A Closer Look at African American Men 

and High Blood Pressure Control 

A Review of Psychosocial Factors and Systems-Level Interventions 

U.S. Department of Health and Human Services 

Centers for Disease Control and Prevention 

National Center for Chronic Disease Prevention and Health Promotion 
Centers for Disease Control and Prevention 

National Center for Chronic Disease Prevention and Health Promotion 

Division for Heart Disease & Stroke Prevention 

Mail Stop K–47 · 4770 Buford Highway, NE · Atlanta, Georgia 30341 

800-CDC-INFO · cdcinfo@cdc.gov · www.cdc.gov/DHDSP 

10_211234-A 
 

 

Suggested Citation: 

Centers for Disease Control and Prevention. A Closer Look at African American Men 

and High Blood Pressure Control: A Review of Psychosocial Factors and Systems-Level 

Interventions. Atlanta: U.S. Department of Health and Human Services; 2010. 

Photos: 

The photographs used in this publication are for illustration purposes only. They 

show African American men from various age groups. They are not intended to 

depict people who have high blood pressure or who had a heart attack or stroke. 

For Free Copies or Additional Information: 

E-mail: cdcinfo@cdc.gov 

Write: Division for Heart Disease and Stroke Prevention, NCCDPHP 

Centers for Disease Control and Prevention 

4770 Buford Highway, NE, Mailstop K-47 

Atlanta, GA 30341 

Phone: 1-800-CDC-INFO (232-4636) 

TTY: 1-888-232-6348 

Online: http://www.cdc.gov/dhdsp 

The findings and conclusions in this document are those of the author(s) and do 

not necessarily represent the official position of the Centers for Disease Control 

and Prevention/the Agency for Toxic Substances and Disease Registry. 
 

 

 

 

 

 

 

Table of Contents
 

Chapter Page 

Acknowledgments.......................................................................................................................................3
 

Top 10 Considerations for Public Health Programs When Planning Systems-Level Interventions for 


African American Men to Control High Blood Pressure.......................................................................5
 

Recommendations ......................................................................................................................................6
 

Preface ........................................................................................................................................................9
 

Chapter 1 - Introduction ..........................................................................................................................13
 

Chapter 2 - The Burden of High Blood Pressure.......................................................................................15
 

2.1 Overview......................................................................................................................................... 16
 

2.2 Morbidity........................................................................................................................................ 16
 

2.2.1 Elevated Blood Pressure ........................................................................................................ 16
 

2.2.2 Hypertension Awareness, Treatment, and Control ................................................................ 17
 

2.2.3 Heart Disease ....................................................................................................................... 19
 

2.2.4 Stroke................................................................................................................................... 20
 

2.3 Mortality ......................................................................................................................................... 20
 

2.3.1 Death Rates from Hypertensive Disease................................................................................ 20
 

2.3.2 Death Rates from Heart Disease........................................................................................... 23
 

2.3.3 Death Rates from Cerebrovascular Disease ........................................................................... 24
 

Chapter 3 - Psychosocial Aspects of Blood Pressure Control among African American Men....................27
 

3.1 Overview......................................................................................................................................... 27
 

3.2 Perceived Racism, Experienced Racism, and Racial Discrimination ................................................. 27
 

3.3 Knowledge, Beliefs, and Attitudes about Hypertension.................................................................... 29
 

3.4 Access to Care ................................................................................................................................. 30
 

3.5 Health Insurance ............................................................................................................................. 30
 

3.6 Quality of Care................................................................................................................................ 31
 

3.7 Socioeconomic Status ...................................................................................................................... 32
 

3.8 Rural Residence............................................................................................................................... 33
 

3.9 Social Support ................................................................................................................................. 34
 

3.10 Depression ...................................................................................................................................... 34
 

3.11 Substance Abuse.............................................................................................................................. 35
 

3.12 Obesity............................................................................................................................................ 35
 

3.13 Emerging Knowledge about Disparities in Hypertension................................................................. 36
 

a review to address blood pressure control in african american men 1 
 

Chapter 4 - Programs with Systems-Level Interventions...........................................................................37
 

4.1 Overview......................................................................................................................................... 37
 

4.2 Summary of Lessons Learned .......................................................................................................... 38
 

4.2.1	 Overall Lessons..................................................................................................................... 38
 

4.2.2	 Lessons on Program Participation by African American Men................................................ 39
 

4.2.3	 Lessons on Cultural Competency ......................................................................................... 40
 

4.3 Interviewed Programs...................................................................................................................... 40
 

4.3.1	 Examples of Program Models ............................................................................................... 40
 

4.3.2	 Interviewed Programs Matrix................................................................................................ 42
 

4.3.3	 Individual Program Summaries............................................................................................. 43
 

4.4 Literature Search Results.................................................................................................................. 80
 

4.4.1	 Journal Article Projects Matrix.............................................................................................. 81
 

4.4.2	 Blood Pressure Control Programs Focusing on African American Men................................. 83
 

4.4.3	 Blood Pressure Control/Coronary Heart Disease Prevention Programs Focusing on the African 

American Community......................................................................................................... 90
 

4.4.4 Other Relevant Systems-Level Health Care Programs Focusing on the African 

American Community......................................................................................................... 99
 

Chapter 5 - General Health Resources....................................................................................................105
 

5.1 Overview.......................................................................................................................................... 105
 

References...............................................................................................................................................117
 

Appendix A – Key Terms and Phrases Used to Find Programs or Interventions for African American Men with 

High Blood Pressure in the Practice Literature ....................................................................................... 123
 

Appendix B – Key Terms Used to Find Peer-Reviewed Articles Relevant to Systems-Level Interventions for 

African American Men with High Blood Pressure .................................................................................. 125
 

2 african american men and blood pressure control: a closer look 
Acknowledgments 

This project was supported by a task order contract (200-2001-00123) between RTI 

International and the Division for Heart Disease and Stroke Prevention (DHDSP), 

National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC). This guide is a continuation of previous work performed by the Program Development and Services Branch 

in DHDSP. We would like to thank the following people for their participation in 

making this document a reality: 

RTI International 

Nancy D. Berkman, PhD* 

Andrea Yuen, BS* 

Erika Willacy, MPH 

Adrienne Rooks, BA* 

Linda Lux, MPH 

Shelly Harris, MPH 

Ben Beatty, MPH 

The MayaTech Corporation 

Suzanne M. Randolph, PhD* 

Expert Panel 

CDC 

Bernadette Ford Lattimore, MPH* 

Belinda Minta, MPH, MBA 

Rosanne Farris, PhD 

Sarah O’Leary, MPH, MA 

Nora Keenan, PhD 

Robert Merritt, MA 

Cathleen Gillespie, MS 

Kathryn Gallagher, MA 

Yuling Hong, MD, MSc, PhD, FAHA 

Michael Schooley, MPH 

Julie Will, PhD 

Darwin Labarthe, MD, MPH, PhD 

Sheree Marshall Williams, PhD 

Angela Soyemi, BA 

*Indicates primary project staff. 

We extend many thanks to the project’s expert panel for their guidance in the 

development and content of this guide. Their contributions and participation 

in the process were key in bringing together the document. The expert panel 

consisted of the following: 

Jean J.E. Bonhomme, MD, MPH 

Founding Member 

National Black Men’s Health Network 

Jules Harrell, PhD 

Professor, Department of Psychology 

Howard University 

B. Waine Kong, PhD, JD 

Chief Executive Officer 

Association of Black Cardiologists 

George Mensah, MD, FACP, FACC 

Director for Heart Health and 

Global Health Policy 

Corporate Research and Development Unit 

PepsiCo., Inc. 

Alan Richmond, MSW 

Director of Health Disparities 

North Carolina Institute of Minority 

Economic Development 

Herman A. Taylor, Jr, MD, MPH, 

FACC, FAHA 

Professor of Medicine 

Shirley Professor for the Study 

of Health Disparities 

Principal Investigator, Jackson Heart Study 

University of Mississippi Medical Center 

a review to address blood pressure control in african american men 3 
Top 10 Considerations for State Programs When 

Special thanks to the key informants for providing us with the information necessary 

to produce this document. They are as follows: 

Shauntice Allen, MA

University of Alabama at Birmingham 

Birmingham, AL 

Karen Boone 

Georgia Department of Human Resources’ 

Division of Public Health 

Atlanta, GA 

Jeanne Charleston 

John Hopkins University 

Baltimore, MD 

Akilah Heggs, MA 

Association of Black Cardiologists, Inc. 

Atlanta, GA 

Devon Love 

Center for MultiCultural Health 

Seattle, WA 

James Plumb, MD, MPH 

Thomas Jefferson University 

Philadelphia, PA 

Sara Eve Sarliker, MPH 

Washington State Department of Health 

Olympia, WA 

Berenice Tow 

Chicago Department of Public Health 

Chicago, IL 

Ronald Victor, MD 

Cedars-Sinai Medical Center 

Los Angeles, CA 

4 african american men and blood pressure control: a closer look 
 

 

 

 

 

 

 

 

 

 

 

 

Top 10 Considerations for State Programs When 

Planning Systems-Level Interventions for African 

American Men to Control Blood Pressure 

Because public health programs share the Division for Heart Disease and Stroke 

Prevention’s mission of “...eliminating disparities in the burden of heart disease and 

stroke,” this document provides a tool that can be used to develop or fund systemslevel interventions, particularly addressing African American men and high blood pressure control. Below is a list of considerations as public health programs plan, develop, 

and implement systems-level interventions for this underserved population: 

1. Review and become familiar with the national prevalence data on hypertension 

in African American men, as well as factors related to awareness, treatment, and 

control. Gather and analyze state and local data on this population; determine 

priority groups or localities if appropriate. 

2. Become familiar with the psychosocial factors (e.g., effects of racism, social support, 

access to care) related to high blood pressure control among African American men. 

3. Identify and share data with stakeholders that public health programs might partner with when developing interventions related to high blood pressure control in 

African American men. 

4. Collaborate with non-traditional partners (e.g., faith-based organizations, 

sororities and fraternities, barbershops) to develop and implement interventions 

for this population. 

5. Before implementing an intervention, examine the history and politics of the 

community. Be sure to include members of the community during the initial 

planning stages of an intervention or activity. Not only does this build trust, but it 

can also increase the chances that the intervention or activity will be successful. 

6. Identify settings or mechanisms for possible intervention, which may include conducting com-munity needs assessments or environmental scans of potential sites 

and how the priority group could best be reached. 

7. Identify reviewed projects and interventions that have been evaluated for possible 

pilot programs; determine characteristics of programs that are most compatible 

with potential pilot program setting. 

8. Consider reviewing information on similar interventions and programs dealing 

with men’s health concerns to discover promising or best practices regardless of 

topic area, such as prostate cancer or diabetes. 

9. Review the Lessons Learned from interviewed programs and Key Findings from 

literature reviews to use as tools to develop interventions or similar activities for 

your target population. 

10. Develop evaluation plans for proposed interventions. 

a review to address blood pressure control in african american men 5 
 

 

 

 

 

 

 

 

Recommendations 

The information gathered from literature reviews, key informant interviews, and the 

expert panel provides a comprehensive picture into the complexities of hypertension 

awareness, treatment, and control as it pertains to African American men. On the 

basis of the data presented, it is clear that high blood pressure disproportionately 

affects African American men. Because the related factors are multi-dimensional— 

ranging from perceived racism to access to care—public health programs should 

take these different factors into consideration when developing and implementing a 

systems-level intervention. 

Below are a set of recommendations created to assist in guiding public health 

programs as they create systems-level interventions to control high blood pressure 

among African American men: 

Recommendation 1:
 

Develop an evaluation plan during the initial stages of developing a systems-


level intervention.
 

Several interventions found in the peer-reviewed literature did not have evaluation 

components. Evaluation is crucial in determining the effectiveness of an intervention. 

Thinking about evaluation at the beginning can also be useful to ensure that the 

intervention is comprehensive. 

Recommendation 2:
 

Focus more research efforts on the priority population.
 

On the basis of our search of the literature, systems-level research specific to African 

American men and blood pressure control is scarce. Articles mainly focused on 

African Americans as a whole. Suggested areas of research include quality of care, 

access to care, social networks, spirituality or religion, racism, and knowledge, 

beliefs, and attitudes about high blood pressure. 

Recommendation 3:
 

Collaborate with nontraditional partners to develop and implement systems-level 


interventions. 


Chapter 5 contains a list of health resources, both traditional and nontraditional, that public health programs can partner with as they develop and 

implement interventions. 

Nontraditional partners such as faith-based organizations, fraternities, and 

barbershops are great entry points into communities and are eager to partner with 

state health departments and public health programs to make a difference in their 

respective communities. Including partners in the planning of the intervention and 

offering incentives can increase the likelihood of the success of the intervention. 

6 african american men and blood pressure control: a closer look 
 

 

 

 

 

 

 

Recommendation 4:
 

Create opportunities to educate providers on the psychosocial and cultural
 

nuances associated with this priority population.
 

Conferences, seminars, e-mail messages, and the like can be developed to educate 

providers on the psychosocial and cultural factors that are more likely to be affecting 

African American men. By providing those opportunities, public health programs 

can be instrumental in improving the quality of care for this population. 

Recommendation 5:
 

Formulate partnerships with programs focused on control and treatment of other
 

disease conditions.
 

Collaborate with other programs such as cancer, diabetes, and obesity, to increase 

the effectiveness of your efforts and to combine resources that may be limited. 

Other programs may have insight that can assist your intervention. 

a review to address blood pressure control in african american men 7 
Preface 

Chapter 1: Introduction 

This document highlights resources and systems-level interventions that focus on 

high blood pressure control among African American men. The information in this 

book will provide valuable guidance to state and local government agencies, health 

care organizations, nonprofit organizations, and other decision makers that work to 

facilitate positive changes in their states and communities. A systems-level intervention 

is defined as a change in policy, legislation, training, or environmental supports 

that impacts individual and community-level outcomes. In this book you will find 

information on lessons learned, considerations, and recommendations for public 

health programs, in hopes that the information will not only increase the number of 

systems-level interventions for African American men and blood pressure control, 

but also provide answers to questions that exist for current interventions. The book 

summarizes what other public health programs are engaged in and provides the contact 

information of those programs to support efforts of cross-program learning. Systemslevel interventions can focus on organizations, providers, patients, and the health care 

system as a whole, and also includes media campaigns. 

The Centers for Disease Control and Prevention’s Division for Heart Disease and 

Stroke Prevention contracted with RTI International to gather information on 

systems-level interventions through input from an expert panel, key informant 

interviews conducted with individuals implementing interventions, and from 

a search of the peer-reviewed and non-peer-reviewed literature. The review also 

summarizes data on the burden of high blood pressure and discusses the psychosocial 

factors associated with having the condition and accessing treatment. Lastly, the 

review identifies resources on men’s health that may be useful when considering the 

implementation of a new program or expanding an existing one. 

a review to address blood pressure control in african american men 9 
Chapter 2: The Burden of High Blood Pressure among 

African American Men 

African American men are more likely to have high blood pressure than white, Hispanic overall, or Mexican American men1 and more likely to be identified by their 

physician as having high blood pressure.2–6 This difference has consistently remained 

over time, from approximately 1988 through 2006 (the most recent data available). 

For example, from 2003 to 2006, 27% of African American men reported having high 

blood pressure, compared to 17% of white men and 15% of Mexican American men.1 

Among African American men with high blood pressure, awareness that they have the 

condition, treatment for the condition (taking medication), and control of the condition (systolic blood pressure of less than 140 mm Hg and a diastolic blood pressure of 

less than 90 mm Hg) has been increasing over time.7 Still, during the 1999 to 2004 

period, while more than half of the group was aware that they had the condition, 56% 

were receiving medications, and only 30% had their high blood pressure under control. A significant predictor of greater awareness, treatment, and control of high blood 

pressure is older age.8 

In contrast to relative trends in high blood pressure rates, the percentage of African American men with heart disease was lower than that of white men, as well as African American 

women, from 2002 to 2006.2– 6 Still, the percentage of African American men who had a 

stroke was higher than that of white and Hispanic men throughout the period. 

While death rates from hypertension (including essential hypertension, hypertensive 

heart disease, and hypertensive renal disease), increased among African American men 

and women and white men from 1999 to 2004, rates among both African American 

men and women were more than double those of white men throughout the period. 

African American men also experienced the largest percentage point increase of the 

three groups during this period; their death rates from hypertension increased by 4.5 

percentage points. African American men had higher death rates than white men 

related to essential hypertension and hypertensive heart disease.9 

Death rates related to heart disease and cerebrovascular disease declined for African 

American men and women as well as for white men from 1999 to 2005, but rates 

remained the highest among African American men.1 

Chapter 3: Psychosocial Aspects of Blood Pressure Control 

among African American Men 

A literature review was conducted to examine the results from prior studies concerning the effects of racism, attitudes towards hypertension, access to care, access to health 

insurance, quality of care, socioeconomic status, and comorbidities on hypertension 

among African American men. 

Several studies found an association between racism and higher blood pressure levels 

in African American men.10–15 Perceived racism was found to contribute to stress and 

low self-esteem, which can ultimately negatively affect blood pressure levels.10,11,12,14 

John Henryism is described as behaviors used to deal with psychosocial and environmental stressors that are often exhibited by African Americans determined to succeed 

in the face of obstacles.16,17 Among African American workers of lower socioeconomic 

status, those with high John Henryism were found to have higher blood pressure levels 

than those with low John Henryism.18 

10 african american men and blood pressure control: a closer look 
Knowledge, beliefs, and attitudes about hypertension among African Americans can 

affect health behaviors, perception of susceptibility to hypertension, and adherence to 

treatment.19 Those who are older, of lower socioeconomic status, or of lower educational attainment are more likely to have myths about hypertension.20 

Lower use of medical care services and medications among African Americans compared to whites has been found to be related to mistrust of the medical system.21–23 

This belief system can also negatively affect communication between providers and 

African American patients.22,24,25 Lack of cultural competence among health care 

providers also contributes to poor communication between providers and their African 

American patients.26 

Health insurance coverage can influence the successful control of hypertension. On 

the basis of 2006 Current Population Survey data, African American males were more 

likely to be uninsured than white males (23% compared to 17%) and less likely to 

have private insurance coverage (54% compared to 70%).27 In African Americans, the 

successful control of hypertension was found to be significantly related to health insurance coverage.28 Lack of prescription drug coverage and access to hypertensive drugs 

may play a role in this trend.29 

Quality care helps to ensure that hypertensive patients adhere to their medication regimen. Seeing the same provider has been found to be positively correlated to successful 

hypertension control. Hypertensive African Americans are significantly less likely than 

hypertensive whites to consistently see the same provider.28 Elements of quality care 

that are important for treating African Americans with hypertension include establishing good doctor-patient communication and trust,19,30 addressing possible racial 

disparities,31 and creating patient-centered interventions.32 African American patients 

with African American physicians were more likely than those non-African American 

physicians to rate their physicians as excellent.33 

While socioeconomic status does not explain all of the racial differences in hypertension rates, low socioeconomic status is a stronger predictor of hypertension among 

African Americans than whites.34, 35 Low socioeconomic status coupled with lack 

of health insurance can make it particularly difficult for this population to obtain 

adequate health care, and therefore African American men are often diagnosed with 

diseases at later stages or after a serious event.36–38 Those who reside in racially isolated 

neighborhoods are especially at risk for poor health.39 

Obesity has been strongly and positively linked to high blood pressure.40–48 Approximately two-thirds of African American men are overweight and, of these, close to half 

are obese.49 In the African American community, cultural dietary patterns and fear of 

social stigmatization have been found to deter significant changes in diet or exercise 

lifestyle modification.50–54 

a review to address blood pressure control in african american men 11 
Chapter 4: Programs with Systems-Level Interventions 

We interviewed key informants from nine programs that provide systems-level 

interventions to address high blood pressure control in African American men. The 

purpose of the interviews was to provide stakeholders with information on successful 

practices, which were determined by the program. Information obtained from 

interviews was supplemented by program evaluations, Web sites, and journal articles. 

Programs were selected on the basis of the services they provide. We did not conduct 

an independent evaluation of program quality. 

Programs were located across seven states and varied in longevity, ranging from 

1 to 34 years. Interventions included blood pressure screenings and monitoring, 

referrals to providers, patient education and media campaigns, patient outreach and 

follow-up, and trainings for community members and professionals. Examples of 

successful, sustainable practices found among these programs included implementing 

interventions in a venue primarily serving African American men (e.g., barbershops), 

forming partnerships with community organizations, using the peer-to-peer approach 

to reach out to the target population, and ensuring that program materials are 

presented in a culturally competent manner. 

This chapter also presents summaries of 11 systems-level interventions found in peer 

reviewed journal articles. These include blood pressure control programs targeting 

African American men, blood pressure control/coronary heart disease prevention 

programs targeting the African American community more generally, and programs 

focusing on other diseases that provide insight concerning recruitment of African 

American men into programs. 

Chapter 5: General Health Resources 

There are a number of organizations with which programs can potentially partner to 

facilitate program design or implement program interventions. The organizations listed 

in this chapter include associations for African American health professionals; African 

American men’s health organizations; African American organizations more generally; 

multicultural health programs at the federal, state, and local levels; and cardiovascular 

health organizations. Also included are nontraditional resources such as Historically 

Black Colleges and Universities (HBCUs) and African American fraternities and 

sororities. Although the programs often used local faith-based organizations as a 

resource, these kinds of partnerships lack central contact information at the national 

level and are not included in the chapter. 

12 african american men and blood pressure control: a closer look 
Introduction 

1 

Chapter 1: Introduction 

Heart disease and stroke impact the U.S. population in epidemic proportions. 

According to the American Heart Association, these conditions have led to direct 

and indirect costs of an estimated $475 billion in 2009. With heart disease and 

stroke being the first and third leading causes of death and major causes of disability, 

national and international experts agree that it is increasingly urgent to take action in 

addressing these conditions and their risk factors. 

The burden of disease and growing health disparities among certain populations are 

characteristics of the heart disease and stroke epidemic. One of the populations greatly 

affected by this epidemic is African American men. African American men suffer 

disproportionately from high blood pressure, a known risk factor for heart disease and 

stroke. Because of this, the Centers for Disease Control and Prevention’s Division for 

Heart Disease and Stroke Prevention (DHDSP) began to focus attention and resources 

to developing materials that provide answers. 

In 2008, DHDSP funded 41 states and the District of Columbia to conduct policy, 

environmental, and systems-level interventions to prevent heart disease and stroke. 

The Program Development and Services Branch of DHDSP is responsible for 

monitoring the activities of these funded states. As a part of the ongoing technical 

assistance provided to the states, the Program Services Branch funded a project to 

create tools identifying systems change interventions that resulted in positive changes 

in the blood pressure control of African American men. This particular population 

had been identified as a priority due to the disproportionate burden of hypertension 

and the paucity of information specific to systems-level change interventions. The 

project resulted in a literature review and a logic model. However, these tools do not 

a review to address blood pressure control in african american men 13 
sufficiently provide the states with comprehensive strategies to use when they develop 

programs to address blood pressure control in African American men. 

To develop a tool that provided strategies and promising interventions about blood 

pressure control in African American men, a 2-year project was conducted by 

DHDSP with the assistance of RTI International and the MayaTech Corporation. An 

expert panel provided guidance throughout the project. The purpose of this project 

was to produce a resource document that could be used by state heart disease and 

stroke prevention programs and other public health programs as a reference as they 

work to develop and implement programs to control high blood pressure in African 

American men. This book consists of the following: (1) burden data pertaining to 

African American men and high blood pressure; (2) psychosocial factors that have 

been found to be related to disproportionately high blood pressure rates among 

African American men; (3) effective and culturally appropriate promising practices 

and interventions; and (4) a list of men’s health informational resources. Designed 

to complement the literature review and logic model previously developed by the 

Program Development and Services Branch, this book will provide more specific 

information on African American men in regards to blood pressure control. In turn, 

public health programs can use this resource to develop or enhance systems level 

interventions that target this priority population. 

14 african american men and blood pressure control: a closer look 
 

 

 

The Burden of High Blood Pressure 

2 

2.1 Overview 

This chapter reports on the burden of high blood pressure among African American 

men, including comparisons with white men, Hispanic men overall or Mexican 

American men, and African American women. Data on the burden of the diseases 

include national level statistics on morbidity and mortality as it relates to high blood 

pressure; hypertension awareness, treatment, and control; heart disease; and stroke. 

African American men have been more likely to have high blood pressure than white 

men, Hispanic men overall, or Mexican American men, both in recent years and 

during earlier periods.1– 6 According to the Seventh Report of the Joint National 

Committee on Prevention, Detection, Evaluation, and Treatment of High Blood 

Pressure (JNC VII report), the classification for hypertension, or high blood pressure, 

measures greater than or equal to 140 mm Hg systolic or greater than or equal to 

90 mm Hg diastolic.55 The percentage of African American men with high blood 

pressure during a recent 5-year period, while fluctuating somewhat, rose overall to 

29% by 2006.2–6 Among African American men with high blood pressure, awareness, 

treatment, and control of the disease have been increasing over time.7 However, by 

the 1999 to 2004 period, while more than half of the group was aware that they had 

disease, 56% were receiving medications, and only 30% had their high blood pressure 

under control. The percentage of African American men with heart disease was lower 

than that of white men and African American women from 2002–2006. In contrast, 

while declining in recent years, the percentage of African American men who have had 

a stroke was higher than it was for white men during this same time period. 

Mortality rates related to hypertensive disease increased among white men as well as 

African American men and women between 1999 and 2004. Even so, rates remained 

higher among African American men and women than among white men throughout 

the period.9 In contrast, mortality rates related to diseases of the heart and cerebrovascular disease (stroke) declined fairly steadily for all three groups between 1990 and 

2005 but again, were higher among African American men than white men.1 This was 

true even though a smaller percentage of African American men had heart disease.2–6 

a review to address blood pressure control in african american men 15 
 

2.2 Morbidity 

Table 1. 

Percentage of Persons with 

Elevated Blood Pressure by 

Race/Ethnicity and Sex, 

2.2.1 Elevated Blood Pressure 

Table 1 reports the percentage of African American, white, and Mexican American 

men and African American women with elevated blood pressure. Elevated blood 

pressure is defined as having systolic pressure of at least 140 mm Hg or diastolic 

pressure of at least 90 mm Hg. 

The data are collapsed into three time spans on the basis of data availability: 1988– 

1994, 1999–2002, and 2003–2006. In all periods, a larger percentage of African 

American men had elevated blood pressure than did white or Mexican American 

men. However, compared with the 1988–1994 period, the percentage of men in each 

race or ethnicity group with elevated blood pressure had declined by the 2003–2006 

period. The percentage of African American women with elevated blood pressure 

fluctuated over the three periods, but by the 2003–2006 period was smaller than that 

of African American men. 

Race/Sex 1988–1994 1999–2002 2003–2006 

African American men 30.3 28.2 26.5 

White men 19.7 17.6 17.4 

Mexican American men 22.2 21.5 15.3 

African American women 26.4 28.8 23.9 

20–74 Years of Age, 

for Selected Years 

Table 2. 

Percentage of Persons with 

High Blood Pressure by 

Race/Ethnicity and Sex, 

18 Years Old and 

Over, 2002–2006 

Note: Percentages are age adjusted. Elevated blood pressure is defined as having systolic pressure of at least 140 mm Hg 

or diastolic pressure of at least 90 mm Hg. Those with elevated blood pressure may be taking prescribed medicine for 

high blood pressure. 

Source: National Center for Health Statistics (2008). Table 71. Hypertension and elevated blood pressure among 

persons 20 years of age and over, by selected characteristics: United States, 1988–1994, 1999-2002, and 2003–2006. 

Health, United States, 2008. With chartbook on trends in the health of Americans. Hyattsville, MD, 312–313. 

Table 2 presents the percentage of adults with high blood pressure during the 2002–2006 

period, comparing rates for African American, white, and Hispanic men, and African 

American women. The percentage of those with high blood pressure fluctuated throughout 

the period, but increased overall in each group. In each of the years, a larger percentage of 

African American men had high blood pressure than white or Hispanic men. 

Race/Sex 2002 2003 2004 2005 2006 

Percentage 

Point Change 

2002–2006a 

African American 26.4 29.1 27.7 28.1 28.6 +2.2 

men 

White men 21.2 21.1 22.0 21.5 23.5 +2.3 

Hispanic menb 16.7 16.2 16.6 17.1 19.2 +2.5 

African American 32.5 33.9 31.0 34.0 34.1 +1.6 

women 

Note: Percentages are age adjusted. High blood pressure is defined as an individual being told on two or more physician 

visits that he or she has hypertension or high blood pressure. 

a This represents the difference between percentages in 2002 and 2006 and does not take into account any fluctuation 

during the intervening years. 

b Refers to those of Hispanic or Latino origin and may be of any race or combination of races. 

Source: CDC Vital and Health Statistics Series 10 Datasets from 2002–2006 (Lethbridge-Cejku et al., 2004, Table 2; LethbridgeCejku & Vickerie, 2005, Table 2; Lethbridge-Cejku et al., 2006, Table 2; Pleis & Lethbridge-Cejku, 2006 and 2007, Table 2). 

16 african american men and blood pressure control: a closer look 
 

Figure 1. 

Hypertension Awareness, 

Treatment, and Control 

Percentages (%) in the 

U.S. Adult Hypertensive 

Population by Race; 

1988–1994 and 1999–2004 

2.2.2 Hypertension Awareness, Treatment, and Control 

Successful hypertension management has been described as having three important 

dimensions: awareness (whether individuals have been told by their physicians that 

they have hypertension or high blood pressure), treatment (whether individuals report 

using a prescribed medication to control their hypertension), and control (whether 

they are maintaining their average systolic blood pressure at less than 140 mm Hg and 

their diastolic blood pressure at less than 90 mm Hg, and report currently using an 

antihypertensive medication). 

Figure 1 presents data on hypertension awareness, treatment, and control rates among 

the U.S. adult hypertensive population for African American men, white men, 

Mexican American men, and African American women during the periods 1988–1994 

and 1999–2004. 

-

Note: The U.S. adult hypertensive population consists of National Health and Nutrition Examination Survey (NHANES) 

respondents with an average systolic blood pressure greater or equal to 140 mm Hg and diastolic blood pressure greater 

or equal to 90 mm Hg or a reported current use of antihypertensive medication. Awareness is defined as hypertensive respondents having been told at least once by a health professional that they have high blood pressure. Treatment is defined 

as hypertensive respondents reporting use of a prescribed medication for hypertension. Control is defined as hypertensive 

respondents with a systolic blood pressure less than 140 mm Hg and a diastolic blood pressure less than 90 mm Hg. 

African American men, white men, and African American women are from the non-Hispanic population. 

Source: Cutler JA, Sorlie PD, Wolz M, Thorn T, Fields LE, Rocella E J. Trends in hypertension prevalence, awareness, 

treatment, and control rates in United States adults between 1988–1994 and 1999–2004. Hypertension 2008; 52: 

818–827. 

2.2.2.1 Hypertension Awareness 

Hypertension awareness has been defined as persons with high blood pressure who 

have been told at least once by a health care professional that they have hypertension 

or high blood pressure;7 self-report having hypertension;56or respond “Yes” to the 

question “Has your health care provider ever told you that you have hypertension?” or 

“Were any of the medications you took in the past 2 weeks for high blood pressure?”8 

As seen in Figure 1, hypertension awareness has increased among all groups (African 

American men, white men, Mexican American men, and African American women) 

between the two periods. However, the change was statistically significant only in 

a review to address blood pressure control in african american men 17 
relation to white men.7 In both periods, awareness among African American men was 

similar to that of white men, higher than that of Mexican American men, and lower 

than that of African American women. 

Multivariate analysis among Jackson Heart Study participants found that significant 

predictors of awareness among African American men include obesity, diabetes, 

increasing age, and use of preventive care.8 Multivariate analyses of Reasons for 

Geographic And Racial Differences in Stroke (REGARDS) data found that awareness 

was significantly higher among African Americans with high blood pressure than 

among their white counterparts (OR = 1.45 [CI, 1.24 to 1.71]). The difference was 

reduced slightly, but was still significant, after controlling for other demographic 

factors, measures of socioeconomic status, and risk factor variables.56 

2.2.2.2 Hypertension Treatment 

Hypertension treatment has been defined as persons who are hypertensive or have 

hypertension awareness that are taking prescribed medications for hypertension.7,8,56 

As shown in Figure 1, patterns across time are similar to those found in relation to 

awareness; the percentage in each group that received treatment increased over time. 

