Short-Term Effects of a LifestyleShort-Term Effects of a LifestyleBehavior Intervention for Overweight Behavior Intervention for Overweight

Latino WomenLatino Women

Deborah Koniak-Griffin, RNC, EdD, FAANDeborah Koniak-Griffin, RNC, EdD, FAANProfessor & Audrienne H. Moseley Endowed Chair Professor & Audrienne H. Moseley Endowed Chair

in Women’s Health Researchin Women’s Health Research

2012 State of the Science 2012 State of the Science Congress on Nursing ResearchCongress on Nursing ResearchSept 15, 2012Sept 15, 2012

NHLBI, R01HL086931-1A1NHLBI, R01HL086931-1A1Co-Investigators: Co-Investigators: Aurelia O’Connell,Aurelia O’Connell,Antronette Yancey, Mary-Lynn Brecht,Antronette Yancey, Mary-Lynn Brecht,Gail HarrisonGail Harrison

Background: Several factors influenced decision to test a lifestyle behavior intervention for overweight Latino women.

Latinos: fastest growing minority population in U.S.

Modifiable lifestyle behaviors influence risk for CVD, diabetes and other chronic diseases that disproportionately impact Latinos overweight/obesity; sedentary lifestyle dietary intake, e.g., increased fat with acculturation

Often lack access to prevention information Earlier partnered projects involving CVPR and

community supported need for study Proposal developed with promotoras & community

AimAim: To evaluate the short-term effects of a : To evaluate the short-term effects of a healthy lifestyle behavior intervention (LSBI) on healthy lifestyle behavior intervention (LSBI) on selected behavioral and clinical outcomes of selected behavioral and clinical outcomes of overweight Latino women.overweight Latino women.

Randomization

Health Program II (n=112)Preparedness/Home Safety

8 group classes spread over 2 months + ITC for 4 months (6 months)

Recruitment and Screening (overweight, 35-64 yrs, Latina)

First Evaluation (n=223)BMI, waist size, BP, physical activity, lipid panel + FBS, questionnaires

Program I: LSBI (n=111)Su Corazon, Su Vida (Your Heart, Your

Life) taught by promotoras8 group classes spread over 2 months + ITC for 4 months (6 months)

Second Evaluation (n=98)(at program completion, 6 months later)

Same procedures as baseline evaluation(88.3% retention)

Third Evaluation (n=99)(about 9 months after first evaluation)

(89.2% retention)

Second Evaluation (n=95)(at program completion, 6 months later)

Same procedures as baseline evaluation(84.8% retention)

Third Evaluation (n=94)(about 9 months after first evaluation)

(83.9% retention)

CBPRAPPROACH

RecruitmentRecruitment

313 Interested and Screened

972 Uninterested

249 Eligible

64 Ineligible

223 Enrolled, Randomized& Started Program

112 Control111 LSBI

Eligibility Criteria Latina 35-64 years BMI > 25 Fluent in Spanish or English

Excluded Insulin dependent diabetes Uncontrolled HTN History of a heart attack or stroke

1285 Approached

8 Group Education sessions (Su Corazon, Su Vida) - 1½ to 2 hours led by promotoras adapted to promote weight loss

8 Individual Teaching and Coaching sessions Incorporates culture (food culture, symbols) Participatory – role play, scenarios, demonstrations Heart healthy behaviors – physical activity and

nutrition

Lifestyle Behavior Intervention Lifestyle Behavior Intervention (LSBI)

Theory-based, culturally-tailored, participatory

Control Control ConditionCondition Comparable Comparable lengthlength

DATA COLLECTION: Community-Based

Cholestech evaluateslipids in 5 min with

fingerstick

Sample Characteristics Sample Characteristics (n=223)(n=223)SociodemographicSociodemographic Latina immigrants, Mexican descent: 84%Latina immigrants, Mexican descent: 84% Low acculturation: Mean = 1.48, SD = .45; 1(low) - Low acculturation: Mean = 1.48, SD = .45; 1(low) -

