Effect of Behavioral Intervention on Dilated Fundus Examination Rates in Older African American Individuals With Diabetes Mellitus: A Randomized Clinical Trial. Cultural characteristics of African Americans: implications for the design of trials that target behavior and health promotion programs. Risk Reduction for HIV-Positive African American and Latino Men with Histories of Childhood Sexual Abuse Rationale and design: telephone-delivered behavioral skills interventions for Blacks with type 2 diabetes Impact of Distress Reduction on Behavioral Correlates and A1C in African American Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER. Readiness to Change and Brief Educational Interventions: Successful Strategies to Reduce Stroke Risk Intervening during and after pregnancy to prevent weight retention among African American women Heart Healthy and Ethnically Relevant (HHER) Lifestyle trial for improving diet and physical activity in underserved African American women. Effects of culturally specific cessation messages on theoretical antecedents of behavior among low-income african american smokers. Influence of prior sexual risk experience on response to intervention targeting multiple risk behaviors among adolescents. Reduction in Sexual Risk Behaviors and Infection Rates Among African Americans and Mexican Americans Low-Intensity Smoking Cessation Intervention among African-American Women Cigarette Smokers: A Pilot Study Improving asthma self-efficacy: developing and testing a pilot community-based asthma intervention for African American adults. Reducing psychosocial and behavioral pregnancy risk factors: results of a randomized clinical trial among high-risk pregnant african american women. Intervention to influence behaviors linked to risk of chronic diseases: a multisite randomized controlled trial with African-American HIV-serodiscordant heterosexual couples. Performance of a Culturally Tailored Cognitive-Behavioral Intervention Integrated in a Public Health Setting to Reduce Risk of Antepartum Depression: A Randomized Controlled Trial. Reaching impaired populations with HIV prevention programs: a clinical trial for homeless mentally ill African-American men. A Multi-City Community Based Smoking Research Intervention Project in the African-American Population A Self-Management Intervention for African Americans With Comorbid Diabetes and Hypertension: A Pilot Randomized Controlled Trial A sexual risk and stress reduction intervention designed for HIV-positive bisexual African American men with childhood sexual abuse histories. A community-integrated home based depression intervention for older African Americans: descripton of the Beat the Blues randomized trial and intervention costs Adherence to diabetes self care for white, African-American and Hispanic American telemedicine participants: 5 year results from the IDEATel project Motivational interviewing fails to improve outcomes of a behavioral weight loss program for obese African American women: a pilot randomized trial
IMPORTANCE African American individuals are at high risk of diabetes mellitus and diabetic retinopathy but have suboptimal rates of dilated fundus examinations ( DFEs ) . Early intervention is crucial for the prevention of diabetic retinopathy in this high-risk population . OBJECTIVE To test the efficacy of behavioral activation for diabetic retinopathy prevention on rates of DFEs in older African American individuals with diabetes mellitus . DESIGN , SETTING , AND PARTICIPANTS Masked r and omized clinical trial at 2 urban medical centers from October 1 , 2010 , to May 31 , 2014 . Participants included 206 African American individuals 65 years and older with diabetes mellitus who had not obtained a DFE in the preceding 12 months . INTERVENTIONS Participants were r and omized to either behavioral activation for diabetic retinopathy prevention , a behavioral intervention design ed to provide education , facilitate identifying and addressing health care barriers , and promote goal setting to improve rates of DFEs , or supportive therapy , a control condition . MAIN OUTCOMES AND MEASURES The primary outcome was medical documentation of a DFE at 6 months ' follow-up . Secondary outcomes included the Risk Perceptions and Risk Knowledge Survey of Diabetes Mellitus , Diabetes Self-Care Inventory , Patient Health Question naire 9 , and National Eye Institute Vision Function Question naire 25 scores and hemoglobin A1c levels . RESULTS More participants in the behavioral activation for diabetic retinopathy prevention group ( 87.9 % ) obtained a DFE compared with those in the supportive therapy group ( 34.1 % ) by the 6-month follow-up assessment ( P < .001 ) . Overall , participants in the behavioral activation for diabetic retinopathy prevention group were 2.5 times more likely to obtain a DFE compared with those in the supportive therapy group ( risk ratio = 2.58 ; 95 % CI , 1.91 - 3.48 ; P < .001 ) . The intervention had no short-term effect on secondary outcomes of hemoglobin A1c levels , depression , or the Risk Perceptions and Risk Knowledge Survey of Diabetes Mellitus or National Eye Institute Vision Function Question naire 25 composite scores ; however , both groups had improved adherence to diabetes mellitus self-care behaviors from baseline to 6-month follow-up . CONCLUSIONS AND RELEVANCE Behavioral activation for diabetic retinopathy prevention significantly increased rates of DFEs in older African American individuals with diabetes mellitus . Behavioral interventions may have the potential to positively affect screening for diabetic retinopathy in at-risk population s. TRIAL REGISTRATION clinical trials.gov Identifier : NCT01179555 OBJECTIVE To identify African American cultural characteristics that may be used to modify clinical trial design s and behavioral programs aim ed at losing weight and maintaining weight loss . DESIGN Focus group discussion s. SETTING University-affiliated biomedical research center . PARTICIPANTS Thirty-one African American men and women who completed the screening process , but were ineligible for the Weight Loss Maintenance ( WLM ) trial , participated in one of five focus group sessions . WLM is a r and omized controlled trial that compares two lifestyle interventions for preventing weight regain in individuals who have successfully lost weight in a group-based behavioral weight loss program .  