White men, African American men, and African American women made statistically 

significant percentage point increases in receiving hypertension treatment from 1988– 

1994 to 1999–2004.7 Still, white men were more likely to have received treatment in 

both time periods compared with African American and Mexican American men. 

Multivariate analysis among Jackson Heart Study participants found that significant 

predictors of treatment among African American men include diabetes, cardiovascular 

disease, hypercholesterolemia, increasing age, being a current smoker, and use of 

preventive care.8 Whites with high blood pressure were significantly less likely to 

receive hypertension treatment, compared with African Americans, after controlling 

for geographic region, demographic variables, socioeconomic status, and risk factors.56 

2.2.2.3 Hypertension Control 

Control of hypertension is defined as a hypertensive person (or a hypertensive person 

receiving treatment) with a systolic blood pressure of less than 140 mm Hg and a 

diastolic blood pressure of less than 90 mm Hg.7,8,56 Patterns over time and between 

groups were similar in relation to control as we found for treatment (Figure 1). 

Hypertension control rates significantly improved from the 1988–1994 to 1999–2004 

period for all four of the population groups.7 More recent data show substantial 

increases in control rates; 46.5% among African Americans, 46.1% among whites, 

and 35.2% among Mexican Americans.57 Still, the percentage of the population 

successfully controlling their hypertension was appreciably smaller than the percentage 

that was aware or receiving treatment. 

Factors significantly related to African American men successfully controlling 

their hypertension include not having chronic kidney disease and being older.8 

A multivariate analysis comparing the African American and white populations 

receiving hypertension treatment found that African Americans were less likely to 

have controlled blood pressure levels compared with their white counterparts, after 

controlling for demographic variables, socioeconomic status, and risk factors. 

18 african american men and blood pressure control: a closer look 
 

 

 

 

Table 3. 

Percentage of Persons with 

Heart Disease, by Race/ 

Ethnicity and Sex, 18 Years 

Old and Older, 2002–2006 

2.2.3 Heart Disease 

In Table 3, we present the percentage of adults with heart disease, comparing African 

American men and other groups, between 2002 and 2006. The percentages of adults 

with heart disease for all groups fluctuated throughout the period but typically were lower among African American men than among white men or African American women. 

In 4 of the 5 years, Hispanic men had the lowest percentage of adults with heart disease. 

Between 2002 and 2006, the percentage of adults with heart disease declined slightly 

among all groups except African American women, which increased slightly. 

Race/Sex 2002 2003 2004 2005 2006 

Percentage 

Point Change 

2002–2006a 

African American 

men 

9.9 10.3 8.4 9.0 9.4 −0.5 

White men 13.4 13.0 13.5 13.7 13.0 −0.4 

Hispanic menb 7.8 6.7 9.2 8.4 7.4 −0.4 

African American 

women 

10.1 9.9 10.5 11.4 10.5 +0.4 

Note: Percentages are age adjusted. Heart disease includes coronary heart disease, angina pectoris, heart attack, or any 

other heart condition or disease. Data were collected through the National Health Interview Survey, 2006. 

a This represents the difference between percentages in 2002 and 2006 and does not take into account any fluctuation 

during the intervening years. 

b Refers to those of Hispanic or Latino origin and may be of any race or combination of races. 

Source: Data are from five CDC Vital and Health Statistics Series 10 Datasets from 2002–2006 (Lethbridge-Cejku 

et al., 2004, Table 2; Lethbridge-Cejku & Vickerie, 2005, Table 2; Lethbridge-Cejku et al., 2006, Table 2; Pleis & 

Lethbridge-Cejku, 2006 and 2007, Table 2). 

2.2.4 Stroke 

As shown in Table 4, the percentage of adults who had a stroke was higher among 

African American men than among white or Hispanic men throughout the period 

2002–2005. Although the percentages of adults who had a stroke in these groups 

fluctuated throughout the period, by 2005 rates had declined for African American 

men and increased substantially for African American women, resulting in African 

American women having the highest percentage experiencing a stroke of any group. 

a review to address blood pressure control in african american men 19 
Table 4. 

Percentage of Persons with 

Stroke by Race/Ethnicity 

and Sex, 18 Years Old and 

Race/Sex 2002 2003 2004 2005 

Percentage 

Point Change 

2002–2005a 

African American 

men 

3.6 3.8 3.5 2.8 −0.8 

White men 2.5 2.5 2.7 2.3 −0.2 

Hispanic menb 2.6 3.0 3.2 2.5 −0.1 

African American 

women 

2.3 3.4 3.0 4.0 +1.7 

Older, 2002–2005 

Note: Data were collected through the National Health Interview Survey, 2006. 

a Percentages are age adjusted. This represents the difference between percentages in 2002 and 2005 and does not take 

into account any fluctuation during the intervening years. 

b Refers to those of Hispanic or Latino origin and may be of any race or combination of races.
 

Source: Data in this table are based on data from five CDC Vital and Health Statistics Series 10 Datasets from 2002­

2006, respectively (Lethbridge-Cejku et al., 2004, Table 2; Lethbridge-Cejku & Vickerie, 2005, Table 2; LethbridgeCejku et al., 2006, Table 2; Pleis & Lethbridge-Cejku, 2006 and 2007, Table 2).
 

2.3 Mortality 

2.3.1 Death Rates from Hypertensive Disease 

Changes over time in rates of death from hypertensive disease are presented first 

for the condition overall and then more specifically for essential hypertension and 

for hypertensive heart disease. Hypertensive disease includes (1) essential (primary) 

hypertension (ICD-9 code: 401), (2) hypertensive heart disease (ICD-9 code: 402), 

(3) hypertensive renal disease, (ICD-9 code: 403) and (4) hypertensive heart and 

renal disease (ICD-9 code: 404). Hypertensive disease excludes complications from 

childbirth, pulmonary hypertension, neonatal hypertension, and hypertension 

involving coronary vessels. Essential hypertension includes high blood pressure; 

hyperpiesia; hyperpiesis; arterial, primary, and systemic hypertension; and hypertensive 

vascular degeneration or disease. It excludes elevated blood pressure without a 

diagnosis of hypertension, and pulmonary hypertension (involving vessels of the brain 

or eye). Hypertensive heart disease is defined as any condition involving heart failure, 

congestive heart failure, heart disease, myocarditis (unspecified), cardiovascular disease 

(unspecified), or cardiomegaly due to hypertension. 

Death rates from hypertensive disease increased from 1999–2004 among African 

American men and comparison groups: white men and African American women (see 

Table 5). In each year, death rates for African American men were more than twice 

those of white men yet were lower than those of African American women. African 

American men experienced the largest rate increase over time (4.5), followed by white 

men (3.4) and African American women (2.7). 

20 african american men and blood pressure control: a closer look 
Table 5. 

Death Rates Due to 


Hypertensive Disease by 


Race/Sex 

African American 

men 

White men 

African American 

women 

1999 2000 2001 2002 2003 2004 

Rate Change 

1999–2004a 

26.8 26.8 27.7 29.3 30.8 31.3 +4.5 

10.8 11.3 11.8 12.7 13.6 14.2 +3.4 

30.3 30.8 30.5 31.9 33.3 33.0 +2.7 

Race and Sex, 1999–2004 

Figure 2. 

Death Rates Due to 

Hypertensive Disease by 

Race and Sex, 1999–2004 

Note: Rates are per 100,000 of the population. Data collected through the National Health Interview Survey, 2006. 

Note: Hypertensive disease includes essential (primary) hypertension (ICD-9 code: 401), hypertensive heart disease 

(ICD-9 code: 402), hypertensive renal disease (ICD-9 code: 403), and hypertensive heart and renal disease (ICD-9 

code: 404). It does not include complications from childbirth, pulmonary hypertension, neonatal hypertension, and 

hypertension involving coronary vessels. 

a This represents the difference between rates in 1999 and 2004 and does not take into account any fluctuation during 

the intervening years. 

Source: National Center for Health Statistics (2007). Death rates from 358 selected causes, by 10-year age groups, race and 

sex: United States 1999–2004 (Worktable No. 12). National Vital Statistics System. 

From 1999–2004, death rates increased continually over the period, as shown in 

Figure 2. They were substantially higher among African American men than among 

white men throughout the period. 

Source: National Center for Health Statistics (2007). Death rates from 358 selected causes, by 10-year age groups, race and 

sex: United States 1999–2004 (Worktable No. 12). National Vital Statistics System. 

Changes in death rates from essential hypertension from 1999–2004, as shown in 

Table 6, followed the same pattern as hypertensive disease overall. In each year, death 

rates for African American men were higher than those of white men and lower than 

those of African American women. Rates for white men and African American women 

generally increased annually, but rates for African American men fluctuated during the 

period. Figure 3 graphically depicts these data and shows that rates were substantially 

higher among African American men and women than among white men throughout 

the period. 

a review to address blood pressure control in african american men 21 
Table 6. 

Death Rates Due to 

Essential Hypertension by 

Race/Sex 

African American 

men 

White men 

African American 

women 

1999 2000 2001 2002 2003 2004 

Rate Change 

1999–2004a 

3.8 4.0 4.3 4.0 4.7 4.4 +0.6 

2.4 2.5 2.6 2.7 2.9 3.2 +0.8 

5.3 5.3 5.5 5.8 6.3 6.4 +1.1 

Race and Sex, 1999–2004 

Note: Rates are per 100,000 population, all ages. Essential hypertension (ICD-9 code: 401) includes high blood pressure; hyperpiesia; hyperpiesis; arterial, primary, and systemic hypertension; and hypertensive vascular degeneration or 

disease. It excludes elevated blood pressure without diagnosis of hypertension, and pulmonary hypertension (involving 

vessels of the brain or eye). 

a This represents the difference between rates in 1999 and 2004 and does not take into account any fluctuation during 

the intervening years. 

Source: National Center for Health Statistics (2007). Death rates from 358 selected causes, by 10-year age groups, race 

and sex: United States 1999–2004 (Worktable No. 12). National Vital Statistics System. 

Figure 3. 

Death Rates Due to 

Essential Hypertension by 

Race and Sex 1999–2004 

Source: National Center for Health Statistics (2007). Death rates from 358 selected causes, by 10-year age groups, race and 

sex: United States 1999–2004 (Worktable No. 12). National Vital Statistics System. 

Death rates from hypertensive heart disease among African American men and women 

from 1999–2004, as shown in Table 7, but were more than twice those of white men 

in each year. Rates for African American men and white men increased in each year 

of the period. African American men experienced the largest rate increase, (3.2 deaths 

per 100,000 population), while African American women experienced a 1 death per 

100,000 population increase over the period. 

As shown in Figure 4, among all groups, death rates from hypertensive heart disease 

showed a gradual increase from 1999–2004. Throughout the period, rates were highest 

among African American women. Rates were also considerably higher among African 

American men and women than white men. 

22 african american men and blood pressure control: a closer look 
Race/Sex 

African American 

men 

White men 

African American 

women 

1999 2000 2001 2002 2003 2004 

Rate Change 

1999–2004a 

15.2 15.6 15.9 17.5 18.1 18.4 +3.2 

5.8 6.1 6.4 7.1 7.7 7.8 +2.0 

15.9 16.5 16.2 16.9 17.8 16.9 +1.0 

Table 7. 

Death Rates Due to 


Hypertensive Heart 


Disease by Race and 

Sex, 1999–2004 

Figure 4. 

Death Rates Due to 

Hypertensive Heart 

Disease by Race and Sex, 

1999–2004 

Note: Rates are per 100,000 population, all ages. Hypertensive heart disease (ICD-9 code: 402) is defined as any 

condi¬tion involving heart failure, congestive heart failure, heart disease, myocarditis (unspecified), cardiovascular 

disease (unspecified), or cardiomegaly due to hypertension. 

a This represents the difference between rates in 1999 and 2004 and does not take into account any fluctuation during 

the intervening years. 

Source: National Center for Health Statistics (2007). Death rates from 358 selected causes, by 10-year age groups, race 

and sex: United States 1999–2004 (Worktable No. 12). National Vital Statistics System. 

Source: National Center for Health Statistics (2007). Death rates from 358 selected causes, by 10-year age groups, race and 

sex: United States 1999–2004 (Worktable No. 12). National Vital Statistics System. 

2.3.2 Death Rates from Heart Disease 

Death rates from diseases of the heart declined annually for all three groups throughout the period 1999–2005, as shown in Table 8. Still, in each of the years, rates for 

African American men were higher than those for white men and African American 

women. The change over time and the relationship between the three groups is shown 

graphically in Figure 5. 

a review to address blood pressure control in african american men 23 
Table 8. 

Death Rates Due to 

Diseases of the Heart, 

Race/Sex 

African 

American 


men
 

White men 

African 

American 

women 

1999 2000 2001 2002 2003 2004 2005 

Rate Change 

1999–2005a 

407.2 392.5 384.5 371.0 364.3 342.1 329.8 −77.4 

327.1 316.7 301.8 294.1 282.9 264.6 258.0 −69.1 

283.7 277.6 269.8 263.2 253.8 236.5 228.3 −55.4 

1999–2005 

Figure 5. 

Death Rates Due to 

Diseases of the Heart by 

Race and Sex, 1990–2005 

Note: Rates are per 100,000 population, all rates are age adjusted. 

a This represents the difference between rates in 1999 and 2005 and does not take into account any fluctuation during 

the intervening years. 

Source: National Center for Health Statistics (2008). Table 35. Death rates for diseases of the heart, by sex, race, Hispanic origin, and age: United States, selected years 1950–2005. Health, United States, 2008. With chartbook on trends 

in the health of Americans. Hyattsville, MD. 229–232. 

Source: National Center for Health Statistics (2008). Table 35. Death rates for diseases of the heart, by sex, race, Hispanic origin, and age: United States, selected years 1950–2005. Health, United States, 2008. With chartbook on trends 

in the health of Americans. Hyattsville, MD. 229-232. 

2.3.3 Death Rates from Cerebrovascular Disease 

Death rates from cerebrovascular disease (stroke) declined annually in virtually all 

years for African American men and comparison groups from 1999–2005, as shown 

in Table 9. Throughout the period, annual rates were highest among African American 

men and lowest among white men. 

24 african american men and blood pressure control: a closer look 
Table 9. 

Death Rates Due to 


Cerebrovascular Disease 


Race/Sex 

African 

American 


men
 

White men 

African 

American 

women 

1999 2000 2001 2002 2003 2004 2005 

Rate Change 

1999–2005a 

89.6 89.6 85.4 81.7 79.5 74.9 70.5 − 19.1 

60.8 59.8 56.5 54.2 51.7 48.1 44.7 −16.1 

76.2 76.2 73.7 71.8 69.8 65.5 60.7 −15.5 

(Stroke) by Race and Sex, 

1999–2005 

Note: Rates are per 100,000 population, all rates are age adjusted. 

a This represents the difference between rates in 1999 and 2005 and does not take into account any fluctuation during 

the intervening years. 

Source: National Center for Health Statistics (2008). Table 36. Death rates for cerebrovascular diseases. by sex, race, 

Hispanic origin, and age: United States, selected years 1950–2005. Health, United States, 2008. With chartbook on 

trends in the health of Americans. Hyattsville, MD. 233–235. 

Similarly, trends show an overall decline in death rates from cerebrovascular disease 

during the period from 1990–2005 for each group, as shown in Figure 6. In each 

of the years, rates were highest among African American men, followed by African 

American women, and were lowest for white men. 

Figure 6. 

Death Rates Due to 

Cerebrovascular Disease 

by Race and Sex, 

1990–2005 

Note: Rates are age adjusted. 

Source: National Center for Health Statistics (2008). Table 36. Death rates for cerebrovascular diseases. by sex, 

race, Hispanic origin, and age. Health, United States, 2008. With chartbook on trends in the health of Americans. 

Hyattsville, MD. 233–235. 

a review to address blood pressure control in african american men 25 
 

 

Psychosocial Aspects of Blood Pressure Control 

among African American Men 

3 

3.1 Overview 

This chapter discusses psychosocial factors found to be related to disproportionately 

elevated rates of high blood pressure among African American men. These factors 

include racism and mechanisms for coping with racism, attitudes about hypertension, 

access to care, socioeconomic status, area of residence, and availability of social 

supports, depression, substance abuse, and obesity. It concludes with a discussion of 

emerging knowledge about disparities in hypertension. 

3.2 Perceived Racism, Experienced Racism, and Racial Discrimination 

We reviewed studies investigating the relationship between perceived racism or 

discrimination and hypertension or high blood pressure in African American men. A 

review article presenting a summary of empirical research on self-reported racism and a 

number of health-related outcomes found that across studies, the main effect of racism on 

blood pressure was mixed. Nineteen studies found that self-reported racism was associated 

with increased blood pressure or hypertension and 59 studies found no association.14 

A significant relationship was found in three-quarters of the studies reviewed.14 This is 

relevant as the relationship between racism and blood pressure level may be mediated by 

mental health effects, such as stress and self-esteem; perceived racism negatively affects 

mental health, which, in turn, may negatively affect blood pressure. 

In one large study, level of exposure to discrimination among African American men 

was found to be related to differences in blood pressure level after controlling for such 

factors as age, marital status, and alcohol consumption, but the relationship differed 

on the basis of the men’s socioeconomic status.13 The study found that among working 

class African American men, systolic blood pressure was higher among those reporting 

a review to address blood pressure control in african american men 27 
that they typically accepted unfair treatment as a fact of life, but talked to others about 

it, than it was among those who both tried to do something and talked to others. 

Blood pressure levels were also higher among those who reported no incidents of racial 

discrimination, as well as among those who reported the highest levels of exposure 

(three or more situations), compared with more moderate levels of exposure (one or 

two situations). 

In contrast, among professional African American men, diastolic blood pressure was 

lower among men who reported no racial discrimination compared with those with 

moderate exposure, suggesting a difference in coping style among men in different 

social classes. Blood pressure levels of professional African American and white men 

were comparable. The authors conclude that responses to racial discrimination and 

coping mechanisms affect blood pressure levels. Greater social and economic resources 

and the resulting increased ability to name and challenge discrimination may be 

protective factors among professional men. This conclusion is bolstered by models 

demonstrating that the health effects of a stressor, such as racism, may depend in part 

on the strategies used to cope with exposure.15 

The metro Atlanta heart disease study found that stressful racism and race-related 

discrimination at work are associated with increased blood pressure and increased 

hypertension.11 Controlling for sociodemographic characteristics in a sample of 356 

African Americans, 55% of whom were men, those who were hypertensive were 

not more likely to have had encounters of racial discrimination that caused stress. 

However, they were twice as likely to be hypertensive if the level of stress was moderate 

or high, rather than low.10 

Investigators have suggested that the effects of racism on high blood pressure can be 

examined within the framework of stress and coping theories. John Henryism is a style 

of coping behaviors used to deal with psychosocial and environmental stressors such as 

chronic financial strain, job insecurity, and racial discrimination.17 The classic traits of 

John Henryism are seen among those African Americans who are extremely focused on 

success, particularly in new environments with which they have little experience. Those 

with a high John Henryism orientation believe that obstacles can be overcome through 

hard work and a strong determination to succeed. Most commonly, people with John 

Henryism are extremely goal-oriented but lack the resources they need for success, 

such as financial or emotional support.17 People with high levels of John Henryism 

and inadequate resources may have a higher prevalence of health disorders. This is due 

to the unrelenting drive with which they push themselves toward specific goals at the 

expense of their health—often without realizing they are doing so. 

The relationship of John Henryism to socioeconomic status and blood pressure 

was examined among African American workers in Pitt County, North Carolina.18 

Socioeconomic status was measured as “high” for high school graduates and “low” 

for those with less than a high school education. Those with low socioeconomic 

status were found to have higher adjusted diastolic blood pressure than those with 

high socioeconomic status. However, when the high and low socioeconomic status 

groups were divided into high and low John Henryism groups, a new effect emerged. 

Among people with low John Henryism, the difference in blood pressure between 

low socioeconomic status and high socioeconomic status was small. However, among 

people with high John Henryism, the difference in mean blood pressure was far 

greater; those in the low socioeconomic status group had significantly higher mean 

blood pressure than did those in the high socioeconomic status group. It is theorized 

that unfulfilled expectations and a lack of opportunities in the high John Henryism 

28 african american men and blood pressure control: a closer look 
 

 

 

 

 

 

 

group (demonstrated by their low socioeconomic status) and elevated stress levels led to 

higher mean blood pressure. 

Studies have replicated S. A. James’ analysis of John Henryism in study populations 

that differ geographically, by age range, and/or educational level.58,59 Using S. A. 

James’ definition of socioeconomic status and method of measuring John Henryism, 

Wiist and Flack found no association between the interaction of John Henryism 

and socioeconomic status, and the risk of elevated blood pressure or hypertension.59 

However, differences in the study populations may account for these null findings. 

Specifically, psychological strategies used to cope with environmental stressors among 

southwest urban African Americans in the Wiist and Flack study, may differ from 

those of the rural southeast African Americans studied by S. A. James and colleagues. 

Additionally, James studied a relatively poor community with a low level of education 

and a high unemployment rate, whereas Wiist and Flack’s study population was better 

educated and had only one-half the unemployment rate. Similarly, in another study, 

John Henryism was not an independent predictor of blood pressure among relatively 

healthy, urban, African American college students.59 

Two additional studies examined the relationship between perceived racism and 

hypertension in workplace samples of African Americans.12,17,60 Research by Dressler60 

found that among 90 employed African Americans, perceived racism was associated 

with various indices of stress, but there was no direct correlation between perceived 

racism and blood pressure. In contrast, in a second study of African American and 

Mexican American employees, a small positive correlation was found between perceived 

intensity of exposure to racism and resting blood pressure levels.12 

3.3 Knowledge, Beliefs, and Attitudes about Hypertension 

Among the most significant problems affecting racial disparities in hypertension control 

are differences between patients and providers in beliefs and attitudes about health. It has 

been theorized that health beliefs of patients are of principal importance in influencing 

behavior change.19 Thus, understanding the role of beliefs and attitudes in communicating 

information about hypertension is essential. 

For African Americans, beliefs about hypertension are varied but are often nonclinical 

in origin, particularly among those of lower socioeconomic status, older age, and 

lower educational attainment.20 For example, some African Americans believe there 

is a difference between hypertension and high blood pressure.19,20 Among those who 

differentiate between the two terms, hypertension is seen as a condition resulting from 

stress, anxiety, or anger. High blood pressure is viewed as a condition resulting from highfat foods that cause the blood to thicken and move more slowly,19 or an illness that causes 

blood to rush to the head.20 Beliefs about the origins of hypertension also affect beliefs 

about susceptibility to the disease. Some African Americans believe that the use of home 

remedies (such as vinegar, garlic, or Epsom salts, which are believed to thin the blood) can 

rid them of the disease.20 

Health beliefs can also have a significant effect on adherence to treatment.19 These 

include beliefs about severity of the disease, susceptibility, and effectiveness of 

treatment. Focus groups conducted with African Americans have demonstrated that 

patients have difficulty believing they have hypertension when they do not have 

symptoms.19 This may affect both confidence in the medical establishment and 

compliance with medical recommendations. 

a review to address blood pressure control in african american men 29 
 

 

 

 

 

3.4 Access to Care 

Medical care use is generally lower among African Americans than among whites. Even 

among those who are aged 65 and older and have health insurance coverage through 

Medicare, African Americans receive fewer medical services than do whites.23 African 

American men, in particular, take fewer prescription and non-prescription medications 

than do their white counterparts.21 

African Americans have historically distrusted the medical system. Doubts about the 

adequacy and necessity of recommended care are fueled both by a difference in the 

medical beliefs of African American patients and medical science, as well as historical 

incidents of racism and abuse by the medical profession.22 These different belief systems 

may affect communication between doctor and patient. Physician stereotypes about 

African Americans’ lack of knowledge, poor education, lack of understanding of clinical 

concepts, and poor compliance with treatment can lead to reduced expectations.25 

Alternately, patients might believe that the provider is not listening to or valuing their 

opinion, or is treating them disrespectfully.24 

Cultural competence or cultural appropriateness is described by Anderson, Scrimshaw, 

Fullilove, Fielding, and Normand61 as “a set of congruent behaviors, attitudes, and policies 

that come together in a system, agency, or among professionals and enable effective work 

in cross-cultural situations.” Communication problems between providers and patients 

can reflect a lack of cultural competence by the provider and can create additional 

barriers that might reinforce negative health behaviors by patients.26 Commonly, African 

American patients are seen by health care providers who are not from their same culture. 

Patients have been found to be more satisfied if their physician was of their same race or 

ethnicity group, suggesting a greater level of trust and comfort.62 

3.5 Health Insurance 

Successful control of hypertension has been found to be related to having health 

insurance. As shown in Table 10, 22.6% of African American males were uninsured 

during all of 2006, whereas just over half (53.6%) had private coverage, and almost 

one-third (31.2%) had government-sponsored coverage (including Medicare and 

Medicaid) at some time during the year. In contrast, white males were less likely to be 

uninsured (16.6%) and much more likely to have private insurance coverage (70.1%). 

Between 1999 and 2004, among adults with hypertension, 41% of those who were 

insured had their blood pressure under control, compared with 21% of those without 

insurance.63 After controlling for other factors, during the earlier period of 1988 to 

1994, a study using a nationally representative sample found that successful control of 

hypertension was significantly related to being insured among African Americans, but 

not among whites.28 

A critical protective component of health insurance may be prescription drug 

coverage. Among Medicare beneficiaries with hypertension, African Americans 

with no supplemental prescription coverage or Medicaid prescription coverage were 

significantly less likely to use any hypertensive drugs. In contrast, African Americans 

with employer-sponsored or Medicare + Choice (M+C) plans were more likely to use 

hypertensive drugs than those without either type of plan.29 

30 african american men and blood pressure control: a closer look 
 

Table 10. 

Health Insurance Coverage 

Rates, 2006 

Race/Sex 

Uninsured all 

year 

Insured at some time during the year bya 

Private 

insurance 

Direct purchase 

insurance 

Governmentsponsored 

health plan 

African American men 22.6% 53.6% 4.7% 31.2% 

White men 16.6% 70.1% 9.1% 24.1% 

Hispanic men 

(of any race) 

37.2% 62.8% 3.3% 24.9% 

African American 

women 

18.6% 53.6% 4.7% 35.2% 

a Insured rates by race/sex may add to greater than 100% because individuals may have more than one type of insurance during the year. 

Source: U.S. Census Bureau, Current Population Survey, Annual Social and Economic (ASEC) Supplement, 

http://pubdb3.census.gov/macro/032007/health/h01_000.htm 

3.6 Quality of Care 

Even if the individual experiences few, if any, symptoms, successful control of 

hypertension requires lifelong adherence to a regimen including medical care and 

lifestyle and behavioral management. If side effects are problematic, patients may need 

to work with their clinician to change their medication. Access to high quality health 

care is an important factor in individuals achieving these goals. Particularly important 

is access to patient-centered care: treatment that is respectful and responsive to the 

patient’s preferences, needs, and values.64 

Analysis of the Third National Health and Nutrition Examination Survey found 

that visiting the same health care facility or having the same health care provider was 

positively related to successful hypertension control.28 Hypertensive African Americans 

were significantly less likely than hypertensive whites to have the same ongoing health 

care provider, but no difference was found in access to the same facility or time from 

the last blood pressure measurement. 

Trust and an ongoing working relationship between a patient and his or her medical 

provider can be crucial to adherence. Among African American patients, adherent 

patients are more likely to report a trusting, honest relationship with their clinician, 

and to report that their clinician worked with them to manage their treatment.19 

Non-adherent patients were more likely to describe their clinicians as being critical, 

not listening or caring, and not seeing them as individuals. Adherent African American 

patients thought that their clinicians should be the primary source of knowledge about 

hypertension and its treatment. Trust in their clinician was a major facilitator of good 

doctor-patient communications.30 

African American patients may fear that the care they receive is different from or 

inferior to the care being provided to white patients. This can be addressed through 

gaining patients’ trust through frank conversations; allaying patients’ fear about 

being experimental subjects; and emphasizing that medications are equally good 

for African Americans; and that much clinical trial evidence has shown the blood 

a review to address blood pressure control in african american men 31 
pressure–lowering effects of both pharmacologic and non-pharmacologic interventions 

in African American patients.31 One university-based clinic addressed dissatisfaction 

among hypertensive African American patients by implementing the routine 

administration of an intake form to gain greater information about patients’ lifestyle 

habits and by distributing patient education handouts.65 

Several studies have been conducted examining racial disparities in hypertension 

control among patients at Veteran’s Affairs (VA) medical facilities. After controlling 

for clinical, psychosocial, and patient characteristics, medication adherence was 

not related to trust as measured through participatory decision-making or a survey 

instrument.32,66 However, a stronger association was found between physician 

counseling and trust in physicians for African American than for white patients, 

further supporting the notion that quality of care for hypertensive African American 

patients requires patient-centered interventions.32 

3.7 Socioeconomic Status 

Although African Americans have been theorized to have certain biological risk factors 

for hypertension, the over-representation of African Americans in the lowest income 

brackets is also a contributing factor to their risk for this disease.34 This correlation 

may be due to lack of health insurance, an inability to pay for medical services and 

preventive care, limited access to healthy foods, and insufficient environmental 

supports that promote healthy lifestyles in low-income neighborhoods (e.g., lack of 

sidewalks and safe recreational facilities, poorly maintained parks).38 Also, non-elderly 

poor men rarely qualify for Medicaid unless they are disabled.67 

Individuals without health insurance must rely on health services from institutions 

such as community health centers and public hospitals. Community health centers 

are particularly active in caring for poor minority patients.36 However, care at such 

facilities may mean that patients may not have one consistent provider or cannot 

afford to pay for the treatments prescribed. Given the difficulty associated with 

seeking medical care, poor individuals are more likely to be diagnosed at later stages 

of or following a serious event (e.g., heart attack, stroke), which makes the need for 

care more immediate and the need to follow treatment recommendations all the 

more crucial. 

African Americans are more geographically segregated from whites than any other 

minority group in the United States. Racial segregation has been found to be a 

predictor of poor health outcomes and a partial explanation for racial disparities in 

health.39 In addition to their individual socioeconomic status, residing in a racially 

isolated neighborhood has also been found to be an additional risk factor for poorer 

health status among African Americans. 

Income and wealth are significant and independent predictors of having a chronic 

condition.68 Individuals in the lowest socioeconomic strata are much more likely to be 

negatively affected by health issues than are those in higher strata. In the Pitt County 

Study, comparisons of African American men by socioeconomic status found that, 

compared with men who had high socioeconomic status in childhood and adulthood, 

the odds of hypertension were seven times as great for low childhood/low adulthood 

32 african american men and blood pressure control: a closer look 
men, four times as great for low childhood/high adulthood men, and six times as great 

for high childhood/low adulthood men.37 The study concluded that both childhood 

and adulthood access to wealth are protective against premature hypertension among 

African American men. 

Although socioeconomic status is a strong contributor to health status in African 

Americans, even after controlling for this factor, hypertension rates are still 

significantly higher than in other groups.34,68 After further controlling for risk factors 

such as diet, smoking, drinking, and exercise, in addition to socioeconomic status, 

the prevalence of chronic disease and impairment, was still higher among African 

Americans. Thus, although a combination of low income and poor health behaviors 

are contributing factors to rates of hypertension in African Americans, they do not 

fully explain disparities. 

Following is a discussion of other candidate factors that have been shown to have an 

influence on blood pressure control; however, this research is largely reporting studies 

of African American populations in general because research specifically addressing 

African American men and high blood pressure is scarce. 

