Jackson Heart Study Partners Newsletter • Winter 2008–2009

Stroke: The “Not-So-Silent Killer”— Much More Common Than Assumed (Herman A. Taylor, Jr. MD, MPH) This issue of our newsletter is dedicated to . By focusing on subclinical “silent” we If is called “the silent killer” then I wish to emphasize the likelihood that the earlier will call stroke “the not so silent killer”. Stroke we intervene the more likely we are to be suc- is related to hypertension and to cardiovascular cessful. Subclinical “silent” stroke is a brain diseases which makes it an important part of the injury most commonly caused by a blood clot Jackson Heart Study (JHS). Since interrupting blood flow in the brain. It is called is in the stroke belt (along with most of our silent because like hypertension there may be no southern neighbors) and observable symptoms. “Silent” strokes are most have a higher incidence of cardiovascular dis- often detected through brain imaging and sev- eases including stroke than Caucasians, we at eral patients who have suffered “silent” strokes the JHS are paying as much attention to stroke who undergo brain imaging tests prove to have as to all other major causes of cardiovascular neurological and neuropsychological damage. diseases and their risk factors. This article will Unlike hypertension where one’s blood pressure draw largely on the news from “World Stroke can be checked regularly and routinely there are Day, October 29, 2008”. no similarly routine and cost effective way of Stroke is the rapidly developing loss of checking for strokes. brain functions due to a disturbance in the blood A recent study (JUPITER) which received vessels supplying blood to the brain. This can be much publicity at the recent meeting of the due to one of two major causes; an interruption American Heart Association suggests that choles- of the blood supply to the brain (Ischemic) or terol drugs (statins) may significantly reduce the to a rupture of the blood vessels (Hemorrhage). risk of stroke and other cardiovascular events in Roughly 80% of all strokes are due to the former. healthy patients. Dr. Phillip Gorelick, Director of As a result, the affected area of the brain is unable the Center for Stroke Research at the University to function leaving Of Illinois College an inability to move Percent of JHS Participants with previous stroke Of Medicine, in an one or more limbs on interview with the one side of the body, National Stroke inability to formulate Association suggest- speech or inability to ed that the JUPITER see one side of the findings will likely visual field. A stroke influence short-term is a medical emer- treatment guidelines gency and can cause for cardiovascular permanent neurolog- prevention including ical damage, compli- stroke. “One must cations and death. I Stroke was more prevalent in older than younger or middle-age bear in mind that participants, and more common in men than women. am sure you know Source: The Jackson Heart Study Data Book: A Report to the Cohort and Community lifestyle modification someone who has NIH Publication No. 08-5848 remains an important had a stroke. September 2008 aspect of stroke and The theme of World Stroke Day 2008 was other prevention.” “Little stroke, big trouble”. The focus on “little” At the JHS, Stroke Surveillance is a critical stroke is chosen for good reasons. Subclinical part of the study. It will help us better understand or “silent” strokes occur five times as often as and monitor stroke risk factors as well as stroke clinically obvious strokes and can affect think- care, stroke incidence and stroke mortality. It ing, mood, and personality. A recent Study by will allow us to develop an overall picture of Professor Hachinski at the University of Western stroke in the African American community, do Ontario, Canada presented at the World Stroke time trend analyses, to better explore its dis- Congress (WSC) found that about 10 percent of tribution, stroke risk and care in this important apparently healthy middle-aged participants with subpopulation. no symptoms of stroke were affected by “silent Such a surveillance system would also help strokes”. Since we live in the USA’s stroke belt us to formulate policy decisions concerning where the incidence of stroke, hypertension and programs and research for the African American cardiovascular disease are much higher than the population. The stroke outcome data obtained national average and even more so in the African through the surveillance will also help to devel- American population, when we analyze the JHS op a stroke prediction model specific for our stroke data, we can expect to find a much higher African American population which can be used incidence among our JHS cohort. to further educate and inform both our cohort The aim of this year’s World Stroke Day as members and the physicians who care for them. well as this article is to improve awareness of the “preventable catastrophe” stroke presents. 2

