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Community-engaged and community-based participatory research to promote American Heart Association Life’s Simple 7 among African American adults: A systematic review

  • Rana Elgazzar,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Writing – original draft, Writing – review & editing

    Affiliation The Ohio State University College of Medicine, Columbus, OH, United States of America

  • Timiya S. Nolan,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Writing – original draft, Writing – review & editing

    Affiliations The Ohio State University College of Nursing, Columbus, OH, United States of America, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America

  • Joshua J. Joseph,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Writing – original draft, Writing – review & editing

    Affiliation The Ohio State University College of Medicine, Columbus, OH, United States of America

  • Emmanuela B. Aboagye-Mensah,

    Roles Writing – original draft, Writing – review & editing

    Affiliation The Ohio State University College of Medicine, Columbus, OH, United States of America

  • Rosevine A. Azap,

    Roles Writing – original draft, Writing – review & editing

    Affiliation The Ohio State University College of Medicine, Columbus, OH, United States of America

  • Darrell M. Gray II

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Writing – original draft, Writing – review & editing

    Affiliations The Ohio State University College of Medicine, Columbus, OH, United States of America, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America



Cardiovascular disease (CVD) is the leading cause of death in the United States and African Americans (AA) have a disproportionately greater burden of CVD as compared to Whites. The American Heart Association (AHA) Life’s Simple 7 (LS7) framework outlines goals for attaining ideal cardiovascular health. Yet, there is a lack of evidence summarizing best practices to maximize LS7 attainment. The objective of the present study was to systematically review the extant peer-reviewed literature on community-engaged and community-based participatory research (CBPR) aimed at improving one or more LS7 metrics among AA.


PubMed, CINAHL, and Embase databases were searched. We included articles that reported quantitative results for one or more of the following LS7 metrics: physical activity, diet, cholesterol, blood pressure, body mass index, smoking, and glycemia. We included analyses with a greater than 50% AA study population focused on adults (≥18 years of age).


Of the 1008 unique studies identified, 54 met inclusion criteria; 27 of which were randomized controlled trials. 50% of studies assessed more than one LS7 metric but only two studies evaluated all seven of the LS7 metrics. No studies had a high proportion of AA males. 40 studies improved at least one LS7 metric at the study end-point. Formative research was used in many studies to guide intervention design. Studies were of varying quality, but overall rated “fair” using a modified approach to the National Institute of Health quality assessment tool.


There is insufficient data to recommend a specific community-engaged or CBPR intervention to improve attainment of LS7 metrics among AA. Future studies using rigorous methodology with increased gender diversity and utilizing the AHA LS7 framework are required to establish a validated program to improve LS7 in AAs.


Cardiovascular disease (CVD) is the leading cause of death in the United States [1]. CVD incidence and mortality is highest among racial and ethnic minorities [2]. This is of critical importance as the percentage of ethnic minorities are projected to vastly increase in the United States. Estimates show that African Americans (AA) will see a 42% population increase between 2014 and 2060 [3]. AA, in particular, have a disproportionately greater burden of CVD and lower life expectancy, as compared to Whites [1, 4, 5]. CVD disparities among AA are facilitated by a high prevalence of a multitude of risk factors, such as obesity, hypertension, and diabetes mellitus [6], in addition to the interaction of social and behavioral health factors [7]. Furthermore, there are striking gender differences which interface racial health disparities. The burden of chronic disease is substantially higher in AA males, who have the highest age-adjusted all-cause mortality of any race-gender group in the U.S [8]. In 2015, the life expectancy of non-Hispanic Black males was 71.8 years compared to 78.1 for Black females and 78.7 for Whites of both sexes [8]. In addition to the higher rates of CVD, Black men are also twice as likely to die from CVD than White men [9].

Given that behavioral and biological factors contribute to a large percentage of health, the American Heart Association (AHA) in 2010 outlined goals for reaching ideal cardiovascular health through the Life’s Simple 7 (LS7) framework [10]. The framework consists of modifiable lifestyle behaviors and biometric factors, including smoking status, body mass index (BMI), physical activity, diet, total cholesterol, blood pressure, and blood glucose. There have been numerous studies showing associations of higher attainment of LS7 with lower risk of CVD, diabetes, and cancer. Additionally, interventions addressing multiple risk factors are more likely to reduce rates of fatal CVD when compared to single risk factor interventions [11]. However, little evidence exists reviewing best practices to maximize LS7 attainment in communities and populations that have high prevalence of CVD along with various chronic diseases and all-cause mortality.

Multi-ethnic cohorts including AA [1214] and studies focused specifically on AAs [13] showed that higher attainment of ideal cardiovascular health as defined by the seven factors (i.e., smoking abstinence or cessation, BMI <25 kg/m2, adequate levels of physical activity, healthy diet, total cholesterol <200 mg/dL, blood pressure <120/80 mmHg, and fasting glucose <100 mg/dL in the absence of diabetes mellitus) is associated with significantly lower risk of CVD [10]. Moreover, ideal cardiovascular health is associated with lower risk of incident cancer and type 2 diabetes [15, 16]. Compared to Whites, Chinese Americans and Hispanic Americans, AAs have lower attainment of ideal LS7 metrics [17]. In addition to individual lifestyle and behavior factors, there are environmental and psychosocial factors that are framed within the social determinants of health (SDOH) that impact the disproportionate burden of chronic disease in AAs. The SDOH are “the conditions in which people are born, grow, live, work and age,” which include domains such as economic stability, education, and built environment [18]. In general, AAs are disproportionately burdened by poor status of SDOH [19]. These upstream factors play a key role in the development of CVD risk factors [20]. Racism is an additional burden on AAs that may impact the individual (individual racism) and underlies inequities in the social determinants of health across AA communities through structural racism, such as lower educational levels, higher poverty, higher violence, and exposure to environmental toxins [21, 22]. On the individual level, there is evidence that racism contributes directly to the higher incidence of HTN in AA [23] and interpersonal racism is associated with increased long-term stress levels [24]. This is further magnified by the social and environmental barriers that stem from institutional racism, such as its negative effect on socioeconomic status and healthcare access, highlighted by the impact of redlining [25, 26].