3.8 Rural Residence 

Historically, residing in a rural area has been related to increased barriers to health care 

due to a lack of available services. It has been estimated that rural areas have one-half 

the number of physicians per capita compared with urban areas, as well as very low 

numbers of nurses and other health care providers.69 Rural areas with a predominately 

African American population tend to have access to even less financial support than do 

those with a predominately white population.69 

Rural populations are also more likely to have lower incomes and be self-employed, 

often resulting in a lack of health insurance and/or an inability to pay for medical 

services. Poor individuals in rural areas are less likely to receive insurance from 

entitlement programs (e.g., Medicaid), and access to care may be limited by other 

barriers such as pride, low functional literacy, and fear of being stigmatized in their 

small community.69 

The limited availability of transportation can also compound the health care problems 

of rural communities. Lower incomes may mean that access to personal automobiles 

is limited whereas the distance between a patient’s home and a medical facility is 

often great. Lack of public transportation may further limit access to care.70 The 

combination of these factors may result in fewer opportunities for preventive care, 

later-stage diagnosis for illness and disease, and disparate health outcomes when 

compared with urban populations.69,70 

African Americans may be at increased risk for poor health if they reside in a rural 

setting.69 Data from the Third National Health and Nutrition Examination Survey 

(NHANES III) found that rural African Americans are more likely to have high blood 

pressure than both urban and rural whites and urban African Americans.70 However, 

despite having significantly worse results than both their urban and rural white counterparts, neither urban nor rural African Americans with high blood pressure significantly differed from each other in their likelihood of successfully controlling their 

condition, after adjusting for socioeconomic factors and access to care. 

a review to address blood pressure control in african american men 33 
3.9 Social Support 

Higher levels of social support of family and friends, including emotional, cognitive, 

and instrumental support, have been found to increase compliance with treatment 

among African Americans with chronic disease.71 

The use of faith-based health interventions in the African American community has 

been well documented by many researchers.72,73 One major reason that such programs 

have had success is that they build on the already existing social networks within the 

community. These programs are able to capitalize on the trust that is already present 

between parishioners and the leadership of a faith-based organization.72 Spirituality in 

and of itself may also be protective. Individuals with lower spirituality scores perceived 

their racist encounters as being stressful and were more likely to report adverse health 

symptoms. This relationship was not found among those with greater spirituality.74 

The social support provided by the faith-based organization, as well as support 

from family, friends, and community leaders can play an important role in behavior 

change, particularly in the African American community.75 Researchers have documented the prominent role of non-familial African American community members 

serving as an extended family in times of need.76 This is due to a variety of factors 

including racism and the resulting segregation of African American communities. 

This social isolation has led to strong ties among African Americans and reflects a 

high degree of social integration. 

The more socially integrated that patients are, the lower their risk for disease.76 

Cultural norms can serve as an indicator of what is appropriate and acceptable 

behavior in a community. Participating in behaviors that are contrary to these norms 

can be difficult without the encouragement and support of others. This support is 

even more helpful when it is coupled with similar changes in behavior by others in the 

social network. Common experience facilitates positive action and reduces barriers to 

change. However, if norms are contrary to what is advised by the medical profession, 

they can pose a barrier to adopting more positive health behavior. 

3.10 Depression 

Extensive epidemiological evidence supports a positive association between depression 

and hypertension.77– 82 Although several studies found depression to be a predictor 

of hypertension, others point out that depression and hypertension share a prominent 

risk factor: stress. 

Epidemiological evidence widely supports the claim that psychological factors (e.g., 

depression) can mediate and negatively influence health behavior, leading to poor diet, 

obesity, inactivity, smoking, and alcohol abuse. This, in turn, can negatively influence 

blood pressure.77,78,79,83,84 The Bogalusa Heart Study found that among 403 African 

American participants, depression was indirectly related to hypertension through 

higher levels of body mass index (BMI).85 

34 african american men and blood pressure control: a closer look 
 

3.11 Substance Abuse 

Substance abuse and alcohol consumption continue to be problems within African 

American communities.86,87 Nationally, African Americans report lower levels of 

alcohol use than whites87,88 and higher abstention rates but similar levels of heavy 

drinking.87,89 Heavy drinking has decreased significantly in white men but has 

remained stable in the African American community.88,89,90 Heavy drinking increases 

the risk of health consequences, which are categorized as drinking consequences (i.e., 

illness) and alcohol dependence symptoms.88 Research results are mixed in concluding 

whether there are racial differences in drinking consequences and alcohol-dependency 

symptoms.88,91,92,93,94,95 

Substance abuse has been associated with acute palpitations, hypertension, stroke, and 

depression.96 Some studies have shown that heavy drinkers have significantly higher 

blood pressure than the rest of the population, and these blood pressure related effects 

tend to surface at an earlier age for men than women.97,98 Blood pressure levels may be 

affected through multiple mechanisms; stress has been identified as a mediator between 

alcohol and blood pressure.99 

Although studies have linked alcohol as a risk factor or mediating factor for high blood 

pressure, epidemiological data do not support drug abuse as a significant factor for 

increased blood pressure in the African American community. However, alcohol and 

illicit drug use are negatively associated with high blood pressure control behaviors, 

and have been found to create barriers to hypertension care and control among African 

American men.79,100,101,102 

3.12 Obesity 

According to the National Health Interview Survey, 67% of African American men 

are overweight, and, of these, close to half are obese.49 Extensive epidemiological 

evidence supports a positive association between weight (BMI) and elevated blood 

pressure.40–48 The strength of the relationship between obesity levels and high blood 

pressure is particularly important in African American men because of their increased 

risk for both.103–107 Many risk factors for both obesity and hypertension can be 

addressed through the same lifestyle modifications, including dietary changes and 

increased physical exercise. Higher socioeconomic status has also been found to be 

protective against obesity.39 In the African American community, cultural dietary 

patterns and fear of social stigmatization have been found to deter significant changes 

in diet or exercise lifestyle modification.50–54 

a review to address blood pressure control in african american men 35 
3.13
 Emerging Knowledge about Disparities in Hypertension 

The relationship between standards of masculinity in African American men and 

hypertension care and treatment has not been studied extensively in the literature. 

Traditionally, men are more likely to neglect their health compared with women, in 

part because of a belief that masculinity is associated with strength, independence, a 

reluctance to seek help, and denial of vulnerability.108 Health-seeking behaviors such 

as regular visits to health care providers and treatment for illness are often seen as 

expressions of helplessness or weakness. 

The healthy behaviors that are necessary for those suffering from hypertension may 

be perceived by men as female in nature.108 This includes watching food intake 

(which may be viewed as dieting) and demonstrating weakness by deferring to a 

medical provider’s advice or submitting to regular treatment. It is also possible that 

men fear the potential side effect of sexual dysfunction as an additional threat to their 

masculinity when taking hypertension medications. 

These fears may be exacerbated in African American men as a result of the 

psychological damage that has been inflicted on African Americans because of a 

history of slavery, segregation, racism, and discrimination. African American men, in 

particular, have suffered from role conflicts due to a personal perception of strength 

and virility by virtue of being male that is in contrast to the inferior role placed 

upon them by society.109 Thus, a reluctance to seek preventive care and secondary 

preventive treatment after a hypertension diagnosis may be even more pronounced 

in this population. 

Future assessments of the role of perceived racism on health outcomes would 

be enhanced by including more systematic assessments of exposure to multiple 

dimensions of racism, including discrimination, stigmatization, social-distancing, and 

threat and aggression.110 

An additional area for further research is the presence of hypertension in middle class 

African American men. Although education and income seem to serve as protective 

factors against hypertension for African American women, it is the opposite for African 

American men.111 Moreover, African American men who fall into the second-highest 

income bracket have the highest rate of hypertension.111 It is theorized that the stress 

of maintaining a higher economic standard is more prevalent in this group as a result 

of the threat of discrimination, as well as the lack of a safety net for wealthier African 

American individuals who may not have relatives or other support systems to provide 

assistance should they have an economic crisis.111 

Although each of the aforementioned factors has had a demonstrated effect on 

hypertension rates in African Americans, it is also clear that there is no single 

factor or consistent combination of factors explaining the difference in rates of 

hypertension between African Americans and whites.112 Additional research is 

needed to more fully understand the role and level of influence of psychosocial 

factors that result in health disparities. 

36 african american men and blood pressure control: a closer look 
4 

Programs with Systems-Level Interventions 

4.1 Overview 

This chapter presents the results of our search for programs that would be relevant 

examples when considering the design and/or implementation of systems-level 

interventions for addressing high blood pressure control among African American 

men. First, we present lessons learned across all identified programs. We then present 

information concerning nine programs identified by searching the Internet and 

through input from program staff and expert panel members. The nine programs 

selected were based on the services they provide. We conducted in-depth telephone 

interviews with administrators from each of these programs. When available, we also 

gathered additional information about programs through reviews of peer-reviewed 

journal articles, Web sites, evaluations, and other documents provided to us by the 

programs. An independent evaluation of program quality was not conducted. 

Information concerning interviewed programs is followed by summaries of 11 

additional programs described in 12 peer-reviewed journal articles that were identified 

through a MEDLINE search. These programs were included in research studies. In 

some cases, researchers were comparing two different treatment approaches, so only 

some of the participants received treatment through the new approach. We include 

studies that we consider directly relevant (systems-level interventions for African 

American men) and others that offer useful information, such as lessons learned on 

recruitment and retention of African American men. 

The following sections report on the findings from both the interviewed programs 

and those programs identified through the electronic literature search. In each of the 

respective sections, we provide individual program summaries and lessons learned in 

recruitment, implementation, and if available, evaluation of the programs. 

a review to address blood pressure control in african american men 37 
4.2 Summary of Lessons Learned 

Presented below is a synthesis of lessons learned that emerged across the 9 interviewed 

programs and the 11 programs identified through peer-reviewed journal articles. 

We have divided them into three categories: overall lessons, lessons on program 

participation by African American men, and lessons on cultural competency. A 

detailed view of what worked for each of the programs can be found under each of 

the program’s individual summaries. 

4.2.1 Overall Lessons 

Having high visibility is important for building trust with program participants 

and the community. Repeat visibility can be achieved through radio, television, 

posters, or through faith-based organizations or community events. 

If a program involves members of the community, such as barbers, stylists, 

community members affiliated with faith organizations, or health educators, 

providing incentives to these providers increases participation. Also, providing 

incentives for program participants is an effective means for garnering and 

maintaining participation. 

It is necessary to go out into the field to learn about the needs of the community 

and shape program interventions around those needs. For example, if a program 

promotes eating healthier foods, it is essential to identify places where specific 

healthier foods can be purchased in the community. 

Continuously evaluating program interventions (through focus groups, surveys, 

or interviews) is necessary for making improvements to the program to meet the 

needs of the community. 

Programs should not only identify health problems in program participants, but 

also provide resources for them to obtain needed services. It is important for 

programs to provide referrals for participants so they can obtain follow-up care. 

Workplace programs that blend behavioral and environmental interventions to 

complement and reinforce each other should support the health outcome being 

shared by the employer and employee. The blending of these approaches may 

promote behavioral change by enhancing workplace awareness. 

Issues of privacy or confidentiality and liability are critical barriers to more 

effective follow-up. Providing screening organizations with a confidentiality 

agreement before the screening may be helpful, or adding a tear off section to the 

screening form where screeners would record the participant’s screening results 

and then detach it for the participant to have for future reference. 

Using volunteers has its assets and liabilities. Volunteers are often recruited 

because of their interest and availability without giving consideration to their 

talents and skills. For example, in one faith-based program, the pastor may 

have assumed that all registered nurses and faith leaders had the requisite skills 

and talents to organize and implement the faith-based organization’s high 

blood pressure program. On the basis of the members’ self-assessments, this 

was not always true. 

38 african american men and blood pressure control: a closer look 
 

In many cases, hypertension is not an isolated condition. Therefore, forming 

partnerships or collaborating with programs focusing on diseases such as 

diabetes or obesity may increase effectiveness since many of these programs 

have overlapping aims. 

Forming partnerships that engage and consistently involve the community is 

essential for program sustainability. For example, community screening events are 

more likely to be successful and sustainable when they are institutionalized and 

supported by the community. 

The following is a list of nontraditional partnerships: 

 Barbershops: They offer a racial, ethnic, and gender-specific environment effective for fostering a systems-level change. 

 Faith-based organizations: These offer access to participants, volunteers to 

provide services, venues for events, and leadership in the community. 

 African American fraternities and sororities: These organizations are 

well-organized and willing to serve and partner with health programs. An 

increasing number of fraternities and sororities identify health as a major 

area of focus. 

 Historically Black Colleges and Universities (HBCUs): HBCUs such as the 

Morehouse School of Medicine and Jackson State University often have research and community-based programs centered on health disparities. 

A more detailed description of these kinds of partnerships can be found in Chapter 5, 

which presents General Health Resources. 

4.2.2 Lessons on Program Participation by African American Men 

Involving family members can help in encouraging men to take charge of their 

own health. 

Many African Americans do not trust the health care system. It can be helpful 

to have prominent community members, such as faith leaders, local celebrities, 

barbers, and trustworthy health educators, participate in and represent programs. 

A peer-to-peer approach sets a good example and encourages African American 

men to participate in health interventions. 

African American men may be more likely to talk about their health or get a 

blood pressure screening as a group than individually. 

Programs must be considerate of participants and lower barriers to participation 

by making interventions and health events as convenient as possible. For 

example, health events should be held at a time when men are not working. Also, 

if a community or screening event requires waiting time, it could be used as an 

opportunity to provide health education so that participants do not feel like they 

are wasting their time. 

Messages need to be tailored to different African American male audiences. For 

example, places of worship may be particularly effective for reaching older men, 

while Web-based education campaigns are more likely to reach younger men. 

Cultural beliefs should not simply be tolerated but understood. Social, 

religious, and other factors may influence the role of fatalism in the African 

American community. 

a review to address blood pressure control in african american men 39 
 

 

 

 

Younger men (aged 18–49 years) or men newly diagnosed with high blood 

pressure are more difficult to recruit and retain. These groups are more at risk 

for inadequate education about high blood pressure. 

It is feasible to identify, recruit, and follow-up on young, inner-city African American 

men; however, the process is very labor intensive. An enthusiastic, energetic, 

committed, and persistent minority staff is essential to recruitment and retention. 

Staff can bring to the study knowledge, experience, nonjudgmental concern about 

the health of the population, and an ability to establish rapport with the men and 

contacts. It is important that the workers are comfortable in the community, but they 

do not need to be from the community. 

4.2.3 Lessons on Cultural Competency 

Program materials need to be culturally relevant and use language familiar to 

members of the community. 

Visual materials need to be aimed at African American men; materials should 

include representations of African American men. 

4.3 Interviewed Programs 

In this section, we summarize the information on the nine programs for which we 

conducted in-depth telephone interviews. Programs selected were based on whether 

their efforts contained systems-level interventions for improving hypertension or 

other cardiovascular diseases. A systems-level intervention was defined as a change 

in policy, legislation, training, or environmental supports that impacts individual 

and community-level outcomes. The target population of the program was also 

examined. Programs selected for an interview generally focused their efforts on the 

African American population, but all did not exclusively target African American 

men. The telephone interviews were conducted with program managers who were 

identified by the organization as being knowledgeable about the program or with 

principal investigators, if the program was a research study. The interviews lasted for 

approximately one hour, and discussions focused on the program’s goals and objectives, 

methods of encouraging program participation by the target population, the types of 

services offered by the program, and the lessons learned. 

These nine programs are systems-level blood pressure control interventions for African 

American men. Programs provide services in settings such as barbershops, faith-based 

organizations, and community events. Types of service providers include barbers, 

community health workers, and staff health educators. Some of the services across 

programs include blood pressure screening, referral to medical providers, and media 

campaigns. After a summary of two model programs, we present a matrix with details 

about selected characteristics of each program. The matrix is designed to provide a snapshot 

of the nine programs with select characteristics to easily access a particular program of 

interest. Detailed, individual summaries for the nine programs follow and are numbered to 

correspond to the numbers in the matrix for ease in locating them within this section. 

4.3.1 Examples of Program Models 

The following two programs are highlighted because they focus specifically on 

reaching African American men and have been evaluated and found to increase 

awareness about high blood pressure, increase use of medical care, and increase 

40 african american men and blood pressure control: a closer look 
adoption of behavior change to support blood pressure reduction. Both programs are 

community-based, one with more participation from the community. The programs 

could be used as a stimulus to work with health care providers to address systems 

issues in serving African American men. 

4.3.1.1 Can Barbers Cut Blood Pressure Too? 

The goal of this program was to train barbers in the African American community 

to become community blood pressure specialists. The barbershop plays an important 

role in the lives of African American men, and the program provides both training 

and support to barbers about blood pressure. The barbers measure and record blood 

pressure readings of customers, provide information about high blood pressure, 

and make referrals to providers. The barbers are supported by a nurse and research 

assistants. The program has been evaluated through two non-randomized studies. 

African American men receiving service through the intervention were found to have a 

decrease in blood pressure and an increase in treatment and control. 

Key characteristics: 

Increased awareness of and knowledge about screening for high blood pressure 

Increased follow-up with medical providers 

Engaged a nontraditional population to improve high blood pressure awareness 

in the community
 

Required an incentive structure to encourage barbers to participate
 

4.3.1.2 	Stroke, Hypertension, and Prostate Education Intervention Team 

(SHAPE-IT) 

The goal of this program was to increase community partnerships that can develop 

methods to address both prostate cancer and stroke among African American 

men. The program had two phases. The first phase established an advisory council, 

developed a community action plan, and conducted a community assessment 

through focus groups. The second phase identified African American men to 

participate in program interventions, developed community contacts to host 

activities, and conducted small and large group educational presentations on prostate 

cancer, hypertension, and stroke. Evaluation of the program found that participants 

had increased knowledge about high blood pressure, increased ability to discuss high 

blood pressure with family and health care providers, and increased medical care 

seeking and lifestyle changes supportive of reducing high blood pressure. 

Key characteristics: 

Fostered partnerships between health care providers, community-based 

organizations, and community members to develop strategies to reduce high 

blood pressure 

Demonstrated integration of services for education about two diseases 

affecting the population 

Increased knowledge about high blood pressure 

Increased behavior changes to reduce high blood pressure 

a review to address blood pressure control in african american men 41 
Selected Characteristics 

1 

Can 

Barbers 

Cut 

Dallas, TX 

2 

CHAMP 

Baltimore, 

MD 

3 

Magic 

City 

Birmingham, AL 

4 

Power to 

Live Smart 

Seattle, WA 

5 

REACH 

Atlanta, 

GA 

6 

REACH 

Chicago, IL 

7 

SHAPE-IT 

Philadelphia, PA 

8 

SHAPP 

GA 

9 

Sound 

Heart 

Seattle, WA 

Sponsoring organization type 

Community-based  

Government   

University    

Program maturity (years) 9 29 4 1 8 7 2.5 34 29 

Funding 

Federal: CDC     

Federal: other  

State    

County/local   

Private   

Setting 

Faith-based organization      

Barber shops/beauty salons      

Community centers   

Clinics   

Community events    

Service delivery 

Barbers     

Staff coordinators       

Staff nurses   

Staff health educators    

Community health/outreach workers    

Service recipient focus 

Low-income/underserved   

African Americans       

Men only  

Program activities 

Blood pressure screening/monitoring       

Referral to providers     

Patient education/media campaign         

Outreach      

Follow-up   

Training community members/ 

professionals 

    

Grants to local orgs 

Partners     

Evaluation      

4.3.2 Interviewed Programs Matrix 

The matrix below provides a guide to the information contained in the summaries 

for each of the interviewed programs. It is intended to assist the reader in more easily 

locating programs that may be of particular interest. 

42 african american men and blood pressure control: a closer look 
4.3.3.1 

Period of operation:

Funding:

Coordinating Board (tobacco settlement money that could be used for minority health 

disparities projects). Funding is also provided by the National Heart, Lung, and Blood 

Institute and the Donald W. Reynolds Foundation. Other supporters include Visa, the 

Aetna Foundation, Biovale, and Pfizer. Overall funding totals more than $4 million.

Mission:

to make barbers in the African American community blood pressure specialists by 

recording their customers’ blood pressure using automated devices, allowing them to 

identify customers with untreated hypertension and refer them to medical care.

Description: 

 

 

 

 

 

4.3.3
 

The barbershop being 

sort of the nerve center 

of daily social life in 

many urban centers. 

If you want to get the 

word on the street or 

what the people are 

thinking or prevailing 

attitudes about things 

or controversial issues, 

that is the place to go. 

Individual Program Summaries 

Below we present more detailed summary information on the nine interviewed 

programs containing systems-level changes for addressing blood pressure control among 

African American men. Information concerning these programs was gathered from key 

informant interviews and supplemental materials, such as journal articles, Web sites, 

and program evaluations. Each program summary includes the program’s location; 

period of operation; funding; mission; a description including activities, partnerships, 

organizational structure, staffing, and target audience; evaluation and research activities; 

lessons learned; a link to the program’s Web site; and contact information. If available, 

information on the characteristics of participants receiving services from the programs, 

program expenditures, and publications concerning the program intervention are also 

listed. Each summary was reviewed by the program’s main contact person. 

Program 1: Can Barbers Cut Blood Pressure Too? Dallas, Texas 

April 2002–December 2008

The project began with a grant from the Texas Higher Education 

The primary goal of the Can Barbers Cut Blood Pressure Too? project is 

Activities: 

This project began in response to the Dallas Heart Study, which showed that 

African American men, particularly those of younger ages, have one of the 

highest rates of hypertension in Dallas County. 

The project trains, equips, and reimburses barbers to: 

 Record their customers’ blood pressure with an automated monitor in the 

barber chair. 

 Educate their customers about high blood pressure using motivational, peer 

experience stories. Barbers also provide Blood Pressure Report Cards to their 

customers and encourage them to bring it to their medical provider. 

 Identify customers with untreated high blood pressure and refer them to 

medical care. 

The barbershops have information packages with providers and provider 

networks with which the program has informal partnerships. The barbers 

distribute the information to customers. A nurse or other intervention staff is 

on-call 24 hours a day, 7 days a week to help participants with the paperwork 

needed to obtain services from providers. 

a review to address blood pressure control in african american men 43 
Barbers fill out an encounter form (in triplicate) each time they measure a 

customer’s blood pressure. The top half of the form goes to the customer. The 

other half of the form contains data that is mailed to the intervention team. 

These forms also serve as reimbursement forms for the barbers. Barbers get 

rewarded for measuring blood pressure and for making referrals. The barbers 

receive $3 per recorded blood pressure and $50 per blood pressure report card 

signed by a medical provider with proof of a new blood pressure prescription. 

Educational materials are all role model or peer experience stories. The teaching 

message emphasizes motivation more than knowledge. 

To sustain barbershop customers’ participation in the program, for each 

completed exit interview, the customer receives a free haircut and the barber 

receives a $5 tip for encouraging customer participation. 

Partnerships: 

Informal partnerships were established with various providers to provide access to 

medical and pharmaceutical care for participants. These partnerships include— 

 Several physicians who had offices within walking distance to the barbershops 

or were within participants’ provider networks. While care is not free, one 

physician has agreed to see referrals at a discounted rate if the individual is 

uninsured or underinsured. 

 The county health care provider, Parkland Hospital and Hospital System 

provides indigent care to residents of Dallas County for a nominal fee. 

To help recruit barbershops to participate in the intervention program, 

community contacts were made through two local African American barber and 

barber stylist organizations: the Texas Association of Tonsorial Artists and the 

Professional Barbers and Stylist Committee. 

Organization: 

Can Barber Cut Blood Pressure Too? is a project being conducted at the University 

of Texas Southwestern Medical Center. Sixteen Dallas County Barbershops are 

participating in the program. 

Staffing: 

Dr. Ronald Victor, a physician researcher, is the principal investigator of the study. 

The intervention team consists of an African American nurse and African American 

research assistants and medical and pre-medical students. 

Target audience/participants: 

The study aims to collect data from African American men 18 years of age or older. 

The program has screened approximately 4,000 African American men, of which, 

approximately 1,000 were found to be hypertensive. A goal of the study was to 

identify 100 hypertensive African American men who were regular customers at 

each barbershop. 

Characteristics of program participants: 

The average age of a participant with hypertension was 50 years of age or older. 

Approximately one-half to two-thirds of participants were married. 

Approximately 75% of participants had at least a high school education; 75% of 

participants were employed full time. 

44 african american men and blood pressure control: a closer look 
 

80%–89% of participants have health insurance. 

Less than half of participants are currently seeing a physician for high blood pressure.
 

Barbershop clientele represent an enormous range of socioeconomic backgrounds. 

Evaluation and Research: To evaluate the effectiveness and sustainability of the 

barbershop intervention, two non-randomized studies were conducted to — 

Compare the effectiveness of hypertension interventions (screening and 

education) in a barbershop setting (enhanced intervention program) versus a 

traditional setting (comparison group). 

Assess the feasibility of having barbers versus research personnel implement 

hypertension interventions in a barbershop setting.

African American men in the enhanced intervention group were found to have a 

significant drop in blood pressure levels compared to the comparison group, which 

experienced no change in blood pressure. In addition, hypertension treatment 

and control were found to increase significantly for the enhanced intervention 

group. Hypertension treatment and control were found to be unchanged for the 

comparison group. 

The barbershop intervention was found to sustain a greater number of participants 

when barbers rather than research personnel offered blood pressure monitoring 

to barbershop customers. The study found that barbers were able to successfully 

incorporate blood pressure screening, health education, and medical referral into 

their role at the barbershop. 

Lessons Learned: 

Overall: 

Because it is unlikely that a meaningful portion of barbers would participate in an 

intervention program such as this for free, it is necessary to have a financial incentive. 

However, some new incentive system would be useful since the fee for service structure 

that the program used was administratively difficult to maintain. 

The success or failure of the project depends on the barbers. The barbers have tremendous ability to affect their customers’ health behavior. The barbers should be chosen 

carefully because some are more motivated than others. 

It is very important to establish credibility. Therefore, the personnel providing support services to the barbers must be credible, and the blood pressure 

machines must be accurate. This program uses research grade machines which 

are checked frequently for accuracy by program staff. Accuracy ensures that the 

barbers are being honest. 

To me it is all a matter of really motivating the barbers and how to get the buyin from the barbers. We have some barbers that are unbelievably fantastic, and 

basically every man that sits in their chair takes part in the program. Some of the 

men, you have to show them time and time again that it is not a fluke, and their 

blood pressure is elevated. We have a lot of highly educated men who will sit in 

the chair and their blood pressure is high, and they say ‘I ran over from work,’ or 

whatever and ‘That [it] is just a fluke,’ and ‘My blood pressure is up.’ If they sit in 

the chair six times in a row, then they start to believe it, and they will eventually 

do something about it. 

a review to address blood pressure control in african american men 45 
The barbershops are 

a wonderful place to 

try to do preventative 

medicine and try to get 

people in their forties 

or thirties treated so 

they can live a full life. 

This program could be replicated anywhere but will need financial support 

from the state health department and/or insurance carriers. The researchers will 

be investigating approaches to sustainability of the program after the current 

funding ends. In particular, they will be considering issues of cost-effectiveness. 

The men are an easier sell than the barbers, and once the barbers buy into the 

project they can have tremendous benefit to their customers. 

Participation by African American men: 

There are several possible barriers that prevent African American men from participating in this program, including an inaccurate perception that they are not 

at risk, lack of medical knowledge, fear, masculine view that it not thought to be 

masculine to worry about blood pressure levels, inadequate insurance, distrust of 

doctors, and inconvenience. 

The key to getting African American male participation is the barber: 

If the barbers will just measure the blood pressure, and really try hard, I am very 

optimistic that the outcomes could be great, and some of the customers will be very 

easy to convince because they are already motivated about their health. It is not 

like every man that sits in that chair is going to be a hard sell. Some are going to 

be already highly motivated and very knowledgeable. All they need is a chance to 

have their pressure measured accurately on a regular basis. 

Reference: 

Hess PL, Reingold JS, Jones J, Fellman MA, Knowles P, Ravenell JE, et al. Barbershops 

as hypertension detection, referral, and follow-up centers for Black men. Hypertension 

2007;49:1040–1046 

Web site: 

http://www8.utsouthwestern.edu/utsw/cda/dept100467/files/138990.html 

Contact: 

Ronald G. Victor, M.D. 

Director, Cedars-Sinai Center for Hypertension 

Associate Director, 

Clinical Research, Cedars-Sinai Heart Institute 

8700 Beverly Blvd. 

Los Angeles, CA 90048 

Assistant: Julie Groth 

E-mail: julie.groth@cshs.org 

46 african american men and blood pressure control: a closer look 
4.3.3.2 Program 2: Church/Community Health Awareness & Monitoring 

Program (CHAMP) Baltimore, Maryland

Period of operation: CHAMP began as a National Heart, Lung, and Blood Institute 

funded demonstration grant in 1979 focusing on hypertension awareness and control. 

In 1990, the focus shifted to all cardiovascular risk factors. Beginning in 1982, 

funding was provided through a block grant. The Hair, Heart, & Health component 

(the focus on training barbers and hair stylists) began in 2006. The program is in its 

third year of funding. 

Funding: Funding for CHAMP is provided by CDC’s Preventive Health and 

Health Services Block Grant and the Maryland Department of Health and Mental 

Hygiene. Hair, Heart, & Health receives funding from Care First (the local BlueCross 

BlueShield provider). The funding amount is unavailable. 

Mission: To place behavior change strategies in the hands of people who can motivate 

and assist one another to adopt healthier lifestyles and become more self-reliant. 

The program’s primary goals are based on the Healthy People 2010 objectives and the 

Maryland Nutrition and Physical Activity Plan goals: 

To reduce coronary heart disease deaths
 

To increase nutrition and physical activity adoption
 

To take part in moderate physical activity at least 30 minutes a day
 

To make dietary behavioral changes in eating habits
 

To increase fiber and dairy intake
 

To increase fruit and vegetable intake
 

Description: 

The program was created by Dr. Elijah Saunders, a cardiologist, and Dr. B. Waine 

Kong, former Executive Director of the Association of Black Cardiologists. 

The program is primarily considered to be faith-based since it works primarily 

with the faith-based organizations in the city of Baltimore. The program also 

works with senior centers, work sites, and recreation centers. 

The Hair, Heart, & Health program works with inner city barbershops and
 

hair salons.
 

Activities: 

CHAMP conducts classes that train community and faith-based organization 

volunteers. Volunteers are called community health advocates. Community 

health advocates provide diabetes, cholesterol, blood pressure, and stroke 

education. They perform screenings and educational activities in the 

community. The CHAMP coordinator meets with community health 

advocates approximately once a month to update them about any new 

information that may be available. The program provides a guest speaker each 

month on a variety of topics. 

Community health advocates conduct blood pressure screenings and 

monitoring at various sites including barbershops, senior centers, and 

community recreation centers.
 

a review to address blood pressure control in african american men 47 
Community physicians request CHAMP to provide ongoing monitoring of 

their patients’ blood pressure and to support and encourage recommended 

lifestyle changes.
 

CHAMP conducts classes concerning weight loss directly for community 

members. Classes led by registered dieticians or health educators include an exercise 

component. Approximately 10% to 15% of the class participants are men. 

Often, individuals participating in classes are informed about the community 

blood pressure screenings, and those attending screenings are told about classes. 

Screenings are done mostly in the faith-based organizations. Each faith-based 

organization has a designated Sunday as the screening and monitoring day. 

Materials are written at the 5th grade level. 

One CHAMP class trains faith-based organization ministers and cooks to modify 

menus to serve heart-healthier meals at fellowship events. 

CHAMP distributes feedback forms regularly to participants and uses these to 

make program improvements. 

CHAMP conducts a companion program called Hair, Heart, & Health with 

funding from Care First (the local BlueCross BlueShield provider). This 

program trains barbers and hair stylists to provide blood pressure measurement 

and cardiovascular disease health education and involves 13 participating 

barbershops. Five CHAMP community health workers assist with paperwork 

when the barber is too busy. There are some shops where the barber has not been 

trained, but they allow community health workers to provide the blood pressure 

screenings and health education at their shop. A total of 1,805 participants 

were screened in the first year; of those, 76% were African American men. The 

program has been more successful in reaching men in barbershops than reaching 

women in hair salons. 

Barbers are compensated by being allowed to keep television sets given to them 

by the program to provide customers with health messages. Program participants 

receive points for various activities, including getting their blood pressure taken, 

seeing a doctor, and lowering their blood pressure. Points can be exchanged for 

gifts such as gift cards for gas, Wal-Mart, etc. 

The health-related DVDs that are given to the shops are not tailor-made 

and are limited to what is available. Some clients have complained that the 

DVDs are not relevant because they do not reflect what occurs in their lives. 

The incentives that were purchased by the program are distributed by the 

community health workers. 

Partnerships: 

Informal agreements exist with organizations that organize community events 

which may be venues for blood pressure screenings and educational activities. 

Partners have included all the faith-based organizations that participate as 

CHAMP Centers, 100 Black Men, Prince Hall Masonic Temple, and African 

American fraternities. A major partner is the American Heart Association. The 

Power To End Stroke and the Red Dress Campaigns are promoted at all the 

CHAMP outreach sites. 

48 african american men and blood pressure control: a closer look 
One of the most important lessons is that visual learning and hands-on learning 

Organization: 

The program is conducted through the University of Maryland, Department of 

Family Medicine and Department of Medicine. The CHAMP office is located 

in the community near a mass transit hub to make it easy for community health 

advocates to access. 

