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. Author manuscript; available in PMC: 2022 Mar 17.
Published in final edited form as: J Best Pract Health Prof Divers. 2021 Spring;14(1):44–62.

The Development and Pilot Testing of an Evidence-Based Cardiovascular Disease Risk-Prevention Program to Promote Healthy Lifestyle Behaviors Among African-American College Students – Rams Have HEART

Vanessa Duren-Winfield 1,†, Loneke T Blackman Carr 2, Georgia A McCauley 3, Elijah O Onsomu 4, Kristina Roberson 4, John Williams 5, Paul N Kizakevich 6, Michelle Krzyzanowski 6, Amanda A Price 7
PMCID: PMC8929670  NIHMSID: NIHMS1775006  PMID: 35310081

Abstract

Objectives:

Cardiovascular disease (CVD) is the leading cause of death in the United States. Among the risk factors for college students, obesity and physical inactivity are disproportionately high among African Americans (AAs), and while studies of the obesity epidemic have increased in recent years, few target AA college-aged students. This study developed and piloted an evidence-based, 15-week, 3-credit hour, CVD risk-prevention and intervention course, Rams Have HEART that used e-learning, web-based technologies, and a mobile application and compared its effects against a control course.

Methods:

Two cohorts were recruited in a two-year period; 124 AA college students voluntarily consented to participate in the study, with n = 63 representing the control group and n = 61 representing the intervention. CVD risk factors were assessed by examining blood markers and anthropometric measurements. Demographic, clinical, and survey data (physical measures, blood marker investigation, and self-report surveys) were collected at baseline, post-intervention, and follow-up over the academic year.

Results:

The mean blood markers for lipid panel and glucose results were within the established optimal range. Intake of fruits and vegetables increased along with knowledge of CVD risk factors; 86% of students enrolled in the intervention passed the course; 100% (n = 61) would recommend it to future students.

Conclusion:

Developing and offering a healthy lifestyle-behavior CVD intervention course to AA college students is feasible and effective in optimizing their awareness of chronic disease risk factors and prompting behavior change.

Keywords: African American, Cardiovascular Disease Prevention, College Students, Lifestyle Behaviors, Mobile Application

INTRODUCTION

In the United States, cardiovascular disease (CVD) is a significant public health problem (Benjamin et al., 2017; Goldstein et al., 2014), with the annual overall costs estimated at $400 billion and projected to rise to more than $818 billion by 2030 (Benjamin et al., 2017). Furthermore, cardiovascular disease accounts for one in three deaths reported each year (Benjamin et al., 2017; National Center for Health Statistics, 2017).

Strategies that address such CVD risk factors such as hypertension, high cholesterol levels, and smoking can greatly reduce this burden (Benjamin et al., 2017; Farley et al., 2010). Hypertension is defined as a systolic blood pressure ≥140 mm Hg or a diastolic blood pressure ≥90 mm Hg, based on the average of up to three measurements; National Cholesterol Education Program (NCEP) Adult Treatment Panel-III (ATP-III) guidelines classify LDL-C as <160 mg/dL, <130 mg/dL, and <100 mg/dL for high, intermediate, and low risk, respectively (United States Department of Health and Human Services [USDHHS], 2001a). Current cigarette smoking was defined in persons who reported having smoked ≥100 cigarettes in their lifetime and currently smoke every day, every other day, or some days and had a measured serum cotinine (the primary nicotine metabolite) level >10 ng/mL (USDHHS, 2001a).

About half of Americans (49%) have at least one of these three risk factors (Bairey Merz et al., 2017; Benjamin et al., 2017; Carnethon et al., 2017; Turner et al., 2017). Several other medical conditions and lifestyle choices put people at a higher risk for heart disease, including diabetes, overweight and obesity, poor diet, physical inactivity, and excessive alcohol use. Nearly one-third of US adults are obese or overweight (Flegal et al., 2007; Kumanyika et al., 2008; Lobstein et al., 2017; Ogden et al., 2012a), which affects their physical and social quality of life and strongly influences CVD development (Goff et al., 2014; Poirier et al., 2006). The prevalence obesity, a serious health problem, has more than doubled since 1976 across all demographic strata (Flegal et al., 2012; Wang & Beydoun, 2007). However, the need for treatment is highest among low-income and ethnic minority populations, who have a high burden of obesity but less access to healthcare services (Goldstein et al., 2014; Smith Jr. et al., 2005). Many disease risk factors are amenable to change, and all individuals can reduce their risk of CVD morbidity and mortality, especially if healthful behaviors are established in childhood or adopted in young adulthood (USDHHS, 2001b).

