Background: Approximately 6 million children in the United States have a diagnosed food allergy, and 32% of caregivers experience significant psychological distress due to the diagnosis. Despite substantial impacts on psychosocial health and quality of life, few interventions aim to help caregivers of newly diagnosed children. There is a clear, unmet need for interventions to address caregiver distress, especially after the initial diagnosis. Objective: We developed a mobile psychosocial health intervention, the Food Allergy Symptom Self-Management with Technology (FASST) app. Primary end points were to determine the app’s feasibility and caregiver satisfaction. Methods: This was a phase II, randomized controlled, implementation study (4-week duration) in caregivers (N = 30) of children ≤ 18 years of age who were newly diagnosed with a food allergy (≤90 days after the diagnosis). Caregivers (n = 20) were randomized to use the FASST app (intervention group) with access to individualized, self-help symptom relief interventions and food allergy support, and educational resources; or to use a limited app with a basic FASST interface and links to a few educational resources (control group [n = 10]). Ten participants (intervention group, n = 5; control group, n = 5) participated in semistructured interviews at week 4. Results: Both groups found the app relatively easy to use. The intervention group scores for safety preparedness during social activities increased by 24%, whereas those in the control group experienced a 1% decline. The intervention group participants increased the use of websites to find food allergy information by 17% at week 4 compared with 4% for the control group. Although the intervention group participants showed greater gains than did those in the control group in their confidence to prepare for and prevent allergic reactions, and greater declines in perceived social limitations, more participants in the control group endorsed confidence in their ability to recognize (11% versus 5%, respectively) and treat (10% versus 6%, respectively) allergic reactions. Conclusion: Analysis of our results suggests that the FASST app may provide a feasible means of delivering psychosocial and educational supports to caregivers of children recently diagnosed with a food allergy.Clinical trial NCT04512924, www.clinicaltrials.gov

The prevalence of hypertension dictates that blood pressure must be managed effectively in primary care. The American Society of Hypertension (ASH) regional chapters and clinical hypertension specialists represent a positive response by ASH to the growing problems of hypertension and metabolic syndrome-related risks and disease. To have a significant public health effect, the impact of clinical hypertension specialists must be leveraged. Key activities in the community include educating other providers locally, delivering care for complex referral patients, and fostering growth of a practice network with a central database in collaboration with academic partners. The database supports practice audit and feedback reports to enhance quality improvement, identify continuing medical education topics, and facilitate clinical trials to test new therapeutic and best-practice approaches to risk factor management. The ASH regional chapters serve as a forum for community and academic hypertension specialists to collaborate with like-minded individuals and organizations. The collaboration among the ASH Carolinas-Georgia chapter, the Hypertension Initiative, and the Community Physicians' Network provides a model for other ASH chapters and health delivery groups to partner in delivering continuing medical education programs focused on cardiovascular risk factor management, recruiting practices into the network, and developing and maintaining a centralized patient database. Evidence suggests that this collaboration is facilitating application of evidence-based medicine and risk factor control.

Among diabetic hypertensive patients, ethnic differences in blood pressure control and outcomes have been attributed in part to greater reluctance of providers to prescribe combination antihypertensive regimens to African Americans than to Caucasians. African Americans purportedly receive fewer angiotensin‐converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs), which reduce target organ complications. To assess these issues, cross‐sectional data were analyzed from 19,864 diabetic hypertensives from 62 primary care clinics. Among diabetic hypertensives, African Americans (N=6230) were less likely than Caucasians (N=8041) to have blood pressure (BP) ≤130/80 mm Hg at their last clinic visit (23.1% [23.0%–23.2%] vs. 30.7% [30.6%–30.9%]) despite a greater number of prescriptions for antihypertensive medications (2.67 [2.63‐2.70] vs. 2.23 [2.20‐2.26]). African Americans were more likely than Caucasians to have an ACEI and/or ARB prescribed and to receive prescriptions for at least two antihypertensive medications that included an ACEI or ARB (64.1 % [63.8%–64.4%] vs. 53.1% [52.8%–53.4%]). Among diabetic hypertensives, African Americans are less likely than Caucasians to attain BP <130/80 mm Hg, despite receiving more antihypertensive medication prescriptions. African Americans receive more ACEIs and/or ARBs than Caucasians for target organ protection and/or BP control. The data suggest provider prescribing patterns are not a major contributor to ethnic differences in BP control and outcomes in diabetic hypertensives.