Staffing: 

A health educator and an administrator work full time. Dieticians and exercise 

instructors from the community are consultants. The program also employs two 

part-time community health workers who work with the volunteer community 

health advocates. 

The Hair, Heart, & Health Program employs one full-time coordinator and four 

part-time community health workers. 

All staff are employed by the University of Maryland. 

Services are provided by approximately 75 volunteers (community health 

advocates). 

Characteristics of program participants: 

Primarily individuals from the African American community, 18 years of age 

or older. 

Approximately one-third are low-income. 

The program reaches approximately 3,000 to 4,000 individuals per year. 

The Hair, Heart, & Health program has seen approximately 1,800 

individuals. The other CHAMP programs see approximately 2,000 to 3,000 

individuals per year.
 

Evaluation and Research: The program reports quarterly to the state but lacks the resources and funding to more substantially evaluate its programs. 

Lessons Learned: 

Overall: 

It would be very hard to sustain the program at the level at which it is currently 

operating without funding. Many of the faith-based organizations have health 

ministries so the screening and monitoring would continue at those places of 

worship. Many of the barbers would continue because they have the tools and 

equipment, but the health education component would not be sustained without 

funding. There are no other programs like CHAMP in Baltimore. CHAMP provides 

the health education in the community sites. 

Volunteers are motivated by the opportunity to work in the medical field. 

The volunteers want to help others and.... many of them had dreams of being a 

doctor or nurse and just didn’t reach that goal and this just gives them a great 

deal of satisfaction knowing that they are working in the medical field, in a sense, 

and helping their fellow man..... This is something that is important to them and 

many of them look at this as their health ministry. 

are more effective than listening to lectures. 

a review to address blood pressure control in african american men 49 
Participation by African American men: 

The Hair, Heart, & Health program component has been much more successful 

in reaching African American men than the faith-based component. To reach 

African American men, community advocates need to go to barbershops, senior 

centers, and community recreation centers, and to have a presence at community 

events such as those sponsored by 100 Black Men. 

One of the things that we learned is that we are not reaching our African 

American men with just targeting churches.... [We] expanded it to involve 

other community sites so that we were able to reach African American men. We 

have actually done barbershops and hair salons, but we sent in our community 

advocates where we were not training the barbers and stylists.... We also go to 

senior centers, community recreation centers and various other community sites. 

In general, female community health workers are better vessels than men, when 

it comes to reaching out to the men. Men tend to be more likely to participate 

in the program if the community health advocate or community health worker 

is a physically attractive woman. This is true in both the barbershops and faithbased organizations. 

African American men are motivated to participate by conducting programs in 

familiar settings. 

Men may be held back from participating based on fear of others finding out 

about their having high blood pressure. Finding out about their age and weight 

does not seem to bother them to the extent that it seems to bother women. 

Men tend to prefer materials that are visual. They like posters, brief videos, and 

demonstrations in classes. They tend to like the discussions less. 

Barbers participate partially because they see one of their roles as being a 

community leader. 

Cultural competency: 

The program tries to include materials that predominately include African 

Americans, but it can be difficult to find a sufficient variety of materials 

and videos. 

Web sites containing program summary: 

http://medschool.umaryland.edu/champ/ 

www.healthfreedominc.com 

Contact: 

C.H.A.M.P. Business Center at Park Circle 

2901 Druid Park Drive Suite A-204 

Baltimore, MD 21215 

Voice: 410-669-6340 

Fax: 410-669-9291 

50 african american men and blood pressure control: a closer look 
The men are an 

easier sell than the 

barbers, and once the 

barbers buy into the 

project they can have 

tremendous benefit to 

their customers. 

Ina Glenn-Smith 

2901 Druid Park Drive, Suite A-204 

Baltimore, Maryland, 21215 

Phone: 410-669-6340 

E-mail: ismith9576@aol.com 

Jeanne Charleston, RN 

Phone: 443-802-5161 

E-mail: jeannebc@comcast.net 

4.3.3.3 Program 3: Magic City Stroke Prevention Project 

Birmingham, Alabama 

Period of operation: August 2004–July 2008

Funding: 4-years, $2.4 million, Community Initiative to Eliminate Stroke (CITIES) 

cooperative agreement from the U.S. Department of Health and Human Services, Office of Minority Health. 

Mission: Bridging the gap between public health science and practice in risk reduction 

across the life span among African-American and other underserved communities, to 

determine the benefits of sustained efforts to build community capacity and to reduce 

risk factors within underserved communities. Goals include increasing community 

awareness and outreach and serving as a coordinator in providing residents with information and activities relating to stroke prevention. 

Description: 

Activities: 

The project produces health messages for radio and TV. Message development 

was based on a review of the literature and materials from the National Heart, 

Lung, and Blood Institute’s No Stroke campaign focusing on African Americans. 

Messages were developed in two phases. Phase 1 created a message that 

emphasized that stroke is a medical emergency and focused on knowing what 

a stroke looks like and calling 9-1-1. The second phase emphasized messages 

about risk factors related to stroke such as hypertension, diabetes, high blood 

cholesterol, and obesity. 

The project helped sponsor a regional championship football game between two 

HBCUs, permitted the airing of the project’s logo, tag line, and a 30-second 

commercial during the televised event; a link to the project’s Web site was also 

associated with the event. 

Funds were provided for home blood pressure monitors for distribution by the 

county health department. A local hospital is evaluating barriers to refilling blood 

pressure medication through a grant from the program. 

The project implemented the American Heart Association’s Search Your Heart 

Program in partnership with Congregations for Public Health. This is a faithbased curriculum that delivers knowledge and action steps to encourage a 

reduction in risk factors for heart disease and stroke among African Americans. 

a review to address blood pressure control in african american men 51 
Partnerships: 

I think that the key, to 

me, of our success has 

been using the community health advocates. First of all...this 

is someone you go to 

church with and many 

times participants are 

more honest with them 

than they are with 

health professionals. I 

think that is one of the 

key things is that using 

community people that 

they know and trust. 

A mini-grant program provides one year of funding to 22 community 

organizations conducting work related to hypertension and stroke. Grantees 

included faith-based organizations, sororities and fraternities, and neighborhood 

associations. Numerous programs that started through this funding continued 

after funding ended, proving that initiatives were sustainable. 

Web site provides information concerning stroke and stroke prevention activities. 

Three work groups were organized. The first assists with the development of the 

media campaigns and provides feedback on materials during production. The 

second work group is informal and has relationships with fire rescue stations 

and Birmingham Health Care, which has a mobile van and several clinics; 

both agencies have agreed to be identified as places that individuals can go to 

have their blood pressure checked. The third work group identifies and trains 

community residents to help administer the AHA’s Search Your Heart Program 

and to administer a survey developed by the project to evaluate the program. 

Outreach specialists are paid by the project and are affiliated with Congregations 

for Public Health. 

Partnership organizations were involved in many important project functions 

including developing scripts for radio PSAs, implementing community projects, 

and coordinating health education media placement for large athletic events. 

American Heart Association and American Stroke Association 

A local faith-based umbrella organization (Congregations for Public Health) to 

coordinate programs in faith-based organizations, neighborhood associations, 

sororities and fraternities, the city of Birmingham Division of Youth Services, 

the Southwest Athletic Conference (SWAC), the Birmingham/ Huntsville AME 

district, and the University of Alabama at Birmingham (UAB) Comprehensive 

Stroke Center 

Local health care providers such as the county hospital (Cooper Green-Mercy 

Hospital) and the Jefferson County Department of Health 

Various television and radio media outlets including ESPN 

100 Black Men of Birmingham
 

Organization: 

Housed within UAB’s Center for the Study of Community Health 

Staffing: 

Housed in the UAB School of Public Health, virtually all day-to-day operations 

are managed by two full-time staff (program manager and coordinator). Staff also 

includes a principal investigator and research assistants. 

Target audience/participants: 

Male and female African Americans in Birmingham, over the age of 35. Of the 

250,000 residents of Birmingham, 75% are African American. Of these, 40% 

are men. 

52 african american men and blood pressure control: a closer look 
Evaluation and Research: No formal evaluation has been conducted. Telephone 

interviews collected information on program awareness/branding and on knowledge 

concerning high blood pressure and stroke awareness. In late 2005, 603 completions 

were collected. 

Lessons Learned: 

Overall: 

Tailoring messages specifically to Birmingham, including local people in videos 

and utilizing local radio personalities in radio messages, have helped to make 

them well received. 

To help promote trust between organizations, it is necessary to plan the 

implementation of new community initiatives with the groups that are going to 

be directly involved. 

It is challenging to do community-based programming from a large researchdriven university. 

Even though project funding has ended, project recognition will continue 

through $10,000 grants provided to 15 community organizations. The 

infrastructure and knowledge developed through grants to faith-based 

organizations and civic organizations will allow for continued dissemination 

of health information and health screenings. In addition, grant recipients 

gained useful experience in grant writing through this process. These skills will 

strengthen their ability to successfully compete for new resources. 

Participation by African American men: 

To reach African American men, televised messages were aired on ESPN during a 

football game produced by the Southwestern Athletic Conference. 

Cultural competency: 

Community members should be asked for feedback on materials. The project’s 

leadership consults with an African American neurologist who has many African 

American patients and provides advice concerning the best approaches for educating African Americans about stroke. 

Web site: 

http://www.magiccitystroke.com/page.asp?id=19 

Contact: 

Shauntice Allen, MA 

Program Manager 

Magic City Stroke Prevention Project 

2001 3rd Ave South Ste. 1081 

Birmingham, AL 35233-0016 

Voice: 205-975-5429 

Fax: 205-934-9310 

E-mail: sallen1@uab.edu 

a review to address blood pressure control in african american men 53 
4.3.3.4 Program 4: Power to Live Smart program 

King and Pierce Counties, Washington 

Period of operation: April 2007–present 

Funding: Funding is provided by CDC and the American Heart Association (AHA). 

CDC funds the majority of the program on a 5-year funding cycle. However, work 

plans must be submitted each year as the funding must be renewed annually. AHA 

has funded portions of the training sessions, materials, and some of the incentives for 

barbers and stylists. The funding amount is unavailable. 

Mission: The Power to Live Smart program is designed to raise awareness of the risk 

factors for heart disease and stroke among African Americans in King and Pierce 

Counties in Washington State. The program coordinates local African American 

nurses who, in turn, train barbers and stylists in African American communities to 

take their clients’ blood pressure readings and provide them with information on heart 

disease and stroke. By doing so, the program hopes to raise awareness of the signs 

and symptoms of stroke and heart disease, provide support for behavior change, and 

encourage at-risk individuals to seek follow-up care from health professionals. 

Description: 

Activities: 

Specific barbershops and salons were targeted by nurses on the basis of their 

knowledge of the community. Nurses held training course for 20 barbers and 

stylists who agreed to take part in the program. Training sessions (of one and 

a half hours) were held from April 2007 to June 2007. During the training, 

barbers and stylists were given automated blood pressure monitors with builtin cuffs and received instruction on how to use them. Participants also received 

instruction on how to communicate with clients about the results of their blood 

pressure readings, and about risk factors for heart disease and stroke. 

Barbers and stylists at 10 shops throughout Pierce and King Counties 

informed clients that blood pressure readings could be done in their shops. 

Clients who wished to do so had their blood pressure tested at the salon or 

barbershop. Between April 2007 and September 2007, over 125 blood pressure 

readings were conducted. The readings were recorded on anonymous log sheets 

by clients or stylists 

Five thousand counter cards were ordered for distribution throughout the target 

community at events, such as Martin Luther King, Jr. Day celebrations. The 

cards described the program, directed people to more information about the 

program, and provided a list of shops that are taking part in the program. 

Educational materials published by AHA were distributed to clients at the 

barbershops and salons. 

Nurses visited each barbershop and salon once or more per quarter to provide 

support, information, and additional educational materials. 

Barbers and stylists were asked to keep track of the number of clients screened 

and the number of elevated readings found through screening. Incentives in the 

form of fitness tracking books and AHA cookbooks (valued at approximately $20 

each) were provided to barbers and stylists who attended the follow-up training 

sessions in March 2008. 

54 african american men and blood pressure control: a closer look 
The Washington State Health Department produced a media campaign designed 

to raise awareness in the African American community about heart disease and 

stroke. The campaign did not specifically talk about going to barbershops and 

beauty salons for readings, but it did target the same population about this issue. 

Partnerships: 

Cultural Health Initiative Committee—part of AHA 

Ebony Nurses Association in Pierce County—an association of African 

American nurses 

Mary Mahoney Professional Nurses Organization in King County—an 

association for African American nurses 

Organization: 

Housed within the Washington State Department of Health 

Staffing: 

At the Department of Health, there is one primary staff member (health educator) 

who spends about 25%–30% of their time on this project. The health educator 

coordinates the administrative aspects of the project (e.g., contracts), reports to the 

Cultural Health Initiatives Committee, coordinates with contractors and nurses, 

reports to the Department of Health on the status of the program, and reports to 

the steering committee for the Department of Health. This steering committee is 

composed on external stakeholders identified by the Department of Health. 

Through a private business contractual relationship, a nurse consultant coordinates 

training and outreach for the nurses that communicate, and interacts with the 

barbershops and beauty salons and serves as their primary point of contact. The 

nurses, who provide services in the community are volunteers, although they are 

paid a stipend for their travel costs. 

An American Heart Association volunteer, who is a researcher from the 

University of Washington (and is not paid through the program), provides 

general consultation. Department of Health epidemiology staff have coordinated 

evaluation efforts over the course of the project. 

The day-to-day operations are conducted by the barbers and stylists in the 10 

shops in King and Pierce Counties. Barbers and stylists may receive incentives on 

the basis of the number of clients screened. 

Target audience/participants: 

African Americans (women and men) in King and Pierce Counties of the state of 

Washington. No data is available about the socioeconomic status or educational 

level of the individuals who have participated in the program. 

a review to address blood pressure control in african american men 55 
 Evaluation and Research: Two types of evaluations were conducted of this 

program. The first evaluated the training program. Pre- and post-tests were given to 

stylists and barbers at training sessions to assess their level of knowledge gained. 

A qualitative evaluation was conducted (in the form of interviews) to assess the 

program’s progress. Thus far, the only individuals who have provided evaluation 

data have been the nurses, barbers, and stylists involved in the program. Additional 

data were collected to assess whether the program is succeeding in its mission and 

objectives, whether the target audience is aware of the program, and how involved staff 

and the cultural health initiatives community are in the project. 

A process evaluation was conducted by collecting tally sheets to assess the number of 

clients screened and the number of individuals found with elevated blood pressure. 

A total of 123 blood pressure measures were recorded at seven salons/shops between 

April 2007 and September 2007. Of these, 19% were in the normal range; 44% were 

in the pre-hypertension range; 21% were in the hypertension stage-1 range; and 15% 

were in the hypertension stage-2 range. Of those who had a value in the hypertension 

range, about one-third were under the age of 45. 

Future evaluation efforts are being coordinated by evaluators from the Department 

of Health. One of the primary objectives of the program will be to increase the 

percentage of African Americans who recognize the risk factors and symptoms of heart 

disease and stroke from an unknown baseline to 70% by June 2008. 

Lessons Learned: 

Overall: 

Barbers and stylists would like to have more support in communicating health 

information to clients. The program plans to provide ongoing training and 

more frequent communication in the future. The program has already held one 

refresher training course. 

Nurses need to receive stipends for travel to the barbershops and beauty salons 

more consistently. In the past, this has not been highly regulated, which has 

resulted in more irregular visits from nurses. As a result, many barbers and stylists 

have reported their lack of confidence in communicating health information 

because they feel that they have not received enough training and guidance. 

The program seeks to develop new ways to recruit more clients to participate in 

blood pressure screenings since they have not screened as many clients as they 

anticipated (123 screened compared to the goal of 200). 

The project would be enhanced if it could be more involved in providing further 

resources to those with elevated blood pressure after they are diagnosed; however, 

the project has already begun offering a list of community health centers that can 

provide low-cost follow-up care. 

56 african american men and blood pressure control: a closer look 
The project’s outreach would be strengthened if it joined with other healthrelated programs targeting African Americans in the Puget Sound area. Other 

interventions in the area that focus on diabetes and other health conditions have 

overlapping aims, so it may be useful to combine resources with these programs. 

It would be helpful to have nurses more available to clients who have had blood 

pressure screenings so that they can serve as a resource for them. 

Participation by African American men: 

The key informant did not provide information specifically pertaining to African 

American men. Women are more likely to participate in the blood pressure 

screening program; the male participation rate is about 22%. Of particular 

interest, however, is that one of the barbershops had the highest number of 

readings completed. 

Having pictures of men on materials helps recruit men, as they feel that the 

program is geared towards them. 

Including prominent men in the community as the “public face” of the program 

can also help cater to men in the community. 

Cultural competency: 

The key informant did not feel she could respond to whether the program was 

culturally competent or not because it had not been formally assessed. Although 

it does not guarantee cultural competency, the nurse consultant and volunteer 

nurses are themselves African American and have worked predominantly with 

African American populations throughout their careers. 

Web site: 

http://www.americanheart.org/presenter.jhtml?identifier=3047257 

Contact: 

Sara Eve Sarliker, MPH 

Heart Disease and Stroke Prevention Program 

Washington State Department of Health 

P.O. Box 47855 

Olympia, WA 98504-7855 

Phone: 360-236-3781 

Fax: 360-236-3708 

E-mail: sara.eve.sarliker@doh.wa.gov 

a review to address blood pressure control in african american men 57 
4.3.3.5	 Program 5: Racial and Ethnic Approaches to Community Health 

(REACH) Cardiovascular Wellness Centers 

Atlanta Empowerment Zone (Fulton County, Georgia, including 

the city of Atlanta) 

Period of operation: 1999–present 

Funding: Six years of grant funding were provided through the Fulton County 

Department of Health and Wellness, ending September 2007. The program is 

ongoing, but financial incentives to those who are taking readings have been 

discontinued. The funding amount is unavailable. 

Mission: To establish lay health promotion specialists through organizing and training 

individuals in faith-based organizations, beauty salons, and barbershops in the Atlanta 

Empowerment Zone. 

Description: 

Activities: 

Individuals were recruited from faith-based organizations, barbershops, and 

beauty salons in the empowerment zone and provided with an 8-hour course 

of training on the cardiovascular system, cardiovascular health, and performing 

blood pressure screenings. 

Barbershops were targeted as a location to reach African American men because 

they are known as a place for social gathering, centrally located, and nonthreatening. It was believed that the health message would be well received from 

a barber because they are already known and trusted. 

Those who received the training agreed to collect, within their business, blood 

pressure readings from at least 40 individuals a month, and provide the results of 

the readings to the program. 

An educational brochure, Seven Ways to a Healthy Heart, was made available for 

distribution to customers. 

Almost 3,000 individuals were screened in 2006. 

Through a separate Reach for Women grant, volunteers received $50 for every 40 

blood pressure readings that were obtained. 

The program provided at least two health fairs annually to increase awareness and 

the level of information in the community concerning cardiovascular health. 

Health promotion specialists (the individuals who do the blood pressure 

readings) were recruited by going door-to-door in the Empowerment Zone. 

Follow-up was provided to those who had their blood pressure checked, 

particularly among those with elevated blood pressure, to make sure they 

contacted their physician and had their pressure checked again. 

Partnerships: 

Fulton County Department of Health and Wellness 

American Heart Association 

National Medical Association 

Association of Black Cardiologists 

Local organizations 

58 african american men and blood pressure control: a closer look 
Organization: 

The Cardiovascular Wellness Centers were established through a subcontract 

with the Reach for Wellness Program, Fulton County Department of Health and 

Wellness. This program is a component of the Association of Black Cardiologists’ 

Division of Community Programs. 

Staffing: 

Includes two full-time staff. Over 50 volunteers were trained to measure 

blood pressure. 

Target audience/participants: 

Individuals who were easily accessible were recruited as participants in the 

program and could be a resource for the community residing in the Atlanta 

Empowerment Zone. Individuals in the community are typically living at the 

poverty level or just above. 

Evaluation and Research: The number of individuals screened with high blood pressure 

and their outcomes were counted. A participant’s blood pressure was taken one month 

after having been screened and given educational information to see if it had lowered. 

Evaluation activities concluded that men screened were more likely to have high blood 

pressure than women and that many of these individuals were less than 35 years of age. 

Lessons Learned: 

Overall: 

The financial incentive helped maintain the motivation among those taking 

blood pressure readings. 

Conducting monthly meetings to bring everyone together and share ideas 

improved motivation and participation. 

Some barbers may not to participate because it takes time away from their business. 

Individuals may not want to get screened because they do not believe that they 

have a problem. The awareness and educational materials help with this. 

African American men in particular may be averse to taking medication; 

therefore, the educational component is critical when teaching that the condition 

may be manageable through diet and exercise. 

African Americans need to understand that they are more likely to die of 

hypertension than cancer or AIDS. 

Participants are more likely to trust the information they receive from a member 

of the community than from a doctor or other health care provider 

Motivating others requires one person who is excited about what he or she 

is doing. 

It is very difficult to raise money for health promotion programs related to 

African American men. The centers could not find a foundation or a drug 

company to fund this initiative. 

a review to address blood pressure control in african american men 59 
Participation by African American men: 

Participation by African American men was supported through the use of barbershops as a project venue and by including African American men as health 

promotion specialists. 

Cultural competency: 

Videos on cultural competency are produced and shown mostly to providers. 

Scenarios are created and providers are asked to respond to them. 

Web site: 

http://www.abcardio.org/reach.htm 

Contact: 

Association of Black Cardiologists, Inc. 

5355 Hunter Road 

Atlanta, GA 30349 

Phone: 404-201-6643 

Fax: 404-201-6601 

E-mail: abcardio@abcardio.org 

4.3.3.6	 Program 6: Chicago REACH 2010/Lawndale Health Promotion 

Project 

Chicago, Illinois 

Period of operation: December 2000–December 2007 

Funding: A five-year grant and an additional 2-year grant funded by CDC. 

Additional REACH funding from CDC was received to implement promising 

practices to the existing and new communities’ efforts. Overall, the funding available 

was reduced by 50% from the original amount for the REACH 2010. The funding 

amount is unavailable. 

Mission: To use a community-based prevention approach to eliminate health disparities 

by reducing and preventing illnesses linked to type 2 diabetes and cardiovascular 

related diseases among African Americans and Hispanics. The project hopes to improve 

the health status in the North and South Lawndale neighborhoods of Chicago. 

Description: 

Activities: 

Phase 1 (the first year) involved a community-based planning process to 

develop a community action plan; Phase 2 (years 2 through 5) involved the 

implementation of the community action plan. 

Community participation began with the initial writing of the competitive grant 

proposal to the CDC and continued throughout the project. 

A planning council was created for the purpose of promoting continuity and 

structure to community involvement in Phase 1 activities. The council was 

composed of representatives from more than 50 community agencies and 

organizations that may play a role in disease prevention among community 

members. The planning council was charged with providing guidance and 

feedback during a comprehensive, multilevel assessment of both needs and 

60 african american men and blood pressure control: a closer look 
resources within the project’s community area. The major aim of the community 

needs assessment was to enhance the understanding of the multitude of factors 

that influence cardiovascular disease and diabetes in individuals living in the 

community area. 

Needs assessment data were gathered through focus groups and key informant 

interviews, the Behavioral Risk Factor Surveillance System (BRFSS), and 

Community Landscape Asset Mapping (CLAM). CLAM is a communitymapping tool used to identify community-level opportunities for and barriers to 

health behaviors. 

The initial development of the project was based on the results of the needs 

assessment, and a community action plan was developed and implemented on 

the basis of the results. 

Community outreach services were provided to increase access and referral to 

health providers in the community and to assist individuals in securing a medical 

home through one of four local clinics that provide services either free or on a 

sliding fee scale. 

Outreach workers conducted classes (e.g., diabetes prevention, cardiovascular 

disease prevention, nutrition, and fitness) and risk assessments and referral to 

neighborhood providers if needed. Initially outreach workers went door-to-door 

to reach community residents. 

Outreach workers offered educational classes at local community-based 

organizations, schools, and churches, and built on the program structure and 

resources available through these other organizations. 

The project hired community residents as peer case managers and trained them 

to conduct health promotion and prevention classes around cardiovascular 

disease. The peer case managers were housed at the two health providers in 

the community and served as liaisons between the patients and providers. 

They managed and helped clients become compliant with standards of care 

and educated those who are at risk of developing cardiovascular disease. They 

monitored the care received by their clients, ensured that they received proper 

referrals and testing, and helped clients develop their own goals for maintaining 

a healthier lifestyle along with their medical regiment. 

Physicians working with case managers were provided training in patient 

communication and cultural competency. 

Patients were recruited into case management by their provider, with the case 

manager following up with a telephone call to enroll the individual. 

Outreach workers, who worked with community-based organizations, 

particularly senior centers, conducted community capacity building. Businesses 

in the community provided space for meetings and trainings. Restaurants put up 

posters and made brochures available to customers. 

Case managers and outreach workers formed a task force for patient education to 

ensure that written media campaign materials were linguistically appropriate and 

to identify which materials were most effective. 

Services also included diabetes and hypertension screenings, information and 

referral services, nutrition and cooking classes, health education classes, exercise 

programs, and walking groups. 

a review to address blood pressure control in african american men 61 
 

Partnerships: 

All blood pressure screening equipment used in the program was obtained 

through collaboration with local community-based organizations and health 

providers. The program worked with two local health providers, and two 

local community-based organizations, in the North and South Lawndale area. 

Partnerships with the two health providers were formal. A formal contract 

agreement specifying services, roles, and responsibilities was signed. 

The program’s case managers were housed at one of the four local health 

providers in the communities. The case managers were paid by the program 

but were hired by the providers so that they would be integrated as integral and 

valued members of the clinic team. 

Informal partnerships were established with five local barbershops to provide 

educational materials to barbers that have been trained in cardiovascular disease 

prevention and education. 

Other partnerships included schools, faith-based organizations, and beauty shops. 

A majority of these partners were involved in the implementation phase of 

the program. 

Organization: 

Housed within the Chicago Department of Public Health (CDPH) under the 

Chronic Disease Initiative. A Community Council comprised of community 

residents oversaw the program. All CDPH program staff attended the Community 

Council meetings. 

Staffing: 

Staff included a director, community coordinator, nurse manager, administrative 

assistant, and faith-health coordinator who were housed at the CDPH but who 

worked in the community. In the community, there were four additional outreach 

workers and four case managers. In-kind services of a nutritionist and a fitness 

instructor from the CDPH were also available. 

Target audience/participants: 

African American and Hispanic adults living in the North and South Lawndale 

areas of Chicago. North Lawndale is 90% African American, and South Lawndale is 

90% Hispanic. Together they include approximately 1,000 residents. Approximately 

23% of participants were African American men. The income level of residents 

in the community is generally low to middle; half are below the poverty level. 

Approximately 60% are high school graduates. 

Evaluation and Research: An evaluation was conducted by the University of Illinois 

at Chicago. They conducted pre- and post-tests every 6 months to a year with case 

management patients, triangulating survey data with the patients’ charts. They also 

conducted the CLAM and did assessments to determine community capacity. The 

evaluation findings from this community-based participatory research project have 

been published and presented at various conferences. 

62 african american men and blood pressure control: a closer look 
Lessons Learned: 

Overall: 

We have discovered 

that [motivation] is 

only going to be as 

good as your field 

staff ....Individuals 

see a face from their 

community that is 

promoting this... In 

terms of case managers, 

they are known—in 

their own words— to 

hound some patients, 

and some patients will 

say, ‘I know she was 

hounding me,’ and 

they know they care 

about them. An... actual individual who... 

cares for them and [is] 

looking out for them 

plays a major role 

The comprehensive community assessment employing multilevel data sources 

suggests a need for health promotion programs that are developed with input 

from the community members they will serve, and that are long-term, welladvertised, and easily accessible. 

Health information needs to be presented in a user-friendly format that is easily 

understood and culturally appropriate. 

It is important to identify partners, particularly clinicians, up-front to make sure 

they have interest and buy-in before starting the program. 

Partner with schools in the community because children can impact their 

parent’s behaviors. 

Have staff that are representative of the target audience; identify African 

American men that can work as case managers or outreach workers. 

Community residents like to attend blood pressure screening events. Many 

residents do not have health insurance and see community health fairs as an 

opportunity to have their blood pressure measured and receive additional health 

education information. Community health events were held at local parks, 

schools, and community organizations. 

Individuals are held back from participating in the program because their health 

becomes secondary to day-to-day issues such as getting a job, paying rent, etc. 

Medical providers showed some resistance to having to go through 

communication training and complained that they did not have time to go. 

However, overall, the providers found the training useful. 

Participation by African American men: 

Hiring the right person to deliver program services motivates participants. 

Outreach workers do not always have advanced education, but they are able to 

relate to the participants and successfully deliver the program’s message. 

Cultural competency: 

Using local residents as peer case managers helped residents feel more welcome 

at the clinic and better taken care of. Representatives were of the same race or 

ethnicity as participants. 

Community trust was generated because the Department of Public Health and 

the University of Illinois agreed that all data obtained through the program 

belonged to the residents and could only be used with their permission. 

Reference: 

Levy SR, Anderson EE, Issel LM, Willis MA, Dancy BL, Jacobson KM, et al. 

Using Multilevel, Multisource Needs Assessment Data for Planning Community 

Interventions. Health Promot Pract 2004;5(1):59–68. 

a review to address blood pressure control in african american men 63 
Websites: 

http://www.uic.edu/cuppa/gci/uicni/partnerships/current%20projects/REACH%20 

2010%20Lawndale%20Health%20Promotion%20Project.htm 

http://www.cdc.gov/reach/pdf/IL_Lawndale.pdf 

http://apha.confex.com/apha/130am/techprogram/paper_45984.htm 

http://apha.confex.com/apha/132am/techprogram/paper_78793.htm 

Contact: 

Berenice Tow, MS 

Chicago Department of Health 

DePaul Center-Room 320 

333 S. State Street 

Chicago, IL 60604 

Phone: 312-745-0590 

E-mail: Tow_Berenice@cdph.org 

4.3.3.7	 Program 7: Stroke, Hypertension, and Prostate Education 

Intervention Team (SHAPE-IT) Philadelphia, Pennsylvania 

Period of operation: January 2005–June 2007 

Funding: The SHAPE-IT program is a Pennsylvania State Department of Health– 

funded disparities initiative that combines CDC funding for prostate cancer control 

and cardiovascular risk reduction. SHAPE-IT received a total of $1.2 million in 

funding from these sources which ended in June 2007. 

SHAPE-IT continues to operate through a partnership with a CDC-funded 

community organization that targets cardiovascular disease in families. The program is 

seeking additional funding to expand beyond the initially targeted zip code areas. 

Mission: The primary goal of SHAPE-IT was to foster partnerships between 

community-based organizations, community members, and health care providers to 

design and implement strategies that can reduce prostate cancer and stroke among 

African American men 35 years of age and older in North and West Philadelphia. 

Aims of SHAPE-IT included: 

Reaching 25% of the target population of 27,000 African American men age 35 

and over in targeted zip codes. 

Integrating community organizations that have the infrastructure to support 

community-based programs through the State Health Improvement Project 

Partners program. 

Developing multiple strategies that are seen by target population as relevant for 

stroke and prostate cancer prevention. 

Identifying factors related to planning, developing, and implementing a 

comprehensive community action plan designed to increase knowledge, change 

attitudes, modify behaviors, and support a social change process related to 

hypertension, stroke, and prostate cancer prevention in African American men. 

64 african american men and blood pressure control: a closer look 
Describing individual attitudes, beliefs, behaviors, barriers, opportunities, and 

assets related to education, prevention, and compliance with treatment and 

screening recommendations. 

Description: 

Activities: 

Phase 1 (Design): 

 Established a project advisory council (PAC) of community members and 

organizational representatives including men who were hypertensive and 

prostate cancer survivors. The PAC provided guidance to the SHAPE-IT staff 

during program development, implementation, and evaluation. They played 

a particularly important role in recruiting African American men into the 

program. Two co-chairs of the PAC served as liaisons between the PAC and 

the project team. Staff held monthly meetings and made calls to the co-chairs. 

Co-chairs were given $25 and provided dinner each time they met. 

 Developed a community action plan (available through the link below) 

presenting a shared responsibility model of community health planning, 

establishing partnerships, and enhancing cultural relevance of activities. 

 Conducted focus groups with African American men and key informant 

interviews with PAC members and other representatives from various 

community health organizations to assess community and individual beliefs, 

assets, and needs. Findings from the focus groups and interviews guided the 

educational interventions the program formulated. 

