Effect of a Plant-based Intervention Among Black Individuals in the Deep South: A Pilot Study.

OBJECTIVE: To explore the feasibility, acceptability, and clinical/behavioral outcomes of a remotely-delivered, culturally-tailored plant-based nutrition and lifestyle intervention designed to improve cardiovascular risk among Black adults in a rural, Black Belt community. METHODS: We implemented a 12-week intervention with weekly educational sessions, cooking lessons, social support, exercise, and food items. OUTCOME(S): Body mass index, waist circumference, total cholesterol, low-density lipoprotein, high-density lipoprotein, high-sensitivity C-reactive protein, trimethylamine N-oxide, diet/physical activity. Paired t tests analyzed preintervention and postintervention differences (n = 24). RESULTS: Body mass index and waist circumference were reduced (P < 0.001), and total and low-density lipoprotein cholesterol decreased by 10.8% and 13.9%, respectively (P < 0.05). There was a 25.8% reduction in high-sensitivity C-reactive protein (P = 0.02). Diet and physical activity were also improved. CONCLUSIONS AND IMPLICATIONS: This pilot study demonstrated the feasibility and acceptability of a remotely-delivered intervention focused on improving cardiovascular risk through plant-based nutrition, physical activity/wellness, social support, and cultural adaptability. Larger scale and longer-term studies are needed.

Pairing Project ECHO and patient navigation as an innovative approach to improving the health and wellness of cancer survivors in rural settings.

PURPOSE: We conducted a 12-month pilot study of 2 complementary strategies for improving rural cancer survivorship outcomes: (1) Project ECHO, a telementoring model to increase knowledge and skills about cancer survivorship among multidisciplinary health care provider teams in rural areas and (2) patient navigation (PN) services to connect rural cancer survivors with resources for enhancing health and wellness. METHODS: We recruited 4 CDC-funded National Comprehensive Cancer Control Program sites to implement Project ECHO and PN interventions for a defined rural population in each of their jurisdictions. Sites received ongoing technical assistance and a stipend to support implementation. We conducted a mixed-methods evaluation consisting of quantitative performance monitoring data and qualitative interviews with site staff to assess implementation. FINDINGS: Site teams delivered 21 cancer survivorship ECHO sessions to rural providers resulting in 329 participant encounters. Almost all (93%) ECHO participants reported enhanced knowledge of cancer survivorship issues, and 80% reported intent to apply learnings to their practices. Site teams engaged 16 patient navigators who navigated 164 cancer survivors during the study period. Successful implementation required strong partnerships, clear avenues for recruitment of rural providers and cancer survivors, and activities tailored to local needs. Fostering ongoing relationships among sites through community of practice calls also enhanced implementation. CONCLUSIONS: Sites successfully implemented a novel approach for enhancing care for cancer survivors in rural communities. Pairing Project ECHO to address structural barriers and PN to address individual factors affecting survivorship may help bridge the health equity gap experienced by cancer survivors in rural communities.

Enhancing the Adoption of Evidence-Based Health Marketing and Promotion Strategies in Local Communities: Building a Communication Dissemination and Support System for the National Diabetes Prevention Program.

The Centers for Disease Control and Prevention (CDC) created a health communication marketing and promotion support system (support system) to help 10 CDC-funded national organizations (recipients) grow enrollment of underserved populations in the National Diabetes Prevention Program. This article describes the creation of a successful support system to increase the use of effective marketing approaches and key messaging. The support system was developed using a systematic approach. It included a needs assessment, audience research, marketing strategy identification, expert panel review, materials development, and dissemination guidance. Hands-on, individualized, and group end-user training and technical assistance was also included. Recipients received culturally and linguistically tailored marketing materials to support their specific priority audiences, as well as corresponding training on recommended dissemination methods. In in-depth key-informant interviews, staff from six recipients reported increased knowledge of local communities and audiences, efficacy and skills to conduct media interviews, capacity to identify and train champions and influencers, and greater community partner investments. With marketing support, 90% of recipients reported increased enrollment, of which 40% exceeded self-set targets and another 40% doubled or tripled their enrollment numbers. These findings indicate that a customized strategic health communication marketing and promotion support system presents a significant opportunity to help recipients increase enrollment in evidence-based interventions. Practitioners disseminating evidence-based interventions may consider a support system to increase program uptake.

