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Traumatic stress and posttraumatic stress disorder (PTSD) are overrepresented in urban African American communities, and associated with health risk behaviors such as tobacco use. Support and resources provided by churches may reduce trauma-related health risks. In the current study, we assessed weekly church attendance as a moderator of relations between (a) traumatic event exposure and probable PTSD, and (b) probable PTSD and tobacco use. Data were drawn from a health surveillance study conducted in seven churches located in Chicago's West Side. Participants (N = 1015) were adults from churches as well as the surrounding community. Trauma exposure was reported by 62% of participants, with 25% of those who experienced trauma reporting probable PTSD. Overall, more than one-third of participants (37.2%) reported current tobacco use. As compared with non-weekly church attendance, weekly church attendance was associated with a lower likelihood of PTSD (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.26-0.62; p < .0001) and lower tobacco use overall (OR = 0.22; 95% CI = 0.16-0.30; p < .0001), but did not moderate the effect of trauma exposure on risk of PTSD, or the effect of PTSD on tobacco use. Findings support church attendance as a potential buffer of trauma-related stress.

Objectives Short sleep duration and poor sleep quality are more prevalent among African Americans (AAs) and may be a modifiable risk factor for cardiometabolic disorders. However, research is limited about sleep-related attitudes, beliefs, and practices among AAs. Our objective was to evaluate these practices and beliefs surrounding sleep among urban-dwelling AAs. Design Qualitative study comprised of five 90-minute focus groups using a semistructured interview guide. Setting Five churches located on the west side of Chicago. Participants Adults (N = 43) ages 25-75 years. Measurements Transcripts were voice recorded, transcribed, and then coded for content analysis using NVivo 12 Pro to capture themes in the discussions. Results Most participants (86%) reported sleeping less than the recommended 7 or more hours. The discrepancy between actual and desired sleep duration was nearly 3 hours per night. Participants reported that sleep is essential for mental and physical health. Napping and consuming caffeine were frequently reported techniques for coping with lack of sleep. Noise, physical discomfort, and stress were reported as barriers to sleep, and participants reported using TV and other electronics to cope with racing thoughts or worry. Many participants were diagnosed with or knew someone with obstructive sleep apnea, but few participants had been diagnosed with insomnia or were aware of nonpharmacologic insomnia treatments. Conclusion A cycle of stress/disruptive environment, stress, rumination at night, and coping by use of electronics and daytime napping may perpetuate sleep disparities in this community. Results suggest that sleep-related interventions should include stress reduction and environmental improvements in addition to the typical sleep hygiene–related behavioral recommendations.

BACKGROUND: African Americans suffer more than non-Hispanic whites from type 2 diabetes, but diabetes self-management education (DSME) has been less effective at improving glycemic control for African Americans. Our objective was to determine whether a novel, culturally tailored DSME intervention would result in sustained improvements in glycemic control in low-income African-American patients of public hospital clinics. RESEARCH DESIGN AND METHODS: This randomized controlled trial (n = 211) compared changes in hemoglobin A1c (A1c) at 6, 12, and 18 months between two arms: (1) Lifestyle Improvement through Food and Exercise (LIFE), a culturally tailored, 28-session community-based intervention, focused on diet and physical activity, and (2) a standard of care comparison group receiving two group DSME classes. Cluster-adjusted ANCOVA modeling was used to assess A1c changes from baseline to 6, 12, and 18 months, respectively, between arms. RESULTS: At 6 months, A1c decreased significantly more in the intervention group than the control group (− 0.76 vs − 0.21%, p = 0.03). However, by 12 and 18 months, the difference was no longer significant (12 months − 0.63 intervention vs − 0.45 control, p = 0.52). There was a decrease in A1c over 18 months in both the intervention (β = − 0.026, p = 0.003) and the comparison arm (β = − 0.018, p = 0.048) but no difference in trend (p = 0.472) between arms. The intervention group had greater improvements in nutrition knowledge (11.1 vs 6.0 point change, p = 0.002) and diet quality (4.0 vs − 0.5 point change, p = 0.018) while the comparison group had more participants with improved medication adherence (24% vs 10%, p