Phase 2 (Implementation): 

 Implementation of identified recruitment and retention strategies of African 

American men into education sessions. Community-based participatory 

research (CBPR) methodology was used to reach African American men 

residing in targeted zip codes. 

 Through PAC members, SHAPE-IT made contacts and strong relationships 

with various community sites (e.g., barbershops, faith-based organizations, 

automotive repair shops). These sites promoted SHAPE-IT and played a large 

role in recruiting African American men. 

 Two special day-long events were held to recruit men. One occurred during 

Black History Month at a local college where African American leaders who 

had suffered from prostate cancer or stroke were honored. A tribute was also 

held for family members who had lost their lives to prostate cancer or stroke. 

The event included entertainment, lectures, and demonstrations. 

 Implementation of large and small group educational programs on 

hypertension, stroke, and prostate cancer. As an incentive, men who 

participated in the educational sessions were entered into raffles to win prizes 

such as bicycles and home exercise equipment. 

 Large group sessions occurred at faith-based organizations, daycare centers, 

health centers, and fraternal organizations. These sessions consisted of lectures, 

plays, videos, and educational handouts. Many of the handouts came from 

the Health Promotion Council of Southeastern Pennsylvania. Blood pressure 

screenings and a Men’s Health Night Out were also held. Large group sessions 

were used to recruit men into small group sessions. 

a review to address blood pressure control in african american men 65 
 Small interactive groups of approximately 20 men were held at a variety of 

locations such as city health centers, faith-based organizations, barbershops 

and fraternal organizations. They initially consisted of two 2-hour sessions, 

but were later condensed into one 3-hour session. Sessions focused on 

educating men on hypertension, stroke, and prostate cancer. Blood pressure 

screenings were provided, and men were encouraged to make an appointment 

with a health provider. Participants were often referred to the Philadelphia 

Department of Public Health health centers, which see patients regardless of 

their ability to pay. 

 SHAPE-IT hosted special events such as a Men’s Wellness Dinner and Tribute 

Events at Girard College and Temple University. 

Partnerships: 

Informal partnerships included:
 

Member organizations on the PAC such as the Masons and the NAACP 

The American Cancer Society
 

Opportunities Industrial Council
 

Project Housing, Opportunities for Employment, Medical Care, 

Education (HOME) 

The American Heart Association 

A network of barbershops, automotive repair shops, drug and alcohol recovery 

programs, and other venues for the recruitment of African American men 

Faith-based organizations and recovery houses 

Formal partnerships (with contractual agreements) included: 

The Health Promotion Council of Southeastern Pennsylvania 

Philadelphia Department of Public Health 

A local affiliate of the American Cancer Society 

State Health Improvement Project Partners including Nicetown-Tioga and 

Haddington Community Health Initiatives 

Thomas Jefferson University and Thomas Jefferson University Hospital 

These partnerships served a variety of roles such as providing staff to the PAC, providing venues for programs, recruiting program participants, providing staff for events 

and programs, and giving advice on program content. 

Organization: 

The SHAPE-IT program consisted of a project team and the PAC. It was housed 

at the Thomas Jefferson University and Hospital. Project team members were from 

various departments within Thomas Jefferson and the Health Promotion Council of 

Southeastern Pennsylvania (including the Department of Family and Community 

Medicine and the Office to Advance Population Health). 

The PAC consisted of 25 members, including two co-chairs. Members included 

African American representatives from organizations such as the Masons, the 

NAACP, the State Health Improvement Project, the Huntington Community 

Health Project, the Nicetown-Toga Improvement Team, and the American Cancer 

Society, as well as clergy members. 

66 african american men and blood pressure control: a closer look 
Staffing: 

Target audience/participants: 

Characteristics of program participants: 

Evaluation and Research:

found that approximately 64% of participants had elevated blood pressure. Key 

findings from a pencil-and-paper pre-test and 2-month telephone follow-up survey 

of participants from the small group sessions regarding knowledge, attitudes, and 

behaviors include the following:

We have discovered 

that [motivation] is 

only going to be as 

good as your field 

staff....Individuals 

see a face from their 

community that is 

promoting this... In 

terms of case managers they are known, in 

their own words, to 

hound some patients 

and some patients will 

say I know she was 

hounding me and they 

know they care about 

them. An... actual 

individual who...cares 

for them and looking 

out for them plays a 

major role. 

Dr. James Plumb was the principal investigator. Staff included four to five fulltime employees with three full-time African American men as health educators. 

Program evaluators came from the Health Promotion Council and Thomas 

Jefferson University. 

SHAPE-IT reached 6,750 men, 25% of a population of 27,000 African American 

men age 35 year of age and over in targeted zip codes of Philadelphia, including 

900 men who were reached with a comprehensive small group workshop. 

Approximately 75% were low income 

More likely to be unemployed, live in poverty, and have less formal education 

than men living in other zip codes 

More likely to not have a regular source of care and to not have seen a primary 

care physician in the last year than men living in other zip codes 

More likely to report extreme stress than men living in other zip codes 

Data collected to evaluate the effectiveness of the program

Knowledge (subset of 173 men) 

 Key knowledge was improved and maintained 2 months after the program. 

 Men demonstrated a high level of knowledge during the pre-test, indicating 

that obtaining care may be more of an attitude and behavior issue. For 

example, 94% of men at the pre-test agreed that African American men 

should be tested for high blood pressure and that controlling hypertension 

reduces the chances of having a stroke. 

Attitudes (subset of 173 men) 

 During the 2-month follow-up, men indicated an increased reliance on family 

for health advice, a greater degree of comfort in talking to their partner and 

other men about health issues, and greater ability to communicate well with 

doctors; more thought “my doctor and I work together.” 

Behaviors (subset of 181 men) 

 Actions taken during the 2-month follow-up period included blood pressure 

measured (87%), scheduling appointments (86%), seeing a provider (76%), 

and obtaining a health care provider for those who did not have one (59%). 

 Lifestyle changes during the 2-month follow-up period included exercising 

more often (68%), eating more fruits and vegetables (73%), cutting back on 

salt (81%), taking blood pressure medications as recommended (92%), quitting smoking (20%), reducing dietary fat (74%), using stress management 

techniques more often (52%), reducing the amount of weekly alcohol consumption (45%), and losing 5 pounds or more (37%). 

a review to address blood pressure control in african american men 67 
 

Data collected on attendance showed that changing the format of the small group 

sessions from two separate short sessions to one longer session increased attendance 

from 40% at both short sessions to nearly 100% at the extended session. 

The final process evaluation was a series of focus groups with PAC members, program 

participants, and program leadership and staff. Key findings for program replication or 

modification are listed below. 

Staff Training and Qualifications: 

Make sure educators are well trained. Trained educators equal an effective program. 

Make sure you find health educators who are invested in and passionate about 

the program. 

The lay leader component was not as effective as had been hoped. This may have 

been due to recruitment strategies as well as leadership commitment to the lay 

health strategy. Consider training PAC members as community champions rather 

than using lay leaders. 

Provide cultural competence training for all project staff and PAC leadership in 

the beginning of the project. 

Project Advisory Council: 

Diversity of the PAC is key. 

Involve PAC to an even greater degree. Involvement should be active, not just 

advisory. Identify and create opportunities for PAC members to be actively involved in the project. 

PAC incentives are important. Consider signing Memorandum of Understanding 

(MOU) with members of what they agree to do as a PAC member. . 

Add PAC membership on a continual basis. Choosing PAC members from 

focus group participants and people known to be active in the community 

was effective, but interested people need to be continually recruited. As PAC 

members become inactive, particularly those from the community, they should 

be replaced. Recruit from men who attend programs (develop a mechanism for 

bringing in new members). 

PAC recognition is important. Let them know how important they are. 

Provide stipends, ask PAC members to do catering (which creates employment 

opportunities and appreciation/celebration dinners). 

Increase consumer input—include more consumers in the PAC. 

Program Curriculum: 

Provide single session programs only.
 

Review group decision-making process for applicability and validity. Develop 

strategies to capture voting preferences. 

Expand focus to other health issues. 

Provide other health resources. Have a table with information about where they 

can go to be tested. Help men to set up an appointment to get tested. Men 

living in shelters need more assistance in accessing screening/setting up doctors’ 

appointments. Men need more assistance/training in how to talk with their 

doctor in general. 

68 african american men and blood pressure control: a closer look 
 

 

Include slide presentation and testimonials (film or in-person). 

Use simple visual aids. 

Outreach Strategies: 

Consider evening hours to bring out other men. 

Include women/significant others in programmatic efforts (programs for women 

and/or the opportunity to attend with men). 

Increase flexibility in program to ensure it meets African American men’s needs 

and is able to reach the desired population. 

Provide refreshments. 

Other venues worth pursuing: churches/mosques, barbershops, and senior 

centers. Venues were correct, but recruitment and program strategies need to be 

fine-tuned. 

Do not limit geographic areas, age groups, or topics that can be covered. Younger 

men need to be included. Men of all ages have poor habits. 

Create more opportunities to discuss health. Participants could bring their sons; 

the earlier they get involved in health, the better. 

Explore use of media for outreach and increasing community awareness about 

the program. 

Include more health care providers in the program. If providers were more aware 

of the program they might refer patients for education and support/follow-up. 

Communication: 

Reinforce the motto “own your own health”; use this in follow-up calls and 

remind men of the importance of speaking up for themselves. 

Increase media exposure for the program. 

Create resource guide to promote empowerment of men in accessing existing 

community resources. 

Build strong relationships on the basis of trust, transparency, and listening to 

all partners. 

Consider copying everyone on all e-mails to improve communication. 

Make sure leadership is willing to listen to the educators. 

Allow men to be active participants, not just listeners. 

Emphasizing to men how their contributions are important to family and 

community. The message to communicate is, ‘It starts with good health.’ 

Provide telephone numbers of educators so participants can call with 

follow-up questions. 

Program Evaluation: 

Shorten survey instruments. Revise instruments to reflect appropriate skip patterns. 

Make sure all program participants sign in so that contact information is available 

for follow-up. 

Consider having evaluation meetings with co-managers outside of regular monthly 

meetings with staff. Monthly meeting should focus on quality not quantity. 

a review to address blood pressure control in african american men 69 
Work to fully integrate evaluators into all program components. Share evaluation 

and outcomes with the PAC on a regular basis, including changes in knowledge, 

attitudes, and behaviors of participants, as well as the number of programs and 

number reached. 

Lessons Learned: 

Overall: 

It was difficult for the program to limit interventions to targeted zip codes and 

age groups, but it had to turn down areas that were outside the target zip code 

regions because of limited resources. 

Changes were made as the program evolved. Program leadership met 

frequently with the health educators to evaluate what worked. Flexibility was 

a key to success. 

Educational messages must be consistent and sustainable, not just one-shots. 

They must be emphasized throughout the year. 

It was important to learn about the communities’ needs and to shape the program’s interventions around these needs. 

The PAC was vital in making the SHAPE-IT project credible to the community. 

I think the PAC was absolutely key in making our project credible and guiding 

us. They were crucial in getting us participants; getting us sites; and talking up 

the program in their respective neighborhoods got us tremendous buy-in from the 

neighborhoods. 

Participation by African American men: 

Participation in the education sessions was inconsistent, so it was more efficient 

to present everything at one time. It was also more effective to address men’s 

health overall rather than address blood pressure, stroke, or prostate cancer as 

separate issues. 

Addressing prostate cancer prevention up-front made it easier for African 

American men to address hypertension control measures. 

Men were interested in their health, and I think prostate cancer actually helped 

to get some of the guys there. They don’t think of hypertension as being important. 

I think prostate cancer is complex but it is also much easier to understand and 

much easier to at least do something about it. You either get tested or you don’t. 

Blood pressure is much more complicated, requires a variety of lifestyle changes 

and monitoring, and I think men were initially drawn to prostate cancer 

because it is a hot topic, then when they learned about hypertension and its risk 

factors and potential outcomes. They began listening and that...evolved into 

[understanding]...that hypertension and stroke are much more common causes of 

morbidity and mortality than prostate cancer. 

70 african american men and blood pressure control: a closer look 
 

 

Using real people and real stories from the community and presenting them in 

a group setting was a way to get African American men to talk about their health. 

Having trustworthy health educators that the men could relate to on a personal, 

“brother-to-brother” level was essential for program participation. 

They did not want academics or celebrities [as health educators]. They wanted 

folks that were just like them that they could relate to. They used the term “we 

want brothers talking to brothers.” Sitting in an academic health center, I can 

provide the brothers with data. I can provide them some theory on how to educate, 

but they [the health educators] have to get down and sit and talk to these guys. 

One of our health educators does rap. One is almost a preacher, and the other is a 

very good teacher. 

Key recruitment of African American men occurred at supermarkets, automotive 

repair shops, public transportation, and polling stations. 

Barriers to participation included insufficient time because of other commitments and priorities. Many also do not make their health a priority and often do 

not discuss health until there is a crisis. 

Cultural competency: 

Presenting educational materials to African American men visually and orally 

(such as through videos and plays) was much more effective than handing out 

reading material. 

Reference: APHA, 2007 (http://apha.confex.com/apha/135am/techprogram/ 

paper_162962.htm) 

Web site containing conference presentation and summary: 

http://apha.confex.com/apha/135am/techprogram/paper_162962.htm 

Contact: 

James Plumb, MD, MPH 

Family and Community Medicine 

Thomas Jefferson University 

1015 Walnut Street, Suite 401 

Philadelphia, PA 19107 

Phone: 215-955-0535 

Email: James.Plumb@jefferson.edu 

4.3.3.8 Program 8: Stroke and Heart Attack Prevention Program (SHAPP) 

(Georgia) 

Period of operation: 1974–present 

Funding: SHAPP has received approximately $1.1 million in funding that is 

distributed as grants to aid health districts. The majority of funding comes from 

CDC’s Preventive Health and Preventive Services Block Grant, but funding is also 

received from the Georgia General Assembly. 

a review to address blood pressure control in african american men 71 
Mission: To provide education and direct services to low-income Georgians with 

hypertension through funding and coordinating district-level care coordinators/providers. 

Description: 

Activities: 

Treatment for hypertension in conjunction with and jointly managed by the 

health department and each patient’s primary care physician. Services are 

provided through the county health departments and include screenings, doctor 

referrals, diagnoses, and treatments. 

Districts conduct training, outreach, and education with local partners. Programs 

are individualized at the district level. Programs fill gaps in care that the patient 

cannot afford or access on their own. Coordinators at the district level sometimes 

see patients directly and sometimes a nurse on staff sees patients. 

Education programs are provided to nurses who see SHAPP patients, including 

blood pressure, medications, diet, exercise, and smoking cessation. 

Counseling is provided on healthy behaviors such as the Dietary Approaches to 

Stop Hypertension (DASH) Diet, physician activity, weight management, and 

smoking cessation. 

At least one county conducts outreach activities and screenings in barbershops 

and beauty salons. Barbers are educated and trained to take blood pressure 

readings. 

Two-day workshops are held throughout the state for the nurses who are seeing 

patients at the local level. Clinical updates are provided, including information 

on medications and healthy behaviors. 

SHAPP clinics utilize a patient tracking system; one had an automated 

voice system reminder and another calls patients to remind them of their 

appointments. Computer printouts of SHAPP patients are reviewed by staff for 

follow-up if patients are not active. 

Partnerships: 

Partnerships are developed at the district level and thus vary by district. The 

following are some examples of partnerships and their role with SHAPP: 

 The Georgia Department of Human Resource’s Health Promotion section 

provides promotional funding for stroke and heart attack awareness through a 

collaborative campaign. 

 Faith-based organizations and health fairs provide opportunities for education. 

For example, SHAPP has a relationship with the annual Evans County 

Community Health Fair. Through these health fairs and other presentations, 

at-risk clients are identified and referred to the SHAPP program at county 

health departments. 

 Parks, recreational centers, clinics, visitor centers, and museums serve as 

venues for distributing literature. The American Heart Association provides 

many education materials for SHAPP. 

 This past year, SHAPP collaborated with local senior centers, recreation 

centers, and supermarkets to provide outreach and education to community 

members through blood pressure screenings, education, and resource 

72 african american men and blood pressure control: a closer look 
linkage. Other sources of outreach, screening, education, and referrals 

include the St. Joseph’s/Candler Hospitals’ African American Community 

Health Initiative and the city of Savannah Fire Department’s Blood Pressure 

Screening Program. 

 Within the Southeast Health District, the 16 local county health departments 

partner with many community resources, such as local hospitals, school 

nurses, chambers of commerce, and faith-based communities, to provide 

outreach for cardiovascular disease and other health promotion efforts. 

 State nurse consultants help SHAPP provide trainings. Local hospitals and 

faith-based organizations have also collaborated. 

 100 Black Men of Savannah, Inc. has been useful for providing leadership 

and guidance to the program. 

 Many of these partners are active member agencies of the Community 

Cardiovascular Council. 

Other partnerships include Community Cardiovascular Council’s Black Male 

High Blood Pressure Coalition (a church-based initiative made up of 32 

churches); African American Barber/Beauty Shop Blood Pressure Screening 

Program (including 12 barbershops and beauty salons); the St. Mary’s 

Community Primary Care Clinic (an African American neighborhood health 

outreach program); African American Health Information & Resource Center 

(an innovative program providing computer/Internet services, health education, 

referral, and access); Head Start; Boys and Girls Clubs; community service 

organizations; businesses that advocate employee health; and various schools, 

colleges, and universities. 

Organization: 

State-level initiative where services are provided at the county-level. 

Staffing: 

State level 

 Project manager/nurse consultant in the State Division of Public Health who 

provides technical assistance and funding allocation to the districts, program 

coordination, and technical assistance concerning funding grants. She 

coordinates with the Office of Pharmacy to ensure that medications provided 

are appropriate and are based on national protocols. 

 Epidemiologist
 

 Data entry (shared FTEs with other programs)
 

District level: staff coordinator for every district (person is likely to also be 

responsible for other relevant activities conducted by other staff such as adult 

health coordinator, county nurse manager, etc.) 

Target audience/participants: 

During the 2007 fiscal year, 56% of participants were African American and 

28% were male. 

Participants came from low-income, underserved populations. 

Reading level is generally below high school. 

a review to address blood pressure control in african american men 73 
Costs: 

SHAPP cost per patient is $486. Estimates of per patient costs with no blood 

pressure treatment are $534. 

Cost-effectiveness of the program is promoted through— 

 Services being provided by nurses and nurse practitioners versus more 

expensive physicians. 

 Adherence to treatment according to protocol, both in terms of services 

(e.g., visits, lab work) and medications. The SHAPP program does not begin 

treatment by using the newer, more expensive medications. Medications are 

added and/or changed according to evidence-based protocols. 

Evaluation and Research: An external evaluation was conducted in 2005 by RTI 

International for CDC. In-depth case studies were conducted with two public health 

clinics in two districts with impressive blood pressure control rates. The evaluation 

included interviews with administrators and clinic staff to examine perceptions of 

the program, access, challenges, patient outcomes and recommendations; focus 

groups with patients to understand their perceptions of the program, experiences 

with high blood pressure, effects of participation, access, and recommendations; 

medical record abstraction to validate program reports and to ensure that treatment 

protocol is being followed; and a cost analysis to evaluate the cost-effectiveness of 

the program. Conclusions from the evaluation are incorporated into the Lessons 

Learned section of the summary. 

Lessons Learned: 

Overall: 

In relation to funding, it is important to have outside champions who support 

the program and see the value in it. 

It is important to communicate the value of the program to people in the 

business community and government, on both the county and state level. 

The program gains acceptance in the community by being consistent and 

trustworthy. Working with key individuals in the community will promote the 

perception of the program as trustworthy. 

Patients are often self-referred or physician-referred, and access to the SHAPP 

is an easy process. Essentially, patients do not feel they are jumping through 

hoops to be accepted into the program, and staff handle enrollment in a 

straightforward manner. 

Patients report that staff make time for them, are well trained, and are accepting 

and non-judgmental of their low-income status. Because patient medication 

adherence for high blood pressure is a major challenge, SHAPP usually writes 

prescriptions for 1 to 3 months, and staff work with patients’ families and 

caregivers as well as patients to stress the importance of medication adherence. 

For elderly patients, it is particularly important to involve family and/or 

caregivers. 

SHAPP clients are often well aware that low-income people with high blood 

pressure cannot go to the doctor to be regularly checked and may not be able to 

afford needed medication. 

74 african american men and blood pressure control: a closer look 
Many patients are clients for over one year; this ongoing, consistent surveillance 

is important to successful blood pressure control. Follow-up care is provided 

every 2 to 6 months, and staff are accommodating to participants’ needs. 

Patient access to affordable medications through SHAPP is imperative for 

medication adherence; this is a cornerstone of the program. 

The use of a protocol-driven, systematic, comprehensive treatment provides for 

comprehensive patient counseling. 

Staff is dedicated and consistently voices the opinion that SHAPP fills an 

important need in the community. They understand the importance of 

their work and that SHAPP patients would not likely receive care for their 

hypertension otherwise. 

Participation by African American men: 

Contracts are formed with men related to keeping appointments, taking 

medications, following a diet, getting physician activity, stopping smoking, etc. 

Referrals sometimes come from someone who had been in the program. 

All people have their own priorities and sometimes health is not a priority. 

Sometimes it is being able to put food on the table and ....being healthy, especially if you don’t feel bad, is difficult. I see that as being a communication issue 

to help people understand that even though you don’t feel bad you still need to be 

on medication....[F]or men, there is the issue of erectile dysfunction in terms of 

certain medications... as a clinician I have seen that and they won’t tell you that. 

Cultural Competency: 

Providers need to be knowledgeable about the local culture. 

Web sites containing program summary and information concerning selected partners: 

http://health.state.ga.us/programs/cardio/shapp.asp 

http://northcentralhealthdistrict.com/content.asp?pid=104&id=162 

http://www.nwgapublichealth.org/counties/gordon/services.htm 

http://www.nwgapublichealth.org/counties/polk/services.htm 

http://www.sehdph.org 

http://www.sjchs.org/body.cfm?id=405 

Contact: 

Karen Boone, RN, MN, MPH 

Georgia Department of Human Resources 

Division of Public Health 

2 Peachtree Street NW, Suite 16-472 

Atlanta, GA 30303 

Phone: 404-657-6638 

Email: kaboone@dhr.state.ga.us 

a review to address blood pressure control in african american men 75 
 

 

 

4.3.3.9	 Program 9: Sound Heart Program (formerly known as the King 

County High Blood Pressure Control Program) 

Seattle and King County Area, Washington 

Period of operation: 1979–present 

Funding: Many years of annual grant funding from the Seattle-King County Department 

of Public Health. Current funding is $28,000 per year. Funding for a companion 

program, the Healthy Sunday program is provided through a grant from CDC. 

Mission: The primary goal of the Sound Heart program is to promote cardiovascular 

health and prevent disease in King County, Washington. Sound Heart aims to provide 

services to low-income and underserved individuals, primarily African Americans, who 

have limited access to healthcare providers and screening tests. 

Description: 

Activities: 

When the program was implemented in 1979, the focus was solely blood pressure screening. After its inception, Sound Heart evolved into the Seattle Hypertension Intervention Program, which was a community research demonstration 

grant program sponsored by Seattle-King County Department of Public Health 

and funded by the National Heart, Lung, and Blood Institute. In 1983, Sound 

Heart received an Outstanding Achievement Award from the Secretary of the 

U.S. Department of Health and Human Services (DHHS) for its collaborative 

efforts with the American Heart Association and Seattle-King County Department of Public Health. In 1987, the Center for Multi Cultural Health was 

awarded a grant by DHHS’ Office of Minority Health to design and develop a 

community-based heart disease and stroke prevention program that would begin 

to address the disproportionately high rates of heart disease and stroke deaths 

among African Americans. In 1999, the Sound Heart program began including 

the screening for glucose. 

The program offers blood pressure, glucose, cholesterol screenings, and behavioral risk factor screenings, community education, and worksite health promotion programs through a variety of community events. Both initial and follow-up 

screenings are available and are intended to build trust with participants. Screenings take approximately 5 to 8 minutes and participants are able to receive their 

results on the spot. After each screening, participants who have elevated readings 

can meet with a health educator to receive additional information related to their 

results. At that time, participants can choose to complete an action plan that 

outlines the steps they are willing and able to take to better manage their blood 

pressure, glucose, and/or cholesterol levels. This is one of only a few local organizations that provide free services to the African American community. 

Sound Heart provides referrals and the name of specific providers to their 

participants. While the program does not provide a copy of the action plan to 

physicians, participants are encouraged to share their results with their primary 

care providers. 

Screenings and outreach activities take place at various community events 

including festivals, health fairs, community centers, senior housing facilities, lowincome housing, community-based organizations, work sites, and small businesses. 

76 african american men and blood pressure control: a closer look 
Participants are followed up within 6 months and encouraged to attend a 

rescreening event. At the re-screening, the health educator is available to review 

the action plan and discuss the participant’s progress. The goal is to determine if 

participants have begun to make lifestyle changes that will improve their health 

status and whether this is reflected in the re-screening results. Because screening 

events are conducted throughout the community, re-screening events occur at 

those places and events where program staff is likely to meet repeat individuals 

(e.g., faith-based organizations). In addition, re-screenings are conducted with 

events that are willing and able to accommodate the activity. 

To reach its target population, Sound Heart builds working relationships with 

businesses, faith-based organizations, community leaders, and community-based 

programs. They have established relationships with several community clinics 

where a majority of the patient population served is African American. 

A substantial proportion of the outreach and screening activities is done in 

predominantly African American faith-based organizations. The Sound Heart/ 

Healthy Sunday staff works with faith-based health ministries to assist them in 

making screenings and resources available to their congregations. 

Partnerships: 

As a representative of the African American community, Sound Heart works 

with fellow community partners on minority health issues. Partners participated 

in designing the program and conducting screenings. Reading materials and 

handouts are obtained from the American Heart Association in Seattle. The 

program was originally started through a collaborative effort with the American 

Heart Association, Seattle Black Firefighters, American Association of Retired 

Persons, and several individuals. 

Organization: 

The project is conducted by the Center for Multicultural Health, a communitybased organization housed within the Urban League, whose mission is to promote 

the health and well-being of diverse communities, including low-income and 

underserved individuals from communities of color. 

Staffing: 

One full-time staff member (health educator) coordinates the project in-house. Four 

other staff members attend community events: two Bastyr medical students perform 

the screenings, and two health educators assist with relaying results to participants 

and providing additional information and resources in the area. 

Target audience/participants: 

African Americans residing in central Seattle and neighborhoods located south of 

central Seattle. The program serves approximately 300 participants a year, through 

a variety of community events. Approximately 20% of participants are men. The 

majority are in the low-income to middle-income range. 

In the last 4 years, Sound Heart/Healthy Sunday has reached about 25 faithbased organizations. There are approximately 60–75 African American faith-based 

organizations in the Seattle/King County area. 

Evaluation and Research: Demographic information including participants’ age range 

and information on the patients’ neighborhoods is collected to evaluate the most 

a review to address blood pressure control in african american men 77 
effective outreach strategies. A conclusion was that the program was able to reach more 

African Americans at faith-based organizations than at community events. There has 

not been a formal evaluation of the program. 

Lessons Learned: 

Overall: 

People are willing to participate in this program because there is no fee. 

Repeat visibility, which includes conducting the initial and follow-up screening, 

builds trust and encourages more people to participate in the program. 

When Sound Heart plans to return to a faith-based organization or community 

event, sending a personal letter to program participants is especially effective. 

A lot of times, because we have been out in the community, people expect us to be 

there. There is, for instance, one community event that we have attended every 

year for at least seven years.... There are a good number of Seattle police officers 

who expect us to be there every year... so that they can participate in our program. 

That is great because we are... able to follow up on them very rigorously. 

Having a limited amount of equipment to conduct screening can hinder 

program participation, especially in a faith-based setting because participants 

may not be willing to wait more than a few minutes for their turn. 

A key to the program’s success is that it fills a need in the community; it is the 

only program of its kind in the area. 

Participation by African American men: 

Men are less inclined to get screenings because of fear or disinterest. 

Most men participate in the program because their wives or girlfriends bring 

them or because they see women working at the booth. 

Conducting men-only programs at faith-based organizations, such as the Soul 

Men Conference has been successful. 

For making connections to faith-based organizations, it is easier to reach out 

to health ministry members rather than a pastor, who is often very busy. The 

strategy is to get the pastors involved in the program to encourage participation. 

A male pastor’s involvement in the program is especially effective in encouraging 

men to participate. 

I had a pastor who just told his congregation I am tired of burying people who 

are dying of premature causes, and ever since then I have had more men from 

his church participating in our screening because they all knew what he was 

talking about. 

78 african american men and blood pressure control: a closer look 
Cultural competency: 

Written materials and information such as flyers and brochures should reflect 

African Americans in the best light possible. 

Web site: 

http://www.multi-culturalhealth.org/programs_svcs/sound_heart.htm 

Contact: 

Devon Love 

Health Educator 

Center for MultiCultural Health 

105 14th Avenue, Suite 2C 

Seattle, WA 98122 

Phone: 206-461-6910 (ext. 210) 

E-mail: devon.love@cschc.org 

a review to address blood pressure control in african american men 79 
 

 

4.4 Literature Search Results 

Our primary focus was to locate programs that would be directly applicable to the 

goals of this book, namely, presenting systems-level programs concerning blood pressure control in patient populations comprised solely or predominantly of African 

American men. We also include summaries of programs found in journal articles that 

focus on diseases other than high blood pressure because they include lessons learned 

on recruiting African American men into health care programs. 

We located programs in the peer-reviewed literature by using the search engine 

MEDLINE®, which indexes articles concerning medical and health services research. 

We used pre-specified relevant search terms. (See Appendix B for a full list of terms) 

We located programs in the practice literature through searches of Web sites and other 

relevant information on the Internet. (See Appendix A for a full description of the 

search strategy) 

We present summaries of 11 programs described in 12 publications from the peerreviewed literature. Each summary includes the objective of the study, how the project 

was related to systems change, a detailed description of the intervention, the outcomes 

and key findings from the study, and lessons learned. The table below presents systemlevel change goals of studies found in journal articles grouped into categories by topic: 

Box 1. Themes of Programs Described in the Peer-Reviewed Literature 

Blood pressure control programs focusing on African American men 

a. Addressing health disparities within Ohio’s African American male population: The creation and 

implementation of a culturally relevant media campaign directed at African American males 

b. A research study to improve high blood pressure care in young urban African American men: 

An educational-behavioral intervention, administered by a nurse-community health work team, in 

combination with usual medical care, to improve entry into care and reduce high blood pressure rates. 

c. Hypertension care and control in underserved urban African American men: A multi-faceted, 

individually tailored, multi-disciplinary team approach to blood pressure control with free medications and 

integrated assessment, counseling, and referral for substance addiction. 

Blood pressure control/coronary heart disease prevention programs 

focusing on the African American community 

a. A hypertension control program tailored to unskilled and minority workers: Classes and 

written handouts with hypertension information, strategies for reducing hypertension, and lifestyle 

modification strategies. 

b. Development of a standardized screening form that can be used at community-based screening 

events conducted by community organizations in the African American community: Conducted in 

partnership with national African American organizations for diabetes and hypertension screening events. 

c. Take It To Heart: A National Health Screening and Educational Project in African American 

Communities: Production of individualized risk assessments in key cardiovascular risk areas, and a coronary 

risk profile to inform and encourage those at high risk to take steps to improve their health status. 

d. Faith-based education: an outreach program for African Americans with hypertension: An educationalbehavioral intervention used to educate church members to support reductions in high blood pressure rates 

and improved heart-healthy lifestyle choices. 

e. Impact of a community-based multiple risk factor intervention on cardiovascular risk in African 

American families with a history of premature coronary disease: An invention directed at individuals at 

high risk based on a sibling’s hospitalization for a coronary event. 

80 african american men and blood pressure control: a closer look 
Other relevant systems-level health care programs focusing on the African American community 

a.	 Recruiting African American men for cancer screening studies: Applying a culturally based model: 

A three component framework, involving health education, educational diagnosis of health behavior and 

cultural appropriateness of health behavior to increase recruitment for prostate cancer screening. 

b.	 Systems-level and community-based interventions for diabetes control: A resource assessment of 

the strengths and gaps of current public health efforts to reduce the burden of diabetes in northeastern 

North Carolina in support of planning regional diabetes prevention efforts. 

c.	 A model for home care clinician and home health aide collaboration: An educational-behavioral 

intervention providing diabetes care by nurse case managers and community health workers. 

