GOOD AFTERNOON, APPROXIMATE
WELCOME.
I WILL TART WITH JUST A FEW
HOUSEKEEPING ITEMS.
THE CME CODE FOR THIS
PRESENTATION, THIS WEDNESDAY
AFTERNOON LECTURE SERIES, IS
50121.
AND IF YOU'RE WATCHING ON
VIDEOCAST AND WANT TO SUBMIT A
QUESTION FOR THE SPEAKER, PLEASE
USE THE SEND LIVE FEEDBACK
BUTTON ON THE VIDEOCAST AND THAT
WILL SEND YOUR QUESTION.
IT IS MY GREAT HONOR TO
INTRODUCE DR. DEBORAH MOSER,
DR. MOSER IS THE ENDOWED CHAIR
OF NURSING AS WELL AS ASSISTANT
DEAN OF THE Ph.D. PROGRAM AND
SCHOLARLY AFFAIRS AT THE
UNIVERSITY OF KENTUCKY.
DR. MOSER IS THE WITH THE
IMPOSSIBLE TO BUILD RAVASCULAR
CARDIOVASCULAR PROGRAM OR RICH
PROGRAM AND HER RESEARCH FOCUSED
ON INDIVIDUALS WITH VULNERABLE
CARDIOVASCULAR CONDITIONS, AS
WELL AS THOSE IN THOSE RURAL
POPULATIONS, AND THEIR
CAREGIVERS, IN ORDER TO IMPROVE
HEALTH AND TO ADVANCE HEALTH
EQUITY.
DR. MOSER HOLDS A MASTERS IN
NURSING AND A DOCTORATE OF
NURSING SCIENCE FROM THE
UNIVERSITY OF CALIFORNIA AT
LOS ANGELES, SHE HAS EARNED MANY
HONORS AND,A WARDS IF I GAVE
THEM ALL TO TO YOU WE WOULD BE
LISTENING TO THAT FOR THIS WHOLE
PER, I WILL POINT OUT JUST A
COUPLE OF THEM.
ONE, SHE HAS BEEN THE AMERICAN
HEART ASSOCIATION KATHLEEN JACOB
MENTORSHIP LECTURER, AND SHE IS
IN THE BRAGZAL NURSING
RESEARCHER HALL OF FAME WHICH IS
SPONSORED BY [INDISCERNIBLE]
WHICH IS THE INTERNATIONAL
NURSING RESEARCH SOCIETY.
ONE MORE REMINDER, THE CME CODE
IS 50121, AND IF YOU WANT TO
SEND A QUESTION, PLEASE USE THE
SEND LIVE FEEDBACK BUTTON.
AND WITH THAT, I'M DELIGHTED TO
INTRODUCE DR. MOSER.
[ APPLAUSE ]
>> THANKS, VERY MUCH KAREN.
I APPRECIATE THE INTRODUCTION,
I'VE HAD A GREAT VISIT AND SEE
ALL KINDS OF PEOPLE AND SEE THE
CLINICAL CENTER.
I'VE NEVER SEEN IT BEFORE, IT'S
ALWAYS BEEN THIS MYSTERIOUS
PLACE THAT A LOT OF NURSES THINK
ABOUT, MAYBE COMING TO AND MAYBE
WORK THERE, EVERYBODY HAS BEEN
SO WONDERFUL TO ME.
I WILL TALK ABOUT MY FAVORITE
TOPIC, CARDIOVASCULAR HEALTH
DISEASE
DISPARITIES--CARDIOVASCULAR
DISEASE DISPARITIES IN RURAL
AMERICA.
AND I TITLED IT, CAN THIS HOUSE
OF CARDS BE SAVED AND HOPEFULLY
YOU WILL SEE WHY, I HAVE THAT
VIEW POINT.
MY E-MAIL ADDRESS IS ON HERE,
PLEASE FEEL FREE TO E-MAIL ME
WITH ANY QUESTIONS AND I AM
HAPPY TO SHARE MY SLIDES WITH
ANYBODY, I NEED TO ALWAYS TART
WITH ACKNOWLEDGMENTS, FIRST OFF
THE COMMUNITY MEMBERS WHO ARE
REALLY IMPORTANT OBVIOUSLY TO
THIS RESEARCH, AND WHO HAVE BEEN
SO ENGAGED AND HAVE MADE IT SO
SUCCESSFUL.
THERE'S A CENTER FOR EXCELLENCE
OF RURAL HEALTH IN HAZARD
KENTUCKY IN APPALACHIA THAT WE
WORK WITH REALLY CLOSELY, GREAT
FUNDING FROM THE NATIONAL
INSTITUTES OF HEALTH, ALSO GREAT
FUND FREE RADICALS GENERATED
PATIENT CENTERED OUTCOMES
RESEARCH INSTITUTE AND HRSA, AND
FIEPALLY THE RICH HEART TEAM IS
THE TEAM I DIRECT IN WHO DOES
ALL THIS RESEARCH AND WE
DEVELOPED THIS AMAZING TEAM WITH
COMPLIMENTARY EXPERTISES AND
HAVE REALLY DONE SOME AMAZING
RESEARCH AND I COULDN'T DO
ANYTHING I DO WITHOUT THEM.
SINCE I'M TALKING ABOUT
RURALITY, I'LL START BY DEFINING
IT AND I THOUGHT, OKAY, I WILL
LOOK THIS UP AND I WILL SEE HOW
EASY IT IS, WELL, IT'S NOT THAT
EASY BECAUSE THERE ARE SO MANY
DEFINITIONS OF RURALITY, I LOVE
THE CDC, DEFINED URBAN AND
EVERYTHING ELSE IS RURAL.
SOW WE FOUND THE RURAL CONTINUUM
CODES TO BE THE MOST HELPFUL FOR
US, YOU CAN EASILY LOOK UP
SOMEBODY'S ADDRESS, IF THEY HAVE
1, TIMES REAL PEOPLE, HAVE
UNUSUAL ADDRESSES, BUT YOU CAN,
IF THAT'S THE CASE, YOU CAN
USUALLY FIGURE OUT THAT THEY'RE
RURAL AND IT'S DIFFERENTIALLY
BASED ON COUNTIES BASED ON
POPULATION SIZE AND ADJACENCY TO
METROAREAS AND THERE ARE 9 CODES
AND WE USE ANYTHING GREATER THAN
OR EQUAL TO 4 AS RURAL.
IT'S IMPORTANT TO KNOW THAT IN
THE UNITED STATES ABOUT
60 MILLION PEOPLE LIVE IN RURAL
AREAS, THAT'S 20% OF THE U.S.
POPULATION, AND WE DEFINED RURAL
AS A TOWN OF LESS THAN 2500, A
METROPOLITAN CENTER OF LESS THAN
50,000 OR AN OPEN COUNTRY AND A
LOT OF PEOPLE THAT WE WORK WITH
IN APPALACHIA, LIVE IN OPEN
COUNTRY AND I JUST LISTED, A FEW
NAMES HERE, I LOVE SOME OF THE
NAMES THAT RURAL CITIES ARE
GIVEN, BUG TUSSLE IS IN MONROE
COUNTY, KENTUCKY AND IT HAS THAT
NAME, IT HAS 376 PEOPLE, THERE'S
ONLY 11,000 PEOPLE IN THE COUNTY
AND IT HAS THAT NAME BECAUSE
IT'S NOTERIOUS FOR THESE FLYING
BUGS THAT ARE SO PROLIFIC AND
ARE AROUND AT CERTAIN TIMES OF
THE YEAR, LATE SPRING, SUMMER
TEEM THAT THEY'RE JUST SMASHING
INTO EVERYBODY AND SMASHING INTO
EVERYTHING, SO THEY NAMED THE
TOWN BUG TUSSLE, THE INDIVIDUAL
MEDIAN INCOME IS ABOUT $25,000 A
YEAR, MANCHESTER IS ANOTHER
COUNTY, ANOTHER CITY IN CLAY
COUNTY, KENTUCKY, IT HAS 1255
PEOPLE, MEDIAN INDIVIDUAL INCOME
IS LESS THAN $15,000 A YEAR.
AND AT ANY GIVEN TIME, IT'S
RECEIVED THIS NAME OR THIS
DISTINCTION OF BEING THE POOREST
COUNTY IN THE ENTIRE UNITED
STATES.
OTHER COUNTIES WILL FIGHT WITH
YOU OVER THIS, THEY WANT TO BE
THE POOREST COUNTY ABOUT YOU IT
HAS BEEN IN AND OUT OF THAT
CATEGORY FOR A LONG TIME.
FORTY-TWO% OF THE PEOPLE IN THAT
TOWN LIVE IN POVERTY.
IT'S ALSO BEEN NAMED THE FATTEST
COUNTY IN AMERICA AND MANCHESTER
THE FATTEST TOWN, SO PEOPLE FROM
THAT TOWN ARE SORT OF TIRED
BEING THE FATTEST, POOREST AND
THE MOST WITH DIABETES AND I
WILL TALK ABOUT SOME OF THE
REACTIONS PEOPLE HAVE TO THESE
NAMES THAT THEY GET.
HAZARD IS A TOWN IN PERRY
COUNTY, IT'S ABOUT 5000 PEOPLE,
IT HAS A LOW INDIVIDUAL MEDIAN
INCOME AND IT'S REALLY
DISTINCTIVE, IN THAT THAT
COUNTY, THAT SINGLE COUNTY HAS
THE WORST LIFE EXPECTANCY OF ANY
COUNTY IN THE UNITED STATES AND
IT'S MAINTAINED THAT DISTINCTION
FOR A WHILE.
SO YOU CAN BEIMIN TO SEE THAT WE
HAVE SOME SERIOUS DISPARITY ANDS
A LOT OF THESE ARE RELATED AS
YOU WILL SEE TOO CARDIOVASCULAR
HEALTH AND JUST SO YOU GET SOME
REFERENCE POINT, THE MEETING,
INDIVIDUAL INCOME IN 2021 WAS
60,000, IN THE UNITED STATES IN
GENERAL ASK IT HAS A POVERTY
LEVEL THAT'S ABOVE 35%, THE
HIGHEST IS I THINK ABOUT 47%.
I GIVE YOU THIS GREAT PICTURE OF
DWAEVER, KENTUCKY, ALL THESE
PEOPLE THAT ARE REALLY PROUD OF
THEIR AREAS BUT THEY NEED HELP
AND THEY RECOGNIZE THE NEED FOR
HELP TO ADDRESS SOME OF THE
SERIOUS DISPARITIES THAT EXIST
THERE.
