Alabama Collaboration for Cardiovascular Equality (ACCE)

The ALABAMA COLLABORATION OF CARDIOVASCULAR EQUALITY (ACCE), is an initiative that comprises four research projects (ADAPT, NUTRIFOODS, STORIES, TRUST) and two core programs (COMMUNITY OUTREACH CORE; EDUCATIONAL AND TRAINING CORE).

Goals and Objectives

One potential method of resolving health related racial inequalities is by promoting equal rates of disease prevention. Given the high mortality and morbidity associated with cardiovascular disease, improving this racial disparity is a key goal. With the ultimate goal of achieving racial equality in cardiovascular health, developing primary and secondary preventive measures that include changing provider practices and patient behaviors is an essential first step toward this goal.
This collaborative initiative involves researchers, ethicists and healthcare delivery organizations with the following objectives:

• To perform research in cardiovascular (CVD) prevention to reduce racial disparities
• To train researchers and clinicians in the acquisition and dissemination of CVD knowledge that would reduce and eventually eliminate health disparities.

The ACCE initiative is under the leadership of Dr. Catarina Kiefe and Dr. Sandral Hullett, and is sponsored by National Heart, Lung, & Blood Institute (NHLBI).

Partnership

In this Partnership, experienced researchers bring together their efforts to reach the objectives of the project.
This Partnership is integrated by:
Cooper Green Hospital
Tuskegee University
Department of Food and Nutritional Sciences
National Center for Bioethics in Research and Health Care
Mineral District Medical Society
University of Alabama at Birmingham (UAB)
Minority Health and Research Center
Center for Outcomes and Effectiveness Research and Education
Data, Information and Statistics Core (DISC)
 
The Cooper Green Hospital is the safety net hospital in Birmingham , Alabama that offers a complete range of health care services for the residents of Jefferson County , with its fees based on family size and income. On an outpatient basis, it offers a full range of primary care and specialty services, such as general surgery, urology, orthopedics, ophthalmology, obstetrics and gynecology, cardiology, pulmonary, nephrology, and hematology/oncology. Cooper Green Hospital also offers inpatient services, a fully staffed and accredited emergency room, rehabilitation services, a complete range of diagnostic services, and social services. All care is provided by full-time, Board-certified staff physicians working with physicians in training from UAB. In addition to the clinics located in the Medical Center District, Cooper Green Hospital also operates three primary care clinics based in the community. These are located in Pratt City , Bessemer and Southtown.
 
Tuskegee University (TU) is an independent, coeducational, non-sectarian and state related historically Black university established in 1881. The fundamental purpose of the University is to develop leadership, knowledge, and service for a global society. Tuskegee University has earned distinction in the life and physical sciences, engineering, agricultural and food sciences, education, business, veterinary medicine and nursing and allied health professions. Also, it is the first black college designated both as a Registered National Historic Landmark and as a National Historic Site, as well as the only private historically black university with a land grant mission. Tuskegee University is located in Tuskegee, Alabama, which is 40 miles east of the Alabama State Capitol in Montgomery and is within easy driving distance to the cities of Birmingham, Alabama and Atlanta, Georgia.
 
The Mineral District Medical Society, is the association of African American physicians in Birmingham. Its mission is to promote the common interests and ideals of physicians and patients of African American descent. It serves as the collective voice of physicians of African American descent and leading force for equality in medicine, elimination of health disparities, and promotion of optimal health.
 
The University of Alabama at Birmingham is a 35-year-old comprehensive, urban university and medical center that encompasses 82 city blocks and has a student enrollment of 16,000.  This is the only four-year, public university in Birmingham, Alabama’s largest metropolitan area with more than 70 research centers. The Division of Preventive Medicine at UAB contributes to knowledge of medical and health systems, behavioral aspects of disease, epidemiology, prevention, control and disease outcomes.  This division includes various centers such as the Minority Health and Research Center , the Center for Outcomes and Effectiveness Research and Education (COERE) and the Data, Information and Statistics Core (DISC).

ACCE Programs

The ACCE Partnership comprises two core programs and four research projects. The Education and Training Program initiated its Research Training Program with nine scholars from Tuskegee and UAB who attend lectures and workshops and work on an independent research project with a mentor. It culminates with a one-week intensive grant-writing course. The Community Outreach Program has convened an advisory board to assist the research projects and cores.
 

ACCE Projects

Project ADAPT 

Jamy Ard, (Project Leader)
Beatrice Phillips and Norman Walton (Co-Project Leaders)
“A culturally appropriate intervention in hypertensive African Americans based on the DASH diet.” 
Objectives
To develop a modified Dietary Approaches to Stop Hypertension (DASH) dietary pattern that is culturally appropriate for African-Americans.
To determine the effectiveness of the modified DASH dietary pattern on blood pressure control for African Americans with pre-hypertension or stage I hypertension to usual care control group. 
Summary
The effectiveness of the Dietary Approaches to Stop Hypertension (DASH) diet has shown to have limited impact on blood pressure control among African Americans, which might be explained by inappropriate adaptation to African American culture and tradition. Therefore, the adequate adaptation of the DASH diet would result in blood pressure control among African-Americans. Using the nominal group technique as a part of the formative assessment, this project proposes to identify key cultural variables that impact dietary patterns for African Americans. Based on those results, a modified behavioral intervention will be developed and tested in African Americans with pre-hypertension or stage I hypertension. Primary outcomes will include change in systolic and diastolic blood pressure at six months. It is expected that this project will contribute an additional tool for physicians, patients and health care systems to improve hypertension control amongst African Americans.

