ghh and heart health
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Alwyn Cohall, MDMailman School of Public Health, Columbia UniversityMay 2012
Every 24 hours… 131 men of color, and 148
women of color will die from cardiovascular disease (heart attacks, strokes, etc.)
American Heart Association, 2008
High Blood Pressure
Plays a significant role in contributing to:
Heart attacks Strokes
CDC. Health, United States, 2008. Hyattsville, MD: National Center for Health Statistics; 2008.
High Blood PressureOne in three adults…Or, about 75 million people, above the age of 20, in the United States have high blood pressure
High Blood Pressure and People of Color
31% of all Americans affected29% of Hispanics
40% of African-AmericansAmong African Americans,
hypertension (HTN) develops earlier in life and tends to be more severe, therefore increasing the risk for HTN-related complications
Preventing 1 million heart attacks and strokes in 5 years
Status of the ABCS
Aspirin People at increased risk of cardiovascular disease who are taking aspirin
47%
Blood pressure
People with hypertension who have adequately controlled blood pressure
46%
Cholesterol People with high cholesterol who have adequately controlled hyperlipidemia
33%
Smoking People trying to quit smoking who get help 23%
Source: MMWR: Million Hearts: Strategies to Reduce the Prevalence of Leading Cardiovascular Disease Risk Factors --- United States, 2011, Early Release, Vol. 60
Case in Point…
Vickie Harlem resident Worships at
Abyssinian Baptist Church
Told by physician that she had high blood pressure…
What we eat
What we drink
What, how much we smoke
How we exercise
How we deal with stress
Play significant roles in the development of disease.
Management
Lifestyle modification Pre-hypertension, Stage 1 and Stage 2
hypertension Weight loss (5-20 mmHg SBP reduction for
every 20 lbs lost) Reduce Sodium (8-14mmHG SBP reduction) Increase Physical activity (4-9 mmHG SBP
reduction) Reduce Alcohol consumption (2-4 mmHG SBP
reduction) Reduce Smoking (10-20 mmHG SBP reduction)
Medications Stage 1 and Stage 2 hypertension
An “activated” Vickie…
Changed her diet Began exercising
regularly Embraced yoga
and meditation Lost 20 lbs Normalized her
blood pressure…without medication
Unfortunately…
Vickie is unique Vickie’s Doctor is
unique
Why?
About 80% of those with high blood pressure, were aware, were in treatment
48% had their high blood pressure controlled
But… 52% were not controlled
AHA.org
Lifestyle Modification
The average visit length was 15 minutes.
Providers have minimal time to provide counseling and education with clients
May not feel comfortable in providing information and support*
Lack of resources for other types of clinic-based supports
Need for adjunctive measures
How can we reach more people with Vickie’s story?
Using the Internet for Health Information, Advice and Support
Background
• “More than any other communication medium or health-related technology, the Internet has the greatest potential to promote health and prevent disease for individuals and communities throughout the world”
• (Bernhardt Health Education Res 2000)
Background
“About 6 million Americans go online for medical advice on a typical day. That means more people seek medical advice online than actually visit health professionals...”
Source: Fox S, Rainie L. Vital decisions: how Internet users decide what information to trust when they or their loved ones are sick. Pew Internet & American Life Project; 2002
Advantages?
Anonymous Private Convenient Spend as much or as little time as
you want or need Multi-media – appeals to different
learning styles Can turn it off whenever you want –
Control!
Pew Internet & American Life Project Reports Pew Internet & American Life Project Reports People Want Information About…People Want Information About…
93% - a particular illness or condition.
65% - nutrition, exercise or weight control
64% - prescription drugs
48% - alternative or experimental treatments or medicines
39% - mental health issue such as depression or anxiety
33% - sensitive health topic that is difficult to talk about
32% - particular doctor or hospital (report cards)
Source: Fox S, Rainie L. Vital decisions: how Internet users decide what information to trust when they or their loved ones are sick. Pew Internet & American Life Project; 2002
Evidence for efficacy?
50% say information influenced eating and exercise habits
48% of Internet users say that retrieved information helped improve the way they took care of themselves
47% say that retrieved information affected their health care decisions about treatment and care Seeking health care Asking doctor new questions Getting a second opinion
Health, Internet, & Harlem Phone survey (n=646) of Harlem residents
Majority have computers (77%) and use the Internet (65%)
Many seek information on medical problems and treatment, diet, nutrition, fitness or exercise
Majority of Internet users trust the Internet for health-related information
But, there is a lack of high quality, culturally-relevant, low-literacy information on health.
…many expressed difficulty understanding information found online and stated a need for assistance in interpreting the health information…
Barriers
Process issues: Consumers often use
large search engines to obtain information
Searches- Confusing, overwhelming, frustrating Cline et al, 2001
Formative research: Focus groups What would
improve your experiences on the web? “Easy navigation…
not being bombarded by advertisement…a good catchy website name that’s easy to recall”
“Seeing people who look like me…”
“Break down complex health issues into understandable information…”
What kind of content would you like to see?
Specific information on health topics, medications
(Provide) Prevention information…like what I can do to avoid a stroke
Locating health providersExercise regimens,
stretching techniquesFinding health food
stores, restaurants that serve raw food
Stress reduction
Web Portal Development
Together with community and academic partners, we developed a Harlem-based health information website
“Creating Digital Partnerships for Health”
www.GetHealthyHarlem.org
Home Page
Health Info
Harlem Word
Profiles of Hope
Diet – Did You Know?
Diet
Diet
Diet
Exercise
Exercise
Exercise
Micro-sites
Stress Management
Stress Management - Yoga
Stress Management – Meditation
Stress Management - Prayer
Medications
Medications
Consumer reactions
Focus group responses to GetHealthyHarlem.org:
“Geared toward residents of Harlem, so more personal and interesting”
“It has more information than (just) medical health issues, such as preventive medicine”
“It keeps you updated (on health issues)” “It has real people as subjects of the
articles” “It has the pulse of the Harlem
community”
Activating the Community!!!
Project SHARE
Support for Hypertension Awareness, Reduction and Education
CDC funded initiative to screen consumers for elevated blood pressure, link them to health care resources and provide supportive education
GHH is a key component
For More Information
Alwyn Cohall, [email protected]
Support for the Harlem Health Promotion Center and Project SHARE is generously provided by the Centers for Disease Control and Prevention under the Prevention Research Centers Program