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Preliminary Investigation of Civic Engagement as a Novel Approach to Behavior Change and Body Weight Improvement in African American Females: The Change Club Study

Sara C. Folta, PhD

+Study Team

Co-I: Linda Hudson, ScD, MSPH

Co-I: Nesly Metayer, PhD

Research Assistants: Deena Altschwager, Claire Anglim, Maria Berrone, Nicole Chenard, Rich Fair, Cailin Kowaleski, Namibia Lebron-Torres, Shenglin Zheng

Project Manager: Alison Brown, MS

Statistician: Kenneth Chui, PhD

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+ African American women: the issue n 82% of overweight or obese1

n 48% have cardiovascular disease2

n Weight loss trials may perpetuate disparities3

1Ogden CL JAMA 2014 2American Heart Association Fact Sheet 2015 Update 3Fitzgibbon ML Obes Rev 2012; Wingo BC Obes Rev 2014

+Purpose To develop a new intervention strategy that will help alleviate health disparities, thereby improving quality of life, health care costs, and disease burden in African American women

n Central hypothesis: civic engagement represents a feasible and effective means of realizing behavior change to improve weight status and health in African American women.

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+Why civic engagement?

n  “Individual and collective actions designed to identify and address issues of public concern”

n  StrongWomen Across America

Seguin RA, Folta SC, Sehlke M, Nelson ME, Heidkamp-Young E, Fenton M, Junot B. The StrongWomen Change Clubs: Engaging residents to catalyze positive change in food and physical activity environments. Journal of Environmental and Public Health 2014

+Why civic engagement?

n  Focuses on strengths n  Cultural assets

n  Empowerment

n  Theoretical justification

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Community/Environment

Group/Collective

Individual – participation in civic engagement

through Change Clubs

Environmental Change •  Policies enacted and changes in

built environment related to access to healthful food and opportunities for physical activity

Collective Change •  Collective efficacy •  Social support

Psychosocial Change •  Improved self-regulation •  Improved self-efficacy •  Lower perceived stress

Behavior Change •  Increased

physical activity

•  Improved dietary intake

•  Improved body weight •  Improved % body fat •  Improved

cardiorespiratory fitness •  Improved blood

pressure

+Specific Aims

n  Feasibility n  Hypothesis 1a: Adherence 80% or better

n  Hypothesis 1b: Retention and satisfaction 85% or better

n  Hypothesis 1c: Change Clubs will meet at least 50% of self-identified benchmarks for community change within 6 months

n  Preliminary Effectiveness n  Hypothesis: Change Club participants will realize pre-post trends

for improvements in anthropometric factors, diet and physical activity behaviors, blood pressure, cardiorespiratory fitness, and psychosocial factors

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+Study Design & Inclusion Criteria

n  Pre-post design

n  Groups of women in 4 churches

n  Inclusion criteria: n  Female

n  Age 30-70 years

n  Self-identified as African American

n  English-speaking

n  BMI ≥25.0

n  Currently sedentary (not meeting Physical Activity Guidelines for Americans)

n  Safe to initiate moderate physical activity

+The Change Club Intervention

n  Month 1: Togetherness and Unity

n  Month 2: The Need

n  Month 3: Planning

n  Month 4: Action

n  Month 5: Action II

n  Month 6: Next Steps

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n  Month 3: Planning for Next Steps




+Change of Heart Club, The Intersection Church, Dorchester

Noble Purpose: To increase access to heart-healthy food among those most in need

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+Heartwise Change Club, St Mary’s Church, Dorchester

Noble Purpose: To increase access to and use of healthy and culturally appropriate foods in the community

+Graceful Healthy Heart Crusaders, Grace Church of All Nations, Dorchester

Noble purpose: To provide information to the greater church community to promote healthier lifestyles

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+Healing WholeHEARTedly Club, Jubilee Christian Church, Mattapan (underway)

Noble Purpose: To inform and educate the community in making healthy eating and fitness choices

+Assessment Methods

n Feasibility: n Adherence. Attendance for weekly

meetings n Retention. Completion of post-intervention

assessments n Satisfaction with the intervention. Survey at

3 months and post-intervention

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Group/Collective








physical activity




pressure

Assessments: Effectiveness


Group/Collective








physical activity




pressure


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Group/Collective








physical activity




pressure


+ Results: Demographics (4 Clubs) Characteristic Mean ± SD or No. (%) Age, years 50.5 ± 9.3

Education Some high school High school graduate Associate’s degree Bachelor’s degree Graduate degree

1 (3.6)

12 (42.9) 3 (10.7) 6 (21.4) 6 (21.4)

Income Less than $25,000 $25,000-$75,000 More than $75,000

7 (25.9)

12 (44.4) 8 (29.6)

Marital Status Single Married Widowed/Divorced

12 (42.9) 10 (35.7) 6 (21.4)

Employment Unemployed Part-time Full-time

5 (17.9) 7 (25.0)

16 (57.1)

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+Results: Baseline (4 Clubs)

Measure Mean ± SD

Physical activity 13.0 ± 8.8 min MVPA/day

Calorie intake 1824 ±965 kcals/day

Fruit intake 1.3 ± 1.4 cup equivalents/day

Vegetable intake 2.2 ± 1.4 cup equivalents/day

Body weight 206.2 ± 35.3

% Body fat 45.6 ± 5.4

Cardiorespiratory fitness 22:05 ± 3:18 completion time

Systolic blood pressure 137.4 ± 23.8 mm Hg

Diastolic blood pressure 81.9 ±10.5 mm Hg

+Results: Feasibility (3 Change Clubs)

n  Adherence: 76.3%

n  Retention: 85.7%

n  Satisfaction: All participants were satisfied with the Change Club progress and with the overall experience

n  Completion of Benchmarks: All 3 Change Clubs met all self-identified benchmarks for community change within approximately 6 months

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+ Results: Pre-post assessments (3 Clubs, N=18) Measure Pre-post change (95% CI) P-value

Physical activity 0.12 min MVPA/day (-3.7 to 3.9) 0.9

Calorie intake* -72.5 (-441.3 to 296.4) 0.7

Fruit intake* 0.7 cup equivalents per day (-0.1 to1.6)

0.09

Vegetable intake* 0.4 cup equivalents per day (-0.7 to 1.5)

0.5

Body weight 0.9 lb (-2.4 to 4.2) 0.6

% Body fat -1.2% (-2.0 to -0.4) 0.005

Cardiorespiratory fitness

-1:41 min:sec (-2:53 to -0:31) 0.005

Systolic blood pressure

-10.3 mm Hg (-16.8 to -3.7) 0.002

Diastolic blood pressure

-2.9 mm Hg (-6.6 to -0.8) 0.12

*2 Clubs, N=15

+Conclusions (to date)

n Reasonable demonstration of feasibility

n Preliminary effectiveness

n Challenges

n Next steps

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+Acknowledgments

The Change Club Study Team

The Change Club participants at The Intersection, St Mary’s, Grace Church of All Nations, and Jubilee Christian Church

The StrongWomen Across American Team: Miriam Nelson, Rebecca Seguin, and Eleanor Heidkamp-Young

Boston Nutrition Obesity Research Center Clinical and Community Core & Aviva Must The Tisch Faculty Fellow Program at Tufts University

friedman seminar 2015-11-04

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