Smart Walk: A Culturally Tailored Smartphone-Delivered Physical Activity Intervention for Cardiometabolic Risk Reduction among African American Women.

This article reports the results of Smart Walk: a randomized pilot trial of an 8-month culturally tailored, smartphone-delivered physical activity (PA) intervention for African American women with obesity. Sixty participants (age range = 24−49 years; BMI range = 30−58 kg/m2) were randomized to the Smart Walk intervention (n = 30) or a wellness comparison intervention (n = 30). Results supported the acceptability and feasibility of the intervention, as demonstrated by participant retention (85% at 4 months and 78% at 8 months), Smart Walk app use, and intervention satisfaction (i.e., 100% of PA participants completing the intervention [n = 24] reported they would recommend it to friend). Smart Walk participants also reported greater increases in moderate-to-vigorous PA (4-month between-arm difference in change [b] = 43.3 min/week; p = 0.018; Cohen's d = 0.69; 8-month b = 56.6 min/week; p = 0.046; d = 0.63) and demonstrated clinically relevant, although not statistically significant (p-values > 0.05), baseline to 4 months improvements in cardiorespiratory fitness (b = 1.67 mL/kg/min; d = 0.40), systolic blood pressure (b = −3.33 mmHg; d = 0.22), diastolic blood pressure (b = −4.28 mmHg; d = 0.37), and pulse wave velocity (b = −0.46 m/s; d = 0.33). Eight-month cardiometabolic outcomes followed similar trends, but had high rates of missing data (45−53%) due to COVID-19 restrictions. Collectively, findings demonstrated favorable outcomes for acceptability and feasibility, while also highlighting key areas for refinement in future research.

Cardiometabolic Risk Factors Among Insufficiently Active African American Women With Obesity: Baseline Findings From Smart Walk.

BACKGROUND: Low moderate-to-vigorous physical activity (MVPA) levels and obesity are associated with increased cardiometabolic disease risk. OBJECTIVE: The aim of this study was to describe MVPA and cardiometabolic risk characteristics of insufficiently active African American women with obesity (N = 60) enrolled in a culturally tailored MVPA intervention. METHODS: We assessed accelerometer-measured and self-reported MVPA, blood pressure, serum lipid profiles, cardiorespiratory fitness (VO 2 peak), and aortic pulse wave velocity. RESULTS: Participants (mean age, 38.4; mean body mass index, 40.6 kg/m 2 ) averaged 15 min/d of accelerometer-measured MVPA and 30 min/wk of self-reported MVPA. Systolic and diastolic blood pressure levels were elevated (135.4 and 84.0 mm Hg, respectively). With the exception of low-density lipoprotein cholesterol (121.4 mg/dL) and high-density lipoprotein cholesterol (47.6 mg/dL), lipid profiles were within reference ranges. Compared with normative reference values, average VO 2 peak was low (18.7 mL/kg/min), and pulse wave velocity was high (7.4 m/s). CONCLUSIONS: Our sample of insufficiently active African American women with obesity was at an elevated risk for cardiometabolic disease.

Theoretical Mediators of Diabetes Risk and Quality of Life Following a Diabetes Prevention Program for Latino Youth With Obesity.

PURPOSE: This study tested self-efficacy and social support for activity and dietary changes as mediators of changes in type 2 diabetes related outcomes following a lifestyle intervention among Latino youth. SETTING AND INTERVENTION: Latino adolescents (14-16 years) with obesity (BMI% = 98.1 ± 1.4) were randomized to a 3-month intervention (n = 67) that fostered self-efficacy and social support through weekly, family-centered sessions or a comparison condition (n = 69). MEASURES: Primary outcomes included insulin sensitivity and weight specific quality of life. Mediators included self-efficacy, friend, and family social support for health behaviors. Data was collected at baseline, 3-months, 6-months, and 12-months. ANALYSIS: Sequential path analysis was used to examine mediators as mechanisms by which the intervention influenced primary outcomes. RESULTS: The intervention had a direct effect on family (ß = 0.33, P < .01) and friend social support (ß = 0.22, P < .001) immediately following the intervention (3-months). Increased family social support mediated the intervention's effect on self-efficacy at 6-months (ß = 0.09, P < .01). However, social support and self-efficacy did not mediate long-term changes in primary outcomes (P > .05) at 12-months. CONCLUSIONS: Family social support may improve self-efficacy for health behaviors in high-risk Latino youth, highlighting the important role of family diabetes prevention. Fostering family social support is a critical intervention target and more research is needed to understand family-level factors that have the potential to lead to long-term metabolic and psychosocial outcome in vulnerable youth.