Background:Physical inactivity in midlife women is associated with increased intra-abdominal adipose tissue development. We describe an innovative multimethod study 1) to better understand barriers to physical activity (PA) and 2) to engage midlife women to product test physical activities and identify local community-based providers and sustainable and fun PA experiences.Methods:Formative research on PA barriers from the Chicago site Study of Women’s Health Across the Nation (SWAN) ancillary study of midlife women was used to develop a pilot testing measure. Feasibility, acceptability and sustainability of the PA activities were determined using the measure.Results:Desirable locations and/or instructors were identified. The first 2 groups identified, pilot tested, and then ranked activities for their ability to promote sustained PA. The 6 top-ranked were: circuit training, total body fitness, kickboxing, Zumba, Pilates, and pedometer. The final group pilot tested highly ranked PA in 2-week blocks, and ranked pedometer and Zumba in their top 3.Conclusion:Consensus was reached regarding activities that could be valuable in promoting sustained PA in midlife women. Choosing convenient sites and popular instructors further facilitates sustainability. Building relationships with key community partners is essential for sustainability. Community-based participant involvement in study design is a critical element in developing a healthy living intervention.

Background. Understanding diabetes-specific quality of life (DSQOL) is important to improving lives of people with type 2 diabetes mellitus (T2DM). Despite the prevalence of T2DM among African Americans, there is scant evidence about DSQOL in this population. This study aims to understand relationships between DSQOL and demographics, clinical markers, psychosocial factors, and stress in African Americans. We hypothesize that: 1) predictors of DSQOL in African Americans will be consistent with predictors identified in prior studies with non-African Americans, and 2) greater stress will independently predict poorer DSQOL. Methods. Participants were 211 low-income African Americans with uncontrolled T2DM. The two hypotheses were tested using distinct linear regression models. Results. Significant predictors of poorer DSQOL were: 1) fewer years of school, 2) fewer T2DM-related complications, 3) longer T2DM duration, and 4) more perceived stress. Implications. Findings suggest that interventions targeting stress could improve DSQOL in African Americans.

A shift from home-prepared to away-from-home and ready-to-eat foods has occurred in recent decades, which has implications for obesity and health. This study tested whether delay discounting, a facet of impulsivity reflecting sensitivity to immediate reward, is associated with the frequency of consumption and typical amount consumed of home-prepared, away-from-home, and ready-to-eat foods among overweight and obese women. Seventy-eight participants completed a binary choice task assessing discounting of delayed monetary rewards. Nutrient analysis of weighed food records characterized dietary intake over seven consecutive days. Foods were categorized as home-prepared, away-from-home, or ready-to-eat by a registered dietitian from information provided by participants. Delay discounting was not associated with the frequency of consuming home-prepared, away-from-home, and ready-to-eat foods as reflected in the percentages of recorded foods or total energy intake from each category. However, once consuming away-from-home and ready-to-eat foods (but not home-prepared foods), impulsive women consumed more energy than less impulsive women. Exploratory analyses indicated that more impulsive women chose away-from-home foods with a higher energy density (kcal/g). Impulsivity was associated with the quantity of away-from-home and ready-to-eat foods consumed, but not the frequency of their consumption. Home food preparation may be critical to weight control for impulsive individuals.

Background: Stroke is a leading cause of long-term disability in the USA; however, we have an incomplete understanding of how stroke affects long-term quality of life. Methods: We report here findings from focus groups with 9 long-term stroke survivors and 6 caregivers addressing patients’ post-stroke quality of life. Results: Key themes identified by patients were: social sup port, coping mechanisms, communication, physical functioning and independence. Role changes in patients were important to caregivers. Much of the discussion with patients and caregivers described specific ways in which the stroke altered social relationships. Conclusion: These findings are consistent with prior re search indicating the importance of social factors to quality of life following stroke. Our findings suggest that measures of stroke-related quality of life should include assessment of social function and social support.