Although studies of the obesity epidemic have increased in recent years, few target college-aged students and, more important, African American (AA) college students, who are disproportionately predisposed to CVD (Holland, Carthron, Duren-Winfield, & Lawrence, 2014). The current literature indicates that most college students are unaware of the risk factors, and some hold false beliefs about the complications (Becker, Bromme, & Jucks, 2008; Collins et al., 2004; Sarpong, Curry, & Williams, 2017). Previous reports indicate that college students do not accurately perceive their own risk factors and rate them as less dangerous than their peers (Goff et al., 2014; Green et al., 2003). In general, studies often overlook young adults (Tran & Zimmerman, 2015). despite research showing that plaque formation in young adulthood can lead to coronary heart disease as they approach middle-age (Liu et al., 2012; Raynor et al., 2013). Awareness of prevention and intervention strategies, such as the Million Hearts project (Million Hearts, n.d.), Healthy People 2020 (Office of Disease Prevention and Health Promotion [ODPHP], n.d.), and guidelines from the National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association (AHA) (Goff et al., 2014), could reduce CVD mortality and morbidity among this population.

This pilot study describes the development and methodology of a subject-preference, controlled, prospective trial of a CVD intervention called Rams Have HEART. This name “was selected based on the following premise: the ram represents our university’s mascot, and “have heart” denotes the fact we are serious about the “heart” health of our students” (Valentine et al., 2012, p. 187). Rams Have HEART was implemented in the General Education Curriculum (GEC) at a Historically Black College/University (HBCU) in the US southeast. The study was designed to test whether incorporating knowledge and awareness of CVD risk factors in a 15 week, 3-credit hour course would increase participants’ physical activity and fruit and vegetable intake and enhance their blood marker results as compared to a control course. Preliminary results are reported but not for final outcomes, anthropometric measurements, and blood marker data.

Obesity is a significant risk factor for CVD, the leading cause of death in the US, especially among AAs (Flegal et al., 2012; Lloyd-Jones, 2009; Ogden et al., 2012a). It rarely manifests in childhood and adolescence, but risk factors and behaviors that accelerate the development of atherosclerosis begin in childhood, according to the NHLBI Expert Panel on cardiovascular health (Expert Panel, 2011). Obesity disparities are prominent in youth; 70 percent of overweight youth are overweight when they become adults. Innovative approaches to prevent obesity early in life are urgently needed (Expert Panel, 2011; ODPHP, n.d.).

Based on NHANES data, overweight and obesity prevalence differs by racial/ethnic group among women, children, and adolescents (Hales et al., 2017; Ogden et al., 2012b). The prevalence among men did not differ by racial ethnicity, but almost 58 percent of non-Hispanic black women aged 40 to 59 years were obese compared to 38 percent of non-Hispanic white women. Among children and adolescents up to age 20, the CDC uses the term overweight rather than obesity and defines overweight as a BMI at or above the 95th percentile of sex-specific BMI-for-age values from the CDC growth charts (Hales et al., 2017; Kuczmarski, 2002; Ogden et al., 2012a). Data reveal differences by racial/ethnic group for both sexes.

The transition from adolescence to young adulthood is associated with increased stress and such health risks as poor diet, physical inactivity, overweight, and obesity, particularly among AAs, who have a higher propensity to develop CVD. Interventions are sorely needed to help them to understand the effect of CVD risk factors on their future health profile; to learn how to assess a family history of CVD, obesity, health behaviors, and lifestyle choices; and to develop self-efficacy to adopt behaviors that will improve life-long health. According to the National Center of Educational Statistics (National Center for Educational Statistics, n.d.). approximately 75 percent of Black college graduates attended an HBCU, making them an ideal venue for reaching this population. At the host HBCU, over 75 percent (>4,650) of students are AA, and 63 percent self-report being overweight or obese (Valentineet al., 2012).