Results of a Culturally Tailored Smartphone-Delivered Physical Activity Intervention Among Midlife African American Women: Feasibility Trial.

BACKGROUND: Regular aerobic physical activity (PA) is an important component of healthy aging. However, only 27%-40% of African American women achieve national PA guidelines. Available data also show a clear decline in PA as African American women transition from young adulthood (ie, 25-44 years) into midlife. This decline in PA during midlife coincides with an increased risk for African American women developing cardiometabolic disease conditions, including obesity, type 2 diabetes, and cardiovascular disease. Thus, effective efforts are needed to promote PA among sedentary African American women during midlife. OBJECTIVE: This study aims to examine the acceptability and feasibility of a culturally tailored, smartphone-delivered PA intervention, originally developed to increase PA among African American women aged 24-49 years, among a slightly older sample of midlife African American women aged 50-65 years. METHODS: A single-arm pretest-posttest study design was implemented. In total, 20 insufficiently active African American (ie, ≤60 min per week of PA) women between the ages of 50-65 years participated in the 4-month feasibility trial. The Smart Walk intervention was delivered through the study Smart Walk smartphone app and text messages. Features available on the Smart Walk app include personal profile pages, multimedia PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported PA and social cognitive theory mediators targeted by the intervention (ie, self-regulation, behavioral capability, outcome expectations, self-efficacy, and social support) were assessed at baseline and at 4 months. Feasibility and acceptability were assessed using a postintervention satisfaction survey that included multiple-choice and open-ended questions evaluating participant perceptions of the intervention and suggestions for intervention improvement. Wilcoxon signed-rank tests were used to examine pre- and postintervention changes in the PA and social cognitive theory variables. The effect size estimates were calculated using the Pearson r test statistic. RESULTS: Participants increased moderate-to-vigorous PA (median 30 minutes per week increase; r=0.503; P=.002) and reported improvements in 2 theoretical mediators (self-regulation: r=0.397; P=.01; behavioral capability: r=0.440; P=.006). Nearly all participants (14/15, 93% completing the satisfaction survey) indicated that they would recommend the intervention to a friend. Participants' suggestions for improving the intervention included enhancing the intervention's provisions of social support for PA. CONCLUSIONS: The results provide preliminary support for the feasibility of the smartphone-based approach to increase PA among midlife African American women. However, before larger-scale implementation among midlife African American women, enhancements to the social support components of the intervention are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT04073355; https://clinicaltrials.gov/ct2/show/NCT04073355.

Yields and costs of recruitment methods with participant phenotypic characteristics for a diabetes prevention research study in an underrepresented pediatric population.

