Health Disparities Literature
Review
Health Promotion and Chronic Disease Prevention Section
Table of Contents
Alzheimer’s Disease ..........................................................................................................2
Asthma................................................................................................................................................7
Cancer............................................................................................................................................... 17
Cardiovascular Disease and Stroke............................................................ 20
Diabetes ......................................................................................................................................... 22
Nutrition, Physical Activity, and Obesity Prevention .......... 25
Safe Riders .................................................................................................................................. 28
Worksite Wellness ........................................................................................................... 30
Alzheimer’s Disease
Title: The effect of adult day care services on time to nursing home placement in older adults with
Alzheimer’s disease.
Author: McCann JJ, Hebert LE, Li Y, Wolinsky FD, Gilley DW, Aggarwal NT, et al.
Year: 2005
Journal: Gerontologist
Hypothesis/Research Question: Does the use of adult day care services delay time to nursing
home placement in persons with Alzheimer’s disease?
Target Population/Geographic Area: Adult day care clients with Alzheimer’s disease in a
large metropolitan area.
Methods: Individuals with Alzheimer’s disease and enrolled in adult day care were frequency
matched to persons with Alzheimer’s disease but not using adult day care based on age, gender, race,
and level of cognitive impairment. Participants were followed at three-month intervals for up to 48
months. Cox proportional hazards models were used to evaluate the effects of adult day care and other
fixed and time-varying factors on risk of nursing home placement.
Results: Risk of nursing home placement increased significantly with the number of days of adult day
care attendance. These effects were greater for men than women. Independent predictors were
participant disability, hospitalizations, caregiver age, and caregiver burden, but their inclusion did not
alter the risk associated with attending adult day care.
Conclusions: More severe disease and greater caregiver burden did not explain the increased risk of
nursing home placement for individuals with Alzheimer’s disease being placed in nursing homes. It
appears that other factors, including willingness/tendency to institutionalize, may be responsible for the
association between adult day care and nursing home risk.
Title: Resources for Enhancing Alzheimer’s Caregivers Health II (REACH II); Enhancing the quality of life
in dementia caregivers from different ethnic or racial groups- a randomized, controlled trial.
Authors: Bell S, Burgio L, Burns R, Coon D, Czaja S, Gallagher-Thomson D, et al.
Year: 2006
Journal: Annals of Internal Medicine
Hypothesis/Research Question: What are the effects of a structured, multicomponent
intervention on quality of life and clinical depression in family caregivers of care recipients with
Alzheimer’s disease (or related disorders) in three diverse racial and ethnic groups (Hispanic or Latin,
white or Caucasian, and black or African American)? What are the effects on rates of institutionalized
placement of care recipients?
Target Population/Geographic Area: 642 participants: 212 in Hispanic group (106 each in
control and intervention); 219 in White group (106 in control, 113 in intervention); and 211 in the
African American group (107 in control and 104 in intervention). This allowed for comparison between
not only the control and intervention groups, but between races and ethnicities.
Intervention/Methods: Caregivers were randomly assigned to control or intervention groups.
The intervention was delivered over a six month period through interactive trainings on caregiver
depression, burden, self-care, social support, and care recipient problem behaviors. There were 12
individual sessions, nine conducted in the home, and three telephone calls. There were also five
structured support group conference calls during the intervention. Participants received resource books
and telephones with screens for use during conference calls.
Results: The intervention group saw small but significant increases in quality of life for all five topics
covered by the intervention. This held for white and Hispanic caregivers, but was seen only for spousal
caregivers in the African American group. Caregiver clinical depression was statistically significantly
lower in the intervention group, even when adjusted for race and ethnicity, and baseline reports.
Hispanic caregivers were more likely to report improved depressive symptoms and problem behaviors,
and white caregivers reported increased social support.
Conclusions: This study was the first of its kind to measure statistically significant differences
between racial and ethnic groups in the intervention and control groups.
Title: REACH OUT; Translating the REACH caregiver intervention for use by Area Agency on Aging
Personnel: the REACH OUT program.
Author: Burgio L, Collins I, Schmid B, Wharton T, McCallum D, & DeCoster J.
Year: 2009
Journal: The Gerontologist
Hypothesis/Research Question: Will a modified version of the Resources for Enhancing
Alzheimer’s Caregivers Health II (REACH II) decrease caregiver burden and depression, increase caregiver
health, and decrease care-recipient risk and behavioral problems?
Target Population/Geographic Area: Informal caregivers for people with Alzheimer’s
disease, 39% of participants were African-American. The intervention was carried out by four Area
Agencies on Aging in Alabama. 55% of participants were rural, 45% were urban.
Methods: A risk appraisal, based on the REACH intervention, for caregiver stress and burden was used
to prioritize problem areas. Five topic areas were identified (education, caregiver health, home safety,
behavior management, and stress management). Case managers and supervisors provided the
intervention over a three to four month period, during four home visits that each lasted one house.
Phone calls in between visits were made to supplement the intervention. Data collection occurred
during home visits and during telephone calls.
