With Every Heartbeat is Life: A Community Health Worker’s Manual for African Americans

A 12-lesson course on heart health education specifically created for the African American community. Complete with activities, group idea starters, and reproducible handouts. Ready to assemble in a 1½ inch binder, with dividers for each section.

This manual is designed to be used with the companion picture card book.

Note: Session 2 requires the Act in Time to Heart Attack Signs Video, available on a compilation DVD.

Item number: 08-5844

Full text

Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 08-5844). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

With Every Heartbeat Is Life

A Community Health Worker’s Manual for African Americans

With Every Heartbeat Is Life

A Community Health Worker’s Manual for African Americans

NIH Publication No. 08-5844 November 2007

Table o f Contents

Dear Community Health Worker Letter......................................................................... v

introduction

The Role of the Community Health Worker................................................................ vii

Acknowledgments....................................................................................................... viii

About the With Every Heartbeat Is Life Project .......................................................... xi

How To Use This Manual............................................................................................ xii

About the Sessions...................................................................................................... xiii

Getting Started............................................................................................................ xvi

Working With Your Group........................................................................................ xviii

Let’s Hear From You!................................................................................................. xxi

session 1

Knowledge Is Power: Know Your Risk for Heart Disease........................................... 1

session 2

Act in Time to Heart Attack Signs............................................................................... 25

session 3

Get Energized! Say YES to Physical Activity............................................................ 51

session 4

Help Your Heart: Control Your High Blood Pressure................................................. 83

session 5

Be Heart Smart: Keep Your Cholesterol in Check................................................... 121

session 6

Embrace Your Health! Aim for a Healthy Weight.................................................... 169

Introduction iii

session 7

Protect Your Heart: Take Good Care of Your Diabetes for Life............................... 203

session 8

Make Heart Healthy Eating an Everyday Family Reunion....................................... 249

session 9

Eat in a Heart Healthy Way—Even When Time or Money Is Tight......................... 279

session 10

Take Control of Your Health: Enjoy Living Smoke Free......................................... 307

session 11

Review and Graduation.............................................................................................. 339

session 12

Use Evaluation To Track Your Progress (Especially for Community Health Workers)............................................................. 367

appendix

Activities for Training Community Health Workers................................................. 427

for more information.......................................................................... 453

iv With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Dear Community Health Worker:

You are important to us. We need your help to deliver lifesaving information to African Americans. Sadly, too many African Americans die of cardiovascular disease (CVD), particularly heart disease and stroke. Among African Americans, heart disease is the #1 killer, and stroke is the #3 leading cause of death. About 1 in 4 African American men and women dies of heart disease, and about 1 in 19 African American men and 1 in 13 African American women die of stroke.

The good news is that we already know a lot about what to do to prevent heart disease and stroke. High blood pressure, high blood cholesterol, obesity, smoking, not being physically active, and diabetes are all factors that increase a person’s risk of heart disease and stroke. African Americans can lower their risk of heart disease and stroke by making healthy lifestyle changes, getting their risk factors checked, and seeing health care providers and following their advice if risk levels are elevated. Community health workers like you can help. The With Every Heartbeat Is Life project can guide you as you begin this journey.

“With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans” is a heart health manual created especially for African American communities by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH), U.S. Department of Health and Human Services (DHHS). You will notice that cultural adaptations are used to make the manual more appealing and relevant to African American communities.

The “With Every Heartbeat Is Life” manual provides all the information you need to put a heart health project into action in your community. Taught by trained community health workers, the manual helps people build skills to make practical, lasting changes to help fight heart disease. The manual can be used to train community health workers, to teach members of the African American community, and to serve as the basis for other community activities.

“With Every Heartbeat Is Life” is dedicated to community health workers like you who devote time and energy to help others improve their health and live longer. Thank you for making a difference.

Much success,

Gregory J. Morosco, Ph.D., M.P.H. Director Division for the Application of Research Discoveries National Heart, Lung, and Blood Institute

Dear Community Health Worker v

The Role of the Community Health Worker

Community health workers play a key role in promoting better health in African American communities. They help people learn about health issues and show them ways to live healthier lives. Without them, many African Americans might not receive such vital information.

Successful community health workers have special qualities. They know their communities well. They are dedicated to improving the health of their communities. They enjoy teaching others, feel comfortable in front of a group, and know how to work with a group. Successful community health workers are also:

Good listeners
Caring
Patient
Fair
Helpful
Reliable
Trustworthy
Nonjudgmental
Pleasant
Approachable
Open minded
Motivated
Confident
Willing to try ways to improve their own health

We thank you for your interest and efforts to help African Americans take steps to protect their hearts. We invite you to give us your feedback on how you are using the manual in your community. To share the With Every Heartbeat Is Life project, please register at the Web site: www.nhlbi.nih.gov/health/prof/afr-am_reg.htm.

Organizations

This manual has been reviewed by or received support from the following organizations:

Association of Black Cardiologists Atlanta, GA

District of Columbia Housing Authority Washington, DC

Introduction vii

Acknowledgments

The “With Every Heartbeat Is Life” manual was developed with the dedication of many people. The NHLBI gratefully acknowledges the contributions of community health workers, families, groups, and organizations for the success of this manual.

Special Recognition

Special appreciation is extended to Lenee Simon, M.P.H., formerly of NHLBI, who initiated the development of this manual. Ms. Simon is currently with the Office of Disease Prevention and Health Promotion, DHHS.

NHLBI also wishes to acknowledge the resident leaders and public housing residents who provided input to the development of the “Baltimore City Public Housing Community Health Worker Educator’s Manual,” which was the springboard to the development of the “With Every Heartbeat Is Life” manual.

NHLBI extends special recognition to the following individuals for assisting NHLBI in pilot testing selected sessions and/or activities from this manual:

Barbara Abdullah

Lay Health Worker

Baltimore, MD

Janice Bowie, Ph.D.

Assistant Professor

The Johns Hopkins Bloomberg

School of Public Health

Baltimore, MD

Ellen Foster

Lay Health Worker

Baltimore, MD

Judith Fradkin, M.D.

Director, Diabetes, Endocrinology,

and Metabolic Diseases Division

National Institute of Diabetes and

Digestive and Kidney Diseases Bethesda, MD Margaret Brewer Lay Health Coordinator Joanne M. Gallivan, M.S., R.D. Baltimore, MD Director National Diabetes Education Program Anne B. Clark National Institute of Diabetes and District of Columbia Housing Authority Digestive and Kidney Diseases Speakers’ Bureau Bethesda, MD Washington, DC

Loretta Elbourne Lay Health Worker Baltimore, MD

viii With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Juanita Green Community Health Worker Housing Authority of Baltimore City Healthy Hearts in Housing Project Baltimore, MD

Mary Hollinger-Haye District of Columbia Housing Authority Speakers’ Bureau Washington, DC

Debbie Johnson Lay Health Coordinator Baltimore, MD

Jennifer Joyner Community Health Worker Housing Authority of Baltimore City Healthy Hearts in Housing Project Baltimore, MD

Marie Y. King District of Columbia Housing Authority Speakers’ Bureau Washington, DC

Jean Lann Lay Health Coordinator Baltimore, MD

Samuel B. Little, Ph.D. Director, Office of Resident Services District of Columbia Housing Authority Washington, DC

Kathy Love Coordinator of Senior Programs, Office of Resident Services District of Columbia Housing Authority Washington, DC

Patricia Malloy District of Columbia Housing Authority Speakers’ Bureau Washington, DC

Dennis McRae Community Health Worker Housing Authority of Baltimore City Healthy Hearts in Housing Project Baltimore, MD

Darlene Miller Lay Health Worker Baltimore, MD

Sheila D. Moore Lay Health Coordinator Baltimore, MD

Carol Bryant Payne, M.S.N. Baltimore Office, U.S. Department of Housing and Urban Development Baltimore, MD

Elisa Rodriguez, M.S. Research Assistant The Johns Hopkins Bloomberg School of Public Health Baltimore, MD

Angelia D. Scott District of Columbia Housing Authority Speakers’ Bureau Washington, DC

Mary Sessoms District of Columbia Housing Authority Speakers’ Bureau Washington, DC

Phyllis Seward Lay Health Worker Baltimore, MD

Introduction ix

David Watson District of Columbia Housing Authority Speakers’ Bureau Washington, DC

NHLBI

Matilde Alvarado, R.N., M.S.N. Coordinator Minority Health Education and Outreach Activities Division for the Application of Research Discoveries Bethesda, MD

Camina Davis, M.S.H.P. Community Health Specialist Division for the Application of Research Discoveries Bethesda, MD

Robinson Fulwood, Ph.D., M.S.P.H. Branch Chief Enhanced Dissemination and Utilization Branch Division for the Application of Research Discoveries Bethesda, MD

Janet de Jesus, M.S., R.D. Nutrition Education Specialist Division for the Application of Research Discoveries Bethesda, MD

Laina Ransom, M.B.A. Program Analyst Division for the Application of Research Discoveries Bethesda, MD

Madeleine Wallace, Ph.D. Public Health Analyst Division for the Application of Research Discoveries Bethesda, MD

Contract Support

IQ Solutions, Inc. Rockville, MD

Sources

Inspirational quotes for this manual were obtained from www.brainyquotes.com, http://leadershipaib.com/quote.php, and www.wikipedia.org.

With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

About the With Every Heartbeat Is Life Project

This manual is one part of the With Every Heartbeat Is Life project. The project includes:

• “With Every Heartbeat Is Life: A Community Health Worker’s Manual for

African Americans” manual and “With Every Heartbeat Is Life Picture Cards for Community Health Workers”

• “Heart Healthy Home Cooking: African American Style” booklet features

recipes for your favorite African American dishes that you can prepare in ways that protect you and your family from heart disease and stroke. Delicious foods from spicy southern barbecued chicken to sweet potato pie are included.

• “On the Move to Better Heart Health for African Americans” booklet highlights

techniques that you and your family can use to start or maintain activities that promote a heart healthy lifestyle.

Ordering information for these materials appears on page 453.

Introduction xi

How To Use This Manual

Community Health Workers

This manual is for you! The “With Every Heartbeat Is Life” manual can be used to train community health workers. After you’ve been trained, you can conduct your own trainings, and teach others how to be community health workers.

The “With Every Heartbeat Is Life” manual consists of 12 sessions that include step-by-step instructions on how to teach 11 fun and educational sessions to community residents or patients. Each session is taught in motivational and interactive ways to keep the attention of the group members. Each session helps people learn about what they can do to prevent heart disease. The manual includes worksheets and handouts for project participants (group members) to take home to read and share with their family and friends.