The rationale for implementing health-promotion interventions for AA college students is clear. Preventing obesity and related co-morbidities early on has the greatest long-term payoff in years of healthy life. Although relatively few AA students participated (American College Health Association, 2009) provides the methodology for the development and pilot testing of Rams Have Heart for AA students enrolled at an HBCU. The intervention incorporates didactic and e-learning technology strategies that align with the evidence-based Centers for Medicaid & Medicare Services (CMS) Quality Improvement Organization (QIO) toolkit, Reducing Cardiac Risk Factors, as well as the Million Hearts Initiative (Million Hearts, n.d.), Healthy People 2020 (ODPHP, n.d.), and the NHLBI and AHA guidelines (Goff et al., 2014).

Rams Have Heart relies on two methods of information transfer: 1) a 15-week, CVD prevention, healthy lifestyle intervention focused on diet and physical activity; and 2) e-learning and web-based health resources. The intervention course was approved by the university’s Academic Standards and Curriculum Committee. The mobile application was designed as a tool for self-monitoring and self-motivating healthy behaviors (Eckhoff, 2015; Kizakevich et al., 2012). Student Health Coaches (SHCs) led the intervention and along with research assistants created added value as allied health students gained exposure to research (Duren-Winfield, et al., 2011).

The study aimed 1) to assess CVD risk factors among AA college students by examining blood markers; and 2) to pilot test the effects of a 15-week, CVD risk-prevention intervention administered as a 3-credit hour, semester-long course versus a control course on two cohorts of AA college students. We hypothesize that, compared to the control group, students enrolled in the evidence-based CVD health curriculum will adopt better health behaviors (increased fruit and vegetable intake, physical activity, cardiovascular fitness, and sleep quality and reduced stress) and improve their anthropometric measurements (BMI and waist circumference) and blood markers (total cholesterol, triglycerides, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and glucose). The overarching CVD prevention goals entail promoting healthy eating, increasing physical activity patterns, and lowering BMI.

METHODS

Theoretical Framework

The proposed intervention is based on the Health Belief Model (Rosenstock, 1988) and constructs from Social Cognitive Theory (Bandura, 2001). This model suggests that readiness and motivation to change have both cognitive and emotional components: perceived susceptibility and seriousness about a potential health problem; perceived benefits of, and barriers to, taking action; and cues to action and self-efficacy. The experimental CVD curriculum uses unique, stimulating, active learning experiences to raise awareness about personal and family CVD risk factors. This elevated awareness may influence perceived susceptibility and increase cues to action. Small group classroom discussions of the benefits of, and barriers to, increasing self-efficacy are used to promote readiness and motivation to change behavior.

Study Design and Recruitment

The study design was a subject-preference, controlled, prospective trial of a CVD intervention conducted in AA college students attending a southeastern HBCU and approved by its IRB. Students between the ages of 17-26 (mean age = 18) voluntarily enrolled in either the CVD intervention or control group. Students were excluded if they were not African American or aged ≤ 17 years, pregnant, or identifying a physical or health condition contraindicated because of possible health risks and limited safeguards for this study population.

Recruitment occurred during the Fall Semester 2016 and 2017. Faculty advisors across the university were informed of the new general education CVD course, Exercise Science (EXS) 1301, Lifestyle Behaviors for a Healthy Heart (intervention). They informed students of the course during the advisement period, and students were enrolled. Likewise, students voluntarily enrolled in the control course, Health Education (HED) 1301, Concepts of Health (control), a basic course covering adoption and maintenance of healthy behaviors without any additional information on CVD risk factors.

The principal investigators obtained informed consent from both the intervention and control groups two weeks after the semester began, delivering a complete overview of the study in a 30-minute PowerPoint presentation. Informed consent forms were reviewed, and each student participant received a copy for future reference. Students understood that if they consented, they were enrolled in the study, not just the class, and could decline participation at any time. Everyone consented. At baseline, post-intervention, and follow-up data collections, participants received a $20 gift card incentive. The original recruitment goal was 50 students per cohort for Fall 2016 and Fall 2017. This goal was exceeded with an enrollment of 63 students for Fall 2016 (cohort 1 [control group = 33; intervention = 30]) and 61 for Fall 2017 (cohort 2 [control group = 31; intervention = 30]).