The Potential for Plant-Based Diets to Promote Health Among Blacks Living in the United States.

Plant-based diets are associated with reduced risks of various chronic diseases in the general population. However, it is unclear how these benefits translate to Blacks living in the United States, who are disproportionately burdened with heart disease, cancer, diabetes, obesity, and chronic kidney disease. The objectives of this study were to: (1) review the general evidence of plant-based diets and health outcomes; (2) discuss how this evidence translates to Blacks following a plant-based diet; and (3) provide recommendations and considerations for future studies in this area. Interestingly, although the evidence supporting plant-based diets in the general population is robust, little research has been done on Blacks specifically. However, the available data suggests that following a plant-based diet may reduce the risk of heart disease and possibly cancer in this population. More research is needed on cardiovascular disease risk factors, cancer subtypes, and other chronic diseases. Further, attention must be given to the unique individual, familial, communal, and environmental needs that Blacks who follow plant-based diets may have. Interventions must be culturally appropriate in order to achieve long-term success, and providing low-cost, flavorful, and nutritious options will be important.

Early Results of States' Efforts to Support, Scale, and Sustain the National Diabetes Prevention Program.

The Centers for Disease Control and Prevention (CDC) developed a cooperative agreement with health departments in all 50 states and the District of Columbia to strengthen chronic disease prevention and management efforts through the implementation of evidence-based strategies, such as CDC's National Diabetes Prevention Program. The National Diabetes Prevention Program supports organizations to deliver the year-long lifestyle change program that has been proven to prevent or delay the onset of type 2 diabetes among those at high risk. This article describes activities, barriers, and facilitators reported by funded states during the first 3 years (2013-2015) of a 5-year funding cycle.

Effects of social injustice on breast health-seeking behaviors of low-income women.

PURPOSE: The study uses qualitative research to gain a better understanding of what occurs after low-income women receive an abnormal breast screening and the factors that influence their decisions and behavior. A heuristic model is presented for understanding this complexity. DESIGN: Qualitative research methods used to elicited social and cultural themes related to breast cancer screening follow-up. SETTING: Individual telephone interviews were conducted with 16 women with confirmed breast anomaly. PARTICIPANTS: Low-income women screened through a national breast cancer early detection program. METHOD: Grounded theory using selective coding was employed to elicit factors that influenced the understanding and follow-up of an abnormal breast screening result. Interviews were digitally recorded, transcribed, and uploaded into NVivo 8, a qualitative management and analysis software package. RESULTS: For women (16, or 72% of case management referrals) below 250% of the poverty level, the impact of social and economic inequities creates a psychosocial context underlined by structural and cultural barriers to treatment that forecasts the mechanism that generates differences in health outcomes. The absence of insurance due to underemployment and unemployment and inadequate public infrastructure intensified emotional stress impacting participants' health decisions. CONCLUSION: The findings that emerged offer explanations of how consistent patterns of social injustice impact treatment decisions in a high-risk vulnerable population that have implications for health promotion research and systems-level program improvement and development.

Assessing levels of adaptation during implementation of evidence-based interventions: introducing the Rogers-Rütten framework.

Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers's diffusion theory and Rütten's framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention.

African Americans' decisions not to evacuate New Orleans before Hurricane Katrina: a qualitative study.

OBJECTIVES: We examined the psychosocial and personal factors that influenced African Americans' decision not to evacuate New Orleans, La, before Hurricane Katrina's landfall. METHODS: We conducted 6 focus groups with 53 African Americans from New Orleans who were evacuated to Columbia, SC, within 2 months of Hurricane Katrina. RESULTS: The major themes identified related to participants' decision to not evacuate were as follows: (1) perceived susceptability, including optimism about the outcome because of riding out past hurricanes at home and religious faith; (2) perceived severity of the hurricane because of inconsistent evacuation orders; (3) barriers because of financial constraints and neighborhood crime; and (4) perceived racism and inequities. CONCLUSIONS: Federal, state, and local government disaster preparedness plans should specify criteria for timely evacuation orders, needed resources, and their allocation (including a decentralized distribution system for cash or vouchers for gas and incidentals during evacuation) and culturally sensitive logistic planning for the evacuation of minority, low-income, and underserved communities. Perceptions of racism and inequities warrant further investigation.