Partnerships between public health and faith-based organizations draw on the strengths of both sectors to achieve a shared interest in promoting health and reducing disparities. However, information about implementation of faith and public health partnerships-particularly those involving diverse racial-ethnic groups-is limited. This paper reports on findings from qualitative interviews conducted with 16 public health and congregational leaders around the country as part of the early phase of the development of a faith and public health partnership to address health disparities in Los Angeles, CA. We identified eight themes regarding the barriers and facilitators to building faith and public health partnerships and distilled these into 10 lessons for developing such approaches. These interviews identified that engaging religious organizations often requires building congregational capacity of the congregation to participate in health programs; and that trust is a critically important element of these relationships. Further, trust is closely related to how well each organization involved in the partnership understands their partners’ belief structures, approaches to addressing health and well-being and capacities to contribute to the partnership. Tailoring congregational health programs to match the interests, needs and capacity of partners was identified as an important approach to ensuring that the partnership is successful. But, this is complicated by working across multiple faith traditions and the racial-ethnic backgrounds, thus requiring increased and diverse communication strategies on the part of the partnership leadership. These lessons provide important information for faith and public health leaders interested in developing partnered approaches to address health in diverse urban communities.

Objective To assess the association of county-level bias about black and white people with patient experience, influenza immunisation, and quality of clinical care for black and white older US adults (age 65+ years).Design Linear multivariable regression measured the cross-sectional association of county-level estimates of implicit and explicit bias about black and white people with patient experiences, influenza immunisation, and clinical quality-of-care for black and white older US adults.Participants We used data from 1.9 million white adults who completed implicit and explicit bias measures during 2003-2018, patient experience and influenza immunisation data from respondents to the 2009-2017 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) Surveys, and clinical quality-of-care data from patients whose records were included in 2009-2017 Healthcare Effectiveness Data and Information Set (HEDIS) submissions (n=0.8-2.9 million per measure).Main outcome measures Three patient experience measures and patient-reported influenza immunisation from the MCAHPS Survey; five HEDIS measures.Results In county-level models, higher pro-white implicit bias was associated with lower immunisation rates and worse scores for some patient experience measures for black and white adults as well as larger-magnitude black-white disparities. Higher pro-white implicit bias was associated with worse scores for some HEDIS measures for black and white adults but not with black-white disparities in clinical quality of care. Most significant associations were small in magnitude (effect sizes of 0.2-0.3 or less).Conclusions To the extent that county-level pro-white implicit bias is indicative of bias among healthcare providers, there may be a need for interventions designed to prevent such bias from adversely affecting the experiences and preventive care of black patients and the clinical quality of care for all patients.

Background Faith-based interventions are promising for promoting healthy behaviors among adults, but their ripple effects on participants' children are unknown. This study is one of the first to assess the effects of a faith-based multilevel obesity intervention on adult participants' children.Methods We analyzed quantitative data from a cluster randomized controlled trial with two African American and two Latino churches in South Los Angeles, California, which invited adult participants to enroll one child (5-17 years) in a sub-study. At baseline and 6-7 months follow-up, parents completed a child health survey, which included the family nutrition and physical activity screening tool, and child height and weight were measured (n = 50).Results Results from linear regression models showed children of intervention participants, compared to control, had significantly better dietary patterns at follow-up.Conclusions Findings suggest the health benefits of a faith-based multilevel obesity intervention for adults can extend to children and may help address obesity disparities.

Given COVID-19's disproportionate impact on populations that identify as Black, Indigenous, and People of Color (BIPOC) in the United States, researchers and advocates have recommended that health systems and institutions deepen their engagement with community-based organizations (CBOs) with longstanding relationships with these communities. However, even as CBOs leverage their earned trust to promote COVID-19 vaccination, health systems and institutions must also address underlying causes of health inequities more broadly. In this commentary, we discuss key lessons learned about trust from our participation in the U.S. Equity-First Vaccination Initiative, an effort funded by The Rockefeller Foundation to promote COVID-19 vaccination equity. The first lesson is that trust cannot be "surged" to meet the needs of the moment until it is no longer deemed important; rather, it must predate and outlast the crisis. Second, to generate long-term change, health systems cannot simply rely on CBOs to bridge the trust gap; instead, they must directly address the root causes of this gap among BIPOC populations.