Curriculum and Mobile Application Development

The curriculum was aligned with the ABCs of the Million Hearts™ Initiative (Million Hearts, n.d.) and developed using evidence-based information from the CMS QIO Toolkit, which provides educational resources to prevent and reduce cardiac risk factors, such as hypertension, smoking, and high cholesterol, and resources to increase heart-healthy behaviors. The content focused on CVD risk factors, diet, physical activity, and their relation to weight reduction, risk prevention, and heart-healthy behaviors. The course was taught two days a week, Tuesday and Thursday, from 9:30 A.M. to 10:45 A.M. Its three units, Understanding Healthy Lifestyle Behaviors, Behavior Modifications, and Cardiovascular Disease Risk Factors, introduced the students to fundamental aspects of cardiovascular health, wellness, fitness, and healthy lifestyle behaviors using evidence-based health data easily accessible to the public at no cost. With emphasis on lifestyle modifications to promote heart health and overall health and wellness, the course prepared undergraduate students to 1) calculate CVD risk factors and to understand how lifestyle behaviors contribute to chronic disease; 2) organize and to analyze data; 3) interpret quantitative information and to draw conclusions; and 4) evaluate the presentation of health data in mass media, e-learning, and web-based sources.

Teaching strategies included high-impact, active learning practices that promote deep learning and enhance student engagement and retention (Kuh et al., 2015). Written materials included lesson plans for the instructor/interventionist, and materials for student participants were to be read prior to class meetings; homework was to be completed after a topic was presented. Content themes included: Who is at risk for CVD? What are CVD risk factors? What is the role of physical activity and healthy eating (fruits & veggies)? What is the clinical treatment for CVD? How can blood pressure be controlled and cholesterol managed? How can we stop smoking? Weekly experiential activities involved CVD risk self-assessment to raise awareness and to cue action. Cooking demonstrations, guest speakers, weekly physical activity (PA) in the gym, and other high-impact activities made the class engaging and interesting. The use of e-learning, web-based technology, and the university’s Learning Management Systems, Blackboard, were integral components, useful in promoting diet change and PA participation.

Rams Have HEART Mobile Application

In collaboration with Research Triangle Institute (RTI International), a mobile app, compatible with any type or style of smart phone, was designed as a tool for self-monitoring and self-motivating healthy behaviors (Eckhoff et al., 2015; Kizakevich et al., 2012; Polishook, 2005; Ramsden, 2005). College students arrive on campus with mobile devices, and their sheer versatility and inherent appeal presented a very promising and exciting vehicle for behavior change and health education (Barnwell, 2016; Duren-Winfield et al., 2015).

The Rams Have Heart app includes a simple menu for quick data entry (see Figure 1a). Daily tracking of fruit and vegetable consumption (FVC; see Figure 2) and PA (see Figure 3) uses similar data entry forms. Each has a dynamic graphic at the top with an icon that moves toward the recommended daily target. As users enter data throughout the day, the icon advances until reaching the daily goal. Since data suggest users sometimes miss a day or two, a method for entering recall data for up to two previous days was included. A trend-charting feature provides a historical view of the past two months’ data (see Figure 4). Additional functions include daily reminders, data transmission, a BMI calculator (see Figures 5 & 6), and educational materials (see Figure 6).

Figure 1.

Figure 1.

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Home screen with friendly icons and clearly-defined task menu

Figure 2.

Figure 2.

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Daily tracking of fruit and vegetable consumption.

Figure 3.

Figure 3.

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Daily tracking of physical activity by level of effort.

Figure 4.

Figure 4.

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Trend display for past two months of FVC and PA data.

Figure 5.

Figure 5.

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Body mass index (BMI) calculator with comparison of personal BMI to normative data.

Figure 6.

Figure 6.

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Educational materials are provided for BMI, FVC and PA.

Instruments and Measurements

Baseline data were collected within the first month of enrollment. Post-intervention data for cohort 1 were collected at 6 and 12 months. Cohorts 2 completed a baseline assessment and post-intervention and follow-up assessments at ~3 and ~8 months, respectively, to coincide with the end of the fall and spring semesters of the 2017-2018 academic year.

