Urban Indians: Reducing Risk of Diabetes & Heart Disease

Transcription

1 Urban Indians: Reducing Risk of Diabetes & Heart Disease September 20, 2011 This webinar is sponsored by the Society for Public Health Education

2 Technical Support Phone: Call (U.S. and Canada toll-free) Both WebEx and Teleconference are in use

3 Questions? All participants, except the host and panelists, are muted. There will be a Q&A session after the presentations. Questions may be submitted any time during the event by clicking on the? button on your toolbar and typing in your question.

4 Feedback Feedback from webinar attendees is important and encouraged. Please complete the brief feedback form that will pop up in your browser immediately following this session.

5 Continuing Education Today s session has been approved for 1.0 Category I continuing education contact hours (CECHs) for Certified Health Education Specialists (CHES). SOPHE, including its chapters, is a designated multiple event provider of CECHs by the National Commission for Health Education Credentialing (NCHEC). Fees: $ 7.00 for National SOPHE members $ for non-members Forms can be downloaded from SOPHE s Continuing Education, Webinars page at: Completed applications, evaluations, and fees should be sent to: Society for Public Health Education 10 G Street NE; Suite # 605 Washington, DC Fax:

6 Today s Moderator Nicolette Warren, MS, MCHES Director of Health Equity Society for Public Health Education nwarren@sophe.org

7 Objectives At the end of this webinar, participants will be able to: Discuss diabetes and cardiovascular disease risk in American Indian and Alaska Native populations, with a focus on the special circumstances of urban Indian populations. Describe use of evidence-based curriculum to reduce diabetes and heart disease disparities among American Indians and Alaska Natives. Discuss new partnerships that are enabling mobilization of community stakeholders to reduce diabetes and heart disease disparities.

8 Today s Speakers Tim Noe, PhD Assistant Professor University of Colorado Denver, School of Public Health Carme Hamilton, RN, CDE RN Diabetes Educator/Case Manager Oklahoma City Indian Clinic Carme.h@okcic.com Cathy Waller, RD/LD, CDE Diabetes Program Coordinator Oklahoma City Indian Clinic Cathy.w@okcic.com Sara R. Kernell, MSN, RN Director of Public Health Oklahoma City Indian Clinic Sara.k@okcic.com Evelina Y. Maho, BS Health Promotion Program Coordinator Native Americans for Action, Inc., Family Health Center, Health Promotion Program eymaho@nacainc.org Kate Brisnon, MEd Diabetes Educator Native Americans for Action, Inc., Family Health Center, Health Promotion Program Carme.h@okcic.com Linda Gonzales Physical Activities Specialist/Lifestyle Coach United American Indian Involvement, Inc. Taquich@aol.com Michael A.Reifel Lifestyle Coach United American Indian Involvement Inc. happyjoyousfreeindian@yahoo.com

9 CDC Center of Excellence in Eliminating Health Disparities (CEED) Urban Indian Wellness Program

10 Angela Brega PhD Tim Noe PhD Crystal Loudhawk-Hedgepeth MEd Dakotah Jim MS Brad Morse MA Angie Generose MS Spero Manson PhD Acknowledgements The staff and patients of the Denver Indian Health and Family Services and Albuquerque First Nations Community Healthsource who participated in the 2010 UCD CEED Baseline Survey and the UCD Denver and New Mexico Coalitions

11 REACH U.S. Racial and Ethnic Approaches to Community Health Across the U.S. National program by CDC to address racial and ethnic disparities in health Supports 40 grantees o 18 CEEDs o 22 Action Communities

12 Health Disparities Differences in the incidence and prevalence of health conditions and health status between groups, based on: Race/ethnicity Socioeconomic status Sexual orientation Gender Disability status Geographic location Combination of these Reference: Braveman P. Health disparities and health equity: concepts and measurement. Annual Review of Public Health 2006;27:

13 Examples of Health Disparities Diabetes Cancer Injury As of 2005, Native Hawaiians or other Pacific Islanders (15%), American Indians or Alaska Natives (14%), African Americans (11%), and Hispanics/Latinos (10%) were all significantly more likely to have been diagnosed with diabetes compared to their White counterparts (7%). 1 In 2004, the overall cancer death rate was 1.2 times higher among African Americans than among Whites. 2 In 2004, American Indian or Alaska Native males between years of age were 1.2 times more likely to die from a motor vehicle-related injury and 1.6 times more likely to die from suicide compared to White males of the same age. 3 1 Pleis JR, Lethbridge-Çejku M. Summary health statistics for U.S. adults: National health interview survey, National Center for Health Statistics. Vital Health Stat 10(232) U.S. Cancer Statistics Working Group. United States Cancer Statistics: 2002 Incidence and Mortality. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; National Center for Health Statistics. Health, United States, 2004 with Chartbook on Trends in the Health of Americans. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004.

14 Social Determinants of Health

15 Health Inequities Systematic and unjust distribution of social, economic, and environmental conditions needed for health Access to healthcare Employment Education Access to resources (e.g., grocery stores, car seats) Income Housing Transportation Positive social status Freedom from discrimination Reference: Whitehead M, Dahlgren G. Levelling Up (Part 1): A Discussion Paper on Concepts and Principles for Tackling Social Inequities in Health. World Health Organization. Available at document/e89383.pdf.

16 Examples of Health Inequities Education Income Access to resources Infants born to African American mothers with only a high school education were 2.2 times more likely to die in the first year of life compared to their White counterparts. Low socioeconomic status is associated with an increased risk for many diseases, including CVD, arthritis, diabetes, chronic respiratory diseases, cervical cancer and frequent mental distress. Lower income and racial/ethnic minority communities are less likely to have access to grocery stores with a wide variety of fruits and vegetables. 1,2 1National Center for Health Statistics. Health, United States, 2007 with chartbook on trends in the health of Americans. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; Pleis JR, Lethbridge-Çejku M. Summary health statistics for U.S. adults: National Health Interview Survey, National Center for Health Statistics. Vital Health Stat 10(235) Available at: K, Wing S, Diez Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med 2002;22(1): Baker E, Schootman M, Barnidge E, Kelly C. Access to foods that enable individuals to adhere to dietary guidelines: the role of race and poverty. Prev Chr Dis 2006;3(3):1-11.

17 Urban Indian Center of Excellence in Eliminating Disparities (CEED) University of Colorado Denver (UCD) Center of Excellence in Eliminating Health Disparities Funded by CDC Under a Cooperative Agreement Only CEED targeting American Indians/Alaska Natives across U.S.

18 Urban Indian Health Disparities and Inequities 16.3% of American Indians and Alaska Native adults have been diagnosed with diabetes compared to 8.7% of non-hispanic whites (2 times higher). There has been a 68% increase in diabetes among AIAN you aged years. 30% of AIAN are estimated to have pre-diabetes Death rate due to diabetes for AIAN is 3 times higher than compared with the US general population. AIAN with diabetes are 3-4 times more likely to develop cardiovascular disease compared AIAN without diabetes 66% of AIAN with cardiovascular disease had diabetes first

19 Urban Indian Health Disparities and Inequities More than 60% of AI/AN live in urban areas yet urban Indian health care receives less than 4% of IHS funds Only 34 funded urban Indian health programs

20 University of Colorado Denver CEED Urban Indian Heart Health Mission Program Reduce cardiovascular disease and diabetes risk among urban American Indians and Alaska Natives Accomplished through: 1. Community Action Plan 2. Training and Dissemination 3. Legacy Awards

21 UCD CEED Community Action Plan Cardiovascular Disease and Diabetes Risk Reduction Program in Urban Programs of Albuquerque Area IHS Denver Denver Indian Health and Family Services Albuquerque First Nations Community Health Source

