Abstract
The purpose of the study was to conduct in-depth qualitative interviews to understand the lived experiences of African American parents of overweight adolescents who had previously participated in a family-based weight loss program and to utilize these insights to inform the essential elements of the LEADS trial, an integrated resilience stress management and health promotion intervention. Participants (N = 30) were African American parents and/or caregivers (96.7% female; Mage = 49.73, SD = 10.88; MBMI = 37.63, SD = 8.21) of adolescents with overweight and/or obesity. Interviews were transcribed and coded using inductive and deductive approaches for themes by two independent coders. Inter-rater reliability was acceptable (r = 0.70–0.80) and discrepancies were resolved to 100% agreement. Prominent stress themes included caregiver responsibilities, work, interpersonal family conflict, and physical and emotional consequences of chronic stress. Participants also noted decreases in physical activity and poor food choices due to stress. Coping mechanisms included prayer/meditation, church social support, and talking with family/partner. Results highlight the importance of mitigating stress among African American parents through stress management and cultural/familial resilience approaches to increase the likelihood of engagement in behavioral strategies in health promotion programs. Future studies should assess the utility of incorporating stress management components and health promotion techniques to improve health outcomes among African American families.
Similar content being viewed by others
Data availability
The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.
References
Alegría, M., Roter, D. L., Valentine, A., Chen, C., Li, X., Lin, J., Rosen, D., Lapatin, S., Normand, S.-L., Larson, S., & Shrout, P. E. (2013). Patient-clinician ethnic concordance and communication in mental health intake visits. Patient Education and Counseling, 93(2), 188–196. https://doi.org/10.1016/j.pec.2013.07.001
An, H.-Y., Chen, W., Wang, C.-W., Yang, H.-F., Huang, W.-T., & Fan, S.-Y. (2020). The relationships between physical activity and life satisfaction and happiness among young, middle-aged, and older adults. International Journal of Environmental Research and Public Health, 17(13), 4817. https://doi.org/10.3390/ijerph17134817
Anderson, R. E., McKenny, M. C., & Stevenson, H. C. (2019). EMBRace: Developing a racial socialization intervention to reduce racial stress and enhance racial coping among black parents and adolescents. Family Process, 58(1), 53–67. https://doi.org/10.1111/famp.12412
Bandura, A. (1978). Social learning theory of aggression. Journal of Communication. https://doi.org/10.1111/j.1460-2466.1978.tb01621.x
Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143–164. https://doi.org/10.1177/1090198104263660
Booth, S. L., Sallis, J. F., Ritenbaugh, C., Hill, J. O., Birch, L. L., Frank, L. D., & Hays, N. P. (2001). Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points. Nutrition Reviews, 59(3), S21–S36.
Bronfenbrenner, U. (1992). Ecological systems theory. In Six theories of child development: Revised formulations and current issues. (pp. 187–249). Jessica Kingsley Publishers.
Brown, A., Wilson, D. K., Sweeney, A. M., & Van Horn, M. L. (2021). The moderating effects of social support and stress on physical activity in african american women. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine, 55(4), 376–382. https://doi.org/10.1093/abm/kaaa051
Brown, A., Wilson, D. K., Sweeney, A. M., van Horn, M. L., Zarrett, N., & Pate, R. R. (2022). Buffering effects of protective factors on light and moderate-to-vigorous physical activity among african american women. Journal of Behavioral Medicine. https://doi.org/10.1007/s10865-022-00360-z
Byrd, A. S., Toth, A. T., & Stanford, F. C. (2018). Racial disparities in obesity treatment. Current Obesity Reports, 7(2), 130–138. https://doi.org/10.1007/s13679-018-0301-3
Chinn, J. J., Martin, I. K., & Redmond, N. (2021). Health equity among black Women in the United States. Journal of Women’s Health, 30(2), 212–219. https://doi.org/10.1089/jwh.2020.8868
Cohen, S. A., Greaney, M. L., & Sabik, N. J. (2018). Assessment of dietary patterns, physical activity and obesity from a national survey: Rural-urban health disparities in older adults. PLoS ONE, 13(12), 1–15.
