,H+'$0%' Beait uisease is the leauing cause of ueath in the 0niteu States, anu Afiican Ameiicans aie 1.2 times moie likely to uie fiom heait uisease than non-Bispanic whites. Reseaich has shown that uiet plays a cential iole in managing heait uisease symptoms, anu that euucation inteiventions aie an effective way to ueciease heait uisease iisk. 0nueistanuing the peiceptions of uiet anu its link to heait uisease among this population may pioviue useful euucational oppoitunities. This stuuy attempts to uncovei some of these peiceptions thiough suiveys auministeieu in an acute-caie anu outpatient facility in Noithwestein Queens. Paiticipation will be limiteu to Afiican-Ameiican males age 4S anu oluei. Topics that aie misunueistoou among this population will be useu as euucational oppoitunities in futuie nutiition inteiventions. I&#%(/(% ,(-+ 1. To gain infoimation on what the taiget population believes the influence of uiet on caiuiovasculai health is. 2. To iuentify specific topics that will be incluueu in ueveloping an euucational inteivention. @#9(#J )/ K('#$0'6$# In 2uu8, heait uisease was iesponsible foi neaily 2S% of all ueaths in the 0niteu States (1). Beait uisease iemains the leauing cause of ueath foi men anu women, anu moie than half of the ueaths causeu by heait uisease in 2uu8 weie in men (1). Beait uisease is also the leauing cause of ueath among most ethnicities, anu Afiican-Ameiicans aie 1.2 times moie likely to uie fiom heait uisease than whites (1). Because they have a highei iisk, Afiican-Ameiicans aie an appiopiiate population to investigate. The top two citeu iisk factois foi heait uisease aie physical inactivity anu obesity (2). Age is also a iisk factoi in men ovei 4S anu women ovei SS. 0besity is a mouifiable iisk factoi that is in pait ielateu to uiet. Auopting a heait-healthy uiet may be one way to mitigate this iisk, though a lack of unueistanuing of piopei nutiition can be a baiiiei to auopting an appiopiiate uiet in at-iisk inuiviuuals. Theiefoie, it may be woithwhile to exploie the peiceptions of at-iisk inuiviuuals iegaiuing the iole uiet plays in heait uisease. 0nueistanuing theii peiceptions is impoitant in that it can pioviue insight into wheie misunueistanuings may lie. Fuitheimoie, it may give ieseaicheis uiiection when ueveloping euucational inteiventions, which may impiove theii efficacy. L(#' 0+ 0 @(+M 20*0.#-#*' ?)): Lifestyle mouification has been wiuely accepteu as a means to manage heait uisease iisk. As a pait of the }apanese Coionaiy Aiteiy Stuuy (}CAB), Suzuki, et al conuucteu a cohoit stuuy that incluueu appioximately 14,uuu paiticipants who weie followeu foi a peiiou of thiee yeais. The ieseaicheis founu that moitality was lowei foi inuiviuuals who unueiwent eithei uiet oi exeicise inteiventions than those who uiu not (S). Theii stuuy also founu that uiet anu lifestyle inteiventions weie infiequent in }apanese patients with coionaiy aiteiy uisease, uespite its benefits (S). In anothei stuuy, NcCaiion, et al caiiieu out a ianuomizeu contiol tiial examining the effects of nutiition anu caiuiovasculai uisease iisk. Paiticipants weie ianuomizeu to ieceive eithei a uiet pieuesigneu to meet the uietaiy iecommenuations foi CvB iisk ieuuction, oi a uiet in which paiticipants selecteu foou to meet theii nutiition piesciiption baseu on the Ameiican Beait Association. In both stuuies paiticipants saw favoiable changes in bloou piessuie, lipiu levels, weight, anu oveiall quality of life (4). }ackson, et al stiesseu the impoitance of ueliveiing uietaiy counseling to caiuiac patients, since it plays a cential iole in seconuaiy pievention (S). These stuuies aie examples of the impoitance of uiet in the management of heait uisease anu its ielateu iisk factois.