Results: Caregivers reported decreased depression and increased social support, and fewer risky
behaviors (leaving the care recipient unsupervised). No change in stress from assisting the care receiver
with activities of daily living was reported by caregivers. Caregivers also reported positive changes to
their own health for all items measured. More African American caregivers reported increased positive
aspects of caregiving, despite a significantly stronger influence in decreasing the overall burden for
white caregivers than African Americans. The authors suggested this was due to lower reported burden
levels for Activities of Daily Living among African American caregivers.
Conclusions: The intervention appeared to benefit caregivers, though there was no comparison
group for this study.
Title: Stress-Busting Program for Family Caregivers; A stress busting program for family caregivers.
Authors: Lewis S, Miner-Williams D, Novian A, Escamilla M, Blackwell P, Kretzschmar J, ArevaloFlechas L, & Bonner P.
Year: 2009
Journal: Rehabilitation Nursing
Hypothesis/Research Question: Will a psychoeducational support group improve stress
management of family caregivers of persons with dementia?
Target Population/Geographic Area: Informal caregivers in a metropolitan area of South
Texas. 25% of caregivers identified as Hispanic/Latin American, primarily of Mexican-American descent.
Methods: The intervention was delivered over nine consecutive weeks for an hour and a half. The
topics covered included stress and relaxation training, reactions to grief and loss, coping skills, positive
thinking, and healthy living. Participants received a handbook, a relaxation CD that they were
encouraged to use daily, and a book of resources.
Results: At nine weeks, caregivers reported significant improvement in perceived stress, burden,
depression, anxiety, and anger/ hostility. Additional improvements in overall health, social function, and
mental health were also reported. Continued improvements were reported two months after the
intervention was completed.
Conclusions: The intervention did improve stress management for participants, though the
researchers noted that the content of the sessions (there were multiple groups conducted) varied
somewhat based on group needs.
Title: Training Dementia Caregivers in Sensitivity to Nonverbal Emotion Signals; Impact of training
dementia caregivers in sensitivity to nonverbal emotion signals.
Author: Magai C, Cohen C, & Gomberg D.
Year: 2002
Journal: International Psychogeriatrics
Hypothesis/Research Question: Will a sensitivity intervention for caregivers increase mood
and reduce symptoms in care receivers, and increase psychological well-being in caregivers?
Target Population/Geographic Area: Formal caregivers, 82% of whom were African
American. 93% of care receivers were white.
Methods: Ten one-hour sessions were conducted by a clinical psychologist over two weeks to train
caregivers in nonverbal communication and emotion expression. The sessions included universal aspects
of basic emotions, but also explored culture-specific aspects, including: selective perception of emotion;
personal triggers; facial, vocal, and bodily indicators; and cues for emotions. Through various media,
caregivers were able to practice recognizing emotional cues, and discuss the impacts of certain kinds of
emotion communication.
Results: For the intervention groups, there was a significant effect on caregivers’ Brief Symptom
Inventory scores, indicative of decreased depression, anxiety, and somatic symptoms. Negative
symptoms for the intervention group also declined somewhat, while they stayed constant for the
control group. Limited effects were seen on care receivers, with a small short-term increase in positive
affect for those receiving care from the intervention group.
Conclusions: The intervention was effective at improving outcomes for caregivers. Though initially
delivered in an institutional setting, the intervention could be adapted for implementation in community
settings.
Asthma
Title: Results of a Home-based Environmental Intervention among Urban Children with Asthma
Author(s): Morgan W, Crain E, Gruchalla R, O’Connor G, Kattan M, Evans III R, et al.
Year: 2004
Journal: New England Journal of Medicine
Hypotheses/Research Questions: Determine whether an environmental intervention tailored
to each child’s allergic sensitization and environmental risk factors could improve asthma-related
outcomes.
Target Population/Geographic Area: Children with asthma in seven major cities in the
United States (Dallas; New York City; Boston; Chicago; the Bronx, New York; Seattle and Tacoma
Washington area; Tuscon, Arizona. The majority of children in the sample were black or Hispanic, as
reported by the child’s caregiver.
Methods: 937 children with atopic asthma, aged 5-11 years, were enrolled in a randomized,
controlled trial of an environmental intervention that lasted one year, and included education and
remediation for exposure to allergens and environmental tobacco smoke. Home environmental
exposures were assessed every six months, and asthma-related complications were assessed every two
months during the intervention year, and for one year after completion of the intervention. Children
were tested for allergic sensitization, and the results were used to determine environmental risk factors
needing remediation. Education and resources for reducing triggers associated with the specific allergies
were provided by intervention staff, though information on medical management of asthma was not
provided as part of the intervention’s activities.
Results/Findings: At each two-month assessment during the intervention year and the follow-up
year, the intervention group reported fewer days with symptoms, unscheduled medical visits, and
missed school days than the control group, as well as larger declines in the levels of allergens in the
home
Conclusions: An individualized, home-based, comprehensive environmental intervention decreases
exposure to indoor allergens and results in reduced asthma-associated morbidity.
Title: Effectiveness of Home-based, multi-trigger, multicomponent interventions with an
environmental focus for reducing asthma morbidity. A Community Guide systematic review.
Author(s): Crocker DD, Kinyota S, Dumitru GG, Ligon CB, Herman EJ, Ferdinands JM, et al.