Jackson Heart Study Partners with the Delta States Stroke Consortium (Evelyn Walker, MD, MPH) The Delta States Stroke Consortium (DSSC) meeting was initiation of the brainstorming management were this group’s specifically is a five-state collaborative effort funded that would provide the building blocks of established priorities. The importance of by the Centers for Disease Control and a 2–5 year action plan. The five working acting fast when stroke symptoms occur is Prevention (CDC) to identify and address groups contributed to the strategic plan in highlighted in the attached graphic. factors associated with the high rate of individual breakout sessions. Encouragement for the development and strokes in the southeastern states. This con- In an effort to maintain an updated adoption of appropriate policies by regional/ sortium of states includes , , stroke burden document, the data support state medical boards and organizations, hos- , Mississippi, and —five (epidemiology) workgroup assessed data pital associations, health departments, and of eight southeastern states comprising the needs and deficits in the region. They began state legislatures dominated the discussion “stroke belt,” where the stroke death rate is the discussion of guideline development of the policy development and advoca- 1.5 times the national average. The DSSC, and coordination of data collection across cy workgroup. Identification of appropri- divided into five working groups, recently the region. ate advocacy partners for increasing the convened in Memphis, TN attention to stroke was seen to discuss stroke mortal- as the first step in policy ity and morbidity reduc- change or development. tion, and prevention/aware- The integration and ness strategies. The overall media workgroup discussed goal focuses on enhancing ways to facilitate integra- the coordination and col- tion of work plans and proj- laboration among partners ects of State Heart Disease in the five-state region. and Prevention Programs, Among Mississippi’s State Task Forces, and other representatives were national and regional part- Dr. Evelyn Walker, the ners and stroke networks. Jackson Heart Study Field This group will assist in the Site Director and mem- development of regional ber of Mississippi’s Task media and advertising mes- Force on Heart Disease sages in collaboration with and Stroke Prevention, and partnering state agencies to members of the Mississippi support the general work of State Department of Health’s Office of Access to care and medication issues the DSSN. Preventive Health. were addressed in the systems change/ The overarching theme of impacting The American Heart Association esti- access to care workgroup. Early trans- the stroke and decreasing the mates that in 2008 the direct and indirect port to an appropriate stroke care facil- burden of stroke in the five-state region was costs related to stroke will exceed 65 billion ity, and enhancement of the Delta Stroke well expressed by all attendees. Much work dollars. Recognizing this alarming cost, and Telemedicine Network were the identified and continued commitments remain for the considering the socio-demographic charac- priorities for this group. consortium; however, maintenance of this teristics of the consortium states, the five The systems change/training and edu- collaborative partnership will assure that working groups discussed and established cation workgroup’s areas of concern includ- through the consortium’s long term goals priorities for data collection, program inter- ed patient and health care provider education. for research, planning, policy development, ventions, and policy improvements related Increasing the public’s awareness and early and program implementation the unfortu- to the delivery of stroke care. The consor- recognition of stroke warning signs along nate “stroke belt” label will become but tium’s anticipated outcome for this fall’s with enhancing providers’ training in stroke another part of the old south’s past.

