Category: Week 4: Public Health in the News Post 3

Carlie Charles

Thomas, Naomi. (October 9, 2018) How church communities can help lower African-Americans’ blood pressure.CNN. https://www.cnn.com/2018/10/09/health/church-hypertension-blood-pressure-intervention-study/index.html (Accessed June, 27, 2019)

• Naomi Thomas wrote an article that discusses an upstream intervention strategy of the intentions to lower and mediate the rates of hypertension in the black community. The study took a different approach and geared towards a faith-based intervention and situated their study in 32 churches across New York City. The study consisted of 373 people and they were split into two group—one received the intervention and the other was categorized into the control group. The group that received the intervention was dedicated 11 90-minute sessions held weekly and focused on educating individuals of healthy life choices. In addition, the intervention group received 3 monthly motivation phone calls to report their progress in lifestyle changes. The control group received only one session educating on lifestyle changes in high blood pressure and the other ten focused on a variety of other topics such as fire safety and Alzheimer’s along with no motivational phone calls from leaders. Church member’s blood pressure was recorded upon initiation of the program, six months, and nine months since the program started. The intervention group had a systolic blood pressure decrease from 5.8 to 5.3 mmHg.

• According to  Ogedegbe, the director of NYU Langone’s Center for Healthful Behavior Change, clinically speaking, the reduction was to observed as a significant decrease. Centralizing the focus groups in the church, members felt more inclined to be cooperative because the church created space for members to share their progress and challenges with the comfort of freedom from judgment.

• The use of the church was significant in the design of the study. Kiser, senior program director at the Interfaith Health Program mentioned that “Faith-based settings are sources of trusted information.” She also mentioned that “It strengthens disease prevention and health promotion activities.” The study also implemented the use of lay health advisors— which are members of the community who volunteer to help for a cause—was an important aspect of the study because it involved regular people in the community an absolved the need to have doctors or clinic officials to conduct the focus groups. Lay Health advisors were also important to consider in the black community because of the culture of how the community beliefs shape around people who are considered strangers means that they are less inclined to absorb the information given by such individuals. In addition, this was not the first time an effort like this was introduced. Thomas also mentioned of a study that was published by the New England Journal of Medicine discovered that when health educators were placed in locations such as barbershops, 63.6% showed lowered blood pressure to a healthy state. Thomas stressed that using the community as agents to promote health with the knowledge and use of medicine, then increased the level of health and health benefits would be observed.

• The church in the black community can play a crucial role in the role of the diffusion of innovations. In the black community, the church is a central component of social life. Pastors and church leaders can play the role of the innovators because they have substantial power to influence the entire congregation to appeal to new ideas. If the intervention was adopted by widely recognized black pastors in the black community such as Bishop T. D. Jakes, initially many of his followers would adopt the idea and other pastors would adopt the idea as well because of the flow of the hierarchy and this would spread to churches across the nation.

a.  The intervention that the article focused on was increasing how much people walk through a 12-week program. It has been proven countless times that exercise is beneficial in many ways, but we are exercising less and less. This lack of physical activity is now estimated to be the 4th risk factor of mortality on a global scale. Researchers in the Population Health Research Institute at St. George’s University of London realized that most studies that were conducted in the past only presented short term outcomes of increased physical activity; so in this study, they decided to study the results of the intervention up to 4 years after. 

b.  Two trials were created for the research; one was called PACE-UP, which was made for adults aged 45 to 75 and the other was called PACE-Lift made for adults aged 60 to 75 years. The participants that were recruited from 10 primary care practices in London. 

The PACE-UP trial had three different groups. The first was the control group who received usual care with no intervention. The second received the intervention program material and instructions in the mail, and the third received the same materials and instructions during the first visit to their three nurse physical activity consultations. The PACE-Lift group had two groups, the control and the intervention group that received assistance from nurses. 

Intervention groups from the two trials were given a pedometer and was asked to increase their step count in increments over the 12 weeks. Data was recorded at 3 months, 12 months, and then at 3 years for PACE-UP and 4 years for PACE-Lift but in the end combined all the groups due to their similarity. The intervention groups maintained an increase of 30 minutes in their weekly moderate to high intensity activity after the 4 years. 