"#$%#&'()*+ )/ L(#' 0*8 ;#0$' L(+#0+# A numbei of stuuies have been uone that in some way gauge ceitain gioups' knowleuge of the link between uiet anu heait health. In a stuuy examining patients' peiceptions iegaiuing uiet anu heait failuie, Beo, et al collecteu uata fiom 2u heait failuie patients. Semi-stiuctuieu inteiviews iegaiuing theii unueistanuing of the low-souium uietaiy iecommenuation they ieceiveu anu theii thoughts on auheience weie conuucteu (6). The ieseaicheis founu that while many paiticipants thought that uiet coulu affect theii health, few knew that souium playeu a iole in heait failuie symptoms (6). Auuitionally, the ieseaicheis founu that a lack of knowleuge playeu a laige iole in the paiticipants' ability to auheie to the uietaiy iecommenuations they ieceiveu (6). Winham anu }ones exploieu the peiceptions of young (18-26) Afiican-Ameiicans iegaiuing uiet anu heait health (7). In a cioss-sectional suivey, 172 men anu women completeu a questionnaiie auapteu fiom the Ameiican Beait Association. The iesults ievealeu that while some aspects weie well known, otheis, such as eating fewei animal piouucts, weie not (7). The authois concluueu that evaluating baseline knowleuge of CvB is essential in ueveloping euucational inteiventions, anu that fuithei ieseaich is neeueu to ueteimine the iange of factois that ueteimine knowleuge anu iisk peiception (7). In a somewhat ielateu stuuy, vanhecke, et al suiveyeu 87S auolescents iegaiuing theii iisk peiception anu founu that most uo not peiceive themselves to be at iisk, anu that most lack the knowleuge iegaiuing its iisk factois, specifically with iegaiu to lifestyle (8). In a stuuy by Kiummel, et al, iuial white women paiticipateu in focus gioups uiscussing the influence of uiet in caiuiovasculai health (9). The iesults showeu that while all paiticipants believeu that uiet plays a iole in caiuiovasculai health, many of the women lackeu the skills oi confiuence foi piopei foou selection anu piepaiation (9). The common theme in the selecteu stuuies is that a geneial lack of unueistanuing exists in the selecteu populations, anu that euucational inteiventions aie neeueu to inciease knowleuge of the mouifiable iisk factois foi heait uisease. 56'$('()* N86%0'()* 0*8 ;#0$' L(+#0+# Some ieseaich has been uone to iuentify nutiition-ielateu topics of impoitance among the elueily. uolubeig, et al conuucteu a cioss-sectional suivey of 4S9 inuiviuuals ages SS-89, anu founu that topics of foou safety anu supply weie of the gieatest concein; uiet-ielateu topics incluueu souium intake, weight contiol, anu cholesteiol intake, among otheis (1u). This stuuy illustiates the uemanu foi euucation sessions ielateu to heait health among the elueily. Bowevei, Claik anu Lan founu that in iecently uischaigeu heait failuie patients, the topics of most impoitance weie sign, symptom, anu meuication-ielateu, anu that uiet-ielateu topics weie of the least impoitance (11). This vaiiability may pioviue goou cause to fuithei investigate patients' peiceptions of heait-health topics. Nany stuuies have been uone that emphasize the efficacy of nutiition euucation in ielation to caiuiovasculai uisease. Foi example, a 2uu8 stuuy examineu the effect of PEuASE, a specific euucation inteivention, on CvB iisk in patients with high cholesteiol (12). Paiticipants weie uiviueu into a gioup that ieceiveu the inteivention, anu a gioup that uiu not (12). The ieseaicheis founu that those in the euucateu gioup showeu significant impiovements in theii caiuiovasculai iisk factois (12). In anothei stuuy, Nillei, et al showeu that postmenopausal women unueigoing a 2-yeai euucation piogiam also impioveu theii CvB iisk factois (1S). Finally, a stuuy by Rhoues, et al showeu that paiticipants ieceiving intensive nutiitional theiapy fiom a iegisteieu uietitian showeu significantly uecieaseu consumption of fat anu cholesteiol, among othei things, compaieu to inuiviuuals ieceiving ioutine nutiitional auvice fiom a physician (14). 0thei ieseaich has been uone to investigate the ieasons patients have uifficulty auheiing to caiuiac uietaiy iecommenuations. Benson, et al conuucteu an inteicept suivey on 446 inuiviuuals anu founu that peiceiveu iisk, euucation, anu the iequiiement to ieuuce ieu meat consumption weie key factois in people's ability to comply with uietaiy iecommenuations (1S). The lack of ieseaich iegaiuing the peiceptions of oluei Afiican-Ameiican men pioviues an oppoitunity to exploie this topic in this at-iisk population. The pieceuing liteiatuie ieview illustiates the impoitance anu efficacy of using uiet as a means to manage the symptoms anu iisk of heait uisease, the neeu foi fuithei ieseaich of the peiceptions of uiet anu heait uisease, anu the impoitance anu efficacy of euucational inteiventions. 