Community-Based, Preclinical Patient Navigation for Colorectal Cancer Screening Among Older Black Men Recruited From Barbershops: The MISTER B Trial.

OBJECTIVES: To test the effectiveness of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer (CRC) screening among older Black men. METHODS: We conducted a 3-parallel-arm, randomized trial among 731 self-identified Black men recruited at barbershops between 2010 and 2013 in New York City. Participants had to be aged 50 years or older, not be up-to-date on CRC screening, have uncontrolled high blood pressure, and have a working telephone. We randomized participants to 1 of 3 groups: (1) patient navigation by a community health worker for CRC screening (PN), (2) motivational interviewing for blood pressure control by a trained counselor (MINT), or (3) both interventions (PLUS). We assessed CRC screening completion at 6-month follow-up. RESULTS: Intent-to-treat analysis revealed that participants in the navigation interventions were significantly more likely than those in the MINT-only group to be screened for CRC during the 6-month study period (17.5% of participants in PN, 17.8% in PLUS, 8.4% in MINT; P < .01). CONCLUSIONS: Telephone-based preclinical patient navigation has the potential to be effective for older Black men. Our results indicate the importance of community-based health interventions for improving health among minority men.

Sleep health in a black community sample.

BACKGROUND: Poor sleep health is a major health disparity and public health concern. The primary goal of this study was to accurately obtain the rates of self-reported sleep disorders, sleep dysfunction, and daytime sleepiness in a true community sample of black adults. METHODS: We used a community-based participatory research design to identify a health priority to design a study that could (a) provide an accurate assessment of the problem, (b) help to better understand the barriers to treatment, and (c) provide the community with access to care. Subsequently, 470 black adults, approached at salons, barber shops, and churches throughout Brooklyn participated. They underwent anthropometric measurement and completed a self-reported sleep assessment. RESULTS: Sleep disorders (insomnia, obstructive sleep apnea) were found in 34% of the sample, and 75% of the population that had a sleep disorder was unaware of it. Fourteen percent of the sample self-identified as having obstructive sleep apnea, 38.0% reported having Insomnia, and 38% reported having excessive daytime somnolence. People with a sleep disorder described less satisfaction with their sleep quality and poorer health than did those without a sleep disorder. CONCLUSION: The variability in the reported rates of sleep disorders in black samples suggests that the true rates of these conditions are not well-known. However, the large number of black individuals who have sleep disturbances warrants increased scientific and public health attention. In addition, with increased community involvement in research, there can be increased buy-in and greater accuracy in the assessments and reduced barriers to treatment.

Barbershop Talk With Brothers: using community-based participatory research to develop and pilot test a program to reduce HIV risk among Black heterosexual men.

There is a need for feasible, evidence-based interventions that support HIV risk reduction among heterosexual Black men. In this article, we describe the process for development of the Barbershop Talk With Brothers (BTWB) program and evaluation. The BTWB program is a theoretically grounded and community-based HIV prevention program that seeks to improve individual skills and motivation to decrease sexual risk, and that builds men's interest in and capacity for improving their community's health. Formative data collection included barbershop observations and barber focus groups, brief behavioral risk assessments of men in barbershops, and focus groups and individual interviews. Based on this information and in consultation with our steering committee, we developed the BTWB program and accompanying program evaluation. From April through November 2011, 80 men were recruited and completed a baseline assessment of a pilot test of the program; 78 men completed the program and 71 completed a 3-month assessment. The pilot evaluation procedures were feasible to implement, and assessments of pre- and post-test measures indicate that key behavioral outcomes and proposed mediators of those outcomes changed in hypothesized directions. Specifically, attitudes and self-efficacy toward consistent condom use improved, and respondents reported lower levels of sexual risk behavior from baseline to follow-up (all p < 0.05). Perceptions of community empowerment also increased (p = 0.06). While HIV stigma decreased, this difference did not reach statistical significance. Our approach to community-engaged program development resulted in an acceptable, feasible approach to reaching and educating heterosexual Black men about HIV prevention in community settings.

Perceptions of HIV Risk and Explanations of Sexual Risk Behavior Offered by Heterosexual Black Male Barbershop Patrons in Brooklyn, NY.

To describe HIV risk factors among adult heterosexual Black men recruited from four barbershops located in high HIV seroprevalent neighborhoods of Brooklyn, NY. Data on HIV-risk related behaviors and other characteristics were collected from barbershop clients. All participants (n=60) completed brief risk assessments; and a subset (n=22) also completed focus groups and/or individual interviews. Of the subset of 22 men, 68% were US born, 59% had been in jail/prison, 32% were unemployed; and during the 3 months before the interviews, 68% reported at least two partners and 45% reported unprotected vaginal or anal sex with two or more women. Emergent themes included: 1) the psychological function of multiple partnerships; 2) calculated risk taking regarding condom use; 3) the role of emotional attachment and partner trust in condom use; 4) low perceived HIV risk and community awareness; and 5) lack of relationship between HIV testing and safer sex practices. Interventions among heterosexual Black men should focus not only on increasing HIV awareness and reducing sexual risk, but also on contextual and interpersonal factors that influence sexual risk.