BACKGROUND/AIMS: Prediabetes and diabetes disproportionately impact Latino youth, yet few diabetes prevention programs have prioritized inclusion of this underrepresented population. This report describes the recruitment process, yields, associated costs, and phenotypic characteristics of Latino youth with obesity and prediabetes enrolled in a randomized controlled diabetes prevention study in the USA. METHODS: Recruitment efforts included referrals from clinics, community outlets, local media, and word of mouth with the goal of enrolling 120 Latino adolescents aged 12-16 with obesity (BMI > 95th percentile) and prediabetes. Prediabetes eligibility was determined by any of the following: HbA1c between 5.7 and 6.5%, fasting glucose between 100 and 125 mg/dL, or a 2-h glucose between 120 and 199 mg/dL following a 75-g oral glucose tolerance test (OGTT), but not meeting any of the diagnostic criteria for diabetes. Eligible participants were randomized 2:1 to either a 6-month community-based lifestyle intervention that included group nutrition and health education classes (1 day/week) and group exercise classes (2 days/week) or usual care control arm. Recruitment yields were determined by review of referral source in the study screening database. Recruitment costs were determined by an after-the-fact financial review of actual and in-kind costs. Participant phenotypic characteristics (i.e., demographics, anthropometrics, and biochemical data) were compared by recruitment strategy using a one-way ANOVA. RESULTS: Recruitment efforts covered 160 mile2 (414 km2) across 26 ZIP codes (postcode) in the Phoenix Metropolitan Area and yielded 655 referrals from clinics (n = 344), community (n = 143), media (n = 137), and word-of-mouth (n = 31). From this pool, 26% (n = 167) did not meet general, pre-screening eligibility criteria; 29% (n = 187) declined participation; and 10% (n = 64) were unable to be contacted. A total of 237 youth were invited to the clinical research unit to determine final eligibility. Following the OGTT, 52% (n = 122) met prediabetes criteria and 117 were subsequently randomized. Clinical recruitment yielded the highest number of referrals (53%; n = 344) while word-of-mouth yielded the highest proportion (35%; n = 11) of randomized participants per referred youth. There were no significant differences in anthropometric or biochemical measures among youth by recruitment strategy. Based upon final enrollment numbers, community recruitment was the costliest approach ($486/randomized participant) followed by clinical ($248/randomized participant) and media ($236/randomized participant). CONCLUSIONS: The ability to meet enrollment goals for a clinical trial of an underrepresented population required multiple recruitment strategies. Although strategies vary in yields and costs, it appears they produce similar phenotypical risk profiles of eligible youth. TRIAL REGISTRATION: ClinicalTrials.gov NCT02615353 . Registered on 26 November 2015.

Familism, Self-Esteem, and Weight-Specific Quality of Life Among Latinx Adolescents With Obesity.

OBJECTIVE: Obesity is a critical public health condition affecting Latinx adolescents and contributes to health disparities across the lifespan. Childhood and adolescent obesity is associated with reduced quality of life (QoL) and decreased self-esteem. The purpose of this study is to examine the role of cultural (e.g., familism) and psychosocial (e.g., self-esteem) factors as predictors of weight-specific QoL among Latinx adolescents with obesity. METHODS: Baseline data from 160 Latinx adolescents (ages 14-16 years) with obesity (BMI > 95th percentile for age and sex) who were recruited for a diabetes prevention intervention were used. Structural equation modeling tested the relationships between four latent constructs (familism, positive self-esteem, self-deprecation, and weight-specific QoL). RESULTS: The model tested paths from familism to positive self-esteem, self-deprecation, and weight-specific QoL, and paths from positive self-esteem and self-deprecation to weight-specific QoL. Higher familism was positively associated with positive self-esteem but not self-deprecation. In turn, positive self-esteem was positively associated with higher weight-specific QoL, whereas self-deprecation was negatively associated. Furthermore, there was an indirect effect of familism on QoL via positive self-esteem. CONCLUSIONS: These data shed light into specific cultural and psychosocial constructs that influence QoL among Latinx adolescents with obesity. This study suggests that familism and positive self-esteem can operate as protective factors associated with higher weight-specific QoL in Latinx adolescents with obesity; whereas self-deprecation may operate as a risk factor for lower weight-specific QoL.

A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk.

BACKGROUND: Smart Walk is a culturally relevant, social cognitive theory-based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women. OBJECTIVE: This study aimed to describe the development and initial usability testing results of Smart Walk. METHODS: Smart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results. RESULTS: The 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week. CONCLUSIONS: The development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention.

Sex as a moderator of body composition following a randomized controlled lifestyle intervention among Latino youth with obesity.

