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, MDatc1@columbia.eduwww.GetHealthyHarlem.org

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