Year: 2011
Journal: American Journal of Preventive Medicine
Hypotheses/Research Questions: Evaluate evidence that interventions that target reducing
allergens and irritants in the home through home visits may be beneficial in improving asthma
outcomes.
Target Population/Geographic Area: Most of the literature evaluated targeted children with
asthma in urban, low SES, and minority communities.
Methods: Using methods previously developed for the Guide to Community Preventive Services, a
systematic review was conducted to evaluate the evidence on effectiveness of home-based, multitrigger, multicomponent interventions with an environmental focus to improve asthma-related
morbidity outcomes. The literature search identifıed over 10,800 citations. Of these, 23 studies met
intervention and quality criteria for inclusion in the fınal analysis.
Results/Findings: In the 20 studies that targeted children and adolescents, the number of
symptom-days was reduced by the equivalent of 21 symptom-days per year, school days missed were
reduced by 12.3 days per year, and asthma acute care visits were reduced by .57 visits per year. Three of
the studies included in the final analysis reported outcomes among adults, and found inconsistent
results.
Conclusions: Home-Based Multi-Trigger, Multicomponent Environmental Interventions were found
to have strong evidence of effectiveness in improving quality of life and productivity for children and
adolescents with asthma.
Title: Healthy Homes Project. Effect of environmental interventions to reduce exposure to asthma
triggers in homes of low -income children in Seattle; The Seattle-King County healthy homes project: a
randomized, controlled trial of a community health worker intervention to decrease exposure to indoor
asthma triggers.
Author(s): Takaro TK, Krieger JA, et al; Krieger JA, Takaro TK, & Weaver M.
Year: 2004; 2005
Journal: Journal of Exposure Analysis and Environmental Epidemiology; American Journal of Public
Health
Hypotheses/Research Questions: To assess the effectiveness of a community health worker
intervention focused on reducing exposure to indoor asthma triggers.
Target Population/Geographic Area: In general, participants were low-income, minority
children with asthma and their families in Seattle and King County, Washington. More specifically,
participants had to have a child aged 4-12 years with diagnoses persistent asthma, be below 200% of the
federal poverty level or be enrolled in Medicaid, and the caregiver had to be fluent in English, Spanish,
or Vietnamese.
Methods: Using community health workers (CHWs) of shared ethnic, linguistic, and cultural
backgrounds as the participants. For the intervention and control groups, CHWs conducted at least one
home assessment to assess triggers, develop action plans, and provide materials to reduce
environmental triggers. Intervention group participants also received cleaning equipment and additional
home visits (five to nine visits) over the intervention period (one year) that included asthma trigger
reduction education and activities.
Results/Findings: Short-term impacts of the intervention showed increased knowledge of
exposure to asthma triggers, along with significant improvements in the following behaviors to mitigate
levels of allergens in the home: vacuuming frequency, vacuuming upholstery, use of mattress and pillow
covers for dust mites, and use of doormats and bathroom fan presence/use. Allergen scores in
intervention homes were also found to have significantly decreased for condensation, cockroach,
moisture, dust weight, and asthma triggers. Caregiver quality of life scores also improved for both
groups, but improvement was greater within the intervention group.
Conclusions: Community health workers that share ethnic, linguistic, and cultural backgrounds with
the families they provide education to are effective in reducing asthma trigger exposure in low-income
children and families.
Title: Home-Based Asthma Education for Latino Families. Increasing asthma knowledge and changing
home environments for Latino families with asthmatic children.
Authors: Jones JA, Wahlgren DR, Meltzer SB, Meltzer EO, Clark NM, & Hovell MF.
Year: 2001
Journal: Patient Education and Counseling
Hypothesis/Research Questions: Will a culturally-tailored, in-home asthma education
program improve asthma knowledge and home environment asthma management procedures?
Target Populations/Geographic Area: Latino families who have a child with asthma and a
smoker living in the home in San Diego County, California.
Methods: Using a modified version of the hospital-based “You Can Control Asthma” curriculum
developed by Georgetown University, bilingual Latino asthma educators conducted home visits in
Spanish, English, or both (based on participant preference) to provide education on multiple asthmarelated topics, including improving communication between the family and medical providers,
presenting asthma recommendations without refuting alternative health beliefs, and improving
translation of medical terminology from English to Spanish words and phrases. The asthma educators
also provided a medicine plan form to participants, and encouraged families to take the form with them
to their next medical visit to aid in the development of an asthma treatment plan.
Results: Asthma knowledge increased significantly, and there was a significant reduction of asthma
triggers/increase in modifications made to the child’s bedroom.
Conclusions: Asthma education provided in a culturally responsive manner increases asthma
knowledge and facilitates changes to the levels of asthma triggers in the child’s bedroom.
Title: Home-based Family Education to Improve Medication Adherence. Enhancing medication
adherence among inner-city children with asthma: results from pilot studies.
Authors: Bartlett SJ, Lukk P, Butz A, Lampros-Klein F, & Rand CS.
Year: 2002
Journal: Journal of Asthma
Hypothesis/Research Questions: Pilot test an intervention through social learning strategies
and targeting known barriers through an individualized, family-based, asthma action plan.