A Note from the Field on Stroke (Mohammad Shahbazi, PhD, MPH, CHES) I was in a post doctoral program, School When the first classes started in 1999, I started ple, particularly, African Americans in Mississippi’s of Public Health at University of California in Los hearing from my students how their families and Delta region experienced strokes. “The stroke treat- Angeles (UCLA) when I learned about Mississippi friends had suffered from preventable, for the most ment in Mississippi” she emphasized was estimated Delta region’s poor health conditions—similar to less- part, diseases in Mississippi. One of my students, to be approximately $367 million annually. Some developed countries in the world’s richest country. Patricia Frye (now holding a doctor of public health nine years later, the picture continues to remain the “How could that be the case?”, I asked myself. from the Jackson State University’s accredited Public same. Something is just wrong with this situation. A few months later I found myself before a Health Program—the first to graduate from the pro- In 1999, Mississippi’s stroke mortality rate was faculty search committee that was established to gram), presented a paper on stroke and showed that the 8th highest in the nation. The African American hire several faculty members for a newly started every 53 seconds someone had a stroke in the United stroke mortality rate was 32% higher than the White Masters of Public Health Program at Jackson State States, and that every 3.3 minutes an individual died American rate. Nationally, at the time, the African University. as a result of it, making stroke the 3rd leading cause American stroke mortality rate was 82.5 per 100,000 of death. The paper also documented that many peo- Continued on page 4 Jackson Heart Study Partners Newsletter • Winter 2008–2009 3

Hypertension Education and Treatment (HEAT) Partnership (Rosie Calvin, RN, DNS and Venetra McKinney, BS) Overview/ Mission tors of the other three cores: research, educa- populations. Specific aims of the The University of Mississippi Medical tion, and community outreach. Specific aims Education Core are to: Center (UMMC) and the Jackson-Hinds for the research, education, and community 1. Enhance cultural competency Comprehensive Health Center (JHCHC) outreach cores were developed to achieve among healthcare providers and propose to address cardiovascular health dis- the objectives of the HEAT Partnership, and address its impact on health parities among African Americans through include the following: disparities among the nation’s the establishment of its HEAT Partnership. • Research Core. The primary goal of racial and ethnic minority HEAT is an acronym for Hypertension the Research Core is to examine the populations. Education and Treatment. effect of provider and patient education 2. Explore issues of race, racism Responding to RFA-HL-04-002, on the control of hypertension among and health disparities in research “Partnership Program to Reduce a minority population. We hypothesize and medical care, particularly as Cardiovascular Disparities,” the University that an intervention comprising they affect African Americans in of Mississippi Medical Center (UMMC) provider and patient education, Mississippi. will participate as the research-intensive access to a patient advocate, and 3. Provide career development medical center (RIMC). Jackson-Hinds encouragement for patients to utilize a training for new investigators Comprehensive Health Center (JHCHC) “health partner” will result in improved capable of conducting research will participate as the minority healthcare rates of hypertension control. In to reduce cardiovascular health serving system (MSS). order to test our hypothesis, we have disparities. The mission of the proposed HEAT identified four specific aims: • Community Outreach Core. The Partnership is to improve cardiovas- 1. Provide a series of workshops for primary goal of our Community cular health, particularly among African healthcare providers that focus Outreach Core is to raise public Americans, by (1) increasing awareness on assessment and treatment of awareness of the prevalence of among the lay public about cardiovascu- hypertensive patients according to hypertension and the importance of lar disease in general and hypertension in current guidelines. managing the disease. Designed to particular; (2) providing easily accessible, 2. Enroll a sufficient number of address the objectives of the HEAT culturally sensitive, state-of-the-art medi- patients with uncontrolled Partnership and the Community cal care for hypertensive patients, which hypertension to participate in our Outreach Core’s primary goal, we have includes a multifaceted approach addressing study and encourage each of them identified the following three specific lifestyle and ; and (3) engaging com- to continue treatment throughout aims: munity residents, leaders, and institutions the duration of the intervention 1. Conduct focus group sessions in to collaborate in an ongoing promotion of as a means of promoting lifetime selected vulnerable