BACKGROUND: Body composition differences between males and females emerge during adolescence and continue throughout adulthood; however, whether sex moderates body composition changes in adolescents with obesity after an intervention is unknown. OBJECTIVE: To examine sex as a moderator of changes in adiposity following lifestyle intervention. METHODS: A total of 136 Latino youth with obesity (BMI% 98.2 ± 1.3) aged 14 to 16 years old were randomized to either a 12-week lifestyle intervention (27 males/40 females) or control (35 males/34 females) group. The intervention included nutrition education (1 h/wk) and moderate-to-vigorous physical activity (3 h/wk). Anthropometric data (body mass index [BMI], BMI%, waist circumference, total body fat, and fat-free mass) were obtained pre- and post-intervention. Sex differences were examined by general linear models with significance determined at P < .05 for the F-statistic. RESULTS: Sex did not moderate changes in BMI (F1,115 = 0.01, P = .9), BMI% (F1,115 = 0.14, P = .7), or waist circumference (F1,117 = 1.1, P = .3). Sex significantly moderated changes in body fat percent (F1,117 = 5.3, P = .02), fat mass (F1,116 = 4.5, P = .04), and fat-free mass (F1,116 = 4.3, P = .04). Intervention males compared with females had greater relative reductions in fat percent (-4.1 ± 0.8% vs -1.2 ± 0.7%, P = .02) and fat mass (-5.0 ± 1.1 kg vs -1.5 ± 0.9 kg, P = .02) and gained more fat free mass (3.6 ± 0.9 kg vs 0.5 ± 0.8 kg, P = .02) when compared with same sex controls. CONCLUSION: Males and females exhibited a differential response to lifestyle intervention for percent fat, fat mass, and fat-free mass indicating that sex-specific improvements in body composition favours males over females.

Interventions for Cardiovascular Disease Risk Reduction in Korean Americans: A Systematic Review.

This systematic review was to identify and synthesize literature that described the cultural appropriateness and effectiveness of interventions aimed at cardiovascular risk reduction in Korean Americans. We searched multiple electronic databases for studies published between January 2000 and August 2017 and identified 14 eligible research reports. All reviewed studies targeted first-generation Korean American adults. Most of the reviewed studies incorporated components of surface structure, and leveraged deep structure in those interventions. Significant changes in cardiovascular health outcomes were reported in most of the reviewed studies; however, the role of cultural factors in the outcomes was rarely evaluated, and few reported long-term effects. Future research needs to consider long-term effects. Deploying cultural factors and evaluating their contributions to the target outcomes will enhance the research on cardiovascular health disparities.

Rationale and design of Smart Walk: A randomized controlled pilot trial of a smartphone-delivered physical activity and cardiometabolic risk reduction intervention for African American women.

BACKGROUND: African American (AA) women perform low levels of physical activity (PA) and are disproportionally burdened by cardiometabolic disease conditions when compared to White women and the U.S. population as a whole. These disparities emphasize the need for innovative and effective interventions to increase PA and reduce cardiometabolic disease risk among AA women. Recent evidence suggests that mobile health (mHealth) interventions have the potential to increase PA and reduce cardiometabolic disease risk factors. Few studies have examined the efficacy of mHealth PA interventions among racial/ethnic minorities, including AA women. This represents a missed opportunity given the reported success of technology-delivered PA interventions in predominately White populations and the high use of technology among AA women. OBJECTIVE: To describe the design, theoretical rationale, and cultural relevance of Smart Walk, a culturally sensitive smartphone-delivered PA intervention for AA women. DESIGN AND METHODS: Smart Walk is an 8-month, randomized controlled pilot trial designed to increase PA and reduce cardiometabolic disease risk among AA women. Sixty physically inactive AA women with obesity will be assigned to receive either a culturally relevant intervention designed to increase PA (by targeting leisure-time, household chore/task-related, and occupational PA) or a culturally relevant wellness attention-matched control condition. Outcomes will be assessed at baseline, 4 months, and 8 months, and include feasibility and acceptability of the PA intervention and evaluation of effects on PA and cardiometabolic risk factors. SUMMARY: Smart Walk represents a culturally relevant, theory-based approach to promote PA and reduce cardiometabolic disease risk in AA women.

Decreased GlycA after lifestyle intervention among obese, prediabetic adolescent Latinos.