THAT'S--I KNOW YOU ALL KNOW THE
MORTALITY FROM CARDIOVASCULAR
DISEASE IS NOT HOMOGENIUS ACROSS
THE UNITED STATES, AND YOU CAN
SEE THE AREA IN THE RED CIRCLE
IS THE AREA THAT I WILL
CONCENTRATE ON, THE DISPARITIES
COMPARED TO RURAL COMPARED TO
URBAN SO MY REGION THAT I AM
SPECIALIZING IN IS IN COUNTIES
IN KEN EXPN I HAVE WORKED IN
RURAL COUNT NEUROECTODERMAL
CALIFORNIA, NO 1 I THINKS
THERE'S A REAL RURAL AREA IN
CALIFORNIA BUT IN FACT, THERE
ARE FARMING AND RANCH
COMMUNITIES THAT REMAIN VERY
RURAL AND ALSO IN NEVADA AND YOU
CAN SEE FROM THIS SLIDE, THE
VERY HIGH RATES IN THE RED ARE
THE HIGHEST RATES OF DEATHS AND
YOU CAN SEE THESE FEW YEARS THAT
ARE REALLY CHARACTERIZED BY
APPALACHIA BUT ALSO THE HEART
AND STROKE BELT.
ANOTHER THING TO NOTE ABOUT THIS
AREA OR THAT THERE ARE CHANGES
IN LIFE EXPECTANCY, THERE ARE 13
U.S. COUNTIES THAT HAVE
EXPERIENCES DECLINES IN LIFE
EXPECTANCY SINCE 1980 ALL OF
THEM ARE RURAL, 8 OF THOSE
COUNTIES ARE IN APPALACHIA AND
KENTUCKY, SO YOU CAN SEE A REAL
CONCENTRATION OF SEVERE
DISPARITIES IN APPALACHIA, AND
YOU CAN SEE THESE DARK COLORS
ISSUES THE CHANGE IN LIFE
EXPECTANCY TO THE LEFT IS A
DECREASE, AND EVERY PLACE ELSE
THAT IT'S NOT ACTUALLY RED AND
ORANGE IS AN INCREASE OR A
MAIPTINENCE.
THIS IS A PICTURE OF APPALACHIA,
YOU CAN SEE AND THERE ARE
80--LET'S SEE, I WANTED TO POINT
OUT THIS AREA IN LIGHT IS
CENTRAL, IS CONSIDERED SEBTERAL
APPALACHIA, IT IS CONSIDERED THE
LEAST HEALTHY OF ALL THE
APPALACHIAN AREAS, IT'S IN THE
TOP 1% OF CARDIOVASCULAR
DISEASE, MORBIDITY AND
MORTALITY, IT HAS THE HIGHEST
RATES OF MULTIPLE CARDIOVASCULAR
DISEASE RISK FACTORS INCLUDING
OBESITY, DIABETES, PHYSICAL
DISABILITY, PHYSICAL INACTIVITY,
SMOKING, MULTIPLE CVD RISK
FACTORS ARE PRESENT IN THE
HIGHEST RATES IN A FEW COUNTIES
IN APPALACHIA, KENTUCKY, THE
CENTRAL APPLICATIONS RACHIA AREA
AND ARE HIGHER THAN ANY OTHER
PLACE IN THE UNITED STATES.
THE HEART DISEASE MORTALITY RATE
IS ABOUT 42% HIGHER THAN THE
NATIONAL RATE AND 80 OF THE
SUBREGION OF 82 COUNTIES IN
CENTRAL APPALACHIA HAVE HEART
DISEASE MORTALITY RATES THAT ARE
HIGHER THAN THE NATIONAL RATES,
ALMOST EVERYBODY IN THIS AREA.
WE BEGENERATED TO SEE SOME OF
THE SOURCE OF--BEGENERATED TO
SEE THE SOURCE OF SOME OF THESE
PROBLEMS WHEN WE SEE THAT HEART
DISEASE, MORTALITY RATES IN
DISTRESS COUNTYS IS 29% HIGHER
FOR THE RATE FOR NONDISTRESSED
AND NONDISTRESSED IS A
DISTINCTION GIVEN TO APPALACHIA
COUNTIES THAT ARE DISTRESSED
SOCIOECONOMICALLY WITH REGARD TO
YOBS, INCOME, RATES OF
DISABILITY, BUT LARGELY INCOME,
AND SO A COUNTY TO BE
DISTRESSED, NOT DISTRESSED,
MARGINAL DISTRESS, MOVING BACK
FROM DISTRESSED, MOVING INTO
DISTRESS, THEY SPEND A LOT OF
TIME MAKING THESE DISTINCTIONS
BUT THE MORE STRESSED THE WORSE
THE CARDIOVASCULAR DISEASE
RATES.
THIS IS A DPRAIT SLIDE THAT
DEMONSTRATES THE DIVERGENCE OF
LIFE EXPECTANCY EMPLOY YOU -
-EXPECTANCY.
I WILL DO IT THIS WAY, THERE IT
IS.
YOU CAN SEE WHEN IT STARTED
URBAN AND RURAL MORTALITY WAS
VERY SIMILAR, BUT AROUND IN THE
1980S, LATE 1980S, 1990S THERE
WAS QUITE A DIVERGENCE AND YOU
CAN SEE THE--THE GREATEST
MORTALITY IS IN RURAL COUNTIES
AND THAT'S CONTROLLING FOR A LOT
OF FACTORS LIKE RACE, INCOME,
EDUCATION, ACTUAL POVERTY LEVELS
AND RURAL RESIDENTS SO
CONTROLLING FOR THOSE THINGS AND
THEN RURAL RESIDENT WAS ON THE
AGE ADJUSTED MORTALITY AND THIS
DISTINCTION IS CARRIED OUT, THIS
SLIDE ONLY GOES TO 2016 BUT IN
FACT, IT'S A DIVERGING PROBLEM.
SO UNFORTUNATELY THESE RURAL
URBAN HEALTH DISPARITY VS
INCREASED OVER TIME, THOSE IN
RURAL AREAS HAVE POORER HEALTH,
MORE PSYCHOLOGICAL DISTRESS,
MORE DISABILITY, AND LESS
PHYSICAL ACTIVITY, COMPARED TO
THEIR URBAN COUNTERPARTS AND
THAT'S A GENERAL SPHAIMENT FOR
ALL RURAL AREAS IN THE UNITED
STATES, THERE'S A RURAL
MORTALITY PENALTY, PEOPLE CALL
IT THE MORTALITY PENALTY FOR
LIVING IN A RURAL AREA AND THE
PENALTY IS A RESULT OF HEART
INJURIES, COPD, LUNG INJURIES,
LUNG CANCER IN KENTUCKY AND IN
MANY RURAL AREAS, STROKE,
SUICIDE ASK DIABETES.
THE GAP IS ACTUALLY INCREASING,
CAN YOU SEE IT WAS ONLY .4 YEARS
IN 1969 TO 1971, AND IT WAS UP
TO 2 YEARS IN 2005 AND 2009, SO
IT ACTUALLY INCREASED, IT'S NOT
THAT THESE DISPARITIES ARE
REALLY RELATED TO US, THE AH
STEER ENVIRONMENT, THE
SOCIOECONOMICALLY AH STEER
ENVIRONMENT AND THE IMPACT OF
SOCIAL DETERMINANTS OF HEALTH.
SO WE, PEOPLE IN THIS, IN RURAL
AREAS, DEAL WITH SOCIOECONOMIC
DEPRIVATION, A NATIONAL LIBRARY
--PHENOMENON
CALLED POVERTY, IT EXISTS WHERE
IT'S IN THE COUNTY OR IN THE
REGION FOR LONGER THAN 5 YEARS
UNCHANGED AND IT IS A MUCH
HIGHER PREDICTER, THE PRESENCE
OF PERSISTENT POVERTY IS A HIGHY
PREDICTER OF ALL OF THESE
NEGATIVE CARDIOVASCULAR DISEASE
DISPARITIES THAT WE SEE.
THERE'S A NUMBER OF UNEQUAL
EXPWRIEWKS OF SERVICES THAT
CONTRIBUTE TO THESE DISPARITIES.
THIS IS A PICTURE THAT LOOKS AT
OR A FIGURE THAT DEMONSTRATES
THE SOCIAL IMPACT OF SOCIAL
DETERMINANTS OF HEALTH EMPLOY SO
WE HAVE BLACK RACE IN THE RED,
PERCENT WITHOUT COLLEGE IN THE
PURPLE DOTS, PER CAPITA INCOME
IN THE YELLOW LINES, PERCENT
POVERTY IN THE GREEN LINE AND
REALITY IN THE PERCENT RURAL
AREAS IN THE ORANGE LINE AND CAN
YOU SEE THE TOP 3 AREAS WHERE
THE HIGHEST MORTALITY IS, IS THE
CONVERGENCE OF BLACK RACE, LOW
EDUCATION AND REALITY.
YOU GET A BETTER PICTURE OF
WHAT'S REALLY GOING ON IN THESE
AREAS WHEN YOU LOOK AT A
SITUATION WHERE THESE
INVESTIGATORS IBT--INTEGRATE
CLUEDED THE INTERACTION OF
RURALITY AS IN POVERTY, YOU CAN
SEE THAT HERE, HUGE INCREASES IN
DEATHS, FROM OR RELATED TO THE
INTERACTION OF RURALITY AND
POVERTY, YOU CAN SEE THAT BLACK
RACE IS STILL A BIG PREDICTER AS
IS LOW EDUCATION, SO HUGE
PROBLEM TO CONSIDER WITH
RELATION TO THE RISK OF
MORTALITY AND
CERTAINLY--CERTAINLY ISSUE
SPECIALLY CARDIOVASCULAR DISEASE
MORTALITY.
AND I REALLY JUST WANT TO POINT
OUT THE IMPACT OF BLACK RACE, SO
WHEN I SAID THAT REALITY A
MORTALITY PENALTY, THERE'S AN
EVEN GREATER MORTALITY PENALTY
FOR BEING BLACK IN A RURAL AREA.
IF YOU LOOK AT THE RISK OF
CARDIOVASCULAR DEATH, IN A
PLAQUE PERSON LIVING IN
THE--BLACK PERSON LIVING IN THE
AREA WITH THE LEAST POVERTY, THE
HIGHER RATES OF EDUCATION, THEY
STILL HAVE WORSE OUTCOMES THAN A
WHITE PERSON LIVING IN THE WORST
RURAL AREA IN ANY COUNTY.
SO NOT ONLY IS THERE A RURAL
MORTALITY PENALTY, THERE'S AN
ESPECIALLY STRONG BLACK RURAL
MORTALITY PENALTY THAT REALLY
HASN'T BEEN ADDRESSED.
I WANT SHORTENED SHOW THE
REASONS WHY WE SEE HAD SOME OF
THESE, DISPARITIES AND THIS IS A
GREAT SLIDE THAT SHOWS WHAT
HAPPENS, LONGITUDINALLY, WHEN
INCOME CHANGES, AND ITS
RELATIONSHIP WITH CARDIOVASCULAR
DISEASE AND THIS IS FROM THE ERA
STUDIES AND YOU CAN SEE UP ON
THE LEFT THOSE DOTTED LINES ARE
THE CONFIDENCE INTERVALS, THAT
GREEN STRAIGHT LINE IS THE RISK
OR HAZARD FOR MORTALITY EMPLOY
YOU CAN SEE IT TARTS UP HIGH,
AND THE LOWER INCOME AS INCOME
CHANGES MORE AND IT IMPROVES AS
INCOME IMPROVES, THIS IS A
REALLY NICE COMPARISON BETWEEN
CARDIOVASCULAR RISK AND DISEASE
MORTALITY.