Importance The Million Hearts Model paid health care organizations to assess and reduce cardiovascular disease (CVD) risk. Model effects on long-term outcomes are unknown. Objective To estimate model effects on first-time myocardial infarctions (MIs) and strokes and Medicare spending over a period up to 5 years. Design, Setting, and Participants This pragmatic cluster-randomized trial ran from 2017 to 2021, with organizations assigned to a model intervention group or standard care control group. Randomized organizations included 516 US-based primary care and specialty practices, health centers, and hospital-based outpatient clinics participating voluntarily. Of these organizations, 342 entered patients into the study population, which included Medicare fee-for-service beneficiaries aged 40 to 79 years with no previous MI or stroke and with high or medium CVD risk (a 10-year predicted probability of MI or stroke [ie, CVD risk score] ≥15%) in 2017-2018. Intervention Organizations agreed to perform guideline-concordant care, including routine CVD risk assessment and cardiovascular care management for high-risk patients. The Centers for Medicare & Medicaid Services paid organizations to calculate CVD risk scores for Medicare fee-for-service beneficiaries. CMS further rewarded organizations for reducing risk among high-risk beneficiaries (CVD risk score ≥30%). Main Outcomes and Measures Outcomes included first-time CVD events (MIs, strokes, and transient ischemic attacks) identified in Medicare claims, combined first-time CVD events from claims and CVD deaths (coronary heart disease or cerebrovascular disease deaths) identified using the National Death Index, and Medicare Parts A and B spending for CVD events and overall. Outcomes were measured through 2021. Results High- and medium-risk model intervention beneficiaries (n = 130 578) and standard care control beneficiaries (n = 88 286) were similar in age (median age, 72-73 y), sex (58%-59% men), race (7%-8% Black), and baseline CVD risk score (median, 24%). The probability of a first-time CVD event within 5 years was 0.3 percentage points lower for intervention beneficiaries than control beneficiaries (3.3% relative effect; adjusted hazard ratio [HR], 0.97 [90% CI, 0.93-1.00]; P = .09). The 5-year probability of combined first-time CVD events and CVD deaths was 0.4 percentage points lower in the intervention group (4.2% relative effect; HR, 0.96 [90% CI, 0.93-0.99]; P = .02). Medicare spending for CVD events was similar between the groups (effect estimate, -$1.83 per beneficiary per month [90% CI, -$3.97 to -$0.30]; P = .16), as was overall Medicare spending including model payments (effect estimate, $2.11 per beneficiary per month [90% CI, -$16.66 to $20.89]; P = .85). Conclusions and Relevance The Million Hearts Model, which encouraged and paid for CVD risk assessment and reduction, reduced first-time MIs and strokes. Results support guidelines to use risk scores for CVD primary prevention. Trial Registration ClinicalTrials.gov Identifier: NCT04047147.

Background: The COVID-19 pandemic shed light on stark racial and ethnic inequities in access to care and accurate health information in the U.S. When COVID-19 vaccines became available, communities of color faced multiple barriers that contributed to low vaccine rates. To address this gap, the Equity-First Vaccination Initiative supported community organizations in five demonstration cities to plan and implement hyper-local strategies to increase COVID-19 vaccine access and uptake among communities of color.Purpose: To draw learnings from the experiences of the participating organizations, we applied a framework that integrated implementation science and health equity principles.Design and sample: In this commentary, we describe how we used this framework to guide qualitative interviews with community organizations, focusing on insights across five implementation elements (reach, design, implementation, adaptation, implementation outcomes).Conclusions: Learnings from this evaluation may help guide future implementation of similarly complex initiatives involving multiple organizations and sites to advance health equity during a public health crisis.

The one-year U.S. Equity-First Vaccination Initiative (EVI), launched in April 2021, aimed to reduce racial inequities in coronavirus disease 2019 (COVID-19) vaccination across five demonstration cities (Baltimore, Chicago, Houston, Newark, and Oakland) and over the longer term strengthen the United States' public health system to achieve more-equitable outcomes. This initiative comprised nearly 100 community-based organizations (CBOs), who led hyper-local work to increase vaccination access and confidence in communities of individuals who identify as Black, Indigenous, and People of Color. In this study, the second of two on the initiative, the authors examine the results of the EVI. They look at the initiative's activities, effects, and challenges, and provide recommendations for how to support and sustain this hyper-local community-led approach and strengthen the public health system in the United States.

The RAND Corporation is a research organization that develops solutions to public policy challenges to help

Medical Care: August 2022 - Volume 60 - Issue 8 - p 555 doi: 10.1097/MLR.0000000000001744