Successful efforts to activate and engage large numbers of AAs to attain ideal cardiovascular health with the goal of reducing disparities in CVD, diabetes, and cancer are vastly needed. However, successfully implementing such interventions can be challenging. Community-engaged research can aid in mitigating this challenge. It overcomes some limitations of the traditional medical model by integrating the cultural, social, and environmental contexts that underlie clinical and public health initiatives [27]. Guided by the social ecological model, community-engaged research is broadly characterized as the process of multidisciplinary collaborative work among community groups sharing special interests to address problems and customize solutions specific to that community [28]. Community-based participatory research (CBPR) is one type of community-engaged research.

CBPR is a highly involved cooperative approach which mobilizes and empowers communities through research partnerships to develop, implement, test, and sustain effective interventions targeted toward a population’s unique goals and challenges [29]. While community-engaged research gives communities shared ownership over the products of research, CBPR goes a step further by necessitating that community stakeholders participate in all stages of research [29]. Through the shared exchange of expertise, CBPR focuses on improving health by involving community members, public leaders, civic organizations, and academic institutions at all levels of research development and translation. CBPR, as well as community engaged research overall, has demonstrated favorable intervention acceptability [30]. Furthermore, utilization of such strategies may be critical to engaging and reducing disparities in attainment of ideal LS7 metrics among AAs.

Within the community-engaged and CBPR frameworks, formative research is often utilized in order to culturally tailor interventions to the population of interest, especially when targeting lifestyle changes [31]. Rather than testing a specific hypothesis, formative research uses qualitative and/or quantitative methods such as interviews, focus groups, direct observation, and surveys, to inform the design and implementation of interventions which take into account community attitudes, needs, and barriers [32].

With AAs attaining fewer ideal components of the LS7 framework, improved knowledge of effective disease prevention strategies aiming to mitigate the disproportionate rates of premature morbidity and mortality among AA due to CVD, diabetes, and cancer are necessary. LS7 interventions developed using CBPR and community-engaged research principles may have significant impact at the individual and population levels. However, best practices to conduct such work have yet to be established. This systematic review aims to examine the current literature on interventions targeting LS7 improvement in AAs. Specifically, this review will focus on CBPR and community-engaged research used to evaluate efficacy and effectiveness of interventions using one or more LS7 metrics in AAs.


We conducted a systematic review of English-language literature to identify and synthesize extant literature on the assessment of one or more LS7 metrics within CBPR and community-engaged interventions for AAs. We searched MESH/Headings and keywords for terms associated with African American, black, community-based participatory research, community engagement, cardiovascular health, cardiovascular disease, physical activity, exercise, healthy diet, nutrition, smoking, smoking cessation, body weight, BMI, blood pressure, hypertension, blood sugar, diabetes, glycemic control, cholesterol, and cholesterol VLDL. In June 2018, we queried PubMed, Embase, and CINAHL databases for relevant articles without time constraints. The search was repeated in December 2019 to include new articles published up to December 16th, 2019. Search strategies are presented in the S1 Appendix. All articles were imported into Covidence Software for reference management [33]. There is not a registered protocol associated with this systematic review.

Articles were screened and reviewed based on selection criteria. Inclusion criteria were applied to meet the study purpose. We included articles that reported quantitative results for the outcomes of interest relating to one or more of the following LS7 health components: physical activity, diet (such as fruit and vegetable consumption), cholesterol, blood pressure, body mass index, smoking, and glycemia (glucose or hemoglobin A1c). Interventional study designs were eligible for inclusion. These included both experimental designs such as randomized controlled trials and cluster randomized trials, as well as quasi-experimental designs such as variations of pre-post tests with or without a comparison group. We included analyses with a greater than 50% AA study population focused on adults (≥18 years of age). Interventions included in the review employed principles of community-engaged research (at a minimum) or community-based participatory research. For example, interventions involving recruited participants from the target population, carried out in community settings such as churches, schools, and businesses, as well as those involving community coalitions in the planning, conduct, and/or analysis of the research study were included. Articles were excluded if they did not meet inclusion criteria. Specifically, studies were excluded if they did not involve ≥ 50% AA adults, present quantitative results for the outcomes of interest, or use community-engaged or CBPR methods.

The following describes the iterative process of review. Citations were gathered through the literature search. There were 124 duplicates which were subsequently removed. Four reviewers (RE, TSN, JJJ, and DGII) reviewed 1008 titles and abstracts for inclusion and exclusion. Disagreements were resolved through review and consensus by all four reviewers. Full text review of 226 articles was conducted in the same manner based on inclusion and exclusion criteria. During full text review, we used ascendency and descendancy to identify relevant articles for inclusion. After full text review, two reviewers (RE, TSN, JJJ, and DGII) performed the critical appraisal (quality assessment) of each of the 54 remaining articles using the National Heart, Lung, and Blood Institute Study Quality Assessment Tools from the National Institute of Health (NIH) with a modified approach [34]. This NIH tool evaluates internal and external validity, in addition to sources of bias, confounding, and other potential flaws specific to each study design. For example, criteria being assessed for controlled studies included methods of randomization, blinding, and sample size. By affirming or negating each query in the tool, studies can be assessed for an overall quality rating of “good”, “fair”, or “poor.” Our team determined “good” studies to be those affirming at least 70% of the items in the assessment tool. “Fair” studies affirmed 50%-69% and “poor” studies affirmed less than 50% of the items in the tool. No studies were excluded based on the quality rating. Questions comprising the quality assessment tool for each study design are included in the S1 Appendix. Finally, data was extracted from selected articles and collated into matrices for content analysis. Data points include author, study design, description of sample, mean age of participants, LS7 metric(s) assessed, description of intervention, and results.


Study selection

A total of 966 citations were gathered through the initial literature search in Pubmed, CINAHL, and Embase. An additional 12 studies were gathered through other sources (reference searches). Using the same search strategies, 154 citations were added in December 2019. In total, 1008 studies remained after 124 duplicate articles were removed. We excluded 782 citations which were irrelevant based on review of titles and abstracts. We collected full text articles for the remaining 226 studies which were reviewed based on inclusion and exclusion criteria. Through the full text analysis, 172 additional studies were rejected. Our systematic review thus identified 54 unique studies meeting inclusion criteria and further assessed for data extraction. Complete results of the search and review process are detailed in the PRISMA flow diagram (Fig 1).

