RESUMO
A seminal report, released in 2001 by the Institute of Medicine, spurred research on the design, implementation, and evaluation of multilevel interventions targeting obesity and related behaviors. By addressing social and environmental factors that support positive health behavior change, interventions that include multiple levels of influence (e.g., individual, social, structural) aim to bolster effectiveness and, ultimately, public health impact. With more than 20 years of multilevel obesity intervention research to draw from, this review was informed by published reviews (n = 51) and identified intervention trials (n = 103), inclusive of all ages and countries, to elucidate key learnings about the state of the science. This review provides a critical appraisal of the scientific literature related to multilevel obesity interventions and includes a description of their effectiveness on adiposity outcomes and prominent characteristics (e.g., population, setting, levels). Key objectives for future research are recommended to advance innovations to improve population health and reduce obesity.
RESUMO
BACKGROUND: Accurate assessment of fruit and vegetable intake (FVI) is essential for public health nutrition research and surveillance. Blood carotenoid concentrations are robust biomarkers of FVI, but collecting blood samples typically is not feasible in population-based studies. Understanding how well non-invasive measures compare to blood estimates is important for advancing surveillance and evaluation. The objective of this study was to examine the associations between serum carotenoids and four non-invasive measures of FVI in overweight and obese women. METHODS: This study utilized baseline data from 157 overweight or obese women (95.5% white, mean age 58.56 years ± 9.49 years) enrolled in the Strong Hearts, Healthy Communities randomized trial, including two direct measures of carotenoids and three self-reported measures of FVI. Participants completed a fasting blood draw, dermal carotenoid scans using resonance Raman spectroscopy (RRS), a two-item FVI screener modeled after the American Heart Association's Life's Simple 7 "My Life Check" tool (modified AHA tool), the National Cancer Institute's All-Day Fruit and Vegetable Screener (FVS), multiple 24-h dietary recalls, physical measurements, and demographic and health behavior questions. We analyzed blood for total carotenoids and derived total FVI estimates from self-report tools. We used multivariate linear regression models to examine associations between each non-invasive tool and serum carotenoids under four scenarios analogous to different research contexts in which varying breadths of participant data are available. We also calculated adjusted Pearson's correlations between serum carotenoids, dermal carotenoids, and the self-reported measures. RESULTS: Dermal carotenoids were strongly correlated with serum carotenoids (0.71, P < 0.00067) and associated with serum carotenoids in all regression models (0.42-0.43, P < 0.002). None of the self-reported FVI measures were significantly associated with serum or dermal carotenoids in adjusted regression models or correlation analyses. CONCLUSIONS: Compared to self-reported FVI, we found dermal carotenoids measured by RRS to be a superior method to approximate serum carotenoids among overweight and obese women. More research is needed to investigate these assessment methods in diverse populations. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02499731, registered July 16, 2015.
Assuntos
Carotenoides/análise , Dieta/estatística & dados numéricos , Frutas , Sobrepeso , Verduras , Idoso , Carotenoides/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/sangue , Obesidade/epidemiologia , Obesidade/metabolismo , Sobrepeso/sangue , Sobrepeso/epidemiologia , Sobrepeso/metabolismo , Ensaios Clínicos Controlados Aleatórios como Assunto , Pele/química , Análise Espectral RamanRESUMO
OBJECTIVE: To examine the frequency of shopping at different food sources and the associations between shopping at different food sources and fruit and vegetable (FV) intake among upstate New York rural residents. DESIGN: Cross-sectional study. Descriptive statistics and linear mixed models were used. SETTING: Eighty-two rural communities in upstate New York, USA. PARTICIPANTS: Adults (n 465; 82·3 % female, mean age 51·5 years, mean BMI 31·7 kg/m2). RESULTS: Within one's community, the majority of participants reported often going to supermarkets (73·1 %). Many participants sometimes or occasionally shopped at superstores (48·0 %), convenience stores (57·9 %), small grocery stores or local markets (57·2 %), farmers' markets or FV stores (66·6 %), dollar stores (51·5 %), pharmacies (46·0 %), or farm stands or community-supported agriculture (56·8 %). Most participants had never utilized food banks or food pantries (94·0 %), community gardens (92·7 %) or home food delivery (91·9 %). While frequent visits to farmers' markets or farm stands were associated with higher fruit intake (P < 0·001), frequent visits to food co-ops or food hubs were associated with lower fruit intake (P = 0·004). Frequent visits to convenience stores (P = 0·002) and dollar stores (P = 0·004) were associated with lower vegetable intake. When FV intakes were combined, frequent visits to farmers' markets or farm stands (P < 0·001) were associated with higher FV intake, and frequent visits to convenience stores (P = 0·005) were associated with lower FV intake. CONCLUSIONS: Findings from the present study provide important insight for informing future food environment interventions related to helping rural residents consume adequate FV.