Target Population/Geographic Area: African American children with asthma and their
mothers living in inner-city Baltimore.
Methods: Nurses made weekly home visits over a period of 4-5 weeks to provide education and
feedback on medication adherence to children and their mothers. Electronic monitors were installed on
the children’s metered-dose inhaler to provide feedback on medication adherence to families and
validate medication use.
Results: At baseline, only 28.6% of children were using their medications as prescribed. Within four
weeks, appropriate utilization of medications increased to 54.1%, the number children underutilizing
their medications decreased from 51.2% to 25.4%. By the end of the intervention, the number of
children not reporting any utilization of their medications decreased from 28.1% to 15.1%.
Conclusion: An individualized, home-based intervention can significantly increase adherence to the
daily use of inhaled steroids by inner-city children with asthma.
Title: Easy Breathing. The effect of Easy Breathing on asthma management and knowledge.
Authors: Cloutier MM, Wakefield DB, Carlisle PS, Bailit HL, & Hall CB
Year: 2002
Journal: Archives of Pediatrics and Adolescent Medicine
Target Population/Geographic Area: Primary care physicians, midlevel practitioners,
nurses, and pediatric and family practices residents and medical students.
Methods: Provider knowledge of asthma facts, guideline recommendations, and applications was
assessed by pre- and post-test after a training program for implementation of Easy Breathing
Results: Using hospital admissions data, there was an increase in physician adherence to National
Asthma Education and Prevention Program Guidelines for inhaled corticosteroid use (98% versus 20%
nationally); an increase in utilization of anti-inflammatory therapy to treat asthma (from .18 to .46),
which is associated with a significant decrease in the number of hospital days for children with asthma;
a decrease from 1.44 hospital days per year among children with asthma in the year before starting the
intervention to .42 hospital days, and a further decrease after the second year of implementation to .19
hospital days. It is worth noting that this number of days comes close to the average hospital days per
year for children without asthma (.12). The intervention also saw a reduction of emergency room visits
by 30%, and a three-fold reduction in oral corticosteroid use.
Conclusion: Easy Breathing increases clinician knowledge and utilization of national asthma
guidelines; primary care physicians believe they are adhering to these guidelines even when data shows
they are not. If equitably, and culturally appropriately, implemented, this intervention has the potential
to significantly decrease the number of sick days and subsequent hospitalizations for all children with
asthma.
Title: Family Coordinator Asthma Education Program. An individualized intervention to improve
asthma management among urban Latino and African American families.
Author: Bonner S, Zimmerman BJ, Evans D, Irigoyen M, Resnick D, & Mellins RB.
Year: 2002
Journal: Journal of Asthma
Target Population/Geographic Area: Urban Latino and African American families with a
child with asthma
Hypothesis/Research Question: An educational intervention based on a readiness model will
lead to improved health outcomes among patients with asthma.
Methods: Baseline interviews were conducted in participants’ homes; families were randomly
assigned to intervention or control groups. The intervention group received education from a family
coordinator who served as a behavioral change agent. Three education sessions were conducted at one
month intervals with the families, and included using an asthma diary as a primary intervention tool and
building on patients’ capacity for asthma management. The family coordinator also conducted home
visits and helped the family prepare for and attend doctor visits.
Results: Intervention families’ knowledge of asthma increased to 67% correct, compared to 40%
among control families. There was a 41% increase in asthma management self-efficacy, and at followup, 66% of the intervention group had reached asthma compliance or self-regulation. Increased
prescription of asthma-control medications by physicians occurred in the intervention group, with more
than 85% reporting proper adherence. At follow-up, 26% of families reported cough or wheeze more
than twice a week, 14% reported waking at nighttime due to asthma more than twice a week, and 26%
reported keeping the child at home more than twice a month. The respective frequencies for the control
group were 50%, 40%, and 48%. The intervention group also reported a 20% reduction in activity
restrictions, compared to a 2% increase among the control group.
Conclusions: The intervention was successful at increasing asthma self-management.
Title: Pediatric Asthma Program. A randomized field trial of the ACINDESs (Association for Health
Research and Development, Buenos Aires, Argentina): a child centered training model for children with
chronic illnesses (asthma and epilepsy).
Author: Tieffenberg JA, Wood EI, Alonso A, Tossutti MS, & Vincente MF.
Year: 2000
Journal: Journal of Urban Health
Hypothesis/Research Question: Assess the effectiveness of a school-based asthma education
program founded on the basis of a child’s autonomy.
Target Population/Geographic Area: Spanish-speaking school-aged children aged 6-15 years
who have been diagnosed with moderate to severe asthma, in Buenos Aires, Argentina.
Methods: Participants attended five weekly two-hour group meetings, parents and children were in
separate sessions conducted at the same time, followed by reinforcements meetings two and six
months after the group meetings ended. Professional teachers led the sessions, and used games,
drawings, stories, videos, and role play to explain concepts surrounding the child’s condition, body
signals, warning signs, triggers, treatment alternatives, risks, emergency home treatment, and decisionmaking skills based on expected values.