General study characteristics

Of the 54 included studies in our review, twenty-seven (50%) were randomized trials (Table 1). The remaining twenty-seven studies (50%) were quasi-experimental studies which used some variation of pre-post test design to analyze data at baseline and post-intervention (Table 2). Studies varied widely. The interventions ranged from 5 weeks to 5 years in duration. Sample sizes ranged from 23 to >10,000 study participants. Forty of the 54 studies (74%) demonstrated statistically significant improvements in one or more LS7 metrics at the final endpoint of the study.

Formative research

Formative research was employed in 36 studies (67%) to guide intervention development and implementation. The majority of these (72%) achieved statistically significant outcomes in the intended LS7 target(s). Information on community needs, perceptions, and values were primarily gathered during planning phases before an intervention began, often with input from community-partners or stakeholders. Some studies also incorporated formative assessments during or after the intervention in order to evaluate program appropriateness and participant satisfaction. Various methods were identified: interviews were used in 8 studies, focus groups were used in 16 studies, and qualitative or quantitative surveys were used in 14 studies. Less commonly, other formative research approaches such as direct observation were also used [3740].

Study quality

With regards to the quality assessment, 11 studies (20%) were rated as good; 35 studies (65%) were rated as fair; and 8 studies (15%) were rated as poor. Among controlled studies (i.e. randomized trials), the most common limitations to quality were lack of double blinding as well as drop-out rates > 20% at the study end-point. In many studies, authors also failed to report that the sample size was adequately large to detect outcome differences with sufficient power. Among pre-post test studies, many lacked the following features: enrollment of all eligible participants who met inclusion criteria, a sufficiently large sample size to provide confidence, blinding of study evaluators to the participants’ intervention exposures, and use of interrupted time-series design. Notably, compared to pre-post test and other study designs, randomized trials were more likely to have an overall quality rating of good to fair.

Target population

No studies were specifically designed for African American men. Seven studies specifically targeted African American women [4147]. Of the remaining 47 studies aimed at both African American men and women, 32 studies had females accounting for more than 70% of participants.


All studies were conducted in the community setting. Specifically, 22 (41%) of the selected studies described faith-based programs. Two studies included schools [48, 49] and 3 took place in public housing developments [44, 50, 51].

Study outcomes

The intervention outcomes of 27 studies included physical activity; 21 included blood pressure; 23 included weight or BMI; 7 included smoking status; 9 included blood glucose; 6 included cholesterol; and 23 included change in diet.

Only two studies evaluated changes in all LS7 components [52, 53]. These interventions were related to the faith-based nutrition and exercise program conducted in AA churches in Minnesota: “Fostering African-American Improvement in Total Health [FAITH!].” [52, 53] Overall, twenty-seven (50%) studies targeted more than one LS7 metric. Such interventions, with > 1 LS7 metric, were more likely than not (70%) to have statistically significant improvements in outcome measures. For studies with ≥3 LS7 metrics, the most commonly combined targets were blood pressure, physical activity, and BMI/weight. Diet interventions were most likely to be paired with physical activity. Interventions targeting blood glucose most often incorporated blood pressure and/or BMI/weight components.

Physical activity.

Sixteen out of 27 studies measuring physical activity achieved statistically significant increases in levels of physical activity post-intervention. Data primarily consisted of participants’ self-reported behaviors gathered through surveys and activity ranking scales which varied widely between studies. Other measures included number of steps per day and weekly time expenditures engaging in recreational or moderate to vigorous physical activity. Among effective interventions, almost all delivered educational materials focused on promoting greater at-home activity levels and developing weekly routines to meet fitness goals. Of the effective interventions, a majority created fitness goals and other physical activity plans with groups facilitated by coaches or leaders recruited from the community to better represent and serve said population [5459]. Other studies allowed participants to establish individualized goals and activity plans [60, 61]. In addition, studies also incorporated supervised exercise ranging from 10 to 90 minutes per week during group sessions. Such activities included walking, stretching, aerobics, strength training, and dancing [35, 38, 39, 6163]. Few interventions targeted local environments through community and policy changes to encourage neighborhood walking/jogging as well as recreational physical activity by increasing bike paths and play areas [51, 64]. Overall, studies that utilized multiple approaches to encourage activity (such as group exercise in addition to tailored curriculum or at-home activities) were more effective than those using only one form of intervention.

Blood pressure.

Only 10 out of the 21 studies which measured changes in blood pressure achieved statistically significant blood pressure reduction. Among these studies, systolic blood pressure decreased by 8.17 mmHg on average following intervention [43, 45, 53, 6568]. Physical activity and diet change were the main approaches for attaining blood pressure control. Coach led walking groups were commonly employed methods [39, 45, 65, 66]. Nutritional components emphasized the DASH diet (Dietary Approaches to Stop Hypertension) in conjunction with the use of community gardens and assistance with healthy food shopping [43, 45, 65, 66, 69]. Interventions ranged in duration from 6 weeks to 5 years; however, longer duration did not consistently correlate with the effectiveness of the intervention. Faith based initiatives used similar intervention techniques but had a lower percentage of studies achieving statistically significant outcomes with regards to blood pressure management [43, 60, 61, 70, 71].


Thirteen of the 23 studies evaluating body weight or BMI achieved statistically significant results. Almost all studies promoted wellness plans targeting diet and physical activity to meet weight loss goals. This was done primarily in the group setting, such as group exercise sessions; however, few studies incorporated individualized meetings to discuss weight management. Three interventions used curricula which were guided by the Diabetes Prevention Program (DPP) [40, 72, 73]. Effective interventions varied in duration and ranged from 6 weeks to 5 years. Among these, many employed faith-based programs or recruited participants from church communities [39, 40, 43, 52, 60, 63, 68, 72, 74]. The average reduction in BMI was 2.03 kg/m2 [40, 43, 45, 72, 75]. Average weight loss was 4.36 pounds [40, 43, 45, 60, 63, 68, 74, 75]. Other studies reported percent of participants losing greater than 5% of baseline weight or a decrease in the prevalence of those who were overweight or obese [39, 47, 69, 73]. Interventions focused on both physical activity and diet were more likely to achieve statistically significant weight loss than those targeting diet alone.