WHEN I WAS LOOKING AT SLIDES
ABOUT APPALACHIA, AND THE
PROBLEMS WITH APPALACHIA, I CAME
ACROSS THIS SITE THAT CALLED THE
APPALACHIA LEARNING INITIATIVE
AND THEY HAVE A LITTLE SIGN LIKE
THIS, IN RURAL KENTUCKY AND THEY
TALK ABOUT THE POPULATION AND
PEOPLE, UNDERINSURED, 37% IN
THIS COUNTY HAVEN'T GRADUATED,
HIGH COOL 52% LIVE BELOW THE
POVERTY LEVEL, 81% OF THE ADULTS
READ AT OR BELOW AN EIGHTH GRADE
LEVEL ON THIS AREA, AND YOU CAN
SEE ON THE RIGHT MANY OTHER
PROBLEMS AND THEY ARE--OR OTHER
PROBLEMS AND THAT I HAVE
HIGHLIGHTED THIS PROBLEM OF
LITERACY ADULT LITERACY AND
APPALACHIAN COUNTIES.
AND I THOUGHT, OKAY, THIS PLACE
WILL KNOW WHAT TO DO ABOUT ALL
THIS,--BUT THEY TALK ABOUT IT AS
A WORK IN PROGRESS THEY HAVEN'T
REALLY IDENTIFIED THE BEST
EVIDENCE YET.
SO WHEN WE LOOK AT SOURCES OF
RURAL DISPARITIES COMPARED TO
URBAN POPULATIONS, IT'S
IMPORTANT TO NOTE THAT RURAL
POPULATIONS HAVE HIGHER POVERTY
LEVELS, HIGHER RATES OF
PERSISTENT POVERTY, FEWER
WORKFORCE OPTIONS, HIGHER
UNEMPLOYMENT RATES, LOWER PAYING
YOBS, LOWER LITERACY, POOR
ACCESS TO HEALTHY FOOD ANDS MORE
FOOD DESERTS, PEOPLE OFTEN LOOK
AT ME LIKE, WHAT THEY CAN JUST
GO TO THE STORE, WELL, IF YOUR
STORE IS 20-MILES AWAY AND YOU
DON'T HAVE A CAR, YOU CAN'T JUST
GO TO THE STORE.
IF YOU LIVE AT THE TOP OF A
MOUNTAIN AND THE ROAD'S SNOWED
IN, 30, 40% OF THE YEAR, YOU
CAN'T JUST GO TO THE STORE AND
WHEN YOU GO TO THE STORE, YOU
MIGHT BE SURPRISED WHAT YOU SEE
SO THIS PROBLEM OF FOOD DESSERS
AND ACCESS TO HEALTHY FOOD
SYSTEM REALLY SEVERE THERE ARE A
LOT OF BARRIERS FOR
OPPORTUNITIES, AND I WAS TALKING
TO FOLKS EARLIER ABOUT YOU KNOW
PEOPLE OFTEN SAY WITH THAT 1,
TOO, JUST GO HAVE A WALK, WHAT'S
THE PROBLEM WITH THAT, BUT IF
YOU GO TO APPALACHIA AND YOU GO
TO MANY OF THESE AREAS, THERE
AREN'T SIDEWALKS, THERE'S NOT
AREAS THAT ARE FLAT, WHERE YOU
CAN WALK, THEY'RE ACTUALLY NOT
EVEN SAFE, IT'S NOT LIKE YOU'RE
HAPLY WALKING THROUGH THE WOODS,
THERE'S STREAMS AND CREEKS AND
ROCKS AND DIVOTS AND WE COME UP
ON THIS PHENOMENON WHERE PEOPLE
HAVE THEIR MOBILE HOMES RIGHT
NEXT TO THE WATER, SORT OF DOWN
IN A DIP, AND THEY--THERE'S NO
PLACE TO WALK AROUND THERE, SO
KIDS PUT UP BASKETBALL HOOPS
BECAUSE KENTUCKY, REALLY
UNIVERSITY FOR KENTUCKY IS
FAMOUS FOR BASKETBALL AND
EVERYBODY LOVES IT, SO THEY PUT
UP BASKETBALL HOOPS IN THE ROAD
AND YOU HAVE TO BE CAREFUL WHEN
YOU'RE DRIVING THERE BECAUSE
KIDS HAVE TO TO PAY ATTENTION
THERE, THAT YOU'RE NOT GOING TO
RUN KIDS OVER PLAYING BASKETBALL
AND IT IS VERY COMMON BECAUSE
THERE IS NO SAFE PLACE TO SAFELY
PLAY OR WALK.
SO IT'S A VERY COMMON PROBLEM,
THERE ARE MUCHA POORER HOUSING
OPGS, LOWER RATES OF INSURANCE,
EVEN THOUGH WE THINK WE'RE ALL
SUPPOSED TO HAVE INSURANCE NOW,
AND VERY HIGH RATES OF
UNDERINSURED FOLKS, POOR ACCESS
TO HEALTHCARE, ALL OF OF THESE
TYPES OF HEALTHCARE AND LONGER
TRANSPORTATION TIMES, IT TAKES 2
OR 3 OR 4 HOURS, TIMES TO GET TO
A PLACE THAT CAN JUST PROVIDE
BASIC CARE, LET ALONE OTHER
SORTS OF CARE.
SO WHEN I THINK ABOUT THE
SOLUTIONS I TALKED ABOUT THE
SOLUTIONS, WORKED WITH PEOPLE
ABOUT SOLUTIONS, THE THING THAT
BECOMES VERY IMPORTANT IS THE
NOTION OF COMMUNITY ENGAGED
RESEARCH, YOU REALLY CAN'T EVER
ADDRESS A PROBLEM THAT AFFECTS A
COMMUNITY TO SUCH DEPTH IN THIS
PROBLEM, IN URBAN AREAS, IN
RURAL AREAS, IN ANYWHERE WHERE
IT'S REALLY ENDEMIC PROBLEMS,
EPIDEMIC PROBLEMS WITHOUT
ENGAGING THE COMMUNITY.
SO WHERE YOU ENGAGE ALL THE
STAKEHOLDERS, SO THAT INCLUDES
THE PATIENTS, THE NONPATIENTS,
BUT THE PEOPLE LIVING IN THE
AREA WHO ARE SUSCEPTIBLE TO POOR
HEALTH, THE HEALTHCARE
PROVIDERS, THE BUSINESS PEOPLE,
THE CHURCH LEADERS, THE PEOPLE
WHO OWN GROCERY TORES, SO WE
REALLY HAVE WORKED ON DEVELOPING
A COMMUNITY ADVISORY BOARD THAT
INCLUDES ALL OF THOSE PEOPLE.
WE MEDE TO FECUS ON PROBLEMS AND
SOLUTIONS IDENTIFIED BY TAKE
HOLDERS, WE NEED TO DO WITH OUR
COMMUNITY ENGAGED RESEARCH
CULTURALLY APPROPRIATE
RECRUITMENT, FOLLOW UP AND
INTERVENTION OR EVERYTHING YOU
THINK YOU WANT TO DO IS GOING TO
FAIL THERE.
PEOPLE ARE VERY SUSPICIOUS OF
THIS AREA OF RESEARCHERS WHO
COME FROM UNIVERSITIES, DO SOME
RESEARCH AND THEN LEAVE AND
NEVER, YOU KNOW GIVE BACK IN ANY
WAY, SO YOU REALLY HAVE TO AVOID
THAT PROBLEM AS WE ALL SHOULD.
WE EMPLOY LOCAL STAFF AND
RESOURCES TO REALLY PROVIDE
JOBS.
IT'S 1 WAY OF PROVIDING JOBS,
BUT ALSO MAKING SURE HAVE YOU
THE RIGHT PEOPLE TO RECRUIT
FOLKS, AND TO DO EFFECTIVE
INTERVENTIONS AND YOU HAVE
TO--YOU NEED SUSTAINABILITY
PLANS, BECAUSE JUST COMING IN,
DOING A PROJECT, SHOWING IT WORK
ANDS LEAVING, EVEN IF--IT'S
STILL A DISASTER IF YOU DON'T
LEAVE PEOPLE WITH SOME OF THE
SOLUTIONS THAT THEY CAN ENGAGE
WITH TO SOLVE THE PROBLEM THAT
YOU IDENTIFIED AND YOU ARE LIKE
MAKING A BIG DEAL OUT OF, IF YOU
JUST LEAVE, REALLY
INAPPROPRIATE.
I SHOW THIS HOUSE HERE, I
COMMONLY PUT IT IN TALKS BECAUSE
IT SHOWS SOME OF THE PROBLEMS
THAT PEOPLE FACE IN THIS AREA.
SO AS YOU CAN IMAGINE, THIS
HOUSE, IT HAS LIKE A PLASTIC
WINDOW, IT'S, YOU KNOW NOT--IT'S
NOT LOOKING SO GOOD, AND IT HAS
A LIGHT ON THE OUTSIDE BUT THERE
IS NO LIGHT INSIDE, THERE'S NO
ELECTRICITY IN THIS HOUSE, AND
THERE'S A LITTLE TRAILER TO THE
SIDE, TO THE RIGHT HAND SIDE, SO
AN OLDER GENTLEMAN WITH HEART
FAILURE LIVES THERE AND HIS SON
TAKES CARE OF HIM THERE AND
LIVES IN THAT LITTLE TRAILER
THING BUT HE HAS MANY PROBLEMS
HIMSELF SO THESE ARE SOME OF THE
LIVING ENVIRONMENT AND PERSONAL
PROBLEMS YOU ARE FACED WHEN YOU
HAVE CAREGIVERS WHO ARE SICK AS
YOU ARE, YOU ARE IN THIS
SITUATION BEING REALLY ILL
ULTIMATELY AND HAVING VERY FEW
RESOURCES, SO COMMUNITY ENGAGED
RESEARCH CAN REALLY HELP THIS
ISSUE.
ALSO STAKEHOLDER ENGAGEMENT IS
ESSENTIAL AND YOU SAW I WAS
FUNDED BY PC ORI, AND A LOT OF
FOLKS KNOW HOW I GOT THE
STAKEHOLDERS A LOT OF PEOPLE
DON'T LIKE THE WORD STAKEHOLDER,
BUT IT INVOLVES THE ENGAGEMENT
OF PEOPLE WHO FOR WHOM THE
PROBLEM IS REALLY RELEVANT.
