Cardiovascular disease (CVD) and stroke are leading killers of African-American men, accounting for 31.7% of deaths annually. According to 2015 statistics, African-American men have nearly two times the risk for first stroke and are more likely to die from this event. Risks for CVD are high, and 46% of African-American men have some form of CVD. There is a disproportionate burden of diabetes in African-American men, and a reported 21% of African-American men smoke, and 45% have high blood pressure—a rate among the highest in the world. Changing health behaviors is perhaps the single most effective method to reduce these risks for CVD and stroke in African-American men.
Baptist churches comprise a nationwide faith community in which African-American men congregate regularly. Within the faith community, members share cultural norms and social and environmental conditions that contribute to the shaping of health behaviors. Therefore, Baptist churches are ideal settings in which to implement programs to change behavior to decrease risks for CVD and stroke in African-American men.
This proposal advances the science in the area of CVD prevention in high-risk populations by developing and testing the feasibility of a new intervention model for primary prevention of CVD in African-American men. The model is designed to increase health knowledge, advance stages of health activation, and improve health behaviors in accordance with 6 of 7 of the American Heart Association’s (AHA) Life’s Simple 7. These 6 include the control of blood glucose, increasing activity, reducing blood pressure, reducing cholesterol, maintaining weight in normal range, and eating a healthy diet. The program will promote changes in health habits and forging of enduring lifestyle behaviors with the instrumental support of small peer groups of African-American men.
Innovation is demonstrated in the novel peer group support mechanism that is designed to raise levels of ongoing accountability, peer encouragement, and advice. The enhanced peer group structure is designed to engage participants in sharing and helping each other to meet behavioral and risk reduction goals, as fashioned after the concept of the small, intimate peer groups that promote health and longevity, evidenced in the culture of centenarians of Okinawa, Japan.
Recent studies have demonstrated that using mobile technologies can improve monitoring and allow provision of efficient feedback, and interaction. Mobile technologies will be used to tailor the lifestyle intervention, provide encouragement, track progress, and monitor results. The purpose of this project is to develop and determine potential efficacy of a novel new model in partnership with men of the African-American Baptist community, using progressive, stepped, behavior change principles, applied in small formal peer groups, and supported by mobile technologies.
African-American men (40-70 yrs.) with risks for CVD will be recruited from two urban Baptist churches to determine feasibility of a 6-month psycho-educational peer group intervention to reduce risk factors for CVD and stroke. The use of small groups of men of this age range in social peer networks fostering peer accountability and engagement in groups comprising other men of similar ages and having similar health needs, may provide the opportunity to build and re-build habits for robust, healthy lifestyles. It is believed that positive changes in routine habits of decision-making and behavior will positively impact the men’s health as measured by meeting health goals defined by Life’s Simple 7.
Feasibility will be assessed by the degree of completion of the five phases of the intervention (See Figure), and protocol-relevant activities including cardiovascular disease risk education; screening for risks; weekly blood pressure checks; a 6-month program of behavior change (including goal-setting, effective use of activity monitors and smart phones to monitor and share activity and dietary intake, and engagement in peer groups); and completion of the study activities and measures.
We will measure changes in study measures after participation in phases of the study in specified subsets of men within the congregation, and at a 2-month follow-up to evaluate the durability of the small group program effects on outcome measures over time. The 6-month program of behavior change is designed as a randomized controlled trial (RCT) that will compare peer/group support vs. simple education provided by the distribution of health related information. Data generated will be used to determine” effect size” of the peer group intervention on the primary outcome (degree of behavioral change in component measures of Life’s Simple 7), and selected secondary clinical measures and CVD risk.
The National USA Foundation, Inc. (NUFI) will provide fiscal and programmatic management and performance site support for the strategic partnership to conduct this study and will co-develop and test the new model that will be tested in a larger future randomized controlled trial. The program of intervention is designed to be “portable” to enable its widespread dissemination. The long-term goal of this academic-community partnership is to establish an intervention model that is effective in reducing cardiovascular disease and stroke risk and is transferable to other Baptist congregations and African-American communities across the nation to reduce the burden of CVD and premature CVD deaths of African-American men.