INTRODUCTIONAfrican American and Latino communities are disproportionately affected by obesity and diet-related diseases in the US.1Hales CM Carroll MD Fryar CD Ogden CL Prevalence of obesity among adults and youth: United States, 2015-2016.NCHS Data Brief. 2017; : 1-8Google Scholar Faith-based organizations can be important partners in promoting health among African American and Latino congregants through infrastructure, programming, and strong social networks.2Flórez KR Payán DD Palar K Williams MV Katic B Derose KP Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review.Nutr Rev. 2020; 78: 304-322PubMed Google Scholar,3Derose KP Rodriguez C A systematic review of church-based health interventions among Latinos.J Immigr Minor Health. 2020; 22: 795-815Crossref PubMed Scopus (4) Google Scholar Clergy, in particular, can provide public health information and promote healthy behaviors using their moral authority, visibility, and credibility.4Lumpkins CY Greiner KA Daley C Mabachi NM Neuhaus K Promoting healthy behavior from the pulpit: clergy share their perspectives on effective health communication in the African American church.J Relig Health. 2013; 52: 1093-1107Crossref PubMed Scopus (46) Google Scholar, 5Baruth M Bopp M Webb BL Peterson JA The role and influence of faith leaders on health-related issues and programs in their congregation.J Relig Health. 2015; 54: 1747-1759Crossref PubMed Scopus (30) Google Scholar, 6Payán DD Flórez KR Bogart LM et al.Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.Health Commun. 2019; 34: 11-20Crossref PubMed Scopus (9) Google ScholarHealth interventions that engage clergy can impact multiple levels in the socioecological model.7Lancaster KJ Carter-Edwards L Grilo S Shen C Schoenthaler AM Obesity interventions in African American faith-based organizations: a systematic review.Obes Rev. 2014; 15: 159-176Crossref PubMed Scopus (106) Google Scholar Clergy can help individuals overcome intrapersonal barriers to healthy eating and physical activity by motivating and empowering them through role modeling and social support. They can also help improve social and built environments to encourage health-promoting behaviors among congregants and the community.Integrating health messages into church sermons can leverage existing trust and shared values to reach vulnerable groups. A potential advantage is that sermons can target multiple levels of the socioecological theory8Sallis JF Cervero RB Ascher W Henderson KA Kraft MK Kerr J An ecological approach to creating active living communities.Annu Rev Public Health. 2006; 27: 297-322Crossref PubMed Scopus (1982) Google Scholar and may help to address key intrapersonal barriers to healthy living—such as lack of motivation9Payán DD Sloane DC Illum J Lewis LB Intrapersonal and environmental barriers to physical activity among Blacks and Latinos.J Nutr Educ Behav. 2019; 51: 478-485Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar—through interpersonal influence. Clergy may also be better positioned to deliver health promotion messages to congregants than external facilitators2Flórez KR Payán DD Palar K Williams MV Katic B Derose KP Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review.Nutr Rev. 2020; 78: 304-322PubMed Google Scholar as trusted messengers and health promoters at the intersection of health and spirituality.4Lumpkins CY Greiner KA Daley C Mabachi NM Neuhaus K Promoting healthy behavior from the pulpit: clergy share their perspectives on effective health communication in the African American church.J Relig Health. 2013; 52: 1093-1107Crossref PubMed Scopus (46) Google Scholar Limited faith-based health interventions describe integrating health messaging into sermons or evaluate implementation.2Flórez KR Payán DD Palar K Williams MV Katic B Derose KP Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review.Nutr Rev. 2020; 78: 304-322PubMed Google Scholar,3Derose KP Rodriguez C A systematic review of church-based health interventions among Latinos.J Immigr Minor Health. 2020; 22: 795-815Crossref PubMed Scopus (4) Google Scholar,6Payán DD Flórez KR Bogart LM et al.Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.Health Commun. 2019; 34: 11-20Crossref PubMed Scopus (9) Google Scholar Although most prior sermon interventions have been conducted in Judeo-Christian congregations, recent work in other faith communities (Muslim) indicates it is feasible and acceptable more broadly.10Padela AI Malik S Ahmed N Acceptability of Friday sermons as a modality for health promotion and education.J Immigr Minor Health. 2018; 20: 1075-1084Crossref PubMed Scopus (13) Google ScholarThis article presents a detailed description of the development and implementation of healthy eating and physical activity sermons that were part of a multicomponent, church-based intervention for African American and Latino congregants in Southern California. The pilot evaluation used a cluster-randomized controlled trial in which churches (n = 6) were randomized to an intervention or waitlist (control) group. About 6 months after baseline data were collected, intervention participants demonstrated statistically significant less weight gain, greater weight loss, lower body mass index scores, and healthier diets.11Derose KP Williams MV Flórez KR et al.Eat, Pray, Move: a pilot cluster randomized controlled trial of a multilevel church-based intervention to address obesity among African Americans and Latinos.Am J Health Promot. 2019; 33: 586-596Crossref PubMed Scopus (15) Google Scholar This article describes the sermon component, provides implementation evaluation results and discusses implications for research and practice.INTERVENTION DEVELOPMENT AND SERMON GUIDE DESCRIPTIONThe research team developed the faith-based intervention (Eat, Pray, Move) in collaboration with a multiethnic faith and public health partnership using a community-based participatory research approach. Two midsized (> 200 congregants) African American churches (Baptist, nondenominational) and a large Latino Roman Catholic church (> 2000 congregants) were randomized to receive the intervention. A detailed description of the study outcomes and other components are available elsewhere.11Derose KP Williams MV Flórez KR et al.Eat, Pray, Move: a pilot cluster randomized controlled trial of a multilevel church-based intervention to address obesity among African Americans and Latinos.Am J Health Promot. 2019; 33: 586-596Crossref PubMed Scopus (15) Google Scholar, 12Whitley MD Payán DD Flórez KR et al.Feasibility and acceptability of a mobile messaging program within a church-based healthy living intervention for African Americans and Latinos.J Health Inform. 2019; 26: 880-896Crossref Scopus (4) Google Scholar, 13Payán DD Derose KP Flórez KR Branch CA Williams MV The food environment in 3 neighborhoods in South Los Angeles, California: access, availability, quality, and marketing practices.Prev Chronic Dis. 2020; 17: E61Crossref PubMed Scopus (4) Google ScholarA 12-page sermon guide (Developing Sermons on Healthy Eating and Active Living) was developed by the research team and Steering Committee. The Steering Committee included 12 faith leaders, 2 public health leaders, and 3 public health researchers and was co-chaired by African American and Latino clergy. The guide contained publicly available evidence-based healthy eating and physical activity information, recommendations for action, and sample sermons with biblical references (Supplementary Data). The 4 overarching themes in the guide included project awareness, obesity awareness and policy context, healthy eating prompts, and active living prompts. The guide was developed in English and not translated because clergy at the Latino intervention church were bilingual with fluency in English. Table 1 provides the key themes in the guide and specific objectives.Table 1Sermon Guide Themes, Specific Objectives, Fidelity across Churches, and Example QuotesThemeSpecific ObjectiveFidelityaFidelity was categorized as high if clergy from all 3 churches met the objective at least once during a sermon; moderate if clergy from 2 churches met the objective at least once during a sermon; low if clergy from only 1 church met the objective at least once during a sermon.Example QuoteProject awareness1Mention church activities to promote healthy eating or active livingHigh“[Coordinator] is already doing this with our community garden and yoga classes” (Catholic Latino church)2Discuss why the church is involved in this effortModerate“We've got to find out the Bible's view of the issue of health and physical fitness” (Nondenominational AA church)“We'll be learning together about healthier eating, healthier habits, and good exercise. ‘Why do that in a church?’ you ask. Because this is where health begins and ends” (Catholic Latino church)3Mention supportive health education components (eg, bulletin inserts, posters)Low–4Share the date of any upcoming activitiesModerate–Obesity awareness and policy context5Talk about how obesity or obesity-related diseases are affecting African American and/or Latino communitiesModerate“I want to start out by sharing some health disparity statistics for our community…heart disease is the leading cause of death for African Americans. Among non-Hispanic Blacks age 20 and older, 46% suffer from cardiovascular disease” (Nondenominational AA church)“70% of African American neighborhoods and 81% of Latino neighborhoods lack recreational facilities compared to 38% of White neighborhoods” (Baptist AA church)6Talk about the importance of policy and program advocacyModerate–Healthy eating (a) or active living (b) prompts7Share a personal story about:aHealthy eatingbActive livingHigh“My family rewarded everything from good behavior to good grades to sports achievements with food. And we grew and grew...birthdays were cakes and ice-cream, right? You did well on a test, you got pizza or McDonalds” (Catholic Latino church)“My doctor told me, ‘you need to lose 40 pounds…you are overworking your body and you have extra weight on your body. My concern with you is you will drop dead from a massive heart attack without warning’” (Baptist AA church)8Talk about the role of the:aCommunity food environmentbThe built and social environmentModerate“One thing our community suffers from is what they call ‘food deserts.’ A food desert is where you have stores and markets that may not have the best meat or freshest vegetables. A food desert is where a community lacks nutritious options” (Nondenominational AA church)“It is a challenge in our community—unhealthy foods are cheaper than healthy, organic food” (Baptist AA church)9Mention:aThe connection between food consumption decisions and values (ie, environmental stewardship, social justice, respect, sustainability)bImportance of encouragement and support to exerciseModerate“God wants you to be a good steward over your body.” (Nondenominational AA church)“Get yourself together, get your children together, get your grandchildren together, and get out there and do something. Walk in your neighborhood. Jog for 30 minutes.” (Baptist AA church)10Talk about the benefits of:aHealthy eatingbActive livingHigh“There are physical benefits, it lowers your risk of heart disease, the top killer of African Americans. Physical activity will lower your blood pressure. It will help with your diabetes. It will help with obesity that produces back pain.” (Baptist AA church)11Mention any of the following topics:aFruits and vegetables, whole grains, fat, sodium, sugarsbRecommended amounts and/or different types of physical activityModerate“Find something you can do. Walking, yoga, Zumba.” (Nondenominational AA church)AA indicates African American.a Fidelity was categorized as high if clergy from all 3 churches met the objective at least once during a sermon; moderate if clergy from 2 churches met the objective at least once during a sermon; low if clergy from only 1 church met the objective at least once during a sermon. Open table in a new tab Pastors from the 3 intervention churches were asked to deliver 2 sermons that included healthy eating and physical activity messages over 5 months. The purpose was to motivate congregants individually and collectively to address obesity and diabetes disparities through nutrition education and physical activity programs, policy, and community advocacy. Research staff met with each pastor to review the sermon guide and address any questions. Pastors were encouraged to tailor the sermon according to their style, content, and religious traditions to facilitate implementation.EVALUATIONPastors and church liaisons notified the research team when intervention sermons were scheduled. Because multiple services were held at each church on the weekend, research staff attended all Sunday services at each institution to collect data. Research staff audio recorded sermons and took detailed notes using an adapted version of a systematic religious observation questionnaire6Payán DD Flórez KR Bogart LM et al.Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.Health Commun. 2019; 34: 11-20Crossref PubMed Scopus (9) Google Scholar,14Derose KP Bogart LM Kanouse DE et al.An intervention to reduce HIV-related stigma in partnership with African American and Latino churches.AIDS Educ Prev. 2014; 26: 28-42Crossref PubMed Scopus (40) Google Scholar to gather information on attendance, message duration, and fidelity. Audio recordings were transcribed verbatim and analyzed by the lead author using an inductive approach.Between December, 2015 and April, 2016, 5 unique sermons were delivered across the 3 churches. The Latino church pastor only delivered 1 sermon because he relocated in early 2016. Each sermon was delivered twice in the African American churches, whereas the same sermon in the Latino church was delivered by a bilingual clergy at 4 services (2 English and 2 Spanish). Although sermons in the Latino church reached the most congregants (on average and overall), sermon duration was considerably shorter than other churches, in part because of sermon length differences across faith traditions. Table 2 provides implementation results by intervention church and overall.Table 2Healthy Eating and Physical Activity Sermon Implementation Results by Church and Overall (n = 3 churches)MeasuresLatino Catholic ChurchAfrican American Baptist ChurchAfrican American Nondenominational Christian ChurchOverallAverage and range of church attendance per service210 (70–350)37 (23–50)64 (50–92)82 (23–350)Participating clergy1113No. of unique sermons delivered1225No. of church services impacted44412Average and range of intervention sermon length in minutes12 (11–12)37 (33–40)41 (30–51)33 (11–51)Note: Values are n (%). Data reflects observational data collected at 10 of 12 services held across the churches. Open table in a new tab Assessing fidelity consisted of verifying if a sermon addressed 11 guide objectives. Sermons delivered at the Latino church met the fewest objectives (4% or 36%), whereas those delivered in the African American churches met >50% (range, 6–10). The nondenominational church pastor demonstrated the highest fidelity among participating clergy and was the sole leader to speak about the role of the broader environment, describing concepts like food deserts.There was high fidelity across the churches (ie, clergy from all 3 churches met the objective at least once during a sermon) to the following objectives: mentioning church activities, sharing a personal story, and talking about the benefits of healthy eating/active living. Personal narratives were a common strategy used by all clergy. They referenced their own weight loss struggles and childhood memories of food, including cultural tendencies to use unhealthy food to reward behavior or accomplishments. Pastors also mentioned benefits to healthy eating and physical activity, like reduced chronic illness risk and improved quality of life. All pastors emphasized social support as a key facilitator for positive influence and accountability, prompting congregants to support and encourage one another in their efforts to improve their dietary behavior and increase their physical activity levels.Nearly all other objectives had moderate fidelity and were met by at least 1 clergy in 2 of the 3 churches. The sole objective with low fidelity consisted of mentioning supportive health education components. Refer to Table 1, which also includes fidelity results across churches and example quotes from the clergy.Beyond the specific objectives from the sermon guide, clergy included faith-based strategies to overcome lack of motivation, such as the following quote from the nondenominational church pastor: “Activate your faith. Pray to God, ‘this is my goal that I would like to be healthy. I want to see my grandbabies graduate.’” He then referenced 2 bible verses from the guide (Psalms 139:13–18; Philippians 4:13). The Baptist pastor similarly used prayer to motivate and encourage congregants: “Father help us to value our health, in the name of Jesus, we want to be healthy. We want to be strong.”DISCUSSIONEmbedding health messages into sermons is a promising avenue to reach Latinos and African Americans. Results indicate clergy were receptive to delivering healthy eating and physical activity sermons from the pulpit—adding to nascent work describing and evaluating sermons as health interventions.6Payán DD Flórez KR Bogart LM et al.Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.Health Commun. 