Demographic information collected at baseline included age, current health status, past medical history, and family history. Each student’s blood pressure, heart rate, BMI (height and weight), waist circumference, cardiovascular fitness, lipids, and glucose were measured. Data were managed using the Personal Health Intervention Tool (PHIT) developed by our partners at Research Triangle Institute International, Inc. (RTI International, Kizakevich et al., 2012). PHIT diaries were employed for daily recall of food and drink consumption, especially fruits and vegetables, and physical activity (Eckhoff et al., 2015; Kizakevich et al., 2008). Questionnaires administered at each timepoint included the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS-10), and International Physical Activity Questionnaire (IPAQ). Rams Have Heart App Evaluation Questionnaire was also administered at one timepoint for each cohort to evaluate the performance and effectiveness of the app.

Physical Measures

Resting Heart Rate.

With the subject seated in a relaxed position, heart rate was assessed at the radial pulse. The researcher’s index finger, placed on the inside of the subject’s right wrist, counted the number of beats per minute for a full minute.

Resting Blood Pressure.

Systolic (SBP) and diastolic (DBP) blood pressure were assessed using an automatic device. The subject was seated with the cuff wrapped around the right arm for at least five minutes. The average of two measures was used.

Height.

A stadiometer was used to determine height to the nearest eighth of an inch without shoes.

Weight.

Body weight, without shoes, was measured to the nearest half pound by a standard scale. Height and weight information was used to determine BMI (weight [kg]/height [m2]).

Waist Circumference.

The waist was recorded to the nearest centimeter with a spring-loaded tape placed superior to the iliac crest, following the NHANES procedure.

Queen’s College Step Test.

The Queen’s College Step Test was used to assess cardiovascular fitness (McArdle et all, 1972). Participants were asked to step on a standardized stair for 3 minutes to a metronome beat based on the participant’s gender (females - rate of 22 steps per minute, and male – rate of 24 steps per minute). Afterward, radial pulse was used to estimate VO2 max, or maximal oxygen consumption. This test has been repeatedly validated as a tool for estimating VO2 max.

Blood Markers

Participants were asked to consent to a fasting blood draw to measure glucose and cholesterol; they had the option to refuse. The Clinical Laboratory Science (CLS) Department collected the samples via finger dermal puncture. The CLS team assisted with phlebotomy collection and analysis of participants’ lipid profiles and glucose values. A CLS specialist calibrated all testing instruments for accuracy and performed quality control. The palmar surface of the distal (end) segment of the third (middle) or fourth (ring) finger was prepped with 70 percent isopropyl alcohol and allowed to dry. A collection device punctured the fingertip to obtain a capillary blood sample, placed on a Cholestech device, which provided total cholesterol, HDL cholesterol, non-HDL cholesterol, triglycerides, LDL cholesterol, TC/HDL ratio (calculated using measures taken with Cholestech), and glucose. The CLS specialist disposed of sharps (collection devices) in a puncture-proof container and testing devices, alcohol swabs, and any other material that came into contact with blood in biohazardous waste receptacles.

Validated Questionnaires - Administered at Each Timepoint

Pittsburgh Sleep Quality Index.

The PSQI (Buysse et al., 1989) is a self-rated questionnaire that assesses sleep quality and disturbances over one month. Nineteen items generate seven “component” scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of the scores for these seven components yields one global score.

Perceived Stress Scale.

The PSS (Cohen, Kamarck, & Mermelstein., 1983) is the most widely used psychological instrument to measure the degree to which an individual considers situations stressful. Items were designed to tap how unpredictable, uncontrollable, and overloaded respondents find their lives. The scale also includes a number of direct queries about current levels of experienced stress; relatively free of content specific to any subpopulation, they ask about feelings and thoughts during the last month and how often respondents felt a certain way.

International Physical Activity Questionnaire.

The IPAQ (Craig et al., 2003), a reliable, internationally validated instrument, will be used to evaluate between-group differences in physical activity. The short form is a 7-item index that asks respondents the amount of time per day spent in vigorous and moderate-intensity activities and walking on each of the seven days prior to the interview. Different levels of physical activity are assigned metabolic equivalent (MET) scores based on the Compendium of Physical Activity (Ainsworth et al., 2000) and can be converted to both continuous and categorical values.