Background: Prevalence of chest pain syndromes (CPS)-chest pain, angina pectoris, chronic angina, and pre-infarction angina/intermediate coronary syndrome (ICS)-among hypertensive patients and medical management of these disorders in primary care are not well defined.Methods: The Hypertension Initiative primary care database with 72,508 hypertensives was analyzed to characterize prevalence and management of CPS. Patients with more than one CPS were categorized by the most severe diagnosis.Its: Eleven percent of hypertensives had a CPS. Of these patients, 66% (5284) were diagnosed with chest pain only, 15% (1204) with angina, and 19% (1508) with ICS. More men than women were diagnosed with angina (18% v 4%) and ICS (21% v 10%). More women than men were diagnosed with chest pain only (86% v 61 %). African Americans received more chest pain diagnoses (71% v 62%), similar angina diagnoses (14% v 16%), and slightly fewer ICS diagnoses (15% v 22%) than whites. Most striking, women and African Americans with CPS received fewer medications than men and whites, both overall and within diagnostic categories. Prescription rates differed more by gender (male/female) than by ethnic group (white/African American) for angiotensin-converting enzyme inhibitor, diuretics, aspirin, statins, and nitrates. Hypertensives with CPS received more medications and achieved better risk factor control than non-CPS hypertensives, but the majority remained above goal levels.Conclusions: Primary care physicians treat cardiovascular risk factors relatively aggressively in hypertensives with CPS. However, substantial numbers of these patients do not reach goal levels. Demographic differences in treatment represent opportunities to reduce disparities.

Dyslipidemic, hypertensive patients (N=48,863) were stratified by gender, age, and angina (n=2502) vs. nonangina (n=46,358) status. Comparing 95% confidence intervals yielded significant differences in treatment and cardiovascular risk factor control between subgroups. More men than women bad low‐density lipoprotein cholesterol (LDL‐C) <100 mg/dL (angina, 43.94‐43.96 vs. 34.42‐34.50; nonangina, 32.43‐32.43 vs. 17.25‐17.25) and 100‐129 mg/dL (angina, 32.12‐32.14 vs. 35.10‐35.18; nonangina, 53.86‐53.86 vs. 32.44‐32.44). More women than men had LDL‐C >130 mg/dL (angina, 27.68‐27.72 vs. 23.91‐23.93; nonangina, 38.70‐38.70 vs. 35.38‐35.39). Women were less likely than men to receive statins (angina, 69.95‐69.99 vs. 82.11‐82.13; nonangina, 59.80‐59.80 vs. 63.72‐63.72), any antilipidemic medication at all (angina, 25.93‐25.97 vs. 13.48‐13.48; nonangina, 36.73‐36.73 vs. 30.73‐30.73), or to have current cholesterol measurements (angina, 56.82‐56.88 vs. 34.54‐34.56; nonangina, 45.77‐45.77 vs. 39.75‐39.75). Primary care providers treat high‐risk patients relatively aggressively; however, opportunities to forestall cardiovascular disease may be missed in hypertensive, dyslipidemic women whose LDL‐C is often not measured and controlled.

