Table 1. Summary of randomized controlled trials.
| Randomized trials (n = 27) | |||||
|---|---|---|---|---|---|
| First author (year) | Description of sample used in analysis | Mean age (years) | LS7 metric(s) | Intervention | Results |
| Ahluwalia (2007)* | 173 participants from 20 housing developments; 63% female and 86.9% AA in fruit & vegetable (FV) arm; 83% female and 75.8% AA in smoking cessation arm. | 48 in FV arm; 43 in smoking cessation arm | Diet | FV consumption arm: a bag of fresh FV, dietary educational materials; two videos on FV. Smoking cessation arm: 8-week supply of nicotine gum, instructions for use, and educational materials related to quitting. Both arms received five sessions of motivational interviewing. | At week 8 and month 6, FV group consumed 1.58 (p = 0.001) and 0.78 (p = 0.04), respectively, more servings than the cessation group in the past 7 days. The FV arm consumed 3.61 (p = 0.01) and 3.93 (p = 0.01) more FV servings at 8 weeks and 6 months, respectively, in the past 30 days compared to cessation group. |
| Allicock (2013)* | 6 AA churches; 302 participants age 50 or older; 71% female | __ | Diet | Body and Soul Program: pastoral support, sampling/preparing fruits and vegetables, healthy foods at church events, motivational interviewing sessions) | 0.35 servings/day increase from baseline (3.9 servings/day) in FV consumption (p = 0.04). Study found low reach and suboptimal implementation of program. |
| Andrews (2007)* | 103 AA from 2 subsidized housing developments in Augusta, Georgia | 44.5 in intervention group; 33 in the comparison group | Smoking status | Smoking Cessation intervention “Sister to Sister”: nurse-delivered behavioral/empowerment counseling in group format, nicotine replacement therapy (NRT), community health worker personal support. Control: self-help materials and 4 total nurse-led group educational sessions. | Six-month continuous abstinence proportions were 27.5% in intervention group and 5.7% in the control group. The Intervention group had significantly higher social support, self-efficacy, and spiritual wellbeing compared to the control group |
| Boltri (2011)* | 5 churches in rural Georgia; 37 AA participants; 62.2% female | 57.2 | Blood glucose; BMI | Group-based diabetes prevention program (DPP) lasting either 6 weeks or 16 weeks: weekly sessions led by trained leaders included prayer, discussion, and questions. Sessions adapted from the NIH-DPP curriculum. | Overall changes post-intervention to 12 month follow up: fasting glucose decreased from 108.1 to 101.7 mg/dL (p = 0.037); BMI decreased from 33.2 to 32.6 kg/m2 (p<0.05). No significant difference in outcomes between 6 week and 16 week interventions, but lower implementation costs for 6 week intervention program. |
| Froelicher (2010) | 60 AA residents from the Bayview-Hunters Point neighborhood in San Francisco, CA; 71.7% female | 46.62 | Smoking status | 5-week smoking cessation program (control group [CG]) or CG plus community co-developed tobacco industry and media messages (IAM). | 11.5% of the CG and 13.6% of the IAM group were smoke-free at 6 months and 5.3% of the CG group and 15.8% of the IAM group remained smoke-free at 12 months. None of the smoking cessation outcomes were significantly different. |
| Haire-Joshu (2003)* | 738 AA parents in the Parent as Teacher (PAT) programs located within 12 school districts in St. Louis, MO; 98% female. | 29 | Diet | Two phase (Fall to Spring) Culturally-appropriate, dietary change program including personal visits, newsletters and group meetings that are led by parent educators for parents of children from birth to age 3. | There was a net difference of 0.53 servings of fruits and vegetables in baseline and post-testing between intervention and control groups (p = 0.03), no significant difference in percent calories from fat consumed daily, and no significant difference in parental modeling behaviors to their children. Parents who received at least one personal visit showed significant reductions in fat intake (p = 0.02) and improvements in low fat eating behaviors (p = 0.01), but no significant improvements in modeling or fruit and vegetable intake. |
| Harmon 2014 | 23 AA participants; 69.6% female. | 62 (intervention arm); 60 control arm | Diet | 12-weekly experiential healthy cooking classes followed by 4 monthly booster sessions over 8 months. | There were no significant differences in fruit and vegetable consumption, fat intake, and body weight between the intervention and control groups over the 8 month study period. |
| Kegler (2016) | 349 overweight or obese women in rural Georgia; 84.8% AA females. | 50.2 | Physical activity | 16-week tailored home environmental profile (with 3 home visits and 4 coaching calls), goal setting and behavioral contracting for 6 healthy actions. The control group received 3 mailings of educational materials at 6-week intervals. | There were no statistically significant changes in moderate to vigorous physical activity. Intervention participants had significantly higher self-reported weight loss (mean = -9.1 pounds) at 6 months than control participants (p = 0.03). The difference in weight loss was not significant at 12 months, but longitudinal intention-to-treat analyses demonstrated significant differences in weight loss over time (p = 0.03). |