The Lifestyle Improvement through Food and Exercise (LIFE) study is a community-based randomized-controlled trial to measure the effectiveness of a lifestyle intervention to improve glycemic control among African Americans with type 2 diabetes attending safety net clinics. The study enrolled African American adults with a diagnosis of type 2 diabetes and HbA1c ≥ 7.0 who had attended specific safety net community clinics in the prior year. 210 patients will be enrolled and randomized to either the LIFE intervention or a standard of care control group, which consists of two dietitian-led diabetes self-management classes. The LIFE intervention was delivered in 30 group sessions over 12-months and focused on improving diet through dietitian-led culturally-tailored nutrition education, increasing physical activity through self-monitoring using an accelerometer, increasing ability to manage blood sugar through modifications to lifestyle, and providing social support for behavior change. In addition to the group sessions, peer supporters made regular telephone calls to participants to monitor progress towards behavioral goals and provide social support. The 12-month intervention phase was followed by a six-month maintenance phase consisting of two group sessions. The primary outcome of the study is change in A1C from baseline to 12-months, and an additional follow-up will occur at 18-months. The hypothesis of the study is that the participants in the LIFE intervention will show a greater improvement in glycemic control over 12-months than participants in the control group.

Introduction The objective of this pilot 6-month randomized controlled trial was to determine the effectiveness of an intensive, community-based, group intervention that focused on diet, physical activity, and peer support for reducing weight among urban-dwelling African Americans with comorbid type 2 diabetes and hypertension. Methods Sixty-one participants were randomized into an intervention or control group. The 6-month intervention consisted of 18 group sessions led by a dietitian in a community setting and weekly telephone calls from a peer supporter. The intervention featured culturally tailored nutrition education, behavioral skills training, and social support focused on changes to diet and physical activity. The control group consisted of two 3-hour group sessions of diabetes self-management education taught by a community health worker. Outcome measures were assessed at baseline and 6 months. The primary outcome was achievement of a 5% weight reduction at 6 months. A secondary outcome was achievement of a 0.5 percentage-point reduction in hemoglobin A1c (HbA1c). Results Groups did not differ in achievement of the weight-loss goal. Intervention participants lost a mean of 2.8 kg (P = .01); control participants did not lose a significant amount of weight. A greater proportion of intervention (50.0%) than control (21.4%) participants reduced HbA1c by 0.5 percentage points or more at 6 months (P = .03). Conclusion The intervention was more effective than usual care (short-term diabetes education) at improving glycemic control, but not weight, in low-income African Americans with comorbid diabetes and hypertension. A community-based 6-month group class with culturally tailored education, behavioral skills training, and peer support can lead to a clinically significant reduction in HbA1c.

Interventions to increase sustained physical activity are needed and should be based on proven theories.To gain a better understanding of the correlates of sustained physical activity in midlife women, we used longitudinal epidemiologic data to investigate links between sustained physical activity and constructs advocated by three basic behavioral and social science theories: (1) self-determination, (2) social cognitive, and (3) social networks. A random sample of 90 midlife women, stratified by level of physical activity over 15 years, was selected from the Chicago cohort of the Longitudinal Study of Women's Health Across the Nation (SWAN).Using data on self-reported physical activity collected over 15 years, women were categorized into consistently active, sporadically active, and sedentary. New data were collected on theory-relevant constructs, i.e., autonomous motivation (assessed by the Treatment Self-Regulation Questionnaire) and self-efficacy (assessed by the Self-Efficacy and Exercise Habits Survey). Every SWAN woman identified a close female friend who also completed the physical activity questionnaire.SWAN women with higher autonomous motivation (p = 0.002) and higher self-efficacy (p0.001) were more likely to be consistently physically active in analyses adjusted for age, race, and socioeconomic status. Sixty-one percent of SWAN women with a history of consistent physical activity had a friend who is currently highly active, versus 38 and 23 % for sporadically active and sedentary women, respectively (test for trend p = 0.008).In midlife women, constructs advocated by basic behavioral and social science theories were consistent with long-term patterns of physical activity behavior. Special focus should be given to these basic theories in the design of interventions to promote sustained physical activity in mid-life women.

Objective To assess body size perception among African American women using cultural definitions of body size terms. Methods Sixty-nine African American women classified Body Image Scale figures as overweight, obese, and too fat, and independently selected the figure they considered closest to their current body size. Results Body size classifications of figures did not vary by participant weight status. Overweight figures were not considered too fat. For 86% of overweight (body mass index [BMI], 25-29.9) women and 40% of obese (BMI > 30) women, the self figure was not defined as overweight, obese, or too fat. Among participants with BMI ≥ 35, 65% did not classify their self figure as obese and 29% did not classify their self figure as overweight. Conclusions and implications The difference between cultural (folk) and medical definitions of body size terms may serve as a barrier to effective communication between patients and providers about health effects of excess adiposity.