WE HAVE DONE FOCUS GROUPS WITH
PATIENTS, CARE PROVIDERS AND
COMMUNITY LEADERS, WE HAVE
COMMUNITY ADVISORY BOARDS THAT
ARE CONVENED BEFORE THE STUDIES
ARE BEGUN AND HELD THROUGHOUT
THE ENTIRE TIME, EVERY MONTH,
MANY OF THE COMMUNITY ADVISORY
BOARD ARE CO INVESTIGATORS, PAID
CO INVESTIGATORS, EVERYBODY WHO
ATTENDS A MEETING IS PAID, ALL
OF THE STAFF ARE HIRED FROM THE
COMMUNITY OF FOCUS, COMMUNITY
HEALTH WORKERS ARE ENGAGED TO DO
A LOT OF THE INTERVENTIONS, WE
INVOLVE PATIENTS IN THE
DISSEMINATION WHICH IS REALLY A
POWERFUL, POWERFUL WAY TO GET
THE RESULTS OUT AND GET
COMMUNITIES ENGAGED IN FOLLOWING
THE INTERVENTIONS OR SUGGIESTING
THE UPTAKE OF INTERVENTIONS THAT
YOU TEST.
I TALK ABOUT THE FIRST PATIENT
THAT I TOOK FOLLOWING 1 OF THE
STUDIES THAT I WILL TALK ABOUT
WHICH WAS VERY SUCCESSFUL IN
REDUCING CARDIOVASCULAR DEC
RISK, I TOOK HIM TO PC ORI WITH
ME AND I WAS PRESENTING AND HE
WAS PRESENTING AND HE HAD NEVER
BEEN OUT ON A PLANE AND HE HAD
VERY, VERY RARELY EVEN BEEN OUT
OF HIS COUNTY BUT HE WAS
WONDERFULLY ARTICULATE AND
REALLY EXCITED ABOUT THE
OPPORTUNITY AND WAS SO ENGAGING.
SO I SPOKE FIRST, AND YOU KNOW
PEOPLE WERE SORT OF, YOU KNOW,
MULTITASKING, LOOKING AT THEIR
COMPUTERS, DOING ALL THIS, AND
THEN HE GETS UP AND HE STARTS
TALKING AND EVERYBODY JUST PUTS
THEIR TOUGH DOWN, JUST STARES AT
HIM BECAUSE HE WAS SO ENGAGING
AND IT'S THE STORY OF HOW YOU
INTERVENE AND HOW YOU'RE
EFFECTIVE AND HOW TO KEEP IT UP.
SO, THIS IS REALLY A POWERFUL
WAY, AND HE ALSO DID SOME
DISSEMINATION IN THE AREAS THAT
WERE AFFECTED, HE ACTUALLY WAS A
GREAT GUY AND HE DID--HE PUT THE
GROUP TOGETHER THAT HE WAS IN
WITH THE INTERVENTION, GOT THEM
TO, YOU KNOW DO A LITTLE CLUB
WHERE, AFTER THE INTERVENTIONS,
WHEN THEY MET DURING THE WEEK,
THEY WOULD WALK UP THE HILL TO
THE SUPER OLD CHURCH, NO, THERE
WAS THE TEA HALL WHICH IS A
REALLY OLD BUILDING AND A BIGOLE
DEAL, ABOUT YOU HE WOULD GET
THEM TO YOU KNOW WALK UP THERE
AND START TO DO THE THINGS THAT
WE TALKED ABOUT WERE IMPORTANT
TO DO.
AND THEY WERE ALL REALLY
INTERESTED IN DOING THESE THINGS
BECAUSE THEY WERE FROM
MANCHESTER AND PLAY COUNTY, THE
POOREST, FATTEST COUNTY IN THE
AREA, THIS THE UNITED STATES AND
THEY DID NOT LIKE THAT AND THEY
REALLY UPON--AS MANY PEOPLE IN
THAT AREA FELT LIKE THEY DIDN'T
HAVE THE RESOURCES OR THE SKILLS
OR THE EXPERTISE TO ENGAGE IN
SIMPLE CARDIOVASCULAR RISK
REDUCTION, AND SO, THEY WERE
DELIGHTED TO GET THIS
INTERVENTION AND THEY WERE
REALLY AMAZINGLY COMPLIANT WITH
IT.
FINALLY, YOU NEED TO UNDERSTAND
THE ENVIRONMENT AND THESE ARE
PICTURES THAT SHOWS THE--YOU
KNOW YOU CAN SEE THE NUMBER IN
THE DARK BROWN OF HOUSEHOLDS,
PERCENTAGE OF HOUSE HOLES WITH
NO CAR, WHO ARE GREATER THAN A
MILE TO THE STORE, AND THERE'S A
HUGE PILE OF THEM IN THAT
EASTERN KENTUCKY AREA, AND WEST
VIRGINIA.
THERE'S YOU KNOW A--THERE'S A
MOBILE HOME WITH THIS IS THE
PICTURE WITH THE STREETS, SEE
THE SIGN THERE THAT SAYS, THE
RIDGE IS THE NAME OF THAT STREET
AND THAT IS THE STREET SO DO YOU
SEE THE STREET, I DON'T SEE THE
STREET, BUT YOU DRIVE DOWN THERE
AND YOU GET SORT OF INSTRUCTIONS
LOAMACYIC THAT WHEN WE WOULD GO
TO PEOPLE'S HOMES, YOU GET
INSTRUCTIONS TO GO DOWN THE ROAD
OR GO UP RIVER ROAD AND WHAT
THAT MEANT WAS GET ON THE ROAD
IN THE RIVER AND DRIVE UP THE
RIVER.
THAT TOOK A WHILE TO FIND
BECAUSE THAT WAS NOT CLEAR WHICH
KEPT CALLING AND CALLING AND
THEY SAID GET ON RIVER ROAD.
AND DO YOU KNOW WHERE THE RIVER
IS?
THAT WAS GOOD.
NOT ON GOOGLE.
[LAUGHTER]
WHEN I TALK ABOUT SOLUTIONS
UNDERSTANDING COMMUNITY
STRENGTHS IS ESSENTIAL AND AS I
SAID WE DID A LOT OF FOCUS
GROUPS AND PEOPLE ON THIS AREA
HAVE A STRONG COMMUNITY OF
AWARENESS OF LOCAL PROBLEM
OCCURS, PEOPLE WE RECRUITED MORE
THAN 1100 PEOPLE TO THE STUDY
THAT--1 OF THE STUDIES I'M GOING
TO TALK ABOUT IN LESS THAN A
YEAR.
THEY ALL ARE TOO HARD TO REACH
AND IF I DO IT RIGHT AND I WILL
TELL WHAT YOU RIGHT IS OR HOW WE
DO IT RIGHT, THERE'S A POTENTIAL
FOR HOME GROWN CHANGE, PEOPLE
ARE REALLY OPEN TO BEING PART OF
THE SOLUTION AND BEING PART OF
PUSHING NOVEL INTERVENTIONS OUT
THERE.
PEOPLE ARE VERY NEIGHBORLY,
THERE'S CONCERN FOR NEIGHBORS
FRIENDS FAMILY AND COMMUNITY
THERE, 'S GENUINE CONCERN FOR
THE HEALTH OF THE COMMUNITY AND
WILLINGNESS TO PROMOTE CHANGE TO
IMPROVE IT.
THERE WAS A HUGE DESIRE TO
IMPROVE HEALTH AND AN INTEREST
IN SELF-CARE WHICH IS OUR OWN
SELF-MANAGEMENT ON A DAILY BASIS
WHICH YOU WILL SEE IN A MINUTE
IS 1 OF THE GOOD THINGS I THINK
IS FUNDAMENTAL TO INTERVENING
AND THEY HAVE A RECOGNITION THEY
DON'T HAVE THE KNOWLEDGE AND
SKILLS THAT ARE NEEDED TO MAKE A
LOT OF THESE CHANGES.
SO PEOPLE ARE VERY, VERY OPEN TO
THIS INTERVENTION, ON THE LAST
DAY THAT WE WERE CLOSING OUT OUR
STUDY, THERE WERE PEOPLE IN
LINES, LIKE 20 PEOPLE IN LINES
WHO WANTED TO BE IN THIS STUDY,
SO WE LET THEM BUT WE DIDN'T
CLOSE IT OUT THEN BUT IT'S NOT
THE SITUATION WHERE WHEN I IRPT
VIEWED A LOT OF HEALTHCARE
PROVIDERS PEOPLE WHO WERE
TEMPORARILY WORKING THERE WHO
SAID THINGS LIKE THESE PEOPLE
DON'T REALLY WANT TO CHANGE,
THEY DON'T CARE, I'M NOT EVEN
TALKING TO THEM ABOUT IT, WHY
ARE YOU?
AND JUST A HUGE MISUNDERSTANDING
ABOUT WHAT PEOPLE NEED AND WANT
IN THESE AREAS, BASED ON
PERCEPTIONS THAT ARE REALLY
MISPERCEPTIONS.
ANOTHER IMPORTANT SOLUTION IS TO
ENGAGE IN SELF-CARE, TEACH
PEOPLE TO ENGAGE IN SELF-CARE,
WE OFTEN ENGAGE IN SELF-CARE,
99.9% OF OUR TIME IS WITH
OURSELVES AND NOT WITH DOCTORS
AND IN A HOSPITAL BUT BY
OURSELVES, TAKING CARE OF
OURSELVES, SO WE NEED TO
UNDERSTAND HOW CARDIOVASCULAR
DEC RISK AT AN INDIVIDUAL LEVEL
AND A FAMILY LEVEL AND THE
COMMUNITY LEVEL.
SO WE TEACH PEOPLE TO KNOW ALL
THEIR NUMBERS, TO KNOW WHAT THEY
MEAN, TO YOU KNOW FIND OUT,
BEINIZEY IS FIND OUT EVERYBODY
ELSE'S UNDERSTAND GOALS THAT ARE
RELEVANT TO THE PROBLEMS YOU
FACE AND SET THOSE AND
UNDERSTAND HOW TO ACHIEVE THEM,
LEARN THE SKILLS TO ACHIEVE
GOALS, DEVELOP PARTNERSHIPS WITH
OTHER PEOPLE WITH HEALTHCARE
PROVIDERS WITH BUSINESSES, AND
BUILTOT SELF-RELIANCE THAT'S
VERY WELL KNOWN AND VERY
CHAISHTISTIC OF MANY RURAL
PEOPLE AND SELF-CARE IN THIS
AREA INVOLVES A LOT OF PROBLEM
SOLVING TEACHING.
WHEN I SAY UNDERSTAND THE
ENVIRONMENT IN WHICH PEOPLE
LIVE, THIS COMES FROM THIS WHOLE
NOTION OF WHAT'S CALLED LEWIN'S
EQUATION, SO THEY ADAPT TO AN
ENVIRONMENT THEY LIVE IN, SO ANY
ASSESSMENT OF AN ENVIRONMENT IS
ESSENTIAL WHEN YOU ARE DEALING
WITH PEOPLE AND COMMUNITY WHO
ARE RURAL AND REMOTE, I HAVE
SOME, I WANT TO POINT OUT THE
IMPORTANCE OF THIS, WE TELL
PEOPLE ALL THE TIME, JUST EAT
MORE FRUITS AND VEGETABLES, I
MEAN, WHAT'S HARD ABOUT THAT,
WELL, HERE'S THE GROCERY STORE
IN THIS AREA, AND IT LOOKS LIKE
THAT, IT'S NOT JUST THAT PEOPLE
HAVE SHOPPED IT OUT, IT'S THAT
IT NEVER FILLS UP, THAT'S WHAT
IT LOOKS LIKE, IT MIGHT HAVE A
FEW MORE FRUITS AND VEGETABLES
OR THEY'RE SHOPPING AT THE LOCAL
GROCERY OR GAS MART, THERE'S NO
FRUITS AND VEGETABLES IN THERE,
TRUST ME.