The data they collected showed that both fatal (which yielded a Hazard Ratio (HR) of 0.24, which means that there are less risk of developing a disease or condition if one takes this action) and non-fatal cardiovascular diseases (HR = 0.34) were lower in the intervention group. The risk of fractures were also lower in the intervention group, yielding an HR of 0.56. 

c. I think the data presented sounds promising, especially with the many other studies that prove the benefits of exercising. However, I feel I need more information and data to determine if the intervention is effective for everyone. We aren’t told the number/percentage of the participants who were able to maintain the increase in physical activity for 4 years. I am sure there were people who decided to quit. If 70% of the people quit (I know it is unrealistic, but just as an example), the intervention is not effective for the majority even if it produces great results for the 30%. That isn’t a very effective intervention method for the general population. Furthermore, I would like to know what the program was and the difference between conventional walking programs. 

d. Based on the Diffusion of Innovations theory, I think this method has the potential to catch on. Some people are Innovators, so they would jump on this new program. If they like it or think it is effective/innovative, the word would spread to the Early Adopters. After the adopters like them, both the Early and Late majority would catch up to testing out the program for themselves. The Laggards will be hard to convince, but reliable statistics of the effectiveness, as well as social pressure, could make them try the program out for themselves.

Reference:

Harris, T. (2019, June 25). Walking intervention tied to long-term health benefits. Retrieved June 25, 2019, from https://www.healio.com/internal-medicine/nutrition-and-fitness/news/online/{b960fe50-f9cc-4944-b47c-93601bc3c9c7}/walking-intervention-tied-to-long-term-health-benefits

Silberner, Joanne. (June 24, 2019). They Thought This HIV Strategy Couldn’t Work. But It Did. National Public Radio, Inc. https://www.npr.org/sections/goatsandsoda/2019/06/24/733674936/they-thought-this-hiv-strategy-couldnt-work-but-it-did (Accessed June 26, 2019).

This article focuses on a team’s intervention plan to prevent the spread of HIV in South Africa and Zambia. Their method is called treatment as prevention (or “test and treat”). Researchers from London School of Hygiene and Tropical Medicine, Imperial College, and various other institutions formed this team, and funded this project called PopART (Population Effects of Antiretroviral Therapy to Reduce HIV Transmission).

Through this project, they found that door to door intervention proved to be the most effective, and they managed to reduce HIV incidence by 30%.

HIV testing began in 14 communities, with about 50,000 people in each neighborhood or town. The door to door intervention plan included training community health workers and having them visit people’s homes to discuss HIV and prevention, distribute condoms, and offer on-the-spot testing.

It was interesting because when people were offered treatment immediately through the “test and treat” intervention, there was only a 7% drop in new HIV infections. In the other group where they utilized the “test and treat” plan, they did not begin treatment until an individual’s white blood cell counts fell below a certain level. This group was the one that had the 30% reduction in HIV incidence.

It is believed that the difference might be due to the upkeep of medication and treatment, but researchers are still trying to understand the difference.

I’m pretty convinced by this intervention’s effectiveness because it makes sense that people may not completely understand the method of treatment or availability of resources until someone comes to their door and explains it to them, especially in countries with less resources or health education. If their local community center is far away, they may not reach out for help or even be aware of the ways in which the community health center can help. It is very possible that people may not be aware of the modes of treatment they can pursue for a disease such as HIV. Therefore, it makes sense to me that a door-to-door treatment and health education plan for intervention would be more effective than a stagnant community center.

I believe that this intervention will need more funding for the training of the community health workers and overall programming. However, the efficacy of this treatment and the gravity of HIV both make this a priority to pursue from a policy and health checkpoint.

From a diffusion of innovation theory, this idea has a relative advantage due to its success rate, it addresses a major world health concern, it is fairly easy to understand, it can be tested in different communities, and it produces tangible results. Hence, I believe that it should catch on because this intervention may be a very valuable one that can change the lives of millions of people.

https://www.usnews.com/news/health-news/articles/2019-06-10/drug-may-help-delay-onset-of-type-1-diabetes

Gordon, Serena. (June 10, 2019) Drug May Help Delay Onset of Type 1 Diabetes. U.S.News. Available at https://www.usnews.com/news/health-news/articles/2019-06-10/drug-may-help-delay-onset-of-type-1-diabetes

This article talks about a new drug, teplizumab, being able to potentially postpone the onset of Type I Diabetes. Type I Diabetes occurs when the pancreas creates little to no insulin. Teplizumab targets specific immune cells that destroy beta cells (cells that produce insulin). The treatment would not prevent the development of type 1 diabetes, but it would slow it down. The hope of the treatment is to decrease the social, economic, psychological, and biological burden of the disease.

