Higher awareness of cardiovascular disease needed among low-income African-American women

July 04, 2000

Despite their high rates of cardiovascular disease, low-income African-American women lack awareness of the importance of the condition, according to the results of a focus group study.

"Cardiovascular disease was not a major health concern among the low-income, African-American women we interviewed," said study co-author Marilyn A. Winkleby, PhD, of the Stanford University School of Medicine in Palo Alto, CA.

"Only after it was emphasized that African-American women comprise one of the highest risk groups for cardiovascular disease did the women realize that information and programs promoting healthy lifestyles are especially needed in their communities," said Winkleby.

The leading cause of death and disability among women in the United States, cardiovascular disease hits African-American women particularly hard, in part because of their high rates of poverty. In 1997, the coronary heart disease death rate was approximately 14 percent higher, and the stroke death rate was approximately 31 percent higher, for black than for white women, according to the American Heart Association.

The primary risk factors for cardiovascular disease are hypertension, physical inactivity, obesity, smoking, and non-insulin dependent diabetes, according to the study.

The women who participated in the six focus groups conducted at six different community sites in Northern California by the researchers were able to identify most of these risk factors, and they were aware that healthy lifestyle changes could reduce cardiovascular disease risk.

However, they were unaware of the high rates of cardiovascular disease among black women, and they didn't describe it as a health priority for themselves. Focus group participants tended to perceive cardiovascular disease as a sudden, traumatic event rather than as a chronic, progressive illness.

Although the women understood the link between diet and heart disease, the relationships between obesity, diabetes, smoking, and cardiovascular disease were not well understood. This is an especially important area for health education given the alarming increase in obesity and diabetes in America. The study results appear in the May/June issue of the American Journal of Health Promotion.

All the groups listed stress as having a major impact on the health of African-American women, with one participant pointing out that "African-American women carry the load in the African-American family. We're doing 80 percent of everything -- work, kids, cooking." Older African-American women were seen as particularly vulnerable because of their lifelong poverty and the stress of continued family responsibilities.

Participants also felt their low socioeconomic status was an impediment to good health. Their view is probably accurate -- previous research cited in the study suggests that individuals with the strongest educational and economic resources can best protect themselves from disease. "The women were very aware that they lacked access to health promotion information and resources that could improve their health status," said Winkleby. "They felt the need for safe and inexpensive places to exercise. Furthermore, they were aware that the media specifically markets unhealthy products to African-American women, via ads that promote smoking and unhealthy foods."

The researchers elicited opinions on how best to improve cardiovascular disease awareness among low-income African-American women. "Focus groups are being used increasingly to involve people who are often missed by more traditional research methods," noted Winkleby.

"Widespread cardiovascular disease prevention education programs should be ubiquitous in African-American communities, similar to the media campaigns and intervention programs for AIDS and childhood immunizations. In addition, programs designed specifically for low-income African-American women are needed in order to promote healthy lifestyle change within their financial and time contraints," said Winkleby.

"Women in the focus groups articulated that although their socioeconomic status affects their health status, they would be eager to continue or adopt healthy behaviors and would be motivated by the implementation of convenient and affordable intervention programs in their neighborhoods," said Winkleby.
This study was funded by an Established Investigatorship Award and a Medical Scholars award, as well as grants from the American Heart Association and the National Heart, Lung, and Blood Institute.

The American Journal of Health Promotion is a bimonthly peer-reviewed journal dedicated to the field of health promotion. For information about the journal call 248-682-0707 or visit the journal's website at http://www.healthpromotionjournal.com.

Posted by the Center for the Advancement of Health http://www.cfah.org. For information about the Center, call Petrina Chong, pchong@cfah.org 202-387-2829.

Center for Advancing Health

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