Chapter Six
The West Virginia Cardiovascular Health Program
Background | Mission and Goals | Minority Initiatives

The burden of cardiovascular disease in West Virginia is being addressed in part by the West Virginia Cardiovascular Health Program, located within the Division of Health Promotion, Office of Epidemiology and Health Promotion, West Virginia Bureau for Public Health. The program is funded by the U.S. Centers for Disease Control and Prevention (CDC).

Program Background. In 1998, an application was made to the CDC for development of a core capacity program for cardiovascular health in West Virginia. West Virginia's application was accepted along with 10 other states. Core capacity funding began in July 1999, while supplemental funds to address racial and ethnic disparities were awarded in October of that year. With funding obtained, the program previously known as the West Virginia Cardiovascular Disease Program was renamed the West Virginia Cardiovascular Health Program.

With its new name and new funding, the program developed a plan to address the requirements outlined by the CDC for "core capacity building" states. Those requirements directed program efforts to:
• develop and coordinate partnerships
• develop scientific capacity to define the cardiovascular disease problem
• develop an inventory of policy and environmental strategies
• develop or update the state plan
• provide training and technical assistance
• develop population-based strategies
• develop culturally competent strategies for priority populations

Program Mission and Goals. The West Virginia Cardiovascular Health Program is guided by the vision of "creating a culture of cardiovascular health in West Virginia." The mission of the program is to establish environments and policies that promote heart health in West Virginia. The program has adopted goals based on the seven expectations (identified above) of the CDC for core capacity states. Those goals are discussed in the following paragraphs.

Goal #1: Develop and Coordinate Partnerships

Objectives: Identify and appropriately involve partners within the state health department and within state government; develop a statewide coalition.

The West Virginia Bureau for Public Health has strengthened the West Virginia Cardiovascular Health Program by developing a CVH team that includes professional staff with expertise in physical activity, nutrition, and minority initiatives, in addition to a program manager and a secretary. The program is placed within the Chronic Disease Section of the Division of Health Promotion and Chronic Disease and works closely with the Tobacco Prevention Program, the Diabetes Control Program, and the Osteoporosis Program to avoid duplication of efforts in reducing risk factors for cardiovascular health as well as for other chronic diseases. The CVH Program also works collaboratively with the Community Health Promotion Section, which works directly with local communities to build capacity, and the Health Statistics Center, which provides data support.

The Cardiovascular Health Steering Committee was established with representatives from the American Heart Association, St. Mary's Hospital, West Virginia University Prevention Research Center, Health Statistics Center/WV Bureau for Public Health, Physical Activity Coalition, Nutrition Coalition, WV Department of Education, the American Cancer Society, the Coalition for Minority Health, the Coalition for a Tobacco-Free West Virginia, as well as the WV Cardiovascular Health Program staff. The steering committee will guide and lend expertise to the WV Cardiovascular Health Program, particularly in developing the state CVH plan.

The Physical Activity Coalition and the Nutrition Coalition will continue to strengthen their organizational memberships with nontraditional partners and establish Memorandums of Understanding. A member survey was implemented in year one that assessed coalition capacity for reaching cardiovascular health objectives. Main barriers identified included inadequate funding, lack of full-time staff, travel time necessary to participate in meetings, and time issues.

Goal #2: Develop Scientific Capacity to Define the Cardiovascular Disease Problem

Objectives: Identify trends in cardiovascular diseases, geographic distribution of the diseases, racial and ethnic identities of populations at highest risk for cardiovascular diseases, and ways to integrate systems to provide comprehensive data.

The Burden of Cardiovascular Disease in West Virginia will be released in July 2001; the report will include mortality, morbidity, risk factor prevalence, hospital discharge, and access to care data. The CVD BRFSS module will be implemented in the same years as the leisure-time physical activity and the fruit and vegetable consumption modules. Epidemiological expertise is provided by selected nutrition and physical activity research scientists at the WVU Prevention Research Center. Results will be disseminated through key partners, at conferences, and through the Internet.

