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 PressurePlays 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 bloodpressure
High Blood Pressure andPeople of Color 31% of all Americans affected 29% of Hispanics40% of African-Americans Among 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 5years
Status of the ABCSAspirin People at increased risk of cardiovascular 47% disease who are taking aspirinBlood People with hypertension who have adequately 46% controlled blood pressurepressureCholesterol People with high cholesterol who have 33% adequately controlled hyperlipidemiaSmoking 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 stressPlay significant roles in the development of disease.
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 morepeople with Vickie’s story?
Using the Internet for HealthInformation, Advice andSupport
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 ReportsPeople 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(n=646) of Harlem residents Phone survey 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 What kind of content your experiences on the would you like to see? web? “Easy navigation…not Specific information on being bombarded by health topics, medications advertisement…a good (Provide) Prevention catchy website name information…like what I that’s easy to recall” can do to avoid a stroke “Seeing people who Locating health providers look like me…” “Break down complex Exercise regimens, stretching techniques health issues into understandable Finding health food information…” 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 Partnershipsfor Health” www.GetHealthyHarlem.org
Consumer reactionsFocus 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”
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 InformationAlwyn Cohall, MDatc1@columbia.eduwww.GetHealthyHarlem.orgSupport 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