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ABSTRACT: Substantial racial/ethnic health disparities exist in the United States. Although the populations of racial and ethnic minorities are growing at a rapid pace, large-scale community-based surveys and surveillance systems designed to monitor the health status of minority populations are limited. CDC conducts the Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Risk Factor Survey annually in minority communities. The survey focuses on black, Hispanic, Asian (including Native Hawaiian and Other Pacific Islander), and American Indian (AI) populations.
2009.
An address-based sampling design was used in the survey in 28 communities located in 17 states (Arizona, California, Georgia, Hawaii, Illinois, Massachusetts, Michigan, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Virginia, West Virginia, and Washington). Self-reported data were collected through telephone, questionnaire mailing, and in-person interviews from an average of 900 residents aged ≥ 18 years in each community. Data from the community were compared with data derived from the Behavioral Risk Factor Surveillance System (BRFSS) for the metropolitan and micropolitan statistical area (MMSA), county, or state in which the community was located and also compared with national estimates.
Reported education level and household income were markedly lower in black, Hispanic, and AI communities than that among the general population living in the comparison MMSA, county, or state. More residents in these minority populations did not have health-care coverage and did not see a doctor because of the cost. Substantial variations were identified in self-perceived health status and prevalence of selected chronic conditions among minority populations and among communities within the same racial/ethnic population. In 2009, the median percentage of men who reported fair or poor health was 15.8% (range: 8.3%-29.3%) among A/PI communities and 26.3% (range: 22.3%-30.8%) among AI communities. The median percentage of women who reported fair or poor health was 20.1% (range: 13.3%-37.2%) among A/PI communities, whereas it was 31.3% (range: 19.4%-44.2%) among Hispanic communities. AI and black communities had a high prevalence of self-reported hypertension, cardiovascular disease, and diabetes. For most communities, prevalence was much higher than that in the corresponding MMSA, county, or state in which the community was located. The median percentages of persons who knew the signs and symptoms of a heart attack and stroke were consistently lower in all four minority communities than the national median. Variations were identified among racial/ethnic populations in the use of preventive services. Hispanics had the lowest percentages of persons who had their cholesterol checked, of those with high blood pressure who were taking antihypertensive medication, and of those with diabetes who had a glycosylated hemoglobin (HbA1C) test in the past year. AIs had the lowest mammography screening rate within 2 years among women aged ≥40 years (median: 72.7%; range: 69.4%-76.2%). A/PIs had the lowest Pap smear screening rate within 3 years (median: 74.4%; range: 60.3%-80.8%). The median influenza vaccination rates in adults aged ≥65 years were much lower among black (57.3%) and Hispanic communities (63.3%) than the national median (70.1%) among the 50 states and DC. Pneumococcal vaccination rates also were lower in black (60.5%), Hispanic (58.5%), and A/PI (59.7%) communities than the national median (68.5%).
Data from the REACH U.S. Risk Factor Survey demonstrate that residents in most of the minority communities continue to have lower socioeconomic status, greater barriers to health-care access, and greater risks for and burden of disease compared with the general populations living in the same MMSA, county, or state. Substantial variations in prevalence of risk factors, chronic conditions, and use of preventive services among different minority populations and different communities within the same racial/ethnic population provide opportunities for public health intervention. These variations also indicate that different priorities are needed to eliminate health disparities for different communities.
These community-level survey data are being used by CDC and community coalitions to implement, monitor, and evaluate intervention programs in each community. Continuous surveillance of health status in minority communities is necessary so that community-specific, culturally sensitive strategies that include system, environmental, and individual-level changes can be tailored to these communities.
MMWR. Surveillance summaries: Morbidity and mortality weekly report. Surveillance summaries / CDC 05/2011; 60(6):1-44.
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ABSTRACT: The Centers for Disease Control and Prevention's (CDC) Racial and Ethnic Approaches to Community Health (REACH) program funded 40 communities in the United States during 1999–2007. Three of these communities implemented interventions to increase physical activity among African Americans. This case study looks at these interventions and the evidence-based recommendations from the CDC's Community Guide for Preventive Services. These recommendations address creating or improving access to physical activity and the dissemination of information via media campaigns. Findings suggest that although the evidence could not be applied in every respect, culturally-tailored change strategies can meet unique characteristics of African Americans with or at risk for heart disease and may contribute to increased physical activity.
Global Health Promotion 03/2011; 18(1):43-6.
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ABSTRACT: Highly controlled research projects demonstrated success in preventing and controlling cardiovascular diseases. Community-based programs have yet to demonstrate significant influence. Data on large-scale community-level interventions targeting minority communities are limited. The aim of this study is to measure the impact of the Racial and Ethnic Approaches to Community Health (REACH 2010) project, a community-based intervention to eliminate racial/ethnic disparities in blood cholesterol screening in minority communities.
Annual survey data from 2001 to 2006 were gathered in 22 communities. Trends in the prevalence of age-standardised blood cholesterol screening were examined for four racial/ethnic groups (black, Hispanic, Asian and American Indian/Alaska Native), stratified by education level, and compared with national data from the Behavioral Risk Factor Surveillance System.