Results: Parents in the intervention group showed increased knowledge about asthma, while those in
the control group showed decreased knowledge. Parental fear of the child’s death due to asthma
decreased dramatically, from 39% to 4%, in the intervention group, while the control group experienced
no change. Children’s confidence in self-care increased, and experienced a significant decrease in
asthma crises. Medical care visits decreased from 3.29 to 1.65, missed school days decreased by almost
half to 5.91 from 10, and school attendance for the intervention group was above that of a sample of
children in Buenos Aires without a chronic illness during the same time period.
Conclusions: This program reportedly represents the first Hispanic child-centered group training
program in Latin America focused on asthma self-management, and resulted in increased selfmanagement of asthma among children, fewer missed school days, and fewer medical visits.
Title: Wee Wheezers at Home
Author: Brown JV, Bakeman R, VCelano MP, Demi AS, Kobrynski L, & Wilson SR.
Year: 2002
Journal: Journal of Pediatric Psychology
Target Population/Geographic Area: Inner-city African American children younger than 7
years from low-income families in the Atlanta, Georgia metro area, who had at least one healthcare visit
for asthma in the previous year, who were prescribed daily use asthma medication, and whose primary
caregiver spoke English.
Hypothesis/Research Question: Does an in-home education intervention positively impact
asthma outcomes for young children?
Methods: Participants received three study-related visits by a social worker (introduction and two
data collection follow-up visits). The Wee Wheezers intervention had previously been adapted and
piloted, so it was modified for use in this target population (individual families), handouts were tailored
for low-literacy and child audience, and the instructors delivered the information in eight sessions rather
than four. The eight education sessions were provided weekly by registered nurses in the participants’
homes. Each session reviewed a checklist of the child’s asthma symptoms over the previous week,
discussion of homework assignments, and asthma topics including management, medications, triggers,
action planning, and communication. Responses to questions based on the educational objectives
guided subsequent sessions.
Results: Children ages 1-3 in the intervention group were less bothered by asthma symptoms, as
were there caregivers, than the control group at three month and one-year follow-up visits. Younger
children also saw significantly more symptom-free days than the control group. The older age group did
not see any significant intervention effects.
Conclusions: There were intervention effects for younger children, though not for older children.
Additional studies should be conducted to determine what could be causing the drop-off in
effectiveness after age 3.
Title: Open Airways. The impact of health education on frequency and cost of health care use by low
income children with asthma and A school health education program for children with asthma aged 8-11
years.
Author: Clark NM, Feldman CH, Evans D, Levinson MJ, Wasilewski Y, & Mellins RB.; Evans D, Clark NM,
Feldman CH, Rips J, Kaplan D, Levinson MJ, Wasilweski Y, Levin B, & Mellins RB.
Year: 1986; 1987
Journal: Journal of Allergy and Clinical Immunology; Health Education Quarterly
Hypothesis/Research Question: Does an educational setting-based intervention increase
school children’s asthma knowledge for symptoms, triggers, and medication use?
Target Population/Geographic Area: Low-income African American and Latino children
between the ages of 8 and 11.
Methods: Six group sessions provided education to children on basic information about asthma, how
to recognize symptoms and triggers, how to use medication effectively, and how to handle problems at
school.
Results: Participants showed significant improvement in school performance, asthma selfmanagement behaviors, and a decreased number of asthma episodes.
Conclusions: The intervention was effective in reducing asthma burden in the intervention group.
Cross-references: School Health
Cancer
Title: The development of a community action plan to reduce breast and cervical cancer disparities
between African-American and White women.
Author: Fouad MN, Nagy MC, Johnson RE, Wynn TA, Partridge EE, & Dignan M.
Year: 2004
Journal: Ethnic Disparities
Hypothesis/Research Question: Can community action plant developed by a coalition of
academic, state, and community-based partnerships eliminate breast and cervical cancer disparities
between African American and White women?
Target Population/Geographic Area: Rural and urban low-income African American women
in Alabama.
Methods: The researchers conducted community capacity building that included establishing a 12member coalition of community organizations, and a community volunteer network. Needs assessments
were conducted and found three levels of barriers to screening, that were incorporated in to the
development of a community-driven community action plan.
Results: A coalition of diverse organizations can partner and create community action plans to
improve the health of their communities.
Conclusions: Involving the community from the beginning and using their knowledge and
experience to develop an action plan increases the likelihood of successful interventions.
Title: Targeted intervention strategies to increase and maintain mammography utilization among
African American women.
Author: Fouad MN, Partridge E, Dignan M, Holt C, Johnson R, Nagy C, et al.
Year: 2010
Journal: American Journal of Public Health
Hypothesis/Research Question: What is the impact of a culturally relevant intervention for
increasing mammography screening among African American women?
Target Population/Geographic Area: African American women in eight underserved
counties in Alabama.
Methods: Trained volunteers provided messages tailored for the target population encouraging
adoption and maintenance of mammography screening behaviors. Data was collected at baseline and
follow up (the intervention spanned two years).
Results: After the intervention, there was a ten percent decrease in women who reported never
being screened, a four percent increase in women who were infrequently screened, and a six percent
increase in women who were regularly screened for breast cancer.