| Keller (2004)* | 29 obese AA females | 54.53 | Blood cholesterol | 36 week low intensity walking program; Group 1 walked 3 days per week and group 2 walked 5 days per week | Walking for 30 minutes for 3 or 5 days a week resulted in clinical increases in serum HDL-C and statistically significant reductions of body fat estimated by bioelectrical impedance analysis and regional fat estimated by waist-to-hip ratio. |
| Leone (2016) | 19 AA churches; 712 participants; 68.6% female. | 62.8 | Physical activity | Colon cancer screening intervention participants (10 churches) received 3 mailed tailored newsletters addressing colorectal cancer screening and physical activity behaviors over approximately 6 months. Nine comparison churches received Body & Soul, a fruit and vegetable promotion program. | At follow-up, there were no significant differences overall (p = 0.15) in changes in moderate-vigorous physical activity for intervention versus the comparison group. Reported screening rates were higher at follow-up for both groups, but there were no statistically significant differences between intervention and comparison groups (p = 0.37). |
| Levine (2003) | 789 AA residents in the Sandtown-Winchester community of Baltimore, MD; 62% female. | 54 | Blood pressure | 40-month interventions: Less intense arm (usual care, community hypertension [HTN] education, HTN patient education materials) vs more intense arm (less intense intervention + a series of 5 home visits by trained community health workers over a 30 month period including education and counseling, outreach and follow-up and social support mobilization). | There was a mean systolic blood pressure (BP) change of 2.7 mmHg and mean diastolic BP change of 3 mmHg in the more intense arm and mean changes of 6.5mmHg ad 4.6 mmHg, respectively, in the less intense arm. Differences from baseline to follow-up were significant in both arms (p = 0.05). The difference at final follow-up was not (p = 0.10). The percentage of individuals with normal BP increased by 12% and 14% in the more and less intense groups, respectively. |
| Miller (2016) | 123 AA; 71% female. | 58.6 | Blood pressure; Diet; blood cholesterol; blood glucose | Intervention group: coach-directed, tailored DASH diet advice via a 1-hour, in-person, one-on-one session with the study coach who delivered a dietitian-developed module on adoption of the DASH diet and weekly 15-minute calls and money to shop for pre-selected food items over the 8 weeks). Control group: printed materials on improving BP control by adoption of the DASH diet at 15-minute visit with the study coordinator along with money to shop for food throughout the 8 weeks | There was no significant difference in change in BP between the DASH-Plus compared to the control group. There were significant increases in potassium, magnesium, vitamin C, and fiber in the DASH-Plus group compared with the control group (p<0.04), but no change in self-reported consumption of daily dietary fat or cholesterol. The DASH-plus intervention had a significant effect on glucose control among those with diabetes at baseline (p = 0.002) |
| Morisky (1982)* | 200 hypertensive patients from an inner city. 91% AA and 70% female | __ | Blood pressure | Family support intervention consisted of a home visit with a lay community person who conducted education concerning hypertension and its management, followed by education using a family member booklet. Small group sessions were the second intervention designed to increase the patient’s understanding and feeling of control over the medical regimen. Group 1 only had family support intervention. Group 2 had family support intervention and small group sessions. | 62% of those in Group 2 and 46% in Group 1 had significant difference in final blood pressure control status (p < 0.05) after the educational program. |
| Resnick (2008) | 166 participants; 72% AA; 81% female. | 73 | Physical activity | 12- week combined physical activity (stretching, resistance and aerobic exercises according to Exercise: A Guide from the National Institute on Aging) and efficacy-enhancing (once a week for 30 minutes) intervention. The control group received nutrition education twice weekly for 1–1.5 hours in a group setting. | The intervention group had significantly higher outcome expectations related to exercise (p = .02) and spent more time in exercise (p = .04) than those in the control group. There were no significant differences in self-efficacy expectations (p = .21) or overall physical activity (p = .63) between the two groups. |