2019; 34: 11-20Crossref PubMed Scopus (9) Google Scholar,15Miranda JJ Taype-Rondan A Bazalar-Palacios J Bernabe-Ortiz A Ariely D The effect of a priest-led intervention on the choice and preference of soda beverages: a cluster-randomized controlled trial in Catholic Parishes.Ann Behav Med. 2020; 54: 436-446Crossref PubMed Google Scholar Sermon interventions have several advantages because they center existing trustworthy sources of information in communities of color and do not have financial cost for implementation.Guide fidelity varied by clergy with the highest fidelity to 3 objectives, including sharing a personal story about healthy eating/active living. This result is supported by a qualitative study investigating African American clergy perceptions about health promotion that found personal storytelling to be a popular communication method.4Lumpkins CY Greiner KA Daley C Mabachi NM Neuhaus K Promoting healthy behavior from the pulpit: clergy share their perspectives on effective health communication in the African American church.J Relig Health. 2013; 52: 1093-1107Crossref PubMed Scopus (46) Google ScholarIMPLICATIONS FOR RESEARCH AND PRACTICEStrategies to improve fidelity include assessing readiness for participation or offer refresher training if there is a time lag between the initial overview of the intervention and delivery of a sermon. A larger evaluation trial could also assess the impact of the sermon intervention on the nutrition and physical activity knowledge, attitudes, and behaviors of participating clergy.Researchers and practitioners can consider developing and testing different health messaging approaches in partnership with clergy, including addressing other health issues or different types of messaging (eg, personal stories compared with data about how an issue is affecting the community). An intervention study in Peru included a brief standardized message delivered by priests to reduce soda consumption with modest significant effects.15Miranda JJ Taype-Rondan A Bazalar-Palacios J Bernabe-Ortiz A Ariely D The effect of a priest-led intervention on the choice and preference of soda beverages: a cluster-randomized controlled trial in Catholic Parishes.Ann Behav Med. 2020; 54: 436-446Crossref PubMed Google ScholarInviting clergy who will deliver the sermon, lay faith leaders, or congregants to help develop specific healthy eating and active living messages may increase their relevance to a particular congregation and/or faith community. Future research can focus on collecting data from congregants on the acceptability of sermon interventions and messaging, which were not included in this evaluation.NOTESThe study procedures, materials, and protocols were approved by RAND's Human Subjects Protection Committee, which serves as the organization's Institutional Review Board. This study was funded by a grant from the National Institute on Minority Health and Health Disparities (grant no. R24MD007943). The authors would like to acknowledge contributions by members of the Community Steering Committee, especially the Rev Rosalynn Brookins, Rev John Cager, Rev Walter Contreras, Rev Jawane Hilton, Jaime Huerta, Rev Martín García, Dr Jan King, Rev Felipe Martínez, Bp Gwendolyn Stone, Nina Vaccaro, and Bp Craig Worsham. The authors thank project team members at RAND, including Marcela Gaither (graphic design of the sermon guide) and Jennifer Hawes-Dawson and Eunice Wong (comments on the sermon guide content). INTRODUCTIONAfrican American and Latino communities are disproportionately affected by obesity and diet-related diseases in the US.1Hales CM Carroll MD Fryar CD Ogden CL Prevalence of obesity among adults and youth: United States, 2015-2016.NCHS Data Brief. 2017; : 1-8Google Scholar Faith-based organizations can be important partners in promoting health among African American and Latino congregants through infrastructure, programming, and strong social networks.2Flórez KR Payán DD Palar K Williams MV Katic B Derose KP Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review.Nutr Rev. 2020; 78: 304-322PubMed Google Scholar,3Derose KP Rodriguez C A systematic review of church-based health interventions among Latinos.J Immigr Minor Health. 2020; 22: 795-815Crossref PubMed Scopus (4) Google Scholar Clergy, in particular, can provide public health information and promote healthy behaviors using their moral authority, visibility, and credibility.4Lumpkins CY Greiner KA Daley C Mabachi NM Neuhaus K Promoting healthy behavior from the pulpit: clergy share their perspectives on effective health communication in the African American church.J Relig Health. 2013; 52: 1093-1107Crossref PubMed Scopus (46) Google Scholar, 5Baruth M Bopp M Webb BL Peterson JA The role and influence of faith leaders on health-related issues and programs in their congregation.J Relig Health. 2015; 54: 1747-1759Crossref PubMed Scopus (30) Google Scholar, 6Payán DD Flórez KR Bogart LM et al.Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.Health Commun. 2019; 34: 11-20Crossref PubMed Scopus (9) Google ScholarHealth interventions that engage clergy can impact multiple levels in the socioecological model.7Lancaster KJ Carter-Edwards L Grilo S Shen C Schoenthaler AM Obesity interventions in African American faith-based organizations: a systematic review.Obes Rev. 2014; 15: 159-176Crossref PubMed Scopus (106) Google Scholar Clergy can help individuals overcome intrapersonal barriers to healthy eating and physical activity by motivating and empowering them through role modeling and social support. They can also help improve social and built environments to encourage health-promoting behaviors among congregants and the community.Integrating health messages into church sermons can leverage existing trust and shared values to reach vulnerable groups. A potential advantage is that sermons can target multiple levels of the socioecological theory8Sallis JF Cervero RB Ascher W Henderson KA Kraft MK Kerr J An ecological approach to creating active living communities.Annu Rev Public Health. 2006; 27: 297-322Crossref PubMed Scopus (1982) Google Scholar and may help to address key intrapersonal barriers to healthy living—such as lack of motivation9Payán DD Sloane DC Illum J Lewis LB Intrapersonal and environmental barriers to physical activity among Blacks and Latinos.J Nutr Educ Behav. 2019; 51: 478-485Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar—through interpersonal influence. Clergy may also be better positioned to deliver health promotion messages to congregants than external facilitators2Flórez KR Payán DD Palar K Williams MV Katic B Derose KP Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review.Nutr Rev. 2020; 78: 304-322PubMed Google Scholar as trusted messengers and health promoters at the intersection of health and spirituality.4Lumpkins CY Greiner KA Daley C Mabachi NM Neuhaus K Promoting healthy behavior from the pulpit: clergy share their perspectives on effective health communication in the African American church.J Relig Health. 2013; 52: 1093-1107Crossref PubMed Scopus (46) Google Scholar Limited faith-based health interventions describe integrating health messaging into sermons or evaluate implementation.2Flórez KR Payán DD Palar K Williams MV Katic B Derose KP Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review.Nutr Rev. 2020; 78: 304-322PubMed Google Scholar,3Derose KP Rodriguez C A systematic review of church-based health interventions among Latinos.J Immigr Minor Health. 2020; 22: 795-815Crossref PubMed Scopus (4) Google Scholar,6Payán DD Flórez KR Bogart LM et al.Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.Health Commun. 2019; 34: 11-20Crossref PubMed Scopus (9) Google Scholar Although most prior sermon interventions have been conducted in Judeo-Christian congregations, recent work in other faith communities (Muslim) indicates it is feasible and acceptable more broadly.10Padela AI Malik S Ahmed N Acceptability of Friday sermons as a modality for health promotion and education.J Immigr Minor Health. 2018; 20: 1075-1084Crossref PubMed Scopus (13) Google ScholarThis article presents a detailed description of the development and implementation of healthy eating and physical activity sermons that were part of a multicomponent, church-based intervention for African American and Latino congregants in Southern California. The pilot evaluation used a cluster-randomized controlled trial in which churches (n = 6) were randomized to an intervention or waitlist (control) group. About 6 months after baseline data were collected, intervention participants demonstrated statistically significant less weight gain, greater weight loss, lower body mass index scores, and healthier diets.11Derose KP Williams MV Flórez KR et al.Eat, Pray, Move: a pilot cluster randomized controlled trial of a multilevel church-based intervention to address obesity among African Americans and Latinos.Am J Health Promot. 2019; 33: 586-596Crossref PubMed Scopus (15) Google Scholar This article describes the sermon component, provides implementation evaluation results and discusses implications for research and practice.