22 UCD CEED Community Action Plan Interventions Individual: Health education classes (Honoring the Gift of Heart Health) and promotion of physical activity Interpersonal: Activities for family members and friends Organizations: Tools/Resources to encourage organizations serving AIANs to become more heart healthy Community/Public Policy: Coalition building to address cardiovascular disease (CVD) and diabetes risk among AIANs and media campaigns to increase CVD and stroke risk awareness among AIANs

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24 UCD CEED National Training and Dissemination At least one national conference per year that will include: Education and training on CVD and diabetes risk reduction topics relevant for urban Indian programs Train the Trainer on Honoring the Gift of Heart Health

25 UCD CEED National Training and Website Dissemination Diabetes and CVD risk reduction tools and resources Lessons learned from other urban Indian health programs on diabetes and CVD risk reduction Information on upcoming UCD CEED national workshops Information on upcoming diabetes and CVD conferences Legacy Award grantees

26 UCD CEED Legacy Awards 2 3 Legacy Awards or mini-grants for Fiscal Years 2010, 2011 and 2012 to urban Indian health programs Fund implementation of Honoring the Gift of Heart Health and activities to reduce diabetes and CVD risk in local urban Indian communities Implementation of policy and environmental change is primary focus Each award will be $25,000 to $40,000 for one year Competitive awards

27 Questions?

28 Urban Indians: Reducing Risk of Diabetes & Heart Disease Oklahoma City Indian Clinic 2011

29 Oklahoma City Urban Indian Clinic Serving all Native Americans with a CDIB card. 16,277 active patients from over 250 tribes

30 Talking Hearts Program Goal 1 Reduction of Cardiovascular risk factors: LDL, Blood Pressure, Glucose, and Smoking. 1. Talking Hearts Blood Pressure 2. Talking Hearts Cholesterol 3. Talking Hearts Freedom from Smoking

31 Talking Hearts Blood Pressure Are You at Risk for Heart Disease? Act in Time to Heart Attack Signs What you need to know about blood pressure, salt and sodium What you need to know about High Blood Cholesterol

32 Talking Hearts Blood Pressure Participants learn how to use a digital blood pressure cuff/meter. Provide a digital blood pressure monitor for home use. Omron Deluxe BP monitor

33 Talking Hearts Cholesterol Be More Physically Active Maintain a Healthy Weight Make Heart Healthy Eating a Family Affair Eat in a Heart Healthy Way- Even When Time or Money is Tight

34 Talking Hearts Cholesterol Promote Heart Health Nutrition Lower Fat Cooking instruction Promote Physical Activity Provide Pedometers for walking trails, etc.

35 7 week course Freedom from Smoking Talking Hearts Freedom from Smoking Prescription for Nicotine Patch from referring medical provider Enjoy Living Smoke Free

36 Talking Hearts Program Goal 2 Address Diabetes and Cardiovascular Disease in Urban Indian Communities 1. Media Campaign 2. Advocating Local Farmers Markets 3. Promote Active Living

37 Media Campaign Activity Mail out Post Cards, promoting Talking Hearts and Smoking cessation classes

38 Advocating Farmers Markets Farmers Markets Edmond Farmers Market Norman Farmers Market OSU-OKC Center Farmers Market Oklahoma City Walker Square Advocating farmers market on OKCIC website Oklahoma City Farmers Market Yukon/Oklahoma City Herban

39 Advocating Walking Trails OKC Trials network of walking, running, bicycling and skating paths Hefner-Overholser Trail Katy Trial Lake Hefner Trail Lightning creek Trail Oklahoma River Trail South Grand Trail Tinker-Draper Trail OKC.Gov The City of Oklahoma