Cooper, L. A., Roter, D. L., Johnson, R. L., Ford, D. E., Steinwachs, D. M., & Powe, N. R. (2003). Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Internal Medicine, 139(11), 907–915. https://doi.org/10.7326/0003-4819-139-11-200312020-00009
Cox, T. L., Krukowski, R., Love, S. J., Eddings, K., DiCarlo, M., Chang, J. Y., Prewitt, T. E., & West, D. S. (2012). Stress management–augmented behavioral weight loss intervention for African American women: A pilot, randomized controlled trial. Health Education & Behavior, 40(1), 78–87. https://doi.org/10.1177/1090198112439411
Dedoose version 8.0.35. (2018). Dedoose: Web applicaiton for managing, analyzing, and presenting qualitative and mixed method research data. In SocioCultural Research Consultants, LLC.
Dunkel Schetter, C., & Dolbier, C. (2011). Resilience in the context of chronic stress and health in adults. Social and Personality Psychology Compass, 5(9), 634–652. https://doi.org/10.1111/j.1751-9004.2011.00379.x
Dunkel Schetter, C., Schafer, P., Lanzi, R. G., Clark-Kauffman, E., Raju, T. N. K., & Hillemeier, M. M. (2013). Shedding light on the mechanisms underlying health disparities through community participatory methods: The stress pathway. Perspectives on Psychological Science. https://doi.org/10.1177/1745691613506016
Ejiri, M., Kawai, H., Kera, T., Ihara, K., Fujiwara, Y., Watanabe, Y., Hirano, H., Kim, H., & Obuchi, S. (2021). Exercise as a coping strategy and its impact on the psychological well-being of Japanese community-dwelling older adults during the COVID-19 pandemic: A longitudinal study. Psychology of Sport and Exercise, 57, 102054. https://doi.org/10.1016/j.psychsport.2021.102054
Fereday, J., Adelaide, N., Australia, S., & Eimear Muir-Cochrane, A. (2006). Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5, 80–92.
Geronimus, A. T., Hicken, M., Keene, D., & Bound, J. (2006). “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. American Journal of Public Health. https://doi.org/10.2105/AJPH.2004.060749
Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief.
Harris, M. L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D., & Attia, J. (2017). Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PLoS ONE, 12(2), 1–13.
Hruby, A., Manson, J. E., Qi, L., Malik, V. S., Rimm, E. B., Sun, Q., Willett, W. C., & Hu, F. B. (2016). Determinants and consequences of obesity. American Journal of Public Health, 106(9), 1656–1662. https://doi.org/10.2105/AJPH.2016.303326
Jacob, S. A., & Furgerson, S. P. (2012). Writing interview protocols and conducting interviews: tips for students new to the field of qualitative research. The Qualitative Report, 17(42), 6.
Jones, H. J., Sternberg, R. M., Francisco, S., Janson, S. L., Francisco, S., Lee, K. A., & Francisco, S. (2018). A qualitative understanding of midlife sources of stress and support in African-American women. Journal of National Black Nurses, 27(1), 24–30.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.
Lester, P., Liang, L.-J., Milburn, N., Mogil, C., Woodward, K., Nash, W., Aralis, H., Sinclair, M., Semaan, A., Klosinski, L., Beardslee, W., & Saltzman, W. (2016). Evaluation of a family-centered preventive intervention for military families: Parent and child longitudinal outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 55(1), 14–24. https://doi.org/10.1016/j.jaac.2015.10.009
Lim, S., Tellez, M., & Ismail, A. I. (2020). Chronic stress and unhealthy dietary behaviors among low-income african-american female caregivers. Current Developments in Nutrition, 4(3), nzaa029. https://doi.org/10.1093/cdn/nzaa029
Lynn Snow-Turek, A., Norris, M. P., & Tan, G. (1996). Active and passive coping strategies in chronic pain patients. Pain, 64(3), 455–462. https://doi.org/10.1016/0304-3959(95)00190-5
Marlatt, G. A., & Gordan, J. R. (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford.
Marlatt, G. A., & George, W. H. (1998). Relapse prevention and the maintenance of optimal health. In The handbook of health behavior change, 2nd ed. (pp. 33–58). Springer Publishing Co.
