Helen Cole

A novel community-based study to address disparities in hypertension and colorectal cancer: a study protocol for a randomized control trial

BackgroundBlack men have the greatest burden of premature death and disability from hypertension (HTN) in the United States, and the highest incidence and mortality from colorectal cancer (CRC). While several clinical trials have reported beneficial effects of lifestyle changes on blood pressure (BP) reduction, and improved CRC screening with patient navigation (PN), the effectiveness of these approaches in community-based settings remains understudied, particularly among Black men.Methods/designMISTER B is a two-parallel-arm randomized controlled trial that will compare the effect of a motivational interviewing tailored lifestyle intervention (MINT) versus a culturally targeted PN intervention on improvement of BP and CRC screening among black men aged ≥50 with uncontrolled HTN who are eligible for CRC screening. Approximately 480 self-identified black men will be randomly assigned to one of the two study conditions. This innovative research design allows each intervention to serve as the control for the other. Specifically, the MINT arm is the control condition for the PN arm, and vice-versa. This novel, simultaneous testing of two community-based interventions in a randomized fashion is an economical and yet rigorous strategy that also enhances the acceptability of the project. Participants will be recruited during scheduled screening events at barbershops in New York City. Trained research assistants will conduct the lifestyle intervention, while trained community health workers will deliver the PN intervention. The primary outcomes will be 1) within-patient change in systolic and diastolic BP from baseline to six months and 2) CRC screening rates at six months.DiscussionThis innovative study will provide a unique opportunity to test two interventions for two health disparities simultaneously in community-based settings. Our study is one of the first to test culturally targeted patient navigation for CRC screening among black men in barbershops. Thus, our study has the potential to improve the reach of hypertension control and cancer prevention efforts within a high-risk population that is under-represented in primary care settings.Trial registrationClinicalTrials.gov, NCT01092078

Factors Associated with Medication Nonadherence among Hypertensives in Ghana and Nigeria

Background. Blood pressure (BP) control is poor among hypertensives in many parts of sub-Saharan Africa. A potentially modifiable factor for control of BP is medication nonadherence (MNA); our study therefore aimed to determine factors associated with MNA among hypertensives in Ghana and Nigeria. Methodology. We conducted a multicenter cross-sectional study. Patients were recruited from Korle-Bu Hospital (n = 120), Ghana; and University of Port Harcourt Teaching Hospital, (n = 73) Apapa General Hospital Lagos (n = 79) and University College Hospital Ibadan (n = 85), Nigeria. Results. 357 hypertensive patients (42.6% males) participated. MNA was found in 66.7%. Adherence showed correlation with depression (r = −0.208, P < 0.001), concern about medications (r = −0.0347, P = 0.002), and knowledge of hypertension (r = 0.14, P = 0.006). MNA was associated with formal education (P = 0.001) and use of herbal preparation (P = 0.014). MNA was found in 61.7% of uninsured participants versus 73.1% of insured participants (P = 0.032). Poor BP control was observed in 69.7% and there was significant association between MNA and poor BP control (P = 0.006). Conclusion. MNA is high among hypertensives in Ghana and Nigeria and is associated with depression, concern about hypertensive medications, formal education, and use of herbal preparations. The negative association between health insurance and MNA suggests interplay of other factors and needs further investigation.

Are green cities healthy and equitable? Unpacking the relationship between health, green space and gentrification

While access and exposure to green spaces has been shown to be beneficial for the health of urban residents, interventions focused on augmenting such access may also catalyse gentrification processes, also known as green gentrification. Drawing from the fields of public health, urban planning and environmental justice, we argue that public health and epidemiology researchers should rely on a more dynamic model of community that accounts for the potential unintended social consequences of upstream health interventions. In our example of green gentrification, the health benefits of greening can only be fully understood relative to the social and political environments in which inequities persist. We point to two key questions regarding the health benefits of newly added green space: Who benefits in the short and long term from greening interventions in lower income or minority neighbourhoods undergoing processes of revitalisation? And, can green cities be both healthy and just? We propose the Green Gentrification and Health Equity model which provides a framework for understanding and testing whether gentrification associated with green space may modify the effect of exposure to green space on health.

Community-Based Settings and Sampling Strategies: Implications for Reducing Racial Health Disparities Among Black Men, New York City, 2010–2013

Introduction Rates of screening colonoscopies, an effective method of preventing colorectal cancer, have increased in New York City over the past decade, and racial disparities in screening have declined. However, vulnerable subsets of the population may not be reached by traditional surveillance and intervention efforts to improve colorectal cancer screening rates. Methods We compared rates of screening colonoscopies among black men aged 50 or older from a citywide random-digit–dial sample and a location-based sample focused on hard-to-reach populations to evaluate the representativeness of the random-digit–dial sample. The location-based sample (N = 5,568) was recruited from 2010 through 2013 from community-based organizations in New York City. Descriptive statistics were used to compare these data with data for all black men aged 50 or older from the 2011 cohort of the Community Health Survey (weighted, N = 334) and to compare rates by community-based setting. Results Significant differences in screening colonoscopy history were observed between the location-based and random-digit–dial samples (49.1% vs 62.8%, P < .001). We observed significant differences between participants with and without a working telephone among the location-based sample and between community-based settings. Conclusions Vulnerable subsets of the population such as those with inconsistent telephone access are excluded from random-digit–dial samples. Practitioners and researchers should consider the target population of proposed interventions to address disparities, and whether the type of setting reaches those most in need of services.