RESULTS Nine themes emerged as cultural characteristics specific to African Americans seeking participation in a lifestyle change program : ( 1 ) religion is a powerful force ; ( 2 ) family structure ; ( 3 ) integration dismantled the African American family ; ( 4 ) general mistrust of Caucasians ; ( 5 ) African Americans are undervalued and not respected as a people ; ( 6 ) limited re sources equal limited ability to make lifestyle changes ; ( 7 ) preservation of an explicit ethnic identity ; ( 8) education is the key to success as an African American ; and ( 9 ) communication skills are vital . CONCLUSIONS Identifying cultural characteristics specific to African Americans may help investigators design clinical trials that will enhance outcomes and improve the generalizability of results in ethnic minority population While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men ( MSM ) , few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women ( MSMW ) . Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse ( CSA ) , a population that may be vulnerable to high-risk sexual behaviors , having multiple sexual partners , and depression . The Men ’s Health Project , a small r and omized clinical trial , compared the effects of two 6-session interventions , the Sexual Health Intervention for Men ( S-HIM ) , guided by social learning theory and aim ed at decreasing high-risk sexual behaviors , number of sexual partners , and depressive symptoms , and a st and ard health promotion control ( SHP ) . A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited . Results were based on an “ intent to treat ” analyses of baseline to post , 3 and 6 month follow-ups . The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test , and from the 3 to 6 month follow-ups , although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants . No significant differences between conditions were reported for depressive symptoms , but the total sample reported a significant decrease at 6 months . These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men , while being sensitive to CSA histories and sexual minority status , and suggest the need to develop additional strategies to heighten HIV risk reduction over time Background African Americans with Type 2 diabetes ( T2DM ) have higher prevalence of diabetes , poorer metabolic control , and greater risk for complications and death compared to American Whites . Poor outcomes in African Americans with T2DM can be attributed to patient , provider , and health systems level factors . Provider and health system factors account for < 10 % of variance in major diabetes outcomes including hemoglobin A1c ( HbA1c ) , lipid control , and re source use . Key differences appear to be at the patient level . Of the patient level factors , consistent differences between African Americans and American Whites with T2DM have been found in diabetes knowledge , self-management skills , empowerment , and perceived control . A variety of interventions to improve diabetes self-management have been tested including : 1 ) knowledge interventions ; 2 ) lifestyle interventions ; 3 ) skills training interventions ; and 4 ) patient activation and empowerment interventions . Most of these interventions have been tested individually , but rarely have they been tested in combination , especially among African Americans who have the greatest burden of diabetes related complications . This study provides a unique opportunity to address this gap in the literature . Methods / Design We describe an ongoing four-year r and omized clinical trial , using a 2 × 2 factorial design , which will test the efficacy of separate and combined telephone-delivered , diabetes knowledge/information and motivation/behavioral skills training interventions in high risk African Americans with poorly controlled T2DM ( HbA1c ≥ 9 % ) . Two-hundred thirty-two ( 232 ) male and female African-American participants , 18 years of age or older and with an HbA1c ≥ 9 % , will be r and omized into one of four groups for 12-weeks of phone interventions : ( 1 ) an education group , ( 2 ) a motivation/skills group , ( 3 ) a combined group or ( 4 ) a usual care/general health education group . Participants will be followed for 12-months to ascertain the effect of the interventions on glycemic control . Our primary hypothesis is that among African Americans with poorly controlled T2DM , patients r and omized to the combined diabetes knowledge/information and motivation/behavioral skills training intervention will have significantly greater reduction in HbA1c at 12 months of follow-up compared to the usual care/general health education group . Discussion Results from this study will provide important insight into how best to deliver diabetes education and skills training in ethnic minorities and whether combined knowledge/information and motivation/behavioral skills training is superior to the usual method of delivering diabetes education for African Americans with poorly controlled T2DM.Trial registration