ed from the articles the organizations leading efforts to address vaccination equity, their location, the target population, the specific access barriers that the effort was tackling, interventions used to address the barriers, challenges encountered and solutions to those challenges, and measures of success, if any. We screened a total of 777 articles from social media and web-based searches and abstracted information from

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Context Multilevel church-based interventions may help address racial/ethnic disparities in obesity in the United States since churches are often trusted institutions in vulnerable communities. These types of interventions affect at least two levels of socio-ecological influence which could mean an intervention that targets individual congregants as well as the congregation as a whole. However, the extent to which such interventions are developed using a collaborative partnership approach and are effective with diverse racial/ethnic populations is unclear, and these crucial features of well-designed community-based interventions. Objective The present systematic literature review of church-based interventions was conducted to assess their efficacy for addressing obesity across different racial/ethnic groups (eg, African Americans, Latinos). Data Sources and Extraction In total, 43 relevant articles were identified using systematic review methods developed by the Center for Disease Control and Prevention (CDC)’s Task Force on Community Preventive Services. The extent to which each intervention was developed using community-based participatory research principles, was tailored to the particular community in question, and involved the church in the study development and implementation were also assessed. Data Analysis Although 81% of the studies reported significant results for between- or within-group differences according to the study design, effect sizes were reported or could only be calculated in 56% of cases, and most were small. There was also a lack of diversity among samples (eg, few studies involved Latinos, men, young adults, or children), which limits knowledge about the ability of church-based interventions to reduce the burden of obesity more broadly among vulnerable communities of color. Further, few interventions were multilevel in nature, or incorporated strategies at the church or community level. Conclusions Church-based interventions to address obesity will have greater impact if they consider the diversity among populations burdened by this condition and develop programs that are tailored to these different populations (eg, men of color, Latinos). Programs could also benefit from employing multilevel approaches to move the field away from behavioral modifications at the individual level and into a more systems-based framework. However, effect sizes will likely remain small, especially since individuals only spend a limited amount of time in this particular setting.