Assuntos
Dieta/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Frutas , População Rural/estatística & dados numéricos , Verduras , Adulto , Comportamento do Consumidor/estatística & dados numéricos , Estudos Transversais , Fazendas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologiaRESUMO
BACKGROUND: Rural women experience health disparities in terms of cardiovascular disease (CVD) risk compared to urban women. Cost-effective CVD-prevention programs are needed for this population. The objective of this study was to conduct cost analysis and cost-effectiveness analyses (CEAs) of the Strong Hearts, Healthy Communities (SHHC) program compared to a control program in terms of change in CVD risk factors, including body weight and quality-adjusted life years (QALYs). METHODS: Sixteen medically underserved rural towns in Montana and New York were randomly assigned to SHHC, a six-month twice-weekly experiential learning lifestyle program focused predominantly on diet and physical activity behaviors (n = 101), or a monthly healthy lifestyle education-only control program (n = 93). Females who were sedentary, overweight or obese, and aged 40 years or older were enrolled. The cost analysis calculated the total and per participant resource costs as well as participants' costs for the SHHC and control programs. In the intermediate health outcomes CEAs, the incremental costs were compared to the incremental changes in the outcomes. The QALY CEA compares the incremental costs and effectiveness of a national SHHC intervention for a hypothetical cohort of 2.2 million women compared to the status quo alternative. RESULTS: The resource cost of SHHC was $775 per participant. The incremental cost-effectiveness ratios from the payer's perspective was $360 per kg of weight loss. Over a 10-year time horizon, to avert per QALY lost SHHC is estimated to cost $238,271 from the societal perspective, but only $62,646 from the healthcare sector perspective. Probabilistic sensitivity analyses show considerable uncertainty in the estimated incremental cost-effectiveness ratios. CONCLUSIONS: A national SHHC intervention is likely to be cost-effective at willingness-to-pay thresholds based on guidelines for federal regulatory impact analysis, but may not be at commonly used lower threshold values. However, it is possible that program costs in rural areas are higher than previously studied programs in more urban areas, due to a lack of staff and physical activity resources as well as availability for partnerships with existing organizations. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02499731 , registered on July 16, 2015.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Serviços Preventivos de Saúde/economia , Serviços de Saúde Rural/economia , Adulto , Idoso , Doenças Cardiovasculares/economia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Montana , New York , Sobrepeso , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Redução de PesoRESUMO
BACKGROUND: Excessive gestational weight gain (GWG) is common and contributes to the development of obesity in women and their offspring. Electronic or e-health interventions have the potential to reach large groups of women and prevent excessive GWG, but their effectiveness has not been demonstrated. The purpose of this study was to evaluate, in a real-world setting, the effectiveness of a self-directed, integrated online and mobile phone behavioral intervention in preventing excessive GWG. METHODS: This effectiveness trial was a double-blind, three-arm trial with a parallel group design. Two arms received the same e-health intervention during pregnancy with the third arm serving as the placebo control. The intervention was based on a previously efficacious non-digital intervention that was adapted to electronic format. It included three behavior change tools: a weight gain tracker, and separate diet and physical activity goal-setting and self-monitoring tools. Both treatment conditions received access to informational tools, event reminders, and a blogging feature. Healthy pregnant women age 18-35 years with body mass indexes (BMI) ≥18.5 and < 35, at ≤20 weeks gestation, and an e-mail address were eligible. The proportion of women with excessive total GWG, as defined by the Institute of Medicine (IOM), was the primary outcome. 1689 randomized women were analyzed in the intent-to-treat (ITT) analysis. The study was designed to have 87% power to detect a 10 percentage point reduction from a control rate of 55% with a sample of 1641 (p = 0.0167, two-sided). RESULTS: In the ITT sample, 48.1% (SD = 2.0%) gained excessively in the intervention group as did 46.2% (SD = 2.4%) in the placebo control group. These proportions were not significantly different (RR 1.09; 95% CI 0.98, 1.20, p = 0.12). The results were not altered in several sensitivity analyses. CONCLUSION: The addition of three behavior change tools to an informational placebo control did not result in a difference in the proportion of women with excessive total GWG compared to the placebo control in this effectiveness trial of an online, self-directed intervention. The similarity of intervention and control treatments and low usage of the behavior change tools in the intervention group are possible explanations. TRIAL REGISTRATION: NCT01331564 , ClinicalTrials.gov.
