Community-Based Strategies to Reduce Cardiometabolic Disease in the Deep South
Principal Investigator: Monica Baskin, PhD
Nearly 3 out of 4 adults in the United States (US) live with overweight or obesity (body mass index (BMI) of ≥ 25 kg/m2), with the highest rates among Blacks, rural residents, and lower socioeconomic groups. Obesity is associated with cardiometabolic diseases like diabetes, heart disease and stroke, as well as multiple cancers. Over the past decade, trends in obesity have been generally stable for men, but increased significantly among women. This is particularly true among Black women who have an obesity prevalence of 56.9% compared to 39.8% seen in White women. Black women living in rural settings have higher rates of obesity compared to their same race/sex peers in urban settings.
Evidence-based interventions (EBIs) that promote weight loss, healthier diet and physical activity are effective at slowing the conversion of pre-diabetes mellitus (pre-DM) and hypertension (HTN) to diabetes and heart failure, respectively. However, these interventions are often underutilized by populations at highest risk, including Black women living in rural areas of the Deep South. The mission of the Deep South Center to Reduce Disparities in Chronic Diseases is to promote health equity and reduce the burden of cardiometabolic diseases across the Deep South. Consistent with the Center’s theme (applying a precision public health approach across the care continuum to achieve health equity), this study leverages two EBIs that achieved clinically-relevant weight loss and other clinical outcomes (group-based weight loss intervention) along with improvements in diet and physical activity (individual gardening intervention) in the target population. Combining these EBIs addresses multiple domains (behavioral, personal environment, socio-cultural) and levels (individual, interpersonal, community) of influence on risk factors for obesity and other cardiometabolic diseases prevalent in the Deep South.
These interventions, delivered by local lay staff and non-academic partners, have a high potential for sustainability; however, there is a need to further evaluate the external validity and implementation-related barriers and facilitators to maximize reach, adoption, and implementation. We will employ a pragmatic, multilevel, cluster-randomized, type 1 hybrid effectiveness-implementation trial. A total of 264 Black women (age ≥30 years) with overweight or obesity and Pre-DM or HTN from 12 rural counties (6 Alabama, 6 Mississippi) will receive either the combined group weight loss intervention (Journey to Better Health; JTBH) plus an individual gardening intervention (Harvest for Health; H4H) or the JTBH intervention alone.
The specific aims are to compare our two interventions on:
(1) primary outcomes related to implementation effectiveness (reach, adoption, maintenance of health behaviors),
(2) secondary outcomes on clinical effectiveness, and
(3) cost effectiveness. Findings will inform discussions with coalition partners to achieve our long-term goal of widely disseminating and sustaining multi-level interventions to reduce the multiple chronic disease burden and health disparities in the Deep South.