National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier # NCT00929838 ) OBJECTIVE Symptoms of emotional distress related to diabetes have been associated with inadequate self-care behaviors , medication non-adherence , and poor glycemic control that may predispose patients to premature death . African American women , in whom diabetes is more common and social support is often insufficient , may be at particularly high risk . The objective of this study was to examine the impact of lowering diabetes-related emotional distress on glycemic control and associated behavioral correlates in rural African American women with uncontrolled type 2 diabetes ( T2D ) . DESIGN Post-hoc analysis of prospect i ve , r and omized , controlled trial . SETTING Rural communities in the southeastern United States . PATIENTS 129 rural middle-aged African American women with uncontrolled type 2 diabetes (T2D)(A1C ≥ 7.0 ) . PRIMARY INDEPENDENT VARIABLE Diabetes-related distress . MAIN OUTCOME MEASURES Changes from baseline to 12-month follow-up in diabetes-related distress , and associated changes in medication adherence , self-care activities , self-efficacy , and glycemic control ( A1C ) . RESULTS Patients with a reduction in diabetes-related distress ( n=79 ) had significantly greater improvement in A1C , medication adherence , self-care activities , and self-efficacy compared with those in whom diabetes distress worsened or was unchanged ( n=50 ) . Changes in distress were also significantly and inversely correlated with improvements in medication adherence , self-care activities , and self-efficacy . CONCLUSIONS Among rural African American women , reductions in diabetes-related distress may be associated with lower A1C and improvements in self-efficacy , self-care behaviors , and medication adherence & NA ; Despite recent advances in stroke treatment and prevention , identifying effective educational interventions for “ at‐risk ” groups that will help reduce their stroke risk and improve the speed of seeking treatment remains of paramount importance . The purpose of this pilot study was to determine whether a brief educational intervention , tailored to the patient 's stage of readiness to change , could affect the initiation and achievement of stroke risk‐reducing behaviors for this at‐risk population . The study also explored potential demographic and medical confounders that could influence behavioral and knowledge goal achievement . Three groups of 20 participants , each with multiple risk factors for stroke , from a family practice clinic were r and omly assigned to a control , simple‐advice , or brief intervention group .  The majority of the participants were African American with a mean age of 68 years . Selected findings showed ( a ) significant differences in the number of newly initiated stroke‐risk‐reduction behaviors and stroke knowledge among the three groups and ( b ) significant positive correlations between the action stage of readiness to change and the initiation and achievement of the new stroke‐risk‐reduction behaviors . Although results supported the usefulness of the brief intervention model to reduce modifiable stroke‐risk factors and increase stroke knowledge , the necessity of additional longitudinal research that refines the targeting of interventions for diverse racial , cultural , and age groups was acknowledged Efforts to prevent postpartum weight retention in extant clinical trials of African American women have proven exceedingly challenging . The primary purpose of this pilot study was to determine whether a behavioral intervention implemented in early pregnancy through 6 months postpartum could increase the proportion of African American women who were at or below their early pregnancy weights by 6 months postpartum . We additionally evaluated whether mothers ' postpartum weight loss could be maintained at 12 months postpartum . Participants were 66 socioeconomically disadvantaged African American women ( 36 % overweight , 64 % obese ) r and omly assigned to a behavioral intervention or usual care group . The intervention , implemented from early pregnancy to 6 months postpartum , promoted weight control through : ( 1 ) empirically supported behavior change goals ; ( 2 ) interactive self-monitoring text messages ; ( 3 ) weekly to monthly health coach calls ; and ( 4 ) skills training and support through Facebook . In modified intent-to-treat analyses , participants assigned to the intervention were significantly more likely to be at or below their early pregnancy weights by 6 months postpartum compared to usual care ( 56 % vs. 29 % , p = 0.04 ) . At 12 months postpartum , the maternal weight difference between intervention and usual care groups was not maintained ( 41 % vs. 38 % respectively at or below early pregnancy weights , p = 0.83 ) . Findings suggest that a combined pregnancy and postpartum weight control intervention improves 6 month weight outcomes in socioeconomically disadvantaged African American women with obesity . Longer interventions may be needed to overcome late postpartum weight gain among this high risk group . Clinical trial registration number : Clinical Trials.gov identifier BACKGROUND African American women are at increased risk for CVD morbidity and mortality relative to white women . Physical inactivity and poor dietary habits are modifiable health behaviors shown to reduce CVD risk . Community health centers have the potential to reach large numbers of African Americans to modify their risk for CVD , yet few lifestyle counseling interventions have been conducted in this setting . METHODS The HHER Lifestyle trial is a r and omized controlled trial to compare the effects of a st and ard care intervention ( provider counseling , nurse goal setting , and educational material s ) to a comprehensive intervention ( st and ard care intervention plus 12 months of telephone counseling and tailored print material s ) on changes in physical activity and dietary fat consumption in financially disadvantaged African American women at 6 and 12 months . Secondary outcomes are body mass index , central adiposity , and total cholesterol . Potential mediators of outcome are self-efficacy for overcoming barriers , social support , and decisional balance . RESULTS African American women ( N=266 ; 130 st and ard care , 136 comprehensive intervention ) 35 years and older from nine clinics within two community health centers were enrolled . Most participants were overweight or obese with existing chronic health conditions . CONCLUSION The HHER Lifestyle trial is unique in that it targets financially disadvantaged African American women from community health centers , incorporates a st and ard care intervention into a routine clinical appointment , and includes a comprehensive process evaluation . The design will permit further research examining the added effect of regular telephone counseling and tailored print material s to a primary care provider and nurse intervention Previous research has highlighted the importance of cultural relevance in health risk communications , including tobacco interventions . However , few studies have examined the active components of smoking cessation messages targeting low-income African American smokers . This study tested the influence of message content and culturally specific framing in a sample of adult smokers . In a 2 x 2 factorial experiment , 243 African American smokers ( M = 19 cigarettes/day ) recruited from the community ( 55 % women ; mean age = 43 years ) were r and omly assigned to 1 of 4 conditions : culturally specific smoking messages , st and ard smoking messages , culturally specific exercise/weight messages , or st and ard exercise/weight messages . The primary outcome measures were theoretical antecedents to behavior change , including risk perceptions ( general , personal , and culturally specific ) , readiness to quit smoking , and smoking-related knowledge . The results showed that the smoking messages produced greater culturally specific risk perceptions , readiness to quit smoking , and smoking-related knowledge . The culturally specific messages produced greater personal risk perceptions and intentions to quit . Culturally specific risk perceptions were most affected by culturally specific smoking messages . Findings support the roles of message content and culturally specific framing in the efficacy of brief written interventions for smoking cessation in this population . Future research is needed to examine the influence of these constructs on behavior change PURPOSE To identify correlates of sexual risk variations among African-American adolescents , and to examine the influence of prior sexual experience on response to a HIV risk-reduction intervention . METHODS Eight hundred seventeen African-American youth aged 13 to 16 years living in and around urban public housing in Baltimore were recruited to participate in a HIV risk-reduction intervention targeting multiple risk behaviors . An instrument design ed to measure three levels of sexual risk ( " abstinent , " " protected sex " [ having sex with a condom ] , and " unprotected sex " [ having sex without a condom ] ) was administered at baseline , 6 months and 12 months postintervention . Multiple regression analyses were conducted to identify predictors of the degree of sexual risk using longitudinal data . Repeated measure analyses were conducted to assess behavioral changes over time among the three groups . RESULTS Data confirmed the co-variation of sexual risk behavior and other problem behaviors among adolescents , cross-sectionally and longitudinally . After exposure to an 8-session risk-reduction intervention , youth engaging in the highest degree of sexual risk demonstrated the greatest reduction in both sexual risk and other risks . These improvements were seen at both 6 months and 12 months postintervention . Youth who were abstinent at baseline maintained the lowest levels in risk involvement throughout the study period when compared with sexually active youth . However , abstinent youth risk involvement significantly increased at 6 months and 12 months after baseline . Youth engaging in protected sex at baseline demonstrated a significant increase in non-condom use and a significant decrease in multiple risk involvement over time . CONCLUSIONS Results support HIV risk-reduction intervention efforts that target multiple risk behaviors . Response of adolescents to the intervention is directly related to the sexual risk behavior at baseline . These data may suggest that the response to risk behavior intervention depends in part on the risk behavior profile of the population to which it is being applied Background Project SAFE , a gender- and culture-specific cognitive – behavioral intervention , was one of the few interventions to have demonstrated a significant reduction in sexually transmitted infections in a r and omized , controlled trial . Goal We evaluated intervention efficacy in 379 Mexican Americans and 170 African Americans ; and in a subset of 477 women , explored ethnic differences in the relationships over time between attitudes/beliefs about relationships , reported sexual behavior , and infection . Study Design Women were question ed intensively at baseline , 6 , and 12 months . We used stratified analyses and multivariate regression to evaluate ethnic differences and the role of behavior in explaining ethnic differences