Assuntos
Terapia Comportamental/métodos , Ganho de Peso na Gestação , Obesidade/prevenção & controle , Complicações na Gravidez/prevenção & controle , Software , Telemedicina/métodos , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Gravidez , Autocuidado/métodos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Rural men are known to have poor health behaviors, which contribute to their elevated burden of cardiometabolic disorders in the United States. Although regular physical activity, healthy eating, and avoiding tobacco can reduce cardiometabolic risk, little is known about how to engage rural men in health promotion programs. To bridge this gap in evidence, we investigate knowledge of modifiable cardiometabolic risk factors among rural men in the western United States, identify their concerns related to heart health and motivation to reduce risk, and explore individual, social, and community-level influences on heart-healthy behaviors, specifically diet, physical activity, and tobacco use. METHODS: We conducted seven focus groups with 54 sedentary, overweight/obese men (mean body mass index [BMI] = 31.3 ± 4.6) aged 43-88 residing in government-designated "medically underserved" rural Montana towns in September and October 2014. All sessions were audio-recorded and transcribed verbatim. Transcripts were coded and analyzed thematically using Nvivo software. Participants also completed a brief questionnaire about personal characteristics and health behaviors. These data were explored descriptively. RESULTS: Despite being classified as overweight/obese and sedentary, no participants reported to be in poor health. Many men described health relative to self-reliance and the ability to participate in outdoor recreation; concern with health appeared to be related to age. Participants were generally knowledgeable of heart-healthy behaviors, but many felt fatalistic about their own risk. Catalysts for behavior change included a serious medical event in the household and desire to reduce aging-associated functional decline. Barriers to adopting and maintaining healthy eating and physical activity habits and abstaining from tobacco included normative beliefs around masculinity and individual liberty, the limited social universe of small towns, winter weather, time constraints, and preferences for unhealthy foods. Facilitators included behavioral self-monitoring, exercising with a partner, and opportunities for preferred activities, such as hunting and team sports. CONCLUSIONS: These findings provide important insight about influences on rural men's health behaviors and provide guidance for possible intervention strategies to promote cardiometabolic health. TRIAL REGISTRATION: ClinicalTrials.gov NCT02499731 . Registered 1 July 2015.
Assuntos
Doenças Cardiovasculares/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Saúde do Homem , Doenças Metabólicas/epidemiologia , Saúde da População Rural , Adulto , Idoso , Idoso de 80 Anos ou mais , Dieta/psicologia , Exercício Físico/psicologia , Grupos Focais , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Montana/epidemiologia , Motivação , Obesidade/psicologia , Sobrepeso/psicologia , Pesquisa Qualitativa , Fatores de Risco , Comportamento Sedentário , Inquéritos e Questionários , Uso de Tabaco/psicologiaRESUMO
BACKGROUND: Cardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms. METHODS/DESIGN: This community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants' friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs. DISCUSSION: Strong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02499731 Registered on July 1, 2015.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Comportamentos Relacionados com a Saúde , Prevenção Primária/organização & administração , População Rural/estatística & dados numéricos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Sobrepeso , Qualidade de Vida , Comportamento de Redução do Risco , Inquéritos e Questionários , Estados UnidosRESUMO
This article investigates the impact of community-based interventions developed by the Healthy Start Partnership (HSP) to promote healthy body weights in families. Intercept surveys were conducted to monitor community exposure. A nonconcurrent, no treatment control design was used to assess population-level weight outcomes. Control (n = 219) and intervention (n = 276) cohorts of pregnant women were recruited and followed until 6 months postpartum. Data were collected through 2 self-administered questionnaires and medical record audits. Results indicate community residents were exposed to interventions. However, little evidence of positive effects of interventions on weight outcomes was found for mothers or infants.
