Wendy F. Auslander - US grants

The purpose of this study is to characterize the potential utility of community organization and empowerment strategies to modify dietary patterns of African American women who are at risk for Non Insulin Dependent Diabetes Mellitus (NIDDM). A second focus is to compare this intervention strategy with a standard dietary counseling intervention delivered by a health professional. The community organization and empowerment (experimental) intervention involves the utilization of informal and formal networks to increase diet-related information and skills, enhance self-mastery, and modify dietary patterns among African American women. The intervention is delivered by 8 trained neighbors (Nutrition Neighbors) who are among graduates of a Wellness Course given by a well-established, credible social service agency in the proposed target community. The social service organization will serve as the sponsor or "lead agency" for the program. Through a variety of educational and skill building activities (discussion of video, development and utilization of shopping tip sheets, healthy food choice training, modification of high fat recipes, development of a Healthy Neighbors Cookbook), the experimental condition encourages active citizen participation, community ownership, and the integration of community norms and values into the program's messages and materials. The sample will consist of 80 African American adult women who reside in low income neighborhoods serviced by the lead agency, and who are overweight. The subjects will be randomly assigned to either the experimental (empowerment) condition or the control (standard counseling) condition. To evaluate the relative effectiveness of the two conditions, assessment interviews will be performed pre-, post, and 2 month follow-up. These assessment interviews will include: physical data, food frequencies and 24-hour food checklists, and self-mastery. Family environmental variables such as family resources and stressors, as well as socio-demographic factors, will be used to characterize the sample.

The purpose of this study is to determine the effectiveness of a Nutrition Activation program to change dietary habits of low-income, obese African American women who are at risk for Non-Insulin-Dependent Diabetes Mellitus (NIDDM). The Activation program consists of a combination of strategies based upon Social Learning Theory, such as peer role modeling, staging, and group social support. A second focus of the study is to evaluate the impact of the program on reducing risk factors for NIDDM and obesity through a measurement of Body Mass Index, blood pressures, lipid levels, and waist-hip ratios. The proposed study will include 250 obese low-income African American women who will be recruited through collaborative efforts with Grace Hill Neighborhood Services, a social service organization located in the target community. The subjects will be randomized into either the Activation condition or a no-treatment control group condition. The Activation program will be delivered over a one-year period by trained peers from the target community. Intervention activities will consist of experiential learning exercises implemented within the target neighborhoods that focus on knowledge and skills related to: healthy food shopping, label reading, developing shopping tip sheets, creating low fat, high fiber recipes. Social support groups led by Nutrition Neighbors will be available to subjects in the Activation condition. Evaluation of the program will be performed through comparison of data assessed during pre-, post-, and six- month follow-up interviews. Assessments will include: l) knowledge and attitudes relating to nutrition and diet; 2) lifestyle risk factors such as smoking, physical activity; 3) dietary habits; 4) 24-Hour Dietary Recall (to be performed quarterly or 6 times for each subject); 5) food frequencies; 6) perceived social support; 7) physical data that includes Body Mass Index, blood pressure, waist-hip ratios, and lipid levels. Data analysis will include descriptive and multivariate analytic techniques to determine the impact of the program on outcome variables. Knowledge derived from this study will help identify effective strategies to reduce obesity and other risk factors of NIDDM among an underserved high risk population.

DESCRIPTION (adapted from the Abstract): In this study the researchers will develop and evaluate an HIV-prevention plus educational planning program for abused and neglected youths in foster care, which will be implemented through the Independent Living Program (ILP), a skills-building program that provides life skills to youths before they are discharged from state custody. Previous research indicates that educational parameters such as relationships with teachers, skipping school, grades, and educational aspirations are predictive of HIV-risk knowledge, attitudes, behavioral intentions, and behaviors. Although brief cognitive-behavioral interventions appear to be promising in the short term, long-term follow-up indicates that outcomes achieved do not last in this high risk adolescent population. An integral part of HIV-prevention with abused and neglected youth should involve providing youths with opportunities, skills, and hope for their futures. This can be achieved by implementing a life skills program that integrates HIV-prevention with a life-options building intervention that emphasizes educational aspirations and planning. An experimental design will be used and 430 youths will be assigned randomly either to an HIV-Prevention Plus Life Options condition or to the usual care condition. Both conditions will be delivered over an 8-month intervention phase. Evaluation of the program will be performed using data assessed during pre-, post-, and 9-month follow-up interviews. The primary outcome will be HIV-risk behaviors. Secondary outcomes include: knowledge and attitudes about HIV prevention, self-efficacy, intentions to engage in HIV-risk behaviors, future aspirations and beliefs about savings, and educational plans. A major strength of this study is that the program will be delivered through the ILP, a well-established, state-administered program in the community. ILP will provide: (1) access to high-risk abused and neglected youths; (2) the involvement of committed staff delivering a program whose philosophy is consistent with that of the study; and (3) the potential to disseminate the curriculum developed for the proposed study to ILP programs both statewide (in the seven regions of Missouri's Department of Social Services) and nationwide.