Date of Award

Spring 2020

Document Type

Open Access Dissertation


Epidemiology and Biostatistics

First Advisor

Swann Arp Adams


Inflammatory-related chronic diseases are disparagingly prevalent among African Americans in the United States, particularly in the Southeastern region. Access to community gardens shows promise in mitigating chronic disease outcomes, despite multiple barriers to physical activity and diet among underserved populations. We seek to determine if psychosocial or clinical factors mediate the association between the treatment effect of a healthy lifestyle intervention and inflammatory biomarker levels among African American women, respectively. We also seek to analyze the relationship between residing in a food desert/swamp and inflammatory biomarker levels, while gaining a qualitative perspective about community garden access among African American women. Quantitative data was obtained from the Sistas Inspiring Sistas Through Activity and Support (SISTAS) trial (N = 337), where we received biological, anthropometric, and demographic measures. Qualitative information came from key informative interviews (n = 15) to gain insight on the views of healthy food access among residents in county level-designated food deserts or swamps. We computed descriptive statistics using frequencies or means and standard deviations (STD) and conducted mediation analyses to evaluate if depression, percent body fat, or diastolic blood pressure mediates the effect of the association between participation in the SISTAS intervention and c-reactive protein (CRP) and interleukin-6 (IL6) levels. We also performed a mixed methods analysis to observe the impact of residing in a food desert or food swamp on CRP and IL6 levels, and then receive common themes on community garden access among SISTAS participants. We found that depression, percent body fat, nor diastolic blood pressure mediated the effect of the treatment assignment of the SISTAS trial on CRP or IL-6, respectively. We also did not find a significantly increased risk of high CRP or IL-6 levels among women residing in food deserts or food swamps. Common themes from the key informative interviews included self-efficacy for the utilization of personal or community gardening. Other psychosocial and clinical factors should be analyzed for future mediation analyses, and unique resources such as community gardens also need to be considered for use in healthy lifestyle interventions to combat inflammatory-related health disparities among underserved populations.


© 2020, Malcolm Seth Bevel