An in-person and technology-implemented holistic health promotion program for older Black adults in low-income communities.

The COVID-19 pandemic halted many in-person programs of research and required researchers to pivot to technology-enhanced approaches. To date, there are no examples or guidelines on how to use technology to implement health promotion programs rooted in the community-based participatory research (CBPR) model among low-income older Black adults. The aims of this paper are (a) to describe and report on the health-related outcomes of an in-person CBPR model-based health promotion intervention program for older Black adults in a low-income community, and (b) to describe the process of adapting this program to a technology-enhanced and Zoom-delivered format and provide preliminary evidence on the health-related outcomes and acceptability of this program. This paper highlights the potential benefits of a technology-enhanced and Zoom-delivered health promotion program among low-income older Black adults and provides recommendations to optimize such efforts to foster these benefits. These recommendations are aligned with the four domains of the CBPR model (i.e., contexts, partnership processes, intervention and research, and outcomes). We conclude that CBPR model-based, technology implemented health promotion interventions for low-income older Black adults are acceptable to such adults and should attend to the values, perspectives, and preferences of these individuals. The information in this manuscript is relevant to health promotion specialists at this seemingly ongoing though post-pandemic era because technology-enhanced interventions are scalable and cost-effective and those anchored in CBPR are well-positioned to promote health equity.

Promoting weight-loss maintenance among Black women primary care patients: A cluster RCT of a culturally sensitive versus standard behavioural approach.

The prevalence of obesity is higher among Black women (56.6%) compared to Hispanic women (50%) and non-Hispanic White women (42%). Notably, interventions to reduce obesity typically result in initial weight loss that is not maintained. This study tested (a) the effectiveness of a 6-month Health-Smart Weight Loss (HSWL) Program for Black women patients with obesity implemented by community health workers (CHWs) within primary care clinics and (b) the comparative effectiveness of two 12-month physician-implemented weight loss maintenance programs-a Patient-Centred Culturally Sensitive Weight Loss Maintenance Program (PCCS-WLM Program) and a Standard Behavioural Weight Loss Maintenance Program (SB-WLM Program). Black women patients (N = 683) with obesity from 20 community primary care clinics participated in the HSWL Program and were then randomized to either maintenance program. The HSWL Program led to significant weight loss (i.e., 2.7 pounds, 1.22 kg, p < .01, -1.1%) among the participants. Participants in both the PCCS-WLM Program and the SB-WLM Program maintained their weight loss; however, at month 18, participants in the PCCS-WLM Program had a significantly lower weight than those in the SB-WLM (i.e., 231.9 vs. 239.4 pounds or 105.19 vs. 108.59 kg). This study suggests that (a) the HSWL Program can produce significant weight loss among Black women patients with obesity when implemented in primary care clinics by CHWs, and (b) primary care physicians can be trained to successfully promote weight loss maintenance among their Black women patients.

The Associations between Depression, Acculturation, and Cardiovascular Health among African Immigrants in the United States.

Cardiovascular disease (CVD) is the leading cause of death both globally and in the United States (U.S.). Racial health disparities in cardiovascular health (CVH) persist with non-Hispanic Black adults having a higher burden of CVD morbidity and mortality compared to other racial groups. African immigrants represent an increasingly growing sub-population of the overall U.S. non-Hispanic Black adult population, however little is known about how specific psychological and social factors (i.e., depression and acculturation) influence the CVH of U.S. African immigrants. We sought to examine the association between severity of depression symptomology and CVH among African immigrants, and whether acculturation moderated the relationship between severity of depression symptoms and CVH. Study participants were those in the African Immigrant Health Study conducted in the Baltimore-Washington D.C. area. Severity of depression symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8). CVH was assessed using the American Heart Association Life's Simple 7 metrics and categorized as poor, intermediate, and ideal CVH. Acculturation measured as length of stay and acculturation strategy was examined as a moderator variable. Multivariable logistic regression was used to examine the association between depression and CVH and the moderating effect of acculturation adjusting for known confounders. In total 317 African immigrants participated in the study. The mean (±SD) age of study participants was 46.9 (±11.1) and a majority (60%) identified as female. Overall, 8.8% of study participants endorsed moderate-to-severe symptoms of depression. African immigrants endorsing moderate-to-severe levels of depression were less likely to have ideal CVH compared to those with minimal-to-mild symptoms of depression (Adjusted Odds Ratio [AOR]: 0.42, 95% CI: 0.17-0.99). Acculturation measured either as length of stay or acculturation strategy did not moderate the relationship between depression and CVH among study participants. Study participants exhibited elevated levels of symptoms of depression. Greater severity of depression symptoms was associated with worse CVH. Efforts to treat and prevent CVD among African immigrants should also include a focus on addressing symptoms of depression within this population.

