This is a randomized controlled trial among African Americans (AA) of the effectiveness of a culturally sensitive self-help nutrition and physical activity intervention, implemented with and without ongoing counseling for maintenance of target health behaviors by the method of Motivational Interviewing. Conducted with the approval and assistance of Atlanta Black churches, the trial is designed with three experimental conditions: Group 1 (Comparison=C) will receive a standardized nutrition and exercise intervention (i.e., commercially available nutrition and exercise videos, audio cassette walking program, and print materials); Group 2 (Tx1) will receive a culturally sensitive self-help intervention that includes nutrition and exercise components. The nutrition component will consist mainly of a the Eat For Life video and cookbook (developed by the investigators for a related ongoing trial with the input of the AA community in Atlanta), a video and audiotape set promoting exercise (""""""""Walk With God"""""""" to be developed along religious themes and pretested in AA focus groups in a fashion similar to the Eat for Life), a quarterly newsletter and other culturally sensitive nutrition and exercise materials. Group 3 (Tx2) will receive the same intervention as Group 2, plus 4 telephone counseling calls based on Motivational Interviewing. The exercise component of the intervention will emphasize walking. Churches, rather than individuals, will be assigned to conditions, and churches will be the unit of analysis. Fifteen churches will participate in this study and will be matched in triplets based on denomination, size and income prior to randomization. To maximize use of personnel and resources and allow for refinement of our recruitment procedures, the interventions will be implemented in several partially overlapping cycles over the 2-year intervention phase. A total of 950 subjects will participate in the study (approx. 60/church). All participants will be recruited at health fairs conducted in participating churches. The goals of the interventions and primary outcomes for the study are: a) to increase fruit and vegetable consumption by serving-a-day in Group Tx1 vs C and in Tx2 vs Tx1; b) increase physical activity by 20 minutes per week in Group Tx1 vs C and in Tx2 vs Tx1. Dietary outcomes will be assessed with food frequency questionnaires plus 24-hour recalls in a 50 percent subsample. Physical activity will be assessed with a seven-day recall as well as cardiovascular fitness (cycle ergometer) in a 20 percent subsample. Recruitment and retention of participants will be maximized by several strategies including incentives for each church, and the use of church liaisons to assist in participant recruitment and tracking.
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