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.

Can Healthy Cities be made really healthy

Strategies such as the Healthy Cities project aim to place health at the centre of urban interventions. Such programmes seek to create cities with adequate housing and public transportation, quality health care, and safe places to exercise and play. However, these common transversal approaches also carry a risk of perverse effects, especially when the effect of market-oriented regulatory processes and uneven dynamics of policy formation are not considered. As a result, the Healthy Cities project and similar approaches, such as the WHO’s promoted Health in All Policies, might in some cases bolster rather than reduce established trends toward urban social and health inequities. In theory, provision of healthful amenities in cities with the crosscutting policy approach has positive effects on health equity. However, environmental privilege, or inequitable exposure to environmental issues or amenities on the basis of social privilege, is not easily undone in the context of urban growth that concentrates extreme wealth and large exclusion. The gap in family wealth, income, educational achievements, and access to housing continues to widen in many cities worldwide, and is often an expression of deep racial, ethnic, or social class divisions. For example, in Boston, MA, USA, white families have a median net worth of US

New scholarly pathways on green gentrification: What does the urban ‘green turn’ mean and where is it going?

247 500 compared with

Awareness of High Blood Pressure by Nativity Among Black Men: Implications for Interpreting the Immigrant Health Paradox

700 for African Americans, which can affect access to housing and mental health resources. Such inequities are often expressed spatially so that lowincome residents and minority populations have worse access to clean air and water, green spaces, healthy and affordable food options, and efficient public transport systems. These differences in exposure and access are one cause of inequities in urban health and one manifestation of environmental privilege—a form of privilege characterised in a socially and racially exclusive manner. When public health interventions are incorporated into varied stakeholder agendas, they risk becoming justifications for actions that expand rather than reduce social inequities. An example of how this scenario might play out is when the US city of Milwaukee, WI, engaged in an extensive greening programme partly to improve the health of residents. During this period, nearly 16 000 homeowners received notice from lenders of impending foreclosure, with African Americans disproportionately affected. In 2013, the city owned and maintained about 900 foreclosed homes and 2700 vacant lots, of which owners had failed to pay property taxes. The city, nonprofit organisations, and businesses have teamed up to convert these sites into gardens and urban agriculture; a prime focus of healthy city interventions to build resilience and provide healthy living environments for residents who can afford them. Similar to Milwaukee, many healthful city interventions, through which added amenities ultimately help to revalorise urban real estate, gain wide support among those who traditionally control decisions on urban land use, especially local government, business, and finance interests. A danger exists of crosscutting health initiatives in cities becoming justifications for new rounds of high-end development and gentrification, but not for intervention on behalf of those who are on the margins of growth cycles. In such a circumstance, health inequities might be exacerbated. Ensuring of healthy and equitable cities requires the incorporation of health and equity as objectives across sectors. Despite the consensus of various stakeholders (eg, public health departments, urban planners, environmental justice activists, and other social justice advocates), the success of the Health in All Policies movement and the development of healthy and equitable cities has proven more difficult than anticipated. The submission of urban planning and social policy to market-oriented regulatory processes is preventing policy interventions from effectively promoting health and environmental equity. For strategies such as Health in All Policies and Healthy Cities to have an impact, crosscutting health initiatives need to become politically unifying agendas for existing social equity and environmental activism in cities to really reduce health inequities.

Factors Associated With Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

Scholars in urban political ecology, urban geography, and planning have suggested that urban greening interventions can create elite enclaves of environmental privilege and green gentrification, and exclude lower-income and minority residents from their benefits. Yet, much remains to be understood in regard to the magnitude, scope, and manifestations of green gentrification and the forms of contestation and resistance articulated against it. In this paper, we propose new questions, theoretical approaches, and research design approaches to examine the socio-spatial dynamics and ramifications of green gentrification and parse out why, how, where, and when green gentrification takes place.

Abstract A15: How does doctor-patient communication about prostate cancer screening influence African-American patients' decisional conflict around screening decisions?

Introduction Differences in the social determinants of health and cardiovascular health outcomes by nativity have implications for understanding the immigrant health paradox among black immigrants. We aimed to understand whether blood pressure awareness, a precursor to achieving blood pressure control among hypertensive patients, varied by nativity among a sample of black men. Methods Data were collected from 2010 through 2014. In 2016, we conducted logistic regression models using data from a large sample of urban-dwelling middle-aged and older black men. All men in the study had measured high blood pressure at the time of enrollment and were also asked whether they were aware of having high blood pressure. Independent variables included demographics, socioeconomic status, access to care, and health-related behaviors. Results Foreign-born participants were significantly less likely than US-born participants to report awareness of having high blood pressure (P < .001). We observed a significant positive relationship between proportion of life spent in the US and being aware of having hypertension (β = 0.863; 95% CI, 0.412–1.314; P < .001). This relationship remained after adjusting the model for salient independent variables (β = 0.337; 95% CI, 0.041–0.634; P = .03). Conclusions Difference in hypertension awareness by nativity may skew surveillance estimates used to track health disparities by large heterogeneous racial categories. Our results also indicate that prior health care experience and circumstances should be considered when studying the immigrant health paradox.