Questionnaire - Administered at One Timepoint:

Rams Have Heart App Evaluation Questionnaire.

This questionnaire evaluated the mobile app developed specifically for this project. The 6-item assessment captured both quantitative and qualitative feedback about the app’s performance from the student perspective. Data will inform the development of future health behavior apps for college students and revision of the existing app for campus use after this study’s conclusion.

Data Collection

At three endpoints - baseline, post-intervention, and follow-up - each student’s blood pressure, pulse, respiration, BMI (height and weight), waist circumference, cardiovascular fitness, lipids, and glucose were measured, and their daily FVC and PA reports on the app and self-reported survey data were collected. The surveys included the International PA Questionnaire, Perceived Stress Scale, and Pittsburgh Sleep Quality Index. In the final analysis paper, only students with all data time points (baseline, post-intervention, and follow-up) will be included in the analysis.

RESULTS

The 15-week Rams Have HEART program, focused on understanding and remediating CVD risk factors through diet and physical activity, was developed and successfully implemented using e-learning and web-based health resources. A user-friendly mobile application was designed to capture fruit and vegetable consumption behaviors and physical activity. The intervention engaged AA students (n = 124), mostly female (73%), in two cohorts (cohort 1, n = 63; cohort 2, n = 61) representing the two semesters in which the program was offered, fall 2016 and 2017. A majority of the intervention students (86%) passed the course and increased their FVC and PA. In this sample of AA college students were aged 18.19 years ± 1.06SD. Overall, students responded positively about their satisfaction with the course and its impact on their attitude, changing their behaviors, and taking more responsibility for their health as follows:

  1. “I would recommend this course to future students.” (100% agreement)

  2. “The course encouraged me to stay active and eat healthy.” (90% agreement)

  3. “Knowing the laboratory values for the blood lipid profile and glucose changed my attitude toward maintaining a healthy lifestyle.” (90% agreement)

  4. “I will take action to improve my health to feel better and live longer.” (100% agreement), and

  5. “I have more responsibility for my health than my healthcare provider.” (100% agreement)

CVD risk factors were assessed by examining blood markers and anthropometrics. However, not all students participated in all aspects of the CVD screening (n = 114). The mean systolic blood pressure was 117.21 ± 12.45SD; diastolic blood pressure = 69.75 ± 9.04SD, age = 18.19 ± 1.06SD, BMI = 27.89 ± 17.73SD, and weight = 162.02lbs ± 40.02SD (see Table 1).

Table 1:

Descriptive Statistics.

Variable N Minimum Maximum Mean Std. Deviation
Age 114 17 26 18.19 1.063
SBP 114 93 159 117.21 12.453
DBP 114 52 90 69.75 9.041
Height in centimeters 114 143 190.5 166.842 8.9976
Heart Rate 112 49 115 74.81 11.725
Waist in centimeters 112 59 115 82.023 12.0394
Weight in kilograms 114 43.3 555.9 77.714 48.6631
Waist in inches 114 0 45.3 31.726 6.3405
Height in inches 114 56.3 75 65.686 3.5424
Weight in pounds 114 95.5 337.4 162.02 40.02
BMI 114 16.3 205.4 27.886 17.7326
PSS10 110 2 32 15.4 6.315
Valid N (listwise) 106
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DISCUSSION

To reduce the risk of developing CVD, the American Heart Association recommends knowing your cholesterol and glucose values. A lipid panel plus glucose was obtained from each participant to assess the contribution of blood markers to CVD risk. The results indicate that the mean participant samples were within the reference range of the lipid profile and glucose blood markers for cohorts 1 and 2 (see Table 2). However, the minimum and maximum results were concerning and indicated that these participants were at high risk for CVD and diabetes.

Table 2:

Blood Marker Assessments.

