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Peer Mentoring and Financial Incentives to Improve Glucose Control in African American Veterans: A Randomized, Controlled Trial

JA Long

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Background Compared to whites, African Americans have a greater incidence of diabetes, decreased control, and higher rates of micro-vascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes. Objective To determine whether peer mentors or financial incentives are superior to usual care in helping African American Veterans improve their glycosylated hemoglobin (HbA1c) levels. Design A six month randomized controlled trial. (ClinicalTrials.gov registration number: NCT01125956) Setting The Philadelphia VA Medical Center. Patients African American veterans, age 50-70 years old, with persistently poor diabetes control. Measurements Change in HbA1c at 6 months Intervention 118 participants were randomized to one of the three arms. Usual care participants were notified of their starting HbA1c and recommended goals for HbA1c. Those in the peer mentor arm were assigned a peer mentor who formerly had poor glycemic control but now had good control (HbA1c < 7.5%) who was asked to talk with the participant at least once a week. Peer mentors were matched on race, sex, and age. Those in the financial incentive arm could earn $100 by dropping their HbA1c by one point and $200 by dropping it by two points or to a HbA1c of 6.5%. Results Mentors and mentees talked the most in the first month (mean calls 4: range 0-30) and dropped to a mean of 2 calls (range 0-10) by the sixth month. HbA1c dropped from 9.9% to 9.8% in the control arm, 9.8% to 8.7% in the peer mentor arm and from 9.5% to 9.1% in the financial incentive arm. Mean change in HbA1c from baseline to 6 months relative to control was −1.07 (95% CI −1.84 to −0.31) in the peer mentor arm and −0.45 (95% CI −1.23 to 0.32) in the financial incentive arm. Limitations The study included only veterans and lasted only 6 months. Conclusions Peer mentorship improved glucose control in a cohort of African American Veterans with diabetes.


HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial.

John Jemmott, Loretta Sweet Jemmott, Paula Braverman, Geoffrey Fong

Archives of pediatrics & adolescent medicine [159:440-9] (2005)

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Adolescent girls in the United States and around the world are at a heightened risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). To determine the efficacy of a skill-based HIV/STD risk-reduction intervention in reducing self-reported unprotected sexual intercourse among African American and Latino adolescent girls. Randomized controlled trial with 3-, 6-, and 12-month follow-ups. Sexually experienced African American and Latino adolescent girls recruited from the adolescent medicine clinic of a children's hospital serving a low-income inner-city community (N = 682, mean age, 15.5 years); 88.6% were retained at the 12-month follow-up. Three 250-minute interventions based on cognitive-behavioral theories and elicitation research: an information-based HIV/STD intervention provided information necessary to practice safer sex; a skill-based HIV/STD intervention provided information and taught skills necessary to practice safer sex; or a health-promotion control intervention concerned with health issues unrelated to sexual behavior. Primary outcome measure was self-reported frequency of unprotected sexual intercourse; secondary outcomes included the frequency of sexual intercourse while intoxicated, the number of sexual partners, biologically confirmed STDs, and theoretical mediator variables, including the intention to use condoms, beliefs about using condoms, and condom-use knowledge. No differences between the information intervention and the health control intervention were statistically significant. Skills-intervention participants (mean [SE], 2.27 [0.81]) reported less unprotected sexual intercourse at the 12-month follow-up than did information-intervention participants (mean [SE], 4.04 [0.80]; P = .03), or health control-intervention participants (mean [SE], 5.05 [0.81]; P = .002). At the 12-month follow-up, skills-intervention participants (mean [SE], 0.91 [0.05]) reported fewer sexual partners (P = .04) compared with health control-intervention participants (mean [SE], 1.04 [0.05]) and were less likely to test positive for STD (mean [SE], 10.5% [2.9%]) than were health control-intervention participants (mean [SE], 18.2% [2.8%]; P = .05). No differences in the frequency of unprotected sexual intercourse, the number of partners, or the rate of STD were observed at the 3- or 6-month follow-up between skill-intervention participants and information-intervention or health control-intervention participants. Skill-based HIV/STD interventions can reduce sexual risk behaviors and STD rate among African American and Latino adolescent girls in clinic settings.


