Adaptation of a Modified DASH Diet to a Rural African American Community Setting

Published:September 12, 2016DOI:


      Cardiovascular disease is the leading cause of death among African Americans in the U.S., with high blood pressure and obesity being two of the main determinants. The Dietary Approaches to Stop Hypertension diet is effective in changing behaviors associated with these health concerns, but has not been adapted to community settings.


      Men on the Move: Growing Communities (MOTMGC) was evaluated using a quasi-experimental cross-sectional design. Surveys were conducted with rural African Americans aged ≥18 years prior to the intervention (2008) and at the end of the project (2013), with the final analysis conducted in 2015. Using a community-based participatory research approach, MOTMGC provided culturally appropriate education and changes to the environment to improve access to fruits and vegetables, low-fat, and low-sodium foods.


      Declines in prevalence of overweight and obese respondents and hypertension were seen in the intervention but not the comparison county. Participants with high levels of participation reported eating five or more servings of fruits and vegetables a day, a greater variety of fruits and vegetables, less salt, and seasoning their vegetables with less fat more often than those who did not participate in educational activities. Participants reported that as a result of their access to MOTMGC gardens, they were more likely to eat more fruits, vegetables, and locally grown food, and less processed food and fast food.


      Adapting the Dietary Approaches to Stop Hypertension diet to community settings through culturally appropriate community-based efforts can improve dietary behaviors, BMI, and blood pressure.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Go A.
        • Mozaffarian D.
        • Roger V.L.
        • et al.
        Heart disease and stroke statistics—2013 update.
        Circulation. 2013; 127: 6-245
        • Vollmer W.
        • Sacks F.
        • Ard J.
        • et al.
        Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH+Sodium trial.
        Ann Intern Med. 2001; 135: 1019-1028
        • Epstein D.
        • Sherwood A.
        • Smith P.
        • et al.
        Determinants and consequences of adherence to the dietary approaches to stop hypertension diet in African American and white adults with high blood pressure: resluts from the ENCORE trial.
        J Acad Nutr Diet. 2012; 112: 1763-1773
        • Appel L.
        • Moore T.
        • Obarazanek E.
        • et al.
        A clinical trial of the effects of dietary patterns on blood pressure.
        N Engl J Med. 1997; 336: 1117-1124
        • Sacks F.
        • Svetkey L.
        • Vollmer W.
        • et al.
        Effects on blood pressure of reduced dietary sodium and the dietary approaches to stop hypertension (DASH) diet.
        N Engl J Med. 2001; 334: 3-10
        • Appel L.
        • Champagne C.
        • Harsha D.
        • et al.
        Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial.
        JAMA. 2003; 289: 2083-2093
        • Lin P.
        • Appel L.
        • Funk K.
        • et al.
        The PREMIER intervention helps participants follow the Dietary Approaches to Stop Hypertension dietary pattern and the current Dietary Reference Intakes recommendations.
        J Acad Nutr Diet. 2007; 107: 1541-1551
        • Bertoni A.
        • Foy C.
        • Hunter J.
        • Quandt S.
        • Vitolins M.
        • Whitt-Glover M.
        A multilevel assessment of barriers to adoption of dietary approaches to stop hypertension (DASH) among African Americans of low socioeconomic status.
        J Health Care Poor Underserved. 2011; 22: 1205-1220
        • Baker E.
        • Motton F.
        Creating understanding and action through group dialogue.
        in: Israel B. Eng E. Schulz A. Parker E. Multiple Methods for Conducting Community-Based Participatory Research for Health. Jossey Bass, San Francisco, CA2005
        • Chin M.
        • Walters A.
        • Cook S.
        • Huang E.
        Interventions to reduce racial and ethnic disparities in health care.
        Med Care Res Rev. 2007; 64: 7S-28S
        • Davis A.
        • Vinci L.
        • Okwuosa T.
        • Chase A.
        • Huang E.
        Cardiovascular health disparities: a systematic review of heatlh care interventions.
        Med Care Res Rev. 2007; 64: 29S-100S
        • Fisher T.
        • Burnet D.
        • Huang E.
        • Chin M.
        • Cagney K.
        Cultural leverage: interventions using culture to narrow racial disparities in health care.
        Med Care Res Rev. 2007; 64: 243S-282S
        • Leeman J.
        • Sommers J.
        • Vu M.
        • et al.
        An evaluation framework for obesity prevention policy interventions.
        Prev Chronic Dis. 2012; 9: 110322
        • Moore L.
        • Diez Roux A.
        Associations of neighborhood characteristics with the locations and type of food stores.
        Am J Public Health. 2006; 96: 325-331
        • Morland K.
        • Diez Roux A.
        • Wing S.
        Supermarkets, other food stores, and obesity: the Atherosclerosis Risk in Communities Study.
        Am J Prev Med. 2006; 30: 333-339
        • Rose D.
        • Richards R.
        Food store access and household fruit and vegetable use among participants in the U.S. Food Stamp Program.
        Public Health Nutr. 2004; 7: 1081-1088
        • Walton-Moss B.
        • Samuel L.
        • Nyugen T.
        • Commodore-Mensah Y.
        • Hayat M.
        • Szanton S.
        Community-based cardiovacular health interventions in vulnerable populations: a systemactic review.
        J Cardiovasc Nurs. 2014; 29: 293-307
        • Wang M.
        • Kim S.
        • Gonzalez A.
        • MacLeod K.
        • Winkleby M.
        Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index.
        BMJ. 2007; 61: 491
      1. U.S. DHHS National Heart Blood and Lung Institute. Your guide to lowering blood pressure. 2003.
      2. USDA. DG TipSheet: salt and sodium. Nutrition Education Series 2011;