in infection . Results African Americans had higher overall infection rates ( 29.0 % vs. 18.3 % ) than Mexican Americans , but the intervention efficacy was similar ( odds ratios , 0.58 and 0.54 , respectively ) . African Americans reported more douching after sex , less mutual monogamy , and more rapid partner turnover . However , Mexican Americans appeared slightly more likely to have sex with an untreated partner , and there was no difference in risky sex . African Americans reported greater difficulty finding partners and reported attitudes more compatible with nonmonogamy . Conclusions Despite substantial ethnic differences in attitudes/beliefs , behaviors , and infection rates , the intervention had a comparable impact on both Mexican Americans and African Americans Relatively little research has been done to test quitsmoking interventions in African-American population s ? Cigarette smoking is integral to higher rates of cancer and cardiovascular morbidity and mortality for AfricanAmericans compared with their non-African-American counterparts in the United States . 2 African-American women smokers , in particular , may experience increased health risks related to cigarette smoking because they are reported to have higher average levels of cotinine , a nicotine metabolite , than other race or gender groups ? Homogeneity in economic , cultural , and social characteristics between client and provider has been identified as important in increasing the likelihood of success in quitsmoking programs . 2 Because of this , efforts to recruit and train facilitators from the African-American community could improve intervention effectiveness ? The purpose of this study was to evaluate the feasibility and effect of a  behavior-change smoking-cessation intervention mailed in four weekly segments supplemented with weekly telephone support calls from an African-American woman ex-smoker , and to compare the effects to an advice-only intervention BACKGROUND Low-income African American adults in Chicago have disproportionately high asthma morbidity and mortality rates . Interventions that improve asthma self-efficacy for appropriate self-management behaviors might ultimately improve asthma control in this population . OBJECTIVE We sought to pilot test an intervention to improve asthma self-efficacy for appropriate self-management behaviors . METHODS Participants for this trial were recruited through 2 primary care clinics located in the largest African American community in Chicago . Participants were then r and omized into one of 2 groups . The control group received mailed asthma education material s. The intervention group was offered 4 group sessions led by a community social worker and 6 home visits by community health workers . Telephone interviews were conducted at baseline ( before intervention ) , 3 months ( after intervention ) , and 6 months ( maintenance ) . RESULTS The 42 participants were predominantly African American and low income and had poorly controlled persistent asthma .  The intervention group had significantly higher asthma self-efficacy at 3 months ( P < .001 ) after the completion of the intervention . Asthma action plans were more common in the intervention group at 3 months ( P = .06 ) . At 6 months , the intervention group had improved asthma quality of life ( P = .002 ) and improved coping ( P = .01 ) compared with control subjects . Trends in behavioral and clinical outcomes favored the intervention group but were not statistically significant . CONCLUSIONS This community-based asthma intervention improved asthma self-efficacy , self-perceived coping skills , and asthma quality of life for low-income African American adults . Larger trials are needed to test the efficacy of this intervention to reduce asthma morbidity in similar high-risk population OBJECTIVES We evaluated the efficacy of a primary care intervention targeting pregnant African American women and focusing on psychosocial and behavioral risk factors for poor reproductive outcomes ( cigarette smoking , secondh and smoke exposure , depression , and intimate partner violence ) . METHODS Pregnant African American women ( N = 1044 ) were r and omized to an intervention or usual care group . Clinic-based , individually tailored counseling sessions were adapted from evidence -based interventions . Follow-up data were obtained for 850 women . Multiple imputation methodology was used to estimate missing data . Outcome measures were number of risks at baseline , first follow-up , and second follow-up and within-person changes in risk from baseline to the second follow-up . RESULTS Number of risks did not differ between the intervention and usual care groups at baseline , the second trimester , or the third trimester . Women in the intervention group more frequently resolved some or all of their risks than did women in the usual care group ( odds ratio = 1.61 ; 95 % confidence interval = 1.08 , 2.39 ; P = .021 ) . CONCLUSIONS In comparison with usual care , a clinic-based behavioral intervention significantly reduced psychosocial and behavioral pregnancy risk factors among high-risk African American women receiving prenatal care BACKGROUND The high morbidity and mortality in African Americans associated with behavior-linked chronic diseases are well documented . METHODS We tested the efficacy of an intervention to increase multiple health-related behaviors in African Americans . In a multisite cluster-r and omized controlled trial , groups of African American human immunodeficiency virus (HIV)-serodiscordant heterosexual couples in Atlanta ( Georgia ) , Los Angeles ( California ) , New York ( New York ) , and Philadelphia ( Pennsylvania ) were allocated to an