Background: Differential access to health care may contribute to lower blood pressure (BP) control rates to under 140/90 mm Hg in African American compared with white hypertensive patients, especially men (26.5% vs 36.5% of all hypertensive patients in the National Health and Nutrition Examination Survey 1999-2000). The Department of Veterans Affairs (VA) system, which provides access to health care and medications across ethnic and economic boundaries, may reduce disparities in BP control.Methods: To test this hypothesis, BP treatment and control groups were compared between African American (VA, n = 4379;non-VA, n = 2754) and white (VA, n = 7987; non-VA, n:=4980) hypertensive men.Results: In both groups, whites were older than African-Americans (P <.05), had lower BP (P <.001),and had BP controlled to below 140/90 mm Hg more often on their last visit (P <.01). Blood pressure control to below 140/90 mm Hg was comparable among white hypertensive men at VA (55.6%) and non-VA (54.2%) settings (P = .12). In contrast, BP control was higher among African American hypertensive men at VA (49.4%) compared with non-VA (44.0%) settings (P <.01), even after controlling for age, numerous comorbid conditions, and rural-urban classification. African American hypertensive men received a comparable number of prescriptions for BP medications at VA sites (P = .18) and more prescriptions at non-VA sites than did whites (P <.001). African Americans had more visits in the previous year at VA sites (P <.001) and fewer visits at non-VA sites (P <.001) compared with whites.Conclusions: The ethnic disparity in BP control between African Americans and whites was approximately 40% less at VA than at non-VA health care sites (6.2% vs 10.2%; P <.01). Ensuring access to health care could constitute one constructive component of a national initiative to reduce ethnic disparities in BP control and cardiovascular risk.

The purpose of this study was to define the prevalence and medical management of chest pain, angina pectoris, chronic angina, and pre-infarction angina/intermediate coronary syndrome (ICS) among hypertensive patients in primary care. The Hypertension Initiative database (N=72,508 records) was analyzed to characterize prevalence and management of chest pain syndromes (CPS) and control of blood pressure (<140/90 mm/Hg) and LDL-cholesterol (<100 mg/dL). Patients with more than one CPS were categorized by the most severe diagnosis. Eleven percent of patients had a CPS diagnosis. Of these, 66% (5,284) were diagnosed with chest pain only, 15% (1204) with angina, and 19% (1508) with ICS. More men than women were diagnosed with angina (18% vs. 4%) and ICS (21% vs. 10%). More women than men were diagnosed with chest pain only (86% vs. 61%). African Americans had more chest pain diagnoses (71% vs. 62%), similar angina diagnoses (14% vs. 16%), and fewer ICS diagnoses (15% vs. 22%) than Caucasians. Women and African-Americans received strikingly fewer medications than men and Caucasians in each diagnostic category. Prescription rates also differed more by gender than by racial group for angiotensin converting enzyme inhibitors, diuretics, aspirin, statins, and nitrates. (Table 1) Hypertensives with CPS received more medications and achieved better risk factor control (blood pressure <140/90 mm/Hg and LDL-cholesterol <100 mg/dL) than hypertensives without CPS but the majority in both groups were above target levels. Primary care physicians treat these high-risk hypertensive patients relatively aggressively. However, large numbers do not reach BP or LDL-c goals and substantial differences between gender and racial groups represent opportunities to reduce disparities. See Table 1. Percent of patients receiving prescription medications of interest by diagnostic category and gender Percent of patients receiving prescription medications of interest by diagnostic category and gender