Church-based programs can act on multiple levels to improve dietary and physical activity behaviors among African Americans and Latinos. However, the effectiveness of these interventions may be limited due to challenges in reaching all congregants or influencing behavior outside of the church setting. To increase intervention impact, we sent mobile messages (text and email) in English or Spanish to congregants (n=131) from predominantly African American or Latino churches participating in a multi-level, church-based program. To assess feasibility and acceptability, we collected feedback throughout the 4-month messaging intervention and conducted a process evaluation using the messaging platform. We found that the intervention was feasible to implement and acceptable to a racially ethnically diverse study sample with high obesity and overweight rates. While the process evaluation had some limitations (e.g. low response rate), we conclude that mobile messaging is a promising, feasible addition to church-based programs aiming to improve dietary and physical activity behaviors.

Faith and public health partnerships offer promise to addressing health disparities, but examples that incorporate African-Americans and Latino congregations are lacking. Here we present results from developing a multi-ethnic, multi-denominational faith and public health partnership to address health disparities through community-based participatory research (CBPR), focusing on several key issues: (1) the multi-layered governance structure and activities to establish the partnership and identify initial health priority (obesity), (2) characteristics of the congregations recruited to partnership (n=66), and (3) the lessons learned from participating congregations' past work on obesity that informed the development of a multi-level, multi-component, church-based intervention. Having diverse staff with deep ties in the faith community, both among researchers and the primary community partner agency, was key to recruiting African-American and Latino churches. Involvement by local health department and community health clinic personnel provided technical expertise and support regarding health data and clinical resources. Selecting a health issueobesitythat affected all subgroups (e.g., African-Americans and Latinos, women and men, children and adults) garnered high enthusiasm among partners, as did including some innovative aspects such as a text/e-mail messaging component and a community mapping exercise to identify issues for advocacy. Funding that allowed for an extensive community engagement and planning process was key to successfully implementing a CBPR approach. Building partnerships through which multiple CBPR initiatives can be done offers efficiencies and sustainability in terms of programmatic activities, though long-term infrastructure grants, institutional support, and non-research funding from local foundations and health systems are likely needed.