Of the seven studies evaluating smoking cessation, four had statistically significant results. Average post-intervention self-reported quit rate was 24% [44, 76, 77]. Studies shared similar intervention methods. Control groups primarily received self-help material such as pamphlets. Mass media campaigns delivering print and electronic communication, including mediums like social media and news/radio stations, were commonly used to promote changes in smoking behavior [64, 77, 78]. In the church setting, scriptural messaging was the primary tool used to encourage smoking cessation [52, 76]. Interventions which incorporated free nicotine replacement therapy generally sustained greater rates of abstinence at long term follow-up when comparing intervention and control groups [44, 78].


Six out of the nine studies reporting results in glycemic control evaluated improvements in diabetes as a primary outcome [52, 65, 72, 7981]. Among the 5 studies with statistically significant results, there was an average decrease in blood glucose of 6.4 mg/dL and Hemoglobin A1c level of 0.7% post-intervention [39, 65, 72, 80, 81]. Interventions commonly implemented lifestyle modifications and used trained coaches to deliver culturally-tailored curricula focused on diet, self-care, and diabetes knowledge [7982]. Other studies implemented group physical activity and walking programs to attain improved glycemic measures [39, 65]. The intervention duration, which varied from 8 to 32 weeks, did not consistently correlate to the significance of results.


Only six studies evaluated changes in cholesterol. Three of these interventions, which achieved statistically significant results, were longer in duration (31 weeks on average). Although interventions targeted dietary changes, programs primarily focused on physical activity through walking groups as a means to improve blood lipid levels [39, 41, 65, 82]. Among these studies, HDL levels increased by an average of 5.7 mg/dL and total cholesterol was reduced by 2.2 mg/dL [39, 41, 65].


Sixteen of 23 studies reporting dietary outcomes achieved statistically significant results. Diet modifications aimed at increasing fruit and vegetable (FV) intake, whole grains, and fiber, while decreasing consumption of sugary drinks and fat. Diet education also emphasized portion control and healthy snacking habits. Some curricula adapted material from specific diets, such as the DASH diet [66, 82]. Among studies reporting change in fruit and vegetable consumption, there was an average increase in FV intake by 0.7 servings/day [48, 50, 53, 68, 8386]. In addition to group informational sessions, effective studies also employed hands-on methods such as cooking classes, demonstrations, and taste testing to promote better nutrition [46, 68, 83, 87]. Policy and community changes such as improving access to farmer’s markets, community gardens, and healthier options at local retailers were also effective strategies [64, 88]. Few studies also directly provided participants with produce or money to purchase fresh foods [50, 82]. Intervention duration did not consistently correlate with improved outcomes.


Life’s Simple 7 (LS7) metrics—an AHA framework for ideal cardiovascular health against which reduction in risk for CVD, diabetes, and cancer can be measured—are empirically supported as a means to reduce development of disease and premature mortality. This review provides a comprehensive account of community-based participatory research and community-engaged interventions applying LS7 metrics to AA. Community-engaged interventions can provide more holistic strategies to address upstream factors such as racism and the social determinants of health underlying the mechanisms leading to racial health disparities.

Overall, we found a lack of consensus on best practices to apply and attain the metrics within interventions represented by wide variation in intervention strategies, intervention efficacy, and insufficient study quality to generalize findings. Moreover, quality did not consistently correlate to the statistical significance of study outcomes.

However, we found that implementation of the interventions shared commonalities. In this review, interventions guided by formative research data were found to increase the effectiveness of community programs. Importantly, formative research can aid researchers in both formulating and modifying interventions to be culturally relative and optimize intended effects. Furthermore, faith-based entities and community health workers are common vehicles for health promotion activities and interventions. Faith-based interventions among AAs are heralded as an approach to assist communities with building capacity with other communities [89, 90]. And although there is a need to enhance the training of and educational programs for church and health ministry leaders who deliver such interventions [91], faith-based organizations have a longstanding history of credible health promotion for the AA community and, as such, faith-based partnerships have been recommended as a necessary driver of national health promotion efforts [92, 93]. This is not surprising, given that evidence suggests that more AA engage with a faith-based organization and AA have the highest church attendance rates in the US as compared to other racial and ethnic groups [9496]. Similarly, utilization of community health workers is an evidence-based approach to navigating AAs beyond barriers to adoption of healthy behaviors and practices (such as mistrust of healthcare providers in medical settings), adherence of provider recommendations, academic-community partnerships and cultivating community capacity for health promotion [97101]. This review demonstrated statistical benefit of faith and community health worker-based interventions, but the clinical benefit is unclear and generalizability of these findings is significantly limited by the variance in study quality.

Content identified within studies included in this review ranged from one to seven LS7 metrics. The most common targets were diet, weight, and blood pressure, and less than 10% of the reviewed studies addressed smoking status. There is a dire need for comprehensive approaches targeting all seven metrics, as there is a graded relationship between the number of ideal cardiovascular health metrics attained and the risk of cardiovascular disease [12]. This effect is even more pronounced among AA as compared to Whites [11]. Therefore, interventions targeting more than one LS7 metric may have greater potential to substantially reduce black-white disparities in CVD. Further, a more holistic approach to health promotion as opposed to singular targets is both preferred [102] and feasible [52] within AA community. Thus, although inclusion of multiple intervention components and assessments may be difficult to analyze, researchers must become more adept in planning such studies to increase uptake and overall outcomes.

There are limitations to this review. First, this review was conducted in three databases and only included full text, peer-reviewed publications. It is possible that potentially relevant studies to this review were missed due to incomplete retrieval of the existing literature as well as variable indexing across databases. Second, there is a dearth of knowledge surrounding the application of all LS7 metrics within targeted interventions for AAs. Of those that were found with one or more LS7 metrics, most exhibited relatively fair appraisal quality. Primary concerns with quality derived from high attrition rates and lack of power to detect effects. Therefore, findings must be interpreted with caution. There were also variable intervention techniques and metrics used across studies, limiting the ability to identify best practices. More research using randomized experimental designs with sufficient sample sizes and high retention rates is needed to strengthen the literature on application of community-based and–engaged LS7 interventions, especially among AA men who were underrepresented in the current studies.


