African American women (AAW) have higher rates of death and disability from chronic cardiometabolic (CM) illnesses compared to any other group of women in the US, including diabetes, cardiovascular disease, and stroke. 80% of AAW are overweight or obese, and they are the largest US sociodemographic group with inadequate engagement in exercise. Nearly 50% of AAW have cardiovascular disease, and AAW have more than twice the rate of diabetes compared to White women. Compelling evidence shows that AAW are least successful at achieving and sustaining CM risk-reduction goals compared to men and women of other racial/ethnic groups, despite participating in comprehensive lifestyle interventions. These alarming disparities are due in part to disproportionately high rates of exposure to psychological stress. Culturally-relevant stressors in AAW are positively and significantly associated with perceived stress, depressive symptoms, unhealthy eating, and physical inactivity in AAW ? CM risk factors. A shortcoming of interventions with AAW is their inadequate focus on stress exposure, including gender and racialized stress, stress physiology and stress- related barriers to healthy eating and exercise known to reduce CM risk. To address this shortcoming, we propose a randomized controlled trial to test a culturally-tailored mindfulness-based stress management intervention. This RCT is designed to help AAW build on their strengths to promote stress management and improved CM health by enhancing positive reappraisal, self-regulation, and self-efficacy, all of which are cognitive-behavioral facilitators of self-management and positively impacted by mindfulness training. In this 2- arm CM-risk reduction RCT with 200 AAW ? 18 years old with CM risk, we will be powered to detect group differences in exercise and healthy eating behaviors Specific aims are:
AIM 1 : Test the hypothesis that AAW participating in an 8-session culturally-relevant mindfulness-based intervention to reduce CM risk have:
AIM 1 A (primary) greater sustained improvements in exercise and healthy eating behaviors and AIM 1B (secondary) greater reduction in CM risk biomarkers (BMI, % body fat, waist to hip ratio [WHR], BP, and inflammatory cytokines [High Sensitivity C-Reactive Protein; hs-CRP])) at 4, 8, and 12 months, compared to AAW in an attention-control CM risk reduction intervention without mindfulness.
AIM 2 (exploratory: Test the hypothesis that improvements in mindfulness, stress management, positive reappraisal, self-regulation, and self-efficacy mediate the effects of the intervention on exercise and healthy eating. We will work with a community health agency and a community advisory board to facilitate the implementation and success of our intervention. We address the NIH call to identify interventions that promote self-management to reduce disparities through a culturally-tailored, community-based mindfulness-based intervention for AAW that targets resilience in the face of culturally-relevant stressors. If effective, we will scale this contextually relevant mindfulness intervention based on AAW's strengths for broad use in community settings.
The HARMONY study will test the effects of a culturally-tailored mindfulness self-management intervention on sustained improvements in healthy eating and exercise through improved mindful stress management, self- regulation, and self-efficacy in overweight African American women at risk for chronic cardiometabolic illness.