It also includes a special session for community health workers on how to evaluate completed projects. This session helps community health workers determine how successful they have been in implementing their training and educational activities and helping community residents to adopt heart healthy habits. The Appendix features special training activities and teaching tips and explains how to start a project in your community. (See pages 427–453.)

xii

“With Every Heartbeat Is Life” Sessions

Knowledge Is Power: Know Your Risk for Heart Disease
Act in Time to Heart Attack Signs
Get Energized! Say YES to Physical Activity
Help Your Heart: Control Your High Blood Pressure
Be Heart Smart: Keep Your Cholesterol in Check
Embrace Your Health! Aim for a Healthy Weight
Protect Your Heart: Take Good Care of Your Diabetes for Life
Make Heart Healthy Eating an Everyday Family Reunion
Eat in a Heart Healthy Way—Even When Time or Money Is Tight
Take Control of Your Health: Enjoy Living Smoke Free
Review and Graduation
Use Evaluation To Track Your Progress (Especially for Community Health Workers)

With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

About the Sessions

Each session covers a different topic related to heart health. The sessions generally follow the same structure, which will be explained next. Sessions also include “More Information” boxes, which have extra facts on selected health topics to help you answer questions from group members.

Length of Sessions

Most sessions last about 2 hours. Session 5, “Be Heart Smart: Keep Your Cholesterol in Check,” and Session 7, “Protect Your Heart: Take Good Care of Your Diabetes for Life,” could last a little longer.

Evaluation

Session 12, “Use Evaluation To Track Your Progress (Especially for Community Health Workers),” describes how to evaluate the effectiveness of the “With Every Heartbeat Is Life” manual. This session is designed to guide community health workers and project evaluators in the planning, implementation, and evaluation of the project. The purpose of the session is to provide ideas for tracking project activities and tools for measuring changes in group members’ behaviors and clinical values. You can use the ideas and tools to: (1) improve the quality of the project, (2) show that your activities work, and (3) provide information to organizations that support your project through funding, referrals, and in-kind contributions.

Glossary

Community Health Workers may find it helpful to have a glossary of terms or more information on cardiovascular topics covered in this manual. The NHLBI Diseases and Conditions Index, http://www.nhlbi.nih.gov/health/dci/index.html, contains information on diseases, conditions, and procedures related to heart disease.

Introduction xiii

Session Outline

Each session begins with a summary page that explains:

What you want group members to do or learn
Materials and supplies that you will need
Handouts and take-home materials
The session outline

In addition, each session includes five major parts:

PART 1—Introducing the Session

• Welcome the group members.

• Review the information from the last session.

• Ask the group members to talk about their pledges. (See the Weekly Pledge

section under this outline.)

• Explain what you will talk about in today’s session.

PART 2—Conducting the Session

• Present new information.

• Lead the group in fun and educational activities.

• Ask the group members questions.

• Allow the group members to ask questions about what they have heard.

PART 3—Review of Today’s Key Points

• Ask questions to help the group members review what they just learned.

• Emphasize the important points.

PART 4—Weekly Pledge

• Help group members come up with a pledge to make healthy lifestyle

changes that relate to the information they have learned during the session.

xiv With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• Give several examples of pledges that are specific and realistic.

• Share the personal value. The value helps encourage participants to keep

their pledge and gain confidence to make lasting lifestyle changes.

PART 5—Closing

• Thank the group members for their comments, and ask them what they

thought of the session.

Symbols

The following symbols are used throughout the manual to let you know quickly what comes next.

Do an activity.

Use a picture card.

Give out a handout.

Help group members create a pledge for heart health.

Give out a recipe.

Do a training activity.

Introduction xv

Picture Cards

The “With Every Heartbeat Is Life” picture cards can be used with the manual to help you present information for each session. When you see the picture card symbol in the manual, you will know to show a picture that relates to the information you will be presenting. On the back of each picture card is a script that you can read aloud while you show the picture card.

Breaks and Refreshments

You should take a short break about halfway through each session. You may want to use the time to do some easy stretches (see the “Stretching Activities” handout in Session 3 on page 79). Another option is to serve a small healthy snack with water during the break. Snack ideas include light yogurt, fruit or vegetables with low-fat dip, and water. Or you can prepare one of the recipes from this manual and have group members taste it.

Getting Started

At Least 6 Weeks in Advance

Find a location where you can teach the With Every Heartbeat Is Life sessions. Find a place in your area that people can get to easily. Local clinics, schools, churches, and community centers are possible sites for holding sessions. Call them to find out if you can reserve a room at a time that is most convenient for community residents.
Tell people about the project. Let community leaders and others know that you will be presenting the sessions. Ask clinic staff, clergy, and caseworkers to recommend the project to their patients, congregations, and clients.

These are some benefits of the project:

• It can help participants and their families find out their own risk for heart

disease and learn how to lead healthier lives.

xvi With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• Participants will learn how to start their own journeys, and journeys for

their families, toward healthier hearts. They will learn how to prevent or control high blood pressure, high blood cholesterol, overweight, and diabetes; prepare healthy meals at a low cost; become more physically active; keep a healthy weight; and quit smoking.

• The course is also for people who have risk factors for heart disease or are

under a doctor’s care because of heart disease. These sessions will guide participants to take steps to protect and improve their heart health.

• Participants will learn that whatever your age or current health status, it’s

never too late to take steps to protect your heart.

Advertise the sessions. Post flyers at health fairs and in community sites, such as clinics, grocery stores, churches, and other places in your community. (See the sample flyer on page xxii.) Place project announcements in local media outlets.
Class size. A small group of about 10 to 12 people is best. Try to get about 20 people to sign up because some may not show up, and others may drop out.

At Least 1 Week Before Each Session

Read through the sessions, picture cards, and handouts. Read through these materials two or three times to be prepared.
Carefully read the information that you will present to the group members. Practice what you will say in front of a mirror or to a friend or family member. Be sure to use the picture cards. Also practice making a few healthy changes in your own life.
Review the instructions for each activity. Make a list of things you need to do before the session, such as displaying items on a table or getting a TV monitor. For some sessions, you will need to create lists of places where people can get their blood pressure, blood cholesterol, and blood glucose (blood sugar) checked.
Pay attention to the “More Information” boxes. This extra information helps you answer questions from the group.

Introduction xvii

Ask a health educator, registered dietitian, nurse, or doctor to explain any information you do not understand. Contact these health professionals at your local hospital or neighborhood clinic.
Review the list of handouts, materials, and supplies you will need for each session.

• Make enough copies of the handouts for all group members.

• Gather all the materials and supplies needed to conduct the session.

The Day of the Session

Review the list of materials, supplies, and handouts. Make sure that you have everything.
Arrive 30 to 60 minutes ahead of time. This will allow you to set up the room.
Tell group members when sessions will meet and how often.

Working With Your Group

Leading the Group

Get to know the members of your group. They may have different

backgrounds, interests, and needs.

Encourage group members to ask questions. Asking questions helps them

apply the information to their own lives and remember what they have learned.

Keep the sessions flowing smoothly, so everyone is interested and involved.

• Be ready to deal with people who talk too much. If someone begins to talk

too long, thank the person for sharing his or her opinion. Then quickly ask if anyone else has something to share.

• Help group members who do not read or write well. Do this in a way that

will not bring attention to them.

xviii With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• Offer help, but do not force anyone to accept help.

• Change the activity to a group discussion if only a few people are talking.

Be observant. Watch for clues from group members who do not

understand, and try to present the information in a different way if you see these clues:

• Puzzled looks

• Wrinkled foreheads

• Looking away from you

• Being quiet

Motivating Group Members

Praise or reward group members’ efforts in order to keep them motivated.

• Give praise when it is deserved. This gives more meaning to what you

are teaching.

• Praise people in front of others. This can help them stay committed.

Encourage group members to share their opinions.

• Show interest in group members and what they have to say.

• Be patient. Some people may not speak because they have never been asked

to share their opinions in a group setting.

• Try to involve everyone in the discussion and activities, but do not force

anyone to speak. People will speak up when they become used to the group.

Taking Small Steps Toward Change

People are more likely to develop new habits if you promote small changes slowly. This brings more success.

Introduction xix

Getting People To Attend

Remind group members that it’s important to come to all the sessions. Tell

them that they will:

• Learn something new at each session.

• Help family members.

• Socialize and meet new people.

Ask people to team up and call one another as a reminder to attend the

sessions. This encourages people to attend.

Remind them of the meeting time and how long the sessions will last.

Answering Hard Questions

Remember that it’s okay not to know all the answers! Say that you will have the correct answer by the next session. Call a local health educator, registered dietitian, or nurse to find out the correct information.

Keeping People on Track

Give the correct information when a group member gives incorrect or incomplete information. Give the person credit for any part of his or her answer that is correct. Say that people often hear incorrect information and believe it to be true. Tell the group members that this is one important reason why they are coming to the sessions— to get correct information.

And Finally . . .

Have a good time. You are doing an important service for yourself and your community. Thank you!

xx With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Let’s Hear From You!

We thank you for your interest and efforts to help African Americans take steps to protect their hearts. We invite you to give us your feedback on how you are using the “With Every Heartbeat Is Life” manual in your community.

Your feedback will help promote the expansion of the project and contribute to the growth of the With Every Heartbeat Is Life network. Establishing a large network of community health workers is important to keep the project going strong!

You may send your feedback to: With Every Heartbeat Is Life Project Division for the Application of Research Discoveries www.nhlbi.nih.gov/health/prof/afr_am_reg.htm

Introduction xxi

Did You Know…

About one out of four African Americans dies of heart disease. But you can do something about it!

The With Every Heartbeat Is Life project will help you:

Learn how to keep your heart and your family’s hearts healthy through games, role-playing, and other activities that make learning fun.

Find ways to increase your physical activity, eat in a heart healthy way, keep a healthy weight, and not smoke.

Learn how to talk to your family, neighbors, and friends about heart disease.

Understand and connect to heart healthy practices through cultural activities.

Get take-home materials you can share with others.

Classes meet once a week for 11 weeks.

Classes meet: ______________________________________________________________

Sponsored by: ______________________________________________________________

Location: __________________________________________________________________

Day/time: _________________________________________________________________

Classes begin on: ___________________________________________________________

For more information or to register, contact: ______________________________________

The course is free.

Everyone who completes the classes will receive a certificate.

xxii

Begin With a Heart

Use this shape to cut out the heart. You will use these heart shapes in Session 1. (See page 3.)

xxiii

Session 1

If my mind can conceive

“

it, and my heart can believe it, I know I can achieve it.

”

Rev. Jesse Jackson

Session 1

Knowledge Is Power: Know Your Risk for Heart Disease

sess i o n

Knowledge Is Power: Know Your Risk for Heart Disease

Objectives

By the end of this session, group members will:

Know about the With Every Heartbeat Is Life project.
Know how the heart works and its importance.
Know that heart disease can be prevented.
Be able to name six risk factors for heart disease that can be prevented.
Know their family risk of heart disease.
Know other group members.

