The urban context: a place to eliminate health disparities and build organizational capacity.

This study seeks to examine the process of building the capacity to address health disparities in several urban African American neighborhoods. An inter-organizational network consisting of a research university, community members, community organizations, media partners, and foundations was formed to develop a community-based intervention designed to provide health promotion and disease prevention strategies for type 2 diabetes and hypertension. In-depth qualitative interviews (n = 18) with foundation executives and project directors, civic organization leadership, community leaders, county epidemiologist, and university partners were conducted. Our study contextualizes a process to build a public health partnership using cultural, community, organizational, and societal factors necessary to address health disparities. Results showed 5 important factors to build organizational capacity: leadership, institutional commitment, trust, credibility, and inter-organizational networks. These factors reflected other important organizational and community capacity indicators such as: community context, organizational policies, practices and structures, and the establishment of new commitments and partnerships important to comprehensively address urban health disparities. Understanding these factors to address African American health disparities will provide lessons learned for health educators, researchers, practitioners, foundations, and communities interested in building and sustaining capacity efforts through the design, implementation, and maintenance of a community-based health promotion intervention.

Beyond the cathedral: building trust to engage the African American community in health promotion and disease prevention.

Effective efforts to eliminate health disparities must be grounded in strong community partnerships and trusting relationships between academic institutions and minority communities. However, there are often barriers to such efforts, including the frequent need to rely on time-limited funding mechanisms that take categorical approaches. This article provides an overview of health promotion and disease prevention projects implemented through the Community Outreach and Information Dissemination Core (COID) of the Center for Minority Health, within the Graduate School of Public Health at the University of Pittsburgh. The COID is one of five Cores that comprised the University of Pittsburgh's NIH Excellence in Partnerships for Community Outreach, and Research on Disparities in Health and Training (EXPORT Health) funded from 2002 to 2007 by the National Center on Minority Health and Health Disparities. Based in large part on the success of the community engagement activities, in 2007, the National Center on Minority Health and Health Disparities, National Institutes of Health, designated the CMH as a Research Center of Excellence on Minority Health Disparities. COID major initiatives included the Community Research Advisory Board, Health Disparity Working Groups, Health Advocates in Reach, Healthy Class of 2010, and the Healthy Black Family Project. Lessons learned may provide guidance to other academic institutions, community-based organizations, and health departments who seek to engage minority communities in changing social norms to support health promotion and disease prevention.

Preventing depression in later life: translation from concept to experimental design and implementation.

OBJECTIVE: The authors detail the public health need for depression prevention research and the decisions made in designing an experiment testing problem solving therapy as "indicated" preventive intervention for high-risk older adults with subsyndromal depression. Special attention is given to the recruitment of African Americans because of well-documented inequalities in mental health services and depression treatment outcomes between races. METHODS: A total of 306 subjects (half white, half African American) with scores of 16 or higher on the Center for Epidemiological Studies of Depression Scale, but with no history of major depressive disorder in the past 12 months, are being recruited and randomly assigned to either problem solving therapy-primary care or to a dietary education control condition. Time to, and rate of, incident episodes of major depressive disorder are to be modeled using survival analysis. Level of depressive symptoms will be analyzed via a mixed models approach. RESULTS: Twenty-two subjects have been recruited into the study, and to date eight have completed the randomly assigned intervention and postintervention assessment. Four of 22 have exited after developing major depressive episodes. None have complained about study procedures or demands. Implementation in a variety of community settings is going well. CONCLUSION: The data collected to date support the feasibility of translating from epidemiology to RCT design and implementation of empirical depression prevention research in later life.

Obese African-American women's perspectives on weight loss and bariatric surgery.

BACKGROUND: African-American (AA) women have higher rates of obesity and obesity-related diseases but are less likely than other women to undergo bariatric surgery or have success with conventional weight loss methods. OBJECTIVE: To explore obese AA women's perceptions regarding barriers to weight loss and bariatric surgery. DESIGN: Focus groups to stimulate interactive dialogue about beliefs and attitudes concerning weight management. PARTICIPANTS AND APPROACH: We partnered with a community organization to recruit women who were AA, were > or = 18 years old, and had a body mass index (BMI) of > or = 30 kg/m2. We audiotaped the 90-minute focus groups and used content analysis for generating and coding recurring themes. RESULTS: In our sample of 41 participants, the mean age was 48.8 years and mean BMI was 36.3. Most participants were unmarried, had some postsecondary education, and reported good or fair health. About 85% knew someone who had undergone bariatric surgery. Qualitative analysis of 6 focus group sessions revealed that the most common barriers to weight loss were lack of time and access to resources; issues regarding self-control and extrinsic control; and identification with a larger body size. Common barriers to bariatric surgery were fears and concerns about treatment effects and perceptions that surgery was too extreme or was a method of last resort. CONCLUSIONS: Only through the elimination of barriers can AA women receive the care needed to eliminate excess weight and prevent obesity-related morbidity and mortality.