Assuntos
Comportamento Cooperativo , Promoção da Saúde/métodos , Obesidade/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Adulto , Aleitamento Materno , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Pesquisa Participativa Baseada na Comunidade , Família , Feminino , Programas Gente Saudável/organização & administração , Humanos , Lactente , Mães , New York , Avaliação de Resultados em Cuidados de Saúde , Gravidez , População Rural , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Gaining more weight during pregnancy than is recommended by the Institute of Medicine is prevalent and contributes to the development of obesity in women. This article describes the development and use of e-Moms of Rochester (e-Moms Roc), an electronic intervention (e-intervention), to address this health issue in a socioeconomically diverse sample of pregnant women. MATERIALS AND METHODS: Formative research in the form of intercept interviews, in-depth interviews, and focus groups was conducted to inform the design of the e-intervention. The Web site continuously tracked each participant's use of e-intervention features. RESULTS: An e-intervention, including Web site and mobile phone components, was developed and implemented in a randomized control trial. Formative research informed the design. Participants in all arms accessed blogs, local resources, articles, frequently asked questions, and events. Participants in the intervention arms also accessed the weight gain tracker and diet and physical activity goal-setting tools. Overall, 80% of women logged into the Web site and used a tool or feature at least twice. Among those in the intervention arm, 70% used the weight gain tracker, but only 40% used the diet and physical activity goal-setting tools. CONCLUSIONS: To maximize and sustain potential usage of e-Moms Roc over time, the e-intervention included customized reminders, tailored content, and community features such as blogs and resources. Usage was comparable to those in other weight studies with young adults and higher than reported in a published study with pregnant women. This e-intervention specifically designed for pregnant women was used by the majority of women.
Assuntos
Manutenção do Peso Corporal , Telefone Celular , Promoção da Saúde/métodos , Internet , Modelos Teóricos , Sobrepeso/prevenção & controle , Gravidez , Aumento de Peso , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Complicações na Gravidez/prevenção & controle , Pesquisa Qualitativa , Estados Unidos , Adulto JovemRESUMO
The objective of this study is to gain an in-depth understanding of issues related to gestational weight gain (GWG) including general health, diet, and physical activity among high and low income women and to elucidate socio-ecological and psychosocial risk factors that increase risk for excessive GWG. We conducted 9 focus groups with high (n = 4 groups) and low (n = 5 groups) income pregnant women aged 18-35 years to discuss health, GWG, diet and physical activity following a discussion guide. The constant comparative method was used to code focus group notes and to identify emergent themes. Themes were categorized within the integrative model of behavioral prediction. Low income women, in contrast to high income women, had higher BMIs, had more children, and were African American. Diet and physical activity behaviors reported by low income women were more likely to promote positive energy balance than were those of high income women. The underlying behavioral, efficacy, and normative beliefs described by both groups of women explained most of these behaviors. Experiencing multiple risk factors may lead to (1) engaging in several behavior changes during pregnancy unrelated to weight and (2) holding more weight gain-promoting beliefs than weight maintaining beliefs. These factors could inhibit diet and physical activity behaviors and/or behavior changes that promote energy balance and in combination, result in excessive GWG. Low income women experience multiple risk factors for excessive GWG and successful interventions to prevent excessive GWG and pregnancy related weight gain will need to recognize the complex web of influences.