populations to cardiovascular health. hypertension control. assess the level of awareness about In order to accomplish our mission, we 3. Provide a program of patient hypertension, and identify realistic have identified the following objectives: education that includes (a) a series lifestyle hypertension-prevention • Foster collaboration between UMMC of workshops for the intervention goals for the intended audience. and JHCHC to improve healthcare participants that focus on the 2. Pursue partnerships with delivery at both institutions; impact of hypertension, and the community-based organizations • Provide cross-training opportunities for efficacy of proper diet and exercise to enhance the activities of the research in health disparities, cultural in managing hypertension; (b) a Community Outreach Core. sensitivity, and cardiovascular health; patient advocate, who will serve 3. Develop and disseminate culturally • Accommodate long-term partnerships as a liaison between patient and and linguistically appropriate in education and health care delivery provider; and (c) a “health partner” education materials to the lay initiatives; from the patient’s social circle public about hypertension, • Conduct joint research addressing of acquaintances who will help including detection, diagnosis, and cardiovascular health disparities; and reinforce the workshop lessons in a strategies for its prevention. • Sponsor outreach initiatives to participatory manner. Recruitment/Workshop provide meaningful public education 4. Compare the results of the Process programs about cardiovascular health, intervention group and the hypertension, and the importance of control group, and determine the Intervention Site lifestyle choices to promote health. effectiveness of the intervention. (JHCHC Main Clinic) Organization • Education Core. The primary goal Participants in the intervention group of the Education Core is to promote The HEAT Partnership is organized into four received a series of workshops that focused enhanced knowledge, professionalism cores. The administrative core includes the on the impact of hypertension, and the effi- and collegiality among those who principal investigators from the RIMC and cacy of proper diet and exercise in managing provide healthcare to Mississippi’s the MSS as well as the directors and co-direc- hypertension. The participants’ knowledge minority and disenfranchised Continued on page 4

Jackson Heart Study Partners Newsletter • Winter 2008–2009 4

Continued from page 3 were encouraged to use home blood pressure sion and the efficacy of diet and exercise in of the workshop topic was assessed prior monitoring as a way to understand the effect managing hypertension. to each workshop. The Instrument used of exercise and diet on blood pressure. Also, a comprehensive assessment of includes portions of the behavioral risk Workshops were conducted at a variety the participants’ knowledge was obtained factor surveillance survey related to car- of times during the intervention. Participants within 3–4 months. The same assessment diovascular health and questions regarding were required to attend the three work- instruments used by the intervention group risk factors and physical activity. A com- shops and the final visit to complete their were used with the control group. Materials prehensive assessment of the participants’ participation. developed for the intervention arm were knowledge was obtained 6 to 8 weeks Health Partners distributed to participants but there were no after the three workshops. The participants To improve adherence to recommended workshops, health partners, or participant received a $10.00 Wal-Mart gift certificate dietary and exercise programs participants advocates. This minimal attention to educa- after each workshop for their participa- were encouraged to identify a health partner. tion reflects the current practice pattern in tion. Secondary analyses, administered via The health partners were friends, family many busy primary care clinics. The control telephone 6 to 8 weeks after the final visit, member, or someone to promote healthy life- group received only a $10.00 Wal-Mart gift evaluated the effectiveness of participant style behaviors, perhaps serve as an exercise certificate for their participation within 3–4 workshops, access to a patient advocate, and partner, and support and offer encourage- months at the final visit. After an 18-month role of a health partner. ment to the participant. The health partners follow-up period, providers and participants Workshop A: Cardiovascular Disease attended all participant workshops and will at the control sites are offered an opportunity Health in the Family. This workshop receive a $10.00 Wal-Mart gift certificate for more intensive education through work- focused on hypertension as a risk factor for each workshop attended with the HEAT shops provided by the HEAT Partnership. for cardiovascular disease, the meaning of participant. Recruitment cardiovascular disease, and the impact on We will distribute the JNC-7 guidelines A total of 203 participants