Purpose: To implement a multilevel, church-based intervention with diverse disparity populations using community-based participatory research and evaluate feasibility, acceptability, and preliminary effectiveness in improving obesity-related outcomes. Design: Cluster randomized controlled trial (pilot). Setting: Two midsized (∼200 adults) African American baptist and 2 very large (∼2000) Latino Catholic churches in South Los Angeles, California. Participants: Adult (18+ years) congregants (n = 268 enrolled at baseline, ranging from 45 to 99 per church). Intervention: Various components were implemented over 5 months and included 2 sermons by pastor, educational handouts, church vegetable and fruit gardens, cooking and nutrition classes, daily mobile messaging, community mapping of food and physical activity environments, and identification of congregational policy changes to increase healthy meals. Measures: Outcomes included objectively measured body weight, body mass index (BMI), and systolic and diastolic blood pressure (BP), plus self-reported overall healthiness of diet and usual minutes spent in physical activity each week; control variables include sex, age, race–ethnicity, English proficiency, education, household income, and (for physical activity outcome) self-reported health status. Analysis: Multivariate linear regression models estimated the average effect size of the intervention, controlling for pair fixed effects, a main effect of the intervention, and baseline values of the outcomes. Results: Among those completing follow-up (68%), the intervention resulted in statistically significantly less weight gain and greater weight loss (−0.05 effect sizes; 95% confidence interval [CI] = −0.06 to −0.04), lower BMI (−0.08; 95% CI = −0.11 to −0.05), and healthier diet (−0.09; 95% CI = −0.17 to −0.00). There was no evidence of an intervention impact on BP or physical activity minutes per week. Conclusion: Implementing a multilevel intervention across diverse congregations resulted in small improvements in obesity outcomes. A longer time line is needed to fully implement and assess effects of community and congregation environmental strategies and to allow for potential larger impacts of the intervention.

The Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services have implemented Million Hearts (MH), an initiative to coordinate efforts across the United States to promote cardiovascular health. This report examines the partnerships developed in MH, defines the practices and approaches to cardiovascular disease prevention that occurred as a result of the program, and provides suggestions for future MH activities.