Could community-based 'Change Clubs' improve heart health in black women?

BOSTON (Feb. 27, 2017)--Heart disease is the leading cause of death for Black/African American women in the US and more Black/African American women die every year from heart disease compared to their white and Hispanic counterparts, according to the Centers for Disease Control. A pilot study, led by researchers at the Friedman School of Nutrition Science and Policy at Tufts University, aimed to address this disparity by investigating the impact of engaging Black/African American women in "Change Clubs" on measures of heart health. The results of the pilot study were published in BMC Public Health on Jan. 24.

Using the African American Collaborative Obesity Research Network (AACORN) model focused on engaging community members in the planning and implementation of interventions, the researchers collaborated with four local churches in predominately Black/African American Boston neighborhoods, and worked with participants to identify and address health concerns in their respective communities.

Working with the researchers from Tufts, a group of 28 self-identified Black/African American women aged 30 to 70 who were clinically overweight and led a mostly sedentary life formed Change Clubs in the four churches. The Change Clubs met weekly for six months.

During the first three months, each Change Club identified a nutrition or physical activity concern in their community and planned a group project to address the concern. For example, one club wanted to increase access to heart-healthy food, while another club decided to educate the community about healthy eating and fitness choices. The final three months were dedicated to implementing the action steps and benchmarks established by the Change Clubs during the first half of the intervention.

During the weekly meetings, a nutrition or physical activity topic was covered. The researchers anticipated that this curriculum would provoke individual behavior changes surrounding nutrition and exercise and that the women would reinforce these behavior changes among each other. By empowering one another, the group was able to effect change in their communities.

Surveys at the end of the intervention indicated that participants believed they had been effective in positively motivating their communities. The Change Clubs met their self-identified action steps and outcomes. For example, one Club decided upon heart-healthy recipes and conducted monthly cooking demonstrations for the community, while another Club engaged children and parents at a local school to develop a heart-healthy cookbook for families.

Additionally, in individual outcomes, the intervention had an effect on specific physical measures of the women's heart health. Overall, the women were able to finish a walk test of cardiorespiratory fitness more quickly and their systolic blood pressure had decreased slightly from pre-intervention measures. Considering the prevalence of heart disease among Black/African American women, this clinically significant decrease in systolic blood pressure is promising and a possible result of the exercise curriculum in the Clubs.

"The nutrition and exercise curriculum during each meeting was adapted to the individual communities from the Strong-Women - Healthy Hearts program developed by Tufts researchers. By interweaving this curriculum into the Change Clubs, we hoped that the individual members would make behavioral changes in regards to nutrition and exercise and reinforce those changes within the group, resulting in improved measures of heart health among the women. Overall, civic engagement and empowerment had a positive effect on the communities as well as the women individually," said senior author Sara Folta, Ph.D., associate professor at the Friedman School who also holds a secondary faculty appointment at the Jonathan M. Tisch College of Civic Life.

"The Change Clubs place the focus on the collective health of the community and champion the strengths of the Black/African American community. Through this pilot, we hoped to determine how feasible and effective the Change Clubs would be in changing the heart health-related behaviors among Black/African American women in order to expand this type of work in the future," said lead author Alison G. M. Brown, M.S., doctoral candidate at the Friedman School. "Overall, the study results indicate that this civic engagement approach is a promising intervention tool to stimulate positive behavior change among Black/African American women."

The researchers note that this was a pilot study and suggest a larger, randomized, control trial to explore Change Clubs and civic engagement as a way to improve the heart health of Black/African American women.

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Additional authors are Linda B. Hudson, Sc.D., and Kenneth Chui, Ph.D., M.P.H., M.S., both assistant professors in the Department of Public Health and Community Medicine at Tufts University School of Medicine, Nesly Metayer, Ph.D., senior fellow at the Moakley Center for Public Management at Suffolk University, Namibia Lebron-Torres, M.S., research coordinator at the Friedman School of Nutrition Science and Policy at Tufts University, and Rebecca A. Seguin, Ph.D., M.S., assistant professor at Cornell University College of Human Ecology.

This study was supported the Boston Nutrition Obesity Research Center, Tisch College of Civic Life and Tufts, and Aviva Must, Ph.D., Morton A. Madoff Professor and Chair of Public Health and Community Medicine and dean of Public Health and Professional Degree Programs at Tufts University School of Medicine.

Brown, A. G. M., Hudson, L. A., Chui, K., Metayer, N., Lebron-Torres, N., Seguin, R.A., Folta, S.C. (2017). Improving heart health among Black/African American women using civic engagement: a pilot study. BMC Public Health. 17(1). DOI: 10.1186/s12889-016-3964-2.

The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University is the only independent school of nutrition in the United States. The school's eight degree programs - which focus on questions relating to nutrition and chronic diseases, molecular nutrition, agriculture and sustainability, food security, humanitarian assistance, public health nutrition, and food policy and economics - are renowned for the application of scientific research to national and international policy.