This review highlights opportunities for academic-community collaborations in addressing disparities among AAs, gaps in community-engaged and community-based participated research, and various ways to capitalize on community capacity to deliver interventions with some indication that such methods can be acceptable and promising to reduce the CVD burden. Academic institutions engaging the community and establishing shared responsibility can build infrastructure to support the development, implementation and dissemination of acceptable, evidence-based, effective and sustainable interventions for future use [103, 104]. Yet, based on the available studies, there is insufficient data to recommend a specific community-engaged or CBPR intervention to improve attainment of AHA LS7 metrics among AAs. Future studies aiming to reduce disparities in CVD and/or chronic disease such as diabetes and cancer among AAs may benefit from use of the comprehensive AHA LS7 framework, greater engagement of AA males, and be conducted with more rigorous study methodology. High-quality, generalizable studies are of vital importance in identifying strategies to achieve health equity.


We would like to thank Anna Biszaha from The Ohio State University Health Sciences Library for her expertise and assistance with the systematic review process including development of our search strategies.


  1. 1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135: e14–e603.
  2. 2. Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. National Vital Statistics Reports. Natl Vital Stat Rep. 2018;67.
  3. 3. Colby SL, Ortman JM. Projections of the size and composition of the US population: 2014 to 2060: Population estimates and projections. 2017.
  4. 4. Carnethon MR, Pu J, Howard G, Albert MA, Anderson CA, Bertoni AG, et al. Cardiovascular health in African Americans: a scientific statement from the American Heart Association. Circulation. 2017;136: e39–e423.
  5. 5. Rosamond WD, Chambless LE, Heiss G, Mosley TH, Coresh J, Whitsel E, et al. Twenty-two–year trends in incidence of myocardial infarction, coronary heart disease mortality, and case fatality in 4 US communities, 1987–2008. Circulation. 2012;125: 1848–1857. pmid:22420957
  6. 6. Kurian AK, Cardarelli KM. Racial and ethnic differences in cardiovascular disease risk factors: a systematic review. Ethn Dis. 2007;17: 143. pmid:17274224
  7. 7. Min Y, Anugu P, Butler KR, Hartley TA, Mwasongwe S, Norwood AF, et al. Cardiovascular disease burden and socioeconomic correlates: findings from the Jackson Heart Study. J Am Heart Assoc. 2017;6: e004416. pmid:28778943
  8. 8. Kochanek KD, Murphy SL, Xu J, Arias E. Deaths: final data for 2017. 2019.
  9. 9. Heron MP. Deaths: leading causes for 2015. 2017.
  10. 10. Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic Impact Goal through 2020 and beyond. Circulation. 2010;121: 586–613. pmid:20089546
  11. 11. Lu Y, Ezzati M, Rimm EB, Hajifathalian K, Ueda P, Danaei G. Sick populations and sick subpopulations: reducing disparities in cardiovascular disease between blacks and whites in the United States. Circulation. 2016;134: 472–485. pmid:27324491
  12. 12. Dong C, Rundek T, Wright CB, Anwar Z, Elkind MS, Sacco RL. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: the northern Manhattan study. Circulation. 2012;125: 2975–2984. pmid:22619283
  13. 13. Ommerborn MJ, Blackshear CT, Hickson DA, Griswold ME, Kwatra J, Djoussé L, et al. Ideal cardiovascular health and incident cardiovascular events: the Jackson Heart Study. Am J Prev Med. 2016;51: 502–506. pmid:27539974
  14. 14. Polonsky TS, Ning H, Daviglus ML, Liu K, Burke GL, Cushman M, et al. Association of cardiovascular health with subclinical disease and incident events: the Multi‐Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2017;6: e004894. pmid:28320747
  15. 15. Joseph JJ, Echouffo-Tcheugui JB, Carnethon MR, Bertoni AG, Shay CM, Ahmed HM, et al. The association of ideal cardiovascular health with incident type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis. Diabetologia. 2016;59: 1893–1903. pmid:27272340
  16. 16. Rasmussen-Torvik LJ, Shay CM, Abramson JG, Friedrich CA, Nettleton JA, Prizment AE, et al. Ideal cardiovascular health is inversely associated with incident cancer: the Atherosclerosis Risk In Communities study. Circulation. 2013;127: 1270–1275. pmid:23509058
  17. 17. Bambs C, Kip KE, Dinga A, Mulukutla SR, Aiyer AN, Reis SE. Low prevalence of “ideal cardiovascular health” in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study. Circulation. 2011;123: 850–857. pmid:21321154
  18. 18. WHO Commission on Social Determinants of Health, World Health Organization. Closing the gap in a generation: Health equity through action on the social determinants of health: Commission on Social Determinants of Health final report. World Health Organization; 2008.
  19. 19. Xanthos C, Treadwell HM, Holden KB. Social determinants of health among African–American men. J Mens Health. 2010;7: 11–19.
  20. 20. Calvin R, Winters K, Wyatt SB, Williams DR, Henderson FC, Walker ER. Racism and cardiovascular disease in African Americans. Am J Med Sci. 2003;325: 315–331. pmid:12811228
  21. 21. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PloS One. 2015;10.
  22. 22. Noonan AS, Velasco-Mondragon HE, Wagner FA. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Rev. 2016;37: 12. pmid:29450054
  23. 23. Brondolo E, Love EE, Pencille M, Schoenthaler A, Ogedegbe G. Racism and hypertension: a review of the empirical evidence and implications for clinical practice. Am J Hypertens. 2011;24: 518–529. pmid:21331054
  24. 24. Taylor J, Grundy C. Measuring black internalization of white stereotypes about African Americans: the Nadanolitization Scale. Handb Tests Meas Black Popul. 1996;2: 217–226.
