This document discusses cardiovascular disease risks among people of color and efforts to address high blood pressure. It notes that every 24 hours, 131 men and 148 women of color die from cardiovascular disease. About 75 million US adults have high blood pressure, affecting 40% of African Americans in particular. Lifestyle changes like diet, exercise, weight loss and stress management can help control blood pressure, but many patients are not achieving control. The document describes the GetHealthyHarlem website created to provide culturally-relevant health information to Harlem residents online and activities like Project SHARE to screen for high blood pressure in the community.

1. Alwyn Cohall, MD
Mailman School of Public Health, Columbia University
May 2012

2. 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

3. 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.

4. High Blood Pressure
One in three adults…
Or, about 75 million people, above the age of 20, in the United States have high blood
pressure

5. High Blood Pressure and
People of Color
 31% of all Americans affected
 29% of Hispanics
40% 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

6. Preventing 1 million heart attacks and strokes in 5
years

7. Status of the ABCS
Aspirin People at increased risk of cardiovascular 47%
disease who are taking aspirin
Blood People with hypertension who have adequately 46%
controlled blood pressure
pressure
Cholesterol People with high cholesterol who have 33%
adequately controlled hyperlipidemia
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

8. Case in Point…
 Vickie
 Harlem resident
 Worships at Abyssinian
Baptist Church
 Told by physician that
she had high blood
pressure…

9.  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.

10. 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

11. An “activated” Vickie…
 Changed her diet
 Began exercising
regularly
 Embraced yoga and
meditation
 Lost 20 lbs
 Normalized her blood
pressure…without
medication

12. Unfortunately…
 Vickie is unique
 Vickie’s Doctor is
unique

13. 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

14. 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

15. How can we reach more
people with Vickie’s story?

16. Using the Internet for Health
Information, Advice and
Support

17. 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)

18. 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

19. 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!

20. Pew Internet & American Life Project Reports
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

21. 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

22. 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…

23. Barriers
 Process issues:
 Consumers often use large
search engines to obtain
information
 Searches- Confusing,
overwhelming, frustrating
 Cline et al, 2001

24. 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

25. Web Portal Development
 Together with
community and
academic partners, we
developed a Harlem-
based health
information website

26. “Creating Digital Partnerships
for Health”
 www.GetHealthyHarlem.org

27. Home Page

28. Health Info

29. Harlem Word

30. Profiles of Hope

31. Diet – Did You Know?

32. Diet

33. Diet

34. Diet

35. Exercise

36. Exercise

37. Exercise

38. Micro-sites

39. Stress Management

40. Stress Management - Yoga

41. Stress Management – Meditation

42. Stress Management - Prayer

43. Medications

44. Medications

45. 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”

46. Activating the Community!!!

47. 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

48. For More Information
Alwyn Cohall, MD
atc1@columbia.edu
www.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