Assuntos
Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Aumento de Peso , Adolescente , Adulto , Índice de Massa Corporal , Características Culturais , Dieta , Exercício Físico , Feminino , Grupos Focais , Humanos , Atividade Motora , Gravidez , Pesquisa Qualitativa , Qualidade de Vida , Fatores de Risco , Classe Social , Apoio Social , Fatores Socioeconômicos , Adulto JovemRESUMO
PURPOSE: The present study aimed to evaluate the implementation of a civic engagement curriculum (HEART Club) designed to catalyze positive environmental change in rural communities. DESIGN: The HEART Club curriculum was integrated into a six-month community-based health behavior intervention to reduce cardiovascular disease risk. SETTING: Participants were recruited from eight rural towns in Montana and New York. SUBJECTS: 101 midlife and older women. INTERVENTION: Participants worked to address an issue related to their local food or physical activity environment and establish progress monitoring benchmarks. METHOD: Evaluation components included after-class surveys, program leader interviews (n = 15), participant focus groups (n = 8), and post-intervention surveys. RESULTS: Intervention sites reported high fidelity (78%) to the curriculum. Average attendance was 69% and program classes were rated as highly effective (4.1 out of 5). Despite positive participant feedback, low readiness for civic engagement and insufficient time were implementation challenges. The majority of HEART Club groups had accomplished two or more benchmarks post-intervention. Facilitators of progress included community support, effective leadership, and collective effort. Participants also indicated that trying to affect community change while simultaneously making personal health improvements likely stalled initial progress. CONCLUSION: These findings highlight the potential and challenges associated with civic engagement within the context of rural lifestyle interventions. Future implementation efforts should focus on reframing civic engagement as an approach to support and maintain behavior change.
Assuntos
Estilo de Vida , População Rural , Humanos , Feminino , Idoso , Comportamentos Relacionados com a Saúde , Exercício Físico , MontanaRESUMO
BACKGROUND: Cardiovascular disease (CVD) prevalence has disproportionately risen among midlife and older female adults of rural communities, partly due to poor diet and diet-related behaviors and psychosocial factors that impede healthy eating. OBJECTIVES: This study aimed to evaluate the impact of Strong Hearts Healthy Communities 2.0 (SHHC-2.0) on secondary diet-related outcomes between intervention and control participants that align with the dietary goal and behavioral aims of the SHHC-2.0, a CVD risk reduction program. METHODS: A community-randomized controlled trial was conducted in rural, medically underserved communities. Participants were female adults ≥40 y who were classified as obese or both overweight and sedentary. Communities were randomized to SHHC-2.0 intervention (n = 5 communities; n = 87 participants) or control (with delayed intervention) (n = 6 communities; n = 95 participants). SHHC-2.0 consisted of 24 wk of twice-weekly experiential nutrition education and group-based physical activity classes led by local health educators. Changes between baseline and end point (24 wk) in dietary intake (24-h recalls), dietary behaviors (e.g., Rapid Eating Assessment for Participants-Short Version [REAP-S] scores) and diet-related psychosocial measures (e.g., Three Factor Eating questionnaire) between groups were analyzed using linear mixed-effects multilevel models. RESULTS: At 24 wk, participants from the 5 intervention communities, compared with controls, consumed fewer calories (mean difference [MD]= -211 kcal, 95% CI: -412, -110, P = 0.039), improved overall dietary patterns measured by REAP-S scores (MD: 3.9; 95% CI: 2.26, 5.6; P < 0.001), and improved psychosocial measures (healthy eating attitudes, uncontrolled eating, cognitive restraint, and emotional eating). CONCLUSIONS: SHHC-2.0 has strong potential to improve diet patterns and diet-related psychosocial wellbeing consistent with improved cardiovascular health. This trial was registered at www. CLINICALTRIALS: gov as NCT03059472.