        • Koepsell T.
        • Wagner E.
        • Cheadle A.
        • et al.
        Selected methodological issues in evaluating community-based health promotion and disease prevention programs.
        Annu Rev Public Health. 1992; 3: 31-37
      3. U.S. Census Bureau: State and county quick facts. Published 2013. Accessed October 14, 2014.

      4. Missouri Association for Communitiy Action. Comprehensive Community Needs Assessment for Delta Area Economic Opportunity Coporation (DAEOC). 2014.
      5. Missouri Department of Health and Human Services. Leading causes of death. Published 2013.

        • Prochaska J.
        • Redding C.
        • Viswanath K.
        The transtheoretical model and stages of change.
        in: Glanz K. Rimer B. Lewis F. Health Behavior and Health Education: Theory, Research, and Practice. 4th ed. Jossey-Bass, San Francisco, CA2009
        • White W.
        • Berson A.
        • Robbins C.
        • et al.
        National standard for measurement of resting and ambulatory blood pressures with automated sphygmomanometers.
        Hypertension. 1993; 21: 504-509
        • Anwar Y.
        • Giacco S.
        • McCabe E.
        • Tendler B.
        • White W.
        Evaluation of the efficacy of the OmRon HEM-737 IntelliSense Device for the use on adults according to recommendations of the Association for the Advancement of Medical Instrumentation.
        Blood Press Monit. 1998; 3: 261-265
      6. National Heart, Lung, and Blood Institute. Measuring blood pressure. Accessed November 11, 2015.

        • NIH
        Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The evidence report.
        National Heart, Lung, Blood Institute, Bethesda, MD1998
      7. CDC. Behavioral risk factor surveillance system survey questionnaire. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Accessed March 2, 2015.

        • Dodani S.
        • Sullivan D.
        • Pankey S.
        • Champagne C.
        HEALS: a faith-based hypertension control and prevention program for African American churches: training of church leaders as program interventionists.
        Int J Hypertens. 2011;
        • Ard J.
        • Carter-Edwards L.
        • Svetkey L.
        A new model for developing and executing culturally approriate behavioral modification clinical trials for African Americans.
        Ethn Dis. 2003; 13: 279-285