Objective Describe lay food group categories of low-income African American women and assess the overlap of lay food groups and MyPyramid food groups. Design A convenience sample of African American mothers from a low-income Chicago neighborhood performed a card-sorting task in which they grouped familiar food items into food groups. Setting One-on-one interviews in a neighborhood community center. Participants Twenty-eight African American mothers. Main Outcome Measure A hierarchical taxonomy of food groups for each participant, represented as a matrix of distances among food items in the individual sort of each participant. Analysis Cultural consensus analysis, hierarchical cluster analysis, and coding of food group category labels and sorting justifications. Results Consensus analysis revealed a consistent cultural model of lay food groups among the women. Lay food groups were systematically different from MyPyramid food groups. Lay food groups were more influenced by how food items are prepared or when and how food items are eaten than are MyPyramid food group categories. Conclusions and Implications Nutrition messages framed using lay food group categories of low-income African Americans may be more effective for that population than messages using MyPyramid food group categories.

The authors assessed associations of body size perception and weight change over 13 years in black men and women and white men and women from the Coronary Artery Risk Development in Young Adults (CARDIA) Study (1992-2005). The perceptions of self and ideal body size were measured by using the Stunkard 9-figure scale at the year 7 examination (1992-1993). Figures were classified into underweight, normal weight, overweight, and obese. Self-ideal discrepancy yielded 4 body size satisfaction categories. Body mass index (BMI) (measured at years 7, 10, 15, and 20) was the dependent variable in gender-specific adjusted multiple regression models stratified by year 7 BMI. Obese women who perceived themselves as obese lost 0.09 BMI units annually, while those who perceived themselves as normal weight gained 0.31 units annually (P = 0.0005); obese women who considered their body size much too large had less annual weight gain than did those who considered their body size a bit too large (0.21 vs. 0.38 BMI units; P = 0.009). Obese women with overweight ideal body size gained less weight annually than did those with normal weight ideal body size (0.12 vs. 0.27 BMI units; P = 0.04). Results for men showed fewer and weaker associations. When obese women perceive themselves as obese and feel that their body size is too large, they gain less weight over time.

Our objective was to determine how large, random samples of Americans define health. Two questions were used to ascertain concepts of health: Are you healthy? and How do you know? (What does health mean to you?) These questions were added to omnibus telephone surveys conducted with two random samples of adults from the 48 contiguous United States: one in 1995 (N = 1,000); the other in 2002 (N = 1,011). The surveys also collected demographic data. This study focuses on cases with complete data (N = 950 in 1995, N = 967 in 2002). In both survey samples, more than 92% of respondents reported that they were healthy. Four distinct conceptions of health emerged from responses to the "how do you know" question: physical, psychosocial, capacity, and control. While prevalence varied with survey year as well as respondent age and education, these four concepts were evident in both 1995 and 2002. There are four robust concepts of health in America. Ongoing attention to these concepts may enhance efforts to communicate about and improve health.

The authors assessed the associations of ethnicity and socioeconomic status (SES) with body size judgments in Black and White young adults. Self-perceived and ideal body size judgments were measured using the Stunkard nine-figure scale (higher value = larger body) at the year 7 examination (1992-1993) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. In sex-specific adjusted multiple regression models, the difference between self-perceived and ideal body size judgments was larger for Whites than for Blacks: 0.74 vs. 0.57 for White men vs. Black men (p < 0.05) and 1.48 vs. 0.96 for White women vs. Black women (p < 0.0001). This ethnic difference was evident in all body mass index-stratified adjusted models (all p's < 0.05). In ethnicity/sex-specific adjusted models, lower education was associated with a smaller difference between self-perceived and ideal body size for all groups except White women (p's for trend: White women, 0.57; Black women

