Proposed is a three-phase exploratory and feasibility study with the following aims:
AIM 1 : To assess the feasibility of: (a) recruiting African American family reunion-organizers and participants to take part in a health promotion and genetics-related research study. (b)administering survey assessments regarding kindreds (blood and nonblood relatives) risk factors for common chronic diseases, eating-related (ER) behaviors and weight outcomes as a component of a family reunion.
AIM 2 : To assess whether robust phenotypes of eating-related behaviors (e.g., food craving, appetite for palatable foods, disinhibition, eating in the absence of hunger;pickiness, and new food phobia) can be characterized; A robust ER phenotype will be characterized based on the consistency, strength and direction of association with indicators of adherence to eating-related weight management behaviors (e.g., frequency of intake of calorie dense foods, participation in formal weight loss programs) and lifetime weight trajectories. Specifically, a behavioral phenotype cluster (i.e., 2 or more eating-related behaviors) will be considered robust if it is quantitatively independent as a construct and is significantly associated with weight management behaviors (e.g., frequency of intake of calorie dense foods) and weight outcomes (difference in highest and lowest adult weight).
AIM 2 a: To explore the degree to which these phenotypes offer opportunities for developing and implementing innovative weight management interventions.
AIM 3 : To assess whether the occurrence of robust eating-related behavior clusters differ significantly between blood relatives and non-blood relatives (i.e., spouses and unrelated kin) in African American families who attend family reunions. The Black Family Reunion is an organized annual event that typically occurs as a three-day weekend affair during the summer months of June through August. These reunions may include as few as 50 people to as many as 500. Our collaborators at the University of North Carolina -Linnan, Dilworth-Anderson &Evans- are conducting a feasibility study using community-based participatory research (CBPR) approaches to explore possible intervention strategies aimed at reducing the burden of chronic diseases and cancer among African American families. Their planned activities provide the opportunity for us to partner with this interdisciplinary team of researchers to conduct the additional research activities described below. In this nine-month developmental planning phase, we will use a purposive sampling approach until we identify 8 family reunion organizers (from 4 reunions) who agree to be interviewed;help recruit reunion participants who will be interviewed;and provide permission for the research team to observe a family reunion event. The study team will work with family reunion organizers to identify four African American families to participate in Phase 1 of the study. We will mail a fact sheet (attached in Appendix A1), as well as a brief pre-interview questionnaire (approximately 15 minutes) to organizers asking about demographics, family dynamics, and family reunion logistics. This survey will be completed and returned to the study team prior to the in-depth interview;the organizers pre-interview questionnaire is attached in Appendix B1. We propose to conduct structured in-depth qualitative interviews with reunion organizers or chairs from four families (n=8) to assess their opinions about how best to conduct formative research within the context of a Black Family Reunion (approximately 45 to 60 minutes). The consent scripts and the drafted interview schedules for organizers are attached in Appendices B2 and B3 respectively. The interviews will be pilot-tested and trimmed accordingly. Organizers will be informed in advance of the survey length. The interviews will be conducted by research assistants who are trainees at the University of North Carolinas Gillings School of Public Health. As part of the structured telephone interview conducted individually with each organizer, we will collect information regarding the potential receptivity of the target audience to research related to heredity and eating-related behaviors. We also will identify which data collection tools are appropriate (e.g. ancestry software, surveys, interviews, video recordings, photovoice, etc.), and ways that future assessment and evaluation efforts might be conducted most effectively and efficiently. During the structured interview we will ask the family reunion organizers about the types of activities planned, logistics of the weekend event;and explore ways health and cancer topics might be integrated into the event. Family reunion organizers will be asked to identify 10 family reunion participants from each of the four families to participate in a structured interview regarding the feasibility of conducting research activities related to disease risk and heredity at family reunions. Participating family reunion organizers will send out the fact sheets (Appendix A1) as well as letters to all reunion invitees 4-6 weeks in advance of the reunion (Appendix A2). The letter will describe the study and clarify that the research team will ask participants questions during the interview to gather ideas/opinions about completing health questionnaires that ask about possible risk factors (e.g. eating habits, tobacco use, exercise habits and family history or preferences that are linked with various diseases such as cancer, heart disease and other chronic health conditions);receiving personal feedback based on responses to health-related questions;and, possibly attending group sessions at the family reunion where patterns of health risk/disease will be discussed. Interested participants will also complete a 15-minute pre-interview questionnaire (Appendix C1) before attending the family reunion for the in-depth-interview. These in-depth interviews will seek to clarify interest and/or concerns regarding: learning about family health and health history at the reunion, interest in receiving health information to address individual and family health risks, and uncover how families transmit health information via the family reunion throughout the extended family system, especially for those who do not attend the reunions. This type of information will be summarized for study participants and provided as feedback during their visit to the health study booth at their reunion. The consent scripts and the drafted interview schedules for participants are attached in Appendices C2 and C3, respectively. The interviews will be pilot-tested and trimmed accordingly. The surveys will be structured to range from 45 minutes to 1 hour. Participants will be informed in advance of the survey length. Interviews will be conducted by research assistants who conducted the interviews with family reunion organizers. Drs. Dilworth-Anderson and Linnan have used similar approaches in a variety of community based settings. Additionally, we plan to develop a video to be used in Phase 2 as a way to give information about the Phase 2 activities. The video will be used to aid in recruitment of families to participate in Phase 2 activities. A subset of participants in Phase 1 will be asked to be filmed for the video. Those who agree will be asked to complete a consent and release form (Appendix D1). The video will include participants answering a standard set of questions (detailed in Appendix D2). We will seek out a quiet location for these interviews to minimize the inadvertent filming of others. Signs will be posted at the reunion to indicate that filming is underway to minimize the likelihood of inadvertently filming those who have not signed the consent and release form. Additionally, we will stage som