Views of Black women patients with obesity on desired and undesired weight-focused clinical encounters.

Non-Hispanic Black women have the highest rates of overweight/obesity of any group in the United States. To date, few interventions have worked to reduce overweight/obesity in this population. This study investigated the views of Black women with overweight and obesity treated in a primary care setting regarding desired and undesired verbal and non-verbal behaviours by providers in provider-patient clinical encounters focused on losing weight, maintaining weight loss, and/or obesity. Two focus groups and an individual interview (n = 15) were conducted. Qualitative data analysis yielded five distinct themes, with 11 codes (listed in parenthesis): (a) desired weight-focused discussions (codes: Discussing weight loss with patients and discussing weight-loss maintenance with patients), (b) desired weight-focused support (codes: Supporting patients experiencing weight loss and supporting patients experiencing weight gain), (c) undesired weight-focused discussions (codes: Things to avoid during weight loss discussions and things to avoid during weight gain discussions), (d) desired attitudes and behaviours during weight-focused discussions (codes: Show caring and understanding and encourage behaviour change for weight loss), and (e) building physician-patient rapport (codes: Enable patients to feel respected by doctors, enable patients to feel comfortable with doctors and enable patients to trust their doctors). The qualitative approach employed in this study generates a deep understanding not only of the experiences of Black women patients but also of potential strategies that physicians could employ to succeed in their discussions with patients regarding healthy weight achievement and maintenance.

Student-led research team-building program may help junior faculty increase productivity in competitive biomedical research environment.

BACKGROUND: Interdisciplinary research teams can increase productivity among academic researchers, yet many junior investigators do not have the training or financial resources to build productive teams. We developed and tested the acceptability and feasibility of three low-cost services to help junior faculty build and maintain their own research teams. METHODS: At an urban academic medical centre, we implemented three types of consultation services: 1) giving talks on evidence-based best practices for building teams; 2) providing easy-to-use team building resources via email; and 3) offering a year-long consultation service-co-led by students-that taught faculty to build and maintain research teams. Our primary outcome was the number of faculty who used each service. For the yearlong consultation service, we asked faculty participants to complete three online self-assessments to rate their leadership confidence, the team's performance, and which of the consultation components were most helpful. We used descriptive statistics to evaluate faculty assessment scores at three timepoints by comparing median scores and interquartile ranges. RESULTS: We gave 31 talks on team building to 328 faculty and postdoctoral fellows from 2014 to 2020. Separately, 26 faculty heard about our research team building expertise and requested materials via email. For the consultation service, we helped build or enhance 45 research teams from 2014 to 2020. By the end of the consultation, 100% of the faculty reported they were still maintaining their team. In the initial survey, the majority of participants (95.7%, n = 22) reported having no or few experiences in building teams. Further, when asked to rate their team's performance at 12-months, faculty highly rated many elements of both teamwork and taskwork, specifically their team's productivity (6/7 points), morale (6/7 points), and motivation (6/7 points). By the end of the program, faculty participants also highly rated two components of the consultation program: recruitment assistance (7/10 points) and provision of team management tools (7/10 points). CONCLUSIONS: For participating faculty, our program provided valued guidance on recruitment assistance and team management tools. The high demand for team-building resources suggests that junior faculty urgently need better training on how to develop and manage their own team.

Impact of Stress and Loneliness on Health-Related Quality of Life Among Low Income Senior African Americans.

Low income senior African Americans are at risk for low health-related quality of life (HRQoL). Loneliness may exacerbate the effects of stress on health. The purpose of this study was to examine the impact of perceived stress and loneliness on the HRQoL of low income senior African Americans (N = 281). Results indicate that loneliness may exacerbate the inverse relationship of perceived stress with psychological HRQoL among this sample. Additionally, both loneliness and perceived stress were associated with poorer physical HRQoL. The present study has implications for interventions seeking to improve HRQoL among a similar sample of senior adults given that loneliness is a modifiable variable.