were tar- the family. and the DASH diet to healthcare providers geted at the intervention site, Jackson Hinds Workshop B: Dietary Approaches to at the two control sites, but we will offer no Comprehensive Health Center Main Clinic. Improve Blood Pressure. This workshop review of them. Baseline data from patient Also, a total of 203 participants were target- was designed to teach the DASH diet and charts will be collected prior to the distribu- ed at both control sites, Copiah and Jackson to provide culturally specific educational tion of recent guidelines. These data will Hinds South Clinic. We exceeded our target materials and instruction on food choices, be the same as collected in the intervention by recruiting a total of 728 participants at reading food labels, and improving dietary group. all sites. intake. Additionally, a discussion included attention to the effect alcohol and Patient Advocate What’s Next? has on blood pressure control and cardiovas- A patient advocate at JHCHC served as The deadline for completion of the inter- cular disease. a liaison between patients and providers and vention process was December 30, 2008. Workshop C: Effect of Exercise and coordinated the scheduling of the partici- We should complete the telephone inter- Body Weight on Blood Pressure. This work- pants for the workshops. views in February 2009. We are currently shop provided information on the meaning Control Sites preparing for data analysis and manuscripts of exercise, culturally appropriate exercise (South Jackson and development. programs and locations in the community, and strategies for increasing exercise in the Hazlehurst Clinics) During the initial visit with participants home. Pedometers were provided to partici- in the control group, baseline data was col- pants to measure daily exercise. Participants lected to assess their knowledge of hyperten-

Continued from page 2 attack (similar to heart attack that most people are Age• individuals versus a White American stroke mortal- familiar with). Gender• ity rate of 59.8 per 100,000 individuals. Mississippi’s • Race/Ethnicity rates in 1999 were 85.9 and 65.1 per 100,000 for Two Known Types of Stroke • Family History • Ischemic (the vessel clogs within) African Americans and White Americans respective- Modifiable risk factors: • Hemorrhagic (the vessel ruptures, causing ly. Not the cost, but the human suffering dimension • High blood pressure blood to leak into the brain) of poor health conditions in general and stroke-relat- Smoking• ed suffering in particular captured my professional Stroke’s Known Warning • Overweight/Obesity enthusiasm, that has continued for close to a decade • High blood cholesterol level now. Through the following sections, I will, briefly, Signs • share my stroke-related activities (in words) with the • Sudden numbness or weakness of the face, arm • Lack of regular physical activity readers. First a few words on stroke. or leg, especially on one side of the body • Sudden confusion, trouble speaking or My Stroke-Related Activities What is Stroke? understanding According to the American Stroke Association • Sudden trouble seeing in one or both eyes Since Arrival in Mississippi First Project: A Pilot Study stroke is a type of cardiovascular disease. It affects • Sudden trouble walking, dizziness, loss of While there are a range of factors that may the arteries leading to and within the brain. A stroke balance or coordination contribute to the high stroke-related morbidity and occurs when a blood vessel that carries oxygen and • Sudden, severe headache with no known cause nutrients to the brain is either blocked by a clot or mortality rates, my first pilot study examined an area bursts. When that happens, part of the brain cannot Documented Risk Factors for that might indeed be one of the more significant fac- get the blood (and oxygen) it needs, so it starts to Stroke tors and one that may be expediently altered—stroke- die. In a layperson’s term, stroke is kind of brain Risk factors that cannot be changed: Continued on page 5 Jackson Heart Study Partners Newsletter • Winter 2008–2009 5

Continued from page 4 tance of rapid transfer—preferably by ambulance— with information and enjoyed lunch with them. See related knowledge. Specifically, knowledge related to hospital/emergency room for evaluation and pos- photos of events described. to signs and symptoms of stroke and the actions an sible treatment. In turn, the 911/emergency response Other activities included delivering stroke-re- individual can take if experiencing stroke signs and system will need to be expanded in rural areas. lated information (flyers, brochures, magnets, etc) to symptoms. Second Project churches both within Greenville and those located My pilot project, sponsored by Jackson State When a group of Jackson State University in rural areas. Such information materials (bundle University, had two main goals: (1) to obtain base- faculty, primarily from the Public Health Program, of 50–100; depending on church sizes) were usually line information on the targeted community’s knowl- decided to apply to the National Institute of Health delivered on Saturday (left at churches’ entrances) edge of stroke-related signs and symptoms; and (2) for a grant, I submitted a proposal where I reported with cover letters addressed to the church pastors to estimate the amount of time it took individuals to the pilot study’s findings. The grant was awarded requesting them to distribute the materials to the arrive at medical treatment facilities after the onset of and a four-year stroke awareness project started in churches’ attendees on Sundays. stroke signs and symptoms. 