Assuntos
Doenças Cardiovasculares , Adulto , Feminino , Humanos , Masculino , Doenças Cardiovasculares/prevenção & controle , Dieta , Obesidade , Ingestão de Alimentos , Comportamento de Redução do RiscoRESUMO
BACKGROUND: Cardiovascular disease is the leading cause of death in the United States; however, women and rural residents face notable health disparities compared with male and urban counterparts. Community-engaged programs hold promise to help address disparities through health behavior change and maintenance, the latter of which is critical to achieving clinical improvements and public health impact. METHODS: A cluster-randomized controlled trial of Strong Hearts, Healthy Communities-2.0 conducted in medically underserved rural communities examined health outcomes and maintenance among women aged ≥40 years, who had a body mass index >30 or body mass index 25 to 30 and also sedentary. The multilevel intervention provided 24 weeks of twice-weekly classes with strength training, aerobic exercise, and skill-based nutrition education (individual and social levels), and civic engagement components related to healthy food and physical activity environments (community, environment, and policy levels). The primary outcome was change in weight; additional clinical and functional fitness measures were secondary outcomes. Mixed linear models were used to compare between-group changes at intervention end (24 weeks); subgroup analyses among women aged ≥60 years were also conducted. Following a 24-week no-contact period, data were collected among intervention participants only to evaluate maintenance. RESULTS: Five communities were randomized to the intervention and 6 to the control (87 and 95 women, respectively). Significant improvements were observed for intervention versus controls in body weight (mean difference: -3.15 kg [95% CI, -4.98 to -1.32]; P=0.008) and several secondary clinical (eg, waist circumference: -3.02 cm [-5.31 to -0.73], P=0.010; systolic blood pressure: -6.64 mmHg [-12.67 to -0.62], P=0.031; percent body fat: -2.32% [-3.40 to -1.24]; P<0.001) and functional fitness outcomes; results were similar for women aged ≥60 years. The within-group analysis strongly suggests maintenance or further improvement in outcomes at 48 weeks. CONCLUSIONS: This cardiovascular disease prevention intervention demonstrated significant, clinically meaningful improvements and maintenance among rural, at-risk older women. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03059472.
Assuntos
Doenças Cardiovasculares , População Rural , Humanos , Masculino , Feminino , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Comportamentos Relacionados com a Saúde , Exercício Físico , Nível de SaúdeRESUMO
Rural women experience disproportionately higher levels of obesity in comparison to their non-rural counterparts. The present exploratory mediation analysis sought to identify mechanisms that might have contributed to rural women's physical activity and diet changes after participating in a 6-month multilevel community-randomized trial: Strong Hearts, Healthy Communities (SHHC). SHHC was conducted in 16 rural towns in Montana and New York, between 2015 and 2016; 194 overweight, sedentary midlife, and older women (mean age 59; 26.8% overweight; 73.2% obese) participated. Participants in eight towns received the SHHC intervention (n = 101), which focused on healthy behavior change at the individual level as well as creating supportive social and built environments for physical activity and healthy eating. Participants in the other eight towns received an education-only control intervention (n = 93). We investigated the direct and indirect effects of the SHHC intervention through changes to self-efficacy, social support, and built environment perception, on changes in participants' physical activity and diet. Compared to the controls, SHHC intervention participants increased their social support from friends for physical activity (p = 0.009) and healthy eating (p = 0.032). Participants' improved social support from friends marginally mediated the intervention effects for walking metabolic equivalent minutes per week, explaining 40.5% of the total effect (indirect effect = +45.24, 95% CI: -1.51, +91.99; p = 0.059). Increasing social support from friends appears to be helpful in encouraging rural women to become more active. Further investigations are needed to better understand how multilevel interventions work in rural communities.
Assuntos
Doenças Cardiovasculares , População Rural , Idoso , Dieta Saudável , Exercício Físico , Comportamento Alimentar , Feminino , Promoção da Saúde , Humanos , Análise de Mediação , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: This study aimed to examine (1) whether the Strong Hearts, Healthy Communities intervention (SHHC) improved social network members' (SNMs') weight, exercise, and diet and (2) whether SNMs' weight and behavioral changes were modified by their relationship closeness and/or spatial closeness with trial participants. METHODS: Eight towns received the SHHC intervention, which focused on building individual healthy behaviors and creating supportive social and built environments for exercise and healthy eating. Eight towns received an education-only control intervention. SNMs (n = 487) were recruited to complete a questionnaire at baseline and at 6 months that asked about demographics, weight, height, exercise, and eating habits. RESULTS: SHHC's effect on SNMs differed depending on their relationship closeness with trial participants. Among SNMs who had a very close relationship with trial participants, those associated with the intervention group lost more weight and decreased BMI more than those associated with the control group (weight [kilograms] between-group difference: Δ = -1.68; 95% CI: -3.10 to -0.25; P = 0.021; BMI between-group difference: Δ = -0.60; 95% CI: -1.16 to -0.04; P = 0.034). Spatial closeness did not modify any of SHHC's ripple effects. CONCLUSIONS: Relationship closeness, rather than spatial closeness, played an important role in influencing a rural community-based intervention's ripple effects.