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Name tags
Hearts cut from red felt (Try to get the kind that has a sticky backing.) or red construction paper (Use the shape on page xxiii to cut out the heart.)
Safety pins (if not using felt with sticky backing)

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 1

Blackboard and chalk or several large pieces of paper, a marker, and tape
Clear container that is filled with 4 cups of water

Handouts

Give each group member these handouts during this session:

“Introducing the Harris Family of the ‘With Every Heartbeat Is Life’ Manual” (page 20)
“Are You at Risk for Heart Disease?” (page 21)
“Harris Family Health History” (page 22)
“My Family Health History” (page 23–24)

Session Outline

Introducing the Session

Welcome
Project Overview
Project Rules

Conducting the Session

Getting To Know Each Other
Getting To Know the Secrets of the Heart

A. How the Heart Works

B. The Heart’s Structure

Facts About Heart Disease

2 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Risk Factor Activity
Family Health History Activity

Review of Today’s Key Points

Closing

Note: Read the “More Information” chart on pages 13–14 to be ready to answer questions from group members.

Introducing the Session

1. Welcome

Introduce yourself as people walk in.
Ask each person his or her name. Write it on a name tag. Give each person a name tag and a felt or paper heart.
Ask group members to wear the name tags on their shirts. Ask them to place the felt or paper hearts where their own hearts are found.
Welcome group members to the session. Tell them that you are very happy to see them.

I want to start today’s discussion with a quote from Rev. Jesse Jackson. He said, “If my mind can conceive it, and my heart can believe it, I know I can achieve it.”

Ask:

What does this quote mean to you?

Note: Allow 2 or 3 minutes for group members to respond.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 3

These classes will prepare you to live heart healthy today and into your future— your tomorrow! I congratulate you on taking this step for your health!

2. Project Overview

Heart disease is the #1 reason why people die in this country. The National Heart, Lung, and Blood Institute (NHLBI), part of the NIH, created the With Every Heartbeat Is Life project to help African Americans prevent heart disease.

We know that knowledge is power. Knowing whether you are at risk for heart disease can empower you with the ability to do something about it. Together, we will empower ourselves by learning about the risk factors for heart disease. We also will learn things you and your family can do to have healthy hearts.

This heart health education program has 12 sessions and an optional grocery store tour. Session 12 explains evaluation and is only for community health workers. The sessions cover these topics.

Show the names of the sessions on the blackboard or on a large piece of paper taped to the wall.

“Knowledge Is Power: Know Your Risk for Heart Disease”
“Act in Time to Heart Attack Signs”
“Get Energized! Say YES to Physical Activity”
“Help Your Heart: Control Your High Blood Pressure”
“Be Heart Smart: Keep Your Cholesterol in Check”
“Embrace Your Health! Aim for a Healthy Weight”

4 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

“Protect Your Heart: Take Good Care of Your Diabetes for Life”
“Make Heart Healthy Eating an Everyday Family Reunion”
“Eat in a Heart Healthy Way—Even When Time or Money Is Tight”
“Take Control of Your Health: Enjoy Living Smoke Free”
“Review and Graduation”
“Use Evaluation To Track Your Progress (Especially for Community Health Workers)

Please come to all of the sessions. I will lead the sessions, but I need each of you to participate. This will help you learn the information and enjoy the sessions more. Please feel free to ask questions. Your questions also help others to learn.

Give each group member the “Introducing the Harris Family of the ‘With Every Heartbeat Is Life’ Manual” handout (page 20). Ask for a volunteer to read it aloud.
Show picture card 1.1.

The Harris family members will appear throughout this manual to show how they are adopting healthy lifestyles.

3. Project Rules

Note: This section will help group members feel like a team. It also will make it easier for you to lead the sessions.

Everyone will feel more at ease if they know what to expect from the training. Before we begin, let’s talk about the best way to run the training. Let’s agree as a group on a few basic rules.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 5

This course takes effort and time from each group member. It is important for you to attend each session and to arrive on time. Each of the sessions is about 2 hours long.

Optional (if you are able to make changes) Ask:

• How often do you want to meet (once a week, twice a week, etc.)?

• Is this a good time to meet?

Note: If not, set a meeting time that is best for most of the group.

Ask:

Is this a good place to meet?

Note: If not, decide on a location that is best for most of the group.

Note: Allow 2 or 3 minutes for group members to answer each question. Help them choose one answer that most people like. Go on to the next question.

Here are some things you can do to help you learn the most from the sessions.

Feel free to ask questions.
Share your personal experiences. This will make the project mean more to all of us.
Try to stay on the subject. We have a lot of information to talk about in a short time.
(Optional) Call me at (telephone number) if you have questions or concerns about this course. I am here to help you in any way that I can.

Because you will share your experiences and opinions, we need to agree on a few things. Say “yes” if you agree to the following questions.

6 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

• Do you agree to keep other group members’ comments to yourself?

• Do you agree not to judge others?

• Do you agree to try to come to all of the sessions?

Ask:

Do you have other rules that you would like to talk about?

Note: Allow a moment for group members to respond.

Conducting the Session

1. Getting To Know Each Other

We’ll begin today’s session by introducing ourselves and getting to know each other a little better.

Ask group members to:

• Give their names and tell one or two things about themselves.

• Tell why they came to this class and what they hope to learn.

Note: Start this activity by going first. Tell the group why you are interested in heart health. Be honest and talk about your own personal experience. Give each group member a chance to answer.

You can help your family and friends by giving them information and encouraging them to live healthier lives. Thank you for making this effort.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 7

2. Getting To Know the Secrets of the Heart

Now that we know a little bit about each other, let’s get to know a few facts about the heart.

A. How the Heart Works

The heart is an amazing part of the body. It pumps approximately 5 liters of blood every minute. It beats about 100,000 times a day.

Note: Hold up a clear container that has 1 liter (about 4 cups) of water in it. Remind the group that the heart pumps five times this amount of blood each minute.

The heart sends blood to the lungs to pick up oxygen. Then it delivers oxygen to all the cells in the body.

You can feel the beat of your heart by taking your pulse. To find your pulse, gently place the index and middle fingers of one hand on the inside wrist of your other hand. Slide your two fingers toward the thumb side of your wrist until you feel a slight heartbeat.

Show group members how to do this.

B. The Heart’s Structure

Show picture card 1.2.

The heart is a hollow, muscular, cone-shaped organ, about the size of a fist.

Hold up your fist for the group members to see.

8 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Point to each part of the heart on the picture card.

• The heart has two upper chambers and two lower chambers.

• The upper chambers (right atrium and left atrium) receive blood.

• The lower chambers (right ventricle and left ventricle) pump blood.

Show picture card 1.3.

• The heart is located in the middle of the chest. Did you place

your felt or paper heart in the correct spot?

• The heart is one of three main components of the circulatory system. The

others are blood vessels and the blood.

• The circulatory system is very important for sustaining life. It is made of all

the vessels that carry the blood throughout the body.

• Blood vessels are long, hollow tubes of tissue, much like drinking straws.

There are various kinds of blood vessels. The main ones are called arteries (shown in red), veins (shown in blue), and capillaries (not shown).

• The circulatory system delivers oxygen and nutrients to cells in your body

and removes carbon dioxide and other waste products.

Show picture card 1.4.

Note: Point to each vein and artery. Describe the two steps while pointing to pictures 1 and 2.

Let’s go over the major veins and arteries.

• Blood (with little oxygen) enters the right top chamber of the heart through

the largest veins in your body. These veins are called the superior and inferior vena cava.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 9

• Blood then flows down to the right lower chamber, so it can be pumped out

to the lungs through the pulmonary arteries. In the lungs, waste (carbon dioxide) is removed from the blood. The blood then gathers more oxygen.

Show picture card 1.5.

Note: Point to each vein and artery. Describe the two steps while pointing to pictures 3 and 4.

• The blood, rich with oxygen, returns to the heart and enters the upper left

chamber through the pulmonary vein. The blood then flows down to the lower left chamber and is pumped out of the aorta to the rest of your body. Your left and right coronary arteries carry oxygen-rich blood to all parts of your heart.

• Heart disease is a condition that affects the heart muscle, heart valves, or

the vessels of the heart. The major form of heart disease is coronary heart disease. Because the heart is such an important organ, you want to keep it free from heart disease. With every heartbeat is life. When the heart stops, life stops. So when you take care of your heart, you take care of your life.

3. Facts About Heart Disease

Note: Before the session, read the “More Information” chart on pages 13–14. This chart lists the risk factors for heart disease that you can do something about. It offers steps you can take to prevent those risk factors.

Now that we know how important the heart is, let’s talk about heart disease and what we can do to protect our hearts.

Ask:

Do you know someone who has heart disease?

Note: Allow about 2 minutes for group members to respond.

Show picture card 1.6.

10 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Heart disease is a serious health problem for African Americans.

• It is the number one cause of death among African Americans in the

United States.

• About one out of four deaths among African Americans is due to heart disease.

• The rate of death from heart disease is 31 percent higher among African

Americans than among whites.

• Some people believe that a heart attack or stroke happens suddenly because

of a scary experience, getting bad news, stress caused by work, family problems, worries, or having strong feelings, such as anger.

• A heart attack or stroke may seem sudden, but the truth is that heart disease

happens over many years. Often it starts when you are very young.

• Taking steps to prevent heart disease is important at any age. Taking these

steps is like performing regular service on a car, such as changing the oil and checking the fluids and tires. Car maintenance helps keep the engine running smoothly so that the car won’t break down on the road. In the same way, you need to take steps to care for your body so you can lower your chances of getting heart disease.

• This course will show you the steps you and your family can take to have

healthier hearts.

Show picture card 1.7.

In every session, you will hear about something called risk factors. Risk factors are traits or habits that make a person more likely to get heart disease. Some risk factors—such as age, family history, and gender—are things you cannot change. But the good news is that you can do something about some risk factors:

• High blood pressure

• High blood cholesterol

• Cigarette smoking

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 11

• Diabetes

• Overweight

• Physically inactive

4. Risk Factor Activity

Give each group member the “Are You at Risk for Heart Disease?” handout (page 21). Read aloud each risk factor. As you read each one, ask group members to check off the risk factors they have.

The more risk factors you have checked, the greater your risk for heart disease and stroke. Talk to your doctor about your risk.

This session will explain how these risk factors affect the health of the heart. It also will teach you ways that you and your family can prevent or control them, such as:

• Lose weight if you are overweight.

• Be physically active.

• Cut down on salt and sodium.

• Eat foods that are lower in saturated fat and trans fat.

• Eat more fruits, vegetables, and low-fat milk and milk products.

• Get your blood pressure, blood cholesterol, and blood glucose (blood sugar)

levels checked.

• Take prescribed medications as your doctor tells you.

• Quit smoking.

(Optional) Note: You can share information on The Heart Truth campaign described in the Appendix (page 437).

12 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

More Information

Heart Disease Risk Factors You Can Do Something About

RIsK FACtoRs

High blood pressure High blood pressure, or hypertension, is called the “silent killer” because it often has no symptoms, yet it can cause very serious illness.