individual-focused health promotion that addressed multiple health-related behaviors or to a couple-focused HIV/sexually transmitted disease ( STD ) risk reduction intervention . Primary outcomes were adherence to fruit and vegetable consumption and physical activity guidelines assessed preintervention , immediately postintervention , and 6 and 12 months postintervention . Secondary outcomes included fatty food consumption , prostate and breast cancer screening , and alcohol use . Generalized estimating equations tested the efficacy of the health promotion intervention over the postintervention assessment s. RESULTS Health promotion intervention participants were more likely to report consuming 5 or more servings of fruits and vegetables daily ( rate ratio [ RR ] , 1.38 ; 95 % confidence interval [ CI ] , 1.18 to 1.62 ) and adhering to physical activity guidelines ( 1.39 ; 1.22 to 1.59 ) compared with HIV/STD intervention participants . In the health promotion intervention compared with the HIV/STD intervention , participants consumed fatty foods less frequently ( mean difference , -0.18 ; 95 % CI , -0.30 to -0.07 ) , more men received prostate cancer screening ( RR , 1.51 ; 95 % CI , 1.21 to 1.88 ) , and more women received a mammogram ( RR , 1.26 ; 95 % CI , 1.06 to 1.50 ) . Alcohol use did not differ between the intervention groups . CONCLUSION This trial demonstrates the efficacy of interventions targeting multiple health-related behaviors in African American HIV-seropositive and HIV-seronegative men and women . Trial Registration clinical trials.gov Identifier : NCT00644163 INTRODUCTION Cognitive-behavioral group interventions have been shown to improve depressive symptoms in adult population s. This article details the feasibility and efficacy of a 6-week , culturally tailored , cognitive-behavioral intervention offered to rural , minority , low-income women at risk for antepartum depression . METHODS A total of 146 pregnant women were stratified by high risk for antepartum depression ( Edinburgh Postnatal Depression Scale [ EPDS ] score of 10 or higher ) or by low-moderate risk ( EPDS score of 4 - 9 ) and r and omized to a cognitive-behavioral intervention or treatment as usual . Differences in mean change of EPDS and Beck Depression Inventory (BDI)-II scores for low-moderate and high-risk women in the cognitive-behavioral intervention and treatment as usual for the full sample were assessed from baseline ( T1 ) , posttreatment ( T2 ) , and one-month follow-up ( T3 ) , and for African American women in the sub sample . RESULTS Both the cognitive-behavioral intervention and treatment-as-usual groups had significant reductions in the EPDS scores from T1 to T2 and T1 to T3 . In women at high risk for depression ( n = 62 ) , there was no significant treatment effect from T1 to T2 or T3 for the EPDS . However , in low-moderate risk women , there was a significantly greater mean change in the BDI-II scores from significant decrease in the BDI-II scores from T1 to T2 ( 4.92 vs 0.59 , P = .018 ) and T1 to T3 ( 5.67 vs 1.51 , P = .04 ) . Also , the cognitive-behavioral intervention significantly reduced EPDS scores for African American women at high risk ( n = 43 ) from T1 to T2 ( 5.59 vs 2.18 , P = .02 ) and from T1 to T3 ( 6.32 vs 3.14 , P = .04 ) . DISCUSSION A cognitive-behavioral intervention integrated within prenatal clinics is feasible in this sample , although attrition rates were high . Compared to treatment as usual , the cognitive-behavioral intervention reduced depressive symptoms for African American women at high risk for antepartum depression and for the full sample of women at low-moderate risk for antepartum depression . These promising findings need to be replicated in a larger controlled clinical trial that incorporates methods to maintain greater participant engagement This study tested an intervention to reduce sexual risk behaviors in a high risk impaired population : homeless African-American , Caucasian and Hispanic men with mental illness . In a comparison group clinical trial , men were assigned to an experimental cognitive-behavioral or a control intervention and followed up over 16 months . Men were recruited from a psychiatric program in two shelters for homeless men in Nashville , Tennessee . An ethnically mixed cohort of subjects ( 54 % African-American , 42 % Caucasian and 4 % Hispanic ) were included in the study . Most had a chronic psychiatric disorder and a co-morbid substance abuse disorder . The 257 participants who were sexually active ( 130 experimental , 127 control ) prior to the trial were the main target of the intervention . An experimental intervention ( SexG ) , adapted from Susser and Associates ( 51 ) , comprised 6 group sessions . The control intervention was a 6-session HIV educational program .  Sexual risk behavior was the primary outcome . The experimental and control groups were compared with respect to the mean score on a sexual risk index . Complete follow-up data were obtained on 257 men ( 100 % ) for the initial six-month follow-up . These individuals have been followed for the remainder of the 16-month follow-up . This intervention , ( SexG ) , successfully reduced sexual risk behaviors of homeless mentally ill African-American , Caucasian and Hispanic men . Similar approaches may be effective in other impaired high-risk population Objective : To carry out a community-based research approach to determine the most effective educational interventions to reduce smoking among African-American smokers . The intervention included preparation of the community , planning and developing a model of change , and developing a community-based intervention . The study population consisted of 2,544 r and