40 Spring 2011 issue. 14,000 copies were mailed

41 Talking Hearts Instructors Cathy Waller RD.LD.CDE. Diabetes Program Coordinator Carmie Hamilton RN.BSN.CDE. Case Manager/Diabetes Educator Sara Kernell RN. MSN. Public Health Director Oklahoma City Indian Clinic 4913 West Reno, Oklahoma City, Oklahoma

42 NACA Family Health Center, Flagstaff, Az. Health Promotion Programs-CEEDS NACA Native Americans for Community Action, Inc. Employee Wellness Program NACA Health Promotion Programs Quarterly Screenings Work closely with Providers Recruitment for HGHH Classes, DM Group support classes, DPP-Lifestyle Balance Classes and Healthy Living Classes. NACA Wellness Center Programs/Classes Native Food Initiative

43 NACA Family Health Center, Flagstaff, Az. Health Promotion Programs-CEEDS NACA Employee Wellness Program -Policy NACA Board of Directors passed policy 2010

44 NACA Family Health Center, Flagstaff, Az. Health Promotion Programs-CEEDS NACA Employee Wellness Program Policy Employee Wellness Initiative Memorandum of Agreement (between employee and NACA) Medical Clearance (Health History Questionnaire Fill out and bring to Physician appointment ) Wellness Center Release of Liability 3 hrs. exercise prescribed sessions with NACA Wellness center fitness specialists Exercise during working hours Initial assessment Prescribed exercise plan developed Scheduled prescribed exercise sessions All sessions with Certified Fitness Specialists

45 NACA Family Health Center, Flagstaff, Az. Health Promotion Programs-CEEDS NACA Health Promotion Program Flow 1 st Level - Community Screening (NACA HP Staff) RBG, Height, Weight, BMI ADA Paper Risk Test, Tobacco Cessation 2 nd Level Screening (NACA Providers and local Providers) A1C, TG, HDL, LDL, A/C Ratio, Diagnosis Providers Refer to Appropriate Programs Participants Recruited into NACA Health Promotion Programs CEEDS: Honoring Gift of Heart Health Classes DM: Adult Wt. Mgmt. (Healthy Living Classes) DPP: Lifestyle Balance Classes Wellness Center (fitness), or RD counseling

46 NACA Family Health Center, Flagstaff, Az. Health Promotion Programs-CEEDS Health Classes/Programs CEEDS- Honoring the Gift of Heart Health DPP- Lifestyle Balance Classes DM-Group Support DM Grant- Health Living Classes (adult wt. mgmt program) Wellness Center Programs/Services Individual Assessment Individual plans developed Prescribed Exercise sessions Group Fitness Classes -Zumba, Steps/Strength, Spinning, -Circuit training Community Events Quarterly hiking, walking program, upcoming winter story series

47 NACA Family Health Center, Flagstaff, Az. Health Promotion Programs-CEEDS Native Food Initiative Preliminary Planning Working collaboratively with local, regional organizations and tribes to address food insecurity in urban Native American communities. Establish relationships with local farmers, ranchers and food distributors. Economic development opportunity. Mobile food vendors to sell regional Native American foods. Create opportunity for schools, programs and organizations to adopt ways in which healthier foods are accessible.

48 Contact Information Native Americans for Community Action, NACA Family Health Center-Health Promotion Programs 1500 E. Cedar Ave., Suite 26 Flagstaff, Az Evelina Y-Maho, Coordinator Phone: (928) , ext Kate Brinson, Health Educator Phone: (928) , ext

49 Honoring the Gift of Heart Health United American Indian Involvement: Los Angeles, CA Urban American Indians: Reducing the Risk of Heart Disease and Diabetes

50 Urban Indian Health Disparities and Inequities Diabetes and cardiovascular disease are epidemic among American Indians and Alaska Natives More than 50% of AI/AN live in urban areas yet urban Indian health care receives less than 4% of IHS funds Only 34 funded urban Indian health programs. * The Office of Minority Health