Background Hypertension is associated with other cardiovascular (CV) risk factors and contributes to ethnic differences in health outcomes. Controlling hypertension and other CV risk factors reduces events and health disparities. Objectives Develop a database to assess and track CV risk factor control rates, treatment patterns, and comorbidities among hypertensive patients in primary care sites throughout South Carolina. Generate and distribute quarterly feedback reports aimed at increasing effective treatment, improving outcomes, and reducing disparities. Methods Data were obtained on 63,496 hypertensive patients from 262 primary care providers at 69 practice sites in the Southeast. Data were obtained by reporting cards or by downloading electronic medical records. Results Among 32,504 hypertensives in JNC-VI Risk Group C (a high risk subset), the last BP was <140/90 in 50% (Figure 1). Among 14,282 dyslipidemic hypertensives in this high risk group with an LDL–c value on record, LDL-c was <130 mg/dL in 65.8% and <100 mg/dL in 46%. Substantially fewer African Americans (AA) than Caucasians (C) (24% v. 37%) had reached this level of LDL control. Among 10,965 diabetic hypertensives with glycosylated hemoglobin values, 48.0% were <7%. A substantially smaller proportion of AA than C (41% v. 54%) had reached this level of blood glucose control. Multiple risk factor control was rare, especially among women and AA. Most hypertensive patients received combination therapy, however statin and betablocker use was less common in women and AA. Conclusion A hypertension quality improvement program based on active audit and feedback at multiple primary care sites which include ethnic minorities and complicated patients is feasible. Individual risk factors are controlled to or near goal in many. The most striking ethnic difference is in LDL-c control which appears to reflect the lower use of statin drugs in African Americans (Figure 2). Such findings suggest that the database can be used to guide education and interventions to improve treatment and reduce disparities. Hypertension is associated with other cardiovascular (CV) risk factors and contributes to ethnic differences in health outcomes. Controlling hypertension and other CV risk factors reduces events and health disparities. Develop a database to assess and track CV risk factor control rates, treatment patterns, and comorbidities among hypertensive patients in primary care sites throughout South Carolina. Generate and distribute quarterly feedback reports aimed at increasing effective treatment, improving outcomes, and reducing disparities. Data were obtained on 63,496 hypertensive patients from 262 primary care providers at 69 practice sites in the Southeast. Data were obtained by reporting cards or by downloading electronic medical records. Among 32,504 hypertensives in JNC-VI Risk Group C (a high risk subset), the last BP was <140/90 in 50% (Figure 1). Among 14,282 dyslipidemic hypertensives in this high risk group with an LDL–c value on record, LDL-c was <130 mg/dL in 65.8% and <100 mg/dL in 46%. Substantially fewer African Americans (AA) than Caucasians (C) (24% v. 37%) had reached this level of LDL control. Among 10,965 diabetic hypertensives with glycosylated hemoglobin values, 48.0% were <7%. A substantially smaller proportion of AA than C (41% v. 54%) had reached this level of blood glucose control. Multiple risk factor control was rare, especially among women and AA. Most hypertensive patients received combination therapy, however statin and betablocker use was less common in women and AA. A hypertension quality improvement program based on active audit and feedback at multiple primary care sites which include ethnic minorities and complicated patients is feasible. Individual risk factors are controlled to or near goal in many. The most striking ethnic difference is in LDL-c control which appears to reflect the lower use of statin drugs in African Americans (Figure 2). Such findings suggest that the database can be used to guide education and interventions to improve treatment and reduce disparities.

BACKGROUND Demographic differences in management of concomitant lipid disorders among hypertensive patients may contribute to health disparities. OBJECTIVES Assess demographic differences in lipid control rates and treatment patterns among dyslipidemic hypertensive patients in primary care. METHODS Demographic information, blood pressure, LDL-cholesterol, and medications were obtained on 72,351 hypertensive patients from 262 primary care providers at 69 sites in the Southeast. Analysis focused on a dyslipidemic hypertensive subset. RESULTS Among 72,351 hypertensives, 38,116 were dyslipidemic. Fifty-two percent of patients did not have a cholesterol measurement documented in the past year. Women and patients <40 years old were less likely to have an annual cholesterol measurement than men and older, same-race counterparts (P < or = .001). Thirty-five percent of all hypertensive dyslipidemic patients had not been prescribed any anti-lipidemic medication, whereas 15% were on a statin and another anti-lipidemic. Women received fewer statin prescriptions than men (47.7% vs 65.1%, P < or = .0001). Fewer African Americans (AA) than Caucasians (C) reached LDL levels of <100 or <130 mg/dL (P < or = .0001). Among C and AA patients, those <40 years old were less likely than older, same-race counterparts to have reached LDL < 100 or <130 mg/dL (p < or = 001). Younger patients had fewer annual cholesterol measurements and were less likely to receive antilipidemic medication and to have LDL controlled than older, same-race counter-parts in each ethnic group (P < or = .0001). CONCLUSIONS Demographic characteristics of hypertensive patients, especially younger age group, are associated with significant differences in diagnostic testing, treatment, and control of hyperlipidemia in primary care. This primary care information can be used to guide education and policy interventions to improve outcomes and reduce disparities.

