What the Jackson Heart Study Has Taught Us About Diabetes and Cardiovascular Disease in the African American Community: a 20-year Appreciation.

PURPOSE OF REVIEW: The burden of cardiometabolic diseases such as cardiovascular disease (CVD) and type 2 diabetes (T2D) is pronounced among African Americans. Research has shown that behavioral, social, metabolic, psychosocial, and genetic risk factors of CVD and T2D are closely interwoven. Approximately 20 years ago, the Jackson Heart Study (JHS) was established to investigate this constellation of risk factors. RECENT FINDINGS: Findings from neighborhood studies emphasize the importance of social cohesion and physical environment in the context CVD and T2D risk. Socioeconomic status factors such as income and education were significant predictors for CVD and T2D. Behavioral studies indicate that modifiable risk factors such as smoking, physical inactivity, lack of sleep, and poor nutrition are associated with CVD risk and all-cause mortality. Mental health also was found to be associated with CVD and T2D. Genetic influences are associated with disease etiology. This review summarizes the joint contributions of CVD and cardiometabolic risk factors in an African American population.

Explaining Poor Medication Adherence among Adults with Type 2 Diabetes in an Urban Community Health Center.

Nonadherence to diabetes medication is a common and costly problem, significantly precluding the evidence-based benefits of diabetes care. Nonadherence is also a poorly understood multifactorial behavior, particularly among African Americans with type 2 diabetes receiving care in under-resourced primary care settings. We investigated several known or suspected individual-level factors influencing diabetes medication adherence among a predominantly African American group of adults with diabetes at a local community health center. Overall diabetes medication adherence was observed to be surprisingly low at 23% (95% confidence interval (CI) = 19%-26%) and did not differ by medication type (p=.435). Common sociodemographic factors were poor predictors of adherence. However, self-perceived health and presence of comorbid conditions were significant. The strongest independent predictors of diabetes medication adherence in this population were a heart attack and having maintained a desired level of glycemic control, indicating the importance of specific comorbidities and motivation for self-care in tailoring interventions to improve adherence.

Peer training of community health workers to improve heart health among African American women.

INTRODUCTION: Training community health workers (CHWs) builds a workforce that is essential to addressing the chronic disease crisis. This article describes a highly replicable CHW training program that targets heart disease risk among African American women. BACKGROUND: African American women suffer disproportionately from heart disease mortality and morbidity. Well-trained CHWs are uniquely positioned to close this disparity gap. Method. We used a Learning Circle approach to train CHWs in heart health education. The curriculum blended web-based, self-directed learning and in-person peer coaching. CHWs learned through (a) peer-to-peer sharing, (b) problem solving and brainstorming, and (c) leadership and experiential activities. Training evaluation measures were CHWs' (a) self-confidence, (b) heart health knowledge, (c) satisfaction with training, (d) training retention, and (e) replication of training within 90 days after training. RESULTS: This training resulted in appreciable effects on four of five outcome measures. Heart health knowledge increased significantly among experienced CHWs (p = .011). CHWs were satisfied with training and retention was 100%. CHWs initiated and subsequently delivered 122 person hours of community heart health education and CHW training in their communities. DISCUSSION/CONCLUSION: CHW heart health training using Learning Circles is a practical and replicable method of training CHWs and holds significant potential for building capacity in resource-poor community organizations.

Using evaluability assessment and evaluation capacity-building to strengthen community-based prevention initiatives.

OBJECTIVES: To examine the process of community-campus engagement in an initiative developed to build evaluation capacities of community-based organizations (CBOs). METHODS: Evaluability assessment, capacity-building, self administered surveys and semi-structured interviews were conducted from 2004 to 2007 and analyzed through transcript assessment and SPSS to identify trends, relationships and capacity changes over time. RESULTS: Evaluability assessment identified CBO strengths in program planning and implementation and challenges in measurable objective development, systematic use of mixed methods, data management and analysis. Evaluability assessment informed evaluation capacity-building (ECB) trainings, teleconferences and webinars that resulted in statistically significant improvements in evaluation knowledge, skills, and abilities. Post-initiative interviews indicated CBO preferences for face-to-face training in logic model development, mixed method data collection and analysis. CONCLUSION: This report illustrates the use of mixed methods to plan, implement and evaluate a model to catalyze CBOs systematic assessment of prevention initiatives and considerations in evaluation capacity-building.

Disease management to promote blood pressure control among African Americans.