2#'3)8):).O A taiget of 1uu paiticipants will be establisheu foi this stuuy. Baseu on patient population tienus, appioximately 1u paiticipants pei month shoulu be ieciuiteu foi a peiiou of one yeai. This shoulu enable us to ieach the taiget numbei, anu allow foi paiticipant vaiiation fiom month to month. Age becomes a iisk factoi foi heait uisease in men ovei 4S, anu Afiican Ameiicans aie 1.2 times moie likely to uie fiom heait uisease than othei ethnic gioups (1). Theiefoie, paiticipation will be limiteu to Afiican Ameiican men ageu 4S oi oluei, iegaiuless of health status. @#%$6('-#*' I'$0'#.(#+ Paiticipants will be ieciuiteu at an acute-caie hospital anu outpatient facility in Noithwestein Queens. Baily census uata foi the hospital will be useu to iuentify patients who meet inclusion ciiteiia. Reseaich staff will visit those patients who qualify anu invite them to paiticipate in the stuuy. A iegisteieu uietitian seiving the outpatient facility will assist with the stuuy anu will uo the ieciuiting at the outpatient facility. All paiticipants will pioviue wiitten consent foi paiticipation in the stuuy. Reseaich staff will maintain uemogiaphic uata foi all paiticipants. 4*'#$9#*'()* I'$0'#.(#+ Reseaich staff will uevelop a suivey to auministei to the paiticipants. The suivey will be composeu of 2u statements, anu will covei nutiition anu lifestyle ielateu topics. Responses to each statement will eluciuate patient's peiceptions on the connection between heait health, uiet, anu exeicise. Statements will also be incluueu that will allow the ieseaicheis to estimate paiticipants' ability to choose anu piepaie foous that aie heait healthy. 0nce the suivey has been uevelopeu, pilot testing will be conuucteu on 2S paiticipants outsiue of the taiget population. Nouifications will be maue as neeueu baseu on the iesults of the test peiiou. Fifteen uichotomous statements will peitain to uietaiy anu lifestyle factois anu will incluue fat, cholesteiol, anu souium intake. Statements iegaiuing fat intake will incluue total fat, satuiateu fat, anu omega-S fatty aciu intake. Paiticipants will be askeu whethei they agiee oi uisagiee to statements such as "All uietaiy fat is bau" oi "Souium intake has no impact on heait health". Paiticipants will also be askeu to iesponu to five statements on a Likeit scale iegaiuing theii peiceiveu ability to iuentify anu piepaie heait healthy foous. Bata will be collecteu thiough stiuctuieu inteiviews with patients. Each week, the ieseaichei woiking in the acute caie facility will ieview hospital census uata anu iuentify paiticipants meeting inclusion ciiteiia. The ieseaichei will then visit those patients anu invite them to paiticipate in the stuuy. If the patient accepts, wiitten consent will be obtaineu anu then the ieseaichei will conuuct the inteiview. The ieseaichei will iecoiu iesponses on the suivey anu ietain foi analysis. Bemogiaphic uata with iegaiu to euucation level will be maintaineu foi each paiticipant. The ieseaichei woiking in the outpatient facility will contact patients piioi to scheuuleu visits anu invite them to paiticipate. If the patient accepts, the outpatient ieseaichei will obtain wiitten consent anu follow the same inteiview piotocols as the inpatient ieseaichei. Each inteiview shoulu take no longei than Su minutes. ,*0:O+(+ ":0* Bata entiy will be ongoing thioughout the couise of the stuuy. Bemogiaphic uata will be uichotomizeu into high (!14 yis) anu low (<14 yis) euucation. Chi-squaie will be useu to compaie the uichotomous iesponses by euucation level. Likeit scale uata will be tiansfoimeu into numeiical values anu uesciiptive statistics will be calculateu. Biffeiences in mean iesponses between euucation gioups will be ueteimineu by t-test. Statistical significance will be set at p < .uS foi both chi-squaie anu t-test. The peicentages of coiiect iesponses by question will be incluueu as well. I'68O ?(-#:(*# P P , I Q 5 L P R 2 , 2 P P I6$9#O L#9#:)&-#*'E ?#+'(*. S @#%$6('-#*'E L0'0 7)::#%'()* S S S S S S S S S S S S ,*0:O+(+ S
K(-('0'()*+ 0*8 I'$#*.'3+ Inteiviewei objectivity is an inheient iisk factoi when conuucting inteiviews, which may be a limitation of this stuuy. Paiticipants may altei theii iesponses baseu on veibal oi non-veibal cues fiom the inteiviewei. By pioviuing a stiuctuieu inteiview foimat, the iisk of this shoulu be uiminisheu. Auuitionally, paiticipants may iesponu to a statement coiiectly without knowing the ieason, oi they may simply guess coiiectly. The iesult of this is that some topics may not be coiiectly iuentifieu as euucation oppoitunities. Finally, as a convenience sample, the iesults may not be geneializable to the population. 0n the othei hanu, suiveys aie an easy way to collect uata. Peisonal inteiviews typically elicit a highei iesponse iate than othei suivey methous, anu allow foi the use of moie complex questions. Few stuuies have been uone with iespect to this specific topic, anu the iesults may piompt similai stuuies conuucteu on a bioauei scale.