4.4.1 Journal Article Projects Matrix 

The following matrix provides a roadmap to the information contained in the 

summaries for each of the projects found in the literature. Similar to our intent 

in relation to the matrix summarizing characteristics of the interviewed projects, 

it is designed to assist the reader in more easily locating projects that may be of 

particular interest. 

a review to address blood pressure control in african american men 81 
Selected 

Characteristics 

1 

Edwards 

et al. 

(2007) 

OH 

2 

Hill 

et al. 

(1999) 

Baltimore, 

MD 

3 

Hill et al. 

(2003) & 

Dennison 

et al. 

(2007) 

Baltimore, 

MD 

4 

Fouad 

et al. 

(1997) 

Birmingham, AL 

5 

Graham 

et al. 

(2006) 

Various 

locations 

6 

Keys 

(1999) 

Various 

locations 

7 

Smith 

et al. 

(1997) 

Chicago, IL 

8 

Becker 

et al. 

(2005) 

Baltimore, 

MD 

9 

Abernethy 

et al. 

(2005) 

Los Angeles, 

CA 

10 

Dickson 

et al. 

(2004) 

NC 

11 

Vetter 

et al. 

(2004) 

Baltimore, 

MD 

Study design 

Descriptive     

Randomized controlled 

trial 

   

Quasi-experimental  

Study length 1 time 1 year 5 years 1 year 6 months 1 year 3 months 1 year unknown ongoing 2 years 

Target health condition 

Hypertension       

Cardiovascular disease  

Diabetes   

Prostate cancer 

Setting 

Faith-based 

organizations 

   

Community    

Medical/clinics   

Workplace 

Government  

Service delivery 

Project staff    

Physicians  

Nurses/nurse 

practitioners 

     

Health educators 

Community health/ 

outreach workers 

   

Community 

organization leaders/ 

staff 

  

Study population 

Low-income/ 

underserved 

 

African American only         

Men only    

Study/program activities 

Blood pressure 

screening/ 

monitoring 

       

Participant education/ 

media campaign 

         

Free medications  

Referral to providers 

Home visits    

Training community 

members 



Forming partnerships     

82 african american men and blood pressure control: a closer look 
 4.4.2 Blood Pressure Control Programs Focusing on African American Men 

4.4.2.1 Addressing health disparities within Ohio’s African American male 

population: Ohio Department of Health, Heart Disease and Stroke 

Prevention Program’s focus groups, 2007 summary report 

and recommendations 

Intervention 

Objective: 

 To assess African American men’s knowledge, attitudes, and beliefs 

about control and treatment of high blood pressure, patient-provider 

communication, and best methods for message dissemination among African 

American men. The analysis focused on comparing findings to themes 

identified in the literature and recognizing emergent themes to better identify 

appropriate messages and strategies for the creation and implementation of a 

tailored high blood pressure treatment and control educational campaign. 

Systems change: 

 Findings will be used to create and implement a culturally relevant media 

campaign for Ohio’s African American male population. 

Detailed description of the intervention: 

 Nine focus groups were conducted in the summer and fall of 2007 (one 

focus group per age group per city). Age groupings were 18 to 29 years 

old, 30 to 49 years old, and 50 to 79 years old. Monetary incentives were 

provided for participating. 

Setting: 

 Focus groups were conducted in Cincinnati, Cleveland, and Columbus, Ohio 

Population: 

 Inclusion criteria: African American men in the cities of interest 

 Sample size: Cincinnati: 30, Cleveland: 24, Columbus: 25 

 Characteristics: Diverse cross-section of socioeconomic groups recruited 

through various means including: the Commission on African American 

Males listserv, targeted television and radio advertising, and word of mouth 

Outcome Measurement 

Design: Descriptive
 

Indicators: N/A
 

Key Findings 

Definition of high blood pressure: The 18- to 29-year olds associated high 

blood pressure with medically related symptoms, lifestyle factors, or personal 

experiences. Most frequently, diet was cited as a cause of high blood pressure 

among all age groups. 

Family history of high blood pressure: Most respondents could easily describe 

their family history of high blood pressure on their maternal side but had 

difficulty similarly describing their paternal history. 

a review to address blood pressure control in african american men 83 
Perceived symptoms: Respondents in all age groups cited various symptoms 

they perceived to be related to high blood pressure such as sweating, weakness, 

fatigue, and stress. 

Deterrents of prevention/management: The youngest men did not consider high 

blood pressure to be a major concern, and competing priorities (e.g., worries 

about money, safety) prevented them from focusing on the management or 

prevention of high blood pressure. Respondents aged 30–49 indicated that lack 

of awareness regarding the importance of high blood pressure treatment and 

control among African American men may contribute to the lack of participation 

in prevention activities among men of this age group. Also, financial cost may be 

a deterrent to healthy eating among men in this age group. 

Prevention of high blood pressure: Men in all focus groups indicated that eating 

a healthy diet (e.g., consuming less sodium and less fatty food, particularly pork) 

and engaging in physical activity were two activities that could prevent and/or 

manage high blood pressure. Men aged 30–49 also mentioned spiritual activities, 

including meditation, as a means of controlling high blood pressure. Men aged 

50–79 identified the importance of establishing a good relationship with health 

care providers, including open and honest communication. 

Patient/provider relationships: The majority of groups expressed general feelings 

of negativity and pessimism towards health care providers and the health care 

system, including lack of respect and lack of attention. 

Acquiring health information: Traditional media sources were considered the 

best sources of information (radio, television, magazines, and newspapers), 

particularly those primarily serving the African American community. Only 

the youngest group cited the Internet as an effective source of information. A 

majority of men in all groups received health information through discussions 

with the women in their lives. Other sources included neighborhood businesses, 

institutions or events including libraries, faith-based organizations, beauty salons/ 

barbershops, recreation centers (gyms) and health fairs. Clinical settings were not 

top choices because the men acknowledged that they did not see their providers 

regularly. 

Framing messages: Respondents 18–29 years of age believed that preventive 

messages, information about risk factors, the consequences of high blood 

pressure, and the ability to control and manage blood pressure within their 

current lifestyle were important. The messages needed to make it cool to address 

high blood pressure. For men aged 30–49, messages that included the personal/ 

human element were important, including testimonials by African American 

men who have successfully controlled their blood pressure, as was information 

about medicinal and non-medicinal (natural) treatment options. Men in the 

oldest group said that a message that high blood was a major and silent killer of 

African American men would appeal to them the most. 

84 african american men and blood pressure control: a closer look 
Lessons Learned 

Future studies should investigate approaches for obtaining family health history. 

Health messages should be created that encourage young African American men 

to make health a priority in their lives. 

Further exploration of better marketing of alternative food-based nutrition 

interventions is needed including community gardens and farmers markets 

accessible to the African American community. 

Aspects of religion or spirituality should be included in health messages; places of 

worship should be considered as means of disseminating health messages to older 

audiences.

The perception that health care providers are not being honest impedes the 

development of relationships. 

Messages need to be tailored to various African American male audiences. 

Web-based health education campaigns should be directed at younger men. 

Trusted female figures should be used in educational campaigns. 

In designing communication plans, educational campaigns should partner with 

trusted local businesses. 

Traditional media sources should be used to disseminate health messages. 

The entertainment factor should be considered when creating a campaign for 

younger men. 

Reference: Edwards J, Greene E, Pryor B. Addressing health disparities within 

Ohio’s African American male population: Ohio Department of Health, Heart 

Disease and Stroke Prevention Program’s focus groups 2007 summary report and 

recommendations. Columbus, OH; 2007: Office of Health Ohio, Ohio Department 

of Health. 

4.4.2.2 A research study to improve high blood pressure care in young 

urban African American men: recruitment, follow-up, and outcomes 

Intervention 

Objective: 

 This 12-month research study (a randomized controlled trial comparing two 

interventions), investigated whether an educational-behavioral intervention 

administered by a nurse-community health worker team in combination with 

usual medical care lowered blood pressure and increased high blood pressure 

control in comparison to usual medical care alone among young, inner-city 

African American men. 

 Secondary aims were to increase understanding of factors influencing entry 

into care, remaining in care, and adherence to treatment recommendations in 

this population, and to develop methodologies to improve high blood pressure 

care and outcomes. 

a review to address blood pressure control in african american men 85 
Systems change: 

 An educational-behavioral intervention, administered by a nurse-community 

health work team, in combination with usual medical care, was used to 

improve entry into care and reduce high blood pressure rates. 

Detailed description of the intervention: 

 Both groups received educational materials explaining high blood pressure, 

goal blood pressure, the importance of remaining in care, and adhering to 

treatment; referral to a physician if necessary; answers to questions; and a 

wallet card to record blood pressure. 

 The intervention group received individualized counseling, monthly telephone 

calls, and a home visit. 

 Men were recruited through the Emergency Department, screenings at the 

Health Department’s sexually transmitted disease clinics, flyers, and word of 

mouth. Three contacts for tracking were obtained. 

 The number of participants keeping screening appointments was maximized 

through multiple letter and telephone contact follow-up. 

Setting: 

 Randomized controlled trial conducted at Johns Hopkins Hospital Outpatient 

General Clinical Research Center, Baltimore, Maryland 

Population: 

 Inclusion criteria: African American male residents living within the Johns 

Hopkins Hospital catchment area; 18–49 years of age; blood pressure 

greater than or equal to 140 or greater than or equal to 90 mm Hg, or blood 

pressure less than 140/90 mm Hg and currently taking high blood pressure 

medication; with no acute or terminal illness; and able to give their written 

informed consent, telephone number, and address, and the verified name, 

address, and telephone number of two or three people through whom they 

could be reached. 

 Sample size: Screened: (N = 528); Baseline: (N = 204); Follow-up: (N = 157) 

 Characteristics: African American male residents living within the Johns 

Hopkins Hospital catchment area; 18–49 years of age; blood pressure 

greater than or equal to 140 or greater than or equal to 90 mm Hg, or blood 

pressure less than 140/90 mm Hg and currently taking high blood pressure 

medication; with no acute or terminal illness; and able to give their written 

informed consent, telephone number, and address, and the verified name, 

address, and telephone number of two or three people through whom they 

could be reached. 

Outcome Measurement 

Design: Research study (randomized controlled trial comparing two 

interventions), individual level data collected at baseline and follow-up 

Indicators: Change in BP, appointment attendance
 

86 african american men and blood pressure control: a closer look 
Key Findings 

Mean change in diastolic blood pressure was significantly different from zero for 

both the treatment and control groups; they were not significantly different from 

one another. The mean change in systolic blood pressure was not significantly 

different from zero for either group. 

In separate regression analyses measuring changes in diastolic blood pressure 

and systolic blood pressure from baseline to follow-up, none of the following 

variables were significantly associated with the change: having a doctor for 

high blood pressure, taking medication for high blood pressure, having health 

insurance, being employed, graduating from high school, or being in the 

intervention group. 

Lessons Learned 

It is feasible to identify, recruit, and follow-up on men with these characteristics; 

however, the process is very labor intensive. 

The Emergency Department is an important recruitment site in underserved 

urban areas. 

Men who were currently or had been in care for their high blood pressure were 

more likely to participate than those who had not previously been diagnosed. 

Word-of-mouth is a valuable approach for recruiting participants. 

The likelihood of reaching men was enhanced by identifying three, rather than 

two verified contacts. 

For many, the provision of transportation, minimal financial assistance with 

medical visit fees, and medication were not sufficient incentives to overcome 

negative prior experiences and the perceived absence of benefit. 

Modest financial and tangible incentives, such as sunglasses and squeeze bottles 

with the study logo, were useful. 

An enthusiastic, energetic, committed, and persistent minority staff was essential 

to recruitment and retention. Staff members brought to the study knowledge, 

experience, nonjudgmental concern about the health of the population, and an 

ability to establish rapport with the men and contacts. It was important that the 

workers were comfortable in the community, but they did not need to be from 

the community. 

Reference: Hill MN, Bone LR, Hilton SC, Roary MC, Kelen GD, Levine DM. 

A clinical trial to improve high blood pressure care in young urban black men: 

recruitment, follow-up, and outcomes. Am J Hypertension 1999;12(6):548–54. 

a review to address blood pressure control in african american men 87 
 

4.4.2.3	 Hypertension care and control in underserved urban African 

American men: behavioral and physiologic outcomes at 36 months 

and hypertension study outcomes and mortality results at 5 years 

Intervention 

Objective: 

 This 5-year research study (randomized controlled trial) compared the 

effectiveness of a more intensive comprehensive educational-behavioralpharmacological intervention by a nurse practitioner–community health 

worker-physician team and a less intensive education and referral intervention 

in controlling blood pressure and minimizing progression of left ventricular 

hypertrophy and renal insufficiency. 

Systems change: 

 A multi-faceted, individually tailored, multi-disciplinary team approach 

to blood pressure control with free medications and integrated assessment, 

counseling, and referral for substance addiction. 

Detailed description of the intervention: 

 More intensive group: received comprehensive individualized intervention 

by a team comprised of a nurse practitioner, a community health worker, 

and a physician. Nurse practitioner visits were scheduled every 1 to 

3 months and included free hypertensive medication. In year 1, the 

community health worker made a home visit to engage and assist the person 

identified by the participant as someone providing them with key support 

with health matters. Subsequent community health worker visits were based 

on the men’s needs, with referrals related to social services, job training, 

and housing. The physician was available for consultation with the nurse 

practitioner and participated in case discussions regarding management of 

hypertension as needed. 

 Less intensive group: referred to sources of hypertensive care in the community. 

 Both groups were reminded of the importance of blood pressure control 

every 6 months by telephone call and at their annual research visit, and both 

received education about the benefits of controlling hypertension. 

Setting: 

 East Baltimore community 

Population: 

 Inclusion criteria: African American men, 18 to 55 years of age, residing in 

inner-city Baltimore, with hypertension defined by systolic blood pressure 

greater than 140 mm Hg and/or diastolic blood pressure greater than 90 mm 

Hg on two separate occasions or a history of being diagnosed with high blood 

pressure and being on antihypertensive medication. Exclusion criteria were 

being on renal dialysis, having an acute or terminal illness or serious mental 

illness, or participating in another hypertension study. 

88 african american men and blood pressure control: a closer look 
 Sample size: Screened: (N = 821); Baseline (N = 309); Follow-up at 36 

months (N = 231); Follow-up at 5 years (N = 200) 

 Characteristics: African American men, age range (21–54 years); employed 

(27%); never married (58%); mean blood pressure (147/99 mm Hg); on 

hypertensive medication (53%); controlled blood pressure (19%) 

Outcome Measurement 

Design: Randomized controlled trial 

Indicators: Blood pressure (BP), left ventricular mass (LVM), and serum 

creatinine, all measured at baseline, 12, 24, and 36 months, and 5 years
 

Key Findings 

Through the 36-month follow-up, improvements in blood pressure rates were 

significantly greater in the more intensive group. While the improvements 

remained greater in the more intensive group at 5-year follow-up, the difference 

was no longer statistically significant. 

At 36 months, blood pressure was considered controlled in 44% of those in the 

more intensive group and in 31% of those in the less intensive group. 

There was a trend toward slowing of the progression of renal insufficiency (incidence of 50% increase in serum creatinine) in the more intensive group compared to the less intensive group. 

Over a 36-month period in both groups, cigarette smoking and high salt intake 

declined, and antihypertensive medication use increased, but high rates of 

obesity and illicit drug use remained unchanged. By 5 years, improvements in 

cigarette smoking and salt consumption remained, but there continued to be no 

improvements in cholesterol and BMI levels. 

While follow-up rates were greater among the more intensive group at 1, 3, and 

5 years, after accounting for men who died or were incarcerated, the differences 

were no longer significant at 5 years. 

Improvements in overall hypertension care compliance was greater in the more 

intensive group at 2, 3, and 4 years, but was lost by 5 years. 

Lessons Learned 

It is possible to recruit, track, and follow a cohort of inner city young African 

American men with hypertension. 

High rates of obesity, smoking, and illicit drug use emphasize the need to better 

incorporate lifestyle modification therapies within BP control programs. 

The multi-faceted, individually tailored, multi-disciplinary team approach 

with free medications appears to have effectively reduced barriers to BP control 

among these men. 

Assistance with life priorities (e.g., job training and housing) appeared to help 

the men better focus on their health problem. 

Even the less intensive intervention (telephone calls every 6 months, annual 

evaluation, appropriate referrals for health conditions and social needs, and 

attention from a culturally competent and motivated staff) helped high-risk 

patients lower their blood pressure. 

a review to address blood pressure control in african american men 89 
Integrating assessment, counseling, and referral for substance abuse is useful. 

The physician visit needs to be supplemented by home visits from community 

health workers, free BP management, and medication. 

Individual interactions influenced the number of nurse practitioner visits. A 

decrease in visits in years 4 and 5 may have been related to participant fatigue as 

the uniqueness wore off. A modified or intensified intervention may have been 

useful in the last years of the study. 

References: Hill MN, Han HR, Dennison CR, Kim MT, Roary MC, Blumenthal 

RS, et al. Hypertension care and control in underserved urban African American men: Behavioral and physiologic outcomes at 36 months. Am J Hypertension 

2003;16:906–913. 

Dennison CR, Post WS, Kim MT, Bone LR, Cohen D, Blumenthal RS, et al. Underserved urban African American men: hypertension trial outcomes and mortality during 

5 years. Am J Hypertension 2007;20:164–171. 

4.4.3	 Blood Pressure Control/Coronary Heart Disease Prevention 

Programs Focusing on the African American Community 

4.4.3.1. A hypertension control program tailored to unskilled and 

minority workers 

Intervention 

Objective: 

 To educate low literacy hypertensive municipal workers about high blood 

pressure and induce behavioral changes that would bring their blood pressure 

under control. 

Systems Change: 

 The Hypertension Intervention Program provided classes and written 

handouts with hypertension information, strategies for reducing hypertension, 

and lifestyle modification strategies. 

Detailed description of the intervention: 

 A 12-month hypertension education intervention included hour- long classes 

(weekly for four weeks and then monthly for 11 months) on hypertension 

control and lifestyle modifications. Blood pressure was measured at every 

class meeting. 

 Both cases and controls received annual medical exams and health newsletters 

and were exposed to a monthly health poster program through the larger 

Birmingham Heart Disease Prevention Project (BHDPP), which was a more 

comprehensive system-wide intervention. 

Setting:
 

 Birmingham, Alabama 

Population:
 

 Inclusion criteria: All municipal workers with blood pressure ≥140/90 

were invited to join the program. The program was targeted towards a 

90 african american men and blood pressure control: a closer look 
subpopulation of low literacy workers, specifically those in working in the 

Streets and Sanitation, Parks and Recreation, and Engineering Departments. 

 Sample size: Participants: Screened: (N = 600); Baseline: (N = 130); 

Follow-up: (N=81) 

 Characteristics: Less than 45 years of age: 63%, male: 86%, African American: 

63%, approximately high school education: 46%, unskilled workers: 58% 

Outcome Measurement 

Design: Quasi-experimental design (cases matched retrospectively to nonparticipating controls by age, sex, race, and baseline blood pressure)
 

Indicators: Change in blood pressure over time 

Key Findings 

There was no significant difference in the change in blood pressure between 

intervention participants and controls. 

Intervention participants had a significant decrease in mean systolic pressure (P = 

0.03) but not in mean diastolic pressure. 

African American participants had a significant decrease in mean systolic pressure 

(P = 0.004) but not in mean diastolic pressure. 

Lessons Learned 

Several barriers to participation became apparent: 

 High rate of illiteracy 

 Lack of understanding of concept of delayed gratification (preventive measure 

to avoid heart disease in future)
 

 Significant variability in health priorities
 

 Inaccurate health beliefs about cardiovascular risk factors
 

 Inadequate support from supervisors
 

 Lack of time for participation
 

 Adverse peer group pressure
 

Involving employees in the creation of the intervention program might have 

improved participation rates. 

Because this study was part of a larger health intervention, it is difficult to 

isolate the impact of the hypertension program from that of the larger health 

intervention project. 

Workplace programs blending behavioral and environmental interventions to 

complement and reinforce each other cause the health outcome to be shared 

by employer and employee. The blending of these approaches may promote 

behavioral change by enhancing workplace awareness. 

Reference: Fouad MN, Kiefe CI, Bartolucci AA, Burst NM, Ulene V, Harvey MR. 

A hypertension control program tailored to unskilled and minority workers. Ethn Dis 

1997;7(3):191–199. 

a review to address blood pressure control in african american men 91 
4.4.3.2 . 	 Development of a standardized screening form that can be used 

at community-based screening events conducted by community 

organizations in the African American community 

Intervention 

Objective: 

 To assess hypertension and diabetes screening data collection practices and 

guidelines and to develop and test standardized diabetes and hypertension 

screening forms for use in community- and faith-based screening events 

in the African American community, conducted by fraternal, professional, 

community-based, and grassroots organizations. 

Systems change: 

 Developing standardized screening forms and guidelines for communitybased health screening events and partnering with national African 

American organizations to conduct community-based screening for 

diabetes and hypertension. 

Detailed description of the intervention: 

 The Department of Health and Human Services’ Office of Minority Health 

(OMH) developed a hypertension screening form to be used at communitybased screening events. Data collected on the form included the following: 

demographics, high blood pressure status, attitudes, risk assessment, access, 

blood pressure reading and explanation, and recommendations. Each 

participant gave the following information: name, address, sex, age, place of 

birth, primary language and language spoken at home, race/ethnicity, whether 

they had diabetes, how they felt about their knowledge and risk, and whether 

they were willing to change behaviors to reduce their risk for hypertension. 

Questions also assessed their risk, health insurance coverage and employment 

status. Two blood pressure readings, systolic and diastolic were taken. 

Setting: 

 The instrument was tested at screening events in Greenbelt, MD; 

Hyattsville, MD; New York, NY; Pittsburgh, PA; Charleston, SC; East St. 

Louis, IL; New Orleans, LA; Fresno, CA; and Washington, DC. 

Population: 

 Inclusion criteria: The screening form was tested on individuals who attended 

community-based screening organized by one of the collaborating national 

African American organizations. 

 Sample size: 265 hypertension screening forms were completed 

 Characteristics: Not available 

Outcome Measurement 

Design: Descriptive 

Indicators: Completion rate for fields on the forms 

Key Findings 

Core questions can be developed for screening events conducted by national 

African American organizations. The hypertension form had 32 fields that 

92 african american men and blood pressure control: a closer look 
needed to be completed. Sections filled out by participants had a higher 

completion rate that those filled out by screeners. Completion rates for the 

follow-up section of the form were low. Screeners noted that many participants 

commented on the personal information given on the forms and were concerned 

about who would have access to this information. Screeners also noted that 

participants may know volunteers, thereby causing them to be uncomfortable in 

answering personal information. 

Lessons Learned 

Collaborative models can be successfully created between OMH and national 

African American organizations. 

Community organizations that are not health oriented may require more 

technical assistance when using screening tools and selecting appropriate 

personnel to conduct health screenings. 

Additional appropriate personnel may ease the time pressures that could lead to 

incomplete completion of the forms. 

Issues of privacy/confidentiality and liability are critical barriers to more effective 

follow-up. Providing screeners with a confidentiality agreement before the 

screening with additional language for handling this situation with participants 

may be helpful, or adding a tear-off section to the forms where the screeners 

would record the participant’s screening results and then detach it from the 

screening form for the participant to use for future reference may also be helpful. 

Reference: Graham GN, Kim S, James B, Reynolds G, Buggs G, Hunter M, et al. 

Benefits of standardized diabetes and hypertension screening forms at community 

screening events. Health Promot Pract 2006;7(1):26–33. 

4.4.3.3. Take It To Heart: a national health screening and educational 

project in African American communities 

Intervention 

Objective: 

 To provide free screening and to increase awareness of the prevalence 

of hypertension and the risks of coronary heart disease in the African 

American community. 

Systems change: 

 Take It To Heart, an educational-behavioral intervention, provided 

individualized risk assessments in key cardiovascular risk areas, and was based 

on these data, produced a coronary risk profile (CRP). The information 

provided was intended to inform individuals and encourage those at high risk 

to take steps to improve their health status. 

Detailed description of the intervention: 

 The project provided free blood pressure testing, cholesterol testing, 

and individualized coronary risk assessment. Participants completed a 

questionnaire about their medical and social history. 

 Screenings were widely advertised; community organizations and faith-based 

organizations were notified by mail. 

a review to address blood pressure control in african american men 93 
 A CRP was produced for each participant that included major risk factors 

indicating the comparative risk for the individual, and suggestions on how to 

modify risk through lifestyle changes. Members of the local National Medical 

Association were available to review the CRP and reinforce changes. 

 The project was conducted by the National Medical Association and the 

Bayer Corporation. 

Setting: 

 Take It To Heart was conducted in faith-based organizations, community 

centers, and shopping malls based in predominantly African American 

neighborhoods in Washington, DC; Detroit, MI; Atlanta, GA; 

Greensboro, NC; and Houston, TX. 

Population: 

 Inclusion criteria: Community program
 

 Sample size: Some screening: (N = 1651), Full screening: (N = 1250) 

 Characteristics: Of those who completed full screening: African American: 

95%, average age: 48 years (range 18–82 years) 

Outcome Measurement 

 Design: Descriptive study 

 Indicators: Blood pressure and risk profile 

Key Findings 

Individuals with high blood pressure: 40% 

Lessons Learned 

Results of screening tests demonstrated the need for more community-based 

programs designed to increase awareness of the importance of regular check-ups 

and health information regarding hypertension. 

The program was well received and has expanded so that the partnership between 

the National Medical Association and the Bayer Corporation has expanded to 

include the National Black Nurse’s Association. This will provide participants 

with greater access to African American health care providers. 

In light of a high percentage of abnormal results, a follow-up program is being 

developed. Several new activities are being explored including educational 

mailing to participants’ homes and phone calls from local National Medical 

Association physicians. 

Reference: Keys R. Take It To Heart: a national health screening and educational 

project in African American communities. J Natl Med Assoc 1999;19(12):649–652. 

94 african american men and blood pressure control: a closer look 
 

4.4.3.4 	Faith-based education: an outreach program for African Americans 

with hypertension 

Intervention 

Objective: 

 To conduct an education outreach demonstration study to prepare 

registered nurses (RNs) as Church Health Educators (CHEs), and to test the 

effectiveness of a hypertension education and support program in African 

American faith-based organizations for persons with high blood pressure. 

 Secondary aims were to determine the effectiveness of a faith-based model and 

a combined education and support intervention for African Americans with 

high blood pressure in increasing knowledge related to high blood pressure. 

Systems change: 

 An educational-behavioral intervention, administered by CHEs in African 

American faith-based organizations in urban Chicago, was used to educate 

faith-based organization members to support reductions in high blood 

pressure rates and improved heart-healthy lifestyle choices. 

Detailed description of the intervention: 

 Phase I: RNs from member congregations were prepared as CHEs and lay person volunteers were prepared as program planners/organizers and facilitators. 

 CHEs were recruited through the American Heart Association of 

Metropolitan Chicago’s Church-Based Hypertension Consortium, with 

congregation members identified by church pastors, and the National Black 

Nurses Association Chicago Chapter. 

 A 24-hour in-service program combined classroom instruction with 

experiential activities. CHEs and program planners were taught assessment 

of health education needs, the process of planning a program to fit within 

the existing structure of the faith-based organization, development of 

overall and specific program planning skills, identification of resources, 

skills for matching learner’s needs with educational methods and 

techniques, ways to create an environment conducive to education, 

methods of evaluating individual and overall educational programs, and 

specific strategies, trends, and issues in hypertension management. 

 Experiential activities included discovering the structure of the member’s 

faith-based organization, conducting a health education assessment of 

the congregation, organizing a health committee, and planning for the 

implementation of a high blood pressure education program. 

 Phase II: CHEs taught their faith-based organization members about HBP 

and strategies for active involvement in the management of one’s high 

blood pressure regimen. 

 The formal education program consisted of eight 1-hour small group classes 

using curriculum guides to standardize class content. Topics included 

understanding high blood pressure, risk factors for high blood pressure, 

a review to address blood pressure control in african american men 95 
 

 

 

 

 

 

sodium and high blood pressure, cholesterol and high blood pressure, stress 

management and exercise, drug therapy, and roles and responsibilities for 

managing high blood pressure. 

 CHEs implemented interventions in small groups of subjects with high 

blood pressure. Support and education were provided formally in class and 

informally during day-to-day or week-to-week contacts, in didactic meetings, 

during visits, and by telephone. CHEs worked with family members to teach 

them about high blood pressure and ways they could support their family 

members with high blood pressure. Blood pressure readings were taken at 

each class. Other data were collected for assessing social support networks, 

lifestyle factors, and background. 

Setting: 17 urban, predominantly African American faith-based organizations 

located in the Chicago metropolitan area 

Population:
 

 Inclusion criteria: African Americans, at least 18 years of age, diagnosed 

as having hypertension, willing to participate in the study, and who had 

completed at least three-fourths of the educational classes. 

 Sample size: 

 Faith-based organization leaders, registered nurses (N = 32), health 

professionals (N = 8), licensed practical nurses (N = 10), laypersons (N = 23) 

 Participants: Screened (N = 198); Baseline (N = 97); Follow-up (unknown) 

 Characteristics: mean age (62 years); female (84%); married (29%); 

employed (42%); median education (high school); median annual income 

($10,000–$20,000) 

Outcome Measurement 

Design: Pre-test/post-test with no control group with data collected at 

baseline (pre), at completion of the intervention (post1), and 3 months postintervention (post2) 

Indicators: Change in blood pressure, changes in knowledge, changes in lifestyle 

modification 

Key Findings 

Knowledge scores significantly increased from pre to post1 and post2. 

Systolic BP and mean arterial BP significantly decreased from pre to post1 

and post2.
 

 DBP significantly decreased from pre to post1 only.
 

Lessons Learned 

Men and individuals who were younger or newly diagnosed with high blood 

pressure were more difficult to recruit and retain. These groups were more at risk 

for inadequate education about high blood pressure. 

Low participation by African American men may be related to a belief that it 

is the woman’s role to direct the management of the men’s high blood pressure 

treatment regimen, as well as a fear of disclosing feelings about the impact of 

high blood pressure and high blood pressure drugs on their sexuality. 

96 african american men and blood pressure control: a closer look 
 

 

 

 

 

 

 

 

 

 

Using volunteers has its assets and liabilities. Volunteers are often recruited 

because of their interest and availability without giving consideration to their 

talents and skills. The pastor may have assumed that all RNs and leaders had 

the requisite talents and skills to organize and implement the high blood 

pressure education program in their faith-based organizations. From members’ 

self-assessments, this was not always true. This may partially explain why some 

leaders did not implement the high blood pressure education program at their 

faith-based organization. 

Reference: Smith ED, Merritt SL, Patel MK. Church-based education: an outreach 

program for African Americans with hypertension. Ethnic Health 1997;2(3):243–253. 

4.4.3.5 	Impact of a community-based multiple risk factor intervention on 

cardiovascular risk in African American families with a history of 

premature coronary disease 

Intervention 

Objective: 

 To determine the relative effectiveness of an alternative model of communitybased care (CBC) compared to “enhanced” primary care (EPC) in reducing 

coronary heart disease risk in high-risk African American families. 

Systems change: 

 A comprehensive community-based invention for African Americans at 

high risk of a coronary heart disease event, which was based on a sibling’s 

hospitalization for such an event. 

Detailed description of the intervention: 

 Participants were randomly assigned to either the CBC or EPC models and 

followed for 1 year. 

 The CBC group received care in an easily accessible, non-clinical site in the 

community. The site had a comfortable conference room for counseling, a 

clinical room for phlebotomy and physical examination, an exercise room 

with a choice of music, and a living room with a children’s play area. It was 

open from 9 A.M. to 5 P.M. Monday through Friday, with no appointments 

necessary, and evening and Saturday appointments available if requested. On 

each visit, the nurse practitioner performed a brief physical assessment including 

blood pressure measurements to monitor compliance. The community health 

worker counseled patients on diet, smoking cessation, and exercise and led 

two free exercise sessions per week at the YMCA. All participants requiring 

pharmacotherapy were given a pharmacy charge service card that allowed them 

to obtain their risk factor therapy prescriptions free of charge at any pharmacy. 

The average total visit was 30 minutes. 

 The EPC group received the same risk-specific materials as the CBC group. 