SO YOU HAVE TO THINK ABOUT WHAT
YOU SAY WHEN YOU TELL PEOPLE TO
EAT MORE FRUSTAND VEGETABLES, SO
AND HOW YOU FACILITATE THAT,
THIS FELLOW DOESN'T HAVE
ELECTRICITY, OR FRIGE OR
FREEZER, HOOT NOT GOING TO BUY
FROZEN FRUITS AND VEGETABLES.
THIS STORE, THIS WAS A PRETTY
ASHES MAZING TORE WHERE WE
WALKED IN, WE OFTEN TELL PEOPLE
TO BUY LOW SOD I DIDN'T MEAN,
CANNED VEGETABLES, THEY REALLY
ARE NOT AVAILABLE IN A LOT OF
THESE AREAS, THERE'S--THERE'S NO
LOW SALT CANNED VEGETABLES OR
JUICES, THERE WERE A FEW FRUITS
WITH HEAVY IN SYRUP, NO FROZEN
FRUITS, NO LOW FAT OR LOW SODIUM
CHEESS, AND THIS IS THE STORE
WHEN IT STOPPED, THERE'S THE
STUFF THAT YOU CAN BUY AND WE
WENT INTO THIS STORE WHEN WE
WERE ASSESSING IT AND WE TALKED
IN AND WHEN YOU WALK IN, THE
ONLY THING THAT'S FULL, ARE
RACKS AND RACKS OF SODA POP, SO,
NOT WATER BUT SODA POP AND THEN
THESE REALLY SPARSELY FILLED
RACKS OF CANNED GOODS AND 1 LIKE
A FREEZER TYPE, A REGULAR FEASOR
TYPE FROZE EXPEN THIS IS AND
THIS IS WHAT PEOPLE HAVE TO
CHOOSE FROM SO ANOTHER THING WE
SAY, LET'S TALK ABOUT EATING
OUT.
IT'S EASY WHEN YOU EAT TOUT
CHOOSE MORE VEGGIES, WELL,
HERE'S AN EXAMPLE OF A
RESTAURANT SO LET ME TELL THAT
YOU FAST FOOD IS POPULAR IN NEEZ
AREAS BECAUSE PEOPLE LIVING IN
RURAL APPALACHIA, THEY WANT TO
NORMALIZE, THEY ARE TIRED TO BE
THE POOR, FAT, DOWN IN THE
HOLLERS, ALL THOSE THINGS WE SAY
ABOUT APPALACHIANS AND THEY WANT
TO GO TO THE FAST FOOD PLACE, SO
FAST FOOD PLACES ARE ACTUALLY
REALLY,A BUNKED ANT IN A LOT OF
THESE TOWNS, BUT THIS IS WHAT
YOU KNOW TRY TO GET FRUITS AND
VEGETABLES AT MCDONALDS, GOOD
LUCK.
THIS WAS A COMMON EATING PLACE
WE WENT TO, IT'S THE 1 THAT I
JUST--THIS 1 ON THE LEFT, IT'S A
RESTAURANT THERE, AND THEIR
SPECIAL IS A MEET AND 2 VEG, SO
LOOK OW CHEAP IT IS SO PEOPLE DO
GO OUT AND EAT BUT DO YOU KNOW
WHAT THE VEGS ARE SO WE WENT
ANDATE, THERE WERE 3 OF US AND
HERE'S THE FOOD, FRIED SHRIMP IS
1 OF THE MEETS AND YOU KNOW
THERE'S FRENCH FRIES AND COAL
SLAW, THAT'S THE VEG.
THERE'S HAMBURGER WITH MORE
FRENCH FRIES AND A--THAT MIGHT
BE POTATO SALIVA--SALIVA AID BUT
THE WHOLE IDEA OF A VEG BEING A
VEG, A DISCREET VEGETABLE IS NOT
IN THE THINKING OF THIS 1 AND 2
VEG.
ONE AND AND 3 IN THE SOUTH.
WE NEED TO THINK ABOUT
UNDERSTANDING THE PEOPLE IN
THEIR ENVIRONMENT AND HOW THEY
REACT TO THE ENVIRONMENT, AND
THIS LADY LOVES TO HAVE US TAKE
HER PICTURE AND SHE SAID, YOU
CAN TALK ABOUT ME ALL YOU WANT,
BUT SHE SPENT HER FIRST SEVERAL
MINUTES TALKING WITH THE LADIES
WHO WERE THE MUCH ASSISTANTS WHO
WERE ENROLLING HER IN A STUDY,
TELLING THEM, YOU KNOW YOU GIRLS
ARE STUPID, STUPID, STUPID.
IT WAS LIKE OH MY GOD THESE POOR
RESEARCH ASSISTANTS, THEY'RE 20
YEARS OLD, THEY'RE WANTING TO
BACK OUT OF THE TRAILER, BUT SHE
WAS TRYING TO SAY THAT, YOU KNOW
YOU'RE ASKING ME TO DO STUFF
THAT'S LITERALLY IMPOSSIBLE, SO
SHE DOESN'T HAVE A CAR, SHE
DOESN'T--SHE LIVERS BY HERSELF
SHE HAS FRIENDS AND FAMILY THAT
COME ONCE A MONTH AND SHE SNOWED
IN THIS THE WINTER AND
EVERYTHING WE WERE TELLING HER
WAS RIDICULOUS UNLESS WE ADAPT
IT.
OUR HEART HEGHT WAS THE NAME OF
OUR INTERVENTION AND THESE
PEOPLE TOOK TO IT AND THIS WAS A
GROUP OF SENIOR SIDES WHERE WE
LET THEM TELL US WHAT WAS WRONG
WITH THEIR ABILITY TO ENGAGE IN
ANY CARDIOVASCULAR DISEASE AND
HOW WE COULD FIX IT AND THAT
INTERACTION RESULTED IN THE
INTERVENTIONS WE DO AND THE
OUTCOMES.
SO 1 OF THESE STUDIES WE DID, WE
TRIED TO DETERMINE IF WE ADDRESS
ALL THESE ADVERSE SOCIAL
DETERMINANTS OF HEALTH, COULD
THEY BE OVERCOME?
THESE REDUCTIONS WERE DESIGNED
SPECIFICALLY FOR RURAL
DISTRESSED ENVIRONMENTS.
WE KNOW THAT LIFESTYLE
INTERVENTIONS CAN REDUCE CBD
RISK BY AT LEAST 40, 50%,
LIFESTYLE IS MOST EFFECTIVE WHEN
PATIENTS ARE GIIVE THE TOOLS TO
ENGAGE IN SELF-CARE AND WE
THOUGHT THAT THAT THESE
INTERVENTIONS NEED TO FOCUS ON
LIFESTYLE CHANGE BUT IT HAS TO
INCREASE THE ABILITIES OF THE
INDIVIDUALS WHO ENGAGE IN
SELF-CARE, AND THEY HAD TO BE
CULTURALLY APPROPRIATE, AND THEY
HAVE TO HAVE COMPONENTS THAT
OVERCOME SOCIAL DETERMINANTS OF
HELT BARRIERS, AND THAT WAS THE
HEART HEALTH INTERVENTION AND
SOMETIMES WHEN I DRIEB THIS
INTERVENTION, I AM LIKE OH GOD
THAT'S MY LIFESTYLE INTERVENTION
AND BUT THIS INTERVENTION IS
VERY DIFFERENT COME TO DEAL WITH
COMMUNITY BARRIERS AND OVERCOME
A LOT OF THE PROBLEMS OF THESE
ADVERSE SOCIAL DETERMINE NABTS
OF HEALTH THAT WILL IF
UNADDRESSED WILL NEVER LET YOU
BE SUCCESSFUL.
OUR SPECIFIC AIMS WERE TO
COMPARE THE IMPACT OF THE HEART
HEALTH INTERVENTION VERSUS USUAL
CARE ON 4 MONTH AND 1 YEAR CBD
RISK FACTOR OUTCOMES AND THIS
WAS SELECTED BY PATIENTS, YOU
KNOW A GOAL, GOOD EVIDENT BASED,
MATERIALS, SHOWING THAT WHEN YOU
PECULIAR A GOAL, YOU HAVE A
BETTER CHANCE OF ACHIEVING IT
AND THEN WE ALL WANTED TO TAKE
THE SAME RISK FACTORS AND
COMPARE 1 MONTH IMPACT IN THOSE
2 GROUPS ON ALL THE CVD RISK
FACTORS WE MEASURED SO RATHER
PEOPLE HAD HIGH BLOOD PRESSURE
OR NOT, WHETHER THEY HAD HIGH
LIPID PROFILES, I WILL TELL YOU
ABOUT THAT, BECAUSE WE--THE
ISSUE IS IN THIS AREA, IS THAT
THEY ARE JUST RAMPANT WITH
CARDIOVASCULAR DISEASE RISK
FACTORS.
SO I WILL GET TO TAKEN--THEY
POINT IN A SEC, HERE, THEY WERE
AT RISK, IT'S 2 GROUP RANDOMIZED
CONTROL TRIAL AND THIS DESIGN
SHOWS WHEN WE MEASURED AND I
TALKED ABOUT THAT, BASE LINE, 3
MONTHS OF INTERVENTION AND AT 4
MONTHS AND 12 MONTHS.
I INCLUDE THIS INCLUSION
CRITERIA HERE TO SHOW THAT YOU
YOU HAD TO FIRST OFF THEY DID
NOT, IF THEY DID NOT--TO BE
INCLUDED THEY COULD NOT HAVE A
PRIMARY CARE PROVIDER OR THEY
HADN'T SEEN 1 FOR MORE THAN A
YEAR, THAT WAS NOT DIFFICULT IN
THIS AREA AT ALL AND SECOND THEY
HAD TO BE AT RISK FOR
CARDIOVASCULAR DEC BY HAVING 2
OR MORE RISK FACTORS.
AND YOU SEE ALL THESE RISK
FACTORS HERE THAT WE ENROLLED
1100 PEOPLE IN A YEAR, THIS
THERE WAS NOT 1 SINGLE PERSON
THERE IS NOT 1 SINGLE PERSON WHO
HAD 2 OR MORE RISK FACTORS, NO 1
FAILED THIS EXCLUSION CRITERIA
WHICH IS REALLY ASTONISHING AND
VERYY WORRISOME.