| Resnicow (2009)* | 468 AA participants; 73% female. | 49 | Diet | Three-month intervention: three print-based fruit and vegetable (F & V) newsletters based on individual ethnic identity (EI) over three months. Control: three print-based F & V newsletters tailored only on demographic, behavioral, and social cognitive variables. | Intervention group participants with an Afrocentric EI showed a 1.4 servings per day increase compared to .43 servings among controls (p<0.05). Conversely, there were no between-group differences among those not classified as Afrocentric (n = 338). And, among individuals with a strong EI match, experimental group members increased 1.3 servings compared to .71 among controls (p = .07). For those with weak EI matches, the changes were identical, .89 and .87, respectively, between the two study groups. |
| Scarinci (2014) | 565 AA female participants from 6 counties; 495 (88%) participants completed all five sessions. | 53.9 | Diet; physical activity | The intervention arm consisted of a 5-week healthy lifestyle intervention (four group sessions and one individual session) that was adapted from the “New Leaf… Choices for Healthy Living with Diabetes”. The comparison arm consisted of educational and behavioral strategies to promote breast and cervical cancer screening (four group sessions and one individual session). Both were delivered by lay health workers. | There was a significant change in physical activity between arms (p = 0.004), but the change in physical activity was not associated with any other factors. There was not a significant change in fruit and vegetable consumption. A large percentage of participants in the healthy lifestyle arm reported engaging in physical activity five or more days per week at 12 months (24% increase) as compared to the screening arm (3% increase) (p < .0001). However, physical activity decreased by 16% from baseline at 24 months in the healthy lifestyle group while the screening group increased by 11% from baseline (p = .024). |
| Schulz (2015)* | 695 participants enrolled; 61% AA; 90% female. | 46.6 | Physical activity; blood pressure; blood glucose; cholesterol; BMI | 32- week Community-Health Promoter (CHP)-facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45–90 minutes (increasing over time). The control group had a lagged intervention that started at least 8 weeks after the intervention group. | Overall Steps increased significantly with both the number of sessions (p<0.001) and consistency (number of weeks attended at least one session) (p<0.001). Those in the intervention group increased average steps/day about 2000 steps more (p < .0001) compared to those in the lagged group during the same 8-week period. Each increase of 1000 overall steps at 8 weeks compared to baseline was associated with lower odds of high blood pressure (p = 0.01), and with reductions in total cholesterol (p = 0.02), high density lipoprotein (p = 0.00), blood glucose (p = 0.04) and waist circumference (p = 0.01). BMI (p = 0.04). |
| Skolarus (2018) | 94 participants; 97% AA; 79% female. | 58 | Blood pressure | Reach Out, a faith-collaborative, mobile health intervention, consisted of four components: prompted BP self-monitoring, tailored text messages related to these BP results, targeted healthy behavior text messages, and generic healthy behavior text messages. There was a 1:1 ratio intervention to control group allocation. | There were no between-group differences in the change from pre- to post intervention systolic or diastolic blood pressure. |
| Spencer (2011)* | 164 AA and Latino adult participants; Intervention group: 53% AA and 75% female; Control group: 61% AA and 67% female. | 50 in intervention group; 55 in control group | Blood glucose (via Hemoglobin A1c) | During the 6-month intervention period, trained community health workers delivered culturally tailored group diabetes education classes in both English and Spanish, conducted two home visits to address participants’ specific self-management goals, and went to 1 clinic visit with the participant and his or her primary care provider. They also contacted intervention participants by phone every 2 weeks. Participants in the control group were contacted once per month to update contact information. | Intervention group participants had a mean HbA1c value improvement of -0.8 percentage points from 8.6% at baseline, to 7.8% at 6 months (P < .01). There was no change in mean HbA1c among the control group. Intervention participants also had significantly greater improvements in self-reported diabetes understanding compared with the control group. |
| Tan (2006) | 113 participants; 96% AA; 94% female | 69 | Physical activity | Experience Corp (EC) Participation: high-intensity volunteering program (15 or more hours per week in public elementary schools) over 8 months. | At 4–8 months, EC participants reported increase in mean minutes expended/week in PA, from 220 to 270 min/week. Control Group decreased from 170 to 140 minutes. This was not significant and the study was not powered to detect a difference. EC participants had 40% increase in Kcal expended compared to a decrease of 16% in controls (not significant). At follow-up, 40% of EC participants met Healthy People 2020 goals. Compared to 25% of controls (p = 0.46). |
