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Health Is Power (HIP) was a community based health intervention designed to increase physical activity among women of color. It was funded by a grant from the National Cancer Institute of the National Institutes of Health. The purposes of the study were (1) to determine whether a 6 month, group cohesion intervention is more effective for increasing physical activity compared to a 6 month, group cohesion comparison targeting improving dietary habits (2) to determine whether residence in a neighborhood supportive for physical activity helped women maintain their physical activity from 6 to , and (3) to determine whether this effect was transculturally replicable.
Objective Physical inactivity and poor dietary habits plague Americans as health challenges, with women of color most vulnerable to their detrimental effects. Individually focused interventions have not demonstrated lasting success, possibly due to the lack of focus on sustainable social and physical environment factors. Health Is Power (HIP) was a transcultural, community based, randomized controlled trial that investigated the effectiveness of a group cohesion intervention to increase physical activity in African American and Hispanic or Latina women in Houston and Austin, Texas and then tested whether women living in more supportive areas maintained their physical activity over time. Intervention development was guided by group dynamics principles anchored within an ecologic model. Women participated in three health assessments and a six month face to face intervention that included evidence-based behavioral methods - integrated into strategies to promote group cohesion - framed to account for environmental factors contributing to health disparities. Women participated in team building activities, environmental mapping exercises, and supervised walks or taste tests. Neighborhood contextual and environmental measures were measured to test ecologic factors that may contribute to behavioral maintenance.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Physical Activity | Experimental | Women completed a physical activity group cohesion intervention which included six content intensive intervention sessions over a 24 week period that focused on specific group dynamics team building strategies to increase physical activity. A small team structure was used for peer problem solving and support throughout the intervention. Teams were given weekly physical activity goals, with slowly increasing weekly minutes milestones to gradually meet recommended amounts of physical activity. Sessions included brief instructions, team-based activities, and discussion with the entire group lead by a trained health educator. The intervention sessions ended with the health educator leading the teams in a brisk 15-minute walk. |
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| Fruit and Vegetable | Active Comparator | Women completed a fruit and vegetable group cohesion intervention which involved six content intensive intervention sessions over a 24 week period that focused on specific group dynamics team building strategies to increase fruit and vegetable consumption. A small team structure was used for peer problem solving and support throughout. Teams were given weekly fruit and vegetable consumption goals at each session, with slowly increasing weekly servings milestones to gradually meet recommended amounts of fruit and vegetable consumption. Sessions included brief instructions, team-based activities, and discussion with the entire group lead by a trained health educator. The intervention sessions ended with the health educator leading the teams in a fruit and vegetable taste test. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group Cohesion | Behavioral | See description in arm/group above |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in Physical Activity as measured by accelerometry and the International Physical Activity Questionnaire (IPAQ) | women were measured at baseline and 6 month | 6 months |
| Maintenance in Physical Activity as measured by accelerometry and the International Physical Activity Questionnaire (IPAQ) | women were measured at 6 months and 12 months | 6 months |
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Inclusion criteria:
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 21826476 | Background | Smith-Ray RL, Mama S, Reese-Smith JY, Estabrooks PA, Lee RE. Improving participation rates for women of color in health research: the role of group cohesion. Prev Sci. 2012 Feb;13(1):27-35. doi: 10.1007/s11121-011-0241-6. | |