High blood cholesterol Cholesterol in your arteries is like rust in a pipe. Low-density lipoprotein (LDL) is known as the “bad” cholesterol. Too much LDL cholesterol can clog your arteries, which increases the risk of heart disease and stroke. Highdensity lipoprotein (HDL) is known as the “good” cholesterol. HDL carries cholesterol away from your arteries.

FACts You NeeD to KNow tAKe tHese stePs to

PReveNt HeARt DIseAse

When your blood pressure is high, your heart works harder than it should to move blood to all parts of the body. If not treated, high blood pressure can lead to stroke (brain attack), heart attack, eye and kidney

• Check your blood pressure once a year. Check it more often if you have high blood pressure.

problems, and death.

Aim for a healthy weight.
Be physically active.

Check your blood pressure numbers (mmHg*):

Choose and prepare foods

Level systolic Diastolic with less salt and sodium.

Normal Less than 120 Less than 80 • Eat more fruits, vegetables,

Prehypertension 120–139 80–89 and low-fat milk products.

High Blood 140 or higher 90 or higher • If you drink alcohol, do so

in moderation. Pressure

If your doctor gives you blood
Millimeters of mercury

pressure medicine, take it the way the doctor tells you.

Check your total cholesterol number (mg/dL*):

Get a blood test called a lipid

Desirable Less than 200 profile at your doctor’s office. Borderline High 200–239 This test measures all your cholesterol levels (total, LDL, High 240 or higher and HDL) and triglycerides.

Get your blood cholesterol levels †

Check your LDL cholesterol number (mg/dL): checked every 5 years if you are age 20 or older. Desirable Less than 100

Learn what your cholesterol

Near Desirable/Above Desirable 100–129 numbers mean. If they are high, Borderline High 130–159 ask your doctor how you can High 160 or higher lower them.

Choose foods that are lower
Milligrams per deciliter in saturated fat, trans fat,

† and cholesterol.

The goal for LDL cholesterol is different for everyone.

Your doctor can help you set your LDL goal. • Aim for a healthy weight.

Be physically active.

HDL levels of 60 mg/dL or higher help lower your risk for heart disease. HDL levels below 40 mg/dL are a major Take these other steps to control risk factor for heart disease. triglycerides:

Limit candy, sweets, regular

Check your triglyceride level (mg/dL) soda, juice, and other beverages high in sugar.

A normal triglyceride level is below 150. • Avoid smoking and alcohol.

Smoking raises triglycerides and lowers HDL cholesterol. Excess alcohol also raises triglycerides.

(continued on next page)

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 13

More Information

Heart Disease Risk Factors You Can Do Something About

RIsK FACtoRs overweight Overweight occurs when

FACts You NeeD to KNow Check your body mass index (BMI) and waist measurement:

extra fat is stored in your Category BMI body. It increases your Normal 18.5–24.9 risk of developing high blood pressure, high blood overweight 25–29.9 cholesterol, heart disease, obese 30 or greater stroke, and diabetes.

A waist measurement of more than

35 inches for a woman and more than 40 inches for a man increases the risk of heart disease.

Diabetes • Diabetes is serious. You may not

know you have it. It can lead to heart When the sugar in the blood attacks, blindness, amputations, and is high, your body cannot use kidney disease. the food you eat for energy.

Nearly 1 out of every 8 adult African Americans has diabetes.
Being overweight is a major risk factor for diabetes.

Physical Inactivity • Adults should do at least 30 minutes

of moderate physical activity on most Being inactive can double days, preferably daily. your chances of heart disease

and take away years from • Some adults need up to 60 minutes of

your life. moderate (medium-level) to vigorous (high-level) activity on most days to prevent unhealthy weight gain.

Adults who used to be overweight need

60 to 90 minutes of moderate physical activity every day to avoid regaining weight.

Children and adolescents need at least

60 minutes of moderate to vigorous physical activity on most days.

smoking You put your health and your family’s health at risk when you smoke.

• Cigarette smoking is addictive. It harms your heart and lungs. It can raise your blood pressure and blood cholesterol and those of others around you.

tAKe tHese stePs to

PReveNt HeARt DIseAse

Get your BMI and waist

measured every 2 years, or more often if your doctor recommends it.

Aim for a healthy weight.

Try not to gain extra weight.

If you are overweight, try to

lose weight slowly. Lose 1 to 2 pounds a week.

Eat smaller portions and be

physically active for at least 60 minutes daily.

Find out if you have diabetes.
Get your blood glucose (blood

sugar) level checked at least every 3 years, beginning at the age of 45. You should be tested at a younger age and more often if you are at risk for diabetes.

Stay active. You can build

up to 60 minutes of exercise each day by being active for 20 minutes three times a day.

Try walking, dancing, or

playing soccer.

Stop smoking now, or cut back

gradually.

If you can’t quit the first time,

keep trying.

If you don’t smoke, don’t start.

With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

5. Family Health History Activity

Looking at your family’s health history can give you information about your own health and habits. Let’s begin by looking at an example of a family health history.

Give each group member the “Harris Family Health History” handout (page 22).

Earlier, we met the members of the Harris family. Their family health history shows health conditions that family members have in common.

Show picture card 1.1 of the Harris family while you review the handout. Ask a volunteer to read the health conditions of the Harris family members aloud.
Ask:

• What can we learn about the Harris family by looking at their family

health history?

• Is there anything the family needs to be concerned about? If so, what?

Note: Allow 2 or 3 minutes for group members to respond.

Add these answers if they are not mentioned:

• The Harris family has a history of high blood pressure.

• Darnell should see a health care provider to get screened for heart disease

and its risk factors.

• Several members of the Harris family smoke cigarettes and need to take

action now to quit.

Knowing your own family health history will help you take action to prevent and control your risk for heart disease and stroke.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 15

If you do not have living relatives or are adopted, it is important to learn your own risk factors for heart disease and live a heart healthy lifestyle.

Give each group member the “My Family Health History” handout (page 23–24).

Please take the “My Family Health History” handout with you, and fill it out at home. It will be important to get your family involved. They may have information that will help you to know more about your risk for heart disease or stroke.

Note: As you give the instructions that appear below, point to the specific area of the handout.

Let’s talk about how to fill out the “My Family Health History” handout.

• For each family member, fill in his or her name, age, and health conditions—

such as high blood pressure, high blood cholesterol, diabetes, heart attack, and stroke.

• For any family member who has passed away, write down the cause of death

and his or her age at the time of death.

• As you move down your family health history, you will complete the health

information for yourself, your spouse or partner, and your children.

Ask:

How will you find out about the health history of your family?

Note: Allow 2 or 3 minutes for group members to respond.

Add these answers if they are not mentioned:

• You can ask your parents, brothers, and sisters whether they have risk factors

for heart disease.

16 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• If your parents or siblings are no longer living, you can discuss what you

know about their health history with other members of your family.

• You can ask your adult children about their heart health. Also, you can

review your young children’s health records or speak with their health care provider on your next visit.

Some family members may feel embarrassed or uncomfortable sharing personal health information. Here are some tips to get the conversation going:

• Share the handout with your family, and ask them to help you fill it out.

• Share your own risk factors, and ask family members if they have the same

risk factors or others.

• Tell family members that you are taking a heart health course and want to

share with them what you’ve learned about family health history.

• In later sessions, I will ask for volunteers to share what they learned by

completing the “My Family Health History” handout.

(Optional) Say:

• Those of you who complete your family health history before the end of this

course will receive a special prize!

Note: If you choose to, you can provide a prize to participants who finish their family health history.

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 17

Review of Today’s Key Points

Ask:

What are the risk factors for heart disease that we can prevent or control?

Add these answers if they are not mentioned.

• Overweight

• Physical inactivity

• High blood pressure

• High blood cholesterol

• Diabetes

• Smoking

Although you cannot control your family health history, knowing your family risk factors can help you better understand your own risk and the actions you and your family can take to reduce your risk of heart disease.

It can be hard to change old unhealthy habits and learn new healthy ones. As Rev. Jesse Jackson said, “If my mind can conceive it, and my heart can believe it, I know I can achieve it.”

This course will teach you what you need to know and how to make these changes slowly. Seeing you make healthy changes may make others want to make these changes, too.

18 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Closing

Ask:

Do you have any questions about the project?

Note: Give group members a moment to respond.

(Optional) Ask:

How many of you want to go on a grocery store tour? During week 8 or 9, a registered dietitian can lead us through a grocery store and help us learn how to shop for our hearts.

Note: If enough group members are interested, call the grocery store in your area and set up a time for a tour.

Thank you for coming. What did you think of today’s session?

Note: Allow a moment for group members to respond.

In the next session, we are going to discuss the warning signs of a heart attack.

Note: Think about today’s session. What worked and what didn’t? Has the session helped you learn your risk for heart disease?

Session 1. Knowledge Is Power: Know Your Risk for Heart Disease 19

Introducing the Harris Family of the “With Every Heartbeat Is Life” Manual

An African American Family’s Triumph

This manual tells the story of how the Harris family and friends have come together to triumph over heart disease and live heart healthy. They know from experience the toll that heart disease can have on families. They support and encourage each other to overcome challenges and learn new ways to live heart healthy.

Ms. Diane Harris (Grandma Harris) is determined to be there for her family. Her resolve and spirit to improve her family’s heart health is a beacon of light that the family follows.

The Harris family and friends show you how you can achieve a heart healthy lifestyle, too. They provide practical steps you can take in your own life and home situations to improve your heart health and feel better overall. Let’s learn from their examples!

By choosing a heart healthy lifestyle, you can embrace the best that life has to offer—for yourself, your family, and future generations.

20 HAnDOuT—SESSiOn 1

Are You at Risk for Heart Disease?

Name: ________________________________________________________________

Risk factors are traits or habits that make a person more likely to develop heart disease. Read this list of risk factors for heart disease. Check the ones you have.

Heart disease risk factors you can do something about:

Check the ones that you have.

r Overweight r High blood pressure r High blood cholesterol r Diabetes

r Not sure r Not sure r Not sure r Not sure r Physical inactivity r Cigarette smoking

Heart disease risk factors you cannot control:

Check the ones that you have.

r Age (45 years or older for men and 55 years or older for women)

r Family history—

• Father or brother with heart disease before age 55

• Mother or sister with heart disease before age 65

The more risk factors you have checked, the greater your risk for heart disease. Talk to your doctor about your risk.

