Project Summary/Abstract Low-income African Americans suffer increased risk of cardiovascular disease and death due to high levels of cardiovascular (CVD) risk factors, such as hypertension, diabetes and obesity. Improving diet quality in African Americans could reduce black-white health disparities but dietary interventions have been less successful in African Americans than other groups. ALIVE is a culturally-tailored, church-based diet intervention designed by a partnership of researchers, African American pastors and congregants using a community-based participatory research methodology. The main components of the intervention include a Bible study to increase intrinsic motivation to eat healthier, paired with small group sessions focused on bui lding self-efficacy through nutrition education, cooking instruction and behavior change techniques. All intervention components are delivered by church members in 24 sessions over 9 months. The ALIVE Pilot study resulted in clinically and statistically significant improvements in vegetable consumption, as well as increased diet quality and reductions in weight and blood pressure. The goal of the proposed study is to conduct a 21 -month behavioral clusterrandomizedcontrolledtrialinwhichchurchesarerandomizedtooneoftwoarms:theinterventionarm, which receives ALIVE intervention in year 1 and Money Smart, a financial education intervention, in year 2, or the comparison arm, which receives the interventions in the reverse order. This study design ad dresses the needs of community partners while controlling for a number of possible confounders such as attention. The primary aim of the study is to assess the efficacy of the ALIVE intervention by comparing enrolled congregants from intervention and comparison churches on change in diet quality as measured by the Alternative Healthy Eating Index (AHEI). Secondary study aims are to evaluate the effect of the ALIVE intervention on plasma carotenoids and evaluate potential mediators of change in diet quality, including self-efficacy, intrinsic motivation, attitudes and subjective social norms for eating healthy. Exploratory aims of the study are to evaluatesustainabilityofchangeinAHEIscoreat12monthspost-interventionintheinterventionarm,evaluate the effect of the ALIVE intervention on changes in blood pressure, lipids, and adiposity, and assess the implementation and participant opportunity costs of the ALIVE intervention. The proposed study is the second phase of an integrated program of research aimed at reducing CVD mortality in African American adults. Phase one showed that the ALIVE intervention resulted in a clinically and statistically significant increase in vegetable consumption. Phase 2, the proposed study, will test whether we can expand this effect to overall diet quality among a larger number of churches and when compared to a control group. Phase 3 will be to conduct a larger trial to test the efficacy of this intervention in reducing blood pressure.

Project narrative A low-cost, sustainable intervention to improve diet quality in African Americans could improve CVD risk factors and reduce black-white disparities in mortality. The proposed research utilizes a community-based participatory research approach to implement and test such an intervention, using a cluster randomized- controlled design, with a community-approved comparator group consisting of a financial education intervention.