Black men have the greatest burden of premature death and disability from hypertension (HTN) in the United States. A major reason for the disproportionate HTN-related morbidity and mortality in black men is the low blood pressure (BP) control rate. Improving BP control leads to significant cardiovascular (CV) risk reduction and can be achieved through interventions targeted at therapeutic lifestyle changes (TLC). Despite the proven efficacy of TLC in large clinical trials in academic research settings, the effectiveness of TLC in community-based settings is largely untested in this population. While the disproportionately high rate of HTN-related morbidity and mortality is well documented, the growing epidemic of colorectal cancer (CRC) among black men is comparatively under-appreciated. CRC is a leading cause of cancer death in black men with a death rate that is 50% higher than in white men. This may be due to the low rates of CRC screening in this population. While several clinic-based approaches have been successfully tested in increasing CRC screening rates, few have focused on improving use of screening colonoscopy among black men in a non- practice community-based setting. We address these gaps in the literature by simultaneously evaluating in a cluster-randomized controlled trial, the effectiveness of two evidence-based interventions targeted at BP reduction and CRC screening. This research design allows each intervention to serve as the control for each other. The target population will be 480 black men aged >50 years with uncontrolled HTN (BP >135/85 mm Hg) and in need of CRC screening recruited from black churches in NYC. We hypothesize that black men, aged >50 years randomized to a motivational interviewing (MINT) lifestyle intervention will have significantly lower BP compared to those randomized to the CRC patient navigation intervention at 6 months. In contrast, black men randomized to the CRC intervention will have significantly higher CRC screening rates compared to those randomized to the MINT intervention at 6 months. Participants in the MINT lifestyle intervention arm will attend one face-to-face counseling followed by 8 sessions of telephone-based MINT sessions over the next 6 months. Those in the CRC intervention will receive three telephone contacts with trained lay health navigators focused on navigation for CRC screening, and 5 additional contacts of similar duration to the MINT sessions over 6 months. The primary outcomes will be (1) within-patient change in systolic and diastolic BP from baseline to 6 months and (2) colorectal cancer screening rates as determined by colonoscopy report or FIT result from the primary care provider at 6 months. Blood pressure will be assessed with an automated digital BP monitor based on American Heart Association guidelines. CRC screening will be assessed by self-report and verified with medical records and/or the actual colonoscopy or FIT report from participants'providers. The long-term goal is to develop a program that could serve as a new non-traditional model of disseminating proven interventions for CV risk reduction and CRC prevention in black men nationwide.
In translating proven interventions for improving blood pressure control and colon cancer screening to community-based settings, we are linking community health promotion to the healthcare system. Thus, our program could serve as a new nontraditional model of disseminating proven interventions for cardiovascular risk reduction and colon cancer prevention in black men nationwide - a group that is often underrepresented in traditional clinical practices. The potential for dissemination is high, as there is at least one church in virtually every neighborhood across the United States.
|Cole, Helen; Schoenthaler, Antoinette; Braithwaite, R Scott et al. (2014) Community-based settings and sampling strategies: implications for reducing racial health disparities among black men, New York City, 2010-2013. Prev Chronic Dis 11:E105|