The study had 76 participants older than 8 years. The majority of participants were under 18 years old. All participants had a very high risk of developing type 1 diabetes; they had a relative diagnosed with type 1 diabetes, there was evidence supporting the degradation of their beta-cells, and their bodies showed signs of improper blood sugar processing. The article doesn’t state where this study was conducted. I would assume participants would go to a health facility to receive treatment on a daily basis and carry out their regular routine otherwise. One group was given teplizumab and the other group was given a placebo intravenously for two weeks. After the two weeks, participants were followed until they developed type 1 diabetes. Some participants haven’t developed type 1 diabetes and are still being followed. The study found that teplizumab was able to postpone the onset of diabetes for an average of 48 months. Participants that were given the placebo developed type 1 diabetes in an average of 24 months. According to this study, teplizumab was able to postpone the onset of type 1 diabetes in high-risk populations for an estimated 1 year. Additionally, 43% of the group treated with teplizumab developed type 1 diabetes while 72% of the placebo group developed type 1 diabetes.

I am not that convinced by the claims about this intervention’s effectiveness. According to the article, teplizumab is a relatively new drug. Furthermore, teplizumab is “the first study to show any drug can delay type 1 diabetes diagnosis a median of two years,” says study lead author Dr. Kevan Herold. This makes me want to see more research testing the effectiveness of it. The article doesn’t state whether the differences observed between the treatment and control group was statistically significant. I am unsure if this difference was due to external environmental factors or not. The article also doesn’t mention if the study controlled for any additional medical conditions or environmental factors that could influence the rate at which beta cells are destroyed.

This intervention is likely to catch on. Millions of people are diagnosed with type 1 diabetes every year. People with type 1 diabetes need insulin and will have to purchase it no matter what price it is. The psychological burden of being diagnosed can be great. Solutions to cure or alleviate the complications associated with type 1 diabetes are in high demand. This article describes the innovators who begin to test a new drug to see how it affects the onset of type 1 diabetes. Early adopters will see this as something new, exciting, and positive for everyone. They will adopt this innovation quickly and easily. With enough research and success stories supporting that teplizumab can delay the diagnosis of type 1 diabetes, the early majority will adopt this intervention. If teplizumab has gained a good reputation and is already widely used, the late majority will slowly adopt the intervention. The laggards may be pressured to adopt the intervention by other groups or maybe finally persuaded by an overwhelming number of statistics in favor of the intervention. Key decision makers are likely to agree to recommend and fund this because of the reasons stated earlier. An intervention that prolongs the diagnosis of type 1 diabetes would affect millions of at-risk people and could greatly decrease the economic and psychological burden of the disease.

Preidt, Robert. (June 21, 2019) New Drug Combats Leading Cause of Dwarfism. U.S. News & World Report. Available at https://www.usnews.com/news/health-news/articles/2019-06-21/new-drug-combats-leading-cause-of-dwarfism (Accessed June 23, 2019).

The intervention that the article focused on was using a drug called vosoritide to regulate the bone development in children with the genetic bone disorder achondroplasia. Achondroplasia is the most common form of dwarfism. In the United States, France, United Kingdom and Australia a four-year phase 2 trial was conducted. 35 children aged 5-14 were separated into four groups and given daily doses of vosoritide in increasing quantities. This caused the children to increase in height an average of 2.4 inches a year. It increased the children’s growth rate on average by 50%. The side effects of the drug were generally minor. I am convinced of the effectiveness of this intervention because of the increased growth rate of the children with only minor side effects. Achondroplasia affects approximately 1 in 25,000 infants and is caused by a FGFR3 gene mutation which adversely affects bone growth. An overactive signal that stops development is what causes achondroplasia. This intervention is effective because vosoritide helps to stop that overactivity thus helping to solve the problem. The intervention is likely to catch on because from a policy perspective it is addressing the needs of these children by improving their future health on a yearly basis. The key decision makers are likely to agree to recommend and fund this intervention because it increased the growth rates of children with achondroplasia per year to nearly the same growth rates per year of children of average height. Many children with achondroplasia have other complications such as spinal chord compression, spinal curvature and bowed legs. These complications require corrective surgeries in approximately half of the children. This intervention may improve the children’s health outcomes, functioning and access to their environment which would increase the likelihood that it would be funded by key decision makers.

https://www.usnews.com/news/healthiest-communities/articles/2019-06-21/barber-backed-sex-talks-a-tool-to-curb-hiv-study-suggests