OUR INTERVENTIONS WERE STANDARD
OF CARE, BUT WE AMPED IT UP A
BIT WHERE WE GOT AN APPOINTMENT
WITH THE PEOPLE IN THIS GROUP,
WITH THE PRIMARY CARE PROVIDER
THEY RECEIVED FREE REFERRAL TO
THAT PROVIDER AND THE FACTORS
THAT WE IDENTIFIED IN THE
SCREENING AND THEY WERE GIVEN
PREOR LOW CAST THIS APPOINTMENT
ABOUT YOU WE DIDN'T OTHERWISE
INFLUENCE THE DELIVERY OF CARE,
WE SENT A LOTTER THAT SAID WE'RE
REFERRING THAT PATIENT TO YOU,
WE I DEBTIFIED THESE RISK
FACTORS, BUT WE DEPARTMENT
INFLUENCE THE DELIVERY OF CARE
TO BE REFLECTIVE OF THE REALITY
OF USUAL CARE.
THIS HEART HEALTH ISHT VENTION
AND MANY MODIFICATIONS SINCE WE
STOPPED OR SINCE WE MODIFIED IT
FOR OTHER STUDIES IT INCLUDES
MULTIPLE INTERACTIVE MODULES AND
ISHT ACTIVE, WE ALWAYS PUT THAT,
WE ENGAGE PEOPLE EVERY MOMENT OF
OUR TIME, DOING THESE MODULES,
WE DON'T JUST STAND UP THERE TG
HEADS, WE ENGAGE THEM WITH
INTERESTING QUESTIONS, WE PAY
ATTENTION TO WHAT THEY SAY, WHAT
THEY'VE DONE BEFORE, WHAT THEIR
PROBLEMS ARE, AND SO AND THESE
MAJOR AREAS, RIGHT HERE, IT'S
DELIVERED OVER 12 WEEKS AND WE
DID GROUPS OF 10 OR LESS, AND WE
ALWAYS ENCLUED SPECIFIC BEHAVIOR
CHANGE PRINCIPLES IN AND A LOT
OF THESE ARE ADDRESSED DOWN
HERE, WE DEALT WITH THE
ENVIRONMENT, WE ADDRESSED LOW
LITERACY, AND ALL OF OUR
INTERVENTIONS, THEY WERE SKILLED
BASED PROMOTION OF SELF-CARE OF
CARDIOVASCULAR DISEASE RISK
FACTORS WHICH WORKS REALLY WELL
IN AN AREA YOU DON'T HAVE
ANYBODY TO GO TO EVEN IF YOU
WANTED TO FOR THIS SORT OF THING
AND IF YOU DID, THEY HAVE A
TENDENCY TO NOT CONCENTRATE ON
THESE AREAS, WE USE SUBJECTIVE
AND OBLIGATIONS YECTIVE MEASURES
FOR ALL OF THESE RISK FACTORS
FOR SPECIFIC GAMES IN 1 AND 2,
SO WE HAD A NICE MIX OF
SUBJECTIVE AND OBJECTIVE
MEASURES.
WE USE INTENTION TO TREAT
CONVENTION, WE LOOKED AT, TO SUM
THIS ALL UP, WE USED MIXED
MODELS FOR REPEATED MEASURES,
AND I AM NOT GOING TO SHOW YOU
ANYTHING ABOUT THIS, EXCEPT THIS
IS THE FLOW OF THE CONCERT
DIAGRAM, DOWN AT THE BOTTOM.
YOU WILL SEE AN 82% RETENTION
RATE WHICH IS PRETTY GOOD GIVEN
ANY SORT OF LONG-TERM LIFESTYLE
INTERVENTION AND ESPECIALLY A
RURAL 1.
WE HAD SIMILARITIES ACROSS ALL
OF OUR GROUPS IN THE BASE LINE
CHARACTER OF THETICS, THESE ARE
BASE LINE CHARACTERISTICS IN ALL
OF THESE THINGS THAT WOULD
CONFLUENCE OR AFFECT OUTCOMES
THAT WERE SIMILAR AT BASE LINE.
WE WERE STUNNINGLY SUCCESSFUL IN
GETTING PEOPLE TO MEET THEIR CVD
RISK REDUCTION GOALS SO IF ANY
GOAL WAS MET IT'S AT LEAST 50%
OF THE PEOPLE AND 16% IN THE
CONTROL GROUP, BECAUSE THEY HAD
A GOAL, TOO.
BODY WEIGHT 36%, BODY WEIGHT
GOAL WHICH IS TO LOSE 10% OR
MORE OF THEIR BODY WEIGHT, 65%
INCREASED PHYSICAL ACTIVITY, 88%
LOWERED THEIR BLOOD PRESSURE,
LOWERED LIPIDS ANOTHER 83% AND
HEMODPLOABIN IEE, AUDIENCE 1 C,
NOTICE LIKE AN ACTIVITY LIKE
SMOKING AND DEPRESSION ARE NOT
ON HERE THAT'S BECAUSE NO 1
PICKED THOSE AS GOALS.
NO 1 IN THIS REALLY HIGH SMOKING
AREA, PICKED SMOKING OR
DEPRESSION MANAGEMENT BECAUSE
THERE'S A HUGE STIGMA ASSOCIATE
WIDE DEPRESSION IN THIS AREA,
AND PEOPLE BELIEVE YOU SHOULD
JUST GET OVER IT BY YOURSELF AND
SO THEY DIDN'T PICK THAT BUT YOU
WILL SEE IN A SECOND, THAT
NONETHELESS, THERE WERE SOME
IMPACTS.
WE ACTUALLY HAD AN IMPACT ON
DECREASING SMOKING DEHAD A FEW,
BASED ON [INDISCERNIBLE] LEVEL,
AND WE THINK THIS IS A NICE
GUESTURE, WE BELIEVE THIS
HAPPENED BECAUSE THE TYPE OF
INTERVENTION WE DID WAS A WHOLE
HEALTH INTERVENTION, SO IT
INVOLVED GOOD DIET, PHYSICAL
ACTIVITY, MANAGING
CO-MORBIDITIES, UNDERSTANDING
THE CONDITION, SO, YOU COULD DO
THIS INTERVENTION TO TREAT ANY
OF THESE RISK FACTORS.
WE ALSO HAVE A DEPRESSION
MANAGEMENT AND STRESS REDUCTION
INTERVENTION AND WE THINK THAT
PEOPLE WHEN THEY SAW OH MY GOD,
I CAN DO THIS, I CAN EAT BETTER,
I CAN BE MORE PHYSICALLY ACTIVE,
I CAN CHANGE MY BLOOD PRESSURE,
THEY DECIDED, SOME PEOPLE
DECIDED TO GIVE IT A GO WITH THE
SMOKING AND YOU CAN SEE, THEY
GOT POSITIVE FEEDBACK FROM THE
PEOPLE IN THEIR GROUP AND FROM
US, SO THERE'S A REALLY AMAZING
LONG-TERM DECREASE IN SMOKING
BEHAVIOR.
BETTER, LOWER BODY MASS INDEX IN
THE INTERVENTION GROUP, THE
FRAMINGHAM 10 YEAR RISK SCORE
DECREASED, THERE WERE CHANGES IN
SIS TOLL-LIKE RECEPTORIC AND
DIAST OLDER PEOPLIC PRESSURE,
THE NUMBER OF STEPS THAT I
CANNEN PER DAY, INCREASED TOTAL
CHOLESTEROL INCREASED, WE DIDN'T
SEE A CHANGE IN DENSITY FOR
LIPOPROTEIN BUT DID SEE 1 IN
HIGH DENSITY AND IMPORTANTLY
DEPRESSION SO SO I DO A LOT OF
RESEARCH ABOUT DEPRESSION AND
MANAGING DEPRESSION AS A RISK
FACTOR FOR CARDIOVASCULAR DEC
AND THIS HAS ALWAYS BEEN IN OUR
STUDY SYSTEM MANAGEMENT OF
DEPRESSION TO DECREASE
CARDIOVASCULAR DEC RISK AND THIS
AREA, HAS HUGE PREPONDERANCE OR
DISPARITIES RELATED TO
DEPRESSION, SO IT'S IMPORTANT TO
MANAGE, SO WE THINK THAT THOSE
INTERVENTIONS LIKE THAT, THAT
FOCUS ON SELF-CARE, OR RISK
FACTORS AND NEGATIVE SOCIAL
DETERMINANTS OF HEALTH THAT ARE
DERIVED FROM COLLABORATION WITH
THE COMMUNITY CAN BE REALLY
EFFECTIVE, IT WAS EASY TO
RECRUIT, THERE WAS HIGH
RETENTION, IT WAS VERY
SUCCESSFUL, AND THAT THESE
INTERVENTIONS MIGHT BE WELL
DEVELOPED OR ADAPTED FOR OTHER
RURAL OR MEDICALLY UNDERSERVED
SOCIOECONOMICALLY DISTRESSED
AREAS.
LET ME TALK ABOUT
SUSTAINABILITY, WHICH IS REALLY
AN IMPORTANT ISSUE IN THE
LONG-TERM, THIS INTERVENTION,
ITS SUCCESS, IT WAS IMPLEMENTED
THEN AND TILL ONGOING AT A PLACE
CALLED HOME PLACE, WHICH
FIREFIGHTERS ADOPTED IT IN
SEVERAL AREAS AS THEIR
YEARLY--THEY WENT THROUGH THIS
TRAINING EVERY YEAR AS PART
OF--YEARLY HEALTH TRAINING THEY
HAVE TO DO, SEVERAL BUSINESSES
INCLUDED IT AND DECREASED THE
INSURANCE RATE FOR FOR THEIR
EMPLOYEES, IF THEY JOINED IN IT,
IT WAS ADOPTED IN HEGHT CARE
SYSTEM IN EASTERN AND WESTERN
KENTUCKY AS PART OF THE EMPLOYEE
HEALTH PROGRAM, PEOPLE GOT LOCAL
GRANDS AND LOCAL CLUBS BECAME
INVOLVED AND THE ADVANTAGE OF
LIKE, WE HAD THE HEAD OF THE
BETTER BUSINESS BUREAU IN RURAL
HAZARD, SHE GOT OUT AND
DEVELOPED THE SAFE WALKING
AREAS.
SOME OF QUESTIONS WE HAVE, YOU
KNOW, CAN WE CHAIRVELG POLICY
THAT IS REALLY FUNDAMENTAL TO
THE PROBLEMS WE CAN EXIST IN THE
FIRST PLACE.
WE CAN OVERRIDE A LOT OF THESE
PROBLEMS BUT FUNDMENTALLY THIS
PLACE WILL HAVE PERSISTENT
POVERTY FOREVER IF WE DON'T DO
ANYTHING ABOUT IT, THE LONG-TERM
IMPACT IS SOMETHING THAT WILL
HAPPEN LONGER THAN A YEAR AND WE
HOPE TO STUDY AND PROBABLY
DOESN'T ADDRESS USHED LYING
PROBLEMS IN THE LONG-TERM, IT
ADDRESSES PEOPLE'S ABILITY TO
DEAL WITH THOSE UNDERLYING
PROBLEMS BUT, YOU KNOW WE NEED
TO WORK ON THOSE UNDERLYING
PROBLEMS AS A COMMUNITY.