African Americans have a higher prevalence of hypertension and poorer cardiovascular and renal outcomes than white Americans. The objective of this study was to determine whether a telephonic nurse disease management (DM) program designed for African Americans is more effective than a home monitoring program alone to increase blood pressure (BP) control among African Americans enrolled in a national health plan. A prospective randomized controlled study (March 2006-December 2007) was conducted, with 12 months of follow-up on each subject. A total of 5932 health plan members were randomly selected from the population of self-identified African Americans, age 23 and older, in health maintenance organization plans, with hypertension; 954 accepted, 638 completed initial assessment, and 485 completed follow-up assessment. The intervention consisted of telephonic nurse DM (intervention group) including educational materials, lifestyle and diet counseling, and home BP monitor vs. home BP monitor alone (control group). Measurements included proportion with BP < 120/80, mean systolic BP, mean diastolic BP, and frequency of BP self-monitoring. Results revealed that systolic BP was lower in the intervention group (adjusted means 123.6 vs. 126.7 mm Hg, P = 0.03); there was no difference for diastolic BP. The intervention group was 50% more likely to have BP in control (odds ratio [OR] = 1.50, 95% confidence interval [CI] 0.997-2.27, P = 0.052) and 46% more likely to monitor BP at least weekly (OR 1.46, 95% CI 1.07-2.00, P = 0.02) than the control group. A nurse DM program tailored for African Americans was effective at decreasing systolic BP and increasing the frequency of self-monitoring of BP to a greater extent than home monitoring alone. Recruitment and program completion rates could be improved for maximal impact.

Enhancing community-based organizations' capacity for HIV/AIDS education and prevention.

The catalytic potential of community-based organizations to promote health, prevent disease, and address racial, ethnic, and socio-economic disparities in local communities is well recognized. However, many CBOs, particularly, small- to medium-size organizations, lack the capacity to plan, implement, and evaluate their successes. Moreover, little assistance has been provided to enhance their capacity and the effectiveness of technical assistance to enhance capacity is likewise limited. A unique private-academic partnership is described that simultaneously conducted program evaluation and addressed the capacity needs of 24 CBOs funded by the Pfizer Foundation Southern HIV/AIDS Prevention Initiative. Assessments of key program staff members at 12 and 18 months after the initial cross-site program assessment survey indicated a significant improvement in the CBOs' knowledge, skills, and abilities and a substantial reduction in their technical assistance needs for HIV/AIDS prevention. Full participation of CBOs in technical assistance and a concurrent empowerment evaluation framework were necessary to enhance prevention capacity.

Community-based organizations' capacity to plan, implement, and evaluate success.

Community-based organizations (CBOs) have the potential to promote and sustain health, prevent disease, and address health disparities, but many lack the capacity to do so. An assessment of the 20 CBOs receiving supplemental grant funding from the Pfizer Foundation Southern HIV/AIDS Prevention Initiative indicated a high level of knowledge for developing goals and objectives (mean score=3.08 on a scale of 0 (none) to 4 (extensive)) and high self-assessed abilities to conduct six of 20 specific intervention activities, including the development of community relationships and coalitions. Lower knowledge and skill levels were observed for intervention evaluation. While CBOs of this Initiative have established prerequisite abilities, they have self-acknowledged needs for technical assistance to maximize HIV/AIDS prevention capacity.

Barriers to prenatal care among Black women of low socioeconomic status.

OBJECTIVE: To qualitatively identify attitudinal and psychosocial determinants of early prenatal care among Black women of low socioeconomic status (SES). METHODS: Focus group discussions were conducted among Black women who attended community clinics for prenatal care. RESULTS: Early initiators of prenatal care, compared with late initiators, had positive attitudes toward pregnancy, were knowledgeable about pregnancy signs/symptoms, and thought prenatal care was important. All participants indicated strong social support during pregnancy. Late initiators, particularly multiparous women, perceived clinic staff to be insensitive. CONCLUSIONS: Findings provide valuable insight into overcoming barriers to early initiation of prenatal care among low SES Black women.

HIV testing rates among African Americans: why are they not increasing?

HIV/AIDS disproportionately affects the African-American community. It is imperative to increase the awareness of HIV/AIDS as well as the amount of people getting tested. Sometimes strategies to increase testing in the African-American community do not have to do with access but more so with other circumstances surrounding testing. These include fear of needles, being discriminated against if HIV-positive, perception of low risk, and long waiting periods for results. It is important to consider that all of these factors have an effect on peoples' decision to be tested for HIV/AIDS when offering testing.