Stephen B. Thomas, Ph.D.

Stephen B. Thomas, Ph.D. Inaugural Philip Hallen Professor of Community Health & Social Justice Associate Dean for Diversity Principal Investigator, Research Center of Excellence on Minority Health Disparities Center for Minority Health Graduate School of Public Health University of Pittsburgh sbthomas@pitt.edu

G-20 Summit: Today, the world comes calling on Pittsburgh

The Healthy Black Family Project: Using Community Engagement Research to Eliminate Health Disparities Presentation for: P2 Collaborative of Western New York Third Annual Conference: Creating A Healthy Community September 24, 2009 Buffalo, NY

The University of Pittsburgh Center for Minority Health Established in 1994 with grant from R.K. Mellon Foundation Vision: Eliminate Racial/Ethnic Health Disparities

Kilbourne, A.M., et al., Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health, 2006. 96(12): p. 2113-21.

The Social Context of Health Disparities The ultimate aim is to uncover social, cultural and environmental factors beyond the biomedical model and address a broad range of issues. This approach includes, but not limited to, breaking the cycle of poverty, increasing access to quality health care, eliminating environmental hazards in homes and neighborhoods, and the implementation of effective prevention programs tailored to specific community needs.

The Burdens of Race and History Because of historic inequalities and racism in the health care system, many African Americans may delay seeking health care. Beliefs about health and illness also influence community response to health communication messages designed to promote health and prevent disease.

Secret Tuskegee Study: free autopsy, free burial, plus $100 bonus! Lou Erikson Atlanta Journal Constitution July 1972

Presidential Apology for the Syphilis Study Done at Tuskegee May 16, 1997 The people who ran the study at Tuskegee diminished the stature of man by abandoning the most basic ethical precepts. They forgot their pledge to heal and repair. They had the power to heal the survivors and all the others and they did not. William Jefferson Clinton The White House

LEADERSHIP MATTERS

THE ORIGINS OF MINORITY HEALTH IN THE U.S. THE NEGRO HEALTH MOVEMENT 1915-1951 In 1915, Booker T. Washington, founder of Tuskegee Institute, viewed the poor health status of blacks as an obstacle to economic progress and issued a call to action for. the Negro people to join in a movement which shall be known as Health Improvement Week".

GREENHOUSE

2001 FEDERAL DHHS TAKE A LOVED ONE TO THE DOCTOR DAY IN PITTSBURGH TAKE A HEALTH PROFESSIONAL TO THE PEOPLE

Natural Choice Barbershop

ACTIVITIES: TAKE A HEALTH PROFESSIONAL TO THE PEOPLE Blood pressures and Ask the Pharmacist in each shop Asthma Screenings Ask the Dentists Nursing and Health Educators Ear Examinations Ronald McDonald Children s Hospital Van and Pediatricians HIV/AIDS Street Outreach

TAKE A HEALTH PROFESSIONAL TO THE PEOPLE DAY Targeting consumers and shop/salon owners and staff in ten (10) African American owned and operated barbershops and beauty salons in predominantly black neighborhoods in the City of Pittsburgh.

EVIDENCE OF REACH In 2006, we had 142 health professionals screen 700 people in ten barbershops/salons in one day. In 2008, we had 250 health professionals screen 700 people in ten barbershops/salons in one day.

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SUSTAINABILITY

In 2002 and 2003, scientific consensus emerged around prevention of diabetes and hypertension. It is noteworthy that pre-diabetes and pre-hypertension share common risk factors amenable to modification through similar lifestyle behavior changes. Namely, increasing physical activity and healthy eating all designed to reduce excess weight and maintain a normal body mass index can lead to significant reductions in morbidity and mortality (NIDDK, DPP Lifestyle Materials, 2006).

A Community-Base Intervention Designed for Health Promotion and Disease Prevention (7,000 plus participants) THE HEALTHY BLACK FAMILY PROJECT:

The Healthy Black Family Project One dot = 100 African Americans Health Empowerment Zone

HBFP Participants Level 1 HBFP Enrollment 7000 Enrollment Kingsley Association 2480 Hosanna House 383 Undesignated 3845 TOTAL 6708 Enrollment Cumulative Male 1714 Female 4994 HBFP Enrollment by Gender n = 6708 6000 5000 Male 26% 4000 3000 2000 1000 0 Female 74% Male Female Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 (Data From 10/1/2005 through 3/31/2007)

LESSONS FROM EVIDENCE BASED RESEARCH Focus on common risk factors for chronic disease Pre-hypertension and Pre-Diabetes Smoking Obesity Stress Genetic Family health history

FAMILY HEALTH HISTORY INTERVIEW

THE PEDIGREE: A GENETIC FAMILY HEALTH TREE The goal of the session is to elicit a three-generation pedigree for accurate risk assessment.