  25. 25. Popescu I, Duffy E, Mendelsohn J, Escarce JJ. Racial residential segregation, socioeconomic disparities, and the White-Black survival gap. PloS One. 2018;13.
  26. 26. Kramer MR, Hogue CR. Is segregation bad for your health? Epidemiol Rev. 2009;31: 178–194. pmid:19465747
  27. 27. Barkin S, Schlundt D, Smith P. Community-engaged research perspectives: then and now. Acad Pediatr. 2013;13: 93–97. pmid:23498079
  28. 28. Clinical and Translational Science Awards Consortium. Community engagement key function committee task force on the principles of community engagement. Princ Community Engagem. 2011; 8.
  29. 29. Israel BA, Coombe CM, Cheezum RR, Schulz AJ, McGranaghan RJ, Lichtenstein R, et al. Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health. 2010;100: 2094–2102. pmid:20864728
  30. 30. Minkler M, Wallerstein N. Community-based participatory research for health: From process to outcomes. John Wiley & Sons; 2011.
  31. 31. Campbell MK, Hudson MA, Resnicow K, Blakeney N, Paxton A, Baskin M. Church-based health promotion interventions: evidence and lessons learned. Annu Rev Public Health. 2007;28: 213–234. pmid:17155879
  32. 32. Gittelsohn J, Steckler A, Johnson CC, Pratt C, Grieser M, Pickrel J, et al. Formative research in school and community-based health programs and studies: “state of the art” and the TAAG approach. Health Educ Behav Off Publ Soc Public Health Educ. 2006;33: 25–39.
  33. 33. Vertitas Health Innovation. Covidence—Better systematic review management. Available:
  34. 34. NIH National Heart, Lung and Blood Institute. Study quality assessment tools. Available:
  35. 35. Forthofer M, Wilcox S, Kinnard D, Hutto B, Sharpe PA. Sumter County on the Move! Evaluation of a Walking Group Intervention to Promote Physical Activity Within Existing Social Networks. J Phys Act Health. 2019;16: 22–28.
  36. 36. Mitchell JB, Paschal AM, Parmelee PA, Murphy PZ. LIVE: A Community-Based Intervention to Reduce CVD Risk Factors in Rural Community-Dwelling African Americans. Am J Health Educ. 2018;49: 326–334.
  37. 37. Allicock M, Johnson L-S, Leone L, Carr C, Walsh J, Ni A, et al. Promoting fruit and vegetable consumption among members of black churches, Michigan and North Carolina, 2008–2010. Prev Chronic Dis. 2013;10: E33. pmid:23489638
  38. 38. Gitlin LN, Chernett NL, Harris LF, Palmer D, Hopkins P, Dennis MP. Harvest health: translation of the chronic disease self-management program for older African Americans in a senior setting. The Gerontologist. 2008;48: 698–705. pmid:18981286
  39. 39. Schulz AJ, Israel BA, Mentz GB, Bernal C, Caver D, DeMajo R, et al. Effectiveness of a walking group intervention to promote physical activity and cardiovascular health in predominantly non-Hispanic black and Hispanic urban neighborhoods: findings from the walk your heart to health intervention. Health Educ Behav Off Publ Soc Public Health Educ. 2015;42: 380–392.
  40. 40. Yeary KHK, Cornell CE, Moore P, Bursac Z, Prewitt TE, West DS, et al. Peer reviewed: feasibility of an evidence-based weight loss intervention for a faith-based, rural, African American population. Prev Chronic Dis. 2011;8.
  41. 41. Keller CS, Robinson B, Pickens L. Comparison of two walking frequencies in African American postmenopausal women. ABNF J. 2004;15.
  42. 42. Scarinci IC, Moore A, Wynn-Wallace T, Cherrington A, Fouad M, Li Y. A community-based, culturally relevant intervention to promote healthy eating and physical activity among middle-aged African American women in rural Alabama: findings from a group randomized controlled trial. Prev Med. 2014;69: 13–20. pmid:25152504
  43. 43. Parker VG, Coles C, Logan BN, Davis L. The LIFE project: a community-based weight loss intervention program for rural African American women. Fam Community Health. 2010;33: 133. pmid:20216356
  44. 44. Andrews JO, Felton G, Ellen Wewers M, Waller J, Tingen M. The effect of a multi‐component smoking cessation intervention in African American women residing in public housing. Res Nurs Health. 2007;30: 45–60. pmid:17243107
  45. 45. Rodriguez F, Christopher L, Johnson CE, Wang Y, Foody JM. Love your heart: a pilot community-based intervention to improve the cardiovascular health of African American women. Ethn Dis. 2012;22: 416–421. pmid:23140071
  46. 46. Salihu HM, Adegoke KK, Das R, Wilson RE, Mazza J, Okoh JO, et al. Community-based fortified dietary intervention improved health outcomes among low-income African-American women. Nutr Res N Y N. 2016;36: 771–779.
  47. 47. Mitchell NS, Polsky S. Innovative Care Delivery Model to Address Obesity in Older African-American Women: Senior Wellness Initiative and Take Off Pounds Sensibly Collaboration for Health (SWITCH). J Am Geriatr Soc. 2013;61: 1971–1975. pmid:24219198
  48. 48. Haire-Joshu D, Brownson RC, Nanney MS, Houston C, Steger-May K, Schechtman K, et al. Improving dietary behavior in African Americans: The parents as teachers high 5, low fat program. Prev Med. 2003;36: 684–691. pmid:12744911
  49. 49. Tan EJ, Xue Q-L, Li T, Carlson MC, Fried LP. Volunteering: a physical activity intervention for older adults—the experience Corps® program in Baltimore. J Urban Health. 2006;83: 954–969. pmid:16763775
  50. 50. Ahluwalia JS, Nollen N, Kaur H, James AS, Mayo MS, Resnicow K. Pathway to health: Cluster-randomized trail to increase fruit and vegetable consumption among smokers in public housing. Health Psychol. 2007;26: 214. pmid:17385973
  51. 51. Dulin-Keita A, Clay O, Whittaker S, Hannon L, Adams IK, Rogers M, et al. The influence of HOPE VI neighborhood revitalization on neighborhood-based physical activity: A mixed-methods approach. Soc Sci Med. 2015;139: 90–99. pmid:26164364
  52. 52. Brewer LC, Balls-Berry JE, Dean P, Lackore K, Jenkins S, Hayes SN. Fostering African-American Improvement in Total Health (FAITH!): An Application of the American Heart Association’s Life’s Simple 7TM among Midwestern African-Americans. J Racial Ethn Health Disparities. 2017;4: 269–281. pmid:27059054