Perceived socioeconomic status and health-related quality of life (HQoL) among urban adults: Evaluating the protective value of resilience.

Health-related quality of life (HQoL) is increasingly used as a measure of population health. The utility of HQoL lies in its ability to capture the subjectivity and totality of health-HQoL is an individual's subjective assessment of their physical, psychological, and social functioning. HQoL disparities exist in the United States, with some groups (e.g., individuals of low socioeconomic status [SES]) experiencing disproportionately low rates of HQoL, though little is known about the impact of perceived SES (PSES) on HQoL. Research is needed in order to (a) investigate the relationship of PSES on HQoL and (b) understand the mechanisms that may mitigate the adverse impact of PSES on HQoL. Therefore, the present study seeks to understand the role of resilience as a mediator in the relationship between PSES and HQoL among a sample (N = 284) of U.S. urban adults. Results from the present study indicate that resilience significantly mediates the relationship between PSES and physical and mental HQoL. The results of the present study have implications for researchers interested in behavioral health promotion interventions among individuals of low PSES. Resilience, a modifiable psychological variable, may be able to mitigate the adverse impact of PSES on HQoL and thus play a role in reducing HQoL disparities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An Examination of Health-Promoting Behaviors Among Hispanic Adults Using an Activation and Empowerment Approach.

BACKGROUND: Obesity is a national epidemic in the United States. Racial/ethnic minorities are disproportionately affected by this obesity epidemic. Hispanic adults have a higher prevalence of obesity compared to non-Hispanic White adults. Levels of engagement in healthy eating and physical activity have been found to be associated with obesity. Research suggests that culturally informed, person-centered factors may influence engagement in healthy eating and physical activity. PURPOSE: The purpose of the present study was to examine the association between person-centered, modifiable variables (i.e., activation, empowerment, and self-praise) and health-promoting behaviors (i.e., healthy eating and physical activity) among a cross-sectional sample of predominantly overweight/obese Hispanic adults (N = 87) recruited from two Hispanic churches and their surrounding communities in the Bronx, New York. RESULTS: A series of hierarchical regressions revealed that empowerment and self-praise were significant and positively associated with greater levels of engagement in healthy eating. Additionally, self-praise was significant and positively associated with greater levels of engagement in physical activity. CONCLUSIONS: The current findings suggest that these modifiable factors may be useful in informing intervention programs designed to improve healthy eating and physical activity among Hispanic adults.

A Culturally Sensitive Church-Based Health-Smart Intervention for Increasing Health Literacy and Health-Promoting Behaviors among Black Adult Churchgoers.

The purpose of the paper is to examine the effectiveness of a six-week, culturally sensitive, church-based health-promotion intervention in increasing nutrition label health literacy and health-promoting behaviors (i.e., healthy eating, healthy drinking, and physical activity) and improving weight and blood pressure among Black adults. Study participants are a sample of 321 Black adult churchgoers (N = 321) who were divided between an intervention group (N = 172) and a wait-list control group (N = 149). The health-promotion intervention program is informed by Health Self-Empowerment Theory. At post-test, the participants in the intervention group demonstrated significantly greater increases in nutrition label health literacy, overall level of engagement in health-smart behaviors, and levels of engagement in two specific health-smart behaviors (i.e., healthy eating and healthy drinking) compared with those in the wait-list control group. Implications of these findings for future similar health-promotion intervention programs and research are discussed.

Clinical Staff's Motivators and Barriers to Engagement in Health-Promoting Behaviors.

Clinical staff can promote patients' engagement in health-promoting behaviors to prevent/treat obesity. However, some clinical staff are overweight/obese and may not model health behaviors for their patients. This cross-sectional survey study tested the hypotheses that clinical staff's level of (1) motivators and (2) barriers to engaging in health-promoting behaviors would be significantly associated with their body mass index (BMI). Barriers were significantly correlated and motivators were not correlated with caregivers' BMI. Implications for nurses in professional development are discussed.

Associations of Health Self-efficacy With Engagement in Health-Promoting Behaviors and Treatment Adherence in Rural Patients.

Rural residents have lower levels of engagement in health-promoting behaviors and treatment adherence than their urban counterparts. This cross-sectional study sought to understand the role of health self-efficacy as a precursor to engagement in health-promoting behaviors and treatment adherence in 273 rural patients. Structural equation model was used to examine whether health self-efficacy predicted engagement in health-promoting behaviors and treatment adherence. Results show that health self-efficacy predicts engagement in health-promoting behaviors and treatment adherence. Boosting patients' health self-efficacy could be a way of increasing their engagement in health-promoting behaviors and treatment adherence and thus of improving their health outcomes.