51 California American Indian and Alaska Natives As of 2008, the American Indian and Alaska Native population in California is the highest of any state at 738,978. Oklahoma was second with 406,492. The U.S. Census

52 Los Angeles American Indian and Alaska Natives Los Angeles County, as of July 2008, has the highest population of AI/AN than all counties in the U.S., with 155,010. * U.S. Census

53 American Indian/Alaska Native adults: Are 1.4 times as likely as White adults to be diagnosed with heart disease. Are 1.3 times as likely as White adults to have high blood pressure. Are 1.4 times as likely as White adults to be current cigarette smokers. The Office of Minority Health

54 Cardiovascular Disease Researchers are have not been able to accurately estimate the annual incidence for heart disease or stroke or the prevalence of their risk factors at state or local levels. CDC

55 How do we prevent the risk of heart disease? *

56 Increasing the use of preventive services Including tobacco cessation screening, alcohol abuse screening to 9 percent of the recommended levels could save $3.7 billion annually in medical costs. Increases productivity. Absenteeism costs are reduced by approximately $2.73 for every dollar spent on workplace wellness programs The Office of Minority Health

57 Better Tracking A comprehensive, national surveillance system that provides timely local data is needed. Such a system would improve our capacity to monitor risk factor trends, identify populations at greatest risk, and evaluate the effect of efforts to control risk factors for cardiovascular disease * The Office of Minority Health

58 Honoring the Gift of Heart Health Criteria for Participation Participants must over the age of eighteen and medically screened for physical activity. Follow up clinic visit after three months of completion of the Honoring the Gift of Heart Health program.

59 * The Honoring the Gift of Heart Health program UAII has had 71 participants, ages 23 to 72, graduate our 9 week course on the prevention of heart attack and stroke, nutrition, exercise, smoking cessation and traditional recipes. Another 101 participants attended at least one of the sessions Our six Waves lost a total of 242 pounds

60 The Honoring the Gift of Heart Health program We have had all participants in one group show a marked improvement in their blood pressure. One with a starting blood pressure of 176/105 had an ending b/p of 146/96.

61 The Honoring the Gift of Heart Health program The HGHH was presented in its entirety at our Diabetes Workshop and our outreach sites: The Indian Revival Church and The Gabrielino Youth Center. *

62 The Diabetes Prevention Program Program Criteria Participants must be: medically diagnosed as pre-diabetic through the use of A1c screening and medically screened for physically activity. Participants must not: have substance abuse issues, being treated for cancer that prohibits them from successfully participating in program, treatment for any condition that would hinder their active involvement in the Diabetes Prevention Program (in the opinion of staff), under eighteen years of age, pregnant or have end stage renal disease on dialysis. The participants have Follow Up Assessments, Annuals at the one year, year and a half, two year, two and half year and three year points.

63 We have had 62 people complete the 16 week program Total weight lost was over 400 pounds

64 Urban Indian Center of Excellence in Eliminating Disparities (CEED) University of Colorado Denver (UCD) Center of Excellence in Eliminating Health Disparities Funded by CDC Under a Cooperative Agreement Only CEED targeting American Indians/Alaska Natives across U.S.

65 United American Indian Involvement, Inc. Staff for the Honoring the Gift of Heart Health and the Diabetes Prevention Program Gene Martinez MBA Director of Public Health and Case Managers Pintip Chotibut MS, RD Dietician/Health Educator Linda Gonzales Physical Activity Specialist/Lifestyle Coach Shondiin Gonzales Data Coordinator Michael Reifel Lifestyle Coach

66 Questions?

67 Questions? To submit a question, click on the? button and type in your question.

68 Thank You! This session was recorded and will be available on the SOPHE website within two weeks at: Please complete the feedback form! CHES credits 1.0 category I CECH Fees: $7.00 national SOPHE members; $14.00 non-members Completed applications, evaluations, and fees to: SOPHE 10 G St. NE; Suite 605 Washington, DC 20002