Community-Responsive Interventions to Reduce Cardiovascular Risk in American Indians and Alaska Natives

Cardiovascular disease (CVD), also known as heart disease, is the disease of heart and circulation. Types of CVD include angina, heart attack, stroke, heart valve disease, heart failure and cardiomyopathy. There are several risk factors for CVD, the most noteworthy being obesity, high blood pressure, high blood cholesterol, physical inactivity, smoking and even ethnic background. According to the U.S. Department of Health and Human Services, Office of Minority Health, American Indians and Alaska Natives (AI / AN) are 1.4 times more likely to be obese (BMI=30 or more) than their white counterparts, 1.3 times more likely to have high blood pressure and 1.4 times more likely to be cigarette smokers than white adults. Figures speak for themselves; no wonder the incidence of coronary heart disease in them is twice as high as in their white counterparts.

Researchers can not pin point the exact reasons for obesity and diabetes epidemic in these communities. Although traditional diets vary by tribe and region, generally they are healthy and include plant products, wild rice, roots, berries, nuts, and lean meats. Similarly, these communities are physically very active – hunting, gathering, fishing, canoeing, traditional dances and games such as hockey and lacrosse are all part of their lifestyle. Some researchers suggested that switching to unhealthy Western diets and lifestyles may probably be the cause of these disorders.

Tobacco is a sacred plant in many ethnic cultures and is used in prayers and other rituals, found some studies. Smoking cigarettes means not adhering to AI / AN culture but the data shows otherwise. Here too, the researchers believe that the permissive attitudes of modern society towards smoking and smoking behavior may be the reason.

Five controlled trials have been initiated to test the effectiveness of community-responsive interventions to promote healthy behaviors that can reduce cardiovascular risk in AI/AN communities. Jared Jobe at the Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, USA, and his colleagues, have discussed these trials and published them as an article in the Journal of Primary Prevention.

In the first trial, the interventions are designed to reduce body mass index (BMI) by altering feeding practices in 600 infants and toddlers from the study communities. The intervention includes promoting breastfeeding, reducing sugar-sweetened beverage consumption, delaying solid food introduction, guiding introduction of type of food, encouraging development of motor skills, and creating safe play opportunities.

The second trial, Healthy Children, Strong Families, involves a home-based healthy lifestyle intervention for 150 AI families with children ages 2–5 years. The intervention includes involving parents using an intergenerational model, focusing on children, educating about nutrition, role modeling, forming partnerships between organizations, and incorporating family events.

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The third trial, A Cardiovascular Risk Reduction Program for American Indians with Metabolic Syndrome: The Balance Study, involves 200 AI adults with metabolic syndrome. The intervention comprises ‘a holistic lifestyle modification program with four components: cultural/spiritual, emotional/motivational, nutritional, and physical fitness and exercise’. The intervention group attends sessions which include discussions on AI culture and health, mental and physical health, nutritional information and healthy cooking demonstrations, and physical activities, such as walking, chair exercises, and AI dancing.

The fourth trial, enrolling 120 parents at risk for CVD, is about developing a non-stigmatizing intervention with a focus on parents to promote intergenerational wellness and future generations' health based on the community related domains of mind, body, spirit, and emotion.

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The fifth trial, initiated in Lakota population residing on or near the Cheyenne River Sioux Reservation in South Dakota, involves 180 adults with type-2 diabetes and dyslipidemia, hypertension, or both. The goal of this trial is to ‘determine whether a web-based diabetes and nutritional intervention, which has previously been found to improve diabetes control in disadvantaged inner-city populations, can significantly reduce the risk of CVD in this population’.

‘All five trials feature strong community partnerships, culturally tailored interventions, and a comparison group that receives benefits from participating in the study, consistent with community standards’, say the authors.

‘The high burden of CVD among AI/AN populations will worsen unless behaviors and lifestyles affecting CVD risk can be modified. These five trials, if successful, represent a starting point in addressing these significant health disparities’, they conclude.

Source: Jobe JB, Adams AK, Henderson JA, Karanja N, Lee ET, Walters KL. Community-Responsive Interventions to Reduce Cardiovascular Risk in American Indians. J Prim Prev. 2012;33(4):153-159. http://www.medscape.com/viewarticle/772106_1

Source-Medindia