Marlatt, G. A., & George, W. H. (1984). Relapse prevention: introduction and overview of the model. British Journal of Addiction, 79(3), 261–273. https://doi.org/10.1111/j.1360-0443.1984.tb00274.x
Masten, A. S. (2018). Resilience theory and research on children and families: Past, present, and promise. Journal of Family Theory & Review, 10(1), 12–31. https://doi.org/10.1111/jftr.12255
Masten, A. S., & Monn, A. R. (2015). Child and family resilience: A call for integrated science, practice, and professional training. Family Relations. https://doi.org/10.1111/fare.12103
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
Ogden, C. L., Fryar, C. D., Martin, C. B., Freedman, D. S., Carroll, M. D., Gu, Q., & Hales, C. M. (2020). Trends in obesity prevalence by race and hispanic origin-1999-2000 to 2017–2018. JAMA, 324(12), 1208–1210. https://doi.org/10.1001/jama.2020.14590
Parks, E. P., Kazak, A., Kumanyika, S., Lewis, L., & Barg, F. K. (2016). Perspectives on stress, parenting, and children’s obesity-related behaviors in Black families. Health Education & Behavior, 43(6), 632–640. https://doi.org/10.1177/1090198115620418
Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J.-P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., & St-Onge, M.-P. (2021). Obesity and cardiovascular disease: A scientific statement from the american heart association. Circulation, 143(21), e984–e1010. https://doi.org/10.1161/CIR.0000000000000973
Quattlebaum, M., Kipp, C., Wilson, D. K., Sweeney, A. M., Loncar, H., & Brown, A. (2021). A qualitative study of stress and coping to inform the LEADS health promotion trial for African American Adolescents. Nutrients, 13(7), 2247.
Saleem, F. T., Lambert, S. F., Stock, M. L., & Gibbons, F. X. (2020). Examining changes in African American mothers’ racial socialization patterns during adolescence: Racial discrimination as a predictor. Developmental Psychology, 56(8), 1610–1622. https://doi.org/10.1037/dev0000993
Schetter, C. D., & Dolbier, C. (2011). Resilience in the context of chronic stress and health in adults. Social and Personality Psychology Compass, 5(9), 634–652. https://doi.org/10.1111/j.1751-9004.2011.00379.x
Sweeney, A. M., Wilson, D. K., Loncar, H., & Brown, A. (2019). Secondary benefits of the families improving together (FIT) for weight loss trial on cognitive and social factors in African American adolescents. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 47. https://doi.org/10.1186/s12966-019-0806-5
Sweeney, A. M., Wilson, D. K., Van Horn, M. L., Zarrett, N., Resnicow, K., Brown, A., Quattlebaum, M., & Gadson, B. (2022). Results from “Developing Real Incentives and Volition for Exercise” (DRIVE): A pilot randomized controlled trial for promoting physical activity in African American women. Journal of Consulting and Clinical Psychology, 90, 747–759.
Sweeney, A. M., Wilson, D. K., Zarrett, N., Brown, A., Quattlebaum, M., Gorman, B., & Loncar, H. (2021). Evaluating experiences of stress and coping among African American women during the COVID-19 pandemic to inform future interventions. Health Education & Behavior : THe Official Publication of the Society for Public Health Education, 48(6), 739–746. https://doi.org/10.1177/10901981211039148
Taylor, R. D. (2010). Risk and resilience in low-income African American families: Moderating effects of kinship social support. Cultural Diversity & Ethnic Minority Psychology, 16(3), 344–351. https://doi.org/10.1037/a0018675
Taylor, R. J., Chatters, L. M., Lincoln, K., & Woodward, A. T. (2017). Church-based exchanges of informal social support among African Americans. Race and Social Problems, 9(1), 53–62. https://doi.org/10.1007/s12552-017-9195-z
Thomas, M. D., Mendez, R. M., Zhang, Y., Wang, Y., Sohail, S., Chae, D. H., Márquez-Magaña, L., Sellers, R., Woods-Giscombé, C. L., & Allen, A. M. (2022). Superwoman schema, racial identity, and cellular aging among african american women. The Gerontologist, 62(5), 762–772. https://doi.org/10.1093/geront/gnac005
Whitfield, K. E., & Thorpe, R. J., Jr. (2017). Perspective: longevity, stress, genes and African Americans. Ethnicity & Disease, 27(1), 1–2.