BACKGROUND: Obese youth with prediabetes are at increased risk for premature morbidity and mortality through multiple mechanisms, including increased systemic inflammation. GlycA is a novel measure of systemic inflammation that predicts type II diabetes, cardiovascular events, and all-cause mortality in adults. OBJECTIVE: The purpose of the present study was to examine changes in GlycA after lifestyle intervention among obese, prediabetic Latino youth. METHODS: Obese, prediabetic Latino youth (n = 27; 15.5 ± 1.1 years, 13 males/14 females) completed a 12-week lifestyle intervention that included weekly nutrition education and 3 d/wk of moderate to vigorous physical activity. Prediabetes was characterized by an expanded definition of impaired glucose tolerance, using 2-hour glucose ≥120 mg/dL after an oral glucose tolerance test. GlycA was assessed at baseline and 12 weeks using nuclear magnetic resonance spectroscopy. RESULTS: After the lifestyle intervention, GlycA was significantly reduced (445.3 ± 51.3 µmol/L to 419.0 ± 50.0 µmol/L, P = .01) (mean ± standard deviation). Additional improvements were observed in multiple cardiovascular risk factors, including body mass index (BMI; 34.8 ± 5.0 kg/m2 to 34.0 ± 5.1 kg/m2, P < .001), total cholesterol (154.1 ± 30.3 mg/dL to 143.3 ± 29.1 mg/dL, P = .003), and 2-hour glucose (141.0 ± 13.2 mg/dL to 115.9 ± 31.4 mg/dL, P < .001). Decreases in GlycA were associated with decreases in 2-hour glucose (r = 0.49, P = .008) and BMI (r = 0.41, P = .03). CONCLUSION: These data are consistent with the hypothesis that lifestyle intervention might improve GlycA levels in obese, prediabetic adolescent Latinos, but randomized trial evidence is needed. Healthy lifestyle modifications among high-risk youth may decrease future risk of cardiometabolic disease through reducing systemic inflammation, in addition to improving traditional cardiovascular risk factors.

Effects of a Community-Based Diabetes Prevention Program for Latino Youth with Obesity: A Randomized Controlled Trial.

OBJECTIVE: This study examined the short- and long-term effects of a community-based lifestyle intervention among Latino youth with obesity. METHODS: Latino adolescents (14-16 years old) were randomized to a 3-month lifestyle intervention (n = 67) or comparison control (n = 69) and followed for 12 months. The intervention included weekly nutrition and health classes delivered to groups of families and exercise sessions (3 days/week) delivered to groups of adolescents. Comparison youth received laboratory results and general health information. Primary outcomes included insulin sensitivity and weight-specific quality of life (QoL) with secondary outcomes of BMI percentile (BMI%), waist circumference, and percent body fat. RESULTS: At 3 months, youth in the intervention group exhibited significant increases in insulin sensitivity (P < 0.05) and weight-specific QoL (P < 0.001), as well as reductions in BMI%, waist circumference, and percent body fat compared with controls. Increases in weight-specific QoL and reductions in BMI% and percent body fat remained significant at 12 months (P < 0.001), while changes in insulin sensitivity did not. In a subsample of youth with prediabetes at baseline, insulin sensitivity (P = 0.01), weight-specific QoL (P < 0.001), and BMI% (P < 0.001) significantly improved at 3 months. CONCLUSIONS: Lifestyle intervention can improve cardiometabolic and psychosocial health in a vulnerable population of Latino adolescents at high risk for developing type 2 diabetes.

The Use of Family Rituals in Eating Behaviors in Hispanic Mothers.

Food rituals often abruptly change when Hispanic families migrate to the United States. This report describes changes in rituals of food procurement, preparation, and presentation (food-PPP) in Hispanic women following migration to the United States. Focus groups and face-to-face interviews were conducted with 13 low-income, overweight/obese Hispanic women 27 to 40 years of age. Content analysis was used to analyze cultural and contextual sources for food-PPP. Changes in rituals and traditions in food-PPP occurred, including materials and ingredients for traditional meals. Food rituals may play a role in healthful eating and could, therefore, serve as leverage points for interventions designed to promote healthy eating behaviors.