HAnDOuT—SESSiOn 1 21

Age: :

Smokes

(if applicable)

Aunt

Faith

Name:Relationship:Health Conditions:cigarettesCause of DeathAge at death:

Age: :

Diabetes,

(if applicable)

Uncle

Harold

Name:Relationship:Health Conditions:high blood pressureCause of DeathAge at death:

Heart

Deceased High blood

Age:

(if applicable)

Father 55

Bill

Name:Relationship:Health Conditions:Cause of DeathAttack

57 10

Age: : Age: :

High blood

(if applicable) (if applicable)

Uncle Nephew

Ronnie Jamar

Name:Relationship:Health Conditions:pressureCause of DeathAge at death: Name:Relationship:Health Conditions:Cause of DeathAge at death:

40 13

Age: : Age: :

Overweight,

(if applicable) (if applicable)

Sister Son

Pam Elijah

Name:Relationship:Health Conditions:high blood pressure, heartattackCause of DeathAge at death:Name:Relationship:Health Conditions:Cause of DeathAge at death:

27 10

Age: : Age: :

High blood Overweight

(if applicable) (if applicable)

Brother Daughter

Darnell Imani

Name:Relationship:Health Conditions:pressure, smokes cigarettesCause of DeathAge at death:Name:Relationship:Health Conditions:Cause of DeathAge at death: pressure, smoked cigarettesAge at death:

37 8

Harris Family Health History

Age: :

Diabetes,

(if applicable)

Mother

Ms. Diane

Name:Relationship:Health Conditions:high blood pressureCause of DeathAge at death:

Age: : Age: :

Prediabetes,

(if applicable) (if applicable)

Self Son

Tina Miles

Name:Relationship:Health Conditions:prehypertension, overweightCause of DeathAge at death:Name:Relationship:Health Conditions:Cause of DeathAge at death:

_________________ _________________ : : ___________ ___________

Name:Age: ___________________________Relationship: _______________Health Conditions: ________________________________________________________________Cause of Death(if applicable)Age at death: ________________Name:Age: ___________________________Relationship: _______________Health Conditions: ________________________________________________________________Cause of Death(if applicable)Age at death: ________________

_________________ _________________ : : ___________ ___________

Health conditions (examples: high blood pressure, high blood cholesterol,diabetes, smoking, overweight, heart attack, and stroke)Cause of death and age at death (if a family member has passed away)

■ _________________ _________________ : : ___________ ___________

My Family Health History

_________________ _________________ : : ___________ ___________

NameAgeRelationship to you

■ ■ Name:Age: ___________________________Relationship: _______________Health Conditions: ________________________________________________________________Cause of Death(if applicable)Age at death: ________________Name:Age: ___________________________Relationship: _______________Health Conditions: ________________________________________________________________Cause of Death(if applicable)Age at death: ________________ Fill in the following information for each family member:

HAnDOuT—SESSiOn 1 23

_________ _________ _________ : : :

____________ ____________ ____________

Name:Age: ______________________________Relationship: _________________Health Conditions: _______________________________________________________________________Cause of Death(if applicable)Age at death: ___________________Name:Age: ______________________________Relationship: _________________Health Conditions: _______________________________________________________________________Cause of Death(if applicable)Age at death: ___________________Name:Age: ______________________________Relationship: _________________Health Conditions: _______________________________________________________________________Cause of Death(if applicable)Age at death: ___________________

(continued)

_________ _________ _________ : : :

____________ ____________ ____________

_________ _________ _________ : : :

____________ ____________ ____________

My Family Health History

_________ _________ _________ : : :

____________ ____________ ____________

Session 2

There’s time enough,

“

but none to spare.

”

Charles W. Chestnutt

Session 2

Act in Time to Heart Attack Signs

sess i o n

Act in Time to Heart Attack Signs

Objectives

By the end of this session, group members will learn:

What a heart attack is
Why it is important to seek treatment quickly if a heart attack happens
The warning signs of a heart attack
Why people delay in seeking help for a heart attack
The benefits of calling emergency medical services
How to plan ahead

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Blackboard and chalk or several large pieces of paper, markers, and tape
VCR and TV monitor

(Optional) Note: Arrange for a health professional to come to the session to discuss cardiopulmonary resuscitation (CPR).

Session 2. Act in Time to Heart Attack Signs 25

Handouts

Give group members these handouts during this session:

“Learn What a Heart Attack Feels Like” (page 44)
“Fast Action Saves Lives” (page 45)
“Fast Action Saves Lives: Role Plays” (pages 46–48)
“My Emergency Card” (page 49)
“Tender Care for a Happy Heart” (page 50)

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

The Facts Don’t Lie
What Is a Heart Attack?
Importance of Rapid Treatment for a Heart Attack
What Are the Warning Signs of a Heart Attack?
Delay Can Be Deadly
The Role of Emergency Medical Services
How To Plan Ahead
Tender Care for a Happy Heart

26 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about the risk factors for heart disease.

Ask:

Who remembers the risk factors that we can prevent or control?

Note: Allow about 3 minutes for group members to respond.

Add the following risk factors if they are not mentioned:

• Overweight and obesity

• Physically inactive

• High blood pressure

• High blood cholesterol

• Diabetes

• Smoking

Session 2. Act in Time to Heart Attack Signs 27

Ask:

Would any of you like to share what you are doing to improve your heart health?

Note: Allow about 2 minutes for group members to respond.

Ask:

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

Ask:

Does anyone want to share what you have learned about your family health history?

Note: Allow about 5 minutes for group members to respond.

3. About This Session

Heart disease develops over many years. Sometimes, despite our best efforts, heart disease can result in a heart attack. That is why it is important to know the warning signs of a heart attack and what to do if you experience them.

Charles W. Chestnutt, an African American writer who lived during the late 1800s and early 1900s, said, “There’s time enough, but none to spare.”

Ask:

What does this quote mean to you?

Note: Allow about 5 minutes for group members to respond.

28 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

In today’s session, we will discuss the warning signs of a heart attack and the importance of taking quick action if you experience warning signs. By the end of this session, you will know:

• How the heart functions

• What a heart attack is

• The importance of fast treatment for a heart attack

• The warning signs of a heart attack

• Why people delay seeking help for a heart attack

• The benefits of calling 9–1–1

• Steps you can take now to help you survive a heart attack

• How to prepare your emergency card

Conducting the Session

1. The Facts Don’t Lie

• Each year about 1.2 million people in the United States will have a heart

attack, and about half of these people will die.

• About half of the people who die of a heart attack will die before they

reach the hospital.

• Among African Americans, about 65,000 men and 60,000 women have a

heart attack each year.

Session 2. Act in Time to Heart Attack Signs 29

To begin our session today, I would like to show a video about the importance of paying attention to heart attack warning signs.

Show the “Act in Time” video (14 minutes).

Now that we’ve seen the video, let’s talk about it.

Ask:

• What did you see in the video?

• What did you hear in the video?

• How did the video make you feel?

Note: Allow about 5 minutes for group members to respond.

2. What Is a Heart Attack?

In the video, you heard facts about heart attacks. Now let’s talk about what a heart attack is and how one happens.

Show picture card 2.1.

A normal artery allows blood to flow freely. A heart attack occurs when the blood supply going to a portion of the heart through one of the coronary arteries is blocked. Here’s how this happens.

• Heart disease, which can lead to a heart attack, develops over time. Fatty

deposits build up on the inside of the coronary arteries. When this happens, the arteries become narrow and not enough blood, oxygen, and nutrients get through to meet the needs of the heart.

30 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• The coronary arteries can become blocked, usually by a clot. When this

happens, the blood flow is closed off and a heart attack happens.

• If the blockage continues, part of the heart muscle will start to die.

• When a heart attack occurs, medical treatment can restore the blood flow to

the heart. This keeps the heart muscle from dying.

• Treatments work best if given as soon as possible, within 1 hour after

warning signs of a heart attack begin.

• When a part of the heart muscle dies, nothing can be done to restore it.

Ask:

Are there any questions about what happens during a heart attack?

Note: Allow about 5 minutes for group members to respond.

3. Importance of Rapid Treatment for a Heart Attack

• Treatments for a heart attack have improved over the years. Twenty years

ago, not much could be done to stop a heart attack.

• Today there are treatments that can open up the heart’s arteries and restore

blood flow.

• “Clot-busting” medicines and other artery-opening treatments can break up

the clots and quickly restore blood flow to the heart.

Show picture card 2.2.

• There is also a treatment called angioplasty. A balloon is placed in the

coronary artery and inflated to open the artery. This restores the blood flow.

Session 2. Act in Time to Heart Attack Signs 31

• Sometimes with angioplasty, doctors will insert a stent. A stent is a wire

mesh tube.

• The stent stays in the artery and keeps it open to improve blood flow to

the heart.

• These treatments should be given as soon as possible, within 1 hour after

warning signs of a heart attack start.

• The more heart muscle that is saved, the better chance a heart attack patient

has of surviving and returning to a normal life.

4. What Are the Warning Signs of a Heart Attack?

It is important to know how to recognize a heart attack. This activity should help you learn the warning signs of a heart attack.

Ask:

What warning signs would make you think someone is having a heart attack?

Note: Write group members’ responses on a blackboard or on a large piece of paper taped to the wall.

Give each group member the “Learn What a Heart Attack Feels Like” handout (page 44).
Show picture card 2.3, and review the handout.

These are the warning signs most commonly reported by heart attack patients, both women and men:

• Discomfort in the center of the chest that lasts more than a few minutes.

It can feel like uncomfortable pressure, squeezing, fullness, or pain.

32 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• Discomfort in one or both arms or the back, neck, jaw, or stomach

• Shortness of breath, with or without chest discomfort

• Cold sweat

• Feeling light-headed

• Nausea or feeling sick to their stomach

The most common warning sign of a heart attack for men and women is chest pain or discomfort.

• Men and women do not need to have all of the warning signs to be having a

heart attack.

• The warning signs mentioned are the most common ones, and most people

experience more than one of them. Some signs can occur together. For example, chest discomfort often occurs with shortness of breath. Also, arm pain, sweating, and nausea may occur together.

Many people think that all heart attacks happen the way you see them on TV or in the movies—a person grabs his or her chest and falls to the floor. This is a myth. The reality is that not all heart attacks happen this way. Many heart attacks start slowly, with signs gradually getting stronger.

• A heart attack often is not a sudden, deadly event. A variety of warning signs

may signal that someone is in danger.

• Sometimes the pain or discomfort is mild, and the signs may come and go.

Ask:

What do you think are other reasons why people do not recognize when they are having a heart attack?

Note: Allow about 5 minutes for group members to call out answers.

Session 2. Act in Time to Heart Attack Signs 33

Add the following reasons if they are not mentioned.

• People may confuse the warning signs of a heart attack with the symptoms of

other diseases, such as asthma.

• People may confuse the warning signs of a heart attack with the symptoms of

a pulled muscle, indigestion, or the flu.

• Some people do not believe they are at risk for having a heart attack. When

they have warning signs, they ignore them or wait to see if the signs get worse before they call for help.

5. Delay Can Be Deadly

People often wait too long before they seek medical care for the warning signs of a heart attack.

• Some people wait 2 to 4 hours, or even a day or more, before getting help.