Wilson, D. K., Kitzman-Ulrich, H., Resnicow, K., Van Horn, M. L., George, S. M. S., Siceloff, E. R., & Prinz, R. (2015). An overview of the Families Improving Together (FIT) for weight loss randomized controlled trial in African American families. Contemporary Clinical Trials, 42, 145–157. https://doi.org/10.1016/j.cct.2015.03.009
Wilson, D. K., Sweeney, A. M., Kitzman-Ulrich, H., Gause, H., & St. George, S. M. (2017). Promoting social nurturance and positive social environments to reduce obesity in high risk youth. Clinical Child and Family Psychology Review, 20(1), 64–77. https://doi.org/10.1007/s10567-017-0230-9
Wilson, D. K., Sweeney, A. M., Van Horn, M. L., Kitzman, H., Law, L. H., Loncar, H., & Resnicow, K. (2022). The results of the families improving together (FIT) for weight loss randomized trial in overweight african american adolescents. Annals of Behavioral Medicine, 56(10), 1042–1055. https://doi.org/10.1093/abm/kaab110
Woods-Giscombé, C. L. (2010). Superwoman schema: African American womens views on stress, strength, and health. Qualitative Health Research, 20(5), 668–683. https://doi.org/10.1177/1049732310361892
Woods-Giscombe, C. L., Gaylord, S. A., Li, Y., Brintz, C. E., Bangdiwala, S. I., Buse, J. B., Mann, J. D., Lynch, C., Phillips, P., Smith, S., Leniek, K., Young, L., Al-Barwani, S., Yoo, J., & Faurot, K. (2019). A mixed-methods, randomized clinical trial to examine feasibility of a mindfulness-based stress management and diabetes risk reduction intervention for African Americans with prediabetes. Evidence-Based Complementary and Alternative Medicine, 2019, 3962623. https://doi.org/10.1155/2019/3962623
Woods-Giscombé, C. L., Lobel, M., Zimmer, C., Wiley Cené, C., & Corbie-Smith, G. (2015). Whose stress is making me sick? Network-stress and emotional distress in African-American women. Issues in Mental Health Nursing, 36(9), 710–717. https://doi.org/10.3109/01612840.2015.1011759
Acknowledgements
Not applicable.
Funding
This research was funded by a grant (R01 HD072153) funded by the National Institutes of Child Health and Human Development to Dawn K. Wilson, Ph.D., Trial registration: ClinicalTrials.gov NCT01796067. Registered 23 January 2013. The research was also supported by the Society for Community Research and Action Student Thesis Award to Colby Kipp and by a General Medical Science grant (T32 GM08740) to Mary Quattlebaum, Asia Brown, and Haylee Loncar. Dr. Demetrius Abshire was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number K23MD013899.
Author information
Authors and Affiliations
Contributions
Conceptualization, CK, DKW, AB, MQ, HL, AS, DA; Methodology, CK, DKW, MQ; Software, CK, MQ; Formal analysis, CK, AB, MQ, HL, AS, DA; Investigation, CK, MQ, AS, HL, AB DA; Resources, CK, DKW; Data Curation, CK, AB, MQ, HL; Writing—original draft preparation, CK, MQ, DKW, AB, HL, AS, DA; Writing—review and editing, CK, DKW, AB, MQ, HL, AS, D.A; Supervision, DKW., AS; Project administration, CK, DKW; Funding acquisition, DKW, CK., MQ, HL, AB All authors have read and agreed to the published version of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Consent for publication
All participants signed informed consent and agreed to have deidentified data published.
Human and animal rights and Informed Consent
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the University of South Carolina Institutional Review Board (Pro00080020; 16 July 2018–15 July 2019).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kipp, C., Wilson, D.K., Brown, A. et al. Compounding effects of stress on diet, physical activity, and wellbeing among African American parents: a qualitative study to inform the LEADS health promotion trial. J Behav Med (2024). https://doi.org/10.1007/s10865-024-00477-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s10865-024-00477-3