ACTUALLY AS A STATE, AS A PEOPLE
THESE ARE LONG-TERM PROBLEMS
THAT HAVE JUST EXISTED FOREVER.
WE DID A SIMILAR INTERVENTION, I
WILL GO FAST BECAUSE I WANT TO
ENTERTAIN QUESTIONS BUT
CAREGIVERS, THE NUMBER OF PEOPLE
PROVIDING INFORMAL CARE TO A
FAMILY MEMBER IS INCREASING AND
CARDIOVASCULAR DISEASE IS A BIG
RISK FACTOR IN INFORMAL
CAREGIVERS, CARDIOVASCULAR DEC
AS A CONSEQUENCE OR PRESENT IN
HIGHER RATES, IN INFORMAL
CAREGIVERS, COMPARED TO
NONCAREGIVERS, AND THOSE PEOPLE
ARE THEN STILL OFTEN REALLY
INVISIBLE TO THE HEMENT CARE
SYSTEM AND POLICY MAKERS, AND
RURAL CAREGIVERS ARE
PARTICULAR,LY AT RISK.
SO WE ADOPTED, WE DEVELOPED THE
RURAL INTERVENTION FOR
CAREGIVERS HEART HEALTH.
WE ARE--WE JUST FINISHED THIS
RANDOMIZED CONTROL TRIAL WITH
MULTIPLE OUTCOMES, SIMILAR TO
THE PREVIOUS STUDY, AND LET ME
SEE IF I JUST--THE DESIGN IS TE
TYPICAL 2 RANDOMIZED TRIAL,
STRATIFIED BY MALE AND FEMALE
SINCE THERE WAS WAY MORE FEMALE
CAREGIVERS, AND THIS WAS
DIFFERENT IN THAT IT WAS A VIDEO
TIME REALTIME CONVINCE BECAUSE
THIS WAS HELPFUL BECAUSE COVID
WAS HAPPENING IN THE STUDY WHEN
IT STARTED AND WE PROPOSED THIS
IN THE FIRST PLACE BECAUSE OF
THE DIFFICULTIES IN GETTING
PEOPLE WHO ARE TAKING CARE OF
SOMEBODY ELSE OUT OF THE HOME
AND IN A PLACE WHERE THEY COULD
GET AN INTERVENTION, SO WE'VE
SINCE ACTUALLY GONE TO THIS
DELIVERY METHOD AND IT WORKS
REALLY WELL BECAUSE WE HAVE
WONDERFUL ENGAGING
INTERVENTIONISTS, VERY SIMILAR,
INTERVENTION TO THE 1 BEFORE WE
GAVE PEOPLE MANY PADS IN BOTH OF
THESE, USUAL CARE WAS THE SAME
THING, HERE'S A GIANT CONCERT
DIAGRAM, BUT THE THING I WANT TO
POINT OUT AGAIN IS 85%
RETENTION, REALLY AMAZING.
AND I ONLY HAVE SOME OUTCOMES, I
HAVEN'T REPORTED ERGTS SO I
WON'T TALK ABOUT ALL THOSE BUT
REGARD TO ADHERENCE, CAN YOU SEE
MUCH BETTER ADHERENCE ACROSS
TIME AND SUSTAINED IN THE
INTERVENTION GROUP AND MUCH
BETTER, THESE ARE ALL INDICES OF
HEALTHY EATING BETTER IN THE
INTERVENTION VERSUS THE CONTROL
GROUP BY MANY OR ANY, BY MANY
INDICES AND THE SAME THING WITH
MORE AND AN IMPORTANT POINT IS
NO MODERATION BY AGE, SO
REGARDLESS OF THE AGE, YOUNGER
OLDER THIS INTERVENTION WAS
EFFECTIVE.
I THINK IT'S AN EFFECTIVE WAY TO
IRPT VENE WITH HARD TO REACH
ANYBODY RURAL PEOPLE EMPLOY WE
HAVE ANOTHER TRIAL THAT'S
ONGOING, THE COMBAT DS TRIAL IS
A COMPARATIVE EFFECTIVE STUDY TO
MANAGE DEPRESSIVE SYMPTOMS IN
RURAL PEOPLE WHO DON'T SEEK
CARE, COULDN'T GET CARE EVEN IF
THEY DID SEEK IT FOR DEPRESSION
BECAUSE OF ITS IMPACT ON
CARDIOVASCULAR DISEASE EMPLOY SO
WE'RE STUDYING PEOPLE WITH
DEPRESSION AND USING 2 DIFFERENT
VIDEO CONFERENCE WITH A LIVE
INTERVENTIONIST, CBT
INTERVENTION AND THEN, A
SELF-RUN CBT AND YOU GO ONLINE
AND TALK TO THE PERSON.
WE ARE LOOKING AT OUTCOMES HERE
BY SOCIAL DETERMINANTS OF HEALTH
AND COGNITIVE FURCHES, WE'RE
WORKING ON ANOTHER TRIAL OF
MANAGING DEPRESSION BEFORE YOU
MANAGE CARDIOVASCULAR DISEASE
RISK FACTORS AND WE'RE TRYING TO
TURN PARTS OF THIS INTERVENTION
INTO AN AT-BASED APPROACH, THE
INTERESTING PART HERE IS THAT
IT'S--DONE WITH MOTIVATIONAL
IRPT VIEWING AND STAGES BASED ON
TAIJING OF CHANGE AND YOU WONDER
WHO THE HECK IS GOING TO BE THE
COACH, WELL, THERE'S SOME
AMAZING AI GOING ON AND
THIS--THE COACHING OR THE PEOPLE
WHO ARE WORKING WITH US TO
DEVELOP THIS AI COACHING ARE
ACTUALLY BETTER, THE AI COACH IS
BETTER AT MOTIVATIONALLY
INTERVIEWING THAN I AM.
SO IT'S NOT LIKE THOSE STUPID
BOTS THAT YOU GET ON THAT WANT
TO CHAT WITH YOU AND YOU WANT TO
KILL THEM AND YOUR COMPUTER
AFTER 2 MINUTES.
IT'S LIKE, THIS AMAZINGLY
INTUITIVE AI THAT I WAS SO
AGAINST AI, BECAUSE OF ALL THESE
EXPERIENCES AND CHAT GPT,
WHATEVER, BUT IT'S JUST
PROGRESSING AT SUCH A RATE THAT
THIS AI COACHING MIGHT TURN OUT
TO BE WELL.
I WILL HAVE 2 MORE SLIDES.
I WANT TO TALK ABOUT RESILIENCE,
AND THIS IS A SLIDE THAT ISSUE
ANYBODY CAN FIND ANYWHERE,
PEOPLE ARE STUDYING THIS AND IT
HAS TO DO WITH THE COUNTIES IN
THE FAITION OF DAOF THER, SO,
TERRORIST ATTACK, ON VIERMAL
DISASTERS, AND IN THIS CASE,
WHAT WE'RE TALKING ABOUT AND YOU
CAN SEE THIS PART OF THE MAP
WHERE PEOPLE HAVE A GREAT DEAL
OF RESILIENCE ACTIVITY.
SO ABOUT 2 YEARS AGO, THERE WAS
THE WORST FLOOD IN EASTERN
KENTUCKY, WHICH IS WHERE WE DO
OUR WORK IN HISTORY, IT KILLED
50 SOMETHING PEOPLE, IT
DESTROYED HUNDREDS AND HUNDREDS
OF HOMES AND COMPLETELY
DESTROYED THE INFRASTRUCTURE, IN
HAZARD, THE PLACE I'VE BEEN
TALKING ABOUT, THERE'S NO
INTERNET, THERE'S NO, THERE WAS
NO PHARMACIES, THERE'S NOTHING,
NOTHING THAT YOU KNOW THE
GROCERY TORES ARE RUINED, THE
BES ARE RUINED AND IT IS A
CONSEQUENCE OF PROBABLY GLOBAL
WARMING AND POOR MANAGEMENT AND
NATURAL RESOURCES AROUND THE
AREA BUT I WONDER ABOUT THE--ANY
IMPACT THAT WE'LL EVER HAVE WHEN
WE'RE FACED WITH THESE SORTS OF
DISATTERS IN INCREASING NUMBERS,
KENTUCKY AS OTHERITATES IS FACE
WIDE ENDLESS DAOF THERES THAT
DESTROY THESE SUPER MARGINAL
AREAS ANYWAY BUT PEOPLE TILL
WANT TO LIVE THERE, SO WHAT ARE
WE GOING TO DO, YOU KNOW AS A
COMMUNITY, AS A HEALTHCARE
COMMUNITY, AS YOU KNOW A NATION
TO RESOLVE SOME OF THESE ISSUES,
SO THAT ALTHOUGH THIS WASN'T A
SIMPLE FLOOD, IT WAS A FLOOD
THAT MANY PEOPLE WANT TO RECOVER
FROM, AND DO RECOVER FROM.
BUT IN THOSE AREAS WITH THE LOW
RESILIENCE, THAT WILL HAPPEN,
THEY WILL GO BACK AND LIVE HERE
BUT IN EVEN WORSE CIRCUMSTANCES,
SO LET ME FINISH WITH QUESTIONS
IF YOU KNOW KUDZU, COVERING UP
ALL THE PROBLEMS BUT WREAKING
HAVOC ANYWHERE.
>> OKAY, THANK YOU.
>> THANK YOU.
KD--SALLY ARK PLAWZ. [ APPLAUSE]
>> LET ME REPEAT THE CME CODE,
50121.
CERTAINLY WELCOME QUESTIONS FROM
THE AUDIENCE HERE, AND LET ME
JUST START OFF WITH FACTUAL
CHECK, WHAT HAPPENED BETWEEN
1992 AND 19 THAT WAS SUCH A
LARGE JUMP IN THE DEATH RATE?
IS THERE A NEW DEFINITION OF
SOME SORT?
>> NO IT PROBABLY WAS, I SHOULD
MENTIONED IT, BECAUSE I NOTICE
IT TOO, A NOTICE IT, ALL THE
TIME BUT PEOPLE THINK IT HAD TO
DO WITH BETTER JUST CHRONICLING
OF DEATH RATES, AND THAT WAS
CARDIOVASCULAR DEC DEATH RATES
OR NO, IT WASN'T SO IT JUST WAS
PROBABLY BETTER RECORD KEEPING,
THAT'S WHAT PEOPLE THINK.
>> OKAY, DR. OWENS?
>> HI, I ENJOYED YOUR TALK.
HAVE YOU TESTED ANY FINANCIAL
LITERACY INTERVENTIONS?
BECAUSE 1 THING I NOTICED IS
THAT HEALTHIER LIFESTYLE HELPS
WITH THE MONEY AND SEEING THE
MONEY ACCUMULATE IN THE PIGGY
BANK CAN BE AN INCENTIVE.