Updated February 18th, 2008 603 African-Americans (97%) 508 African-American Females (84%) 95 African-American Males (16%) Research Database (84.8%) 624 Individuals Enrolled in Minority 610 African-Americans (98%) 522 Females (84%) 101 Males (16%) Data has been analyzed on 623 family histories 736 Genetic Family Health Histories

Individuals with a Moderate or High Risk of Disease Based on Genetic Family Health History Hypertension 475 (77%) Diabetes 369 (60%) Cardiovascular Disease 374 (60%) Cancer 189 (30%) Breast cancer 86 (14%) Colon cancer 64 (10%) Ovarian cancer 24 (5%) Prostate cancer 15 (15%)

PROGRAM ACTIVITIES Physical Activity Nutrition Education & Guidance Stress Management Smoking Cessation Family Health History Self-Management of Chronic Disease Referral to Medical Home

LEVEL 4: PRELIMINARY IMPACT

35 30 25 20 15 10 5 0 Underweight (<18.50) BMI Categories of Baseline and Time 1 of Healthy Black Family Cohort of Women (n=122), February 25, 2006 Healthy (18.5-24.9) Overweight (25.0-29.9) BMI Categories ObeseCl1 (30.0-34.9) ObeseCl2 (35.0-39.9) ObeseCl3(>40.0) Baseline Time 1 Percentage

Cohort of Women in the Healthy Black Family Project, Percent Weight Change from Baseline to Time 1 (n=122) Feburary 25, 2008 8 10 18 Mean Total Classes: 40 3 3334 4 4444 4 5555 6 6 66 7 Gained (39%) 3 3333 2 2223 Mean Total Classes: 77-1 -1-1-1-1 -1-2 -2-2 -2-2 -2-2 -2-1-1 0 0-100 0 0000 0 1 1111 Same Weight (10%) Lost 0-5% (32%) -29-18 -14-11 -11-10 -10-10 -9-8-8-8 -8-8-7-7-7-7 -3-3-3-3-3-3-3-3 -6-5 -5-5 -5-5 -5-5 -5-5 -5-4 -4-4-4-3 Lost 5-7% (6%) Lost >=7% (12%) -40-30 -20-10 0 10 20 Percent Change 1 112 2

Actual Member: Name: LH Gender: Female Age: 58 Classes Attendance African Dance-Evening 2 1 Beginning Yoga-Evening 8 Beginning Yoga Morn: 20 Body Toning-Afternoon 50 Body Toning-Evening 30 Nutrition Seminar-Evenin 1 Silver Sneakers-Afternoo 1 Silver Sneakers-Morning 2 Stress Management-Evenin 4 Walk/Run-Evening 1 Walking Class-Afternoon 1 Water Aerobics/Workout-M 1 Yoga-Evening 1 7 Yoga-Morning 1 11 Yoga-Morning 2 2 Yoga-Morning 3 69 TOTAL ACTIVITIES 209 Fitness Assessment 1: 9/14/2005 Member Analysis Member Analysis Fitness Assessment 2: 1/10/2007 Weight 220 Weight 196 BMI 39.0 BMI 34.7 Meds n/a/ Meds n/a/ Member's Participation Over Time Activities 35 30 25 20 15 10 5 0 Oct '05 Nov '05 Dec'05 Jan '06 Feb '06 Mar '06 Apr '06 May '06 Jun '06 Jul '06 Aug '06 Sep '06 Oct '06 Nov '06 Dec '06

AUTOMATED HBFP ID CARD

SELECTED FUNDING PARTNERS The Pittsburgh Foundation The DSF Charitable Foundation Highmark Foundation Heinz Endowments Robert Wood Johnson Foundation NIH National Center on Minority Health & Health Disparities Dr. Judith Davenport Mr. Nicolas Beldecos

Stephen B. Thomas, Ph.D. Inaugural Philip Hallen Professor of Community Health & Social Justice Associate Dean for Diversity Principal Investigator, Research Center of Excellence on Minority Health Disparities Center for Minority Health Graduate School of Public Health University of Pittsburgh sbthomas@pitt.edu

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