Effects of the Start For Life treatment on physical activity in primarily African American preschool children of ages 3-5 years.

James Annesi, Alice Smith, Gisèle Tennant

Psychology, health & medicine [18:300-9] (2013)

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In U.S. children of ages 2-5 years, combined overweight and obesity has increased to 21%, with African American children of this age range highest at 26%. Lack of physical activity is highly predictive of overweight and obesity in children. Preschools may be a useful point for intervention. An innovative preschool physical activity treatment (Start For Life) was developed based on principles of social cognitive and self-efficacy theory. It incorporated 30 minutes daily of highly structured physical activity with behavioral and self-regulatory skills training (e.g. goal setting, self-monitoring, productive self-talk) interspersed. Data obtained from accelerometry was used to contrast physical activity outputs during the preschool day in the Start For Life condition (n = 202) with a usual-care control condition (n = 136). After controlling for age and sex of the primarily African American participants (M age = 4.7 years), changes over eight weeks in moderate-to-vigorous and vigorous physical activity were significant, and significantly more favorable in the Start For Life group; F(1, 344) = 4.98, p = .026 and F(1, 344) = 3.60, p = .058, respectively. Start For Life was associated with a weekly increase in moderate-to-vigorous physical activity of approximately 40 minutes. After sufficient replications that better account for different sample types, parental effects and physical activity outside of the school day, and long-term effects, widespread dissemination may be considered.


Physical activity with spiritual strategies intervention: a cluster randomized trial with older African American women.

Karen Joy Anderson, Carol Pullen

Research in gerontological nursing [6:11-21] (2013)

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A cluster randomized study was conducted using a convenience sample of four Christian faith communities from which 27 African American women 60 and older were recruited. The purpose was to determine whether African American women receiving a physical activity intervention with spiritual strategies compared to a control group would demonstrate differences over time in physical activity behaviors and biomarkers, in self-efficacy for physical activity, and in barriers to physical activity. Results with baseline and 12-week measurements included significant between-group findings at 12 weeks on muscle strength activity (minutes per week, z = -3.269, p = 0.001; days per week, z = -3.384, p = 0.001), favoring the intervention group. There were significant between-group findings in 6-minute walk change scores (z = -2.546, p = 0.009), favoring the intervention group. Barriers were significantly reduced within the intervention group (z = -2.184, p = 0.029). Evidence suggests a physical activity intervention with spiritual strategies increases physical activity behavior. The Health Promotion Model can be used to develop physical activity interventions with spiritual strategies for older African American women in faith communities, thus, supporting Healthy People 2020 goals.


Intervention induced changes on parenting practices, youth self-pride and sexual norms to reduce HIV-related behaviors among rural African American youths.

Velma McBride Murry, Cady Berkel, Yi-Fu Chen, Gene Brody, Frederick Gibbons, Meg Gerrard

Journal of youth and adolescence [40:1147-63] (2011)

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AIDS is the leading killer of African Americans between the ages of 25 and 44, many of whom became infected when they were teenagers or young adults. The disparity in HIV infection rate among African Americans youth residing in rural Southern regions of the United States suggests that there is an urgent need to identify ways to promote early preventive intervention to reduce HIV-related risk behavior. The Strong African American Families (SAAF) program, a preventive intervention for rural African American parents and their 11-year-olds, was specially designed to deter early sexual onset and the initiation and escalation of alcohol and drug use among rural African American preadolescents. A clustered-randomized prevention trial was conducted, contrasting families who took part in SAAF with control families. The trial, which included 332 families, indicated that intervention-induced changes occurred in intervention-targeted parenting, which in turn facilitated changes in youths' internal protective processes and positive sexual norms. Long-term follow up assessments when youth were 17 years old revealed that intervention-induced changes in parenting practices mediated the effect of intervention-group influences on changes in the onset and escalation of risky sexual behaviors over 65 months through its positive influence on adolescents' self-pride and their sexual norms. The findings underscore the powerful effects of parenting practices among rural African American families that over time serve a protective role in reducing youth's risk behavior, including HIV vulnerable behaviors.