African-Americans aged 45-64 have an all-cause mortality rate nearly twice that of non-Hispanic whites. Cardiovascular disease (CVD) secondary to hypertension is a major contributor to this excess mortality. Over 80 percent of African-Americans in this age group have a usual health care source and report at least one physician visit in the past year. Successful primary care-based interventions to change several adverse behaviors, such as smoking, sedentary lifestyle, and a CVD risk promoting dietary pattern could significantly reduce CVD morbidity and mortality in African-Americans. Many individuals have multiple adverse behaviors that need to be changed, and adherence to behavioral advice is more difficult than adherence to medication regimens. It is unknown if attempting to change multiple behaviors simultaneously is more or less effective than intervening on a single behavior. We propose to conduct a randomized clinical trial of two stage-of-change based approaches to behavior change in low-income, African-American) primary care patients with high blood pressure who are smokers, not exercising to goal, and not meeting recommended ;odium intake goals: 1) simultaneous introduction of three target behaviors in a clinic counseling session with stage specific telephone support and follow-up; 2) sequential introduction of each of three target behaviors presented singly n a clinic session, with stage-specific telephone support and follow-up. We will test the hypotheses that: 1) both experimental conditions are better than usual care (regular primary care clinic visits); 2) sequential presentation is more effective than simultaneous presentation. The primary study endpoint will be adherence to two or more target behaviors at 24 months defined as: urine cotinine verified 6-month smoking abstinence; at least 30 minutes of accumulated moderate to vigorous physical activity at least 5 days per week (pedometer verified); and < 100 mmol.
| Mansyur, Carol L; Pavlik, Valory N; Hyman, David J et al. (2013) Self-efficacy and barriers to multiple behavior change in low-income African Americans with hypertension. J Behav Med 36:75-85 |
| Hyman, David J; Pavlik, Valory N; Taylor, Wendell C et al. (2007) Simultaneous vs sequential counseling for multiple behavior change. Arch Intern Med 167:1152-8 |
| Goodrick, G Ken; Kneuper, Suzanne; Steinbauer, Jeffrey R (2005) Stress perceptions in community clinic: a pilot survey of patients and physicians. J Community Health 30:75-88 |