Health Self-Empowerment Theory: Predicting Health Behaviors and BMI in Culturally Diverse Adults.

Health Self-Empowerment Theory asserts that 5 controllable psychological variables predict engagement in health-promoting behaviors. This study tests the theoretical integrity of Health Self-Empowerment Theory and its usefulness in predicting health-promoting behaviors and body mass index. Results from surveying 189 predominantly low-income, overweight/obese, and culturally diverse adults showed that most Health Self-Empowerment Theory variables were positively correlated. Structural equation modeling showed that 4 variables significantly predicted engagement in health-promoting behaviors, which mediated the relationships between body mass index and (a) motivation, (b) health self-efficacy, and (c) self-praise. Results support creating psychologically informed interventions to increase engagement in health-promoting behaviors and decrease body mass index among low-income adults, particularly racial/ethnic minorities, at risk for obesity-related health problems.

Predictors of Cancer Screening Among Culturally Diverse Men.

Men have higher rates of all cancers and are more likely to die from cancer than women; however, men are less likely to utilize disease prevention services. African American/Black men and Hispanic men have lower cancer survival rates and are less likely to utilize health care services than non-Hispanic White men. The present study examined demographic variables (age, household income, education, marital status, race/ethnicity, health insurance status), motivators to engage in healthy eating, and motivators to engage in physical activity as predictors of culturally diverse, medically underserved men's likelihood of getting a cancer screening (a) at the present time, (b) if no cancer symptoms are present, and (c) if a doctor discovers some cancer symptoms. Analyses were conducted using data from 243 men (47.3% non-Hispanic Black, 29.5% Hispanic, 16.5% non-Hispanic White, and 6.8% "other") recruited at the Men's Health Forum in Tampa, Florida. Age, having a medical or health condition that benefits from eating healthy, and having a commitment to physical activity were significant positive predictors of the likelihood of receiving a cancer screening. Motivation to engage in physical activity because of a personal priority was a significant negative predictor of the likelihood of getting a cancer screening. The findings from this study suggest that interventions to increase cancer screenings among culturally diverse, medically underserved men should be informed at least in part by an assessment of participating men's motivators for engaging in health promoting lifestyle behaviors such as physical activity and healthy eating.

Current Demographics and Roles of Florida Community Health Workers: Implications for Future Recruitment and Training.

The high prevalence of health disparity diseases (e.g., obesity, Type 2 diabetes) among underserved populations in the United States suggests the need for increased resources to prevent these diseases and to improve health care access and quality in underserved communities. Community health workers are valuable resources and facilitators of health care access and quality treatment. The purpose of the present study is to provide descriptive information about community health workers in Florida and to provide recommendations for improved training and expansion of community health workers' roles in research and intervention. The study participants were 396 adults (85.1% Female, 75.5% Community health workers) who completed the 2015 Florida Community Health Workers Census. Participants were recruited by the Health Council of South Florida through emails and phone calls to members of the Florida Community Health Worker Coalition and various organizations. It was found that several groups disproportionately affected by health disparities were underrepresented among the community health workers who participated in the census and among the communities served by these community health workers. Actions are needed to improve and increase the recruitment and training of community health workers in Florida.

Correction to: Sexual Minority Stress, Coping, and Physical Health Indicators.

The original version of this article unfortunately contains a mistake. In page 229, first paragraph, line 5, the value 0.353 should read as 0.347. In page 230, first paragraph, line 10, the value 0.121 should read as - 0.121.

Validation of an Inventory for Providers to Self-Assess Their Engagement in Patient-Centered Culturally Sensitive Health Care.

OBJECTIVE: Cultural sensitivity training of health-care providers could help eliminate health disparities. The Tucker-Culturally Sensitive Health-Care Provider Inventory (T-CSHCPI) is an inventory for providers to self-assess their engagement in patient-defined/-centered culturally sensitive health care. The T-CSHCPI is novel in that it assesses providers' strengths and areas of growth in their efforts to provide culturally sensitive care as defined by culturally diverse patients. METHODS: Using ratings on this inventory by a sample of culturally diverse providers (N = 291) from 67 health-care sites across the United States, a confirmatory analysis of the T-CSHCPI was conducted, and its validity and reliability were determined. RESULTS: Factor analysis produced a final solution with 4 factors (interpersonal skills, conscientiousness, sensitivity, and disrespect/disempowerment) that were reliable. These 4 factors are associated with cultural competence, suggesting validity. DISCUSSION: The T-CSHCPI measures independent dimensions of patient-centered care as identified by a national sample of health-care providers. The T-CSHCPI can be used to inform training that promotes patient-centered culturally sensitive health care by providers.