• If you think a heart attack is happening, the most important thing to

remember is this—call 9–1–1 in 5 minutes or less.

When people having heart attacks decide to seek help, they often do not call 9–1–1. Only half of all heart attack patients arrive at the hospital by ambulance.

Give each group member the “Fast Action Saves Lives” handout (page 45).

Let’s go over how to take fast action when you think a heart attack is happening.

Note: Ask a volunteer to read the handout aloud.

34 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

Think about yourself and your family—what might prevent you from calling 9–1–1 quickly if you think you are having a heart attack?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add these reasons if they are not mentioned.

• They did not think their symptoms were severe enough.

• They were unaware that calling 9–1–1 has many lifesaving advantages.

• They believed that the emergency personnel would not respond to their call

fast enough.

• They thought driving themselves to the hospital would be faster.

• They were concerned about being embarrassed when an emergency vehicle—

ambulance or fire engine—showed up at their door.

• They were concerned about the cost of the ambulance and medical care.

• They were afraid of being embarrassed if the symptoms were a false alarm.

If you are having a heart attack and you or someone else cannot call 9–1–1, have someone drive you to the hospital at once. Never drive yourself. You may pass out along the way, putting yourself and others in danger.

It is easy to talk about what to do when a heart attack happens, but it is not so easy to take the right action if you or someone you know is actually having symptoms. Let’s take time to act out different scenarios to prepare you for a real situation.

Note: Ask for volunteers in the group to form three teams of two people each. Give each team one of the three different role plays in the “Fast Action Saves Lives: Role Plays” handout (pages 46–48).

Session 2. Act in Time to Heart Attack Signs 35

Note: Ask the teams to take a few minutes to read the role play, decide who will play the characters, and think about what they will say. Then ask each team to present their “drama” to the group.

Ask:

Now that you have seen the three scenarios, what do you think is the main action you must take when someone is having the warning signs of a heart attack?

Note: Allow a moment for group members to call out the answer. If no one gives the correct answer, say:

The answer is to call 9–1–1 in 5 minutes or less.

6. The Role of Emergency Medical Services

Our actors did a great job of showing us why it is important to call 9–1–1 right away. Calling 9–1–1 is like bringing the hospital emergency department to your door.

Ask:

What are the benefits of calling emergency medical services?

Note: Allow 3 minutes for group members to respond.

Add these answers if they are not mentioned:

• Emergency personnel arrive fast and can start treatment right away. They

may carry oxygen, heart medicine, pain relief medicine, aspirin, or other medications that can help in case of a heart attack.

• In many locations, emergency personnel are linked to the hospital. They can

send information about a patient’s condition to the emergency department before the patient arrives at the hospital.

• Heart attack patients who are brought by ambulance receive faster treatment

than patients who have someone drive them to the hospital.

36 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• Your heart may stop beating during a heart attack. Emergency personnel

carry equipment to restart the heart if that happens.

Note: Most communities have the 9–1–1 system. However, if your community does not, say:

The best way to get the care you need is to call the local emergency medical number. In our community, that number is _____________________.

It is a good idea to plan ahead for who will take care of your family in an emergency. Emergency medical personnel will usually contact a relative or friend to make arrangements, if necessary.

Ask:

What would you plan to do if you suddenly had to go to the hospital in an ambulance?

Note: Allow about 5 minutes for group members to discuss their answers.

7. How To Plan Ahead

We have learned a lot today about heart attacks and what to do if one happens. Here’s the good news: Planning ahead with your family can help you survive a heart attack. Here are things you can do now to prepare for a possible heart attack.

Show picture card 2.4.

You now know the warning signs of a heart attack. Talk to your family and friends about these signs and the importance of calling 9–1–1 right away.

Show picture card 2.5.

Session 2. Act in Time to Heart Attack Signs 37

You and other adults in your family should talk to your doctor about your risk of a heart attack and how to lower it.

Show picture card 2.6, and give each group member the “My Emergency Card” handout (page 49).

You and your family should have a plan of action in case of an emergency. This plan should include an emergency card. This card gives health care providers the information they need to know about you in case of an emergency. Let’s look at your emergency card. The emergency card includes the following information:

• Name, relationship, and phone number of emergency contacts who should be

called if you have to go to the hospital

• Emergency numbers in your area

• Name and phone number of your doctor or clinic

• Your health conditions

• Current medicines

• Known allergies

• Any other important information

Make copies for all adults in your family and encourage them to fill out the card.

Note: Allow 3 minutes for group members to complete the card.

Ask for volunteers to tell you how they would explain the importance of making a survival plan to their family members.
Ask group members to tell you how they would make sure that all of their family members (such as a grandparent, spouse, or uncle) know what to do in case of a heart attack.

Note: Allow 2 or 3 minutes for group members to respond.

38 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

More Information

Aspirin: Take With Caution

A person who is thinking about using aspirin for heart problems should talk to a doctor first. If the doctor thinks that aspirin is a good choice, it is important to take the correct dose.

If a person has had a heart attack or stroke, aspirin can help lower the risk of a second one. It can also help keep arteries open in persons who have had heart surgery. It has also been shown that healthy women who take a low dose of aspirin every other day may prevent a first stroke. Aspirin may also prevent a first heart attack in women over the age of 65.

8. Tender Care for a Happy Heart

After you finish preparing your emergency card, try some of these actions.

Give group members the “Tender Care for a Happy Heart” handout (page 50).

Note: Allow 2 to 3 minutes for group members to read the handout.

Ask:

Which of these things would you like to do first?

Note: Allow about 3 minutes for group members to respond.

Choose one or two action items from this handout that you would like to do during each week of the training. Then, write down the date that you complete each action.

Session 2. Act in Time to Heart Attack Signs 39

Review of Today’s Key Points

Let’s review the main points that we learned today.

What is a heart attack?

• A heart attack occurs when a coronary artery becomes blocked, and blood

flow is closed off.

• If the blood flow is stopped, parts of the heart muscle start to die.

What stops a heart attack?

• Quick action and medical treatment restores blood flow and saves

heart muscle.

Why is it important to get treatment quickly?

• Quick treatment can prevent the heart muscle from dying.

• It is best to receive treatment within 1 hour after warning signs start. This

will improve chances of survival and will help save the heart muscle.

• “Clot-busting” and other medicines open up the artery and restore

blood flow.

• Angioplasty opens the artery and restores blood flow.

What are the warning signs of a heart attack?

• Your chest may hurt or feel squeezed.

• One or both of your arms, your back, or your stomach may hurt.

• You may feel pain in your neck or jaw.

• You may feel like you cannot breathe.

• You may feel light-headed or break out in a cold sweat.

• You may feel sick to your stomach.

40 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

What should you do if you experience these warning signs?

• Call 9–1–1 in 5 minutes or less, even if you are not sure you are having a

heart attack. Calling 9–1–1 gets you treated more quickly.

• Do not drive yourself to the hospital.

Weekly Pledge

Our quote today states, “There’s time enough, but none to spare.” This quote is especially true if you or your family members experience warning signs of a heart attack.

You have learned a lot today about how to be prepared if a heart attack happens. Now let’s think about how you can practice what you have learned. Please think of one change you can make. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• Within the next week, I will think about what to do if a heart attack happens

at home, at work, in the middle of the night, or in other situations.

• I will talk with family and friends within the next week about the heart attack

warning signs and the need to call 9–1–1 right away.

• I will set up an appointment within the next month to talk to my doctor about

my heart attack risk.

Note: Allow 5 minutes for group members to think of a pledge.

Session 2. Act in Time to Heart Attack Signs 41

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional) Say:

A personal value is a quality that you consider valuable or important. Personal values can help you make changes in your everyday life to improve your health.

Today, the value is serenity. Serenity helps you stay calm, even when you face problems or worries. It can help you manage stress and anger, which are two things that can bring about a heart attack.

Ask the group members to share how serenity, or another personal value, can help them keep their pledge.

Note: Allow 3 minutes for group members to share their ideas.

We will talk about how you did with your pledge at the next session.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

The next session is about physical activity. Please wear comfortable clothing and walking shoes.

42 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Please continue to work on your family health history.

Note: Think about today’s class. What worked? What didn’t work? Have you made any changes in your own life that were covered in today’s session?

Session 2. Act in Time to Heart Attack Signs 43

Learn What a Heart Attack Feels Like

Act fast. Call 9–1–1. It could save your life.

Clot-busting medicines and other treatments can stop a heart attack as it is happening. These treatments work best if given within 1 hour of when heart attack signs begin. If you think you are having a heart attack, call 9–1–1 right away.

KnOW THE HEART ATTACK WARnIng SIgnS:

Your chest may hurt You may feel discomfort You may feel or feel squeezed. in one or both arms, or the discomfort in your back or stomach. neck or jaw.

You may feel like You may feel light-headed You may feel sick you can’t breathe. or break out in a cold sweat. to your stomach.

44 HAnDOuT—SESSIOn 2

Fast Action Saves Lives

YOu MAY nOT BE SuRE IT IS A HEART ATTACK. A heart attack may not be sudden or very painful. You may not be sure what is wrong. But it is important to check it out right away.

ACT FAST. CALL 9–1–1.

Call 9–1–1 in 5 minutes or less. When you call 9–1–1, an emergency vehicle arrives Do not drive yourself to the hospital. right away. Medicines can be given at once.

TO HELP SuRvIvE A HEART ATTACK, TAKE THESE STEPS:

Learn the warning signs of a heart attack, and act fast if you feel them.
Talk with family and friends about the warning signs and the need to call 9–1–1 right away.
Ask your doctor about your heart attack risk and how to lower it.
Complete the “My Emergency Card” handout (page 49).

HAnDOuT—SESSIOn 2 45

Fast Action Saves Lives: Role Plays

Role Play 1: At Home

Actor 1 You are at home having breakfast with your spouse. You tell your spouse that you woke up not feeling well. You have a variety of warning signs, including:

You feel some pressure and discomfort in your chest.
Your arm hurts.
You feel short of breath.
You feel a little light-headed.

Actor 2 You look worried—you are not sure what is wrong, but your spouse looks sick. You tell your spouse you have recently heard about the signs of a heart attack and are worried that this may be the problem. You say that maybe it is best if you call 9–1–1.

Actor 1 You insist it is nothing, probably just indigestion. It will pass; you will be fine.

Actor 2 You reply by telling your spouse why it is important to call 9–1–1 right away:

Even if you are not sure it is a heart attack, it is best to check it out.
If it is a heart attack, fast treatment can prevent damage to the heart.
Getting to the hospital quickly means that treatment can start right away and maybe save your life.

You call 9–1–1.

46 HAnDOuT—SESSIOn 2

Fast Action Saves Lives: Role Plays (continued)

Role Play 2: At Work

Actor 1 You are at work one afternoon, and you see that your coworker does not look well. You ask if anything is wrong.