Conclusions: Tailored motivational messages provided by peers can increase mammography
screening rates among African American women.
Title: Knowledge about breast cancer and participation in a faith-based breast cancer program and
other predictors of mammography screening among African American women and Latinas.
Author: Darnell JS, Chang CH, & Calhoun EA.
Year: 2006
Journal: Health Promotion Practice
Hypothesis/Research Question: What is the impact of participation in a church-based breast
cancer education program on mammography screening among African American and Latina women?
Target Population/Geographic Area: African American and Latina women.
Methods: Passive exposure to breast cancer information, as measured by information that was heard,
seen, or read was collected. Self-reported data on mammography utilization was collected from women
in each setting and compared using logistic regression to assess the impact of the information
provided/women were exposed to, to the self-reports.
Results: Passive exposure was found to be significantly associated with the likelihood of
mammography use among African American women, specifically those who reported exposure to the
information at their churches four or more times in the last year. These women were fifteen times more
likely to report mammography use than women reporting exposure to the information one time.
Messages from pastors and included in the church bulletin were the most significant predictors of
mammography use. Knowledge was not associated with increased utilization of mammography. The
hypothesis did not prove to be statistically significant for Latinas.
Conclusions: A faith-based breast cancer program is effective at increasing awareness about the
importance of mammography screening in African American women. The study would have benefited
from collecting baseline information on frequency of mammography use by women in the churches, in
order to more directly determine a causal effect of the information being presented in a faith-based
setting.
Cardiovascular Disease and Stroke
Title: Well-integrated Screening and Evaluation for Women across the Nation (WISEWOMAN);
Racial/ethnic disparities in coronary heart disease risk factors among WISEWOMAN enrollees
Author: Finkelstein EA, Khavjou OA, Mobley LR, Haney DM, & Will JC.
Year: 2004
Journal: Journal of Women’s Health
Hypothesis/Research Question: Assess the presence of racial/ethnic disparities and test if
those disparities can be explained by differences in individual characteristics and/or community
characteristics.
Target Population/Geographic Area: The study used baseline data for all WISEWOMAN
participants, with findings stratified by race/ethnicity.
Methods: Using baseline data for WISEWOMAN participants, the researchers captured information
on cardiovascular disease risk factors including body mass index (BMI), systolic and diastolic blood
pressure, high-density lipoprotein (HLD) and total cholesterol, diabetes and smoking prevalence, tenyear coronary heart disease (CHD) risk, and treatment and awareness of high cholesterol, hypertension,
and diabetes.
Results: There was a high prevalence of cardiovascular disease (CVD) risk among WISEWOMAN
participants, and statistically significant racial and ethnic disparities for risk factors. Black participants
were at highest risk for CVD compared to other groups, while Hispanic and Alaska Native participants
were at less risk than White participants. Though some racial and ethnic disparities were explained by
differences in individual and community characteristics, others remained even after they were
controlled for.
Conclusions: The relationship between community characteristics and racial and ethnic disparities in
CVD risk factors indicates that community-wide interventions may be required to eliminate disparities.
WISEWOMAN projects that are successful are likely to decrease racial and ethnic disparities in addition
to overall CVD risk factors.
Cross-references: Nutrition, Physical Activity, and Obesity; Diabetes; Tobacco
Title: An evaluation of the Nashville REACH 2010 community health screening strategy.
Author: Schlundt DG, Greene C, Reid R, McClellan L, Dowling L, Sheats JL, et al.
Year: 2006
Journal: Journal of Ambulatory Care Management
Hypothesis/Research Question: Are community screening participants representative of the
target population for the Nashville REACH 2010 project? How often were screening participants with
undiagnosed hypertension, high cholesterol, and diabetes identified? How often were participants in
community screenings identified as “elevated risk” for developing hypertension, high cholesterol, or
diabetes? How often were community screening participants identified as “suboptimal” in the
management of their disease (hypertension, high cholesterol, and diabetes)?
Target Population/Geographic Area: African Americans attending community based
screenings in North Nashville, Tennessee
Methods: The researchers stratified data collected during community screenings to evaluate the
differences in populations served versus those not seeking out screenings. Results from the community
screenings were compared to telephone surveys among Nashville residents.
Results: Community screening participants were younger and healthier overall than the target
population of African Americans in North Nashville, Tennessee. Rates for potentially undiagnosed cases
of diabetes, hypertension, and high cholesterol in the community screening group were .8%, 17.4%, and
32.7% respectively. Individuals at high risk were identified 13.1% (diabetes), 45.3% (hypertension), and
21.3% (cholesterol) of the time. Poorly controlled disease rates were 23.5% for diabetes, 39% for
hypertension, and 58.2% for cholesterol.
Conclusions: Though the population participating in community screenings was younger and
healthier than the community as a whole, there were still many people identified for potential health
risks, and the model used in this study can be used to implement a successful community-based
screening.
Cross-reference: Diabetes
Diabetes
Title: Special Diabetes Program for Indians, Diabetes Prevention Program; Translating the diabetes
prevention program into American Indian and Alaska Native communities: results from the Special
Diabetes Program for Indians Diabetes Prevention demonstration.
