A researcher at The University of Alabama in Huntsville (UAH) has been awarded a $179,000 subcontract to explore community-based strategies for reducing high-burden chronic disease like obesity, diabetes, heart disease and cancer as part of an overall award totaling $4.2 million. The funding is being provided by the National Institute on Minority Health and Health Disparities (NIMHD). Dr. Jennifer Bail, an assistant professor in the College of Nursing at UAH, a part of the University of Alabama System, will be the subcontract principle investigator (PI) in support of an overall grant study titled, Community-Based Strategies to Reduce Cardiometabolic Diseases in the Deep South.
Nearly three out of four adults in the United States are overweight or living with obesity, with the highest rates among Black people, rural residents and lower socioeconomic groups. “Over the past decade, obesity trends have been generally stable for men, but have increased significantly among women,” Dr. Bail says. “This is particularly true among Black women who have an obesity prevalence of 57%, compared to 40% in white women. Black women living in rural settings also have higher rates of obesity compared to their same race/sex peers in urban settings.”
Evidence-based interventions that promote weight loss, healthy diet and physical activity have been shown to be effective at slowing the conversion of pre-diabetes mellitus and hypertension to diabetes and heart failure, the researcher reports. However, Dr. Bail explains that “despite multiple large, well-designed randomized clinical trials (RCTs), proven weight loss interventions have failed to reach populations at highest risk and often result in less weight loss among Black participants than other racial groups.”
Residents of rural communities report greater environmental barriers to healthy eating and physical activity than their urban/suburban counterparts. “Larger food stores are more likely than smaller grocers and convenience stores to stock healthy foods at lower cost,” Dr. Bail notes. “As such, behavioral change interventions alone may be insufficient for positive and sustained outcomes if the environmental context is not supportive of the healthy changes. In contrast, supportive environments for individual behavior change have shown promise in improving diet, increasing physical activity and reducing obesity.”
Through a study named Stepping Into Lifestyle Changes (SILC), this research aims to reduce chronic disease burden and health disparities among Black women living in the rural Deep South by combining a weight loss intervention called Journey to Better Health (JTBH) with a mentored vegetable gardening intervention known as Harvest for Health (H4H).
Approximately 264 Black women will be enrolled in the SILC study. Lay health educators, who are trusted local community members, will recruit 20-25 study participants in each of the 12 targeted rural counties, including Barbour, Butler, Conecuh, Macon, Perry and Wilcox counties in Alabama, as well as Clay, Holmes Jasper, Jefferson, Noxubee and Wilkinson counties in Mississippi.
“The targeted counties have historically lacked access to adequate health and social services and have higher percentages of persons living in poverty than national and state averages,” Dr. Bail says. “Potentially eligible women will be identified through announcements in church bulletins, presentations at local community meetings, fliers and word-of-mouth.”
Combining these two evidence-based interventions addresses multiple domains (behavioral, personal environment, sociocultural) and levels (individual, interpersonal, community) of influence on chronic disease risk factors and may result in better implementation and effectiveness outcomes. “By reducing environmental barriers to healthy eating and increasing opportunities for physical activity, we hypothesize greater improvements in clinical outcomes, such as weight, blood pressure and glucose, among participants in the JTBH plus H4H interventions versus JTBH alone,” Dr. Bail points out.