Project NUTRIFOODS 
Ralphenia Pace (ProjectLeader)
James Shikany (Co-ProjectLeader)
“Chemical characterization of functional foods with culturally appropriate community dissemination”.
Objective
To chemically characterize the composition of traditional foods in the diets of African Americans, and to incorporate these findings into culturally appropriate messages for regional dissemination through a community-based intervention program.
Summary
The overall goal of this project is to improve the cardiovascular health of the community by educating leaders (e.g. health care providers, teachers, and community health advisors) who can effectively influence nutrition decisions of individuals with or at risk of CVD on ways to use nutrition knowledge to improve their diets. This goal will be met by laboratory research completed in the Department of Food and Nutritional Sciences at Tuskegee University. Specifically, thirteen or more different fruits and vegetables common and selected ones are novel in the traditional Southern African-American diet, such as: mustard greens, collards, sweetpotato greens, purslane, green onions, okra, purple hull peas, butter beans, butter peas, egg plant, rutabagas, muscadine grapes and figs will be analyzed for their phytochemical (to include total phenolics, phenolics as gallic, ellagic, , catechins and kaempferol and polyphenolics as anthocyanins, tannins and catechins) content and total antioxidant capacity. The results of which will then be integrated into tailored, culturally appropriate dietary education programs in the prevention of cardiovascular disease for the community in which Tuskegee University is located in Macon county, Tuskegee, AL. The results will also be shared with the DASH participants and with the patients at Cooper Green Hospital, Birmingham, AL.

Project STORIES
Stories to Communicate Risk About Tobacco
Thomas K. Houston, MD  MPH- UAB (Principal Investigator)
Pamela Foster, MD –Tuskegee University (Co-Principal Investigator)
Stories to Communicate Risk About Tobacco is an innovative approach to smoking cessation programs provided in medical facilities for patients seeking assistance with quitting smoking.  Our approach is to provide the patient with counseling prior to being discharged from the hospital in an effort to assist them with quitting smoking. The DVD will include current and previous smokers telling their stories regarding their tobacco use.  We feel having the patient see other people similar to them express their views, struggles and successes with quitting smoking will motivate them to quit smoking. The patient will also receive 2 booster mailed DVDs, 3 follow up telephone calls from the nurse to check on their progress.  Our hypothesis is that patients exposed to the interactive DVD will be more likely to quit, compared with those not exposed.

The Specific Aims for this health communication project are:
I. To Develop a series of interactive, testimonial-based, stage of change-matched   Health Communication DVD video interventions targeted a low-income, low- literacy African Americans in the Deep South.
II. To Train a nurse research assistant to counseling inpatient smokers to quit, and  assist the community members with learning to use the DVDs, and then to follow- up by telephone at 48 hours, 1 and 2 weeks after discharge. 
III. To Evaluate the impact of the intervention on processes of change and one-year   cessation rates among smokers using a group-randomized controlled trial.

We will recruit inpatients at Cooper Green Hospital admitted for angina and myocardial infarction that desire to quit smoking.  Our goal is to enroll 350 participants and controls. 

Project TRUST
Sandral Hullett (Project Leader)
Jeroan Allison (Co-Project Leader)
Objectives

• To generate new knowledge on influence of perceived discrimination on health care status and health care delivery.
• To develop an innovative approach to reduce disparities by influencing providers.

Summary
The consequences of cardiovascular disease (CVD) are severe, and the burden is unequally shouldered by African-Americans. This project will explore potentially ground-breaking relationships between perceived discrimination and adherence to evidence-based guidelines for treatment and prevention of CVD in a population of inner-city African-Americans. Emerging evidence suggests that the personal experience of racism leads to significant changes in physiology and changes in how patients interact with the health care system. The significance of this study will hopefully lay the foundation that will lead to an innovative approach to reduce disparities by influencing providers.

 

Investigators

Principal Investigators:
Sandral Hullett, MD, MPH
Catarina Kiefe, MD, PhD

Co-Principal Investigators:
Mona Fouad, MD, MPH

Jeroan Allison, MD
Jamy Ard, MD
Monica Baskin, PhD
Thomas Houston, MD, MPH
Michelle Martin, PhD
Sharina Person, PhD
Richard Shewchuk, PhD
James Shikany, DrPH
Dale Williams, PhD

For Information
Contact:

Ann Smith, MPH email:
asmith@dopm.uab.edu

ACCE internal SharePoint web site (login required)

ACCE Evaluation Form (PDF)

ACCE Evaluation Form (Word)