omly selected adult African-American smokers residing in four sites in the northeastern and southeastern parts of the United States . The research design provided a comparison of active intervention sites with passive control sites as well as low income and moderate income areas . Major Outcome Measures : Point prevalence of non-smoking at the time of interview ; Period prevalence of non-smoking at the time of interview ; Period prevalence of quit attempts in the prior six months ; Number of smoke-free days in the prior six months ; Number of cigarettes smoked daily at the time of interview . Results : Based upon a survey eighteen months after baseline data was collected , all four measures of cigarette smoking behavior showed a strong statistically significant reduction of personal smoking behavior among those receiving active interventions versus the passive group . On the basis of process variable analysis , direct contact with the project staff in the prior six months was significantly higher in the active intervention areas . There was only a small non-significant increase in personal smoking behavior in moderate income groups as opposed to low income groups . Conclusion : An analysis of process variables strongly suggests that , within this African-American Community , “ h and s on ” or “ face to face ” approaches along with mass media , mailings , and other less personal approaches were more effective in reducing personal smoking behavior than media , mailings , and other impersonal approaches alone addressed to large audiences Introduction The objective of this pilot 6-month r and omized controlled trial was to determine the effectiveness of an intensive , community-based , group intervention that focused on diet , physical activity , and peer support for reducing weight among urban-dwelling African Americans with comorbid type 2 diabetes and hypertension . Methods Sixty-one participants were r and omized into an intervention or control group . The 6-month intervention consisted of 18 group sessions led by a dietitian in a community setting and weekly telephone calls from a peer supporter . The intervention featured culturally tailored nutrition education , behavioral skills training , and social support focused on changes to diet and physical activity . The control group consisted of two 3-hour group sessions of diabetes self-management education taught by a community health worker . Outcome measures were assessed at baseline and 6 months . The primary outcome was achievement of a 5 % weight reduction at 6 months . A secondary outcome was achievement of a 0.5 percentage-point reduction in hemoglobin A1c ( HbA1c ) . Results Groups did not differ in achievement of the weight-loss goal . Intervention participants  lost a mean of 2.8 kg ( P = .01 ) ; control participants did not lose a significant amount of weight . A greater proportion of intervention ( 50.0 % ) than control ( 21.4 % ) participants reduced HbA1c by 0.5 percentage points or more at 6 months ( P = .03 ) . Conclusion The intervention was more effective than usual care ( short-term diabetes education ) at improving glycemic control , but not weight , in low-income African Americans with comorbid diabetes and hypertension . A community-based 6-month group class with culturally tailored education , behavioral skills training , and peer support can lead to a clinical ly significant reduction in HbA1c OBJECTIVES HIV transmission risk is high among men who have sex with men and women ( MSMW ) , and it is further heightened by a history of childhood sexual abuse ( CSA ) and current traumatic stress or depression . Yet , traumatic stress is rarely addressed in HIV interventions . We tested a stress-focused sexual risk reduction intervention for African American MSMW with CSA histories . METHODS This r and omized controlled trial compared a stress-focused sexual risk reduction intervention with a general health promotion intervention .  Sexual risk behaviors , psychological symptoms , stress biomarkers ( urinary cortisol and catecholamines ) , and neopterin ( an indicator of HIV progression ) were assessed at baseline and at 3- and 6-month follow-ups . RESULTS Both interventions decreased and sustained reductions in sexual risk and psychological symptoms . The stress-focused intervention was more efficacious than the general health promotion intervention in decreasing unprotected anal insertive sex and reducing depression symptoms . Despite r and omization , baseline group differences in CSA severity , psychological symptoms , and biomarkers were found and linked to subsequent intervention outcomes . CONCLUSIONS Although interventions design ed specifically for HIV-positive African American MSMW can lead to improvements in health outcomes , future research is needed to examine factors that influence intervention effects Background Primary care is the principle setting for depression treatment ; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended st and ard of care . Older African Americans are at high risk for depression due to elevated rates of chronic illness , disability and socioeconomic distress . There is an urgent need to develop and test new depression treatments that resonate with minority population s that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness . Methods / Design Beat the Blues ( BTB ) is a single-blind parallel r and omized trial to assess efficacy of a non-pharmacological intervention to reduce depressive symptoms and improve quality of life in 208 African Americans 55 + years old . It involves a collaboration with a senior center whose care management staff screen for depressive symptoms ( telephone or in-person ) using the Patient Health