BLOOD MARKER TC¥ HDLβ LDL€ TRG† TC/HDL Ratio Glucose
Optimal Range (fasting) <170 mg/dl ≥50 mg/dl <130 mg/dl <100 mg/dl ≤4.5 <100 mg/dl
COHORT 1
Pre-Intervention
N = 58 141 52 72 82 3.2 90
Mean (x−)
COHORT 1
Post-Intervention
N = 18 153 58 80 94 2.7 87
Mean(x−)
COHORT 2
Pre-Intervention
N = 59 149 52 81 95 3 90
Mean (x−)
COHORT 2
Post-Intervention
N = 51 152 59 92 92 2.7 92
Mean (x−)
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Notes:

¥

TC (Total Cholesterol);

β

HDL (High Density Lipoprotein);

€

LDL (Low Density Lipoprotein);

†

TRG (Triglycerides);

This study involved the development and pilot testing of a CVD risk-factor prevention program using an evidence-based curriculum and a combination of didactic and technology tools to enhance physical activity and healthy eating. Its strengths support its translation to other settings with populations at high risk for CVD and its complications; its potential for generalizability and impact is high. Students improved their health behaviors and gained the tools necessary to improve their own chronic disease risk profiles and to identify chronic disease symptoms and risk factors in others. Additionally, they may be able to use their ability to record and to assess these blood markers and anthropometrics as a solid baseline for their ongoing healthcare.

The study had two limitations. First, data were collected at different timepoints for each cohort. Cohort 1 data collection occurred at baseline, 6, and 12 months, which did not coincide with the timing of course delivery and contributed to a loss of follow-up data on students who did not return to school after winter or summer recess. Secondly, retention of college students to the post assessment was limited because they were reluctant to continue using the mobile app after the 15-week course ended. However, in a systematic review and meta-analysis study by (Plotnikoff et al., 2015) investigating the impact of lifestyle interventions targeting improvement of health outcomes (specifically physical activity, diet, or weight) for college students found positive health outcomes despite retention challenges in some of the studies used.

Every effort was made to enhance cohort 2’s collection of follow-up data and to learn from experience through process evaluation. Upon our request, the National Institutes of Health (NIH) granted approval to conduct the CVD assessments during the academic year, while students were still enrolled in the course, thereby avoiding the summer months when they were not in school and did not input data into the mobile app. The new timepoints implemented at the beginning of the fall semester (August 2017) for cohort 2 allowed data collection while they were enrolled in the course. Instructors accompanied them to the baseline and post-intervention screenings during their regular class period. Continuing data entry and returning for the final follow-up assessment at the end of the academic year was at the students’ discretion. To mediate data-entry reluctance and maintain retention for the follow-up collection, research assistants assigned to a specific group of students delivered bi-weekly motivational text messages and email reminders. Monthly incentives of $20 gift cards were offered to the three participants who entered the most data in the Rams Have Heart mobile app. In spite of these efforts, some students were unwilling to continue entering the data after completing the course, citing course load, studying, after-school jobs, and extracurricular activities as impediments. However, many more cohort 2 students returned for the final follow-up assessment (cohort 1, n = 18; cohort 2, n = 51).

CONCLUSION

AA adults are disproportionately vulnerable to chronic CVD disease, and the need for interventions to help young AA adults understand the importance of CVD risk factors for their future health profile is great. They must learn how to assess a family history of CVD, obesity, health behaviors, and lifestyle choices and develop the requisite self-efficacy to adopt behavioral changes that will improve their life-long health. AA college students are an ideal target population for risk factor-reduction programs, especially since more than half of the study population had one or more CVD risk factors. The pilot study showed evidence that the Rams Have HEART assessment, prevention, and health-promotion intervention was achievable and acceptable to participants. Further, university administrators recognized the need for such a program and allowed the course EXS1301 Lifestyle Behaviors for a Healthy Heart to remain a part of the General Education Curriculum (GEC) for all students.

The investigative team intends to develop a full-scale intervention using the NIH R01 mechanism and potentially partnering with other HBCUs to implement it.

Acknowledgments

This study was supported by the National Institutes of Health (Grant Number: R15MD010194; Vanessa Duren-Winfield†, PhD, MS, and Amanda Alise Price, PhD, Principal Investigators). Dr. Vanessa Duren-Winfield was an accomplished Clinical Associate Professor and researcher at Winston-Salem State University and at the time of her passing had just started her new role as Associate Professor at North Carolina A&T State University, Department of Leadership Studies and Adult Education.

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