Assuntos
Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Comportamentos Relacionados com a Saúde/fisiologia , Saúde Pública/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , População Rural/estatística & dados numéricos , Adulto , Idoso , Peso Corporal , Dieta , Dieta Saudável/métodos , Exercício Físico/fisiologia , Comportamento Alimentar/fisiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Primária/métodos , Prevenção Primária/organização & administração , Saúde Pública/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Rural women have higher rates of cardiovascular disease than their nonrural counterparts, partially because of their social and environmental contexts. The study objective is to test a refined version of the multilevel Strong Hearts, Healthy Communities intervention, which used extensive process and outcome evaluation data from the original randomized trial to optimize effectiveness as measured by improved Simple 7 score, a composite measure of cardiovascular disease risk. STUDY DESIGN: The intervention was implemented in a 6-month, delayed intervention, community-randomized trial; control participants received the program following 24-week outcome assessment. The study was conducted in 2017-2018; data analysis occurred in 2018-2019. SETTING/PARTICIPANTS: The study was conducted in 11 rural, medically underserved towns in New York. Participants were women aged ≥40 years who were either (1) obese or (2) overweight and sedentary. INTERVENTION: The intervention group received 24 weeks of hour-long, twice-weekly classes including strength training, aerobic exercise, and skill-based nutrition- and health-related education, as well as civic engagement activities focused on healthy food and physical activity environments. MAIN OUTCOME MEASURES: Measures included weight and height; blood pressure; blood cholesterol; blood glucose; and self-reported smoking, diet, and physical activity behaviors. Individual Simple 7 components were examined, and mixed linear regression analyses were used to examine change in Simple 7 score. RESULTS: A total of 182 participants were randomized. Compared with control participants, the intervention group had greater improvements in Simple 7 score (difference=1.03, 95% CI=0.44, 1.61, p<0.001) and 3 of the Simple 7 components (physical activity, healthy diet score, and BMI). CONCLUSIONS: These findings highlight the importance of rigorously evaluating programs in real-world community settings and, when appropriate, revising and retesting interventions to optimize dissemination potential. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT03059472.
Assuntos
Doenças Cardiovasculares/prevenção & controle , Etnicidade , Grupos Minoritários , Saúde da Mulher , Adulto , Índice de Massa Corporal , Exercício Físico , Feminino , Humanos , New York , Sobrepeso , População RuralRESUMO
OBJECTIVES: To describe (1) the use of a diet goal-setting tool in a self-directed online intervention aimed at promoting a healthy lifestyle, and (2) the association of tool use with gestational weight gain (GWG). DESIGN: Cross-sectional analysis of data from the intervention group in a randomized effectiveness trial. SETTING: An urban county in the northeastern US. PARTICIPANTS: A total of 898 healthy pregnant women aged 18-35 years with body mass indexes of (BMI) ≥18.5 and <35; 39.1% were low-income. MAIN OUTCOME MEASURES: Physical, sociodemographic, and psychosocial characteristics; use of tool features; and GWG. ANALYSIS: Frequencies, chi-square tests of independence, and regression analysis. RESULTS: Use of the online dietary tool was 45.1% completed the assessment, 35.3% set a goal, and 22.6% engaged in self-monitoring. Among women with normal BMI, setting ≥2 goals and engaging in self-monitoring were significantly (P < .05) associated with less GWG. Among women with higher BMI, setting ≥2 goals was significantly associated with greater GWG. CONCLUSIONS AND IMPLICATIONS: Although online diet goal setting is a potentially effective weight management tool for pregnant women with normal BMI, findings suggest that it may not be for higher-BMI women. Additional research is needed to explain this finding.
