Abstract A37: A group randomized trial to reduce obesity among Appalachian church members: The Walk by Faith study
Authors: Baltic Ryan , Paskett Electra D. , Lesko Samuel , Kennedy Stephenie , Lengerich Gene , Roberto Karen A. , Schoenberg Nancy , Young Gregory , Dignan Mark 
Published: May 2016

Abstract
Purpose: Appalachia is a rural, socioeconomically disadvantaged region with limited access to preventive health services. The Appalachia Community Cancer Network (ACCN) is an NCI-funded research initiative that collaborates with community-based cancer coalitions and other community groups to increase awareness, provide education, and promote cancer prevention. Using Community Based Participatory Research (CBPR) principles, ACCN tested a program to reduce overweight and obesity, a modifiable risk factor for cancer, by working with churches, an important institution in Appalachia. The primary outcome of this study was change in weight from baseline to twelve months. The goal of this report is to present trial results for weight reduction at 12 months.
Methods: The study was a group randomized trial where county or group of counties in five Appalachian states (Ohio, Pennsylvania, Kentucky, Virginia, and West Virginia) were randomly assigned to receive either an intervention program on diet and physical activity titled “Walk by Faith” (WbF) or an educational program focused on cancer screening titled “Ribbons of Faith” (RoF). Participants attended an information session, provided informed consent, were screened for eligibility, and completed biometric measurements including height, weight, blood pressure, and waist and hip circumference. Biometric measurements were also collected at 12 and 24 months. Participants reported on demographic, tobacco use, cancer and cancer screening history, healthcare access, Appalachian identity, physical activity and diet-related information at baseline and annually for two years. Church members were eligible if they were 18 years of age or older, overweight, willing to use a computer, and medically cleared to participate. Ohio and Pennsylvania sites enrolled participants from January through September in 2012, while the other three states enrolled participants from February to November 2013.
Participants in the WbF program received pedometers, monthly education sessions focused on healthy eating and exercise, healthy eating guide books, physical activity journals, and access to a website (Faithfully Living Well) customized for each church and designed to assist participants to overcome barriers to healthy eating and physical activity, track their weight and activities, and access health-related articles and healthy recipes. RoF participants were invited to attend monthly educational sessions about cancer and cancer screening.
Results: Of 866 interested parishioners at 28 churches, 159 (18%) were ineligible; of the 707 eligible individuals who completed screening, 663 (94%) were enrolled. Participants were predominantly female (71%) with average BMI of 33.2; 42% reported regular exercise, 25% had a high school education or lower, and 26% had household incomes &lt;$40,000. Although the difference in weight loss from baseline to 12 months for WbF compared to RoF was not statistically significant overall (1.1% decrease in weight for WbF vs. RoF, p=0.17), results varied by gender. Among men, those in the WbF arm experienced a 2.5% loss in weight compared to men in the RoF arm (p=0.03). Participants in the WbF group increased fruit and vegetable consumption by 26% at 12-months compared to the RoF group (p=0.03). Among WbF participants, greater participation in monthly educational sessions was associated with greater weight loss; for every two sessions attended, weight at 12-months reduced on average by 0.7% (p=0.002).
Conclusions: Overall, the WbF program facilitated weight loss in mainly male participants, and all participants improved fruit and vegetable intake. If participants were engaged in WbF activities, they lost more weight; thus, ways to improve participation should be explored. These results lend support to church-based intervention programs for underserved rural communities.
Citation Format: Ryan Baltic, Electra D. Paskett, Samuel Lesko, Stephenie Kennedy, Gene Lengerich, Karen A. Roberto, Nancy Schoenberg, Gregory Young, Mark Dignan. A group randomized trial to reduce obesity among Appalachian church members: The Walk by Faith study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A37.