MOCHA Moving Forward: a CBPR Investigation of Chronic Disease Prevention in Older, Low-income African-American Men

Low-income, African-American men continue to be disproportionately burdened by chronic
diseases and associated morbidities and mortalities. Primary modifiable and interrelated
causes of chronic disease include high levels of stress, low levels of physical activity, and
malnutrition. There are few demonstrated effective, preventive interventions that are
culturally relevant and gender appropriate for low-income, African-American men.

Local community concerns about health disparities led to a year-long series of community-wide
discussions and planning that resulted in the creation of Men of Color Health Awareness
(MOCHA) project. Started in 2010, in an unusual public-private partnership between the YMCA
and the state Department of Public Health, MOCHA's mission is to improve the health and
wellbeing of men of color in Springfield, MA and surrounding areas. MOCHA runs a 12-week
program with 15-20 men per cohort to decrease chronic disease vulnerability and bolster
resilience among low-income, African-American men, by addressing exercise, eating habits, and
stress stemming from impoverished economic conditions, racial and class discrimination, and
gender role strain. The MOCHA Steering Committee contacted a group of health disparities
researchers at the University of Massachusetts School of Public Health and Health Sciences in
2012, requesting assistance in documenting the impact of MOCHA on the community.

Over 350 men ages 40-60 years have completed the MOCHA program and preliminary data indicate
that the program has decreased weight, body fat percentage, and systolic blood pressure;
increased self-reported fitness and vitality scores; and decreased mean stress scores on the
Cohen Perceived Stress scale by 19%. Based on these preliminary data, we propose to
rigorously test MOCHA program effectiveness and to identify the causal pathways through which
it impacts outcomes.

In addition, the MOCHA Steering Committee has expressed strong interest in strengthening the
quality of their program, by incorporating narrative strategies for communicating key health
concepts and information into the existing program. Current research of the investigators
provides strong evidence that culture-centered narrative strategies are more effective in
producing positive health effects than didactic presentations. We have pilot tested the
feasibility of developing digital stories with the MOCHA Steering Committee, and with this
proposal, we are mutually excited about the possibility of integrating narrative
communication strategies into the MOCHA program, henceforth called MOCHA+.

To test the effectiveness of the existing MOCHA chronic disease prevention program in
decreasing stress and compare its effectiveness with a new to-be-developed MOCHA+ program
(that integrates narrative communication strategies), we propose to conduct a
randomized-controlled trial with three arms: MOCHA, MOCHA + and wait-list control comparison
groups. Using a community-based participatory research approach, the three specific aims of
the proposed research are thus to:

1. Further refine a Minority Stress Model developed by Co-PI Graham, to capture and explain
the dynamic, reciprocal and synergistic interactions of factors affecting the health of
low-income African-American men;

2. (a) Determine the effectiveness of the MOCHA program in decreasing stress among
low-income African-American men, as measured by both self-report (Cohen's Perceived
Stress Scale) and bio-physiological measures of cortisol (assessed in hair samples); and
(b) Determine whether the MOCHA+ program is significantly more effective than the MOCHA
program in decreasing stress among low-income African-American men, on these same
measures;

3. Assess the effects of the MOCHA and MOCHA+ interventions on mediating variables along
hypothesized causal pathways identified through intervention mapping and the
construction of a logic model, based on the Minority Stress Model finalized in achieving
Aim 1.

The proposed research will proceed in two stages. During the first 18 months, phase one of
the study will focus on (a) formative research designed to further elaborate the minority
stress model and (b) the incorporation of narrative communications strategies into the MOCHA+
intervention. In phase two, we will recruit 240 low-income African-American men between 35-65
years of age over a three-year period to participate in a randomized controlled trial, with
three arms: MOCHA, MOCHA+, or wait-list control. The primary research endpoint is
bio-physiological assessment of the ELISA cortisol hair-test (average hormone levels over the
past 3 months), administered at pre, post, and 3 month follow-up, as well as self-reported
stress levels using Cohen's Perceived Stress scale. Secondary outcomes include the
bio-physiological indicators of blood pressure and BMI.

The proposed research will determine the effectiveness of MOCHA in reducing stress and
whether it can be further strengthened by introducing narrative communication strategies. The
results of the proposed research will contribute to the development of an enhanced
theoretical model of factors affecting low-income African-American male health and to the
evidence base of effective interventions aimed at chronic disease prevention and control
programs in this population.

Inclusion Criteria:

All participants must meet all of the inclusion criteria in order to be eligible to
participate in the study.

Inclusion criteria include:

1. self-identification as black, African-American, or bi-racial including black man;

2. age between 35-70 years;

3. insufficient or low income;

4. lived in Springfield area for the previous 6 months;

5. Informed consent;

6. Understand study procedures; and

7. Ability to comply with study procedures for the entire length of the study

Exclusion Criteria:

Exclusion criteria include:

1. BMI>40;

2. BP>179/ 119;

3. PTSD scale score >50

4. Physical or movement l imitations wherein unable to perform 60 minutes of moderately
vigorous physical activity 2 times per week