The prevalence of cholesterol screening increased among persons in black, Hispanic and Asian REACH communities (p<0.001), whereas prevalence decreased in the total US and Hispanic populations (p<0.001) and remained similar among blacks and Asians nationwide. The relative disparity between the total US population and most REACH communities decreased (p<0.05). Relative disparity in cholesterol screening related to education level decreased (p<0.05) within REACH communities, whereas relative disparity related to education level nationwide remained similar in blacks and increased (p<0.001) in Hispanics.
The REACH project decreased racial and ethnic disparities in cholesterol screening between REACH communities and the total US population, as well as disparities related to education level within REACH communities.
Journal of epidemiology and community health 09/2009; 64(4):292-9. · 3.04 Impact Factor
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ABSTRACT: Although overall health has been defined holistically as the integration of a person's optimal mental, physical, social, intellectual, and spiritual well-being, a mental health focus remains on the fringe of many public health efforts. This report describes recent efforts by the Centers for Disease Control and Prevention (CDC) to explore job stress among female blue-collar workers. Using a more holistic approach to understand its impact on blue-collar women's overall health, health-related quality of life (HRQOL) was used to assess optimal human performance. Attempting to encapsulate how overall health affects one's ability to participate and fulfill daily personal/professional tasks, HRQOL yields a broader understanding of the interaction between psychological well-being (mind) and physical functioning (matter). Embedding CDC HRQOL-4 measures into a questionnaire used as part of a larger mixed methods project, blue-collar women responded to questions about their health, including both mental and physical. For these female workers, mental health appeared to be of greater consequence, which could be interpreted as mind being more significant than matter. This paper highlights the findings related to HRQOL issues experienced by these female blue-collar workers and summarizes recommendations for effective individual and organizational approaches to address job stress.
Journal of Women s Health 01/2007; 15(10):1105-10. · 1.57 Impact Factor
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ABSTRACT: Since the release of former Secretary Margaret Heckler's Secretary's Task Force Report on Black and Minority Health more than two decades ago, excess death from chronic diseases and other conditions between African Americans and Whites have increased. The conclusion of that report emphasized excess death and thus clinical care, paying little attention to the sociocultural environment and its effects on risk of disease. The authors of this article contend that eliminating health disparities between the African American and White populations in the United States requires a focus on improving the social environment of African Americans. They examine the interface of culture, gender, and power and how those are central to analysis of the root causes of health disparities. The REACH 2010 project of the Centers for Disease Control offers examples on how a coalition of community and research organizations can infuse community interventions with informed considerations of culture, gender, and power to eliminate health disparities.
Health Education & Behavior 09/2006; 33(4):488-501. · 1.54 Impact Factor
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Health Promotion Practice 08/2006; 7(3 Suppl):179S-80S.
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ABSTRACT: The Centers for Disease Control and Prevention (CDC) supports 40 Racial and Ethnic Approaches to Community Health (REACH 2010) community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities in racial and ethnic groups. The REACH 2010 logic model was developed to assist grantees in identifying, documenting, and evaluating local attributes of the coalition and its partners to reduce and eliminate local health disparities. The model emphasizes the program's theory of change for addressing health disparities; it displays five distinct stages of evaluation for which qualitative and quantitative measurement data are collected. The CDC is relying on REACH 2010 grantees to provide credible evidence that explains how community contributions have changed conditions and behaviors, thus leading to the reduction and elimination of health disparities.
Preventing chronic disease 02/2006; 3(1):A21. · 1.82 Impact Factor
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ABSTRACT: The Centers for Disease Control and Prevention (CDC) supports 40 Racial and Ethnic Approaches to Community Health (REACH 2010) community coalitions in designing, implementing, and evaluating community-driven strategies to eliminate health disparities in racial and ethnic groups. The REACH 2010 logic model was developed to assist grantees in identifying, documenting, and evaluating local attributes of the coalition and its partners to reduce and eliminate local health disparities. The model emphasizes the program’s theory of change for addressing health disparities; it displays five distinct stages of evaluation for which qualitative and quantitative measurement data are collected. The CDC is relying on REACH 2010 grantees to provide credible evidence that explains how community contributions have changed conditions and behaviors, thus leading to the reduction and elimination of health disparities.
Preventing Chronic Disease. 01/2005;
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ABSTRACT: Eight studies included in a recent systematic review of the efficacy of diabetes self-management education were qualitatively reexamined to determine the presence of theoretical frameworks, methods used to ensure cultural appropriateness, and the quality of the instrument. Theoretical frameworks that help to explain complex pathways that produce health outcomes were lacking; culture indices were not incorporated into diabetes self-management education; and the instruments used to measure outcomes were inadequate. We provide recommendations to improve research on diabetes self-management education in community settings through use of a contextual framework that encourages targeting multiple levels of influence--individual, family, organizational, community, and policy.
Annals of internal medicine 07/2004; 140(11):964-71. · 16.73 Impact Factor
