Metabolic Syndrome for Urban African Americans, Research Paper Example

Public Health Program for Reducing Risks of Metabolic Syndrome for Urban African Americans

Public health intervention programs have enjoyed some success in the history of their application. One such program is developed here with the goal of serving the African American community living in urban areas. The strategic goal of the program is to reduce the risks associated with metabolic syndrome among this demographic. As such, the program is intended to work at the county level. Nevertheless, it is incumbent upon researchers to understand some of the pathological implications at least in part in order to determine a specifically targeted program protocol.

To assess the magnitude of the problem of diabetes among African Americans in urban areas, researchers have gathered information about the incidence of these criteria. One stark fact is that African Americans have a statistically higher chance of developing diabetes than their white counter-parts (Signorello, Schlundt, Cohen, Steinwandel, Buchowski, McLaughlin, Hargreaves, Blot, 2007)

Understandings about the pathology of diabetes are helpful in structuring preventive intervention. Thus, one of the aims of the program is to reduce the proportion of adults who are obese with the target population (Ford & Giles, 2003). Metabolic syndrome is a highly correlative factor in the incidence of diabetes. As such, one of the aims of the program must be to reduce the impact of factors related to constituent conditions. As a traditionally underserved demographic, African Americans are more likely to suffer from metabolic syndrome which contributes to the probability that they are more likely to become obese and thus develop diabetes.

Nevertheless, lifestyle habits are known to contribute to the incidence of metabolic syndrome, and thus, diabetes. Education as a form of prevention is the aim of this program. The more the target demographic is privy to information about healthy eating habits and physical activity, the more they will be able to make healthy lifestyle choices. Over time, these choices will translate into a lower risk for metabolic syndrome its consequences in general, and diabetes in particular.

The stakeholders and partners that will be involved in implementing the program are enumerated here. The primary stakeholders are members of the African American community living in urban areas. They have the most to gain by its success. Next, medical professionals serving the demographic stand to gain from this program in two ways. The first way is that their rate of positive outcomes will increase with respect to African Americans at risk for diabetes within the population they serve. The other way is that health care professionals will be able to concentrate on other pressing matters with the resources that have been freed up as a result of a lower incidence of diabetes and related illnesses that are part and parcel to the causative factors outlined above. Furthermore, we expect to gain partnership from funding agencies such as non-profit organizations that serve the affected community as well as government agencies such as county health departments.

A review of evidence for other similar diabetes intervention programs is conducted to substantiate the requirements of the program developed here. One study determined the impact and cost-effectiveness of primary care versus community intervention programs with respect to some of the risk factors associated with diabetes. 542 urban African-Americans with type 2 diabetes who were members of a managed-care organization in Baltimore, MD were divided into two groups for 2 years (Gary, Batts-Turner, Bone, Yeh, Wang, Hill-Briggs, Levine, Powe, Hill, Saudek, McGuire & Brancati, 2004). The control group had normal medical care. The experimental group participated in intensive intervention by a nurse case manager (NCM) and/or community health workers (CHW). The NCM/CHW team performed individual care focusing on diabetes management, complications, and social issues. NCM consultations were conducted annually, and CHW consultations were conducted up to three times per year or more (if necessary). Researchers found that NCM/CHW approach was cost-effective, and it worked to reduce the consequences associated with diabetes for urban African-Americans.

In another study, researchers studied one hundred fifty-one African American and Latino adults with diabetes recruited from 3 health care systems in Detroit, Michigan (Feathers, Kieffer, Palmisano, Anderson, Sinco, Janz, Heisler, Spencer, Guzman, Thompson, Wisdom & James, 2005). The subjects participated in the Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership diabetes intervention program. The curriculum focused on lifestyle training, and was taught by residents trained to present the material.  The aim was to improve diet, physical activity levels, and diabetes self-maintenance. Data was gathered before and after the course to quality-of-life, diet, physical activity, knowledge and behaviors, and hemoglobin A1C. What researchers found was statistically significant improvements in knowledge and behaviors with respect to diet and physical activity. Furthermore, compared to subjects within the same health care community (P=.160), the REACH program participants showed statistically significant improvement in A1C levels (P<.0001). This demonstrated the effectiveness of community training programs aimed at combating diabetes among urban African Americans.

