December 12th, 2017
Background: Nationwide, as well as within the city of Baltimore, a number of agencies are now partnering with housing authorities to address the multiplicity of health risks that may characterize the residents of public housing communities. National data reveal that approximately one-quarter of all public housing residents live in low-income areas, and more than 40 percent of housing authority residents live in majorityAfricanAmerican neighborhoods. The average income for the 50,000 residents in Baltimore City public housing is $7,000 per year. Currently, the National Heart, Lung, and Blood Institute (NHLBI) is collaborating with the HousingAuthority of Baltimore City (HABC) in an effort to decrease cardiovascular disease (CVD)-related illness and death in these exceptionally impoverished public housing communities. Purpose: Before designing and implementing a public housing public health program, consumer assessments are necessary to create effective heart health programs by promoting knowledge, attitudes, and behaviors among public housing residents. NHLBI and HABC conducted a consumer assessment in July andAugust 2002 to assess the current levels of cardiovascular health (CVH) awareness, knowledge, and behaviors among public housing residents in Baltimore City. This consumer assessment project was an outcome of the formation and planning activities of the Baltimore City Cardiovascular Health Partnership (BCCHP), a collaborative partnership to address CVH in Baltimore City. The partnership is comprised of a core group of health and housing institutions in Baltimore City including: (1) HABC; (2) Morgan State University Public Health Program; (3) Baltimore Field Office of the U.S. Department of Housing and Urban Development; and (4) the Baltimore City Department of Recreation and Parks. Methods: NHLBI and HABC used a small group discussion assessment approach. Each session consisted of nine or fewer participants, a lead facilitator, resident cofacilitators, graduate student notetakers, an NHLBI observer, and occasionally additional resident and resident leader observers. The topic areas of inquiry were: ?? What are the current levels of CVH knowledge among public housing residents? ?? To what degree are the current levels of knowledge reflected in the health practices and behaviors of public housing residents? ??Are CVH knowledge levels, practices, and behaviors affected by public housing as a community and social context for CVH? ?? What types of educational products and behavioral skills and techniques can be used to effect CVH-related behavioral changes amongst public housing residents? In order to gain insights regarding the areas listed above from public housing demographic subgroups, males and females ages 15 older were recruited and assigned to age and gender-specific sessions. Findings: Overview: Public housing residents had a preexisting knowledge and awareness of heart healthy lifestyles and CVD risk factors. The comments made during the small group discussions suggest that programs targeting heart healthy lifestyles for the public housing community population must address the various stages of readiness to adopt heart healthy behavior. These stages are diverse and are a function of an individual’s readiness and needs, as opposed to the demographic population segment to which one belongs. However, some common themes do exist that are functions of the age and gender groups that mitigate the ability to practice and maintain heart health-promoting lifestyles once a person has made this decision. One cardiovascular risk behavior, cigarette smoking, is pervasive among the demographic groups probed (excluding teen females) and accordingly smoking cessation is a critical element of any community outreach strategy that would be developed. Stress, from environmental and personal stimuli, is also cited by participants as a major barrier to improving health, including young adults ages 15–18. In fact, many participants cite stress as a primary risk factor for heart disease and a barrier to heart disease prevention. Diet and PhysicalActivity: Heart healthy dietary behaviors are not as consistent across age and gender groups nor within a homogenous group (e.g., females ages 19–34). Many discussants expressed readiness to adopt and maintain heart healthy diets, as shown by some participants’ requests for nutrition education classes. However, there were as many discussants with an opposing practice or attitude regarding heart healthy diets who were resistant to change or to consistently adopting heart healthy dietary recommendations. Participants’ current physical activity behaviors and behavior change readiness was dependent upon demographic group(s).Although the majority of participants, irrespective of age and gender status, cited walking as their main means of exercise, males ages 15–34 cited sports, exercise programs, and the requirements of their occupation as additional sources of physical activity. Females ages 19 and older cited child care and housework. Based on these findings, there are some content emphasis areas, such as smoking and stress in particular. With regard to other heart health topics, including managing CVD clinical risk factors and dietary and physical activity behaviors, heart health educational products should meet the individual’s needs and be specific to his or her readiness level. Heart Health Education Products: Participants recommended that products should be presented “straight” and “to-thepoint” with hard facts to substantiate claims and recommendations. Print products should clearly and plainly identify the health topic or behavior, as this was the first point of interest among participants in selecting sample materials. The second point of interest is the artistry.A majority of participants preferred photos of people compared to line art, artist illustrations, or cartoons. Participants ages 15–18 however, preferred mixed medium graphics, including cartoons, photos of youth, 3-D art, and real-life anatomical representations of the body and heart. These participants also preferred products that were specifically geared to the youth audience. Participants in adult sessions (ages 19 and above) preferred intergenerational representation in materials. The majority of all participants identified that effective daily reminders were in a format that can be placed on refrigerators, walls, mirrors, and locations in the home that can be hung at eye level. They recommended a daily heart health reminder and messages in calendar format, allowing one to chart progress daily. Participants were also interested in products that demonstrate what they should do to be heart healthy. They preferred products with comprehensive content such as a single booklet versus a series. However, because participants are interested in products that meet their health needs, print products should allow for easy navigation of sections/topics. Themes that motivate participants included the importance of family and children, the loss of a loved one due to heart disease, and for some, their own personal desire to improve their health and life. Females ages 19 and above mentioned their belief in God, prayer, and gospel music as sources of inspiration to get through hard days. Because some participants demonstrated a low literacy level, products should meet the various literacy and education levels in public housing. In depth findings and recommendations are made in the full report that follows.