The investigators will develop and demonstrate the efficacy of a set of original cardiovascular disease (CVD) nutrition education materials designed to reduce intake of sodium (Na), fat and cholesterol, and determine which will be appropriate for urban, black adults with 5th to 8th grade reading levels. The investigators will design materials to accomplish the objectives of conventional nutrition education and behavior change programs, but avoid the usual dependency of traditional programs on strategies that require a high level of reading and arithmetic. Guiding principles will be: 1) the need to identify the food- related conceptual, cultural, and social frameworks of members of the target audience; and 2) to develop a program that builds upon already- developed, alternative communication and coping skills. Using a randomized two-group design and a 12-24 month follow-up, serum cholesterol, and blood pressure levels of persons (n=200) counseled with the CARDES program will be compared with values for a control group (n=200) receiving usual care. Process measures will describe adherence outcomes and determinants. Secondary outcomes related to CVD risk factor status also will be evaluated. Prior to the evaluation, a pilot study determined best sequence for delivering the information related to dietary change (i.e., Na first, fat/cholesterol first, or concurrently) and the potential utility of CARDES with other black populations with low literacy skills was assessed. This project should lead to an improved capability for reducing risks related to hypertension and elevated cholesterol in black populations by enabling interventions to reach the subpopulations that are only marginally literate.
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