Objective Few studies targeting obesity in serious mental illness report clinically significant risk reduction, and none have been replicated within community settings or have demonstrated sustained outcomes after intervention withdrawal. This pragmatic clinical trial aims to replicate positive health outcomes demonstrated in a prior randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population. Methods Persons with serious mental illness and BMI>25 receiving services in three community mental health organizations were randomized to the 12-month In SHAPE program (health promotion coach and membership to a public fitness club) or to fitness club membership alone. Primary outcomes were weight and cardiorespiratory fitness (measured with the 6-Minute Walk Test) collected at baseline, 3-, 6-, 9-, 12-, and 18-months. Results Participants (N=210) were ethnically diverse (46% non-White) with mean baseline BMI=36.8±8.2. At 12-months In SHAPE (n=104) compared to a fitness club membership alone (n=106) contributed to greater reduction in weight and improved fitness. Primary outcomes were maintained at 18-months follow-up. Approximately half of In SHAPE participants (51% at 12-month program completion and 46% at 18-month follow-up) achieved clinically significant cardiovascular risk reduction (≥5% weight loss or >50 meter increase on the 6-Minute Walk Test). Conclusions Sustained weight loss and improved fitness can be achieved by community mental health organizations providing health promotion coaching and access to fitness facilities. Health promotion should be integrated into mental health services for persons with serious mental illness at risk for cardiovascular disease and early mortality.

Background Beliefs concerning the causes of mental illness may help explain why there are significant disparities in the rates of formal mental health service use among racial/ethnic minority elderly as compared with their Caucasian counterparts. This study applies the Cultural Influences on Mental Health framework to identify the relationship between race/ethnicity and differences in: (1) beliefs on the cause of mental illness; (2) preferences for type of treatment; and (3) provider characteristics. Method Analyses were conducted using baseline data collected from participants who completed the Cultural Attitudes toward Healthcare and Mental Illness Questionnaire, developed for the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) study, a multi-site randomized trial for older adults (65+) with depression, anxiety, or at-risk alcohol consumption. The final sample consisted of 1257 non-Latino Whites, 536 African-Americans, 112 Asian-Americans, and 303 Latinos. Results African-Americans, Asian-Americans, and Latinos had differing beliefs regarding the causes of mental illness when compared to Non-Latino Whites. Race/ethnicity was also associated with determining who makes healthcare decisions, treatment preferences, and preferred characteristics of healthcare providers. Conclusions This study highlights the association between race/ethnicity and health beliefs, treatment preferences, healthcare decisions, and consumers' preferred characteristics of healthcare providers. Accommodating the values and preferences of individuals can be helpful in engaging racial/ethnic minority patients in mental health services.

Objective The purpose of this study was to examine ethnic differences in female dementia family caregivers’ knowledge, attitudes, and beliefs about Alzheimer disease (AD). Methods Baseline data were collected from 215 female caregivers before their participation in various psychoeducational intervention programs. Caregivers were questioned about the epidemiology, etiology, and treatment of AD. Logistic regressions and one-way analysis of variance were conducted to assess ethnic differences. Results Hispanic and Chinese caregivers were more likely to believe that AD is a normal part of aging and that AD can be diagnosed by a blood test than the white group. These beliefs about AD may delay help-seeking activities for these patients and their family caregivers. Conclusion Increased public education about AD is needed in these communities. Results are discussed in terms of barriers to accessing information about AD and ways to improve public informational outreach activities, so that the intended audiences are reached more effectively.

OBJECTIVES-To compare lifetime and 12-month prevalence of DSM-IV psychiatric disorders among a national representative sample of older Latinos, Asians, African-Americans, and AfroCaribbean to non-Latino Whites. DESIGN-Cross METHODS-The World Health Organization Composite International DiagnosticInterview assessed lifetime and 12-month psychiatric disorders. Interviewers matched the cultural background and language preference of participants. Bayesian estimates compared psychiatric disorder prevalence rates among ethnic/racial groups. RESULTS-After gender adjustments, older non-Latino Whites had higher lifetime rates of any depressive disorder than African-Americans but were no different than older Latinos. Older Asians and Afro-Caribbean had significantly lower lifetime rates of any depressive, anxiety, and substance use disorders than non-Latino Whites. Immigrant Asians had higher lifetime rates of GAD than the U.S.-born Asians and immigrant Latinos had higher lifetime rates of dysthymia and GAD than U. S.-born Latinos. U.S. born Latinos had higher lifetime rates of substance abuse, especially alcohol abuse, than immigrant Latinos. There were no significant differences in the rates of 12-month psychiatric disorders between non-Latino whites and ethnic/racial minorities, except that older African-Americans had higher 12-month rates of any substance use disorder compared to non-Latino Whites.CONCLUSION-Prevalence rates vary considerably by ethnicity and race as well as by nativity for older minorities, suggesting different patterns of illness and risk.