| Tucker (2017)* | 70 overweight/obese AA participants; 81.4% female. | __ | Diet; physical activity; blood pressure; BMI | 6-week church-based health empowerment program designed to promote healthy behaviors. A goal-setting session during week 1 and was followed by four weekly, 90-min meeting sessions that were led by two of the health empowerment coaches. Components included individualized coaching, family health self-empowerment, health-smart behavior resource guide, individual and group exercise (150 mins/week), and provider and community member health panel. | The intervention group, as compared to a waitlist control group, demonstrated a significant increase in the level of healthy eating (p = .001) and physical activity (p < .001). There was no significant change in blood pressure or BMI. |
| Voorhees (1996)* | 22 AA churches; 69% female | 46.1 in intensive intervention group; 47.05 in minimal intervention group | Smoking status | Intensive culturally specific, spiritually-based, intervention incorporated smoking behavioral stages of change versus minimal self-help intervention also administered in churches. Analysis compared the two intervention groups at 1-year follow-up with baseline stages. | Differences between interventions for self-reported and biochemically validated quit rates were not statistically significant, but both the intensive (p < 0.0001) and minimal (p < 0.0001) intervention groups differed significantly from the spontaneous quit rates reported in churchgoers in the community reference population. The intensive intervention group was more likely to make positive progress along the stages of change continuum, compared with the self-help intervention group (OR = 1.68; P = 0.04). |
| Wilcox (2007)* | 20 AA churches; 571 participants; 68% female. | __ | Physical activity | Faith-based and volunteer-led program with physical activity messaging, teaching behavior change skills for physical activity and healthy eating, use of a 10 min exercise CD, and action-oriented programs including praise aerobics, chair exercises and walking programs. | There was no significant change in moderate-intensity physical activity, meeting physical activity recommendations, or physical activity stage of readiness. |
| Wilcox (2013) | Seventy-four African Methodist Episcopal (AME) churches in South Carolina and 1257 members within them participated in the study; 99.4% AA; 76% female. | 54.1 | Physical activity; Diet; blood pressure | 15-month physical activity and dietary intervention (immediate vs delayed [control]) that targeted social, cultural and policy influences within the African Methodist Episcopal churches. Churches were asked to distribute bulletin inserts (provided); share messages from the pulpit; pass out educational materials (provided); create a Faith, Activity, and Nutrition (FAN) Program bulletin board, and suggest physical activity and healthy eating policy/practices that the pastor could set. | There was a significant effect favoring the intervention group in self-reported leisure- time moderate-to-vigorous physical activity (MVPA) (p = 0.02), but no effect for other outcomes. |
| Wilson (2015) | 434 AA; 62% female. | 51 | Physical activity | 24-month intervention: Three matched communities were randomized to a police-patrolled walking plus social marketing, a police- patrolled walking-only, or a no-walking intervention. | There were no significant differences across communities for moderate-to-vigorous physical activity. |
| Woods (2013)* | Five churches; 106 participants; 90% AA; 73% female. | __ | BMI; blood pressure; physical activity | Intervention group: Live Well By Faith 8-week program included nutrition as well as 30-minute physical activity components and individualized wellness plans. Minimal intervention control group: Single 90-minute educational workshop at church where basic information was provided about diet, nutrition, exercise and cancer screening. This also included an exercise demonstration of the home-based program, and distribution of the same print materials, pedometer and resistance band given to the intervention group. | At 2-months follow up, the intervention group, compared to the control group, showed significant decreases in weight (p < .02), BMI (p < .05), and % body fat (p < .03), with a significant increase in physical fitness (p < .02). Systolic blood pressure also showed group differences in the predicted direction (p = .10). |
| Zoellner (2013)* | 91 participants; 62% AA; 91% female. | __ | Physical activity; BMI | 15-week randomized controlled interventions: group 1 was offered fitness sessions and education in healthful eating and physical activity; group 2 was offered fitness sessions only. | Group 1 experienced significantly greater improvements in body mass index (p< .001) and waist circumference (p = .01), compared with group 2. Both groups significantly increased weekly minutes of moderate physical activity (p < .003). Participants in group 1 also had significantly greater weight loss with higher attendance at the education (p < .001) and fitness sessions (p < .001). |
*statistically significant outcomes in at least one measure used to assess LS7 metric(s).