| 25562756 | Background | Soltero EG, Hernandez DC, O'Connor DP, Lee RE. Does social support mediate the relationship among neighborhood disadvantage, incivilities, crime and physical activity? Prev Med. 2015 Mar;72:44-9. doi: 10.1016/j.ypmed.2014.12.030. Epub 2015 Jan 3. |
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D000091782 | Social Cohesion |
| ID | Term |
|---|---|
| D000091542 | Neighborhood Characteristics |
| D012111 | Residence Characteristics |
| D003710 | Demography |
| D011154 | Population Characteristics |
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| 21736740 | Background | McAlexander KM, Mama SK, Medina A, O'Connor DP, Lee RE. The concordance of directly and indirectly measured built environment attributes and physical activity adoption. Int J Behav Nutr Phys Act. 2011 Jul 7;8:72. doi: 10.1186/1479-5868-8-72. |
| 22375580 | Background | Lee RE, O'Connor DP, Smith-Ray R, Mama SK, Medina AV, Reese-Smith JY, Banda JA, Layne CS, Brosnan M, Cubbin C, McMillan T, Estabrooks PA. Mediating effects of group cohesion on physical activity and diet in women of color: health is power. Am J Health Promot. 2012 Mar-Apr;26(4):e116-25. doi: 10.4278/ajhp.101215-QUAN-400. |
| 22375575 | Background | McAlexander KM, Mama SK, Medina AV, O'Connor DP, Lee RE. Concordance and correlates of direct and indirect built environment measurement among minority women. Am J Health Promot. 2012 Mar-Apr;26(4):239-44. doi: 10.4278/ajhp.100715-QUAN-241. |
| 24476972 | Background | Ledoux T, Adamus-Leach H, O'Connor DP, Mama S, Lee RE. The association of binge eating and neighbourhood fast-food restaurant availability on diet and weight status. Public Health Nutr. 2015 Feb;18(2):352-60. doi: 10.1017/S1368980013003546. Epub 2014 Jan 24. |
| 21519867 | Background | Lee RE, Mama SK, Medina AV, Reese-Smith JY, Banda JA, Layne CS, Baxter M, O'Connor DP, McNeill L, Estabrooks PA. Multiple measures of physical activity, dietary habits and weight status in African American and Hispanic or Latina women. J Community Health. 2011 Dec;36(6):1011-23. doi: 10.1007/s10900-011-9403-5. |
| 22666558 | Background | Ledoux TA, Mama SK, O'Connor DP, Adamus H, Fraser ML, Lee RE. Home Availability and the Impact of Weekly Stressful Events Are Associated with Fruit and Vegetable Intake among African American and Hispanic/Latina Women. J Obes. 2012;2012:737891. doi: 10.1155/2012/737891. Epub 2012 May 14. |
| 23760851 | Background | Adamus-Leach HJ, Wilson PL, O'Connor DP, Rhode PC, Mama SK, Lee RE. Depression, stress and body fat are associated with binge eating in a community sample of African American and Hispanic women. Eat Weight Disord. 2013 Jun;18(2):221-7. doi: 10.1007/s40519-013-0021-3. Epub 2013 Apr 9. |
| 22365808 | Background | Wilson PL, O'Connor DP, Kaplan CD, Bode S, Mama SK, Lee RE. Relationship of fruit, vegetable, and fat consumption to binge eating symptoms in African American and Hispanic or Latina women. Eat Behav. 2012 Apr;13(2):179-82. doi: 10.1016/j.eatbeh.2012.01.007. Epub 2012 Jan 24. |
| 21782975 | Background | Lee RE, Medina AV, Mama SK, Reese-Smith JY, O'Connor DP, Brosnan M, Cubbin C, McMillan T, Estabrooks PA. Health is Power: an ecological, theory-based health intervention for women of color. Contemp Clin Trials. 2011 Nov;32(6):916-23. doi: 10.1016/j.cct.2011.07.008. Epub 2011 Jul 18. |
| 22185287 | Background | Lopez Y 3rd, O'Connor DP, Ledoux TA, Lee RE. Analysis of body composition methods in a community sample of African American women. Women Health. 2011 Nov 30;51(8):709-23. doi: 10.1080/03630242.2011.623222. |
| 22243907 | Background | Lee RE, Mama SK, Medina AV, Ho A, Adamus HJ. Neighborhood factors influence physical activity among African American and Hispanic or Latina women. Health Place. 2012 Jan;18(1):63-70. doi: 10.1016/j.healthplace.2011.08.013. |
| 21942159 | Background | Mama SK, Quill BE, Fernandez-Esquer ME, Reese-Smith JY, Banda JA, Lee RE. Body image and physical activity among Latina and African American women. Ethn Dis. 2011 Summer;21(3):281-7. |
| 25290599 | Background | Mama SK, McNeill LH, McCurdy SA, Evans AE, Diamond PM, Adamus-Leach HJ, Lee RE. Psychosocial factors and theory in physical activity studies in minorities. Am J Health Behav. 2015 Jan;39(1):68-76. doi: 10.5993/AJHB.39.1.8. |
| D000080442 | Social Integration |
| D000091444 | Community Resources |
| D004472 | Health Care Economics and Organizations |
| D015991 | Epidemiologic Measurements |
| D011634 | Public Health |
| D004778 | Environment and Public Health |