Author: Jiang L, Manson SM, Beals J, Henderson WG, Huang H, Acton KJ, & Roubideaux Y.
Year: 2013
Journal: Diabetes Care
Hypothesis/Research Question: Can a modified version of the Diabetes Prevention Program
prevent or delay the onset of diabetes for American Indian and Alaska Native communities?
Target Population/Geographic Area: American Indian and Alaska Native tribes.
Methods: The modified Diabetes Prevention Program was delivered in 36 healthcare programs that
served a total of 80 different tribes. At baseline, participants received a clinical assessment to determine
their diabetes status and risk. The intervention was a 16 session “Lifestyle Balance Curriculum”. Shortly
after finishing the curriculum, participants again received a clinical assessment. For up to three years
after completion of the intervention, participants’ diabetes status was evaluated.
Results: Significant improvements in outcome measures (weight, blood pressure, lipid levels) were
seen in the intervention group at each stage of data collection. Intervention participants that attended
the greatest number of the 16 sessions were more likely to have decreased incidence of diabetes,
increased weight loss, and an improvement in systolic blood pressure.
Conclusions: This modified lifestyle intervention has great potential to work in American
Indian/Alaska Native communities.
Cross-references: Cardiovascular Disease and Stroke; Nutrition, Physical Activity, and Obesity.
Title: Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving
diabetes related outcomes among African American and Latino adults.
Author: Two Feathers J, Kieffer EC, Palmisano G, Anderson M, Sinco B Janz N, et al.
Year: 2005
Journal: American Journal of Public Health
Hypothesis/Research Question: What are the effects of a community-based diabetes lifestyle
intervention on risk factors for diabetes complications in African Americans and Latinos with type 2
diabetes?
Target Population/Geographic Area: African American and Latino adults with diabetes in
Detroit, Michigan.
Methods: An educational curriculum was delivered by trained community residents to provide
information on dietary, physical activity, and diabetes self-care behaviors. Baseline data were collected
on quality of life, diet, physical activity levels, self-care knowledge, self-care behaviors, and hemoglobin
A1C levels; these measures were collected again at post-intervention.
Results: Statistically significant improvements were seen in post-intervention dietary knowledge and
behaviors, and in post-intervention physical activity knowledge. A statistically significant improvement
in hemoglobin A1C levels was seen in the intervention group when compared to individuals in the same
healthcare system (who saw no change).
Conclusions: A culturally tailored diabetes intervention delivered by trained community residents
produced significant improvements in dietary and diabetes self-care knowledge and behaviors, in
addition to improvements in metabolic outcomes.
Cross-reference: Nutrition, physical activity, and obesity.
Title: Diabetes management: utilizing community health workers in a Hawaiian/Samoan population.
Author: Beckham S, Bradley S, Washburn A, & Taumua T.
Year: 2008
Journal: Journal of Health Care for the Poor and Underserved
Hypothesis/Research Question: What are the impacts of community health workers on
diabetes management among a predominantly Native American and Samoan population?
Target Population/Geographic Area: Native Hawaiian and Samoan individuals with
hemoglobin A1C greater than 10%.
Methods: Community health workers delivered tailored interventions to the population. Baseline
hemoglobin A1C levels were compared to levels measured after the intervention.
Results: Participants completing the intervention saw a statistically significant reduction of
hemoglobin A1C levels (2.2-1.8%) compared to individuals who did not receive the intervention (.2%1.5% reduction).
Conclusions: Community health workers can positively impact diabetes self-management as
measured by hemoglobin A1C levels in the Native Hawaiian and Samoan populations.
Nutrition, Physical Activity, and Obesity Prevention
Title: Improving health behaviors in an African American community: the Charlotte Racial and Ethnic
Approaches to Community Health project.
Author: Plescia M, Herrick H, & Chavis L.
Year: 2008
Journal: American Journal of Public Health
Hypothesis/Research Question: What is the effect on low fruit and vegetable consumption,
low physical activity, and cigarette smoking of an intervention in an African American community in
North Carolina?
Target Population/Geographic Area: An African American community in North Carolina.
Methods: A community coalition, lay health advisor program, and policy and community
environmental changes were implemented over a four year period in a predominantly African American
community. Responses to the Behavioral Risk Factor Surveillance System survey, administered to a
cross-section of the community every year, were compared to African Americans’ responses to the
national survey.
Results: All three health behaviors were improved in the intervention populations. Among women
and middle-aged adults, these improvements were statistically significant for physical activity and
smoking. After the intervention, physical activity rates increased from baseline to comparable to those
of African Americans nationwide, and reported fruit and vegetable consumption rates were significantly
higher when compared to the national sample.
Conclusions: Policy and community environmental changes alongside community engagement are a
promising practice to improve health behaviors and outcomes in African American communities.
Cross-reference: Cardiovascular Disease and Stroke; Diabetes; Tobacco Prevention and Control.
Title: Wellness within REACH: mind, body, and soul: a no-cost physical activity program for African
Americans in Portland, Oregon, to combat cardiovascular disease.
Author: McKeever C, Faddis C, Koroloff N, & Henn J.