Goal #3: Develop an Inventory of Policy and Environmental Strategies

Objective: Develop an inventory of policy and environmental issues in systems and settings (state, communities, health care sites, work sites, schools) that affect the cardiovascular health of the general and priority populations.

Partners at WVU Prevention Research Center will be conducting a comparison of policy and environment inventories in two counties (one high-risk county and one low-risk county). These inventories will focus on the CDC community and school indicators for physical activity and nutrition. The CVH Program is partnering with the Tobacco Prevention Program to conduct a work site survey that will include selected indicators for physical activity and nutrition. St. Mary's Hospital is working with the CVH Program, WV Hospital Association, and the WV Medical Institute to survey providers regarding the American Heart Association Prevention Guidelines.

The results of these inventories were presented at the June 2001 CVH Conference. Many of these inventories will provide baseline data for the WV Healthy People 2010 Objectives.

Goal #4: Develop or Update the State Plan

Objective: Develop or update a State Plan for cardiovascular diseases, to include specific objectives for future reductions in cardiovascular diseases and related risk factors.

The CVH Steering Committee reviewed the current Plan and developed the purpose for the new Plan. The State Plan will offer strategies to meet the WV Healthy People 2010 Objectives. Additional assessments of selected risk factors will be compiled and written into appropriate chapters. An evaluation component of the Plan will be developed to monitor progress. The Plan will be disseminated by key partners, presented at conferences, and made available to interested parties on the Internet.

Goal #5: Provide Training and Technical Assistance

Objective: Increase the skills of state health department and external personnel.

Staff have been hired to build and develop partnerships and draft the CVH Plan. All personnel are participating in CDC-sponsored CVH trainings and other national and state trainings that focus on physical activity and/or nutrition and related CVH issues. Members of the Physical Activity Coalition and the Nutrition Coalition are receiving further training on CVH policy and environment issues. St. Mary's Hospital coordinates an annual training conference for health care providers and public health professionals each June. The first Cardiovascular Health in Appalachia: Partnering for Change conference was attended by approximately 100 professionals.

Goal #6: Develop Population-Based Strategies

Objective: Develop population-based intervention strategies to reduce the burden of cardiovascular diseases in the state, with a strong emphasis on policy and environmental approaches for the general population. Primary strategies must address the cardiovascular risk factors of nutrition and physical activity.

Specific work groups were developed to address particular WV Healthy People 2010 Objectives in the areas of Heart Disease & Stroke, Physical Activity & Fitness, Nutrition & Overweight, and Tobacco Use. Work groups have used CDC Policy and Environmental Indicators to guide strategy development for each of the objectives. These strategies will be part of the CVH State Plan.

The WV CVH Program is partnering with the WV Trails Coalition in developing and implementing the state trails plan. The Walk Across West Virginia, a statewide physical activity campaign, has been promoted in targeted populations. As additional successful policy and environmental changes are identified through the policy and environment inventory, these strategies will be implemented statewide with training and technical assistance provided to those state and local partners.

The CVH Program supports the efforts of the WV Tobacco Prevention Program, which has received a portion of tobacco settlement dollars to implement CDC Best Practices. The Tobacco Prevention Program implements several population-based strategies that impact youth, schools, health care settings, work sites, and the media.

The CVH Program collaborates with the Community Health Promotion Program and the Office of Rural Health Policy to provide technical assistance to Community-Based Initiatives grants that address physical activity and nutrition strategies to meet the WV Healthy People 2010 Objectives.

Goal #7: Develop Culturally Competent Strategies for Priority Populations

Objective: Develop, and include in the State Plan, strategies for enhanced program efforts to address priority populations.

A social marketing campaign focusing on symptom awareness and primary prevention will be piloted in Lincoln County, a rural county very typical of Appalachia. The CVH Steering Committee will work with partners to review culturally competent policy and environmental strategies for physical activity and nutrition among priority populations. The CVH Steering Committee will assist in developing criteria for selecting appropriate strategies.