>> YEAH, SO WE USE THAT MEASURE
OF ELT LITERACY AND BASE OUR
INTERVENTIONS ON HEALTH LIT RASE
MODEL EXPE A LOT OF THE
MOTIVATIONAL INTERVIEWING WE DO
TALKS ABOUT ACHIEVING THOSE
SORTS OF GOALS, YOU KNOW IT'S
BASED ON WHAT PEOPLE SAY THEIR
GOALS ARE, THEY SAY THINGS LIKE
I CAN'T GET SICK ANYMORE, IT
COSTS ME TOO MUCH AND SO WE CO
INCLUDE THAT BUT IT NEEDS TO BE
MORE INTENTIONAL, THAT YOU'RE
ABSOLUTELY RIGHT THAT IT'S A
GOAL THAT MANY PEOPLE WANT TO
ACHIEVE AND IF WE WERE MORE
INTENTIONAL WITH TI THINK IT
WOULD BE EFFECTIVE.
NTHANK YOU NTHANK YOU.
N.
>> THANK YOU FOR A LOVELY TALK.
I AM INTERESTED IN DISCOVERING,
DO YOU HAVE MUCH IN THE WAY OF
RACE DIFFERENCES OR IS IT MOSTLY
WHITE?
>> APPALACHIAN KENTUCKY IS
MOSTLY WHITE AND YOU MAY HAVE
SEEN THAT 1 SLIDE AND YOU KNOW
IT'S RESULTED IN OUR DRIVE IN
THE NEXT STUDIES THAT WE DO, YOU
NOTICE THE RICHEST STUDY, WE ARE
GOING TO STRATIFY BY RACE, SO
THAT WE INCLUDE AT LEAST 50/50,
SO WE OVERENROLL BY DIFFERENT
RACES OTHER THAN WHITE AND WE
WANT TO DO A GOOD BLACK AND
WHITE COMPARISON, NOT COMPARISON
BUT ENOUGH PEOPLE TO MAKE
CONCLUSIONS ABOUT THE
EFFECTIVENESS OF ISHT VENTIONS
AND IT'S AN AREA THAT'S BEEN
NEGLECTED BY US AND EVERYONE
BECAUSE THEY ALL SAY, OH,
THERE'S ONLY WHITE PEOPLE LIVING
THERE, THAT'S NOT TRUE AND THERE
ARE MANY OTHER AREAS OF
APPALACHIA THAT ARE HEAVILY
BLACK AND WE JUST HAVE REALLY
INCREASED OUR ABILITY AND
THOUGHTS ABOUT ON DOING THAT IN
ALL SEBS QUENT STUDIES HAVING
MUCH MORE DIVERSITY.
GREAT QUESTION.
>> THANK YOU.
>> HI, DR. MOSER, THANK YOU SO
UPON FOR YOUR TALK, TIFFANY
POWELL AT NHLBI, CAN YOU TALK
ABOUT ANY EFFORTS THAT MAY BE
HAPPENING TO COMBINE OR TO BRING
TOGETHER, URBAN COMMUNITY
ADVISORY BOARDS WITH RURAL
COMMUNITY ADVISORY BOARDS, A LOT
OF THINGS YOU BROUGHT UP IN
TERMS OF ASSETS ARE THINGS THAT
WE TALK ABOUT IN OUR--NYES.
>> --COMMUNITY BASED WORK I
WOULD LOVE TO HEAR YOUR THOUGHTS
ON THAT.
>> I THINK IT'S A FABULOUS IDEA
BECAUSE YOU POINT OUT THE
OBVIOUS THAT IT'S, YOU KNOW FOOD
DESERTS EXIST IN URBAN AREA,
HORRIBLE FOOD DESERTS OR
INEQUITY IN WHAT'S IN A STORE, A
WAL-MART, IN A YOU KNOW A LOWER
INCOME AREA, DOESN'T HAVE THE
FRESH FRUITS AND VEGETABLES IN A
HIGHER INCOME AREA AND IN FACT
THEY'RE MORE EXPENSIVE WHERE HE
LIVE, IT'S JUST SORT OF SHOCKING
BUT, SO MANY OF THE SAME
PROBLEMS, NO SAFE PLACE TO
EXERCISE, YOU KNOW, SCARED TO GO
TO THE DOCTOR, THE DOCTORS ARE
AREN'T IN THE AREAS OR THE
HEALTHCARE PROVIDERS, OFTEN.
SO I WORK WITH
DR. [INDISCERNIBLE] WILLIAMS,
AND SHE DOES SIMILAR BUT, YOU
KNOW HE CONCENTRATES ON
PREDIABETES AND SHE STUDIES
PLAQUE PEOPLE WITH PREDIABETES
AND I'M A CO INVESTIGATOR ON HER
GRANT WHERE SHE HAS A FABULOUS
COMMUNITY ADVISORY BOARD AND SHE
DOES HER WORK IN CHURCHES AND
ITS IN TOWN ISSUES NOT RURAL AND
I HAVE THOUGHT ABOUT WORKING
WITH HER TO COMBINE THOSE
COMMUNITY ADVISORY BOARDS
BECAUSE PATIENTS ARE SUCH AN
INCREDIBLE SOWSHES, NOT JUST
PATIENTS BUT THE PEOPLE WHO LIVE
IN THE AREAS ARE PERFEC, WHEN
I FIRST THOUGHT ABOUT HAVING A
COMMUNITY ADVISORY BOARD, I SAID
EON, GOOD LORD, WHAT ARE THEY
GOING TO KNOW IN WELL, IN FACT,
BUT I WILL BE HONEST THAT'S WHAT
I THOUGHT AT FIRST BUT AFTER 1
MEETING I REALIZE THEY ACTUALLY
KNOW EVERYTHING.
AND WE REALLY NEED TO TALK TO
THEM AND FIGURE IT OUT, AND
THEN, SO I WORKED WITH DR. MUD,
DR. MUD DOES WORK WITH HISPANIC
PEOPLE, SHE HAS A FABULOUS
COMMUNITY ADVISORY BOARD AND ALL
OF US, YOU KNOW PUT TOGETHER,
COULD COME UP WITH IMRAIT
SOLUTIONS THAT CROSS ALL THESE
AREAS.
NTHANK YOU SO MUCH NGREAT POINT.
THANK YOU.
>> ALAN FROM HEART LUNG AND
BLOOD, ENJOY TODAY VERY MUCH,
HAVE 2 RELATED QUESTIONS.
IS THERE A NEED FOR PERHAPS MORE
INTENSE INTERVENTIONS IN AND IF
SO, I CAN IMAGINE IN THE GENERAL
POPULATION, ADHERENCE COMPLIANCE
FOR EXAMPLE WITH STATIN SYSTEM
TERRIBLE AND WHETHER THAT'S AN
ISSUE AS WELL THAT NEEDS TO BE
ADDRESS?
>> IT IS AND WE HAVE BEEN, I
THINK I WOULD SAY WE'RE VERY
LUCKY BECAUSE WE WERE REALLY
SUCCESSFUL IN GETTING
INTERVENTIONISTS AND RECRUITERS
FROM THE COMMUNITY AND THAT WAS
A GREAT WAY TO GET TO KEEP
COMPLIANCE WITH THE INTERVENTION
UP AND KEEP ENIMAIJMENT IN THE
ISHT VENTION UP, WE HAVE A
STUNNING INTERVENTIONIST WHO IS
FROM, YOU KNOW RURAL KENTUCKY,
AND SHE IS A PSYCHIATRIC NURSE
PRACTITIONER WITH EXPERTISE IN
CARDIAC, SO, I HAVE KEPT HER FOR
20 YEARS AND I HOPE I
ALWAYS--SHE CAN MOVE WITH ME
WHEN I MOVE, SHE IS SO ENGAGING
AND SO PERFECT, IT WORRIES ME
THAT TIMES THAT SUCCESSFUL
INTERVENTIONS OF OURS, ARE
INTERVENTIONIST DEPENDENT SO WE
TRIED TO SORT OF BOTTLE HER AND
FIGURE OUT THE CHARACTERISTICS
OF BEING A GREAT INTERVENTIONIST
AND IT HAS TO BE EMPATHETIC, YOU
HAVE TO BE ENGAGING, YOU HAVE TO
BE WILLING TO CONTRARY ON
CONVERSATIONS THAT APPEAR TO NOT
BE RELATED TO WHAT WE'RE TALKING
ABOUT AT ALL.
BUT I THINK WE WILL COVER THAT
IN THE LONG-TERM EVEN THOUGH WE
HAD THESE 12 MONTH IMPACTS WE
ARE GOING TO HAVE THAT HAVE--OH
GEEZ, SORRY, MORE INTERVENTIONS
THAT YOU HAVE TO INTERVENE, YOU
HAVE TO GET IN THERE YEAR AFTER
YEAR, I THINK TO SEE ANY SORT OF
LONG-TERM SUCCESS AND ANY OF
THESE LESS INTENSIVE
INTERVENTIONS THAT WE TRY.
SO THIS WAS A MULTIPLE
CARDIOVASCULAR DISEASE RISK
INTERVENTIONS AND EVEN THE
SINGLE FOCUSED INTERVENTIONS ARE
NOT OFTEN SUCCESSFUL, SO, YOU
CAN IMAGINE TRYING TO MAINTAIN
MULTIPLE CARDIOVASCULAR DISEASE,
RISK FACTOR REDUCTION IS
DIFFICULT SO I DO THINK MORE
INTENSIVE INTERVENTION IS
NEEDED,.
>> I WAS THINKING AS PRIME--AS A
SECONDARY PREVENTION BUT YOU
ANSWERED MY QUESTION.
>> PRIME--OH YES, YES, YES.
PERSPECT, YES, WE ARE DOING
WORK WITH GRAND PARENTS, THEY
WOULD BE SECONDARY USUALLY BUT
WE ALSO ARE TRYING TO DO WORK IN
SCHOOLS HARDER JUST BECAUSE OF
THE RULES ABOUT GETTING INTO THE
SCHOOLS BUT THE PERFECT PLACE TO
DO THIS KIND OF WORK.
THANK YOU FOR CLARIFYING THAT
EMPLOY I WILL ANSWER ANY
QUESTIONS EVEN IF YOU DIDN'T ASK
IT.
>> DR. MOSER, THANK YOU VERY,
VERY MUCH CLEARLY THIS HAS BEEN
A VERY INTERESTING TOPIC THAT'S
LED TO A LOT OF ENGAGEMENT, FOR
THOSE OF YOU WHO ARE HERE AT
LIBRARY IPSETT, YOU ARE WELCOME
TO JOIN DR. MOSER AND THE REF OF
US, WE'RE GOING TO HAVE A LITTLE
RECEPTION TIME OUTSIDE, FOR
THOSE OF YOU WHO ARE VIDEOCAST,
THANK YOU FOR YOINING US AND WE
ARE SO GLAD TO HAVE YOU HERE.
THANK YOU.
>> APPRECIATE IT, LOVE IT.
IT WAS GREAT.
[ APPLAUSE ]