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Original Investigation
April 25, 2011

Intervention to Influence Behaviors Linked to Risk of Chronic Diseases: A Multisite Randomized Controlled Trial With African-American HIV-Serodiscordant Heterosexual Couples

Author Affiliations

Author Affiliations: Social Intervention Group, Columbia University School of Social Work, New York, New York (Dr El-Bassel); Annenberg School for Communication and Departments of Psychiatry (Dr Jemmott) and Biostatistics and Engineering (Drs Landis and Bellamy), University of Pennsylvania, Philadelphia; Division of AIDS, National Institutes of Health/National Institute of Mental Health, Bethesda, Maryland (Dr Pequegnat); Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia (Dr Wingood); and Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles (Dr Wyatt).

Arch Intern Med. 2011;171(8):728-736. doi:10.1001/archinternmed.2011.136

Background  The high morbidity and mortality in African Americans associated with behavior-linked chronic diseases are well documented.

Methods  We tested the efficacy of an intervention to increase multiple health-related behaviors in African Americans. In a multisite cluster-randomized controlled trial, groups of African American human immunodeficiency virus (HIV)–serodiscordant heterosexual couples in Atlanta (Georgia), Los Angeles (California), New York (New York), and Philadelphia (Pennsylvania) were allocated to an individual-focused health promotion that addressed multiple health-related behaviors or to a couple-focused HIV/sexually transmitted disease (STD) risk reduction intervention. Primary outcomes were adherence to fruit and vegetable consumption and physical activity guidelines assessed preintervention, immediately postintervention, and 6 and 12 months postintervention. Secondary outcomes included fatty food consumption, prostate and breast cancer screening, and alcohol use. Generalized estimating equations tested the efficacy of the health promotion intervention over the postintervention assessments.

Results  Health promotion intervention participants were more likely to report consuming 5 or more servings of fruits and vegetables daily (rate ratio [RR], 1.38; 95% confidence interval [CI], 1.18 to 1.62) and adhering to physical activity guidelines (1.39; 1.22 to 1.59) compared with HIV/STD intervention participants. In the health promotion intervention compared with the HIV/STD intervention, participants consumed fatty foods less frequently (mean difference, −0.18; 95% CI, −0.30 to −0.07), more men received prostate cancer screening (RR, 1.51; 95% CI, 1.21 to 1.88), and more women received a mammogram (RR, 1.26; 95% CI, 1.06 to 1.50). Alcohol use did not differ between the intervention groups.

Conclusion  This trial demonstrates the efficacy of interventions targeting multiple health-related behaviors in African American HIV-seropositive and HIV-seronegative men and women.

Trial Registration  clinicaltrials.gov Identifier: NCT00644163