Actor 2 You reply that you came to work this morning not feeling quite right. You describe the warning signs:

A heavy feeling in the center of the chest
Difficulty catching your breath
Feeling sick to your stomach
Feeling light-headed
Some pain going down the left arm

Actor 1 You say you have heard that these signs may mean a heart attack. If so, it is best to get it checked out right away at the hospital. You offer to call 9–1–1.

Actor 2 You give your coworker many reasons why this is not necessary.

You ate a big lunch, and it’s just indigestion, nothing serious.
You don’t want to cause a scene at work and get everybody worried.
You want to wait and see if the pain goes away in a little while.
If you went to the hospital, no one would be there to pick up your grandson from daycare.

Actor 1 You tell your coworker why it is important to call 9–1–1 right away. You make the call.

HAnDOuT—SESSIOn 2 47

Fast Action Saves Lives: Role Plays (continued)

Role Play 3: At Night

Actor 1 You are at home one night reading a magazine when you suddenly start to feel very sick. You call your neighbor on the phone to say you are not feeling well. You describe the signs.

You suddenly feel a very bad pain in the center of your chest.
You are out of breath, and you are breaking out in a cold sweat.

You feel it is something bad, and you think you should drive yourself to the hospital. Will your neighbor go with you?

Actor 2 You tell your neighbor you are worried because these symptoms sound like the warning signs of a heart attack. You say in this case it is best to call 9–1–1, not to drive yourself, so you will get to the hospital safely and be treated right away.

Actor 1 You protest that you don’t want to wake up the neighborhood and cause a big scene with the siren and all the lights; it’s easier to drive.

Actor 2 You tell your neighbor why it is better to call the emergency service.

Emergency personnel can start medical care right away.
If your heart stops beating, emergency personnel can revive you.
Heart attack patients who arrive by ambulance tend to receive faster treatment when they get to the hospital.

Actor 1 You agree that this makes sense. You ask your neighbor to call 9–1–1 for you right away and then come over to be with you.

48 HAnDOuT—SESSIOn 2

My Emergency Card

Phone ________

Relationship

My Emergency Card

_____________ Home Phone:

_______________________

(FOLD 1)

Name Name:Date of Birth:Emergency Contacts:

(FOLD 2)

OtherDiabetesHigh blood cholesterolHigh blood pressurePrevious Heart AttackHeart DiseaseDo you have any of the following conditions?

______________

_______________________

___________________

_______ _____________

q q q q q YesYesYesYesYes

q q q q q No No No No No

________________________________________________________________________________________________________Other Information:Known Allergies:Current Medications:other information.List current medications, known allergies, and any

___________________ _____________________________________ ___________________________________

______________

________________

___________________________________ umbers n

___________________________________________

EmergencyPhone:Local Clinic/Hospital:Phone:Fire Department:Local Police Department: Family Doctor: _____________________________________

Cut along dotted lines. Fold card in half and paste with a glue stick (Fold 1).Fold in half again to make your own personal wallet card (Fold 2).

Front "

HAnDOuT—SESSIOn 2

Back "

Tender Care for a Happy Heart

Choose one or two action items from this handout that you would like to do during each week of the training. Then, write down the date that you complete each action. Action

q Say something nice, positive, or uplifting to someone.

q Allow additional time to do things and get to places without rushing.

q Try a new hobby such as arts and crafts.

q Look for an activity that will allow you to make new friends.

q Show gratitude to at least five people.

q Tell your loved ones that you love them.

q Do something nice for someone.

q Think about three things that make you happy.

q Value what you have, and try to see the positive side of things.

q Do something special for yourself.

q Laugh and be positive. If you like jokes, tell one.

Date Action Date

q Call a friend you have not seen for a long time.

q Look at yourself in the mirror and say, “I am special and unique.”

q Write down how you feel.

q At the end of the day, think about the things that were good and the things you can improve.

q Rest. Go to bed 1 hour earlier than usual.

q Listen to soft music to relax.

q Help someone in need.

q Plant a garden.

q Be thankful for your family.

q Seek support in your faith community.

q Speak calmly.

q Take 15 minutes to breathe deeply and relax.

q Be kind to someone with whom you have differences.

HAnDOuT—SESSIOn 2

It is time for every one of

“

us to roll up our sleeves and put ourselves at the top of our commitment list.

”

Marian Wright Edelman

Session 3

Get Energized! Say YES to Physical Activity

sess i o n

Get Energized! Say YES to Physical Activity

Objectives

By the end of this session, group members will learn that:

Physical activity is good for the heart and overall health.
Adults should be physically active for 30 to 60 minutes on most days.
Children and adolescents should be physically active for about 60 minutes on most days, preferably daily.
Brisk walking is a simple activity nearly everyone can do.
There are ways to fit more activity into a busy schedule.

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Blackboard and chalk or several large pieces of paper, a marker, and tape
Cool drinking water and cups
(Optional) Tape or CD player for music during walking activity

Session 3. Get Energized! ! Say YES to Physical Activity. 51

Handouts

Give group members these handouts during this session:

(Optional) “Health Freedom Walk Role Play” (page 74)
“Getting Started With Physical Activity” (page 75)
“Getting Started With Physical Activity: Ms. Diane’s Answers” (page 76)
“Take Heart—Say Yes to Physical Activity” (pages 77–78)
“Stretching Activities” (page 79)
“How To Be Physically Active” (page 80)
“Make Physical Activity a Habit—My Personal Record” (page 81)
“Sample Walking Program” (page 82)

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

Facts About Physical Activity
(Optional) Health Freedom Walk Role Play
Benefits of Physical Activity
Types of Physical Activity

52 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Getting Started: Important Things To Know
Finding Time To Be Physically Active
Walking: An Activity for Almost Everyone*

A. Discussion and Stretching

B. Walking Activity

Review of Today’s Key Points

Weekly Pledge

Closing

Note: If you have time, include a 30-minute activity, such as walking, at the beginning or end of each of the rest of the sessions.

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

At the last session we talked about the heart attack warning signs. Who remembers the warning signs of a heart attack?

_______________

Prepare for the walking activity by reading the “Tips for Preparing for the Walking Activity” box on page 67.

Session 3. Get Energized! ! Say YES to Physical Activity. 53

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add these signs if they are not mentioned:

• Your chest may hurt or feel squeezed.

• You may feel like you can’t breathe.

• You may feel pain in your neck or jaw.

• One or both of your arms, your back, or your stomach may hurt.

• You may feel sick to your stomach.

• You may feel light-headed or break out in a cold sweat.

Ask:

Who remembers what you should do if you feel these symptoms?

The answers are:

• Call 9–1–1 in 5 minutes or less, even if you are not sure you are having a

heart attack. Calling 9–1–1 gets you treated more quickly.

• Do not drive yourself to the hospital.

At the end of the session, we pledged to do one thing to be prepared if a heart attack happens. Please share with the group what you did.

Note: Allow 2 or 3 minutes for group members to respond.

Ask:

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

54 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

Does anyone want to share what you have learned about your family health history?

Note: Allow about 5 minutes for group members to respond.

3. About This Session

Marian Wright Edelman, an African American civil rights activist and founder of the Children’s Defense Fund, said, “It is time for every one of us to roll up our sleeves and put ourselves at the top of our commitment list.”

Ask:

What does this quote mean to you?

Note: Allow 2 to 3 minutes for group members to respond.

During today’s session, we will discuss physical activity and how important it is to your heart health. When the session ends, you will know:

• How physical activity can help you and your family

• What kinds of activities are good for you and for your heart

• How much activity you should do

• How you can find time to be active

Note: “Physical activity” and “exercise” mean the same thing.

Session 3. Get Energized! ! Say YES to Physical Activity. 55

Conducting the Session

1. Facts About Physical Activity

Not getting enough physical activity is a major health risk for people today.

• Being physically inactive puts you at risk for heart disease. The good news is

that you can do something about this risk factor.

• African Americans, especially women and children, are not getting enough

physical activity.

• As a person gets older, having little or no physical activity can lead to health

problems.

2. (Optional) Health Freedom Walk Role Play

Note: Ask for two volunteers to be the actors in a role play. Give these two group members the “Health Freedom Walk Role Play” handout (page 74). Read the introduction aloud. After the activity is completed, allow 5 minutes for discussion by asking the following questions:

What did you learn from this story?
What are some of the issues you might face in trying to be more physically active or

in getting your family to be more physically active?

3. Benefits of Physical Activity

Ask:

How do you think physical activity can help you?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

56 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Show picture card 3.1.

Physical activity can help you:

• Strengthen your heart and lungs. • Feel better about yourself.

• Build and maintain healthy bones, • Lower your stress.

muscles, and joints.

• Reduce feelings of depression • Control your weight. and anxiety.

• Have more energy. • Improve sleep.

Show picture card 3.2.

Physical activity can also help you:

• Lower your blood pressure.

• Control your blood cholesterol.

• Lower your risk of getting heart disease, diabetes, and cancer.

If you have any of these risk factors, it is important to talk to a doctor before starting a physical activity program.

Show picture card 3.3.

People feel better when they are active. Physical activity may help you lose weight.

4. Types of Physical Activity

Ask:

What do you do to be physically active?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Session 3. Get Energized! ! Say YES to Physical Activity. 57

There are different types of physical activity. Physical activity includes some of the things that you probably do each day, like walking, climbing stairs, or doing household chores.

Show picture card 3.4.

You may want to start with moderate (medium-level) activities. Moderate activities should require you to make some physical effort, but you should be able to have a conversation comfortably while doing them. Examples of moderate activities include:

• Walking at a brisk pace • Actively playing with children

(walking, running, or climbing)

• Gardening (mowing, raking) • Weightlifting • Dancing (African dancing,

hand dancing, line dancing, or stepping) • Making home repairs (painting)

• Taking the stairs instead of the elevator • Doing floor exercises

(pushups, situps)

• Washing and waxing a car • Doing chair exercises (for • Scrubbing floors and

seniors or persons with washing windows physical disabilities)

Show picture card 3.5.

After a while, you will be able to do more vigorous (high-level) activities. Vigorous activities require a lot of physical effort and make your heart rate and breathing much faster. You usually can’t carry on a conversation comfortably while you are doing vigorous activities. Vigorous activities that you might enjoy include:

58 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Playing basketball, baseball,

or football

Swimming laps
Running or jogging
Jumping rope such as

double dutch

Skating
Using a stair climber machine or stationary bike

• Bicycling fast or uphill

at a fast pace

• Doing aerobic dance or step aerobics

All types of physical activity are good for you. Aerobic activities, such as brisk walking that speeds your heart rate and breathing, help your heart. Other activities such as weightlifting and stretching can help improve strength and flexibility.

Start slowly. Then move on to higher-level activities. For example, when you are comfortable walking, gradually begin to jog. You’ll feel great!

Ask:

How much physical activity do you think you need to do each day to improve your health?

• Adults should have at least 30 minutes of moderate physical activity daily to

lower their chances of getting heart disease.