Their primary care providers received results from various reports and 

guidelines. The free pharmacy charge services card was mailed to providers to 

give to their patients, and the benefit of the card was emphasized. Participants 

were given a full explanation of the card and instructed to ask their provider for 

it. Participants and their providers were sent information about the free YMCA 

a review to address blood pressure control in african american men 97 
 

 

 

 

 

exercise programs. Participants were informed about resources available from 

their provider, and providers were encouraged to use them for their patients. 

Setting: Baltimore 

Population: 

 Inclusion criteria: Siblings of African American patients with coronary heart 

disease, ages 30–59, blood pressure greater than or equal to140/90 mm Hg, 

LDL cholesterol greater than or equal to 3.3 mmol/L, or currently smoking. 

Participants were included if they had no known history of coronary heart 

disease, no chronic glucocorticosteroid therapy, no autoimmune disease, no 

current cancer therapy, and no immediate life-threatening comorbidity. 

 Sample size: Baseline (N = 364); Intervention group (N=196); Control group 

(N=168) 

 Characteristics: mean age (48 years); education mean(13 years); female (64%); 

insured (80%); married (42%) 

Key Findings 

The CBC group was twice as likely to achieve goal levels of LDL cholesterol 

and blood pressure compared with the EPC group, after controlling for 

reductions in baseline characteristics. The CBC group demonstrated a 

significant reduction in global coronary heart disease risk, whereas no 

reduction was seen in the EPC group. 

Lessons Learned 

While the CBC intervention was superior, the EPC group demonstrated 

a smaller improvement in risk factors, suggesting that barrier-reducing 

enhancements to primary care may moderately improve individual risk factors. 

Even in the best-case scenario in which the major well-known risk barriers have 

been reduced, risk factor goals were not attained by a relatively large number of 

individuals in both groups. 

The superior results of the CBC group may be due in large part to the community 

health worker, who served as a culturally sensitive navigator through the systems 

of care including filling prescriptions, shopping for and preparing healthier foods, 

and accessing exercise facilities. Also, assistance of the nurse practitioner to the 

CBC group may have helped individuals’ ability to manage pharmacotherapy 

effectively, as evidenced by more frequent use of the pharmacy card. 

Unexpectedly, the small exercise room at the CBC was a strong incentive because 

individuals could use it for a short period of time at their convenience. 

Reference: Becker DM, Yanek LR, Johnson WR, Garrett P, Moy TF, Reynolds SS, et 

al. Impact of a community-based multiple risk factor intervention on cardiovascular 

risk in black families with a history of premature coronary disease. Circulation 

2005;111:1298–1304. 

98 african american men and blood pressure control: a closer look 
 

4.4.4 Other Relevant Systems-Level Health Care Programs Focusing on 

the African American Community 

4.4.4.1 	Recruiting African American Men for cancer screening studies: 

applying a culturally based model 

Intervention 

Objective: 

 To identify barriers to recruiting African American men to study Prostate 

Cancer Screening (PCS) and to determine whether relationships exist among 

religiousness, cancer fatalism (belief in the inevitability of death if cancer is 

present), and PCS factors (beliefs, attitudes, and behavior), which impede 

African American men’s participation in PCS. 

Systems change: 

 A three component framework, involving health education, educational 

diagnosis of health behavior and cultural appropriateness of health behavior to 

increase recruitment for PCS. 

Detailed description of the intervention: 

 To successfully recruit African American men for the study, the PEN-3 model 

was used to understand factors that may shape health behavior and influence 

recruitment efforts. PEN-3 is a cultural empowerment model that highlights the 

role of the community and offers specific ways that cultural context may shape 

health education and values. It consists of three interdependent dimensions of 

health belief and behaviors that may influence the process of recruiting African 

American men for prostate cancer prevention studies: health education, the 

educational diagnosis of health behavior, and the cultural appropriateness of 

health behavior. 

 Health education refers to the notion that individuals make health decisions 

consistent with their familial and community roles. 

 Educational diagnosis of behavior refers to the notion that cultural attitudes, 

values, and beliefs arise from a cultural context where there may be forces that 

encourage or impede positive health behavior. 

 The cultural appropriateness of health behavior provides a framework for 

categorizing culturally based behaviors: (a) existential behaviors are specific to 

a cultural group and may often be misunderstood but are not detrimental to 

health, (b) positive behaviors promote health, and (c) negative behaviors are 

harmful to health but must be understood within their cultural context before 

an attempt to change them is made. 

 Men who were faith-based organization members were recruited through 

publicity in the faith community. This centered the recruitment in a 

supportive community while also addressing fatalistic orientations. Senior 

pastors articulated the value of PCS from a spiritual perspective in a simple 

message that men could easily understand. 

 Fatalistic attitudes were addressed in a culturally appropriate way. 

a review to address blood pressure control in african american men 99 
 

 

 

Setting: African American religious community in the Los Angeles area 

Population: 

 Inclusion criteria: African American men from three mega faith-based 

organizations in the Los Angeles area. 

 Sample size: Screened (NA); Baseline (N = 655); Follow-up (NA) 

 Characteristics: Not described 

Outcome Measurement 

Design: Descriptive 

Indicators: No outcomes from the intervention are measured. 

Key Findings 

In recruiting African American men for PCS studies, the general views of 

men toward preventive health care must be considered as well as their specific 

concerns about the behavior that is being studied. 

Collaborating with community supporters of improved health behavior and 

community-based research, as well as addressing negative forces, were critical to 

successful recruitment. 

Careful reflection on how culturally based values may facilitate or impede efforts 

facilitated the research team’s ability to incorporate appropriate cultural messages 

in the recruitment process. 

Lessons Learned 

Efforts to recruit African American men for cancer prevention studies are 

enhanced by the application of culturally based models that provide a framework 

for understanding the unique concerns of African American men in cancer 

prevention research. 

Cultural beliefs should not simply be tolerated but understood. Social, 

religious, and other factors may influence the role of fatalism in the African 

American community. 

Cultural tailoring in recruitment is also an important strategy. Giving 

consideration to racial, gender, socioeconomic, educational, and religious 

characteristics of the proposed sample is key to maximizing participant 

recruitment. 

Viewing prevention efforts from a collective rather than exclusively an 

individualistic perspective, as well as identifying the specific concerns of African 

Americans regarding PCS, may be an important element in maximizing the 

recruitment of African American men and other cultural groups where the 

community has a primary role. 

Reference: Abernethy AD, Magat MM, Houston TR, Arnold HL, Bjorck JP, & 

Gorsuch RL. Recruiting African American men for cancer screening studies: applying a 

culturally based model. Health Educ Behav 2005;32(4):441–451. 

100 african american men and blood pressure control: a closer look 
4.4.4.2 	Systems-level and community-based interventions for diabetes 

control 

Intervention 

Objective:
 

 The purpose of the diabetes investigation was to assess the strengths and 

gaps of current public health efforts to reduce the burden of diabetes 

in northeastern North Carolina in order to plan regional diabetes 

prevention efforts.
 

Systems change: 

 Resource assessment 

Detailed description of the intervention: 

 In its analysis of diabetes, the North Carolina Partnership for Public Health 

reviewed in-depth, diabetes data currently available for the region through the 

Behavioral Risk Factor Surveillance System. 

 Since diabetes is one of the leading causes of death and disability in northeastern North Carolina, region-specific diabetes mortality and hospitalization data 

was also reviewed to assess the burden. 

 The Partnership assessed the current diabetes programs in each of the region’s 

public health departments. 

Setting: Eastern North Carolina 

Population: 

 Inclusion criteria: Northeastern North Carolina county health agencies 

 Sample size: Ten county health departments in northeastern North Carolina 

 Characteristics: Counties are rural and economically depressed 

Outcome Measurement 

Design: Descriptive 

Indicators: Diabetes education and awareness, advocacy programs, 

marketing campaign 

Key Findings 

Results of the 2003 survey showed that 12.5% of adults (39,205 people) in 

northeastern North Carolina reported that they have been told they have 

diabetes. Because about one-third of diabetes cases are undiagnosed, the true 

number of adults with diabetes in the area is most likely higher. 

African Americans and other minority groups are disproportionately affected 

by diabetes. The age-adjusted mortality rate for African Americans, Native 

Americans, and other non-white races combined was 1.9 times higher than for 

whites (189.7 compared to 98.9 deaths per 100,000). 

Six of the 10 health departments have primary prevention programs to increase 

awareness about diabetes (health communication). However, the Partnership 

determined that none of the health departments used a multimedia approach 

including radio, newspapers, and television, or a social marketing approach to 

determine elements or messages that could bring about behavior change within 

the region. 

a review to address blood pressure control in african american men 101 
The Partnership’s strengths and gaps assessment of diabetes programs 

determined that five of the health departments have primary prevention 

programs to increase physical activity and improve nutrition in the community 

(community intervention). 

All health departments reported providing screening or testing for diabetes. 

Eight of the health departments have tertiary prevention programs or 

diabetes self-management and education programs to prevent the incidence 

of diabetic complications.
 

Lessons Learned 

The Partnership is addressing the lack of multimedia campaigns by launching 

a major social marketing campaign aimed at diabetes prevention. Funding will 

be provided through a recent appropriation of the state legislature to establish 

“public health incubators” across the state. Social marketing campaigns aimed at 

heart disease, stroke, and HIV/AIDS prevention will be developed in subsequent 

years. The major social marketing campaign aimed at diabetes has the potential 

for great impact with a limited amount of new resources. 

The Partnership is attempting to convince state legislators and state public health 

leaders to make an ongoing funding commitment to the region to tackle not 

only the diabetes, heart disease, stroke, and HIV/AIDS health issues of pressing 

concern, but also to strengthen the local public health infrastructure and improve 

its ability to assess, address, and assure the public’s health. . 

Reference: Dickson CW, Alexander JG, Earley BH, Riddle EKR. Northeastern North 

Carolina partnership for public health and health disparities in Northeastern North 

Carolina. NC Med J 2004;65(6):377–380. 

4.4.4.3 	A model for home care clinician and home health aide collaboration:

 diabetes care by nurse case managers and community health workers 

Intervention 

Objective: 

 To determine whether a multifaceted, culturally sensitive, primary care–based 

behavioral intervention implemented by a nurse case manager and/or a 

community health worker could improve diabetes control in a sample of 

inner-city African Americans with type 2 diabetes. 

Systems change: 

 An educational-behavioral intervention provided interaction with a nurse case 

manager (NCM), community health worker (CHW) or both. 

Detailed description of the intervention 

 For this 2-year intervention, patients were randomly assigned to one of 

four groups: NCM Group, CHW Group, NCM+CHW Group, or the 

control group. 

 NCM Group received a 45-minute face-to-face clinic visit and telephone 

calls with a nurse who had a baccalaureate degree who was in training to be 

a diabetes educator. The nurse coordinated care according to the American 

Diabetes Association clinical practice recommendations including direct 

102 african american men and blood pressure control: a closer look 
patient care, management, education, counseling, follow-up, referrals, and 

physician feedback and prompting. Usual medical care was also provided. 

 The CHW Group received 45–60 minute home visits by a CHW to 

facilitate preventive care. The CHW assisted with scheduling appointments, 

monitoring participant and family behavior, reinforcing adherence to 

treatment recommendations, mobilizing social support, and providing 

physician feedback. Usual medical care was also provided. 

 The combined NCM and CHW Group received both sets of care described 

above, in addition to biweekly conferences to coordinate interventions and 

promote synergy. Usual medical care was also provided. 

 The control group received usual medical care, which consisted of ongoing 

care from each patient’s own health care professional and quarterly newsletters 

containing information on diabetes related topics. 

Setting: 

 East Baltimore
 

Population:
 

 Inclusion criteria: African Americans with type 2 diabetes 

 Sample size: Screened: Screened (not stated); Baseline (N = 186); 

Follow-up (N = 149) 

 Characteristics: mean age 59 years, female 77%, participants had diabetes for 

an average of 9 years, most (91%) were on medications 

Outcome Measurement 

Design: Research study, a randomized clinical trial comparing outcomes in two 

groups receiving different interventions 

Indicators: Blood pressure, HDL, LDL, HbAlc, dietary risk 

Key Findings 

All three experimental groups experienced improved diabetes control compared 

to the control group. The greatest improvements were seen with combined nursing and community health worker visits. No differences were statistically significant, but researchers say they were clinically significant. 

All three experimental groups experienced decreases in triglyceride levels and diastolic blood pressure compared to the control group, with the greatest decreases 

in the combined NCM+CHW group. 

The CHW Group experienced the largest improvement in dietary risk scores. 

Both the CHW and the combined NCM+CHW groups experienced larger 

increases in physical activity compared with the control group. 

All intervention groups experienced a weight gain. This was a disappointing finding because the intervention was intended to promote weight loss. The researchers speculated that improved adherence to anti-diabetic medications may have 

resulted in a weight gain, but they lacked data to confirm their speculation. 

a review to address blood pressure control in african american men 103 
Lessons Learned 

The findings suggest the importance of nonprofessional community health 

workers on the diabetes care team. Many issues with which the CHW assisted 

patients—including finances, family responsibilities, and insurance—went 

beyond the traditional diabetes care provided in outpatient primary care settings. 

In light of a high percentage of abnormal results, it has been recommended that a 

follow-up program be developed. Several programs are being explored including 

educational mailings to participants’ homes and phone calls from local National 

Medical Association physicians. 

The integration of NCMs and CHWs into the primary care setting can produce 

improvements in diabetic control and reduce the excess burden of diabetesrelated complications in African Americans. 

Additional outcome improvements might have occurred if study personnel had 

provided the amount of interventions typically provided to home care patients 

with diabetes. In this study, improved outcomes occurred despite a lower than 

planned number of interventions. The number of face-to-face visits conducted 

by both the NCMs and CHWs was very modest compared with the number of 

home visits typically provided to home care patients with diabetes. Insufficient 

staff time and patient noncompliance were barriers to achieving this goal. 

Reference : Vetter MJ, Bristow L, Ahrens J. A model for home care clinician and home 

health aide collaboration: diabetes care by nurse case managers and community health 

workers. Home Healthcare Nurse 2004;22(9):645–648. 

104 african american men and blood pressure control: a closer look 
General Health Resources 

5 

5.1 Overview 

This chapter presents several organizations in which programs can potentially partner 

with to design or implement program interventions. The organizations listed in 

this chapter include associations for African American health professionals; African 

American men’s health organizations; African American organizations more generally; 

multicultural health programs at the federal, state, and local levels; and cardiovascular 

health organizations. Also, nontraditional resources such as Historically Black 

Colleges and Universities (HBCUs) and African American fraternities and sororities 

are included. Although local faith-based organizations are often used as a resource 

by programs, several of these organizations lack central contact information at the 

national level; therefore they are not included in this chapter. 

a review to address blood pressure control in african american men 105 
Resource Aims Description/Programs 

Co

Association of BlackCardiologists, Inc. (ABC) 

To eliminate disparities related to cardiovascular disease in all people of color. Organizational goals: create leadership that drives a national agenda, achieve a reduction in cardiovascular disease through awareness, and establish a sufficient endowment to fund its programs. 

ABC is a nonprofit organization founded in 1974 with an international membership of more than 

600 health care professionals. ABC publications include resources on reducing cardiovascular risks among African Americans and 

people of color: http://w

w

w.abcardio.org/resources.htm

ABC sponsors community health programs such as Not in Mama’s Kitchen, a secondhand smoke 

prevention campaign: http://w

w

w.abcardio.org/commhealth.htm 

53AtPhE-mabWehtt

The Association To have a positive impact on the mental ABPsi’s objectives include (1) improving organizing skills and abilities to influence necessary P.O

of Black health of the national African American change and (2) addressing significant social problems that aff ect the African American community WaPsychologists, community through planning, programs, and other segments of the population whose needs have not been met by society. Ph

Inc. (ABPsi) services, training, and advocacy. Fax

E-m

We

Black Caucus of To improve the health of African Health 

Workers Americans through relevant 

(BCHW) database development, professional 

development, policy analysis, research, and legislative revie

w. 

BCHW’s mission is to improve, advance, and maintain the quality of life for African Americans. 

Established in 1968 and affiliated with the American Public Health Association (APHA), the BCHW works with APHA and other health-related groups, to improve the health status of African 

Americans through (1) professional development, (2) health policy analysis, (3) research, and (4) 

legislative revie

w. 

BCHW provides an entry point to APHA for African American professional and paraprofessional public health workers. It provides programs that explore the special nature of public health problems facing people of color in the United States, including poverty, discrimination, and lack of health care access; equal opportunity for work force entry and advancement; and related issues.Local BCHW chapters and affiliates give African American health professionals the opportunity to participate in recruitment, mentoring, career development, continuing education, service and 

delivery, and research. 

c/o of 21

ChPhWehtt

The Black 

Young 

Professionals’

Public Health Net

work, Inc. 

(The Net

work) 

To promote net

working opportunities 

for junior-level public health professionals and enhance awareness 

around issues relevant to the health of African Americans. 

The Net

work was established in recognition of an increased need for more deliberate 

and concerted opportunities for professional development (education, employment, and advancement) of African Americans in APHA and the public health field. It also strives to increase 

communication bet

ween traditional Schools of Public Health and the newly forming M.P.H. 

programs at Historically Black Colleges and Universities (HBCUs). 

P.OMoPhE-m

We

National 
Black Nurses
Association, Inc. 
(NBNA)
 

To provide a forum for collective action 

by African American nurses to investigate, define, and advocate for the health care needs of African Americans and to 

implement strategies that ensure access to health care equal to, or above, health care standards of the larger society.

Objectives include building consumer 

knowledge and understanding of health care issues and educating, mentoring, and 

providing career development for nurses. 

All chapters provide screening and health education activities related to cardiovascular disease. 

Chapters provide hypertension screening and referral; smoking-cessation intervention programs; 

cholesterol screening and referral; CPR training; and education regarding heart attack prevention 

and early treatment. NBNA holds seats on committees within the National Heart, Lung and Blood Institute (the Hypertension, Cholesterol Education, Heart Attack, and Smoking committees) and the International Society for Hypertension in Blacks (ISHIB). Chapters have been involved in national research projects in collaboration with ISHIB. 

86SilPh1-8E-mWe

106 african american men and blood pressure control: a closer look Professional Health Associations of African Americans
National Medical 

Association (NM

A) 

To advance the art and science of medicine for people of African descent through education, advocacy, and health policy; promote health and wellness; eliminate health disparities; and sustain physician viability. 

For more than 30 years, the NMA has served as the collective voice of African American physicians.

One of NMA’s activities is providing patients and the public with information about various 

conditions and interventions, including asthma and smoking cessation. NMA also conducts an annual meeting and colloquiums, convenes consensus panels concerning issues related to health 

disparities, and publishes a journal. Programs include the Black Bag Mentoring Program and the Turning Education into Action (TEA) Talk©.Link to NMA programs: 

http://w

w

w.nmanet.org/index.php/NatProgList/index 

10WaExePhFaxWe

Health Programs 

Targeting African American Men

Resource Aims Description/Programs	 Co100 Black Men of To improve the quality of life within America, Inc.	 African American communities and to 

enhance educational and economicopportunities for all African Americans. 

100 Black Men of America, Inc., is a national organization committed to the intellectual development of youth and the economic empowerment of the African American community, based on the following precepts: respect for family, spirituality, justice, and integrity. This organization has a Health and Wellness Initiative containing programs such as The Partners in Prevention (PIP) program, which was established by the National Black Leadership Initiative on Cancer II (NBLIC II) under the Morehouse School of Medicine. It is a national intervention program for African Americans and other people of color and focuses on increasing awareness, educating, and providing diagnostic examinations and follow-up in the areas of hypertension, heart disease, diabetes, and cancer. Medical experts (cardiologists, endocrinologists, urologists, and nutritionists) and community-based organizations (American Heart Association, Association of Black Cardiologists, American Diabetes Association, and American Cancer Society) provide services as screeners, workshop facilitators, and educators. Client follow-up is conducted by an independent, medical expert to encourage further assessment and a formal diagnosis by a health care practitioner(s). Data gathered from pre-test, post-test, and screenings are published in a comprehensive report. 

14AtlPhWe

Black Men’s To educate African American men Health Initiative about the risks and complications of (BMHI) chronic disease.

The BMHI was chartered as a nonprofit corporation in South Carolina in March 2005 and focuses on community competent prevention education and innovative interventions that will have direct results in lowering risk and improving the health status of African American men. The BMHI sponsors the “Putting DASH in Our Diets” project to reduce hypertension and stroke in African American men. The organization makes presentations, holds discussions, and provides blood pressure screenings through men’s groups at faith-based organizations located in counties/towns with high prevalence of cardiovascular disease. 

Wi48DuPhFaxE-mWe

The National To provide education and raise Established in 1987, The National Black Men’s Health Network provides education and 25Black Men’s public awareness about the excessive awareness information on African American male health.. AtlHealth Network morbidity and mortality rates in the Ph

African American community in E-mgeneral and among African American Wemen in particular. Fo

Jea

a review to address blood pressure control in african american men 107 
108 african american men and blood pressure control: a closer look Project To provide primary, holistic health care Brotherhood and improve health awareness in African Black Men’s Clinic American men by creating a culturally and gender-specific environment. Project Brotherhood provides medical and social services necessary to improve the overall health and well-being of African American men in the Chicago community. A weekly clinic session is 

available in the early evening. Medical care is not dependent solely on appointments; walk-in visits are allowed. Innovative strategies that take into account the disenfranchisement of African American men are used to recruit and retain African American men into primary care. Free haircuts and food, as well as transportation assistance, are made available for every clinic session. 

63ChPhE-mWeneFoCo

Programs Targeting African Americans

Resource Aims Description/Programs CoCongressional Black Caucus Foundation, Inc. (CBCF) 

To serve as the nonpartisan policyoriented catalyst educating future leaders and promoting collaboration among legislators, business leaders, minority-focused organizational leaders, and organized labor to eff ect positive and sustainable change in the African American community. 

The CBCF is a national organization that focuses on leadership education, public health, and economic development. Its activities include the following:Black Health Empowerment ProjectA public health initiative implemented in response to the escalating rates of overweight and obesity among African American adults, adolescents, and children. The program educates African Americans about obesity’s link to chronic health conditions and introduces strategies for achieving and maintaining a healthy weight.The Health and Wellness of the African-American Male America’s Challenge; Our ImperativeCBCF sponsored this public health event April 19–20, 2007, which consisted of a series of speakersdiscussing health issues pertaining to African American men, including mental health concerns, HIV/AIDS, prostate cancer, and cardiovascular health. Link to agenda and presenters: http://www.cbcfinc.org/pdf/health_braintrust_agenda.pdf 

17WaPhFaxE-m

National To ensure the political, educational, Among NAACP Health Department’s goals are to; develop national health education initiatives; NAAssociation for social, and economic equality of rights expand community outreach; and sponsor collaborative programs with other national and local 48the Advancement of all persons and to eliminate racial health organizations. One of its target areas is reducing disparities in obesity and other related Phof Colored People hatred and racial discrimination. diseases such as diabetes, hypertension, and heart disease. To(NAACP) We

http://www.naacp.org/advocacy/health/index.htm ho

National Caucus To improve the quality of life for 
and Center on elderly African American and low-
Black Aged, Inc. income minorities.
 (NCBA)

NCBA sponsors the following:The Health and Wellness Program: Prevention and control of chronic diseases in elderly African Americans, emphasizing cancer (prostate, colorectal, breast, and cervical), diabetes, cardiovascular disease, hypertension, substance abuse, and HIV/AIDS. The program provides public awareness and community health promotion dissemination campaigns and technical assistance and training. It promotes healthy living and prevention through nutrition, physical activity, early detection, and screening with the intent of changing behaviors. 

12WaPhFaxE-mWeAnDirPhE-m
a review to address blood pressure control in african american men 109 

National Urban To enable African Americans to secure League economic self-reliance, parity, power, and

civil rights. One of the program’s focuses is health and quality of life empowerment. 

National Urban League is the nation’s oldest and largest community-based movement devoted to empowering African Americans to enter the economic and social mainstream. There are more than 100 local affiliates of the National Urban League located in 35 states and the District of Columbia providing direct services to more than 2 million people through programs, advocacy, and research.National Urban League has worked with CDC, the National Eye Institute of NIH, and the American Legacy Foundation, among other organizations, to address prevention strategies concerning diabetes, cancer, Alzheimer’s, and depression. Two main initiatives are as follows: The Lift Every Voice Diabetes Education Program: Targets the prevention and treatment of diabetes The National African-American Wellness Initiative: A Web site promoting proper nutrition, physical fitness, health care, and prevention of disease: http://www.makeeverydropcount.com/wellness/wellness-initiative.html 

12NePhWe

Minority/Multicultural Health Organizations and Programs (Federal)

Resource Aims Description/Programs	 CoNational To improve and protect the health of As a part of the NIH, NCMHD conducts and supports basic, clinical, social, and behavioral 67Institutes of racial and ethnic minority populations research; promotes research infrastructure and training; fosters emerging programs; BeHealth’s (NIH) through the development of health disseminates information; and reaches out to minority and other health disparity communities. PhNational Center policies and programs that will eliminate Faxon Minority health disparities. E-mHealth and WeHealth Disparities (NCMHD))Office of Minority To improve and protect the health of Health (OMH) racial and ethnic minority populations 

through the development of health policies and programs that will eliminate health disparities. 

Within the U.S. Department of Health and Human Services (DHHS), OMH develops health policies and programs to eliminate health disparities, including initiatives geared toward African Americans. Programs include the following: 9 A Day for African American Men: A national campaign to encourage African American men to eat 9 servings of fruits and vegetables a day. The Community Initiatives to Eliminate Stroke (CITIES) Program: Grants intended to increase community awareness and knowledge and promote the prevention of hypertension and stroke. http://www.omhrc.gov/templates/content.aspx?ID=2837&lvl=3&lvlID=24Closing the Health Gap Campaign: An educational campaign designed to help make good health an important issue among racial and ethnic minority populations, who are aff ected by serious diseases and health conditions at far greater rates than other Americans. http://www.omhrc.gov/templates/content.aspx?ID=2840&lvl=3&lvlID=24Take a Loved One for a Checkup day: Part of a national campaign by DHHS that focuses on the health gap between racial and ethnic minorities and the general population. http://www.omhrc.gov/templates/content.aspx?ID=2839&lvl=3&lvlID=24Thirty-two states have established an official minority health entity (such as an office, commission, council, center, branch, project, or other unit) either through executive or legislative branch action. Other states have designated minority health contacts. Contact information on State Offices ofMinority and Multicultural Health Liaisons: http://www.omhrc.gov/images/stateliaisons.htm 

ThPaRoPhFaxE-mWe
110 african american men and blood pressure control: a closer look Project EXPORT: Excellence in Partnerships for Community Outreach and Research on Disparities in Health and Training To build research capacity at designated institutions enrolling a significant number of students from health disparity populations and to promote participation and training in biomedical and behavioral research among such populations. Funded by the National Center on Minority Health and Health Disparities (NCMHD), this center of excellence program was authorized by the Minority Health and Health Disparities Research and Education Act of 2000 and is in support of the DHHS initiatives to address and ultimately eliminate health disparities. The centers focus specifically on health disparities research, community outreach, and training. Among the EXPORT grantees are HBCUs such as Florida A & M University, Howard University, Jackson State University, Meharry Medical College, Morehouse School of Medicine, and University of the Virgin Islands. EXPORT Centers at HBCUs:*
 Florida A & M University (Tallahassee, FL) http://www.projectchoice.org/index.cfm
 Howard University (Washington, DC) http://www.cpnahs.howard.edu/ctr_excellence/Default.htm
 Jackson State University (Jackson, MS) http://www.jsums.edu/~cmh/
 Meharry Medical College (Nashville, TN) http://export.mmc.edu/
 Morehouse School of Medicine (Atlanta, GA) http://web.msm.edu/EXPORT/index.html
 National Center for Primary Care http://web.msm.edu/ncpc/mission.htm
 Morehouse College (Atlanta, GA) http://www.morehouse.edu/centers/phsi/disparities.html
 Other Relevant Health Disparities Centers with Community-Based Research on Best Practices for 
 African Americans:.
 The Hopkins-Morgan Center for Health Disparities Solutions (HCHDS)
 A collaboration between Johns Hopkins Bloomberg School of Public Health and Morgan State 
 University (an HBCU) in Baltimore, MD http://www.jhsph.edu/healthdisparities/index.html
 University of Pittsburgh EXPORT Center and Center for Minority Health http://www.cmh.pitt.edu/
 history.asp
 *A Web link to a complete list of HBCUs can be found in the Historically Black Colleges and 
 Universities section.
 NC

httce
Minority/Multicultural Health Organizations and Programs (National)

Resource Aims Description/Programs Co

a review to address blood pressure control in african american men 111 

Community To eliminate men’s health disparities. With its national headquarters located at the Morehouse School of Medicine, Community Voices: MeVoices: Health Health Care for the Underserved is a 5-year national health initiative. It is a group of community- HeCare for the based demonstration projects dedicated to providing greater access to quality health care to the NaUnderserved underserved and uninsured people in America. Mo

72

The program founded this country’s first Men’s Health Clinic in Baltimore, MD, and continues to Atlspread this work across other sites. Link to descriptions of Community Voices’ Men’s Health Best PhPractices: http://www.communityvoices.org/Uploads/ FaxInterventions_that_work_00108_00189.pdf Em

Wehtt

Health Power for To eliminate racial and ethnic health Minorities disparities by promoting multicultural 

health improvement.. 

Health Power provides a Web site with culturally relevant health information, printed materials (brochures, tip sheets, newsletters), consultative and training services to other organizations, and collaboration with other organizations to achieve mutual purposes.Its Web site includes a “Men’s Health Channel” (http://healthpowerforminorities.org/specific/men.cfm) and “African American Channel” (http://healthpowerforminorities.org/specific/aaChannel/index.cfm) with links to health issues relevant to men, including hypertension. 

No30BroPhE-mheWehtt

National Minority To strengthen national and local eff orts Quality Forum to eliminate the disproportionate burden (NMQF) of premature death and preventable 

illness in racial and ethnic minorities through the use of evidence-based, data-driven initiatives. 

NMQF is a research and educational organization dedicated to ensuring that high-risk racial and ethnic populations and communities receive optimal health care. Activities include conducting research and analyses, fostering cultural competency among health care providers, and evaluating the eff ect of policy initiatives.Healthy Heart InitiativeThis pilot program is designed to strengthen the capacity of local communities in Atlanta and Dallas to eliminate the disproportionate burden of premature death and preventable illness from cardiovascular disease (CVD). It mobilizes local government and health care community leaders, businesses, physicians, medical centers, faith-based organizations, and the media to promote CVD awareness, prevention, and treatment. The program off ers screening events held in target zones, with dissemination of resulting data; patient education about the importance of proper diet; and patient referrals to health care facilities for treatment and follow-up.The results are intended to serve as a model for conducting CVD programs in other communities with CVD disparities. Link to participating organizations in the pilot program: http://www.nmqf.org/healthy_heart_beat.aspx 

12WaPhFaxWe
112 african american men and blood pressure control: a closer look Minority/Multicultural Health Programs (State and Local) Resource Aims Description/Programs C

Center for To promote the health and well- Multicultural being of diverse communities Health through innovative health advocacy, health promotion, disease prevention, and immigrant and refugee service programs. Since 1976, the Center for Multicultural Health has worked in partnership with individuals, groups, and organizations in the community to promote health and well-being in diverse communities. Programs include the following: “Let’s Talk About It” Prostate Cancer Education Program Educational forums are placed throughout the Seattle area to create an open dialogue to help educate African American men over 40 about their risk for prostate cancer. This also encourages them to talk with their doctor about the disease. REACH 2010 Community-based diabetes education, support groups, and self-management classes for African Americans. 10

SeaPhFaxE-mWehtt

Grand Rapids To promote health care parity in African American the Grand Rapids African American Health Institute community through advocacy, (GRAAHI) education, and research to achieve 

positive health outcomes 

An independent, not-for-profit organization funded by numerous entities, GRAAHI serves the Grand Rapids African American community. It includes the following: A Comprehensive Study of Cardiovascular Health in the African American Population in West Michigan (CHAAP), a research study focusing on cardiovascular disease and its risk factors and on meeting benchmarks in treatment guidelines. The program aims at drawing attention to these benchmarks and raising awareness around “treatment to goal.”The program’s tool is a registry including personal health information from all participants around their CVD risk factors. The program determines each participant’s risk (Framingham risk score), compares the collected data with current treatment guidelines to determine whether participants are treated to goal. All information is shared with each participant in the form of “risk assessments”to help the individual understand his or her benchmarks, areas in need of attention (e.g., physical activity, nutrition), and how to improve visits with primary care providers. The information is also shared with physicians (with participants’ permission).http://www.graahi.org/Default.aspx?tabid=49 

30GraPhFaxE-mWeDr. CHPhE-m

Henry Ford To improve the health of System Institute community members in the on Multicultural Detroit metropolitan area. Health (IOMH) 

The IOMH conducts AIMHI (African American Initiative for Male Health Improvement): a community-based screening and education program focusing on African American men in the Detroit metropolitan area. This program has provided blood pressure, diabetes, cholesterol screening, and stroke risk assessment for more than 9,000 people since 1999. Screenings are conducted at two community health resource centers and through mobile screenings at other community locations. After screening sessions those with abnormal results receive follow-up calls to see whether results were confirmed by their primary care physician and to provide assistance in accessing the health care system as needed. Previously, the IOMH conducted Heartbeat: A Program to Improve Early Detection of High Blood Pressure in African American Men, which provided blood pressure screening to African American men in barbershops and off ered education focusing on cardiovascular disease and hypertension. The program also collected information from participants about their health practices, attitudes, and beliefs. 