Acculturation and Physical Activity Among Latinas Enrolled in a 12-Month Walking Intervention.

This report evaluates the relationship between acculturation and assimilation with the physical activity (PA) outcomes of a 12-month walking intervention for postpartum Latinas ( n = 81, M age = 29.2 years, M BMI [body mass index] = 30.0). PA was measured by ActiGraph GT1M accelerometers. Acculturation and assimilation were measured by the Hazuda Acculturation and Assimilation Scales. Data were collected at baseline, 6 months, and 12 months. Results showed a trend for participants classified in the least acculturated groups to engage in more moderate-to-vigorous PA than participants classified in the higher acculturated/assimilated groups for two dimensions of acculturation (Adult Proficiency in English Versus Spanish, p = .002; Adult Pattern of English Versus Spanish Language Usage, p = .001) and two dimensions of assimilation (Childhood Interaction With Members of Mainstream Society, p = .028; Adult Functional Integration With Mainstream Society, p ≤ .001). No other significant effects were observed. Findings highlight the continued need to understand the context in which acculturation and assimilation influence PA.

Cultural Factors relevant to Korean Americans in Health Research: A Systematic Review.

To eliminate health disparities in the United States, identifying cultural contexts salient to the target populations in an intervention study is critical; however, little research has been conducted on the identification of cultural contexts among Korean Americans who have significant risk factors for chronic diseases. This systematic review identifies critical cultural contexts central to the literature discussed in health research on Korean Americans. We examined 14 research reports of 801 potentially eligible articles published between 2000 and 2016 and analyzed their contribution to cultural contexts among Korean Americans based on the PEN-3 model. This review highlights how cultural contexts impact health and health behaviors of Korean Americans, and may contribute to health disparities in the United States. The key cultural contexts highlighted in this review include social support/social network, family, gender role expectations, and a holistic view of health and illness. These cultural contexts should be incorporated in designing culturally relevant, effective, and sustainable health interventions for Korean Americans, which will contribute to eliminating health disparities for this ethnic group who experience great obstacles to healthcare access and healthy behaviors.

Cardiovascular Disease in Korean Americans: A Systematic Review.

BACKGROUND: Despite Korean Americans being one of the fastest growing immigrant groups in the United States, little is known about their cardiovascular health or cardiovascular disease risk factors. PURPOSE: The purpose of this report is to describe the prevalence of cardiovascular disease risks and their contributing factors in Korean Americans and recommend future directions for the development of cardiovascular disease prevention or management research to meet the unique needs of this ethnic group. METHODS: We conducted a systematic review using databases of PubMed, CINAHL, PsycINFO, Web of Science, and the Cochrane Database of Systematic Reviews and identified 27 studies that reported the prevalence of cardiovascular disease or its risk factors in Korean Americans, published in English between 2000 and 2016. RESULTS: We found high rates of unhealthy behaviors (eg, consumption of a high-sodium diet, physical inactivity, smoking) and risk factors (eg, hypertension, diabetes) for cardiovascular disease. Moreover, they were less likely to receive counseling about their diseases from healthcare providers and modify their lifestyle (eg, reduce their diet sodium intake, control their weight) to manage their diseases than were other ethnic populations. Individual-, interpersonal-, community-, and societal-level influences contributed to the high prevalence of cardiovascular risk factors. CONCLUSIONS: Data on subgroups of Asian Americans indicate that Korean Americans have significant lifestyle-related cardiovascular disease risks, which could be a critical agenda for researchers and clinicians to better understand cardiovascular health disparities in the United States.

Incorporating religion and spirituality into the design of community-based physical activity programs for African American women: a qualitative inquiry.