Significant health disparities exist between majority and minority populations related to cardiovascular risk factor control. Computer technology is a powerful tool for visualizing the distribution of these disparities. A more specific picture of these distributions can help focus efforts to achieve parity. The Hypertension Initiative database gathered medical record information on 71,012 hypertensive patients receiving healthcare at 63 primary care sites in the Southeast. Patient information was grouped by zip code and analyzed for differences in risk factor control between African Americans (AA) and Caucasians (C). Only zip codes containing at least 200 C or 200 AA hypertensives were included in analysis. Risk factors of interest included blood pressure, LDL-cholesterol, and Hemoglobin A1c. Twenty-seven zip codes contained > 200 C or > 200 AA hypertensives. Of these, 14 contained > 200 of both groups (N=18,527, C=12,610, AA=5,917). In these 14 zip codes, more C than AA had reached blood pressure control levels of <140/90 mmHg. In 11 zip codes, racial groups were different by > 10%. In 1 zip code, the percent of each racial group in control was different by 5%-10%. In 1 zip code, the racial groups' blood pressure control rates were different by < 5%. Regarding LDL-C control to <130 mg/dL, more C than AA patients in all but one zip code had reached this level of control. In 2 zip codes, the between-race difference in LDL-C control was > 10%. In 4 zip codes, the difference between racial groups was 5%-10%. In 8 zip codes, the difference in LDL-C control was < 5%. More AA than C patients had reached Hemoglobin A1c (HbA1c) control levels of <7%. In 10 zip codes, a higher percentage of AA patients had achieved HbA1c control than C patients. In all 14 zip codes the difference in control rates between the two racial groups was < 5%. The most striking ethnic difference found was in blood pressure control. Differences in LDL-C control were less pronounced. Analysis of the distribution of HbA1c control showed the least disparity. Using a large electronic database to identify disparities is both feasible and effective. Analyses of medication and screening are underway and will further illuminate these differences. Am J Hypertens (2004) 17, 198A–198A; doi: 10.1016/j.amjhyper.2004.03.524

Previous research has shown that controlling hypertension and other cardiovascular (CV) risk factors reduces the number of CV events and racial/ethnic health disparities. The objectives of this study were to assess CV risk factor treatment, control, and disparities among patients with hypertension using data from retrospective medical record audits. Data were obtained from 63 primary care sites with 201 providers. In 49% of 35,940 patients with hypertension, the last blood pressure reading was less than 140/90 mm Hg. In 62% of 18,627 patients who also had dyslipidemia, low-density lipoprotein cholesterol was less than 130 mg/dL. In 49% of 6,616 patients with hypertension and diabetes, glycosylated hemoglobin levels were less than 7%. Multiple risk factor control was rare, especially among women and African Americans. It appears that programs to improve CV risk factor control using audit and feedback in primary care are feasible and instructive.

The purpose of the Healthy Challenges Project (HCP) was to increase health instruction in grades 3–12 via teacher training in problem-based learning (PBL), resources, and incentives to instruct students on tobacco prevention. The HCP provided teacher training, incentives to encourage participation, and funding to purchase classroom health education materials. Teachers were trained to use the PBL teaching technique to increase critical thinking skills and depth of inquiry among students. This study utilized a repeated measures quasi-experimental design. Subjects included 53 participating teachers and 42 nonparticipating (comparison) teachers. Analysis of variance results determined six variables that were significantly different for participating versus nonparticipating teachers. These were ratings of passive student participation; perceptions of other teacher support; positive feelings about teaching health; feeling that “my teaching method was effective”; preparation time for class, and time students spent working in small groups. Results suggest that PBL teacher training combined with incentives can increase and improve health education classroom instruction.