In still another study, the effect of a community program aimed at improving lifestyle as a method of intervention was studied (Seidel, Powell, Zgibor, Siminerio & Piatt, 2008). 88 subjects were selected based on their propensity for metabolic syndrome. They were asked to participate in a 12-week lifestyle intervention program that taught about healthy weight loss and physical exercise. Over 45% lost up to 5% of their weight and more than 25% lost up to 7%. After 6 months, over 85% and over 65% maintained the 5% and 7% losses, respectively. Over 33% demonstrated improvement in one or more areas of metabolic syndrome, and after 6 months, nearly 75% of them maintained this improvement. After adjusting for age, gender, race, and average number of classes, there was an overall improvement in waist line measures and blood pressure levels overall. These statistics demonstrate the effectiveness of short-term education with respect to diabetes risk factors among African Americans living in urban environments.

Not only does this evidence demonstrate the effectiveness of the methods employed in mitigating the impact of diabetes in our population of interest, it also helps describe applicability to it. The program proposed here is manifold based on knowledge gleaned for previous research. Time-frames and techniques are barrowed from programs shown to have some success such that hypothetical program based on these findings addresses the problem of diabetes among urbanized African Americans.

The program consists of community training sessions and protocols carried out over a two year period. First, participants are asked to engage in an intensive one-on-one screening with a county nurse to determine their eligibility for the program along with an initial consultation about diet, exercise, diabetes management, and metabolic risk factors. Next, they would be asked to participate in a 12 weeks of classes aimed at educating them about the specific, individual changes they can make as a way of mitigating the consequences of both metabolic syndrome and diabetes. For the remaining months, they would attend 2 clinical visits with a nurse and up to 5 in-home visits by community educators to gauge their progress and refresh them about information they learned in the previous sections of the program.

Specific, measurable objectives are enumerated as a method of tracking the effectiveness of the program itself. At intake, participant baselines would be gathered based on waste line measures, metabolic syndrome risks, and quality-of-life measures. These same measures would be replicated at each of the nursing and community educator visits over the subsequent months.

Certain public health intervention programs have been shown to be effective in combating some prevalent diseases among certain populations. A program aimed at African American communities in urban areas has been developed here. The basic goal of the program is to reduce the impact of metabolic syndrome on African Americans who have diabetes that live in urban areas. The strategic goal is to help people reduce risk factors among this demographic. The program is intended to work at the county level, and it hinges upon research that outlines pathological implications of the risk factors as well as the outcomes of similar such programs to help combat problem of diabetes among urbanized African Americans.

References

Feathers, J.T., Kieffer, E.C., Palmisano, G., Anderson, M., Sinco, B., Janz, N., Heisler, M., Spencer, M., Guzman, R., Thompson, J., Wisdom, K. & James, S.A. (2005). Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership: Improving Diabetes-Related Outcomes Among African American and Latino Adults. American Journal of Public Health, 95(9): 1552-1560.

Ford, E.S. & Giles, W.H. (2003).  A Comparison of the Prevalence of the Metabolic Syndrome Using Two Proposed Definitions. Diabetes Care, 26(3):575-583.

Gary, T.L., Batts-Turner, M.Bone, L.R., Yeh, H., Wang, N., Hill-Briggs, F., Levine, D.M. Powe, N.R., Hill, M.N., Saudek, C. McGuire, M. & Brancati, F.L. (2004). A randomized controlled trial of the effects of nurse case manager and community health worker team interventions in urban African-Americans with type 2 diabetes. Controlled Clinical Trials, 25(1): 53-66.

Seidel, M.C., Powell, R.O., Zgibor, J.C., Siminerio, L.M. & Piatt, G.A. (2008).Translating the Diabetes Prevention Program Into an Urban Medically Underserved Community: A nonrandomized prospective intervention study. Diabetes Care, 31(4): 683-689.

Signorello, L.B., Schlundt, D.G., Cohen, S.S., Steinwandel, M.D., Buchowski, M.S., McLaughlin, J.K., Hargreaves, M.K. Blot, W.J. (2007). Comparing Diabetes Prevalence Between African Americans and Whites of Similar Socioeconomic Status. American Journal of Public Health, 97(20): 2260-2267.