Background-Obesity and diabetes are epidemic in the predominantly minority Harlem community. To address them, a coalition of community and academic leaders tested the effectiveness of a peer-led weight loss course.

Background Traditional research approaches frequently fail to yield representative numbers of people of color in research. Community-based participatory research (CBPR) may be an important strategy for partnering with and reaching populations who bear a greater burden of illness but have been historically difficult to engage. A Community Action Board of 20 East Harlem residents, leaders and advocates used CBPR to compare the effectiveness of different strategies in recruiting and enrolling adults with prediabetes into a peer-led diabetes prevention intervention. Methods The Board created five different recruitment strategies: recruiting through clinicians, at large public events like farmers markets, organizing special local recruitment events, recruiting at local organizations, and a partner-led approach in which community partners developed and managed the recruitment efforts at their sites. Results In 3 months, 555 local adults were approached; 249 were appropriate candidates for further evaluation (overweight, nonpregnant, East Harlem residents without known diabetes); 179 consented and returned fasting for 1/2 day of prediabetes testing; and 99 had prediabetes and enrolled in a pilot randomized trial. The partner-led approach was most successful, recruiting 68% of people enrolled. This was also the most efficient strategy; 34% of those approached through partners were ultimately enrolled, versus 0%–17% through the other four strategies. Participants were predominantly low-income, uninsured, undereducated Spanish-speaking women. Conclusions This CBPR approach highlights the value of a partner-led recruitment to identify, reach out and motivate a vulnerable population into research, using techniques that may be unfamiliar to researchers, but are nevertheless rigorous and effective.

Background: Latinos, whose views are infrequently examined in genomic research, may be at risk of missing out on the benefits of genomic medicine. Aims: To explore this possibility, we conducted a qualitative study of awareness and attitudes about genetic testing among Latinos with lower acculturation in New York City. Methods: We conducted four focus groups (7 English-speaking men, 5 Spanish-speaking men, 13 English-speaking women and 13 Spanish-speaking women) to explore factors that influence the adoption of new innovations through the discussion of genetic testing in general, and a hypothetical vignette describing a genetic test for skin cancer risk, in particular. Results: Through inductive thematic text analysis of focus group transcripts, our multidisciplinary team identified themes within knowledge and attitudes, communication and sources of information, anticipated responses, factors that may increase adoption, and barriers to adoption of genetic testing. Specifically, a majority of participants expressed some degree of uncertainty regarding the purpose of genetic tests and information these tests provide, rarely discussed genetic testing with others in their social networks, and expressed concerns about the misuse of and possible adverse emotional responses to genetic information. However, participants also expressed high levels of interest in receiving a skin cancer genetic test in response to the vignette and believed that receiving actionable health information was a primary reason to consider testing. Gender-based differences in perceived barriers to testing emerged. Conclusions: The results highlight beliefs and barriers that future interventions could target to help ensure that Latinos have adequate understanding of and access to genomic medicine advances.

Objective-Diabetes prevalence and mortality are increasing, with minority populations disproportionately affected. Despite evidence that weight loss due to improved nutrition and increased physical activity can prevent or control diabetes, there is often a disconnect between this evidence and individuals' lifestyles. Methods-EastHarlem is a predominantly African-American and Latino neighborhood that has the highest rates of diabetes prevalence and mortality in New York City. The East Harlem Diabetes Center of Excellence is a community-centered coalition. To help direct their work, the coalition used their experiences, research, outreach, and literature review to build a conceptual model describing how local factors affect health behaviors and health outcomes such as obesity and diabetes.Results-This model describes the relationship between the physical environment, the social/ medical environment and individual factors including demographic data, food and exercise beliefs and behaviors, and health outcomes. The coalition inserted local data from surveys and focus groups into the model to identify targets for future interventions, research, and activism.Conclusions-This type of collaboration and the model may be useful tools to help communities identify and address the deficits that prevent their residents from enjoying the health benefits of improved nutrition and increased physical activity, and that also lead to racial and ethnic disparities in health.

Background and Purpose Efforts to reduce disparities in recurrent stroke among Black and Latino stroke survivors have met with limited success. We aimed to determine the effect of peer education on secondary stroke prevention amongst predominantly minority stroke survivors. Methods Between 2009 and 2012, we enrolled 600 stroke or transient ischemic attack survivors from diverse, low-income communities in New York City into a 2-arm randomized clinical trial that compared a 6 week (1 session/week) peer-led, community-based, stroke prevention self-management group workshop (N=301) to a wait-list control group (N=299). The primary outcome was the proportion with a composite of controlled blood pressure (<140/90 mmHg), low density lipoprotein (LDL) cholesterol < 100 mg/dL, and use of antithrombotic medications at 6 months. Secondary outcomes included control of the individual stroke risk factors. All analyses were by intent-to-treat. Results There was no difference in the proportion of intervention and control group participants’ achieving the composite outcome (34% versus 34%, p=0.98). The proportion with controlled blood pressure at 6 months was greater in the intervention group than in the control group (76% versus 67%; p=0.02). This corresponded to a greater change in systolic blood pressure in the intervention versus control group (−3.63 SD 19.81 mm Hg versus +0.34 SD 23.76 mmHg; p=0.04). There were no group differences in the control of cholesterol or use of antithrombotics. Conclusions A low-cost peer education self-management workshop modestly improved blood pressure, but not LDL cholesterol or antithrombotic use, among stroke and TIA survivors from vulnerable, predominantly minority urban communities.