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Short-Term Effects of a Lifestyle Behavior Intervention for Overweight Latino Women

Short-Term Effects of a Lifestyle Behavior Intervention for Overweight Latino Women Deborah Koniak-Griffin, RNC, EdD, FAAN Professor & Audrienne H. Moseley Endowed Chair in Women’s Health Research. NHLBI, R01HL086931-1A1 Co-Investigators: Aurelia O’Connell,

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Short-Term Effects of a Lifestyle Behavior Intervention for Overweight Latino Women

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  1. Short-Term Effects of a Lifestyle Behavior Intervention for Overweight Latino Women Deborah Koniak-Griffin, RNC, EdD, FAAN Professor & Audrienne H. Moseley Endowed Chair in Women’s Health Research NHLBI, R01HL086931-1A1 Co-Investigators: Aurelia O’Connell, Antronette Yancey, Mary-Lynn Brecht, Gail Harrison 2012 State of the Science Congress on Nursing Research Sept 15, 2012

  2. Background:Several factors influenced decision to test a lifestyle behavior intervention for overweight Latino women. • Latinos: fastest growing minority population in U.S. • Modifiablelifestyle 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

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

  4. Recruitment and Screening (overweight, 35-64 yrs, Latina) First Evaluation (n=223) BMI, waist size, BP, physical activity, lipid panel + FBS, questionnaires C B P R A PP RO A CH Randomization Program I: LSBI (n=111) Su Corazon, Su Vida (Your Heart, Your Life) taught by promotoras 8 group classes spread over 2 months + ITC for 4 months (6 months) Health Program II (n=112) Preparedness/Home Safety 8 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) Second Evaluation (n=95) (at program completion, 6 months later) Same procedures as baseline evaluation (84.8% retention) Third Evaluation (n=99) (about 9 months after first evaluation) (89.2% retention) Third Evaluation (n=94) (about 9 months after first evaluation) (83.9% retention)

  5. Recruitment 313 Interested and Screened 972 Uninterested 64 Ineligible 249 Eligible 223 Enrolled, Randomized & Started Program 112 Control 111 LSBI 1285 Approached • Eligibility Criteria • Latina • 35-64 years • BMI > 25 • Fluent in Spanish or English Excluded • Insulin dependent diabetes • Uncontrolled HTN • History of aheart attack or stroke

  6. 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 (LSBI)

  7. Theory-based, culturally-tailored, participatory

  8. Control Condition Comparable length

  9. DATA COLLECTION: Community-Based Cholestech evaluates lipids in 5 min with fingerstick

  10. Sample Characteristics (n=223) Sociodemographic Latina immigrants, Mexican descent: 84% Low acculturation: Mean = 1.48, SD = .45; 1(low) - 5(high) 35-64 years old (Mean = 44.6 yrs, SD = 7.9) Married/living together: 72.2% < 8th grade education: 52.6% Low income; no health insurance: 68.2% Diabetes (FBS > 126 mg/dL or on oral meds): 6.3% Hypertension (BP > 140/90 mmHg or on antihypertensive meds): 12.1%

  11. Sample Characteristics (n=223) Clinical Variables BMI: Mean = 32.6, SD = 5.7 Waist circumference: Mean = 101.4 cm (39.9in), SD = 11.5cm (4.5 in) BP: Mean = 114/75 Cholesterol Total-C: Mean = 188.4, SD = 33.8 HDL-C: Mean = 44.5, SD = 13.4 LDL-C: Mean = 111.6, SD = 29.2 Triglycerides: Mean = 165, SD = 87.9 FBS: Mean = 100.43, SD = 18.8

  12. Findings 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

  13. Accelerometer Readings of Daily Steps

  14. Feasibility 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%)

  15. Conclusions and Recommendations • 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

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