Question naire ( PHQ-9 ) . Individuals screened positive ( PHQ-9 ≥ 5 ) on two separate occasions over 2 weeks are referred to local mental health re sources and BTB . Interested and eligible participants who consent receive a baseline home interview and then are r and omly assigned to receive BTB immediately or 4 months later ( wait-list control ) . All participants are interviewed at 4 ( main study endpoint ) and 8 months at home by assessors masked to study assignment . Licensed senior center social workers trained in BTB meet with participants at home for up to 10 sessions over 4 months to assess care needs , make referrals/linkages , provide depression education , instruct in stress reduction techniques , and use behavioral activation to identify goals and steps to achieve them . Key outcomes include reduced depressive symptoms ( primary ) , reduced anxiety and functional disability , improved quality of life , and enhanced depression knowledge and behavioral activation ( secondary ) . Fidelity is enhanced through procedure manuals and staff training and monitored by face-to-face supervision and review of taped sessions . Cost and cost effectiveness is being evaluated . Discussion BTB is design ed to bridge gaps in mental health service access and treatments for older African Americans . Treatment components are tailored to specific care needs , depression knowledge , preference for stress reduction techniques , and personal activity goals . Total costs are $ 584.64/4 months ; or $ 146.16 per participant/per month . Trial Registration Clinical Trials.gov # Objectives . Adherence to diabetes self care is poor for Hispanic American and African-American patients . This study examined the change in adherence over time and in response to a telemedicine intervention for elderly diabetes patients in these groups compared to white diabetes patients . We also examined whether adherence mediated the effect of the intervention on glycemic control ( A1c ) . Design . The Informatics for Diabetes Education and Telemedicine project r and omized medically underserved Medicare patients ( n=1665 ) to telemedicine case management ( televideo educator visits , individualized goal - setting /problem solving ) or usual care .  Hispanic and African-American educators delivered the intervention in Spanish if needed . Main outcome measures . Annual assessment included A1c and self-reported adherence ( Summary of Diabetes Self-Care Activities scale ) . A simple model ( only time and group terms ) and a model with covariates ( e.g. , age ) were examined for baseline and 5 years of follow-up . SAS PROC Mixed was used with non-linear terms to examine mediating effects of adherence on A1c , by performing tests of the mediating path coefficients . Results . Over time , self-reported adherence improved for the treatment group compared to usual care ( p<0.001 ) . There was no significant interaction with racial/ethnic group membership , i.e. , all groups improved . However , minority subjects were consistently less adherent than whites . Also , greater comorbidity and diabetes symptoms predicted poorer adherence , greater duration of diabetes and more years of education predicted better adherence . Adherence was a significant mediator of A1c ( p<0.001 ) . Conclusions . A unique , tailored telemedicine intervention was effective in achieving improved adherence to diabetes self care . However , African-American and Hispanic American participants were less adherent than white participants at all time points despite an individualized and accessible intervention . The finding that adherence did mediate glycemic control suggests that unique interventions for minority groups may be needed to overcome this disparity Abstract Compared to other racial/ethnic groups , African American ( AA ) women are more likely to be obese but less likely to participate in weight loss interventions or to successfully lose weight . Sustained motivation for weight loss may be especially difficult for AA women due to socioeconomic and cultural factors . The purpose of this study was to examine whether the addition of motivational interviewing ( MI ) to a culturally-targeted behavioral weight loss program for AA women improved adherence to the program , diet and physical activity behaviors , and weight loss outcomes .  Forty-four obese ( mean BMI = 39.4 , SD = 7.1 ) AA women were r and omized to receive a 16-week behavioral weight loss program plus four MI sessions , or the same behavioral weight loss program plus four health education ( HE ; attention control ) sessions . Results showed that participants in both MI and HE conditions lost a significant amount of weight , reduced their energy intake and percent calories from fat , and increased their fruit and vegetable consumption ( ps < .05 ) . However , adherence to the behavioral weight loss program and changes in diet , physical activity , and weight did not differ across MI and HE conditions . Future research is warranted to determine the sub population s with which MI is most effective
Characteristics of successful interventions included using problem solving with the patient , culturally tailoring the intervention , and using a nurse educator .
OBJECTIVE The use of behavioral interventions has been shown to improve glycemic control , however , the effectiveness of different behavioral interventions in one of the most high risk population s , African Americans , remains unclear .
Our systematic review identified and examined findings of published behavioral interventions targeted at African Americans to improve glycemic control .
The goal of our study was to distinguish which interventions were effective and identify areas for future research .