Population-based interventions engaging communities of color in healthy eating and active living: a review.
BACKGROUND
The U.S. obesity epidemic is escalating, particularly among communities of color. Obesity control efforts have shifted away from individual-level approaches toward population-based approaches that address socio-cultural, political, economic, and physical environmental factors. Few data exist for ethnic minority groups. This article reviews studies of population-based interventions targeting communities of color or including sufficient samples to permit ethnic-specific analyses.


METHODS
Inclusion criteria were established, an electronic database search conducted, and non-electronically catalogued studies retrieved. Findings were aggregated for earlier (early 1970s to early 1990s) and later (mid-1990s to present) interventions.


RESULTS
The search yielded 23 ethnically inclusive intervention studies published between January 1970 and May 2003. Several characteristics of inclusive interventions were consistent with characteristics of community-level interventions among predominantly white European-American samples: use of non-interpersonal channels for information dissemination directed at broad spheres of influence (e.g., mass media), promotion of physical activity, and incorporation of social marketing principles. Ethnically inclusive studies, however, also placed greater emphasis on involving communities and building coalitions from study inception; targeting captive audiences; mobilizing social networks; and tailoring culturally specific messages and messengers. Inclusive studies also focused more on community than individual norms. Later studies used "upstream" approaches more than earlier studies. Fewer than half of the inclusive studies presented outcome evaluation data. Statistically significant effects were few and modest, but several studies demonstrated better outcomes among ethnic minority than white participants sampled.


CONCLUSIONS
The best data available speak more about how to engage and retain people of color in these interventions than about how to create and sustain weight loss, regular engagement in physical activity, or improved diet. Advocacy should be directed at increasing the visibility and budget priority of interventions, particularly at the state and local levels.
Yancey
Antronette K
AK
Department of Health Services and Division of Cancer Prevention and Control Research, UCLA School of Public Health, 71-279 CHS, 650 Charles Young Dr. South, Los Angeles, CA 90095. Phone: 310-794-9284. ayancey@ucla.edu
Kumanyika
Shiriki K
SK
Ponce
Ninez A
NA
McCarthy
William J
WJ
Fielding
Jonathan E
JE
Leslie
Joanne P
JP
Akbar
Jabar
J
D004032:Diet; D015444:Exercise; D006293:Health Promotion; D006801:Humans; D008913:Minority Groups; D009765:Obesity / Q000208:ethnology* / Q000517:prevention & control*; D014481:United States