Obesity is now considered epidemic in the United States and is a high priority for preventive and therapeutic interventions.1-2 Obesity and the resulting negative health effects are a particularly important problem for African American women. As called for by a recent Institute of Medicine report, more eco-social interventions at the neighborhood level are needed.3 This requires partnerships between traditional neighborhood organizations and experienced intervention developers with culturally appropriate programs.3 Local churches are the most important neighborhood organizations for African American (AA) women in terms of reach and family orientation.4-7 ? The current proposal builds upon an existing and demonstrably effective 12-hour video-based weight management program for Black women. Existing video footage will be adapted and new content added to develop a series of 36 half hour sessions and 6 boosters targeting nutrition, physical activity and self management techniques. The program will be designed as a church-based program with intervention materials delivered by mail directly to women at home. Churches will be randomly assigned to treatment or to attention placebo comparison groups. We will then conduct a field trial to compare participants receiving the church-based, home delivered program versus an attention placebo program in terms of changes in weight, dietary behavior, and physical activity. The study will test the following Specific Aims. ? SA. To determine if African American women who participate in a church-based (and home delivered) video weight control program versus an Attention Placebo Comparison will demonstrate more positive changes in weight of at least 5 pounds at 12 months and at least 2.5 pounds at 24 months. Secondarily, we expect to see positive changes in major mediators of weight including intake of fat (FHQ), servings of fruit and vegetables, portion size, increased time spent in physical activities [7 Day Recall (PAR), and increased walking (pedometers) (increasing monthly at least 400 steps per day per month). ? A secondary aim is to gather and analyze process evaluation data concerned with: 1) implementation process variables between and across churches; 2) the women's reaction to various components of the intervention; 3) the specific barriers and facilitators to dietary and physical activity changes encountered by these women; 4) solutions to barriers that work for these women; 5) motivational themes that are effective in both the short and long term; and 6) Sustainability of the intervention. We will also measure several key mediators from Social Action Theory (SAT). In addition to the diet and PA measures listed above. These will include self efficacy, use of self management skills, changes in food preparation skills, use of self monitoring feedback aids and social support. ? ?