OBJECTIVE: Limited research has examined how aspects of religion and spirituality can be incorporated into community-based physical activity programs delivered outside of religious institutions. The purpose of this study was to qualitatively explore how spirituality and religion can be leveraged in the design of community-based physical activity programs for African American women delivered outside of faith-based or faith-placed settings. RESULTS: Three focus groups were conducted were conducted with 23 African American women (M age = 37.8 years, M BMI = 39.6 kg m2). Results showed that incorporating aspects of spirituality (i.e., words encouraging connectedness to a higher power, meditation, mind-body activities) into a physical activity program was universally accepted among participants, regardless of religious affiliation. In contrast, including concepts of religion (i.e., bible verses and/or quotes from religious leaders) was controversial and not recommended among women who did not identify with a religious faith. Findings indicate that when developing community-based physical activity interventions that will not be delivered through faith-based or faith-placed settings, researchers should avoid references to specific religious beliefs. Instead, interventions should focus on spirituality and emphasize the mind-body relationship between physical activity and an African American women's inner-being and her connectedness with a higher power. Trial Registration ClinicalTrials.gov NCT02823379. Registered July 1, 2016.

Utility of Social Cognitive Theory in Intervention Design for Promoting Physical Activity among African-American Women: A Qualitative Study.

OBJECTIVE: We examined the cultural relevance of Social Cognitive Theory (SCT) in the design of a physical activity intervention for African-American women. METHODS: A qualitative study design was used. Twenty-five African-American women (Mean age = 38.5 years, Mean BMI = 39.4 kg·m2) were enrolled in a series of focus groups (N = 9) to elucidate how 5 SCT constructs (ie, Behavioral Capability, Outcome Expectations, Self-efficacy, Self-regulation, Social Support) can be culturally tailored in the design of a physical activity program for African-American women. RESULTS: For the construct of Behavioral Capability, participants were generally unaware of the amount, intensity, and types of physical activity needed for health benefits. Outcome Expectations associated with physical activity included increased energy, improved health, weight loss, and positive role modeling behaviors. Constructs of Self-efficacy and Self-regulation were elicited through the women perceiving themselves as a primary barrier to physical activity. Participants endorsed the need of a strong social support component and identified a variety of acceptable sources to include in a physical activity program (ie, family, friends, other program participants). CONCLUSIONS: Findings explicate the utility of SCT as a behavioral change theoretical basis for tailoring physical activity programs to African-American women.

Preventing diabetes in obese Latino youth with prediabetes: a study protocol for a randomized controlled trial.

BACKGROUND: Obese Latino adolescents are disproportionately impacted by insulin resistance and type 2 diabetes. Prediabetes is an intermediate stage in the pathogenesis of type 2 diabetes and represents a critical opportunity for intervention. However, to date, no diabetes prevention studies have been conducted in obese Latino youth with prediabetes, a highly vulnerable and underserved group. Therefore, we propose a randomized-controlled trial to test the short-term (6-month) and long-term (12-month) efficacy of a culturally-grounded, lifestyle intervention, as compared to usual care, for improving glucose tolerance and reducing diabetes risk in 120 obese Latino adolescents with prediabetes. METHODS: Participants will be randomized to a lifestyle intervention or usual care group. Participants in the intervention group will attend weekly nutrition and wellness sessions and physical activity sessions twice a week for six months, followed by three months of booster sessions. The overall approach of the intervention is framed within a multilevel Ecodevelopmental model that leverages community, family, peer, and individual factors during the critical transition period of adolescence. The intervention is also guided by Social Cognitive Theory and employs key behavioral modification strategies to enhance self-efficacy and foster social support for making and sustaining healthy behavior changes. We will test intervention effects on quality of life, explore the potential mediating effects of changes in body composition, total, regional, and organ fat on improving glucose tolerance and increasing insulin sensitivity, and estimate the initial incremental cost effectiveness of the intervention as compared with usual care for improving glucose tolerance. DISCUSSION: The proposed trial builds upon extant collaborations of a transdisciplinary team of investigators working in concert with local community agencies to address critical gaps in how diabetes prevention interventions for obese Latino youth are developed, implemented and evaluated. This innovative approach is an essential step in the development of scalable, cost-effective, solution oriented programs to prevent type 2 diabetes in this and other populations of high-risk youth. TRIAL REGISTRATION: NCT02615353, registered on June 8, 2016.