PROJECT 3 Abstract Hypertension is a strong but modifiable risk factor for cardiovascular disease and stroke. Compared to Whites, Native Hawaiians and Pacific Islanders (NHPIs) are 3 to 4 times more likely to develop these conditions. They also manifest at younger ages among NHPIs, and are more likely to be fatal than in the all-races population. Hypertension prevalence is 70% higher in NHPIs than in Whites, and nearly 50% of NHPIs over the age of 21 have hypertension. Yet, NHPIs are largely absent from research on this topic. Many NHPIs consume diets high in sodium and sugar. Education on self-care for reducing sodium intake, increasing potassium intake, and encouraging weight loss, smoking cessation, and physical activity can improve blood pressure (BP). We will adapt an existing educational intervention to address self-management of hypertension in NHPIs. The multilevel 6-month intervention ? ?Engaging NHPIs and Activating Communities to Take Steps? (ENACTS) ? will operate use peer-facilitated, self-care BP education delivered weekly for 8 weeks emphasizing healthy diet, traditional NHPI foods, adherence to medication, and encouragement to increase physical activity and stop smoking; with text messaging to boost adherence. We will implement ENACTS as a randomized controlled trial at 3 community sites serving NHPIs in the Puget Sound area of Washington. We will randomize 270 NHPI adults (90 per site) with a self-reported physician diagnosis of hypertension and elevated BP measured at enrollment to either ENACTS or usual care. Both groups will receive general health education brochures, plus a $30 weekly credit for online grocery shopping. We will use a Geographic Information Systems (GIS) mobile phone app to track participants. The primary outcome is change in systolic BP. Secondary outcomes are food purchasing behaviors (online ordering, grocery receipts); medication adherence; social support; smoking cessation; and GIS data on daily energy expenditure. Outcomes will be measured at baseline, weekly, and at 6 months. We will also examine change in household food purchasing patterns, enhanced family support for BP control, and BP improvement among family members. A subset of intervention participants and family members will be invited to participate in a program that uses personal photographs for narrative art projects to promote labeling of healthy foods by local retail outlets.
Our Specific Aims are: 1) at the individual level, to compare within-person change in BP and secondary outcomes between the intervention and control groups; 2) at the family level, to evaluate ENACTS? effects on BP and secondary outcomes as within-person change in family members who provide primary support, and as mean change in other adult family members who are not directly engaged in the intervention; and 3) at the policy level, to evaluate the intervention?s ability to influence grocery store policy on clearly identifying foods that are low in sodium or high in potassium, some of which might not be easily identified with existing labels (e.g., fresh produce). ENACTS combines empirically supported elements of existing programs, thus increasing its probability of success. It aligns with the American Heart Association?s call for multilevel prevention.
Medications can improve control of blood pressure, but alone are not optimal. Unhealthy diets high in salt and low in potassium and other lifestyle behaviors contribute to high blood pressure, especially blood pressure that is poorly controlled. Native Hawaiians and Pacific Islander more often have hypertension, heart disease, and strokes the Whites. Learning to manage these conditions is an proven way to improve blood pressure control and reduce heart disease and stroke in these populations.
