To improve cardiovascular disease (CVD) outcomes in racial and ethnic minorities.

BACKGROUND: While there has been great progress in reducing CVD morbidity and mortality in the U.S. over the past 40 years, some minority groups have not shared fully in this progress and continue to have lower life expectancy and higher CVD morbidity. On average, minorities have less access to medical care, receive less aggressive care and fewer diagnostic and therapeutic cardiac procedures, and adhere poorly to prescribed medical regimens. Thus, research to reduce health disparities by improving CVD outcomes in minorities offers potential for a substantial positive public heath impact. Academic medical centers and institutions capable of carrying out such research, however, often lack access to and the trust of minority patients. Minority patients often receive fragmented care because they lack access to regular medical care, present to emergency departments rather than primary care physicians for complications of an advanced chronic CVD condition, and are less likely to follow medical regimens. Minority communities often harbor distrust of clinical research. Minority patients report greater satisfaction when receiving care from minority providers and are reluctant to receive treatment outside their minority healthcare serving systems.

In general, minorities have high rates of hypertension, elevated cholesterol, cigarette smoking, obesity, metabolic syndrome, and diabetes, as well as other behavioral, environmental, and occupational risk factors for cardiovascular diseases, such as sleep problems - all elements that contribute to excess CVD morbidity and mortality. The causes of minority health disparities are complex and incompletely understood. Although evidence of genetic, biologic, and environmental factors is well documented, poor outcomes are also attributed to under-treatment. Such under-treatment may be due to limited access to health care or, in some cases, break-down of the medical system, or failure of the physician and/or patient to allow for optimal health care, even when access is not impaired. The complex interactions of behavior, socio-economic status (SES), culture, and ethnicity are important predictors of health outcomes and sources of health disparities. Despite efforts to elucidate genetic and environmental risk factors and to promote cardiovascular health in high-risk populations, trends in CVD outcomes suggest that CVD health disparities continue to widen.

The Partnerships Program to Reduce Cardiovascular Health Disparities involves collaboration between research-intensive medical centers (RIMCs) that have a track record of NIH-supported research and patient care; and minority healthcare serving systems (MSSs) that lack a strong research program. Each Partnership Program will: a) design and carry out multiple interdisciplinary research projects that investigate complex biological, behavioral and societal factors that contribute to CVD health disparities and facilitate clinical research within the MSS to improve CVD outcomes and reduce health disparities, and b) provide reciprocal educational and skills development programs to develop investigators able to conduct research aimed to reduce cardiovascular disparities and thereby enhance research opportunities, enrich cultural sensitivity and cardiovascular research capabilities at both institutions.

The Request for Applications for Partnership Programs to Reduce Cardiovascular Disparities was released in September, 2003. The awards were made in September, 2004.

DESIGN NARRATIVE: The study has the long-term goal of eliminating CVD disparities by (1) investigating associations between adherence to evidence-based guidelines and measures of trust in providers and of perceived discrimination; (2) developing and testing an anti-hypertensive intervention based on the DASH diet modified to be culturally appropriate for African-Americans; (3) characterizing the bioactive polyphenolic composition of traditional African-American foods, followed by the developing, disseminating, and evaluating dietary education programs built on culturally appropriate translation of results; and (4) developing and testing an intervention for tobacco smoking cessation in a low-literacy population, using literacy-appropriate electronic tools, tailored to the user's readiness for change. The education component aims to provide emerging disparity researchers with: (1) basic tools of clinical and outcomes research, including biostatistics, epidemiology, psychometrics, behavioral interventions, equity and disparity assessment; and (2) knowledge of fundamental bioethical issues, principles, attitudes, and practices underlying equitable research with culturally diverse and underserved populations.

Genders Eligible for Study:  Both

Criteria