African American Men And High Blood Pressure Executive

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A Review of Psychosocial Factors and Systems-Level InterventionsA Closer Look at African American Men andHigh Blood Pressure Control – Executive SummaryU.S. Department of Health and Human ServicesCenters for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health Promotion

Suggested Citation:Centers for Disease Control and Prevention. A Closer Look at African American Menand High Blood Pressure Control: A Review of Psychosocial Factors and Systems-LevelInterventions. Atlanta: U.S. Department of Health and Human Services; 2010.Photos:The photographs used in this publication are for illustration purposes only. Theyshow African American men from various age groups. They are not intended todepict people who have high blood pressure or who had a heart attack or stroke.For Free Copies or Additional Information:E-mail: [email protected]:Division for Heart Disease and Stroke Prevention, NCCDPHPCenters for Disease Control and Prevention4770 Buford Highway, NE, Mailstop K-47Atlanta, GA 30341Phone: 1-800-CDC-INFO (232-4636)TTY:1-888-232-6348Online: http://www.cdc.gov/dhdspThe findings and conclusions in this document are those of the author(s) and donot necessarily represent the official position of the Centers for Disease Controland Prevention/the Agency for Toxic Substances and Disease Registry.

Table of s.3Introduction.4The Burden of High Blood Pressure.5Psychosocial Aspects of Blood Pressure Control among African American Men.9Programs With Systems-Level Interventions.11General Health Resources by Category.25References.30african american men and blood pressure control: a closer look · executive summary 1

AcknowledgmentsThis project was supported by a task order contract (200-2001-00123) between RTIInternational and the Division for Heart Disease and Stroke Prevention (DHDSP),National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP),Centers for Disease Control and Prevention (CDC). This document is a continuationof previous work performed by the Program Development and Services Branch inDHDSP. We would like to thank the following people for their participation in makingthis document a reality:Contributors:Bernadette Ford Lattimore, MPH1; Nancy D. Berkman, PhD2; Andrea Yuen, BS2;Suzanne M. Randolph, PhD3; Erika Willacy, MPH2; Linda Lux, MPH2; Ben Beatty,MPH2; Shelly Harris, MPH2; Rosanne Farris, PhD1; Belinda Minta, MPH, MBA1;Adrienne Rooks, BA2; Sheree Marshall Williams, PhD1; Sarah O’Leary, MPH,MA1; Nora Keenan, PhD1; Robert Merritt, MA1; Cathleen Gillespie, MS1; KathrynGallagher, MA1; Yuling Hong, MD, MSc, PhD, FAHA1; Michael Schooley, MPH1;Julie Will, PhD1; Angela Soyemi, BA1 and Darwin Labarthe, MD, MPH, PhD1.1Centersfor Disease Control and Prevention, 2RTI International, 3The MayaTech CorporationWe extend many thanks to the project’s expert panel for their guidance in thedevelopment and content of this guide. Their contributions and participation in theprocess were key in bringing together the document. The expert panel consisted of: JeanJ.E. Bonhomme, MD, MPH; Jules Harrell, PhD; B. Waine Kong, PhD, JD; GeorgeMensah, MD, FACP, FACC; Alan Richmond, MSW; and Herman A. Taylor, Jr., MD,MPH, FACC, FAHA.Special thanks to the key informants for providing us with the information necessary toproduce this document. They are as follows: Shauntice Allen, MA; Karen Boone, RN,MN, MPH; Jeanne Charleston, RN; Akilah Heggs, MA; Devon Love; James Plumb,MD, MPH; Sara Eve Sarliker, MPH; Berenice Tow, MS; and Ronald Victor, MD.african american men and blood pressure control: a closer look · executive summary 2

RecommendationsTop 10 Considerations for Public Health Programs WhenPlanning Systems-Level Interventions for African AmericanMen to Control High Blood PressureBecause public health programs share the Division for Heart Disease and StrokePrevention’s mission of “ eliminating disparities in the burden of heart disease andstroke,” this document provides a tool that can be used to develop or fund systems-levelinterventions, particularly addressing African American men and high blood pressurecontrol. Below is a list of considerations as public health programs plan, develop, andimplement systems-level interventions for this underserved population:1. Review and become familiar with the national prevalence data on hypertensionin African American men, as well as factors related to awareness, treatment, andcontrol. Gather and analyze state and local data on this population; determinepriority groups or localities if appropriate.2. Become familiar with the psychosocial factors (e.g., effects of racism, social support,access to care) related to high blood pressure control among African American men.3. Identify and share data with stakeholders that public health programs might partnerwith when developing interventions related to high blood pressure control inAfrican American men.4. Collaborate with nontraditional partners (e.g., faith-based organizations, sororitiesand fraternities, barbershops) to develop and implement interventions for thispopulation.5. Before implementing an intervention, examine the history and politics of thecommunity. Be sure to include members of the community during the initialplanning stages of an intervention or activity. Not only does this build trust, but itcan also increase the chances that the intervention or activity will be successful.6. Identify settings or mechanisms for possible intervention, which may includeconducting community needs assessments or environmental scans of potential sitesand how the priority group could best be reached.7. Identify reviewed projects and interventions that have been evaluated for possiblepilot programs; determine characteristics of programs that are most compatible withpotential pilot program setting.8. Consider reviewing information on similar interventions and programs dealing withmen’s health concerns to discover promising or best practices regardless of topic area,such as prostate cancer or diabetes.9. Review the Lessons Learned from interviewed programs and Key Findings fromliterature reviews to use as tools to develop interventions or similar activities for yourtarget population.10. Develop evaluation plans for proposed interventions.african american men and blood pressure control: a closer look · executive summary 3

