Faculty Bibliography

INTRODUCTION/BACKGROUND:This community-based participatory research pilot study explored multilevel perceptions and strategies for developing future faith-based organization blood pressure interventions for young black men. METHODS:Community partners recruited the sample through two, southeastern U.S. urban churches as potential intervention hubs; academic partners conducted phone interviews with church leader key informants, and three focus groups with black men aged 18-50 years. Qualitative content analysis helped generate themes from: key informant questions assessing organizational assets and capacities, and factors influencing participation; and focus group questions assessing lifestyle and self-management behaviors. Questions assessing themes on blood pressure intervention strategies were asked. Data were collected in 2016 and analyzed in 2016-2017. RESULTS:The sample included 21 key informants and 19 young black men. Key informants' leadership experience averaged 16.6 (SD=12.1) years and 28.6% were male. Focus group participants were primarily single (55.6%), college educated (61.1%), and employed (77.8%). Mean blood pressure was 131.1 (SD=15.3)/79.5 (SD=11.2) mmHg, 33.3% self-reported having hypertension, 88.9% report a family history of hypertension, and 88.9% see a provider annually. For key informants, young black men lack understanding of hypertension despite available resources, and pastors are important role models and advocates. For focus group participants, hidden sodium and stressful, busy schedules impact lifestyle behaviors; and church support for busy schedules are important. Common strategies included incentive-laden, activity-integrated programs, and male social context (testimonials, peer mentoring, engagement outside of the church). CONCLUSIONS:Findings and lessons learned will help design future community-based participatory research, faith-based organization-led blood pressure interventions relevant to young black men. SUPPLEMENT INFORMATION/UNASSIGNED:This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.

INTRODUCTION/BACKGROUND:Differences in the social determinants of health and cardiovascular health outcomes by nativity have implications for understanding the immigrant health paradox among black immigrants. We aimed to understand whether blood pressure awareness, a precursor to achieving blood pressure control among hypertensive patients, varied by nativity among a sample of black men. METHODS:Data were collected from 2010 through 2014. In 2016, we conducted logistic regression models using data from a large sample of urban-dwelling middle-aged and older black men. All men in the study had measured high blood pressure at the time of enrollment and were also asked whether they were aware of having high blood pressure. Independent variables included demographics, socioeconomic status, access to care, and health-related behaviors. RESULTS:Foreign-born participants were significantly less likely than US-born participants to report awareness of having high blood pressure (P < .001). We observed a significant positive relationship between proportion of life spent in the US and being aware of having hypertension (β = 0.863; 95% CI, 0.412-1.314; P < .001). This relationship remained after adjusting the model for salient independent variables (β = 0.337; 95% CI, 0.041-0.634; P = .03). CONCLUSIONS:Difference in hypertension awareness by nativity may skew surveillance estimates used to track health disparities by large heterogeneous racial categories. Our results also indicate that prior health care experience and circumstances should be considered when studying the immigrant health paradox.

BACKGROUND:African Americans develop hypertension earlier and have worse cardiovascular outcomes than Caucasians. Accumulating evidence suggests that psychological distress may play a role in the observed racial differences in hypertension. Several studies have investigated the relationship between depression and hypertension while little is still known about the role of demoralization. METHODS:Using data from the Trial Using Motivational Interviewing, Positive Affect, and Self-affirmation in African Americans with Hypertension (TRIUMPH), logistic regression models were used to estimate differences in blood pressure control at 12 months among participants with demoralization, depression, and both conditions. RESULTS:Our logistic models showed that reported psychosocial symptoms significantly differed in predicting success in blood pressure control at 12 months. Contrast analyses showed that, after adjusting for sociodemographic, clinical, and psychosocial variables, demoralized patients were less likely to achieve blood pressure control than participants without affective conditions (p = 0.020). Similar results emerged for patients with depression (p = 0.042) and both conditions (p = 0.022). CONCLUSIONS:Depression can be extremely debilitating and has serious health consequence. Our findings confirm this result and show that, even though depression and demoralization share common features, they are two distinct clinical phenomena with similar negative impact on blood pressure control in African Americans.

BACKGROUND:Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN/METHODS:In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION/CONCLUSIONS:The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION/BACKGROUND:NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.

Traditional methods of health surveillance often under-represent racial and ethnic minorities. Our objective was to use geospatial analysis and emergency claims data to estimate local chronic disease prevalence separately for specific racial and ethnic groups. We also performed a regression analysis to identify associations between median household income and local disease prevalence among Black, Hispanic, Asian, and White adults in New York City. The study population included individuals who visited an emergency department at least once from 2009 to 2013. Our main outcomes were geospatial estimates of diabetes, hypertension, and asthma prevalence by Census tract as stratified by race and ethnicity. Using emergency claims data, we identified 4.9 million unique New York City adults with 28.5% of identifying as Black, 25.2% Hispanic, and 6.1% Asian. Age-adjusted disease prevalence was highest among Black and Hispanic adults for diabetes (13.4 and 13.1%), hypertension (28.7 and 24.1%), and asthma (9.9 and 10.1%). Correlation between disease prevalence maps demonstrated moderate overlap between Black and Hispanic adults for diabetes (0.49), hypertension (0.57), and asthma (0.58). In our regression analysis, we found that the association between low income and high disease prevalence was strongest for Hispanic adults, whereas increases in income had more modest reductions in disease prevalence for Black adults, especially for diabetes. Our geographically detailed maps of disease prevalence generate actionable evidence that can help direct health interventions to those communities with the highest health disparities. Using these novel geographic approaches, we reveal the underlying epidemiology of chronic disease for a racially and culturally diverse population.

