical privacy law.
Your PHI will be used and shared with others until the end of the study.
You are not required to sign this consent and authorization to allow researchers to collect, use and
share your PHI. Your refusal to sign will not affect your treatment, payment, enrollment, or
46
eligibility for any benefits outside this research study. However, you cannot participate in this
research unless you sign this consent and authorization.
You have the right to review and copy your protected health information. However, we can make
this available only after the study is finished.
You can revoke your authorization at any time before, during, or after your participation in this
study. If you revoke it, no new information will be collected about you, but information that was
already collected may still be used and shared with others if the researchers have relied on it to
complete the research. You can revoke your authorization by giving a written request with your
signature on it to the Principal Investigator.
Signing this document means that the research study, including the above information, has been
described to you orally and/or that you have read this document, and you voluntarily agree to
take part.
________________________________ ______________
Signature of Person Obtaining Consent Date
________________________________ ______________
Consent and Authorization of Participant Date
Consent to be Photographed, Video and/or Audio Recorded
With your permission, you will have the following done during this research (check all that
apply):
photographed video recorded audio
recorded
Your name or personal information will not be identified on the photograph(s), video or
audio recordings, and confidentiality will be strictly maintained. However, when these
photograph(s), video and/ or audio recordings are shown or heard, others may be able to
identify you.
The Principal Investigator (PI) of this study, Dr. Carolyn M. Tucker, or her successor, will
keep the photograph(s), video and/or audio recordings in a locked cabinet, in a folder on a
password protected computer server drive, or as an encrypted electronic file. These
photograph(s), video and/or audio recordings will be shown under her direction to students,
researchers, doctors, or other professionals and persons.
Please indicate under what conditions Dr. Carolyn M. Tucker has your permission to use
the photograph(s), video and/or audio recordings, and sign and date below.
47
The following will be destroyed once the study is closed (initial next to all that apply):
____ photograph(s) _____ video
recording(s) _____ audio recording(s)
As described in the Informed Consent Form, and for the purposes of education at the
University of Florida Health Science Center. The PI may keep the following for an indefinite
period of time in a locked file, in a password protected computer server drive, or as an encrypted
electronic file (initial next to all that apply):
____ photograph(s) _____ video
recording(s) _____ audio recording(s)
As described in the Informed Consent Form; for the purposes of education at the
University of Florida Health Science Center; and for presentations at scientific meetings
outside the University. The PI may keep the following for an indefinite period of time in a
locked file, in a password protected computer server drive, or as an encrypted electronic file
(initial next to all that apply):
____photograph(s) _____video
recording(s) _____audio recording(s)
__________________________________________________________________
_________________________________
Signature Date
48
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56
BIOGRAPHICAL SKETCH
Victoria Rodríguez was born and raised in Miami, Florida. She obtained a Bachelor of
Arts in women and gender studies from Washington University in St. Louis in May 2010. She
then attended Florida International University and graduated with a Master of Social Work in
April of 2012. She remained in Miami for the next three years working at the Tobacco, Obesity,
and Oncology Laboratory, a health psychology research laboratory at the University of Miami.
Victoria relocated to Gainesville, Florida in August 2015 to begin her doctoral studies in
counseling psychology with Dr. Carolyn Tucker at the University of Florida.