Comparative effectiveness of interventions to address hypertension control and colorectal cancer screening in Black men: Baseline findings and lessons learned

Background: Black men in the US have the greatest burden of death from hypertension and colorectal cancer (CRC), in part due to adverse lifestyle behaviors, and lower rates of timely CRC screening. While lifestyle interventions can lower BP and patient navigation (PN) can increase CRC screening in clinic settings, few studies have examined the comparative effectiveness of these approaches among black men in community-based settings.

Objective: To evaluate the impact of community-based lifestyle counseling, PN, and the combination of both on BP and CRC screening among hypertensive black men.

Methods: Black men aged >50 years with uncontrolled hypertension without previous CRC screening were recruited from barbershop/churches and randomized to a lifestyle intervention using motivational interviewing (MI), a culturally-targeted PN intervention or a combination of MI/PN. Outcomes include within-person change in BP, CRC screening rate at 6-months, and the impact of the interventions on life expectancy and quality-adjusted life-years.

Results: In a 16-month period, we screened 4035 black men aged 50+ at 79 barbershops and 39 churches; 1106 were eligible; 794 were randomized and initiated one of the three interventions. Among enrolled men, 67% of non-retired men were unemployed, and 40% reported not having a primary care doctor. Six-month follow up is ongoing, and mathematical models of the potential population-wide impact of the interventions are being developed.

Implications: Our comparative effectiveness program provides valuable insight into how best to address important public health challenges among Black men, and informs the process of implementing public health comparative effectiveness research in real-world settings.