5(high)5(high) 35-64 years old (Mean = 44.6 yrs, SD = 7.9)35-64 years old (Mean = 44.6 yrs, SD = 7.9) Married/living together: 72.2%Married/living together: 72.2% << 8 8thth grade education: 52.6% grade education: 52.6% Low income; no health insurance: 68.2%Low income; no health insurance: 68.2% Diabetes (FBS Diabetes (FBS >> 126 mg/dL 126 mg/dL oror on oral meds): 6.3% on oral meds): 6.3% Hypertension (BP Hypertension (BP >> 140/90 mmHg 140/90 mmHg oror on on

antihypertensive meds): 12.1%antihypertensive meds): 12.1%

Sample Characteristics Sample Characteristics (n=223)(n=223)Clinical VariablesClinical Variables BMI: Mean = 32.6, SD = 5.7 BMI: Mean = 32.6, SD = 5.7 Waist circumference: Mean = 101.4 cm Waist circumference: Mean = 101.4 cm

(39.9(39.9 in), SD = 11.5cm (4.5 in)in), SD = 11.5cm (4.5 in) BP: Mean = 114/75BP: Mean = 114/75 CholesterolCholesterol

Total-C: Mean = 188.4, SD = 33.8Total-C: Mean = 188.4, SD = 33.8 HDL-C: Mean = 44.5, SD = 13.4HDL-C: Mean = 44.5, SD = 13.4 LDL-C: Mean = 111.6, SD = 29.2LDL-C: Mean = 111.6, SD = 29.2 Triglycerides: Mean = 165, SD = 87.9Triglycerides: Mean = 165, SD = 87.9

FBS: Mean = 100.43, SD = 18.8FBS: Mean = 100.43, SD = 18.8

FindingsFindings Mixed effects model to test for change over

time between groups (age adjusted); significant differences at 6 and 9 months for:

Lifestyle behaviors, F = 5.02, p=.008• LSBI group improved dietary habits

Waist circumference, F = 3.26, p=.04• decreased 2.84 cm (1.12 in) in LSBI group

Significant effects from baseline to 9 months for daily steps, t = 2.07, p =.048

Pretest-Posttest comparison showed significant improvement in scores for Heart Knowledge questionnaire

Accelerometer Readings of Daily StepsAccelerometer Readings of Daily Steps

GroupGroup Baseline, Mean Baseline, Mean (SD)(SD)

6 Months, Mean 6 Months, Mean (SD)(SD)

9 Months, Mean 9 Months, Mean (SD)(SD)

LSBILSBI 8600.92 8600.92 (3149.57)(3149.57)

8768.89 (2747.42) 8768.89 (2747.42)

8641.46 (2833.44)8641.46 (2833.44)

ContrControlol

8522.00 8522.00 ((3259.81))

8480.16 (3506.18)8480.16 (3506.18) 7312.48 (2700.82)7312.48 (2700.82)

8600.92

8768.898641.46

8522.008480.16

7312.487200

7700

8200

8700

Baseline 6 Months 9 Months

LSBIControl

Feasibility FindingsFeasibility Findings Promotoras/CHW able to recruit hard-to-

reach population and deliver LSBI Well accepted in community Extensive training & close supervision needed Challenges, e.g., written record keeping, time

management, organizational skills Attendance at LSBI classes

Attended at least half of classes: n=92 women (82.9%)

Attended entire series of classes: n=44 women (39.6%)

Conclusions and Conclusions and RecommendationsRecommendations

Findings support positive short-term effects of LSBI on: lifestyle behaviors (dietary) waist circumference physical activity

Further strategies or more focused approach may be needed to promote weight loss

Promotora model of LSBI delivery has many strengths

and works well with immigrant Latinas Recommendations

RCT with long-term follow-up Strategies to further develop promotoras as community

resource