This study utilizes a community-based approach to nutrition education in an urban African American community. The overall goal is to achieve a significant increase in the proportion of African Americans consuming a low fat, low salt """"""""prudent"""""""" diet and to increase the proportion with optimal levels of blood pressure and total blood cholesterol.
The specific aims are to: 1) assess the eating patterns and attendant nutrition literacy issues in urban African Americans, 2) determine the effectiveness of a lay volunteer-mediated multimodal culturally-specific church-based intervention compared with a strategy using solely written and visual self-help materials, 3) determine the impact of an intensive culturally-specific nutrition education intervention on the selection of """"""""prudent"""""""" low fat, low salt alternatives when compared with the usual approaches to influencing food selection in major markets and fast-food restaurants, and 4) to develop a process module which will allow generalization of this community- based technique to other low literacy high cultural-specificity groups. The study is comprised of 3 phases and utilizes a social-marketing approach. Phase 1, the first year of the study, is a community diagnosis consisting of a population-based random-digit-dialing survey and a series of focus groups to define eating patterns and nutrient intake in their social context in the African American population. Community focus groups will be conducted to design culturally-specific nutrition education modules to be used in two subsequent randomized trials. Phase I also consists of the adaptation of existing instruments to determine nutrition literacy levels, comprehension and the readability specifically in this population. Phase 2, in years 2,3 and the first 6 months of Year 4 of the study, is comprised of a randomized trial of a nutrition education module administered through trained lay nutrition counselors in East Baltimore churches compared with churches which receive only self-help materials designed for the literacy level. Outcomes include assessment of total calories from fat, from saturated fat, cholesterol in mg/day and blood pressure and blood cholesterol levels measured 1,6 and 12 months after the intervention. A total of 1982 individuals in 25 churches comprise the expected participant population. Phase III, conducted in the second half of Year 4 and first half of Year 5, consists of a randomized trial of an intensive nutrition intervention which is designed for the culture and is compared with usual advertising and food-selection influence techniques in 8 fast food restaurants and 4 large food markets in East Baltimore. Outcomes include the shift in sales from high to low fat and salt alternatives (as determined by computerized sales and inventory data) during the intervention and two weeks following the intervention. All interventions in Phase II and III will evolve from the focus groups and survey work performed in Phase I. This study is significant because it: 1) evolves the interventions from the community itself to make them culturally and literacy level specific, 2) reaches a broad segment of the African American population, 3) provides strong potential for """"""""ownership and sustainability"""""""" because it utilizes existing social and commercial structures, and 4) provides potential national generalizability as techniques developed should be applicable to other high cultural- specificity, low literacy groups.
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