Expanding the obesity research paradigm to reach African American communities.

Obesity is more prevalent among African Americans and other racial and ethnic minority populations than among whites. The behaviors that determine weight status are embedded in the core social and cultural processes and environments of day-to-day life in these populations. Therefore, identifying effective, sustainable solutions to obesity requires an ecological model that is inclusive of relevant contextual variables. Race and ethnicity are potent stratification variables in U.S. society and strongly influence life contexts, including many aspects that relate to eating and physical activity behaviors. This article describes a synthesis initiated by the African American Collaborative Obesity Research Network (AACORN) to build and broaden the obesity research paradigm. The focus is on African Americans, but the expanded paradigm has broader implications and may apply to other populations of color. The synthesis involves both community and researcher perspectives, drawing on and integrating insights from an expanded set of knowledge domains to promote a deeper understanding of relevant contexts. To augment the traditional, biomedical focus on energy balance, the expanded paradigm includes insights from family sociology, literature, philosophy, transcultural psychology, marketing, economics, and studies of the built environment. We also emphasize the need for more attention to tensions that may affect African American or other researchers who identify or are identified as members of the communities they study. This expanded paradigm, for which development is ongoing, poses new challenges for researchers who focus on obesity and obesity-related health disparities but also promises discovery of new directions that can lead to new solutions.

Outcomes from Walk the Talk: a nursing intervention for Black women.

OBJECTIVE: Explore changes in walking behavior, blood pressure, and weight over the course of a pilot intervention designed to increase physical activity. DESIGN: A pre/post single group design was used to examine outcomes of a 12-month group intervention with 6-month follow-up. SAMPLE: Twenty-one sedentary hypertensive African American women residing in Mid-Missouri with a mean age of 50.3 years. INTERVENTION: A 3-hour monthly meeting was paired with an at-home walking component. RESULTS: Mean steps per day taken by participants were 3857 at baseline, 4060 at the end of the group intervention, and 5282 at the end of the follow-up period. Mean systolic blood pressure was 142 mmHg at baseline, 123 mmHg at intervention end, and 130 mmHg at 18 months. Mean diastolic blood pressure at baseline was 87 mmHg, 80 mmHg at 12 months, and 78 mmHg at the end of the follow-up period. Mean weight decreased from 206 lbs at baseline to 188 lbs at the end of the intervention. However, mean weight had increased to 213 lbs by the end of the 6-month follow-up. CONCLUSIONS: Outcomes from this pilot study are encouraging with respect to the potential of group level interventions as a strategy for promoting cardiovascular health among hypertensive African American women. It is particularly noteworthy that women maintained decreases in systolic blood pressure and further decreased diastolic blood pressure despite regaining weight during the follow-up period. Replication of this study with a larger sample size and control group will significantly enhance our ability to evaluate whether the unusual pattern of change in walking behavior noted in this pilot was a fluke or indicative of a slower pattern of change in this population.

Changes in steps per day over the course of a pilot walking intervention.

UNLABELLED: The objective of this study is to explicate changes in steps per day observed over the course of a pilot study concerned with promoting walking. A pre/post single group design was used to evaluate a 12-month group intervention with 6-month follow-up with a sample of twenty-one sedentary, hypertensive African American women 25-68 years of age. A 3-hour monthly meeting was paired with an at-home walking component. Results indicated that the total group experienced a slight increase (5%) in mean steps per day at the end of the 12-month intervention, while a subgroup experienced a 13% decrease. However, mean steps per day increased from baseline to 6-month follow-up for both groups. Mean steps per day increased from 3857 to 5582 (37%) for total group and from 4659 to 7038 (51%) for the subgroup. CONCLUSIONS: A group intervention can have a positive impact on promoting walking among African American women; however, multi-phased interventions may be necessary to assist this population meet current physical activity recommendations.

Development of scholars interested in community-based health promotion research.

Culturally consistent community-based health promotion interventions have been identified as integral components of strategies to decrease health disparities. The limited number of culturally competent scholars impedes the development of appropriate interventions. This article examines issues relevant to the development of scholars interested in community-based health promotion research. It is the outcome of a series of discussions by the authors held over a 3-month period. Specific topics include classroom and communal educational opportunities to enhance cultural competence and creation of supportive environments for aspiring community-based scholars. Particular attention is given to the importance of ongoing opportunities for interaction between students and lay community scholars.

Talk that talk: storytelling and analysis rooted in African American oral tradition.

