With increased attention to the determinants of disparities in morbidity and mortality from cancer and cardiovascular disease, we are developing a better understanding of targets and strategies for risk-reducing interventions. Despite this, African Americans continue to experience excess rates of morbidity and mortality from cancer and cardiovascular disease compared to individuals from other ethnic and racial groups. To reduce the burden of these diseases among African Americans, innovative approaches that actively involve community stakeholders are needed to motivate healthy behavior changes. Recent research has emphasized the need for integrated approaches to reduce racial disparities in health outcomes;considering the interaction of multiple types of factors that operate at individual and community levels is an important aspect of integrated approaches. However, for the most part interventions that target African Americans use a disease specific approach and target individuals at risk for one disease in limited community settings. In response to RFA-MD-07-003, NCMHD Community-Based Participatory Research Initiative in Reducing and Eliminating Health Disparities: Intervention Research Phase, we propose to evaluate the effects of a novel integrated risk counseling program on behavioral and psychological outcomes in African American men and women in a randomized trial that is implemented and evaluated collaboratively through the West Philadelphia Consortium to Address Disparities, which is an academic-community partnership that was established to conduct community-based participatory research (CBPR) to improve the health outcomes of African American residents in West and Southwest Philadelphia.
The specific aims of the proposed research are to (1) evaluate the effects of integrated (IRC) versus disease specific counseling (DSC) on risk exposure behaviors (e.g., diet and physical activity);(2) evaluate effects of integrated versus disease specific counseling on psychological outcomes (e.g., risk comprehension, self-efficacy, motivation);and (3) identify the mechanisms through which integrated risk counseling leads to behavioral change in a randomized trial. Participants are African American men and women who are residents of West and Southwest Philadelphia. Following completion of a baseline telephone interview, eligible participants will be randomly assigned to receive either IRC or DSC that is delivered by an experienced health educator. IRC will provide integrated risk information about cancer and cardiovascular disease and motivational interviewing to encourage primary prevention behaviors. Follow-up telephone interviews will be completed at 1-, 6-, and 12-months after risk counseling. Generalized estimating equations and structural equation modeling will be used to evaluate the effects IRC versus DSC on study outcomes. The results of this study will provide important information on how to enhance primary prevention behaviors among African Americans using CBPR methods.
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