Type 2 diabetes (T2DM) currently affects more than three million African American adults with double the number expected by 2025. The most effective and safest treatment for T2DM is lifestyle change therapy, including healthful eating, monitoring of blood glucose, and physical activity. However, current lifestyle change interventions are limited in their scope to alter the behaviors of individuals to more healthful ones. These limitations may be attributed, in part, to a lack of attention given to enhancing an individual’s psychosocial process variables, such as resilience, coping skills, selfleadership, and empowerment. Incorporating resilience education into lifestyle change therapies is a novel approach that addresses the behavior modification limitations of current interventions by aiming to enhance psychosocial process variables. Therefore, the purpose of this project was to conduct a six-month pilot study to determine the feasibility of our resilience and diabetes self-management intervention, The Diabetes Coaching Program: Transforming Lives Through Resilience Education, in a convenience sample of African American adults (n=16) with T2DM. The intervention included four weekly resilience and diabetes education classes and eight bi-weekly support group sessions. Survey data and blood samples were collected at baseline and at six months. Twelve participants completed the study (75% retention). Results indicated that higher perceived stress scores were associated with less resilience, fewer adaptive coping skills, lower selfleadership, lower diabetes empowerment and greater depressive symptoms. However, diabetes empowerment was the only psychosocial process variable to be significantly enhanced by the intervention at six months. Weight, BMI, HbA1c, total cholesterol, LDL cholesterol, blood pressure, and IGF-1 levels were significantly decreased at six months, whereas, lymphocyte proliferation and physical activity were significantly increased. These data indicate that our intervention has the potential to improve diabetes selfmanagement among African Americans with T2DM and increase positive health outcomes, though further studies are needed to confirm these findings. Additionally, several lessons were learned from conducting the pilot study that may be useful for improving the intervention for future studies, including: recruitment and retention strategies; cultural competency issues; the use of complementary and alternative medicine practices by African Americans with T2DM; and approaches for increasing participant self-assessment and goal-setting. / text

A six-week nutrition education program was designed for adult African Americans and pilot-tested in one church in Farmville, Virginia. The content of this program was determined from health topics selected by the participants and based on Healthy People 2000 objectives. The topics selected were the following: 1. Hypertension Prevention and Control 2. Stress Management 3. Heart Healthy Eating and 4. Nutrition and Cancer Prevention. The Food Guide Pyramid also was incorporated into the program. Effectiveness for improving health knowledge was determined using pre-tests and a post-test, while improvements in short-term behavior pertaining to dietary intake were described by the participants themselves. Anthropometric measurements, three day diet records and a health risk appraisal were obtained from participants. In addition, the program itself and the data collected were evaluated based on several Healthy People 2000 objectives. Attendance at each session ranged from seven to twelve participants. A paired t-test indicated that no significant improvement took place in health knowledge based on the pre-test and post-test scores. However, comprehension of the Food Guide Pyramid was judged to be very good and behavioral improvement was suggested by the participants with regard to lowering their intake of sodium and fat and increasing their intake of fruit. Dietary intake from three day food records was analyzed based on the number of servings consumed from each food group in the Food Guide Pyramid This analysis indicated that only one person was meeting the minimum recommendations made by the Food Guide Pyramid. Data from eleven pre-intervention diet records indicated that over half of the group was not meeting 70 percent of the RDA for pantothenic acid, copper, and zinc. However, all eleven diet records indicated that at least 70 percent of the RDA was being met for Vitamin C, iron and magnesium. Anthropometric measurements indicated that five participants were within their desirable weight range, while five were slightly overweight and five were classified as obese according to their desirable weight ranges. Seven participants had systolic blood pressure values greater than 140 mm Hg, two of whom also had diastolic values greater than 90 mm Hg. / Master of Science

The aim of this exploratory qualitative study is to identify the problems African American adolescent girls face in making eating choices and to learn how they make decisions about eating. Differences related to culture and socioeconomic status influences, and decision-making strategies were explored. Three sites in African American communities were selected for focus groups and individual adolescent girl-parent dyad interviews for data collection. Data were gathered in 5 focus groups and 4 individual adolescent girl-parent dyad interviews with African American adolescents (n=30). Bronfenbrenner's Ecological Systems Theory (EST) provided the conceptual framework for informing the analysis and interpretation of the data. Using grounded theory methods, the researcher identified the core variable or basic psychosocial problem that faced the participants was receiving mixed messages. Low income African American adolescent girls receive mixed messages about nutrition, health and foods from their microsystems that are comprised of friends and family, and from macrosystems that include textbooks and the media. Filtering the mixed messages is the basic psychosocial process that low income African American girls use to handle the barrage of mixed messages they receive from their microsystems and macrosystems regarding eating choices and exosystem influences. The process of filtering the mixed messages is comprised of five phases: Applying a lens, surveying available resources, weighing influences, then choosing alternating eating strategies and evaluating their eating choices. How the adolescent girl applies a lens, surveys resources and weighs the influences together impact the alternating eating strategies that they implement. Over time they evaluate the effectiveness of their eating choices. / text