Stories are the foundation of qualitative research. However, the development of qualitative methods rooted in oral traditions remains largely unexplored by researchers. The contextual and historical influences on storytelling and storytaking are critical features of the African American oral tradition that are often ignored or minimized in qualitative research. Despite the complex and often contentious history of African Americans, their oral traditions have not been explored to reveal the depth of their lived experiences and the way those experiences inform their health concerns. The purpose of this article is twofold. First, dialogues about storytelling and storytaking are revisited and critiqued. Second, a comprehensive analytic process for gathering and interpreting stories rooted in African American oral tradition is outlined.

Recruitment and entrance of participants into a physical activity intervention for hypertensive African American women.

Decreasing health disparities between White Americans and racial/ethnic minority populations is a public health priority. An ongoing inability to attract sufficient numbers of African Americans and other people of color to participate in research studies is a major barrier to accomplishing this goal. Participation of racial/ethnic minorities in intervention studies is especially critical to the development of appropriate strategies to promote health among these populations. This article examines the effectiveness of preintervention meetings as well as interactions between African American research team members and potential participants as recruitment strategies. Intersections between recruitment and health promotion are also addressed.

Re/Affirming and re/conceptualizing disciplinary knowledge as the foundation for doctoral education.

Global shortages of nurses, limited resources, and increasing transnational crises mandate changes in healthcare planning and delivery. Disciplinary knowledge is integral to the development of nurse practitioners and researchers who can provide leadership role in addressing critical healthcare problems. This collaborative meditation examines how critical reflection about disciplinary knowledge in the context of nursing doctoral education facilitates this endeavor. Factors that constrain the development of disciplinary knowledge are discussed. Suggestions for further development of disciplinary knowledge are offered.

Achieving healthy weight in African-American communities: research perspectives and priorities.

The longstanding high burden of obesity in African-American women and the more recent, steeper than average rise in obesity prevalence among African-American children constitute a mandate for an increased focus on obesity prevention and treatment research in African-American communities. The African-American Collaborative Obesity Research Network (AACORN) was formed to stimulate and support greater participation in framing and implementing the obesity research agenda by investigators who have both social and cultural grounding in African-American life experiences and obesity-related scientific expertise. AACORN's examination of obesity research agenda issues began in 2003 in conjunction with the Think Tank on Enhancing Obesity Research at the National Heart, Lung, and Blood Institute (NHLBI). The assessment was subsequently expanded to take into account the overall NIH strategic plan for obesity research, literature reviews, and descriptions of ongoing studies. In identifying priorities, AACORN members considered the quality, quantity, focus, and contextual relevance of published research relevant to obesity prevention and treatment in African-American adults or children. Fifteen recommended research priorities are presented in five categories adapted from the NHLBI Think Tank proceedings: health effects, social and environmental context, prevention and treatment, research methods, and research training and funding. These recommendations from an African-American perspective build on and reinforce certain aspects of the NHLBI and overall NIH research agendas by providing more specific rationale and directions on areas for enhancement in the type of research being done or in the conceptualization and implementation of that research.

It's all sacred: African American women's perspectives on spirituality.

In this study, we examined the meaning and function of spirituality for a group of African American women. Participants had been recruited for a focus group study exploring the significance of mother-daughter-sister relationships to the well being and health behavior choices of women. Women developed individually defined concepts of spirituality by combining Judeo-Christian traditions and African cosmology. Spirituality was a cornerstone of many participants' daily lives. It influenced women's decision-making and behavior across many realms. For example, many women came to the conclusion that domestic violence was not part of God's plan for their lives. Spiritual-based strategies may provide a rich foundation for innovative and efficacious health promotion interventions targeting African American women. Clinicians can assist in the co-creation of sacred spaces where women can connect with themselves and each other.

Interventions to promote physical activity among African American women.

The lack of routine physical activity among African American women places them at risk for negative health outcomes associated with inactivity. The number of studies focused on African American women has increased dramatically in the past decade. This review examined the intervention research literature testing strategies to increase activity among African American women. Eighteen studies with 1,623 subjects were retrieved. Diverse interventions, settings, and measures were reported. Common methodologic weaknesses included lack of randomization of subjects, single-group design, instruments without documented validity and reliability, significant attrition, and questionable timing of outcome variable measurement. Strategies to design and deliver culturally appropriate interventions are reviewed. Suggestions for future research, such as examining intragroup differences and communal resources, are provided.