  53. 53. Brewer LC, Hayes SN, Jenkins SM, Lackore KA, Breitkopf CR, Cooper LA, et al. Improving Cardiovascular Health Among African-Americans Through Mobile Health: the FAITH! App Pilot Study. J Gen Intern Med. 2019; 1–3.
  54. 54. Dulin-Keita A, Clay O, Whittaker S, Hannon L, Adams IK, Rogers M, et al. The influence of HOPE VI neighborhood revitalization on neighborhood-based physical activity: A mixed-methods approach. Soc Sci Med 1982. 2015;139: 90–99.
  55. 55. Gitlin LN, Chernett NL, Harris LF, Palmer D, Hopkins P, Dennis MP. Harvest health: translation of the chronic disease self-management program for older African Americans in a senior setting. The Gerontologist. 2008;48: 698–705. pmid:18981286
  56. 56. Kim KH, Linnan L, Campbell MK, Brooks C, Koenig HG, Wiesen C. The WORD (wholeness, oneness, righteousness, deliverance): a faith-based weight-loss program utilizing a community-based participatory research approach. Health Educ Behav Off Publ Soc Public Health Educ. 2008;35: 634–650.
  57. 57. Parker VG, Coles C, Logan BN, Davis L. The LIFE project: a community-based weight loss intervention program for rural African American women. Fam Community Health. 2010;33: 133–143. pmid:20216356
  58. 58. Pinsker EA, Enzler AW, Hoffman MC, Call KT, Amos S, Babington-Johnson A, et al. A Community-Driven Implementation of the Body and Soul Program in Churches in the Twin Cities, Minnesota, 2011–2014. Prev Chronic Dis. 2017;14: E26. pmid:28333599
  59. 59. Plescia M, Herrick H, Chavis L. Improving Health Behaviors in an African American Community: The Charlotte Racial and Ethnic Approaches to Community Health Project. Am J Public Health. 2008;98: 1678–1684. pmid:18633087
  60. 60. Woods G, Levinson AH, Jones G, Kennedy RL, Johnson LC, Tran ZV, et al. The Living Well by Faith Health and wellness program for African Americans: an exemplar of community-based participatory research. Ethn Dis. 2013;23: 223–229. pmid:23530305
  61. 61. Tucker CM, Wippold GM, Williams JL, Arthur TM, Desmond FF, Robinson KC. A CBPR study to test the impact of a church-based health empowerment program on health behaviors and health outcomes of black adult churchgoers. J Racial Ethn Health Disparities. 2017;4: 70–78. pmid:26830631
  62. 62. Wilcox S, Laken M, Bopp M, Gethers O, Huang P, McClorin L, et al. Increasing physical activity among church members: community-based participatory research. Am J Prev Med. 2007;32: 131–138. pmid:17234487
  63. 63. Kim KH, Linnan L, Kramish Campbell M, Brooks C, Koenig HG, Wiesen C. The WORD (wholeness, oneness, righteousness, deliverance): a faith-based weight-loss program utilizing a community-based participatory research approach. Health Educ Behav. 2008;35: 634–650. pmid:17200103
  64. 64. Plescia M, Herrick H, Chavis L. Improving health behaviors in an African American community: the Charlotte Racial and Ethnic Approaches to Community Health project. Am J Public Health. 2008;98: 1678–1684. pmid:18633087
  65. 65. Zoellner J, Connell CL, Santell R, Fungwe T, Strickland E, Avis-Williams A, et al. Fit for Life Steps: Results of a community walking intervention in the rural Mississippi Delta. Prog Community Health Partnersh Res Educ Action. 2007;1: 49–60.
  66. 66. Zoellner J, Connell C, Madson MB, Thomson JL, Landry AS, Molaison EF, et al. HUB city steps: a 6-month lifestyle intervention improves blood pressure among a primarily African-American community. J Acad Nutr Diet. 2014;114: 603–612. pmid:24534602
  67. 67. Brown AG, Hudson LB, Chui K, Metayer N, Seguin RA, Folta SC. Improving heart health among Black/African American women using civic engagement: a pilot study. BMC Public Health. 2017;17: 112. pmid:28118823
  68. 68. Lynch E, Emery-Tiburcio E, Dugan S, White FS, Thomason C, Jenkins L, et al. Results of ALIVE: A Faith-Based Pilot Intervention to Improve Diet Among African American Church Members. Prog Community Health Partnersh Res Educ Action. 2019;13: 19–30.
  69. 69. Baker EA, Barnidge EK, Schootman M, Sawicki M, Motton-Kershaw FL. Adaptation of a modified DASH diet to a rural African American community setting. Am J Prev Med. 2016;51: 967–974. pmid:27633485
  70. 70. Skolarus LE, Cowdery J, Dome M, Bailey S, Baek J, Byrd JB, et al. Reach out churches: A community-based participatory research pilot trial to assess the feasibility of a mobile health technology intervention to reduce blood pressure among African Americans. Health Promot Pract. 2018;19: 495–505. pmid:28583024
  71. 71. Wilcox S, Parrott A, Baruth M, Laken M, Condrasky M, Saunders R, et al. The Faith, Activity, and Nutrition program: a randomized controlled trial in African-American churches. Am J Prev Med. 2013;44: 122–131. pmid:23332327
  72. 72. Boltri JM, Davis-Smith M, Okosun IS, Seale JP, Foster B. Translation of the national institutes of health diabetes prevention program in African American churches. J Natl Med Assoc. 2011;103: 194–202. pmid:21671523
  73. 73. Dodani S, Fields JZ. Implementation of the Fit Body and Soul, a church-based life style program for diabetes prevention in high-risk African Americans. Diabetes Educ. 2010;36: 465–472. pmid:20508263
  74. 74. Goldfinger JZ, Arniella G, Wylie-Rosett J, Horowitz CR. Project HEAL: peer education leads to weight loss in Harlem. J Health Care Poor Underserved. 2008;19: 180. pmid:18263994
  75. 75. Zoellner J, Hill JL, Grier K, Chau C, Kopec D, Price B, et al. Randomized controlled trial targeting obesity-related behaviors: Better Together Healthy Caswell County. Prev Chronic Dis. 2013;10: E96. pmid:23764345
  76. 76. Voorhees CC, Stillman FA, Swank RT, Heagerty PJ, Levine DM, Becker DM. Heart, body, and soul: impact of church-based smoking cessation interventions on readiness to quit. Prev Med. 1996;25: 277–285. pmid:8781005