This study’s objective was assessment of cardiovascular disease (CVD) risk factor knowledge in young adults, its association with 10-year changes in risk factor levels, and variables related to risk factor knowledge. A total of 4,193 healthy persons (55% female, 48% Black; mean age ¼ 30 years) from four urban US communities were queried about risk factor knowledge in 1990–1991 and were reexamined in 2000–2001. Of six risk factors considered (hypertension, hyperlipidemia, smoking, overweight, sedentary lifestyle, and unhealthy diet), participants mentioned a mean of two; more than 65% were not aware of any risk factors, and less than 35% recognized being overweight as a risk factor. After adjustment, variables associated with mentioning more than two CVD risk factors versus one or fewer were Black race (OR ¼ 0.52, 95% confidence interval (CI): 0.44, 0.61), having a high school education or less (OR ¼ 0.88, 95% CI: 0.80, 0.95), having one or two (vs. zero) risk factors (OR ¼ 1.27, 95% CI: 1.05, 1.53), and having three or more (vs. zero) risk factors (OR ¼ 1.79, 95% CI: 1.35, 2.38). More knowledge was marginally associated with less increase in body mass index 10 years later (p ¼ 0.06) but was unrelated to other risk factor changes. Knowledge of CVD risk factors was very low in these young adults but increased with the presence of risk factors. Knowledge alone did not predict 10-year changes in risk factors.

Background Recent attention to racial and ethnic disparities in health outcomes highlights the excess coronary heart disease mortality in black patients compared with white patients. We investigated whether traditional cardiovascular disease (CVD) risk factors were similarly associated with CVD mortality in black and white men and women. Methods Participants included 3741 black and 33 246 white men and women (44%) without a history of myocardial infarction, aged 18 to 64 years at baseline (1967-1973) from the Chicago Heart Association Detection Project in Industry study. Blood pressure, total cholesterol level, body mass index, cigarette smoking, and physician-diagnosed diabetes were assessed at baseline using standard methods. Results Through 2002, there were 107, 1586, 177, and 2866 deaths from CVD in black women, white women, black men, and white men, respectively. In general, the magnitude and direction of associations between traditional risk factors and CVD mortality were similar by race. However, in black women the multivariable-adjusted hazard ratio (HR) per 12 mm Hg of diastolic blood pressure was 1.08 (95% confidence interval [CI], 0.90-1.29), whereas it was 1.31 in white women (95% CI, 1.25-1.38). There was no association between higher cholesterol level (per 40 mg/dL [1.04 mmol/L]) and CVD mortality in black men (HR, 0.94; 95% CI, 0.80-1.10), whereas the risk was elevated in white men (HR, 1.21; 95% CI, 1.16-1.26). Conclusions Most traditional risk factors demonstrated similar associations with mortality in black and white adults of the same sex. Small differences were primarily in the strength, not the direction, of association.

Many accounts of categorization equate goodness-of-example with central tendency for common taxonomic categories; the best examples of a category are average members#x2014;those that are most similar to most other category members. In the present study, we asked 24 tree experts and 20 novices to rate goodness-of-example for a sample of 48 trees and found (1) that the internal structure of the categorytree differed between novices and experts and (2) that central tendency did not determine goodnessof-example ratings for either group. For novices, familiarity determined goodness-of-example ratings. For experts, the “ideal” dimensions of height and weediness, rather than average similarity to other trees, were the primary predictors of goodness-of-example ratings for experts. The best examples oftree were not species of average height, but of extreme height. The worst examples were the weediest trees. We also found systematic differences in predictors of goodness-of-example as a function of type of expertise. We argue that the internal structure of taxonomic categories can be shaped by goal-related experience and is not necessarily a reflection of the attributional structure of the environment. Implications for models of category structure and category learning are discussed.

To what degree do conceptual systems reflect universal patterns of featural covariation in the world (similarity) or universal organizing principles of mind, and to what degree do they reflect specific goals, theories, and beliefs of the categorizer? This question was addressed in experiments concerned with categorization and reasoning among different types of tree experts (e.g., taxonomists, landscape workers, parks maintenance personnel). The results show an intriguing pattern of similarities and differences. Differences in sorting between taxonomists and maintenance workers reflect differences in weighting of morphological features. Landscape workers, in contrast, sort trees into goal-derived categories based on utilitarian concerns. These sorting patterns carry over into category-based reasoning for the taxonomists and maintenance personnel but not the landscape workers. These generalizations interact with taxonomic rank and suggest that the genus (or folk generic) level is relatively and in some cases absolutely privileged. Implications of these findings for theories of categorization are discussed.