Year: 2004
Journal: Ethnic Disparities
Hypothesis/Research Question: Can a no-cost physical activity program increase the number
of African Americans leading active lifestyle and influence community norms?
Target Population/Geographic Area: African Americans living in Portland, Oregon.
Methods: African American instructors were certified to conduct exercise classes at community
locations. A pre- and post- exercise questionnaire was administered quarterly to participants to assess
attendance frequencies, lifestyle changes, and attitudes.
Results: More than 700 participants have attended the exercise classes, and 58% of respondents
reported exercising more currently than in the six months before joining the program.
Conclusions: Providing classes that are centered around the community’s culture, a movement of
health, active living has started in the community.
Cross-reference: Cardiovascular Disease and Stroke; Diabetes.
Title: Partnership for an Active Community Environment (PACE); Effect of changes to the
neighborhood built environment on physical activity in a low-income African American neighborhood.
Author: Gustat J, Rice J, Parker KM, Becker AB, & Farley TA.
Year: 2012
Journal: Preventing Chronic Disease
Hypothesis/Research Question: How will changes in the built environment affect residents’
physical activity levels in a low-income, predominantly African American neighborhood in New Orleans?
Target Population/Geographic Area: Low-income, African Americans in New Orleans,
Louisiana.
Methods: The researchers built a six-block walking path and installed a school playground in the
intervention neighborhood. Data on physical activity levels in the neighborhood and two comparison
neighborhoods was collected by self-report, conducting door-to-door surveys, and through direct
observation before and after the intervention.
Results: At baseline, all three neighborhoods were similar in demographics, physical activity locations,
and percent of residents reporting physical activity. Self-reports of physical activity increased for all
three neighborhoods over time, though the proportion of residents who were observed being active
increased in the section of the intervention neighborhood where the walking path was installed. Levels
of physical activity observed were more likely to be moderately to vigorously active in the intervention
neighborhood (41%) than in the comparison neighborhoods (24% and 38%).
Conclusions: Changes to the built environment may increase levels of physical activity in lowincome, African American neighborhoods.
Safe Riders
Title: Restraint use law enforcement intervention in Latino communities.
Author: Schaechter J, Uhlhorn SB.
Year: 2011
Journal: Journal of Trauma-Injury Infection and Critical Care
Hypothesis/Research Question: What is the effect of an intervention that combines warnings
and citations enforcement on restraint use in Latino communities?
Target Population/Geographic Area: Latino-majority communities
Methods: Researchers conducted a community awareness campaign, equipment distribution and
education demonstrations for proper use of restraints, and a phased law-enforcement intervention.
Data was collected in all three communities for baseline information on restraint use, and again at each
stage of the intervention.
Results: The combined intervention showed a significant increase in driver and child passenger
restraint in one of the intervention communities, only driver restraint in the other intervention
community. Significant increases in restraint use were also observed among drivers in the control
community. The law enforcement phase of the intervention did not result in significant increases in
restraint use, and complications related to unlicensed drivers interrupted this phase.
Conclusions: The combined efforts of this intervention may be effective in Latino communities,
though it is likely that the law-enforcement phase is unnecessary to realize similar results.
Title: Child care centers: a community resource for injury prevention.
Author: Stuy M, Green M, Doll J.
Year: 1993
Journal: Journal of Developmental and Behavioral Pediatrics
Hypothesis/Research Question: Will a child care center-based intervention positively
influence routine use of child restraint devices?
Target Population/Geographic Area: Urban child care centers, children two to six years old.
Methods: A five month educations intervention was implemented at one of the child care centers.
These interventions included weekly presentations by staff to the children at the center and
documentation of parental awareness of the center’s policies surrounding child restraint use.
Results: There were statistically significant increases in child restraint use among participants
enrolled in the intervention
Conclusions: Child care center policies and programming can effectively promote child passenger
safety and increased use of child restraint devices.
Worksite Wellness
Title: Putting promotion into practice: the African Americans building a legacy of health organizational
wellness program.
Author: Yancey AK, Lewis LB, Guinyard JJ, Sloane DC, Nascimento LM, Galloway-Gilliam L, et al.
Year: 2006
Journal: Health Promotion Practice
Hypothesis/Research Question: Will an organizational wellness intervention successfully
incorporate physical activity and healthy food choices into the daily activities of public and private
agencies?
Target Population/Geographic Area: Public and private non-profit sector agencies in Los
Angeles.
Methods: A training on physical activity and healthy food choices was conducted over a 12-week
period by the local health department, and a modified version was available over a six-week period.
Attendance and retention rates were collected, as were information on feelings of sadness or
depression, fruit and vegetable intake, and body mass index.
Results: Attendance/retention improved for the six-week version of the training. The 12-week session
resulted in significant reduction in feelings of sadness/depression and significant increases in fruit and
vegetable intake, while marginal decreases in body mass index were seen in the same group. Six-week
intervention participants saw a significant increase in the number of days participating in vigorous
physical activity.
Conclusions: This model is a promising practice for increasing the reach of environmental-change
level work-site wellness programming to organizations and populations that are not traditionally
involved in these efforts.
Cross-reference: Cardiovascular Disease and Stroke; Nutrition, Physical Activity, and Obesity