Dr. Stanley Frencher

1. Dr. Stanley Frencher

2. Partnered Program Development to Address Black Men’s Health Stanley K Frencher, Jr MD MPH UCLA Department of Urology Seminar to Focus on Innovative Methods to Improve the Health of African American Men May 14, 2013

3. Research Arch Men’s Health Community-based Partnered Research Public health, health admin & policy, politics Urology Reducing health disparities Quality care Improvement

4. Outline • Phase 1: Building an infrastructure for community-academic partnership • Phase 2: Conducting partnered research: Prostate Education Project “PEP Talk” • Phase 3: Preparing to expand and sustain

5. Phase 1 Bringing research & outreach together to combat health inequities among Black men Building an infrastructure for community-academic partnership

6. Health & Healthcare Inequities Among Black Men • Life expectancy is 6 years less* • 1.3-2.4X death rate • Higher rates of hospital admissions for DM complications, HTN & angina* • 75% more likely to be uninsured* • 2X rate of unemployment* • 5.5 greater odds of going to prison* *compared to Non-Hispanic Whites

7. Solving this National Embarrassment Needs to Be a Priority “There is a compelling need for the development and implementation of long-range, coherent, and coordinated strategies—and the resources to follow—to reduce and eliminate racial and ethnic disparities in health. These strategies must be developed and advocated by policymakers, health professionals, business leaders, and civic and community leaders.” “Further research and study about community-based approaches to advance health promotion and disease prevention in communities wracked by poverty, racism, and other adverse environmental conditions is critical.” R Lavizzo-Mourey 2005

9. Building A Partnered Infrastructure & Action Plan • Collaboratively develop a conceptual model: Community-Based Participatory Research (CBPR) • Create a data management system • Obtain Institutional Review Board approval • Perform and publish descriptive analyses • Diversify funding strategy • Develop new partnerships • Map barbershop network in LA • Establish clinical referral process • Compete for research grants and initiate research projects April 2009 Oct 2010

10. CBPR Conceptual Model Design Complete rigorous trial & propose multi-site demonstration project Establish Centers or Program Project Grants Conduct pilot projects Research Pathway Community-level change via public health advocacy & action Community-based strategies Institutional partners Alternate Pathway + =

11. Create a Data Management System & Perform Descriptive Analyses • Description of the model used to conduct barbershop-based outreach • Releford BJ, Frencher SK Jr, et al. J Natl Med Assoc. 2010 Apr. • Commentary arguing for importance of barbershop as a setting for health promotion among black men • Releford BJ, Frencher SK Jr, et al. Ethnicity & Disease. 2010 May. • Early results from Chicago Initiative • 1 in 3 men had elevated blood pressures • Ruggier, L, Releford, BJ, et al. Under review, Preventing Chronic Disease e-Journal CDC • Results from the national effort that has reached over 2500 men in 6 states • Frencher SK Jr, Releford BJ, Norris, K, Yancey, AK. Barbershop-based health promotion: Results from a nationwide outreach program. In preparation.

12. Diversify Funding Sources & Develop New Partnerships • Grants & sponsorships: • # applied: 32 • # received: 17 • ~ $2M awarded

13. Conceptual Model Implementation Barbershop-based Health Promotion Clinical Referral Network Patient Navigation Federally Qualified Health Centers “P.E.P. Talk” Cooper, et al. Barry, et al. Freeman, et al.

14. Phase 2 “P.E.P. Talk”

15. CaP among Black Men Higher risk (1.6X) for developing CaP Higher rate (2X) CaP-related death More aggressive CaP tumors Younger age at dx CaP early detection Benefits (vs harms) of early detection unproven American Cancer Society recommends that…“men make an informed decisionwith their doctor about whether to be tested for prostate cancer.” Prostate Cancer (CaP) Early Detection & Black men

16. Specific Aim To use a CPBR approach to test effect of using a CaP decision aid in a community setting (e.g., barbershops) among Black men

17. Hypothesis Black men exposed to a culturally-tailored decision aid in barbershop will be more… a. knowledgeable, b. participatory in decision making, c. intent on pursuing a discussion regarding CaP early detection with a doctor • …after exposure as compared to before, and 2. …as compared to Black men exposed to a decision aid prepared for general audience

18. Study Design

19. DVD-based decision aids Evidenced-based Outline risks/benefits Provide testimonials Encourage shared, patient-centered decision making Foundation for Informed Decision Making “Is the PSA Test Right for You? General Audience American Cancer Society/Virginia Commonwealth “It’s a Big Decision!” Culturally- tailored to Black men Intervention

21. Community-partnered Approach • Input from “community” obtained at every point of research study design • Conducted focus groups • Tested fidelity of intervention design (i.e., showing DVD in barbershop) & data collection methods • Established plan for uninsured men dx w/CaP • Recruited barbershops • Started subject recruitment & intervention