1 FDePhFaxWeorgDeDirIOME-m
Cardiovascular Health Organizations

Resource	 Aims Description/Programs CAmerican Heart To fund research and educational The The AHA focuses its planning on three areas: cardiovascular science, cardiovascular education 72Association (AHA) programs to reduce the burden of and community programs, and fund-raising. Da

cardiovascular disease. Ph

AHA sponsors an annual scientific session, at which researchers, clinicians, and health care Weprofessionals from around the world discover the latest findings in cardiovascular research. Link: hehttp://scientificsessions.americanheart.org/portal/scientificsessions/ss jht

a review to address blood pressure control in african american men 113 

American Stroke To reduce risk, disability, and death from ASA sponsors “Power To End Stroke“ (PTES), an aggressive education and awareness campaign that WeAssociation (ASA)	 stroke through research, education, fund- embraces and celebrates the culture, energy, creativity, and lifestyles of African Americans. It unites org

raising, and advocacy (a division of the African Americans to make an impact on the high incidence of stroke within their communities.. American Heart Association). 

American Society of Hypertension, Inc. (ASH) 

To organize and conduct educational activities designed to promote and encourage the development, advancement, and exchange of scientific information in all aspects of research, diagnosis, and treatment of hypertension and related cardiovascular diseases. 

The Society fulfills its mission by holding annual meetings that provide participants with the opportunity to exchange information and ideas with more than 3,000 fellow scientists from around the world. ASH Chapter information: http://www.ash-us.org/chapters/chapters_overview.htmLink to designated specialists in clinical hypertension: http://www.ash-us.org/specialist_program/directory.htm#Link to journals and publications:http://www.ash-us.org/pub/index.htm 

14NePhFaxE-mWe

International To eliminate cardiovascular Society on health disparities Hypertension in Blacks (ISHIB) 

ISHIB achieves its mission through professional and public education, targeted clinical research, and by facilitating the delivery of higher quality cardiovascular health care. ISHIB sponsors accredited professional educational programs; participates in patient and community education, is involved in the publication of the journal Ethnicity & Disease, and hosts an annual International Interdisciplinary Conference.Among ISHIB’s community outreach program are Unite for Healthy Hearts! and the Worship-Site Health Education Program (WSHEP):http://www.ishib.org/PR_comout.asp 

15McPhFaxE-mWe
Contact Information/Web Site of Fraternity Name National Headquarters

Alpha Phi Alpha 22313 Saint Paul St.

Baltimore, MD 21218-5211Phone: (410) 554-0040Fax: (410) 554-0054Web site: http://w

w

w.alpha-phi-alpha.org/

Iota Phi Theta 1600 N. Calvert St.

Baltimore, MD 21202Phone: (410) 514-5225 Fax: (866) 510-1301 Web site: http://w

w

w.iotaphitheta.org/index.html

Kappa Alpha Psi 2322-24 North Broad St.

Philadelphia A 9132-4590 Phone: (215) 228-7184Fax: (215) 228-7181Web site: http://w

w

w.kappaalphapsi1911.com/index.asp

Omega Psi Phi 3951 Snapfinger Parkway

Decatur, GA 30035Phone: (404) 284-5533Fax: (404) 284-0333Web site: http://w

w

w.omegapsiphifraternity.org/

generalpublic.asp 

Phi Beta SigmaPhi Beta Sigma health initiative, “Living 

Well Brother 

to Brother,” seeks to partner with community groups/

organizations and health care institutions to reduce health conditions that adversely aff ect African American men. Link to the program guide: http://w

w

w.

pbs1914programs.org/9.html 

145 Kennedy St., NWWashington, DC 20011-5294Phone: (202) 726-5434Fax: (202) 882-1681Web site: http://w

w

w.pbs1914.org/default.asp 

114 african american men and blood pressure control: a closer look Other Nontraditional Resources
 Historically Black Colleges and Universities (HBCUs)*
 A complete list of HBCUs is located on the National Association for Equal Opportunity in Higher Education Web site: http://w

*A list of HBCU programs funded by NIH EXPORTs grant is found in the Minority/Multicultural Health Organizations and PAfrican American Fraternities Web sites of national organizations may provide contact information for local affiliates
African American Sororities

Web sites of national organizations may provide contact information for local affiliates

a review to address blood pressure control in african american men 115 

Contact Information/Web Site of Sorority Name National Headquarters

Alpha Kappa Alpha 5656 South Stony Island Ave.

Chicago, IL 60637Phone: (773) 684-1282Web site: www.aka1908.com

Chi Eta Phi (African American Nurses’ Sorority) 3029 13th Street, NW

Washington, DC 20009Phone: (202) 232-3858Fax: (202) 232-3460Web site: http://www.chietaphi.com/

Delta Sigma Theta 1707 New Hampshire Ave., NW

Washington, DC 20009Phone: (202) 986 - 2400 Fax: (202) 986 - 2513 Web site: www.deltasigmatheta.org

Sigma Gamma Rho	 1000 Southhill Drive, Suite 200

Cary, NC 27513Phone: (919) 678-9720Fax: (919) 678-9721Web site: http://www.sgrho1922.org/

Zeta Phi Beta	 1734 New Hampshire Ave., NW

Washington, DC 20009E-mail: ihq@zphib1920.orgWeb site: www.zphib1920.org 

MasonsWeb site of the national organization may provide contact information for local affiliates

Lodge Name	 Web Site of National HeadquartersMost Worshipful Prince Hall Grand Lodges African Lodge No. 459

24 Washington Street P.O. Box 173Dorchester, MA. 02121Phone: (617)-445-1145Fax: (617)-445-8698E-mail: Info@AfricanLodge459.orgWeb site: http://www.princehall.org/ 
116 african american men and blood pressure control: a closer look 
 

 

 

 

 

 

 

References 

1. National Center for Health Statistics. Health, United States: 

with chartbook on trends in the health of Americans. 

Hyattsville, MD: US Centers for Disease Control and 

Prevention; 2008:229–313. 

2. National Center for Health Statistics. Vital and Health 

Statistics. Hyattsville, MD: U.S. Centers for Disease 

Control and Prevention; 2004: 10(222). 

3. National Center for Health Statistics. Vital and Health 

Statistics. Hyattsville, MD: U.S. Centers for Disease 

Control and Prevention; 2005: 10(225). 

4. National Center for Health Statistics. Vital and Health 

Statistics. Hyattsville, MD: U.S. Centers for Disease 

Control and Prevention; 2006: 10(228). 

5. National Center for Health Statistics. Vital and Health 

Statistics. Hyattsville, MD: U.S. Centers for Disease 

Control and Prevention; 2006: 10(232). 

6. National Center for Health Statistics. Vital and Health 

Statistics. Hyattsville, MD: U.S. Centers for Disease 

Control and Prevention; 2007: 10(235). 

7. Cutler JA, Sorlie PD, Wolz M, Thorn T, Fields LE, Rocella EJ. 

Trends in hypertension prevalence, awareness, treatment, 

and control rates in United States adults between 1988– 

1994 and 1999–2004. Hypertension 2008;52:818–827. 

8. Wyatt SB, Akylbekova EL, Wofford MR, Coady SA, Walker 

ER, Andrew ME, et al. Prevalence, awareness, treatment, 

and control of hypertension in the Jackson Heart Study. 

Hypertension 2008; 51: 650–656. 

9. National Center for Health Statistics. Death rates from 358 

selected causes, by 10-year age groups, race and sex: United 

States 1999–2004. Hyattsville, MD: U.S. Centers for 

Disease Control and Prevention; 2007: Worktable No. 12. 

10. Davis SK, Liu Y, Quarells RC, Dim-Dzietham R. Stressrelated racial discrimination and hypertension likelihood in 

a population-based sample of African Americans: The metro 

Atlanta heart disease study. Ethn Dis 2005;15:585–593. 

11. Din-Dzietham R, Nembhard WN, Collins R, Davis SK. 

Perceived stress following race-based discrimination at work 

is associated with hypertension in African-Americans. The 

metro Atlanta heart disease study, 1999-2001. Soc Sci Med 

2004;58:449–461. 

12. James K, Lovato C, Khoo G. Social identity correlates 

of minority workers’ health. Acad Manage J 

1994;37(2):383–396. 

13. Krieger N, Sidney S. Racial discrimination and blood 

pressure: The CARDIA Study of young black and white 

adults. Am J Public Health 1996;86(10):1370–1378. 

14. Paradies Y. A systematic review of empirical research 

on self-reported racism and health. Int J Epidemiol 

2006;35:888–901. 

15. Williams DR, Neighbors H. Racism, discrimination and 

hypertension: evidence and needed research. Ethn Dis 

2001;11(4):800–816. 

16. James SA. John Henryism and the health of AfricanAmericans. Cult Med Psychiatry 1994;18(2):163–182. 

17. James SA, LaCroix AZ, Kleinbaum PG, Strogatz DS. John 

Henryism and blood pressure differences among black 

men. II. The role of occupational stressors. J Behav Med 

1984;7(3):259–275. 

18. James SA, Keenan NL, Strogatz DS, Browning SR,Garrett 

JM. Socioeconomic status, John Henryism, and blood 

pressure in black adults: The Pitt County Study. 

Am J Epidemiol 1992;135(1):59–67. 

19. Lukoschek P. African Americans’ beliefs and attitudes 

regarding hypertension and its treatment: a qualitative 

study. J Health Care Poor Underserved 2003;14:566–587. 

20. Wilson RP, Freeman A, Kazda MJ, Andrews TC, Berry L, 

Vaeth, PA, et al. Lay beliefs about high blood pressure 

in a low- to middle-income urban African-American 

community: an opportunity for improving hypertension 

control. Am J Med 2002; 112(1):26–30. 

a review to address blood pressure control in african american men 117
21. Fillenbaum GG, Hanlon JT, Corder EH, Ziqubu-Page T, 

Wall WE, Brock D. Prescription and nonprescription drug 

use among black and white community-residing elderly. 

Am J Public Health 1993;83:1577–1582. 

22. LaVeist TA, Nickerson K, Bowie J. Attitudes about racism, 

medical mistrust, and satisfaction with care among African 

American and White cardiac patients. Med Care Res Rev 

2000; 57 Suppl 1:146–161. 

23. Lee AJ, Gehlbach S, Hosmer D, Reti M, Baker CS. 

Medicare treatment differences for Black and Whites. Med 

Care 1997;35:1173–1189. 

24. Collins KS, Tenney K, Hughes DL. Quality of health care 

for African Americans: findings from the Commonwealth 

Fund 2001 health care quality survey. New York (NY): 

The Commonwealth Fund; 2002. 

25. Van Ryn M, Burke J. The effect of patient race and 

socioeconomic status on physicians’ perceptions of 

patients. Soc Sci Med 2000;50:813–828. 

26. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong 

O. Defining cultural competence: a practical framework 

for addressing racial/ethnic disparities in health and health 

care. Public Health Rep 2003;118(4):293–302. 

27. Bureau of the Census, Current Population Survey, Annual 

Social and Economic (ASEC) Supplement, http://pubdb3. 

census.gov/macro/032007/health/h01_000.htm. 

28. He J, Mutner P, Chen J, Roccella EJ, Streiffer RH, & 

Whelton PK. Factors associated with hypertension control 

in the general population of the United States. Arch Intern 

Med 2002; 162(9):1051–1058. 

29. Briesacher B, Limcangco R, Gaskin D. Racial and ethnic 

disparities in prescription coverage and medication use. 

Health Care Financ Rev 2003;25(2):63–76. 

30. Ogedegbe G, Harrison M, Robbins L, Mancuso CA, 

Allegrante JP. Barriers and facilitators of medication 

adherence in hypertensive African Americans: a qualitative 

study. Ethn Dis 2004a;14(1):3–12. 

31. Ogedegbe G, Mancuso CA, Allegrante JP. Expectations 

of blood pressure management in hypertensive AfricanAmerican patients: a qualitative study. J Natl Med Assoc 

2004b; 96(4):442–449. 

32. Rawaf MM, Kressin NR. Exploring racial and 

sociodemographic trends in physician behavior, physician 

trust and their association with blood pressure control.

 J Natl Med Assoc 2007; 99(11):1248–1254. 

33. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patientphysician racial concordance and the perceived quality and 

use of health care. Arch Intl Med 1999;159:997–1004. 

34. Bell AC, Adair LS, Popkin BM. Understanding the 

role of mediating risk factors and proxy effects in the 

association between socio-economic status and untreated 

hypertension. Soc Sci Med 2004; 59(2):275–283. 

35. Sharma S, Malarcher AM, Giles WH, Myers G. Racial, 

ethnic, and socioeconomic disparities in the clustering 

of cardiovascular risk disease factors. Ethn Dis 

2004;14(1):43–48. 

36. Grumbach K. Insuring the uninsured: time to end the aura 

of invisibility. J Am Med Assoc 2000;284:2114–2116. 

37. James SA, Van Hoewyk J, Belli RF, Strogatz DS, Williams 

DR, Raghunathan TE. Life-course socioeconomic position 

and hypertension in African-American men: The Pitt 

County Study. Am J Public Health 2006;96(5):812–817. 

38. Shulman NB, Martinez B, Brogan D, Carr AA, Miles CG. 

Financial cost as an obstacle to hypertension therapy. Am J 

Public Health 1986;76:1105–1108. 

39. LaVeist TA (2005) Minority populations and health: An 

introduction to health disparities in the United States. San 

Francisco (CA): Jossey-Bass; 2005. 

40. CDC. Cardiovascular disease risk factors and preventive 

practices among adults—United States, 1994: A 

behavioral risk factor atlas. MMWR 1998;47(5):35–69. 

41. Heyden S, Schneider KA. Obesity and hypertension: 

Epidemiological aspects of the relationship. J Hum 

Hypertens 1990;4(4):431–435. 

42. Higgins M, Agostino R, Kannel W, Cobb J. Benefits and 

adverse effects of weight loss: observations from the 

Framingham Study. Ann Intern Med 1993;119(7 Pt 

2):758–763. 

43. Hu G, Tuomilehto J, Silventoinen K, Barengo N, Jousilahti 

P. Joint effects of physical activity, body mass index, waist 

circumference and waist-to-hip ratio with the risk of 

cardiovascular disease among middle-aged Finnish men 

and women. Eur Heart J 2004;25(24):2212–2219. 

44. Jonsson S, Hedblad B, Engstrom G, Nilsson P, Berglund 

G, Janzon L . Influence of obesity on cardiovascular risk. 

Twenty-three-year follow up of 22,025 men from an 

urban Swedish population. Int J Obes Relat Metab Disord 

2002;26(8):1046–1053. 

45. Jousilahti P, Tuomilehto J, Vartiainen E, Pekkanen J, 

Puska P. Body weight, cardiovascular risk factors, and 

coronary mortality: 15-year follow-up of middleaged men and women in eastern Finland. Circulation 

1996;93(7):1372–1379. 

46. Kannel WB, et al. Regional obesity and risk of cardiovascular 

disease; The Framingham Study. J Clin Epidemiol 

1991;44(2):183–190. 

47. Kannel WB. Hazards, risks, and threats of heart disease from 

the early stages to symptomatic coronary heart disease 

and cardiac failure. Cardiovasc Drugs Ther 1997;11(Suppl 

1):199–212. 

48. Rosengren A, Wedel H, Wilhelmsen L. Body weight 

and weight gain during adult life in men in relation 

118 african american men and blood pressure control: a closer look 
 

 

 

to coronary heart disease and mortality. A prospective 

population study. Eur Heart J 1999;20(4):269–277. 

49. National Center for Health Statistics. Health, United States: 

with chartbook on trends in the health of Americans. 

Hyattsville, MD: U.S. Centers for Disease Control and 

Prevention, 2006; 2068:304–306. 

50. Adrogue HJ, Wesson DE. Role of dietary factors in the 

hypertension of African Americans. Semin Nephrol 

1996;16(2):94–101. 

51. Bediako SM, Kwate NO, Rucker R. Dietary behavior 

among African Americans: assessing cultural identity and 

health consciousness. Ethn Dis 2004;14(4):527–532. 

52. Peters RM, Aroian KJ, Flack JM (2006). African American 

culture and hypertension prevention. West J Nurs Res 

2006;28(7):831–863. 

53. Reusser ME, DiRienzo D, Miller G, McCarron D. Adequate 

nutrient intake can reduce cardiovascular disease risk in 

African Americans. J Natl Med Assoc 2003;95(3):188–195. 

54. Tucker K. Dietary patterns and blood pressure in African 

Americans. Nutr Rev 1999;57(11):356–358. 

55. Chobanian AV, Bakris GL, Black HR, Cushman WC, 

Green LA, Izzo JL Jr, et al. The seventh report of the 

Joint National Committee on Prevention, Detection, 

Evaluation, and Treatment of High Blood Pressure. 

Hypertension 2003; Dec 42(6):1206–52. 

56. Howard G, Prineas R, Moy C, Cushman M, Kellum M, 

Temple E, et al.. Racial and geographic differences in 

awareness, treatment, and control of hypertension: the 

reasons for geographic and racial differences in stroke 

study. Stroke 2006;37:1171–1178. 

57. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, 

Ferguson TB, Flegal K, et al. Heart Disease and Stroke 

Statistics 2009 Update. Circulation 2009;119(3):e1–e161. 

58. Wiist WH, Flack JM. A test of the John Henryism 

hypothesis: Cholesterol and blood pressure. J Behav Med 

1992;5(1):15–29. 

59. Jackson LA, Adams-Campbell LL. John Henryism and 

blood pressure in black college students. J Behav Med 

1994;17(1):69–79. 

60. Dressler WW. Social identity and arterial blood pressure 

in the African-American community. Ethn Dis 

1996a;6(1–2):176–189. 

61. Anderson LM, Scrimshaw SC, Fullilove MT, Fielding 

JE, Normand J. Culturally competent healthcare 

systems: a systematic review. Am J Prev Med 

2003;24(Suppl.3):68–79. 

62. LaVeist TA, Nuru-Jeter A. Is doctor-patient race 

concordance associated with greater satisfaction with care? 

J Health Soc Behav 2002;43(3):296–306. 

63. Commonwealth Fund. (2008, July). Commonwealth 

Fund National Scorecard on U.S. Health System 

Performance, 2008. Compiled in The Commonwealth 

Fund Commission on a High Performance Health 

System, Chartpack. 

64. Institute of Medicine (US). Crossing the quality chasm: a 

new health system for the 21st century. Washington (DC): 

National Academies Press; 2001. 

65. Coleman MT, Lott JA, Sharma S. Use of continuous quality 

improvement to identify barriers in the management of 

hypertension. Am J Med Qual 2000;15(2):72–77. 

66. Bosworth HB, Dudley T, Olsen MK, Voils C, Powers B, 

Goldstein, MK et al. (2006). Racial differences in blood 

pressure control: potential explanatory factors. Am J Med 

2006; 119(1):70 e9–15. 

67. Provost C, Hughes P. Medicaid: 35 years of service. Health 

Care Financ Rev 2000;22(1):141. 

68. Kingston RS, Smith JP. Socioeconomic status and racial 

and ethnic differences in functional status associated with 

chronic diseases. Am J Public Health 1997;87:805–810. 

69. Strickland W, Strickland D. Barriers to preventive health 

services for minority households in the rural south. J Rural 

Health 1996;12:206–217. 

70. Mainous AG, III, King DE, Garr DR, Pearson WS. Race, 

rural residence, and control of diabetes and hypertension. 

Ann Fam Med 2004;2:563–568. 

71. Belgrave FZ, Lewis DM. The role of social support in 

compliance and other health behaviors for African 

Americans with chronic illnesses. J Health Soc Policy 

1994; 5(3/4):55–68. 

72. Davis DT, Bustermante A, Brown CP, Wolden-Tsadik 

G, Savage EQ, Cheung X, et al. The urban church and 

cancer control: a source of social influence in minority 

communities. Public Health Rep 1994;109:500–606. 

73. Tuggle M. It is well with my soul: churches and institutions 

collaborating for public health. Washington (DC): 

American Public Health Association; 2000. 

74. Bowen-Reid TL, Harrell JP. Racist experiences and health 

outcomes: An examination of spirituality as a buffer. 

J Black Psychol 2002;28:18–36. 

75. Glanz J, Grant B, Monteiro M, Tabakoff B. WHO/ 

ISBRA study on state and trait markers of alcohol use 

and dependence: Analysis of demographic, behavioral, 

physiologic, and drinking variables that contribute to 

dependence and seeking treatment. Alcohol Clin Exp Res 

2002;26(7):1047–1061. 

76. Dressler WW, Bindon JR. The health consequences of 

cultural consonance: Cultural dimensions of lifestyle, 

social support, and arterial blood pressure in an African 

American Community. Am Anthropol 2000;102:244–260. 

a review to address blood pressure control in african american men 119 
77. Artinian NT, Washington O, Flack JM, Hockman EM, 

Jen K. Depression, stress, and blood pressure in urban 

African-American women. Prog Cardiovasc Nurs 

2006;21(2):68–75. 

78. Dressler WW. Hypertension in the African American 

community: social, cultural, and psychological factors. 

Semin Nephrol 1996b;16(2):71–82. 

79. Kim MT, Hill MN. Validity of self-report of illicit drug use 

in young hypertensive urban African American males. 

Addictive Behav 2003;28(4):795–802. 

80. Levenstein S, Smith MW, Kaplan GA. Psychosocial 

predictors of hypertension in men and women. Arch Intern 

Med 2001;161(10):1341–1346. 

81. Markovitz JH, Jonas BS, Davidson K. Psychologic factors 

as precursors to hypertension. Curr Hypertens Rep 

2001;3(1):25–32. 

82. Reiff M, Schwartz S, Northridge M. Relationship of 

depressive symptoms to hypertension in a household 

survey in Harlem. Psychosom Med 2001;63(5):711–721. 

83. Kulkarni S, Farrel I, Erasi M, Kochar MS. Stress and 

hypertension. Wis Med J 1998;97(11):34–38. 

84. Walcott-McQuigg JA. Psychological factors influencing 

cardiovascular risk reduction behavior in low and middle 

income African-American women. J Natl Black Nurses 

Assoc 2000;11(1): 27–35. 

85. Kabir AA, Whelton PK, Khan MM, Gustat J, Chen W. 

Association of symptoms of depression and obesity with 

hypertension: The Bogalusa heart study. Am J Hypertens 

2006;19:639–645. 

86. Ensminger ME, Anthony JC, McCord J. The inner city and 

drug use: initial findings from an epidemiological study. 

Drug Alcohol Depend 1997;48:175–184. 

87. CDC. Tobacco use among U.S. racial/ethnic minority 

groups—African-Americans, American Indians and Alaska 

Natives, Asian-Americans and Pacific Islanders, Hispanics. 

MMWR 1998;47(RR-18): v–xv, 1–16. 

88. Jones-Webb R. Drinking patterns and problems among 

African-Americans: recent findings. Alcohol Health Res 

World 1998;22(4):260–264. 

89. Caetano R, Kaskutas LA. Changes in drinking patterns 

among whites, blacks and Hispanics, 1984–1992. J Stud 

Alcohol 1995;56(5):558–565. 

90. Caetano R, Kaskutas LA. Changes in drinking problems 

among whites, blacks, and Hispanics: 1984–1992. Subst 

Use Misuse 1996;31(11–12):1547–1571. 

91. Grant BF. Prevalence and correlates of alcohol use and 

DSM-IV alcohol dependence in the United States: Results 

of the National Longitudinal Alcohol Epidemiologic 

Survey. J Stud Alcohol 1997;58(5):464–473. 

92. Herd D. Subgroup differences in drinking patterns 

among black and white men: Results from a national 

survey. J Stud Alcohol 1990;51(3):221–232. 

93. Herd D. Predicting drinking problems among black and 

white men: Results from a national survey. J Stud Alcohol 

1994;55(1):61–71. 

94. Kandel D, Chen K, Warner LA, Kessler RC, Grant B. 

Prevalence and demographic correlates of symptoms of 

last year dependence on alcohol, nicotine, marijuana and 

cocaine in the U.S. population. Drug Alcohol Depend 

1997;44(1):11–29. 

95. Lozina C, Russell M, Mudar P. Correlates of alcohol-related 

problems in African-American and white gynecologic 

patients. Alcohol Clin Exp Res 1995;19(1):25–30. 

96. Jones-Webb, R, Hsiao CY, Hannan P, Caetano R. Predictors 

of increases in alcohol-related problems among black 

and white adults: results from the 1984 and 1992 

National Alcohol Surveys. Am J Drug Alcohol Abuse 

1997;23(2):281–299. 

97. Marmot MG, Elliott P, Shipley MJ, Dyer AR, 

Ueshima H, Beevers DG, et al. Alcohol and 

blood pressure: The INTERSALT study. Br Med J 

1994;308(6939):1263–1267. 

98. Strogatz DS, James SA, Haines PS, Elmer PJ, Gerber AM, 

Browning SR, et al. Alcohol consumption and blood 

pressure in black adults: The Pitt County Study. Am J 

Epidemiol 1991;133(5):442–450. 

99. Curtis AB, James SA, Strogatz DS, Raghunathan TE, 

Harlow S. Alcohol consumption and changes in blood 

pressure among African Americans. The Pitt County 

Study. Am J Epidemiol 1997;146(9):727–733. 

100. Hill MN, Bone LR, Kim MT, Miller DJ, Dennison CR, 

Levine DM. Barriers to hypertension care and control in 

young urban black men. Am J Hypertens 1999;12(10 Pt 

1):951–958. 

101. Kim MT, Dennison CR, Hill MN, Bone LR, Levine DM. 

Relationship of alcohol and illicit drug use with high 

blood pressure care and control among urban hypertensive 

Black men. Ethn Dis 2000, 10(2), 175–183. 

102. Kim MT, Han H, Hill MN, Rose L, Roary M. Depression, 

substance use, adherence behaviors, and blood pressure 

in urban hypertensive black men. Ann Behav Med 

2003;26(1):24–31. 

103. Arfken CL, Houston CA. Obesity in inner-city African 

Americans. Ethn Health 1996;1(4):317–326. 

104. Curtis AB, Strogatz DS, James SA, Raghunathan TE. The 

contribution of baseline weight and weight gain to blood 

pressure change in African Americans: The Pitt County 

Study. Ann Epidemiol 1998;8(8):497–503. 

120 african american men and blood pressure control: a closer look 
105. Gibbons GH. Physiology, genetics, and cardiovascular 

disease: Focus on African Americans. J Clin Hypertens 

(Greenwich) 2004;6(4 Suppl 1):11–18. 

106. Jamerson KA. The disproportionate impact of hypertensive 

cardiovascular disease in African Americans: getting to 

the heart of the issue. Journal of Clinical Hypertension 

(Greenwich) 2004;6(4 Suppl 1):4–10. 

107. Johnson EH, Saha S, Arbelaez J, Beach MC, Cooper L. 

Obesity and hypertension among African-Americans: do 

African-American primary care providers address these 

conditions when secondary to primary illness? J Natl Med 

Assoc 1996;88(4):225–229. 

108. de Souza P, Ciclitira KE. Men and dieting: a qualitative 

analysis. J Health Psychol 2005;10:793–804. 

109. Welch, M. Care of Blacks and African Americans. In J.A. 

Bigby (Ed.) Cross-Cultural Medicine. Philadelphia (PA): 

American College of Physicians; 2003. p. 29–60. 

110. Brondolo E, Rieppi R, Kelly KP, Gerin W. Perceived 

racism and blood pressure: a review of the literature and 

conceptual and methodological critique. Ann Behav Med 

2003;25(1):55–65. 

111. Williams DR. The health of men: structured inequalities 

and opportunities. Am J Public Health 2003;93:724–731. 

112. Dimsdale JE. Stalked by the past: the influence of ethnicity 

on health. Psychosom Med 2000;62: 161–170. 

a review to address blood pressure control in african american men 121 
 

 

 

Appendix A 

Key Terms and Phrases Used to Find Programs or Interventions for African 

American Men with High Blood Pressure in the Practice Literature 

Searches were conducted using the following key terms when searching foundation 

and organization Web sites, government agency Web sites, and common search 

engines: 

To ensure a focus on African American men: 

“African Americans”
 

“Black” 

“Blacks”
 

“Men”
 

To focus on hypertension: 

“hypertension” 

“hypertension/prevention” 

“hypertension/control” 

“hypertension programs” 

“high blood pressure” 

“high blood pressure/prevention” 

“high blood pressure/control” 

To explore related work with heart disease and stroke: 

“heart disease” 

“heart attack” 

“heart prevention” 

“stroke” 

“stroke prevention” 

“cardiovascular disease” 

“cardiovascular health” 

a review to address blood pressure control in african american men 123 
 

To capture appropriate interventions or programs: 

“programs”
 

“health promotion”
 

“provider”
 

“providers”
 

“knowledge”
 

“awareness”
 

To explore the work of particularly relevant foundations, government agencies, 

organizations, and associations: 

“American Heart Association”
 

“Centers for Disease Control and Prevention” 

“Association of Black Cardiologists”
 

“National Institutes of Health” 

“Department of Health and Human Services”
 

Located through snowball searches: 

“The Center for African American Health” 

“Stroke Belt Elimination Initiative” 

“International Society on Hypertension in Blacks” 

“Institute for African American Health” 

“Cardiovascular wellness centers” 

“Joslin” 

“American Diabetes Association” 

“National High Blood Pressure Education Program” 

“Health Power for Minorities” 

“California Black Health Network” 

124 african american men and blood pressure control: a closer look 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix B 

Search Strategy to Find Peer-Reviewed Articles Relevant to 

Systems-Level Interventions for African American Men with 

High Blood Pressure 

Searches were conducted using the following MeSH terms in PubMed. 

To ensure a focus on African American Men: 

“African Continental Ancestry Group”[MeSH] OR
 

“African Americans”[MeSH]
 

“Men”[MeSH]
 

To focus on hypertension: 

“Hypertension/adverse effects”[MeSH] OR
 

“Hypertension/complications”[MeSH] OR
 

“Hypertension/diagnosis”[MeSH] OR
 

“Hypertension/economics”[MeSH] OR
 

“Hypertension/epidemiology”[MeSH] OR
 

“Hypertension/ethnology”[MeSH] OR
 

“Hypertension/etiology”[MeSH] OR
 

“Hypertension/mortality”[MeSH] OR
 

“Hypertension/physiopathology”[MeSH] OR
 

“Hypertension/prevention and control”[MeSH] OR
 

“Hypertension/psychology”[MeSH] OR
 

“Hypertension/statistics and numerical data”[MeSH] OR
 

“Hypertension/therapy”[MeSH]
 

To explore related work on prostate cancer: 

“Prostatic Neoplasms”[MeSH] OR 

“early prostate cancer antigen, human”[Substance Name] 

a review to address blood pressure control in african american men 125 
 

 

 

 

 

To explore related work on diabetes: 

“Diabetes Insipidus”[MeSH] OR
 

“Diabetes Mellitus”[MeSH] OR
 

“Diabetes Mellitus, Type 2”[MeSH] OR
 

“Diabetes Mellitus, Type 1”[MeSH] OR
 

“Diabetes Complications”[MeSH]
 

To capture appropriate interventions or studies: 

“Intervention Studies”[MeSH]
 

“Attitude to Health”[MeSH]
 

“Outcome and Process Assessment (Health Care)”[MeSH]
 

“Health Promotion”[MeSH] OR
 

“Health Education”[MeSH]
 

Limits: 

English language 

Publication Date from January 1990 to March 2008 

Humans 

126 african american men and blood pressure control: a closer look 
Notes 

a review to address blood pressure control in african american men 127