The need to understand the driving factors behind persistent black-white health disparities in overall longevity, cardiovascular disease, and cerebrovascular disease, has led to the development of the NIA IRP Healthy Aging in Neighborhood of Diversity across the Life Span (HANDLS) Program, a community-based research effort designed to focus on evaluating health disparities in socioeconomically diverse African-Americans and whites in Baltimore. This study is unique because it is a multidisciplinary project that will not only assess physical parameters but also evaluate genetic, demographic, psychosocial and psychophysiological parameters over a 20-year period. It will also employ novel research tools, mobile medical research vehicles to improve participation rates and retention among non-traditional research participants. In December 2001, we completed the wave 1 pilot phase of HANDLS after 16 months in the field. This phase of the pilot had the goal of examining the feasibility and assessing the logistical requirements of doing community-based clinical research in a mobile medical research vehicle. This pilot recruited a largely African-American, low socioeconomic (median income level of $7,764 and a mean education level of grade 12) sample of convenience consisting of 442 participants nearly 40% of whom were men. Wave 1 of HANDLS pilot phase was successful in addressing its primary goal, assessing the feasibility of conducting a community-based study using a mobile medical research vehicle. The first wave of the pilot also allowed refinement of the logistical requirements for the conduct of clinical research focused on several scientific and clinical domains among a diverse socioeconomic sample. The second goal of the first wave of the pilot was to begin to collect data that would expand our understanding about the possible causes of health disparities in the African American community and the effect of race and socioeconomic status (SES) on health and the development of age-related disease and disability. The findings within this cohort from the wave 1 pilot include identification of: Increased frequency of depressive symptoms Premature increases in intimal medial thickness in carotids Genetic polymorphisms implicated in cardiovascular disease have altered frequency Decreased muscle strength Altered blood pressure and heart rate variability responses to stress and delays in cardiovascular recovery among African Americans Significant association between symptoms of depression and cardiovascular reactivity. Wave 2 of the pilot phase, currently being conducted in the same West Baltimore neighborhood, will permit further logistical assessments of the mobile medical research vehicle (MRV I) and the newly procured mobile medical research vehicle II (MRV II), evaluation of retention strategies for non-traditional research participants, conduct a 3-year interim follow-up on participants to verify and expand on findings from wave 1 of the pilot and evaluation of new questionnaires and physical assessments to be used in the upcoming epidemiological study. Since February 3, 2003, 258 participants have undergone re-evaluation as part of wave 2. The collection of this important additional data will facilitate the publication of several manuscripts that will be enhanced by additional data in this sample of convenience. The plan is to attempt to see at least 80% of the pilot cohort or 353 participants in order to further develop and validate our strategies for retention and recontact of participants. It is hoped that we can complete this by early Winter 2003. HANDLS, the epidemiologic study, will be known as Healthy Aging in Neighborhoods of Diversity across the Life Span. It is planned as a multidisciplinary, prospective epidemiologic longitudinal study examining the influence and/or interaction of race and socioeconomic status on the development of cardiovascular and cerebrovascular health disparities among minority and lower socioeconomic status subgroups. The study plans to recruit a representative sample of whites and African Americans between 30 and 64 years old from twelve census tracts in Baltimore City in both low and high socioeconomic strata as a fixed cohort following the overall design. By collecting a baseline assessment and 5 follow-up triennenial assessments over approximately 20 years, there will be sufficient power (>.80) with 30 participants per group (race by SES by sex by age group) remaining after 20 years. There will also be sufficient power (>.80) to compare rates of change among groups after the baseline assessment. Anticipating attrition due to non-response, morbidity, and mortality yields an initial sample of approximately 4,000 participants or about 335 participants per tract. The initial examination and recruitment phase will take approximately 3 years to complete. The study data will be collected in two parts. The first part of participant examination is a household interview that will include questionnaires about health status, health services, psychosocial factors, nutrition, neighborhood characteristics, and demographics. The second part of the examination data will be collected on the medical research vehicles; these include medical history and physical examination, dietary recall, cognitive evaluation, psychophysiology assessments including heart rate variability, arterial thickness, carotid ultrasonography, assessments of muscle strength and bone density, and laboratory measurements (blood chemistries, hematology, biomaterials for genetic studies). The primary objective of HANDLS is to create a new longitudinal study on minority health focused on investigating the differential influences of race and socioeconomic status on health in an urban population. Specifically, HANDLS will to investigate the longitudinal effects of socioeconomic status and race on the development of cerebrovascular disease and cardiovascular disease; changes in psychophysiology, cognitive performance, strength and physical functioning, health services utilization, and nutrition, and their influences on one another and on the development of cardiovascular and cerebrovascular disease. Selecting a cohort that spans ages 30-64 at baseline enhances the opportunities to gain insights into minority aging and the development of age-related disease over the planned 20 years of this study.
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