West Virginia Minority Initiatives for Cardiovascular Health Project

The seventh core capacity building mandate from the CDC provides the framework for the West Virginia Minority Initiatives for Cardiovascular Health Project. Within that project, the four goals direct efforts that will determine the direction of the overall Cardiovascular Health Program. West Virginia currently has a 4.1% minority population, with 3.2% African Americans and 0.9% represented by other minorities. In order to address the needs of these individuals, the following efforts have been undertaken by the Cardiovascular Health Program.

Goal #1: Develop and Coordinate Partnerships.

The CVH Program partners with the WV Coalition for Minority Health, the WV Minority Health Program, and the American Heart Association in implementing the Minority Initiatives for Cardiovascular Health Project. Its goal is to establish health ministry networks in the three counties where most African Americans reside (Kanawha, Raleigh, and McDowell). Once these efforts are under way, the project will expand to serve four additional counties (Mercer, Cabell, Fayette, and Jefferson). These seven counties comprise 66.6% of the total African American population in WV.

Activities of the Minority Initiatives for Cardiovascular Health Project to date:

• Initial focus groups were held to determine the validity of channeling our efforts through the faith community. Seventeen African American pastors participated (11 from Kanawha and six from McDowell County). The primary question was "What is the role of the African American church in the community?" The results were that most church leaders believe that in addition to the spiritual needs the church has an obligation to also address health, economic, and social issues affecting their members.

• Twenty-five individuals have either volunteered or were appointed by their pastors to be wellness coordinators for their congregations and the key contact for the Project.

• To raise awareness of the Project's existence and to expand our partnerships, the print media have been used to promote the Project. During our first year, stories were published in the Charleston Daily Mail, the WV State Medical Journal, and the State Health Education Council newsletter.

• There has been increased collaboration between the Minority Initiatives Project and the WV Diabetes Control Program. In addition to participating in MultiFest 2000, representatives from both programs attended the Diabetes Today facilitators' training. The techniques learned could be used when addressing any chronic disease.

Goal #2: Develop Scientific Capacity to Define the Cardiovascular Disease Problem in African Americans in WV

The West Virginia Minority Health Chart Book was released in 1999. For the first time, detailed statistics were provided to define the health status of African Americans in West Virginia. Of the six leading causes of years of potential life lost before age 65, cardiovascular disease ranks number one.

Focus group tests will be used to explore current dietary and physical activity patterns, root causes of physical inactivity and poor nutrition, and issues concerning modification of those patterns for improved physical activity and diet.

Goal #3: Provide Training and Technical Assistance

In addition to providing a project coordinator, an advisory committee has been formed. The group meets semiannually, receives periodic reports, and is involved in specific activities for the Project. The advisory committee is made up of a cross section of minority community members as well as representatives from the faith and medical communities and Bureau for Public Health members.

Through the Partnership of African American Churches, the Project is funding the training of 11 wellness coordinators to conduct exercise classes for their congregations and communities. They will conduct two classes per week for 16 weeks.

In conjunction with the core capacity grant, St. Mary's Hospital coordinates a CVH conference for health care providers and health promotion specialists. This conference also includes sessions on cultural competency.

Goal #4: Develop Culturally Competent Strategies for African Americans in WV

The Project partnered with All-Aid International, Inc. (a community-based, minority-focused organization) to conduct an Underground Railroad Walk, held in May 2000, to promote physical activity and increase the awareness of black history. Due to the walk's success, the Project is funding three walks in 2001 in Kanawha, Cabell, and Raleigh counties.

More culturally appropriate literature is being made available to the public through the Minority Initiatives Project, including African American heart healthy cookbooks that have been distributed to wellness coordinators, faith congregations, and minority civic/social organizations statewide.

WV Cardiovascular Health Program Staff

Betsy Thornton, Program Manager
Cardiovascular Health Program
West Virginia Bureau for Public Health
OEHP - Health Promotion, Room 319
350 Capitol Street
Charleston, WV 25301-3715
304-558-0644
Fax: 304-558-1553
E-mail: Betsy.D.Thornton@wv.gov

Kristy Blower, Coordinator
Physical Activity
E-mail: Kristy.D.Blower@wv.gov