There is a significant evidence base for the Diabetes Prevention Program, a lifestyle intervention to prevent onset of type 2 diabetes among high-risk individuals; however, translation of this intervention for men has been challenging. This report presents outcomes of the pilot study of an adapted 16-week diabetes prevention program entitled " Power Up for Health." The study goal was to better engage men of color with prediabetes from disadvantaged neighborhoods of New York City. It was implemented at five different recreation centers located in predominantly low-income neighborhoods across New York City. The curriculum was facilitated by male lifestyle coaches only; one group was conducted in Spanish. Primary outcome was weight loss from baseline to 16 weeks. Other measures included lifestyle activities, depressive symptoms, and self-reported health status. Men ( N = 47) were screened by telephone. Of the 29 eligible men who began the program, 25 attended at least 4 sessions (52% non-Latino Black, 32% Latino, mean age 51.7 ± SD 9.9 years, mean body mass index 35 ± SD 6.9 kg/m²). End of program outcomes ( n = 23) varied by site and included a mean weight loss of 3.8% (9.7 lbs); 3 of the 5 sites had a mean weight loss of 5.6%, meeting the national goal of 5%-7%. Men ( n = 23) attended a mean of 11.6 of 16 sessions. Improvement in depressive symptoms, healthy eating and exercise, and health status were also seen. While recruitment was challenging with many lessons learned, the adapted men's diabetes prevention program shows promise of success for participants and their coaches.

This article explores the role the Black Church could play in facilitating spiritually sensitive, culturally relevant and gender-specific services to address the mental health and well-being of Black males. The help-seeking behaviors of Black men are examined as the authors offer two theories: the body, mind, spirit, environment, social, transcendent, and health, illness, men, and masculinities that may assist the Black Church in functioning as an effective support networks for healthy Black male mental health. Next, the authors discuss implications for practice, research, and education, and lastly, eight recommendations for Black Church leadership, social workers, and mental health professionals are also discussed.

Geographic surveillance can identify hotspots of disease and reveal associations between health and the environment. Our study used emergency department surveillance to investigate geographic disparities in type 1 and type 2 diabetes prevalence among adults and children. Using all-payer emergency claims data from 2009 to 2013, we identified unique New York City residents with diabetes and geocoded their location using home addresses. Geospatial analysis was performed to estimate diabetes prevalence by New York City Census tract. We also used multivariable regression to identify neighborhood-level factors associated with higher diabetes prevalence. We estimated type 1 and type 2 diabetes prevalence at 0.23% and 10.5%, respectively, among adults and 0.20% and 0.11%, respectively, among children in New York City. Pediatric type 1 diabetes was associated with higher income (P = 0.001), whereas adult type 2 diabetes was associated with lower income (P < 0.001). Areas with a higher proportion of nearby restaurants categorized as fast food had a higher prevalence of all types of diabetes (P < 0.001) except for pediatric type 2 diabetes. Type 2 diabetes among children was only higher in neighborhoods with higher proportions of African American residents (P < 0.001). Our findings identify geographic disparities in diabetes prevalence that may require special attention to address the specific needs of adults and children living in these areas. Our results suggest that the food environment may be associated with higher type 1 diabetes prevalence. However, our analysis did not find a robust association with the food environment and pediatric type 2 diabetes, which was predominantly focused in African American neighborhoods.

Cardiovascular disparities remain pervasive in the United States. Unequal disease burden is evident among population groups based on sex, race, ethnicity, socioeconomic status, educational attainment, nativity, or geography. Despite the significant declines in cardiovascular disease mortality rates in all demographic groups during the last 50 years, large disparities remain by sex, race, ethnicity, and geography. Recent data from modeling studies, linked micromap plots, and small-area analyses also demonstrate prominent variation in cardiovascular disease mortality rates across states and counties, with an especially high disease burden in the southeastern United States and Appalachia. Despite these continued disparities, few large-scale intervention studies have been conducted in these high-burden populations to examine the feasibility of reducing or eliminating cardiovascular disparities. To address this challenge, on June 22 and 23, 2017, the National Heart, Lung, and Blood Institute convened experts from a broad range of biomedical, behavioral, environmental, implementation, and social science backgrounds to summarize the current state of knowledge of cardiovascular disease disparities and propose intervention strategies aligned with the National Heart, Lung, and Blood Institute mission. This report presents the themes, challenges, opportunities, available resources, and recommended actions discussed at the workshop.