Lessons learned from building an infrastructure for community-engaged research.

Before community-based participatory research (CBPR) can commence an infrastructure needs to be established whereby both academic researchers and community members can participate in CBPR as equitable partners throughout the research process. OBJECTIVES: We describe the key principles of the Brooklyn Health Disparities Center (BHDC), a community-academic-government partnership, to guide the development for an infrastructure to support, increase, and sustain the capacity of academics and community members to engage in CBPR to address cardiovascular health disparities in Brooklyn, New York. METHODS: The guiding principles of the BHDC consist of 1) promoting equitable and collaborative partnerships 2) enhancing research capacity and 3) building/sustaining trust. Delphi survey, youth summer internship programs, and workshops were among the tools utilized in enhancing community capacity. RESULTS: Several lessons were gleaned: design programs that are capable of building trust, skills, capacity, and interest of community members concomitantly; be flexible in terms of the priorities and objectives that the partners seek to focus on as these may change over time; and build a groundswell of local advocates to embrace the research and policy agenda of the BHDC.

Engaging minority high school students as health disparities interns: findings and policy implications of a summer youth pipeline program.

PURPOSE: The purpose of this paper was to describe the development and implementation of a health disparities summer internship program for minority high school students that was created to increase their knowledge of health disparities, provide hands-on training in community-engaged research, support their efforts to advocate for policy change, and further encourage youth to pursue careers in the health professions. PROCEDURES: Fifty-one high school students who were enrolled in a well-established, science-enrichment after-school program in Brooklyn, New York, participated in a 4-week summer internship program. Students conducted a literature review, focus groups/interviews, geographic mapping or survey development that focused on reducing health disparities at 1 of 15 partnering CBOs. FINDINGS: Overall, student interns gained an increase in knowledge of racial/ethnic health disparities. There was a 36.2% increase in students expressing an interest in pursuing careers in minority health post program. The majority of the participating CBOs were able to utilize the results of the student-led research projects for their programs. In addition, research conclusions and policy recommendations based on the students' projects were given to local elected officials. CONCLUSIONS: As demonstrated by our program, community-academic partnerships can provide educational opportunities to strengthen the academic pipeline for students of color interested in health careers and health disparities research.

Healthy families Brooklyn: working with health advocates to develop a health promotion program for residents living in New York City housing authority developments.

Decreasing health disparities must increase access to care, improve health education and ease navigating the health care system. Community Health Workers (CHW) take on these tasks in professional and culturally competent manners. The Healthy Families Brooklyn (HFB) Program serves residents in two public housing developments in Brooklyn, NY. Healthy Families Advocates (HFA), a type of CHW, are at the core of HFB. Curriculum development for, training of and services provided by the 10 HFA over 19 months are described. Pre and post knowledge assessments of HFAs are analyzed. Data from HFA surveys regarding training were analyzed using grounded theory methods. HFA served 172 unique clients at 222 visits. Services offered include accessing public benefits, health education, and connection to hospitals. There was a significant increase between pre and post assessment knowledge scores (P < 0.01). Taking temperature, building trust, and communicating care and connection emerged as themes related to interpersonal skills used by the HFA. The HFA are committed to moving clients forward in their health knowledge and behaviors. Themes from the HFA survey closely mirrored the HFA training curriculum. Lessons learned pertaining to training needs, data collection, and supervision are explored. The HFB program is a model way of working in communities in New York City and expansion with faith-based groups and other housing development communities is underway. Engaging communities to improve access, screening, prevention and treatment is paramount to the nation's health and the success of the 2010 Affordable Care Act. CHW's role in this mission is integral.

Community-academic partnerships: lessons learned from replicating a salon-based health education and promotion program.

BACKGROUND: We present a model of a community-academic partnership formed to replicate a unique salon-based health education and promotion program among African-American and Latino communities in Philadelphia. OBJECTIVES: The purpose of this article is to describe the partnership principles established and lessons learned in replicating the salon-based program that sought to develop a cadre of community-academic partners and build community-based organizations' (CBOs) capacity to implement and evaluate the program. METHODS: As the lead organization, the Arthur Ashe Institute for Urban Health (AAIUH), formed a partnership with two CBOs, three universities, and 17 salons. Guiding principles were established to manage the large collaborative and ensure success. LESSONS LEARNED: By embracing a common mission and principles of understanding, co-learning, building capacity and sharing responsibility and recognition, this partnership was able to achieve positive outcomes. Challenges faced were related to replication, CBO infrastructure, data management capacity, and other process issues. CONCLUSIONS: Despite challenges, we created and sustained an enduring partnership and brought positive change to the community. Lessons learned highlight issues to examine before furthering this work such as fostering trust and building meaningful relationships.