2003–2004. The following activities were conducted Several months after conducting the last edu- A telephone survey was conducted to determine during the second project. cational activities in Washington , the same stroke-related knowledge levels. Hospital data was Digital telephone surveys were administered digital telephone surveys were administered in both collected to determine how long it took individuals to several hundred Warren and Washington County counties to find out if the educational campaign had to present at medical treatment facilities after the residents (Washington County had the highest num- any impact on the County’s residents. Below are the onset of stroke-related sign and symptoms. While the ber of stroke victims in Mississippi). The plan was results of the second survey. number of people participating in this pilot study was to provide educational materials on stroke signs and small, and fewer numbers of stroke patients’ records symptoms to Washington County residents, but not County Comparison In many cases, when there was an increase qualified to be included (records were not complete); to residents in Warren County. So that we could in percentages in Washington County, a similar nevertheless the findings were quite telling. determine if educating people with stroke-related increase was seen in Warren County. Even in those knowledge would make a difference in terms of the cases where an increase occurred in Washington Summary of Findings number of stroke victims, and the action people, with • most people had never had stroke-related County while a decrease occurred in Warren County, knowledge of stroke signs and symptoms, would information provided by a health care provider; numbers (sample size) were not sufficiently large to take (e.g., calling 911 or getting to a hospital). • high blood pressure is the risk factor most show statistical significance, with one exception. The The questions in the survey were designed to often reported; however, nearly half of exception was in the percentage reporting high blood give us information on how much people living respondents did not report high blood pressure pressure as a risk factor for stroke, which increased in these two counties knew about stroke sing and as a contributing factor for stroke; from 48% to 57.3% in Washington County while symptoms. • smoking (the second most important risk decreasing from 50.3% to 44.2% in Warren County In both counties, approximately 80% of respon- factor for stroke after high blood pressure) was for difference between counties. dents stated that strokes could be prevented, but reported only by one-fifth of respondents; knowledge of specific stroke risk factors was poor. • majority of people couldn’t name one stroke Conclusion Less than 50% of respondents named hypertension symptom or sign; Although response rates to several of the ques- (blood pressure) as a risk factor, and knowledge of • many people said they would call 911 / tions increased after the intervention in Washington other risk factors was much poorer. Recognition of ambulance after stroke onset; County, the results of this small sample survey do not individual stroke warning signs was fair to poor: just • however, a large percentage of people said they show sufficient evidence to support any effect of the under 50% named weakness or numbness and fewer would go directly to hospital / emergency room intervention. A valuable lesson that was learned from than 25% named others such as dizziness or loss of or call the doctor’s office; this study was that intervention activities must target vision. When responses were analyzed in aggregate, • there was not much difference between rural well-defined groups rather than the entire population the results were very poor: and urban residents; the urban residents were only 2–3% could name in a county. major warning signs of stroke, and only more likely to call 911; all 5 1–2% Yet, another valuable lesson learned from this and state the correct • according to the charts (patients’ records) could name all signs correctly project was that many stroke survivors in the region action to be taken (call 911). reviewed, most people came directly to the reported that they did not feel they were at risk of Soon after completing this phase, an educational hospital / emergency room, using private stroke. In other words, they didn’t smoke, were not campaign was implemented in Washington County transport; only a few people called 911; on the heavy side, ate “good” food, and were physi- and continued for 6 months. With support from • time of arrival at hospital was recorded in cally active. Such observation made me wonder if one of my former students, her family/friends, and nearly all cases; there are other factors that have not been looked at. other Jackson State University’s alumni, a network • however, in most cases time of onset of stroke I am therefore currently looking at some 200 stroke was established for disseminating information to was not recorded in the chart; survivors data. Hopefully, collecting life histories Washington County residents. • therefore, in most cases, time between onset from some of these individuals might explain if there Several times each month for 6 months, I would and arrival at hospital / emergency room was are other contributing factors to stroke. load up the School of Public Health’s van with stu- not known; dents and head to Greenville. We would set up tables Acknowledgements • in the cases where onset times were available, in the Greenville Shopping Mall and the Wal-Mart I must thank Jackson State University offi- the mean time between onset and arrival was Store (usually on Saturdays). These tables held fly- cials for sponsoring the pilot project, which helped nearly seven hours—the mean time was about ers, brochures, know-your-numbers information, and with getting the NIH grant # 5P20-MD000543-02 five and a half hours; a Mississippi like magnetic map with stroke sign and (EXPORT PROJECT), which funded my stroke • in the cases where onset times were available, symptoms printed on them. awareness project. I also wish to express my thanks the mean times between onset and evaluation To let shoppers know about our stroke related to Dr. Sarpong, and other colleagues at Jackson by a physician were nearly six hours; activities, such events were announced in local media Heart Study who have always treated me like one • in the cases where evaluation times were (radio, newspaper, and television stations). Banners of their own. Obviously, I want to thank all of my available, the mean time between arrival and were almost always displayed at the entrances of public health students at Jackson State University evaluation was about one hour and the mean the locations where the educational campaign team and my friends in Greenville Without help from the time three-quarters of an hour members were at work. To further bring the shop- students/local friends who often scarifies their week- It is important to note that stroke victims who qualify pers to the tables with information, we had several end for over 6 months, I couldn’t have completed my for immediate treatments (with a chemical that bust students at the table ready to take the blood pressure second project. I thank them all. the vessel’s clog) must receive the chemical within of anybody who approached them. These opportuni- or sooner than three hours from the onset of the ties were utilized to ask the participants a few ques- stroke. There were obvious issues at hand here. Join Us for Celebration of Life tions about their stroke-related knowledge and to Given these disturbing findings, it became clear UMMC Conference Center provide them with pertinent information along with to me that awareness of stroke’s signs and symp- the magnet that was mentioned earlier. On at least Saturday, February 28, 2009 toms as well as timely treatment must be advocated. one occasion we joined a congregate, as they cel- Obviously, people needed to recognize the impor- 8:30 a.m. ebrated an event, in a park where we provided them Jackson Heart Study Partners Newsletter • Winter 2008–2009 6

Article Submissions JHS Heartbeat is published quarterly to enhance health awareness and understanding of cardiovascular disease among the community by presenting research findings, articles, book reviews on cardiovascular disease, diabetes, hypertension, strokes, cholesterol, physical activity and . Additionally, the newsletter facilitates communication among Jackson Heart Study staff, investigators, cohort members, contractors and the extended JHS family. Articles are being selected for the following upcoming issues: Submission Date Newsletter Publication March 15 Summer Edition September 15 Winter Edition Submissions should be about 800 words or less. Relevant pictures, illustrations and/or charts may be submitted with the articles. Information regarding forthcoming educational conferences and/or meetings is also requested. All material is subject to copyediting. Please include the author’s full name and credentials, the agency’s full name, street and web address and the author’s contact information, including telephone, fax and e-mail. Information should be e-mailed or mailed to Ms. Brenda Jenkins, at: By mail: JHS Newsletter, 350 W. Woodrow Wilson Drive, Suite 701, Jackson, MS 39213, or By e-mail: [email protected] JHS HEARTBEAT Clifton Addison, Ph.D., Editor-in-Chief Justin Vincent, Technical Editor Cynthia Dorsey Smith, Managing Editor Brittany May, Editorial Assistant

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