Assuntos
Dieta/métodos , Ganho de Peso na Gestação/fisiologia , Promoção da Saúde/métodos , Internet , Adolescente , Adulto , Estudos Transversais , Feminino , Objetivos , Humanos , Sobrepeso/prevenção & controle , Gravidez , Adulto JovemRESUMO
BACKGROUND: Rural midlife and older women have high rates of cardiovascular disease (CVD) risk factors and lower access to healthy living resources. The Strong Hearts, Healthy Communities (SHHC) intervention, tailored to the needs of rural women, demonstrated effectiveness on many outcomes. The purpose of the Strong Hearts for New York (SHNY) study is to evaluate the efficacy of an enhanced version of the curriculum (SHHC-2.0). METHODS: SHNY is a randomized controlled efficacy intervention, comparing participants receiving the SHHC-2.0 curriculum with a delayed intervention control group. SHHC, informed by formative research, includes core elements from three evidence-based programs. Changes based on extensive outcome and process evaluation data were made to create SHHC-2.0. Classes will meet twice weekly for 24â¯weeks and include individual, social, and environmental components. Overweight women age 40 and over will be recruited from 11 rural, medically underserved communities in New York; data will be collected at baseline and 12, 24, 36, and 48â¯weeks across individual, social, and environmental levels. Primary outcome is body weight. Secondary outcomes include Simple 7 (composite CVD risk score), anthropometric, physiologic, biochemical, physical activity, and dietary intake measures; healthy eating and exercise self-efficacy and attitudes; and self-efficacy of the social network of participants. DISCUSSION: The aims of this study are to evaluate the efficacy of the enhanced SHHC-2.0 program for participants, changes among participants' social networks, and the difference in outcomes when participants are and are not provided with technological tools (Fitbit and body composition scale).
Assuntos
Doenças Cardiovasculares/prevenção & controle , Promoção da Saúde/métodos , Comportamento de Redução do Risco , Adulto , Currículo , Exercício Físico , Feminino , Comportamentos Relacionados com a Saúde , Educação em Saúde/métodos , Humanos , New York , Educação de Pacientes como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , População RuralRESUMO
Little is known about the relationship between perceived and objective measures of the built environment and physical activity behavior among rural populations. Within the context of a lifestyle-change intervention trial for rural women, Strong Hearts, Healthy Communities (SHHC), we examined: (1) if Walk Score (WS), an objective built environment measure, was associated with perceived built environment (PBE); (2) if WS and PBE were associated with moderate-to-vigorous physical activity (MVPA); and (3) if MVPA changes were modified by WS and/or PBE. Accelerometers and questionnaires were used to collect MVPA and PBE. Bivariate analyses and linear mixed models were used for statistical analyses. We found that WS was positively associated with perceived proximity to destinations (p < 0.001) and street shoulder availability (p = 0.001). MVPA was generally not associated with WS or PBE. Compared to controls, intervention group participants increased MVPA if they lived in communities with the lowest WS (WS = 0), fewer perceived walkable destinations, or extremely safe perceived traffic (all p < 0.05). Findings suggest that WS appears to be a relevant indicator of walkable amenities in rural towns; results also suggest that the SHHC intervention likely helped rural women with the greatest dearth of built environment assets to improve MVPA.
Assuntos
Terapia Comportamental , Ambiente Construído , Comportamentos Relacionados com a Saúde , Coração/fisiologia , Estilo de Vida , Caminhada/estatística & dados numéricos , Adulto , Cidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Percepção , População Rural/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
PURPOSE: Social environments exert an important influence on health behaviors, yet evidence from rural-specific contexts is limited. This study explored how social relationships influence health-related behaviors among midlife and older rural adults at increased risk of chronic disease. METHODS: Seventeen focus groups were conducted with 125 sedentary, overweight/obese adults (aged 40-91 years) residing in "medically underserved" rural Montana towns in 2014. Groups were stratified by age (40-64 and ≥65) and gender. Transcripts were examined thematically using NVivo software according to social influences on diet, physical activity, and tobacco use. Analyses were conducted in 2015-2016. RESULTS: Attitudes and actions of family members and friends were key influences on health behaviors, in both health-promoting and health-damaging ways. In these small, isolated communities, support from and accountability to family and friends were common facilitators of behavior change and maintenance. However, expectations to conform to social norms and traditional gender roles (eg, caregiving duties) often hindered healthy lifestyle changes. CONCLUSIONS: These findings suggest that health behavior interventions targeting adults in rural settings need to consider and, if possible, integrate strategies to address the impact of social relationships in both supporting and sabotaging behavior change and maintenance.