Sexual Minority Stress, Coping, and Physical Health Indicators.

Sexual minorities experience higher rates of several physical health problems compared to their heterosexual counterparts. The present study uses Meyer's Minority Stress Model (Psychological Bulletin, 129(5): 674-697, 2003) to examine physical health indicators among 250 adults who identified as sexual minorities. Study hypotheses include that sexual minority stress is predictive of two physical health indicators (i.e., engagement in a health-promoting lifestyle and number of physical health problems) and that planning (i.e., problem-focused) and social support coping will partially mediate the relationship between sexual minority stress and each physical health indicator. Results showed that as level of sexual minority stress increased, engagement in a health-promoting lifestyle decreased and the number of physical health problems increased. Planning and social support coping did not mediate these relationships; however, as levels of coping increased, engagement in a health-promoting lifestyle increased. These findings have implications for researchers and healthcare professionals in their efforts to promote the physical health of sexual minorities.

A CBPR Study to Test the Impact of a Church-Based Health Empowerment Program on Health Behaviors and Health Outcomes of Black Adult Churchgoers.

Black adults in the United States are disproportionately affected by health disparities, such as overweight and obesity. Research suggests that Black adults engage in fewer health-promoting behaviors (e.g., physical activity and healthy eating) than their non-Hispanic White counterparts. These health-promoting behaviors are known protective factors against overweight/obesity and related health concerns. This community-based participatory research study employed a waitlist control design and a university-church partnership approach to test the impact of a church-based health-empowerment program designed to increase health-promoting behaviors (called health-smart behaviors) and improve health indicators (e.g., reduce weight) among overweight/obese Black adult churchgoers. Results indicate that the intervention group (n = 37) experienced a significant increase in levels of healthy eating and physical activity and a significant decrease in weight compared to the waitlist control group (n = 33). Results from this study have implications for the design of church-based, culturally sensitive health promotion interventions to increase health-smart behaviors and ultimately prevent and reduce obesity and related diseases in Black communities.

Frequency of visits to a health care provider, health promoting behaviors, and perceived health status among African American women.

The primary purpose of this study was to examine whether the self-reported number of health care visits over a 1-year period was associated with engagement in health promoting behaviors (i.e., healthy eating and physical activity) and perceived health status among a cross-sectional sample of African American women who were pre-hypertensive/hypertensive and/or overweight or obese (N = 180). The study participants were recruited in predominantly African American churches and had their data collected in April and May of 2009. Age, income, and education were also examined as moderators in the aforementioned relationships. Results revealed that the self-reported number of health care visits was significantly positively associated with healthy eating and perceived health status. Income moderated the relationship between self-reported number of health care visits and engagement in healthy eating. These results provide support for health promotion programs for African American women with program components that explain the relationships among routine care from a health care provider, engagement in health promoting behaviors, and prevention of chronic health conditions.

Impact of a University-Community Partnership Approach to Improving Health Behaviors and Outcomes Among Overweight/Obese Hispanic Adults.

Objective. To examine the impact of a community-informed and community-based Health-Smart Church (HSC) Program on engagement in health promoting behaviors (healthy eating and physical activity) and health outcomes (body mass index, weight, and systolic and diastolic blood pressure). Design. A total of 70 overweight/obese Hispanic adults participated in an intervention group (n = 37) or a waitlist control group (n = 33) in 2 Hispanic churches in Bronx, New York. Results. Post-intervention the intervention group significantly increased in frequency of healthy eating and physical activity compared to the waitlist control group. Although no significant changes in body mass index or systolic blood pressure were found for either group, the intervention group decreased significantly in weight from pre-intervention to post-intervention. Conclusions. The results of the present study add to the growing body of literature evidencing the successful use of community-engaged and community-based participatory health promotion interventions with racial/ethnic minority populations and highlight important practices and considerations for similar health promotion interventions with these communities.