  77. 77. Darity WA, Tuthill RW, Winder AE, Cernada GP, Chen TT, Buchanan DR, et al. A multi-city community based smoking research intervention project in the African-American population. Int Q Community Health Educ. 2007;26: 323–336.
  78. 78. Froelicher ES, Doolan D, Yerger VB, McGruder CO, Malone RE. Combining community participatory research with a randomized clinical trial: the Protecting the Hood Against Tobacco (PHAT) smoking cessation study. Heart Lung J Acute Crit Care. 2010;39: 50–63.
  79. 79. Cené CW, Haymore LB, Ellis D, Whitaker S, Henderson S, Lin F-C, et al. Implementation of the power to prevent diabetes prevention educational curriculum into rural African American communities: a feasibility study. Diabetes Educ. 2013;39: 776–785. pmid:24129595
  80. 80. Two Feathers J, Kieffer EC, Palmisano G, Anderson M, Sinco B, Janz N, et al. Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. Am J Public Health. 2005;95: 1552–1560. pmid:16051927
  81. 81. Spencer MS, Rosland A-M, Kieffer EC, Sinco BR, Valerio M, Palmisano G, et al. Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101: 2253–2260. pmid:21680932
  82. 82. Miller ER III, Cooper LA, Carson KA, Wang N-Y, Appel LJ, Gayles D, et al. A dietary intervention in urban African Americans: results of the “five plus nuts and beans” randomized trial. Am J Prev Med. 2016;50: 87–95. pmid:26321012
  83. 83. Allicock M, Johnson L-S, Leone L, Carr C, Walsh J, Ni A, et al. Peer Reviewed: Promoting Fruit and Vegetable Consumption Among Members of Black Churches, Michigan and North Carolina, 2008–2010. Prev Chronic Dis. 2013;10.
  84. 84. Resnicow K, Davis R, Zhang N, Strecher V, Tolsma D, Calvi J, et al. Tailoring a fruit and vegetable intervention on ethnic identity: results of a randomized study. Health Psychol. 2009;28: 394. pmid:19594262
  85. 85. Pinsker EA, Enzler AW, Hoffman MC, Call KT, Amos S, Babington-Johnson A, et al. A Community-Driven Implementation of the Body and Soul Program in Churches in the Twin Cities, Minnesota, 2011–2014. Prev Chronic Dis. 2017;14.
  86. 86. Yancey AK, Lewis LB, Guinyard JJ, Sloane DC, Nascimento LM, Galloway-Gilliam L, et al. Putting promotion into practice: the African Americans building a legacy of health organizational wellness program. Health Promot Pract. 2006;7: 233–246S.
  87. 87. Pinsker EA, Enzler AW, Hoffman MC, Call KT, Amos S, Babington-Johnson A, et al. Peer Reviewed: A Community-Driven Implementation of the Body and Soul Program in Churches in the Twin Cities, Minnesota, 2011–2014. Prev Chronic Dis. 2017;14.
  88. 88. Liao Y, Siegel PZ, Zhou H, Grimm K, Njai R, Kent C, et al. Reduced Disparity in Vegetable Consumption in 16 Disadvantaged Black Communities: A Successful 5-Year Community-Based Participatory Intervention. J Racial Ethn Health Disparities. 2015;2: 211–218. pmid:26150921
  89. 89. Turner J, Smith J, Bryant K, Haynes T, Stewart MK, Kuo DZ, et al. Community building community: the distinct benefits of community partners building other communities’ capacity to conduct health research. Prog Community Health Partnersh Res Educ Action. 2017;11: 81.
  90. 90. Brewer LC. We’veComeThis Far by Faith: The Role of the Black Church in Public Health. Am J Public Health. 2019;109: 385–386. pmid:30726121
  91. 91. Pullins CT, Seele PC, White RO, Willis FB, Poole K, Albertie ML, et al. Health Behaviors and Preventive Healthcare Utilization Among African–American Attendees at a Faith-Based Public Health Conference: Healthy Churches 2020. J Relig Health. 2018;57: 2538–2551. pmid:29995232
  92. 92. Levin J. Faith-based initiatives in health promotion: history, challenges, and current partnerships. Am J Health Promot. 2014;28: 139–141. pmid:24380422
  93. 93. Harmon BE, Kim S-H, Blake CE, Hebert JR. Health care information in African-American churches. J Health Care Poor Underserved. 2014;25: 242. pmid:24509024
  94. 94. Sahgal N, Smith G. A Religious Portrait of African Americans. 2009 Jan. Available:
  95. 95. America’s Changing Religious Landscape. 2015 May. Available:
  96. 96. Mouzon DM. Religious involvement and the Black–White paradox in mental health. Race Soc Probl. 2017;9: 63–78.
  97. 97. Palmas W, March D, Darakjy S, Findley SE, Teresi J, Carrasquillo O, et al. Community health worker interventions to improve glycemic control in people with diabetes: a systematic review and meta-analysis. J Gen Intern Med. 2015;30: 1004–1012. pmid:25735938
  98. 98. Allen JK, Dennison-Himmelfarb CR, Szanton SL, Bone L, Hill MN, Levine DM. Community Outreach and Cardiovascular Health (COACH) Trial: A randomized, controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers. Circ Cardiovasc Qual Outcomes. 2011; 4: 1–8. Natl Cent Chronic Dis Prev Health Promot Div Heart Dis Stroke Prev More Inf Please Contact Cent Dis Control Prev. 2017;1600.
  99. 99. Brownstein JN. Charting the course for community health worker research. Prog Community Health Partnersh Res Educ Action. 2008;2: 177–178.
  100. 100. Rosenthal EL, de Heer H, Rush CH, Holderby L-R. Focus on the future: a community health worker research agenda by and for the field. Prog Community Health Partnersh Res Educ Action. 2008;2: 225–235.
  101. 101. Lapidos A, Lapedis J, Heisler M. Realizing the Value of Community Health Workers-New Opportunities for Sustainable Financing. N Engl J Med. 2019;380: 1990. pmid:31116918
  102. 102. Wynn-Wallace TA. Using community feedback to improve community interventions: results from the Deep South Network for Cancer Control Project. Fam Community Health. 2016;39: 234. pmid:27536928
  103. 103. Smith SA, Whitehead MS, Sheats JQ, Ansa BE, Coughlin SS, Blumenthal DS. Community-based participatory research principles for the African American community. J Ga Public Health Assoc. 2015;5: 52. pmid:26336653
  104. 104. Addison C, Campbell Jenkins B, Odom D, Fortenberry M, Wilson G, Young L, et al. Building collaborative health promotion partnerships: the Jackson heart study. Int J Environ Res Public Health. 2016;13: 25.