Associations Between Healthy Eating, Physical Activity, and Stress Among African American Adults Using Ecological Momentary Assessment Methodology: A Narrative Review

African Americans (AAs) tend to have unhealthy eating behaviors, less physical activity (PA) participation, and higher stress levels compared to people who are White. These variables also have bidirectional relationships. Ecological Momentary Assessment (EMA) methodology can be used to examine these relationships through repeated data collection. This narrative review aims to assess EMA studies that examine the bidirectional relationships between healthy eating, PA, and stress in AA adults. Four databases were searched for studies that met inclusion criteria. Two separate searches were completed: one for healthy eating and stress, and one for PA and stress. Two reviewers independently assessed articles to minimize bias, while resolving discrepancies through discussion. Of the 97 articles identified, four studies met inclusion criteria (one on diet, two on PA, and one on both). These studies used five daily prompts sent for seven days and found that stress was associated with daily unhealthy eating and less daily PA, and increased PA participation was associated with less daily stress among AA women. No studies examined how healthy eating impacts stress or how both healthy eating and PA can influence stress, and three of the studies only included AA women. EMA methodology is useful for exploring how stress influences healthy eating and PA, and how PA impacts stress. Given the disproportionate stress burden among AA adults, future research should utilize EMA to explore how healthy eating impacts stress and the combined impact of healthy eating and PA on stress among this population.