Although African Americans have the highest prevalence and incidence of hypertension (HTN) in the US, Black men have an earlier onset of HTN with concomitant earlier onset and higher mortality of HTN related end-organ damage compared to Whites and Black women.
Blacks are less likely to meet goal levels for evidence-based lifestyle modifications (e.g., the Dietary Approaches to Stop Hypertension (DASH) diet, sodium reduction, physical activity) and are less likely to engage in medical care compared to Whites.
It is critical to find ways to engage Black men early in their course of HTN to prevent complications that take years to develop. However, there have been few interventions aimed toward improving health behaviors and addressing psychological barriers to HTN control specifically among Black men, particularly those under age 50.
Prior qualitative studies have clearly linked health and religion among Southeastern Blacks, yet little is known about attitudes and beliefs of younger Black men toward HTN, and it is not clear if a faith-based context can improve engagement in their health and disease prevention related to HTN.
Community based interventions have shown promise in engaging Black men in health care. However, many of these programs: a) have primarily consisted of education, HTN screening and monitoring, or referral to health care providers rather than changing behaviors; b) have not systematically evaluated the influence of faith and religious practices on Black men under the age of 50 and their health in general or with regard to HTN; c) have consisted of primarily Black women and/or targeted Black men 50 years and older rather than those under age 50; and d) are implemented locally and not designed to disseminate evidence-based interventions for coordinated, nationwide reach and sustainability.
Historically Black churches provide an infrastructure which includes prominent and respected male leadership and an organizational structure that can support widespread dissemination of interventions not only within the church, but throughout surrounding communities.
The National Baptist Convention, USA, Inc. (NBC-USA) is the nation’s oldest and largest Black religious organization with an estimated membership of 7.5 million, which equates to at least 2 million men (with an estimated 45-50% age 18-50), showing the potential for extensive reach. The National USA Foundation, Inc. (NUFI) exclusively supports NBC-USA in order to provide fiscal and programmatic management and support for strategic partnerships with individuals and organizations that support NBC-USA priorities and missions. NBC-USA and NUFI are committed partners in this research and dissemination program with the overarching goal of identifying effective interventions to improve HTN control in Black men under age 50 nationwide.
This pilot study, Understanding Hypertension among Black Men in a Faith-Based Setting, will take the first step in this program. We will first utilize qualitative methods to determine the attitudes and beliefs toward HTN prevention, treatment, and control among Black men under age 50 in two NBC-USA churches in the southeastern US. This, in turn, will inform the collaborative development of an intervention that will eventually be tested in a larger randomized controlled trial in the R01-type proposal that emerges from this pilot study. Once proven effective, this tested program will be disseminated through the NBC-USA nationally, including a large scale-up of the intervention across the Nation.
This pilot study will solidify an academic-community partnership between the University of Alabama at Birmingham (UAB) and the National USA Foundation, Incorporated (NUFI), one of the National Transdisciplinary Collaborative Center (NTCC) for African American Men’s Health community partners.
A collaborative approach, including integration of community partners with the research team, will be used to conduct the study. The study aims are focused on investigating biological, psychosocial, and environmental factors that contribute to Black men’s health, specifically, HTN, which is a significant contributor to disparities in cardiovascular disease outcomes such as myocardial infarction and stroke.
We focus on younger Black men, in an effort to engage them at a critical period in their life course where intervention may have the most significant impact on improving health outcomes and thereby eliminating disparities. Findings will be used to develop interventions that will impact the prevention, detection, treatment, and control of HTN among Black men by utilizing the infrastructure within faith-based organizations for large-scale dissemination. The project will support the career development of a dedicated health disparities researcher interested in building her career on the foundation of implementation studies.
This highly innovative project is intended to create a model for an academic-private partnership with the goal of testing scalable solutions to improve the health and wellness of Black men, eventually moving beyond HTN to other cardiovascular diseases, as well as other health priorities among NBC-USA members.