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    1. Barbers and Stylists Defeating Diabetes An innovative and effective form of lay health educators in underserved areas A New DEAL (Defeating Diabetes through Education, Awareness and Leadership) DUVAL COUNTY HEALTH DEPARTMENT Jacksonville, FL

    2. Closing the Gap The Reducing Racial and Ethnic Health Disparities "Closing the Gap" grant program, section 381.7351, Florida Statutes, was signed into law on June 8, 2000. Administered by the Florida DOH - Office of Equal Opportunity and Minority Health. 7 target priority health areas including diabetes. Nearly $25 million awarded since inception. FY 07/08, total funding of $1,815,000; diabetes: $900,000 or over 49% among 8 projects through Florida. The Reducing Racial and Ethnic Health Disparities "Closing the Gap" grant program, section 381.7351, Florida Statutes, was signed into law on June 8, 2000. The program is administered by the Office of Equal Opportunity and Minority Health. Since the initial appropriations, a total of $24.8 million has been awarded by the Legislature to provide funding through grants to local counties and organizations. These grants are utilized to stimulate the development of community and neighborhood-based organizations to improve health outcomes of racial and ethnic populations and promote disease prevention activities. The "Closing the Gap" grant program targets seven priority health areas: cancer, cardiovascular disease, diabetes, adult and child immunizations, HIV/AIDS, maternal and infant mortality and oral health care. Projects funded through the Closing the Gap grant program help stimulate broad-based participation and the support of both public and private entities by: - Fostering partnerships between local governments, community groups and private sector health care organizations; - Helping communities address their most pressing health needs through targeted health screenings, education and awareness programs; - Helping communities better understand the nature of health disparities among ethnic and racial groups; and - Allowing state epidemiologists to evaluate the effectiveness of the interventions so that identified "best practices" can be shared with other high-risk Florida communities. The Reducing Racial and Ethnic Health Disparities "Closing the Gap" grant program, section 381.7351, Florida Statutes, was signed into law on June 8, 2000. The program is administered by the Office of Equal Opportunity and Minority Health. Since the initial appropriations, a total of $24.8 million has been awarded by the Legislature to provide funding through grants to local counties and organizations. These grants are utilized to stimulate the development of community and neighborhood-based organizations to improve health outcomes of racial and ethnic populations and promote disease prevention activities. The "Closing the Gap" grant program targets seven priority health areas: cancer, cardiovascular disease, diabetes, adult and child immunizations, HIV/AIDS, maternal and infant mortality and oral health care. Projects funded through the Closing the Gap grant program help stimulate broad-based participation and the support of both public and private entities by: - Fostering partnerships between local governments, community groups and private sector health care organizations; - Helping communities address their most pressing health needs through targeted health screenings, education and awareness programs; - Helping communities better understand the nature of health disparities among ethnic and racial groups; and - Allowing state epidemiologists to evaluate the effectiveness of the interventions so that identified "best practices" can be shared with other high-risk Florida communities.

    3. A New DEAL Grant-funded diabetes disparities reduction program focused on African-Americans living in the urban Core of Jacksonville, FL. July 1, 2006 to June 30, 2009: $125,000 per Fiscal Year Three main components: - A Community Health Worker Initiative - A Partnership with the local Front Porch Community - Diabetes Self-Management Education (DSME)

    4. Community Health Workers through History As early as 1950s, CHW used in the US to reach migrant farm workers. Federal Migrant health Act of 1962 and Economic Opportunity Act of 1964. 1968: Indian Health Service adopted a Community Health Representative program. Positive results through various research and studies (Rosenthal et al, 1998; Meister et al, 2003; Samuels et al, 2003; Mock et al, 2006, etc.) Today, CHWs used by CHDs, CBOs, FBOs, and other local and national organizations.

    5. Barbers and Stylists? DCHDs partnership with local barbers started in 2004 with the CTG Prostate Cancer program. Barbershop = Black Mens Country Club and the program was trying to reach black men for Prostate Cancer Awareness and Early Detection. High success rate ? more trainings with our local barbers (Colorectal Cancer, CVD, etc.) A New DEALs target population was the whole African-American family, so stylists were added to the cadre of lay health workers for the diabetes initiative.

