HUB city steps: a 6-month lifestyle intervention improves blood pressure among a primarily African American community

Authors: ZOELLNER, JAMIE - Virginia Biotechnology Institute; CONNELL, CAROL - University Of Southern Mississippi; MADSON, MICHAEL - University Of Southern Mississippi; Thomson, Jessica; LANDRY, ALICIA - University Of Southern Mississippi; MOLAISON, ELAINE - University Of Southern Mississippi; REED, VICKIE - University Of Southern Mississippi; YADRICK, KATHY - University Of Southern Mississippi

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/22/2013
Publication Date: 3/18/2014
Citation: oellner, J., Connell, C., Madson, M., Thomson, J.L., Landry, A., Molaison, E.,2014. Reed, V., Yadrick, K. 2014. HUB city steps: a 6-month lifestyle intervention improves blood pressure among a primarily African American community. Journal of the Academy of Nutrition and Dietetics.114(4):603-612.

Interpretive Summary: Hypertension, or high blood pressure, has been called the ‘silent killer’ because it often goes undetected and hence untreated. This is particularly relevant for African American populations as they suffer from higher rates of hypertension than other racial groups. Community involvement in the planning and implementation of research interventions is one way to engage the community and develop culturally sensitive programs to improve health outcomes. Hence, the purpose of this study was to determine the effectiveness of a community-engaged lifestyle intervention to reduce blood pressure and related risk factors for hypertension. The intervention included components such as social support, self-monitoring of physical activity (steps taken per day), and diet and physical activity education. Blood pressure, body composition (e.g. weight, body mass index, percent body fat), blood lipids and glucose, as well as dietary intake and physical activity measures were collected on participants. Significant reductions were observed in both systolic (7 mm Hg) and diastolic (4 mm Hg) blood pressure at 3- and 6-months follow-up. A significant reduction was also observed in sugar intake. Results from this study suggest that a community-engaged lifestyle intervention can effectively reduce the burden of hypertension in African American communities.

Technical Abstract: The effectiveness of community-based participatory research (CBPR) efforts to address the disproportionate burden of hypertension among African Americans remains largely untested. The objective of this 6-month, non-controlled, pre- post-experimental intervention was to examine the effectiveness of a CBPR intervention in achieving improvements in blood pressure (BP), anthropometric measures, biological measures, and diet. Conducted in 2010, this multicomponent, lifestyle intervention included motivational interviewing, social support provided by peer coaches, pedometer diary self-monitoring, and monthly nutrition and physical activity education sessions. Of 269 enrolled participants, most were African American (94%) females (85%). Statistical analysis included generalized linear mixed models using maximum likelihood estimation. From baseline to 6-months, systolic BP [126.0 (SD=19.1) to 119.6 (SD=15.8) mmHg; p=0.0002] and diastolic BP [83. 2 (SD= 12.3) to 78.6 (SD=11.1) mmHg; p<0.0001] were significantly reduced. Sugar intake also decreased significantly as compared to baseline (by approximately three teaspoons; p<0.0001). Time differences were not apparent for any other measures. Results from this study suggest that CBPR efforts are a viable and effective strategy for implementing non-pharmacologic, multicomponent, lifestyle interventions that can help in addressing the persistent racial and ethnic disparities in hypertension treatment and control. Outcome findings help fill gaps in the literature for effectively translating lifestyle interventions to reach and engage African American communities to reduce the burden of hypertension.