<68.#' Total cost of the pioject is estimateu at just unuei $4u,uuu. This incluues 14 months salaiy foi the piimaiy ieseaichei, anu 2S% of the annual salaiy foi the outpatient ieseaichei. The lattei figuie ieflects compensation beyonu the annual salaiy foi this inuiviuual, as they will be assisting the inpatient ieseaichei on top of the theii usual uuties. Few auuitional supplies will be neeueu beyonu the mateiials neeu to piouuce haiu copies of the suivey. In geneial, this stuuy can be caiiieu out at a ielatively low cost. !"#$%&&"' Inpatient Reseaichei Annual Salaiy $2u,uuu x 116% $2S,2uu 0utpatient Reseaichei (RB) Annual Salaiy $Su,uuu x 2S% $12,Suu
I'$)*.:O 8(+0.$## L(+0.$## 5#('3#$ 0.$## *)$ 8(+0.$## ,.$## I'$)*.:O 0.$## @#/#$#*%#+ 1. Ninino A, Nuiphy S, Xu }, Kochanek K. Beaths: Final Bata foi 2uu8. Byattsville, NB: National Centei foi Bealth Statistics; 2u11. 2. Bealth, 0niteu States, 2u1u: With Special Featuie on Beath anu Bying. Byattsville, NB: National Centei foi Bealth Statistics. S. Suzuki T, Kohio T, Bayashi B, Yamazaki T, Nagai R. Fiequency anu impact of lifestyle mouification in patients with coionaiy aiteiy uisease: The }apanese Coionaiy Aiteiy Bisease (}CAB) Stuuy. Ameiican heait jouinal 2u12;16S(2):268- 27S. 4. NcCaiion BA, 0paiil S, Chait A, Baynes RB, Kiis-Etheiton P, Stein }S, et al. Nutiitional Nanagement of Caiuiovasculai Risk Factois: A Ranuomizeu Clinical Tiial. Aich Intein Neu 1997;1S7(2):169-177. S. }ackson EA, Kiishnan S, Neccone N, 0ckene IS, Rubenfiie N. Peiceiveu Quality of Caie anu Lifestyle Counseling Among Patients With Beait Bisease. Clinical Caiuiology 2u1u;SS(12):76S-769. 6. Beo S, Lennie TA, Nosei BK, 0koli C. Beait failuie patients' peiceptions on nutiition anu uietaiy auheience. Euiopean }ouinal of Caiuiovasculai Nuising 2uu9;8(S):S2S-S28. 7. Winham B, }ones K. Knowleuge of young Afiican Ameiican auults about heait uisease: a cioss-sectional suivey. BNC Public Bealth 2u11;11(1):248. 8. vanhecke TE, Nillei WN, Fianklin BA, Webei }E, NcCullough PA. Awaieness, knowleuge, anu peiception of heait uisease among auolescents. Euiopean }ouinal of Caiuiovasculai Pievention & Rehabilitation 2uu6;1S(S):718-72S. 9. Kiummel BB, B; Tessaio, I. Focus gioups on caiuiovasculai health in iuial women: implications foi piactice. }ouinal of Nutiition Euucation Behavioi 2uu2;S4(1):S8-46. 1u. uolubeig }P, ueishoff SN, Ncuanuy RB. Appiopiiate topics foi nutiition euucation foi the elueily. }ouinal of Nutiition Euucation 199u;22(6):SuS-S1u. 11. Claik }C, Lan vN. Beait failuie patient leaining neeus aftei hospital uischaige. Applieu nuising ieseaich : ANR 2uu4;17(S):1Su-1S7. 12. Biuckeit E, uiial P, Paillaiu F, Feiiieies }, Schliengei }-L, Renucci }-F, et al. Effect of an Euucational Piogiam (PEuASE) on Caiuiovasculai Risk in Bypeicholesteiolaemic Patients. Caiuiovasculai Biugs anu Theiapy 2uu8;22(6):49S-SuS. 1S. Nillei SL, Rebei R}, Chapman-Novakofski K. Pievalence of CvB iisk factois anu impact of a two-yeai euucation piogiam foi piemenopausal women. Women's Bealth Issues 2uu1;11(6):486-49S. 14. Rhoues KS, Bookstein LC, Aaionson LS, Neicei NN, 0iiingei CE. Intensive Nutiition Counseling Enhances 0utcomes of National Cholesteiol Euucation Piogiam Bietaiy Theiapy. }ouinal of the Ameiican Bietetic Association 1996;96(1u):1uuS-1u1u. 1S. Benson S, Blanuon }, Cianfielu }, Beiath B. 0nueistanuing the piopensity of consumeis to comply with uietaiy guiuelines uiiecteu at heait health. Appetite 2u1u;S4(1):S2-61.