22. Results | DQ: Knowledge

23. Results | DQ: Knowledge

24. Results | DQ: Knowledge

25. Results | DQ: Knowledge

26. Results | DQ: Knowledge

27. Results | DQ: Preferences

28. Results | DQ: Intentions

29. Discussion • Knowledge increased equally across both VCU and FIMDM groups • Paradoxically, few AA in either group preferred engaging in shared-decision making (13% & 8% respectively), which decreased after the intervention

30. Discussion • Similar proportions (75% & 72%) of men intended on having PSA test after the intervention, however, only VCU group showed a statistically significant increase 44% • The majority of AA men, after viewing the video, planned to discuss PSA testing and CaP with a provider (85% vs 81%)

31. Discussion • To date, 58 of the subjects have undergone PSA testing and 1 subject was diagnosed with CaP via referrals from the project

32. Phase 3 Preparing to Expand and Sustain

33. Plans for Sustainability • Expanding toward a multi-institutional intervention • Soliciting policymaker support • Obtaining long-term funding • Cultivating staff & new talent • Developing a “Men’s Health Program”

34. Expanding toward a national multi-site intervention

36. Developing a Men’s Health Program • “The Men’s Center for the Elimination of Health Equity” in Los Angeles • Develop and test new approaches to understanding and reducing health inequities among minority and underserved men.

37. Men’s Center | Vision • Eliminating health inequities through research, outreach, clinical care/training and policy

38. Men’s Center | Priority Areas • Research • Outreach (advocacy, community collaboration, policy) • Clinical care • Training/Education • Policy

39. The Men’s Center | Goals • Improve the health of men experiencing a disproportionate burden of poor health outcomes through research that informs health policy and public health • Conduct research that leads to sustainable community building and improvement of biopsychosocial factors that affect men’s health

40. The Men’s Center | Goals (cont) • Create novel community, academic, public-private partnerships that facilitate access to care and development of practical strategies for the reduction of health inequity • Coordinate and amplify research and outreach efforts across departments, locally, state-wide, nationally and globally

41. The Men’s Center | Goals (cont) • Support community-based participatory research and other approaches that integrates community perspectives and promotes diverse faculty involvement/advancement

42. The Men’s Center | Proposed Project Areas • Health Promotion: nutrition, fitness, supplement use, male wellness visits, disease screenings/early detection • Access to care • Patient Navigation/Community health worker • Prisoner re-entry • Geriatrics • Urologic Disease-focused • Erectile Dysfunction & Cardiovascular disease • Prostate cancer • BPH/LUTS • Low Testosterone

43. Where to begin… • Proposal: Improving the health of minority and underserved men in South Los Angeles • Background • Programs to Improve Men’s Health: • 3 Case Studies • Propose Research Project

44. Background | Structure Inequalities & Opportunities • Men of all SES are doing poorly in terms of health • High risk groups include: • Low SES men of all races • Low SES minority men • Middle class black men • Risk factors: economic marginality, adverse working conditions, gendered coping responses to stress  high levels of substance use, health-damaging behaviors & aversion to health-protective behaviors

45. Miami | Overtown Men’s Health Study • Collins Center for Public Policy • Research-focused • Setting: Overtown neighborhood, one of poorest areas in FL w/largest public hospital, yet men do not access it

46. Miami | Overtown Men’s Health Study • Assessment tool: “Rapport, Right question, Right way, at Right time” • 100 data pts, 45 min survey, 130 participants, 92% response rate • Sustainability: “Men’s Team” (researchers & neighborhood residents) • Policy advocacy: “Community Voices Miami”

47. Denver | Men’s Health Initiative • Denver Health (DH) • DH is primary safety net provider, $280M uncompensated care, 40% uninsured, ¼ Denver residents • Setting: 31% Hispanic, 11% Black, 32 medically underserved neighborhoods • Assessment: Existing data, BRFSS; followed by focus groups • Used data to guide media messaging, public policy and organizational development

48. Denver | Men’s Health Initiative • Intervention: Community Health Worker program • 5116 men between 2002 & 2006 • Effectively increased access to primary and specialty care & promoted better use of safety net & ER services • Sustainability & Policy • Salaries of MHI workers incorporated into DH budget, leveraged grant funding for public health programs • Policy advocacy focused on ex-offenders and Dept of Corrections

49. Baltimore | Men’s Health Center • Baltimore City Health Department • Setting: Sandtown Winchester • 10K residents, 98% black • Concentrated poverty & unemployment • Life Expectancy black man in Baltimore: 61ya

50. Baltimore | Men’s Health Center • Assessment: commissioned evaluation, 18-64ya men • 50% uninsured, 50% unemployed • 5 clinical priority areas established: dental, PE, HIV testing, pharmacy, eye exams • Service delivery (COWs), outreach, marketing (e.g., campaign, slogans, etc.) • Ex-offenders represented a particularly vulnerable population • Sustainability & Policy Advocacy • Earmarking of budget funds for men’s health in city budget