    6. Lay Health Worker Training INCENTIVES WORK! Held on a Monday (most barbers and stylists day off) Develop social conscience and offer a way for concerned citizens to help their community Half-day training with a stipend offered for attendance and completion Friendly competition between shops - Recruited from current cadre of barbers - Flyers made and circulated in barbershops and beauty salons by our New DEAL CHWs - Flyers posted at beauty supply stores where target trainees would visit to purchase supplies- Recruited from current cadre of barbers - Flyers made and circulated in barbershops and beauty salons by our New DEAL CHWs - Flyers posted at beauty supply stores where target trainees would visit to purchase supplies

    7. Lay Health Worker Training (contd) Pre-test Diabetes 101 presentation which was tailored to the audience. Program CHWs Risk test Q&A Post-test Acanthosis Nigricans Evidence shows acanthosis nigricans is often associated with hyperinsulinemia and may indicate increased risk of type 2 diabetes mellitus. Patients with acanthosis nigricans are likely to have multiple risk factors for type 2 diabetes. Acanthosis nigricans may be an independent risk factor for this disease. Detection of acanthosis nigricans may help clinicians more rapidly identify high-risk individuals for diabetes counseling. [Annals of Family Medicine 5:202-208 (2007) 2007; doi: 10.1370/afm.678] Myth Busters 1- Eating too many sweets is not the cause of diabetes (related to increased risk from overweight from uncontrolled eating habits) 2- You do not have to GIVE UP food once you are diagnosed with diabetes or eat special diabetic food (related to portion control and effective blood sugar monitoring) 3- Diabetes is a preventable condition (introduced the twins, diet and exercise, and controllable for those diagnosed, effective self-management and working together with your healthcare team) Acanthosis Nigricans Evidence shows acanthosis nigricans is often associated with hyperinsulinemia and may indicate increased risk of type 2 diabetes mellitus. Patients with acanthosis nigricans are likely to have multiple risk factors for type 2 diabetes. Acanthosis nigricans may be an independent risk factor for this disease. Detection of acanthosis nigricans may help clinicians more rapidly identify high-risk individuals for diabetes counseling. [Annals of Family Medicine 5:202-208 (2007) 2007; doi: 10.1370/afm.678] Myth Busters 1- Eating too many sweets is not the cause of diabetes (related to increased risk from overweight from uncontrolled eating habits) 2- You do not have to GIVE UP food once you are diagnosed with diabetes or eat special diabetic food (related to portion control and effective blood sugar monitoring) 3- Diabetes is a preventable condition (introduced the twins, diet and exercise, and controllable for those diagnosed, effective self-management and working together with your healthcare team)

    8. Outreach Task Display board in a highly visible area of the shop. Talk to customers about diabetes (risk factors, symptoms, complications). Ask customers to fill out a risk assessment if they are undiagnosed. Turn in assessments to program CHW for follow up. NB: A time frame of 3 weeks was set to turn in assessments due to customer recycling in a barbershop setting. The Display board contained 3 pockets with: 1- risk assessments (participants information page and risk test on the back) 2- information for people living with diabetes 3- information on diabetes for a healthier community (for people who do not have diabetes)The Display board contained 3 pockets with: 1- risk assessments (participants information page and risk test on the back) 2- information for people living with diabetes 3- information on diabetes for a healthier community (for people who do not have diabetes)

    9. The Results 37 Barbers and Stylists were trained as lay health workers, distributed among a total of 18 different shops in the city (August 2007). From a sample of 25 participants, we found that each LHW talked on average to 8 unduplicated customers a day, or 40 customers a week. As a whole, we collected upwards of 600 risk assessments from our participating shops, and nearly 3000 people were reached through the initiative. Most shops (16) kept their boards and still have them up to date. Risk tests were replaced with self-scoring assessments.

    10. Lessons Learned Survey Results Main Challenges faced by LHW: 1) Many customers had deeply rooted misconceptions about diabetes, which made it hard to keep them engaged in conversation (ex: not overweight, not feeling sick, no family history or someone had it and lived to be 90 SO I should not be concerned). 2) Customer privacy (did not want to give information on risk test). 3) Dont want to know and Got to die of something syndromes.

    11. Lessons Learned Survey Results (Contd) Top Health Issues Customers wanted to know more about from the discussion with their barber/stylist Weight Loss Diet and Exercise High Blood Pressure

    12. Lessons Learned Survey Results (Contd) Health Issues our barbers/stylists wanted to know more about after implementing the initiative In addition to the issues laid out by their customers 1- Access to care for the uninsured 2- Smoking and lung cancer 3- Breast cancer 4- Skin care issues 5- Obesity in the African American community 6- Main health issues affecting the elderly

    13. Contact Information Anta James, MA. Program Manager A New DEAL (Defeating Diabetes through Education, Awareness and Leadership) 900 university blvd. North, suite 209 Jacksonville, FL 32211 Tel. 904-253-2310 Fax. 904-745-3015 Anta_James@doh.state.fl.us