Williams, Joseph P. (June 21, 2019) Barber-Backed Sex Talks to Curb HIV. U.S. News and World Report. Available at https://www.usnews.com/news/healthiest-communities/articles/2019-06-21/barber-backed-sex-talks-a-tool-to-curb-hiv-study-suggests

The intervention is a primary intervention on educating an at risk population to prevent them from getting HIV by teaching them about safe sex practices through the Brothers talking with brothers program which has barbers talking about health issues with their clients. Since it can be awkward for people especially men to talk about safe sex with others Tracey Wilson, one of the lead authors on the study, helped come up with the idea of going into barbershops and having either the barber themselves do the talking or a health expert sit there and talk while the barber gives the client a cut. They decided this would be an effective venue for African American males as it is a place they frequent often and feel very relaxed during. The effectiveness was tested in fifty barbershops in the Brooklyn area and by their out comes they saw a little bit of success they feel they can build upon in the future. A group received a talk about the risks of unprotected sex in relation to HIV while a control group received a talk about prostate cancer. After 6 months they asked the groups about their sexual partners and their use of prophylactics. Reportedly of the 320 members of the HIV group 64% reported that they had not had any vaginal or anal sex without a condom in the past ninety days while comparatively the control group reported in at a 54% rate out of the 200 members. While I can see why they thought it was a success in comparing it with a control group they don’t offer information about the efforts to reduce confounding or alternate reasons for the improvement in condom use. I believe for me to trust the experiment a little bit more I would need the groups to know the originating information, i.e. the percentages of those who received either talk that always or mostly used condoms. If the starting percentages were 60% then I would feel like it was less effective than if the starting percentages were 30% or 40%.

I think that this intervention maybe likely to catch on especially in African American communities where going to the barbershop is a more meaningful time than some other communities where the men do not really have a relationship with their hair dresser. However the fact that for the African American male community it is in a place they feel more comfortable at, probably have a relationship with their barber that has fostered trust of the barber, and the inability to just walk away makes it ideal to offer health talks, especially to a group that is often disenfranchised and may not have as much access to resources on their own.

Mammoser, Gigen. (June 13, 2019). Starting School Later in the Morning Helps Teens Get Their Homework Done. Heathline. Available at https://www.healthline.com/health-news/pushing-back-school-help-teens-get-homework-done (Acessed June 17, 2019).

A.) Because kids’ and teens’ sleep cycles change over the course of puberty, they tend to wake up later at around eight or nine in the morning. But unfortunately, school usually starts way before then, distrubing their sleep cycles and making them more tired and unfocused during school hours and thereafter. To find a way to make teens more energized and focused throughout the school day, a study was done where a school district volunteered to start the school day about an hour later at or after 8:30 am.

B.) Over the course of the school year starting from the fall of 2017 until the spring of 2018, the study took place at Cherry Creek School District, where more than 15,000 students in the grades 6-11 participated in the study by taking surveys on their condition in response to the new time change. The intervenion was incredibly effective as students had more sufficient sleep and on the weekends lessened oversleeping by 38 minutes. Fewer students reported being too sleepy to do homework and there was a signifigant increase of academic engament during school hours.

C.) While I can’t think of anything to be seen as confounding, as sleeping-in leading to more energization throughout the day seems to be pretty striaght-forward. Speakig from personal experience, I definately felt more energized throughout the school day when I woke up at around eight am instead of the usual five am. However, the study design could be improved upon. For example, whose to say that the students who reported their conditions didn’t just lie so that they could sleep in more instead; having to go to school later doesn’t necessarily mean that they will go to bed around an apporpriate time. I think that the teachers and parents should have also had a survey distributed to see if the students claims really are true, and thus have more consistent findings.

D.) I think it’s very possible for this to catch on again, as this has happened before in the past. I myself used to go to school that started at around 9:00 am when I was in elementary, however, for some reason my school district set the start time earlier and earlier from middle school to high school to the point where I would wake up at around 5:00 am. In theory, I think if this study was proposed to my school district for instance, as being more healthy for the students, they would be willing to consider changing it back to 9:00 am. Though I think the reason it was set earlier is because of the fact that parents need to get to work on time and can’t do that if their kids need a ride to school. Though a way to solve that would be to reinstate school buses again, and maybe possibly change the starting time of workplaces themselves. It could possibly be marketed as “new” and “innovative” since now there are studies that prove what is the most effective for sleep cycles and class focus. This study could also be interpreted to the sleep cycles of employees and wanting to monopolize their time and energy to their work. Essentially, this will only be changed if it benefits adults as well, as adults are the ones who would make a decision on this implementation.