Hair salon stylists as breast cancer prevention lay health advisors for African American and Afro-Caribbean women.

OBJECTIVES: To assess the effectiveness of breast health promoting messages administered by salon stylists to clients in the salon setting. METHODS: Forty salons in an urban, minority area were randomly assigned to provide messages to clients or to serve as controls. Pre-intervention surveys were completed by 1,185 salon clients. Following program initiation, assessments of 1,210 clients were conducted. RESULTS: Among women completing surveys at control salons, 10% reported exposure to breast health messages, as opposed to 37% at experimental salons (OR 5.4, 95% CI 3.7-7.9). Self-reported exposure to stylist-delivered messages was associated with improved breast self-examination rates (OR 1.6, 95% CI 1.2-2.1) and with greater intentions to have a clinical breast examination (OR 1.9, 95% CI 1.1-3.3). CONCLUSION: Hair salons are a potentially important venue for promotion of health behaviors related to breast cancer detection.

Training community health workers to be advocates for health promotion: efforts taken by a community-based organization to reduce health disparities in cardiovascular disease.

Compared to white adults, blacks are less likely to be aware of their cardiovascular risk factors and are less likely to respond appropriately to signs and symptoms of a myocardial infarction or stroke. This fact highlights the need for better dissemination of health information about cardiovascular disease among communities of color. Community health workers (CHWs) are important resources for disseminating health information. Recognizing this important role of CHWs, the Greater Southern Brooklyn Health Coalition and its community and academic partners developed a workshop designed to educate CHWs about the risk factors, signs and symptoms of cardiovascular disease. The purpose of this workshop was to educate CHWs so that they themselves could be better informed and thus, be in a better position to educate their respective clients. The resulting workshop, Taking Action Against Cardiovascular Disease in Our Communities: A Training for Service Providers, was a half-day workshop attended by 70 CHWs from various community service organizations. Approximately 97% of attendees said that the workshop met their expectations. More than half said they learned the signs and symptoms of cardiovascular disease and about 90% said that they received clear and concrete information that they could use with their clients. These evaluations also provided critiques regarding aspects of the workshop that could be improved upon and other information which will be used as a formative tool in developing future educational initiatives. In conclusion, this workshop demonstrated that it was feasible to develop effective community programs targeted at educating CHWs about cardiovascular disease.

Assessment of preventive health knowledge and behaviors of African-American and Afro-Caribbean women in urban settings.

OBJECTIVES: This report measures the extent of health knowledge and preventive behaviors of African-American and Afro-Caribbean women in New York City. METHODS: Two-hundred-twenty-one females in 10 Brooklyn-area beauty salons were surveyed in mid-June 2004. Participants completed a 30-item questionnaire (Cronbach's alpha=0.76) focusing on six domains: heart health, breast health, prostate health, second-hand smoke, asthma and sexual health. The instrument included 10 items on preventive behaviors related to the aforementioned domains. Mean knowledge scores were calculated, and analyses were performed to evaluate the factors associated with higher knowledge scores and with greater likelihood of preventive health behaviors. RESULTS: Despite a high level of knowledge about risk factors and symptoms for several common diseases, a large percentage of the sample engaged in high-risk behaviors. In addition, higher knowledge scores were associated with family history of heart disease (p=0.035), family history of prostate cancer (p=0.032) and being a member of an HMO (p=0.001). Higher scores, in turn, were associated with not currently smoking (p=0.049) and going for a blood cholesterol screening in the past year (p=0.045). CONCLUSION: Future intervention efforts should place greater focus on educating participants about symptoms and risk factors for commonly occurring diseases in the community, and on generating behavioral changes.

The importance of accurately assessing orthostatic hypotension.

Potential adverse outcomes of orthostatic hypotension (OH) range from mild symptoms of dizziness to more severe consequences of falls, fractures, and immobility. OH can be a significant problem among patients who use psychotropic medications. Clinical practitioners have observed that OH assessment among patients receiving psychotropic medications is often overlooked or inaccurate. This article addresses two areas critical to the development of a clinical standard for measuring orthostatic blood pressure: a review of procedural inconsistencies regarding OH assessment and recommendations for obtaining accurate orthostatic measurements.