Introduction1Heart disease and stroke impact the U.S. population in epidemic proportions. Accordingto the American Heart Association, these conditions have led to direct and indirect costsof an estimated 475 billion in 2009. With heart disease and stroke being the first andthird leading causes of death and major causes of disability, national and internationalexperts agree that now is the time to take action in addressing these conditions and theirrisk factors.Disease burden and growing disparities among certain populations are characteristics ofthe heart disease and stroke epidemic. One of the populations greatly affected by thisepidemic is African American men. African American men suffer disproportionatelyfrom high blood pressure, a known risk factor for heart disease and stroke. Because ofthis, the Centers for Disease Control and Prevention’s Division for Heart Disease andStroke Prevention (DHDSP) began to focus attention and resources to developingmaterials that provide answers.DHDSP contracted with RTI International, with assistance from the MayaTechCorporation, to create a document addressing high blood pressure control in AfricanAmerican men. The purpose of the book is to highlight resources and systems-levelinterventions regarding high blood pressure control of African American men tostakeholders (such as state and local government agencies, health care organizations,non-profit organizations, and others) to facilitate positive changes in their states andcommunities. A systems-level intervention is defined as a change in policy, legislation,training, or environmental supports that impacts individual and community-leveloutcomes. Systems-level interventions can focus on organizations, providers, patients, andthe health care system as a whole, and can also include media campaigns. Information forthe review was gathered through input from an expert panel, key informant interviewswith individuals conducting interventions, and a search of the literature.This executive summary (abridged version) of the book was created to use as aquick reference guide. It contains an overview and summaries of the more in-depthinformation and findings presented in the unabridged version including: Alist of recommendations to guide state programs as they create systems-levelinterventions to serve African American men; Keystatistics on burden data pertaining to African American men and highblood pressure; Asummary of psychosocial factors that have been found to be related todisproportionately high blood pressure rates among African American men; Anoverview of effective and culturally appropriate promising practicesand interventions; Alist of men’s health informational resources.african american men and blood pressure control: a closer look · executive summary 4

2The Burden of High Blood PressureOverviewIn this chapter, we summarize the burden of high blood pressure in African Americanmen and include comparisons with other groups. According to the Seventh Report ofthe Joint National Committee on Prevention, Detection, Evaluation, and Treatmentof High Blood Pressure (JNC VII report), the classification for hypertension, or highblood pressure, measures greater than or equal to 140 mm Hg systolic or greaterthan or equal to 90 mm Hg diastolic.1 We include statistics at the national level onmorbidity and mortality related to hypertension and the associated conditions ofheart disease and stroke.MorbidityElevated Blood PressureTable 1 reports the percentage of African American, white, and Mexican American menand African American women with elevated blood pressure. Elevated blood pressureis defined as having systolic pressure of at least 140 mm Hg or diastolic pressure of atleast 90 mm Hg.The data are collapsed into three time spans on the basis of data availability: 1988–1994,1999–2002, and 2003–2006. In all periods, a larger percentage of African Americanmen had elevated blood pressure than did white or Mexican American men. However,compared with the 1988–1994 period, the percentage of men in each race or ethnicitygroup with elevated blood pressure had declined by the 2003–2006 period. Thepercentage of African American women with elevated blood pressure fluctuated over thethree periods, but by the 2003–2006 period was smaller than that of African Americanmen.Table 1.Percentage of Persons withElevated Blood Pressureby Race/Ethnicity and Sex,20–74 Years of Age, forSelected canAmerican men30.328.226.5White men19.717.617.4MexicanAmerican men22.221.515.3AfricanAmerican women26.428.823.9Note: Percentages are age adjusted. Elevated blood pressure is defined as having systolic pressure of at least 140 mm Hg or diastolicpressure of at least 90 mm Hg. Those with elevated blood pressure may be taking prescribed medicine for high blood pressure.Source: National Center for Health Statistics (2008). Table 71. Hypertension and elevated blood pressure among persons 20 yearsof age and over, by selected characteristics: United States, 1988–1994, 1999–2002, and 2003–2006. Health, United States, 2008.With chartbook on trends in the health of Americans. Hyattsville, MD, 312–313.african american men and blood pressure control: a closer look · executive summary 5

Hypertension Awareness, Treatment, and ControlFigure 1 shows that among African American men with high blood pressure, awareness(told by physician that they have high blood pressure or hypertension), treatment(taking prescribed medication) and control (maintaining their blood pressure withinnormal limits) has been increasing over time. Still, during the 1999 to 2004 period,while more than half of African American men were aware that they had high bloodpressure, 56% were receiving medications, and only 30% had their high blood pressureunder control. The percentage of African American men who were aware of theirhypertension was similar to that of white men, larger than that of Mexican Americanmen but smaller than that of African American women. Regarding hypertensiontreatment and control, percentages among African American men were larger comparedto Mexican American men but smaller than that of white men and African Americanwomen. These trends were consistent during both the 1988–1994 and the 1999–2004time periods. A significant predictor of greater awareness, treatment, and control of thedisease in African American men is increasing age.2Figure 1.Hypertension Awareness,Treatment, and ControlPercentages (%) in theU.S. Adult HypertensivePopulation by Race; 1988–1994 and 1999–2004-Note: The U.S. adult hypertensive population consists of National Health and Nutrition Examination Survey (NHANES)respondents with an average systolic blood pressure greater or equal to 140 mm Hg and diastolic blood pressure greateror equal to 90 mm Hg or a repor