• Some adults need up to 60 minutes of moderate physical activity on most

days to prevent unhealthy weight gain.

• Adults who used to be overweight need 60 to 90 minutes of moderate

physical activity every day to avoid regaining weight.

• Children and adolescents need at least 60 minutes of moderate to vigorous

physical activity on most days, preferably daily.

Show picture card 3.6.

Session 3. Get Energized! ! Say YES to Physical Activity. 59

If you can’t set aside 30 or 60 minutes at one time to be active, you can break your activity into shorter periods of 10 minutes or longer. It’s the total time of physical activity that is important. Just make sure that the total time adds up to 30 or 60 minutes on most days.

For example, if you can only do 30 minutes of physical activity a day:

• Ride your stationary bike for 10 minutes before you go to work...............10

• Take a 10-minute walk with your kids after work................................... +10

• Do aerobic exercises for 10 minutes later in the day................................+10

30 minutes

Show picture card 3.7.

If you have more time, you can build up to 60 minutes a day with activities like these:

• Take an early morning jog for 10 minutes................................................. 10

• Use your stationary bike for 10 minutes before you

go to work....................................................................................................10

• Take a 15-minute walk with coworkers during your

lunch break................................................................................................ 15

• Play basketball with your children for 15 minutes after dinner................. 15

• Dance for 10 minutes later in the day.......................................................+10

60 minutes

60 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

More Information

Just Move It

Physical activity is important in weight control.
Try to be physically active for 30 to 60 minutes on most days.

Here are some examples of how many calories you can burn from various activities for 30 minutes.

Activity Calories burned per 30 minutes*

Weightlifting	110
Walking (briskly), 31/2 miles per hour	140
Gardening	165
Raking leaves	165
Dancing	240
Bicycling (slowly), 10 miles per hour	145
Playing basketball	220
Jogging, 5 miles per hour	295

These calories are for a healthy 154-pound person. A lighter person burns fewer calories;

a heavier person burns more.

Source: “The Compendium of Physical Activities Tracking Guide,” University of South Carolina, 2000.

Session 3. Get Energized! ! Say YES to Physical Activity. 61

5. Getting Started: Important Things To Know

Note: This session gives information to people who are just starting to be active. It also helps people add more activity to what they already do.

There are a few things you should know before starting to be physically active.

Give each group member the “Getting Started With Physical Activity” handout (page 75).

It’s very important to know when to talk with a doctor before starting a physical activity program. In the list on your handout, check which people should see a doctor before they begin physical activity.

Read the passages below while the group members check off the boxes.

Charles is 65 years old and had a heart attack 10 years ago, but he is fully recovered.

Vernita is 32 years old and had a healthy baby 8 months ago.

Darius is 38 years old and has diabetes, but he controls his condition very well with medication.

Corretta is 35 years old and wants to start being more physically active to lower her high blood pressure and help herself to quit smoking.

Alicia is 27 years old and in good health, and she wants to start running.

Terrance is 57 years old and broke his leg 2 years ago, but it healed very well. He walks every day but wants to start jogging.

Note: Allow a few minutes for group members to discuss.

Give each group member the “Getting Started With Physical Activity: Ms. Diane’s Answers” handout (page 76).

62 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Let’s look at the handout to see what Ms. Diane has to say about this.

Note: Go over the answers with the group.

These are Ms. Diane’s answers:

Charles should see a doctor before starting a physical activity program because he has had a heart attack. Even though he is fully recovered, he should still check with his doctor.

Vernita does not need to see a doctor before starting a physical activity program. Having a baby is not a risk factor, and she is young.

Darius should see a doctor before starting a physical activity program because he has diabetes. Even though he is young and he controls his condition very well with medication, he should still check with his doctor.

Corretta should see a doctor before starting a physical activity program because she has two risk factors: high blood pressure and smoking.

Alicia does not need to see a doctor before starting a physical activity program. Even though she wants to start a harder activity, such as running, she is young and in good health.

Terrance should see a doctor before starting a physical activity program. His broken leg is not a factor, but he should check with the doctor first because he wants to start a harder physical activity program, and he is more than 45 years old.

Here are some other things you should know before starting a physical activity program:

Start slowly. Build up the time and effort that you put into any activity. You should not be tired the next day.

Session 3. Get Energized! ! Say YES to Physical Activity. 63

Drink plenty of fluids before, during, and after physical activity, even if you are not thirsty. Drink water. Water has no calories and will prevent you from becoming dehydrated. Special sports drinks are not needed.
Wear shoes and socks that give your feet support. Shoes with thick soles will cushion your feet and absorb shock.
Wear comfortable clothing. You do not need to buy fancy outfits.
Never wrap your body in plastic or wear clothing that is too heavy. This will not help you lose fat, but it can:

Make you sweat too much.
Make your body temperature rise.
Make your heart beat too fast.
Make you sick to your stomach.
Cause you to pass out.
Cause damage to your organs.

• You should also know that some larger people may face special challenges in

trying to be physically active, but there are many good options.

• Start with these activities:

Weight-bearing activities, such as walking, involve lifting or pushing your own body weight.
Nonweight-bearing activities, such as swimming and water workouts, put less stress on your joints because you do not have to lift or push your own weight. If your feet or joints hurt when you stand, nonweight-bearing activities may be best for you.
Lifestyle activities, such as gardening, do not have to be planned.

64 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Note: For more information on being active at any size, visit the Weight-Control Information Network at http://win.niddk.nih.gov or call 1–877–946–4627 (toll free).

Ask:

How many of you are concerned about what will happen to your hair and hairstyle when you are physically active?

Note: Allow about 2 minutes for group members to respond.

Try these hair care tips to help control moisture and salt buildup in your hair while being physically active:

• Use a mild pH-balanced shampoo to wash your hair at least once a week.

This will remove salt buildup from sweating when you are physically active.

• Styles like braids, dreadlocks, nubian knots, twists, and cornrows may be

easier to maintain and stay in place while you are physically active.

Ask:

Does anyone have any questions?

Note: Allow 2 or 3 minutes for group members to respond.

6. Finding Time To Be Physically Active

I know that all of you have busy lives. You may be wondering how you will ever find time to be active. Let’s look at some ways.

Give each group member the “Take Heart—Say Yes to Physical Activity” handout (pages 77–78). Read the handout aloud.

Session 3. Get Energized! ! Say YES to Physical Activity. 65

Ask:

What are some other ways to become more active even when time is limited?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add these ways if group members do not mention them.

• Take a 15- to 20-minute walk during your lunch break at work or after dinner

with your family.

• Jump rope a few minutes each day. Work up to jumping for 10 minutes.

• Play basketball with your children. You’ll burn calories and have

fun together.

Another way to find more time to be active is to reduce screen time. Screen time is the amount of time we spend watching TV, videos, or DVDs; using our computers; or playing video games. Instead of having too much screen time, you can use some of that time to do physical activities.

66 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

7. Walking: An Activity for Almost Everyone

Tips for Preparing for the Walking Activity

Before the start of this session:

Review the “Stretching Activities” handout (page 79).
Practice until you know each part well enough to teach it to the group members.
Practice a brisk walk. Take long strides, and swing your arms.

When leading this activity, remember:

Music can get people in the mood for being active. Use a lively song for the warmup exercises, a faster beat for the walking, and a relaxing song for the cool-down period. First, make sure that no one objects to the music.
Be enthusiastic. Group members will pick up on your enthusiasm and feel good about exercising.
Lead the walk in a circle if you have to do the walking indoors or if space is limited.
Have plenty of cool drinking water available before and after the activity.

A. Discussion and Stretching

Brisk walking is an excellent form of physical activity. It’s easy to do, and you do not need special equipment. All you need are shoes for support and socks for cushioning.

Session 3. Get Energized! ! Say YES to Physical Activity. 67

Walking can be done outdoors or indoors. If you do not feel safe walking in your neighborhood, a school or churchyard may be a safer place to walk. Walk in well-lit areas at night. Many shopping malls let people walk inside the mall before the stores open. Some malls even have walking clubs that meet every day.

It’s important to spend time warming up and cooling down each time you are physically active. Although the risk of injury from walking is low, the warmup gets your leg muscles ready for the activity. The cooldown lets your heart rate slowly return to normal. This also keeps your leg muscles from getting stiff.

Note: Ask the group members to stand up and spread out, with at least 3 feet between them and other group members. Start the music.

It’s important to warm up your muscles and stretch before you begin physical activity. First, we will warm up our muscles, and then we will stretch. Let’s walk in place slowly for 3 minutes.

Now, I am going to show you some stretching activities. Watch me, and then try doing them yourselves. Some are easier to do than others. With time and practice, you will be able to do them all. If you have a bit of trouble at first, just do your best. You will get a handout that tells you how to do these stretching activities. Use the handout to help you do them at home.

B. Walking Activity

Note: After the stretching activities, lead the group members on a 15- to 20-minute walk. Walk slowly for the first 5 minutes. Then show them how to do a brisk walk for 5 to 10 minutes. During the last 5 minutes, slow your pace.

68 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

We are slowing down now so that our bodies can gradually relax. This important part is called the cool-down period. It’s usually recommended that you gradually slow your pace during the last 5 minutes of an activity. Doing a few stretching exercises to loosen the muscles should also be part of your cooldown.

For example, runners or joggers may cool down by walking for a few minutes and then stretching their leg muscles before they stop entirely.

Ask:

How do you feel? Do you think you could continue to walk like this? Why or why not?

Note: Allow 3 to 5 minutes for group members to respond.

If you already walk three or more times a week, add other activities to become more fit. Try running, jumping rope, or aerobics.

One of the hardest parts of being more active is staying motivated. Many people find that having a partner helps them stay active. A partner can be a family member, neighbor, or friend. The benefits of having a partner are:

• You can motivate each other. You can set goals together and help each

other meet them.

• It makes the time go by faster. You focus on talking rather than on

the activity.

Walking clubs are a great way to enjoy physical activity and make friends.

Note: See page 438 in the Appendix for tips on how to organize a walking club, so you can share these tips with the group members.

Session 3. Get Energized! ! Say YES to Physical Activity. 69

Ask:

• What would help you stay motivated to continue being physically active?

• Where are some safe places in your neighborhood to be active?

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Give each group member the following handouts: “Stretching Activities” (page 79), “How To Be Physically Active” (page 80), “Make Physical Activity a Habit—My Personal Record” (page 81), and “Sample Walking Program” (page 82).

Use the “Make Physical Activity a Habit—My Personal Record” handout to track your daily progress.

Review of Today’s Key Points

Let’s review what we have learned today.

What are some of the benefits of regular physical activity?

Regular physical activity can:

• Strengthen your heart and lungs.

• Build and maintain healthy bones, muscles, and joints.

• Help you lose excess weight and prevent weight gain.

• Control blood cholesterol and lower blood pressure.

• Help you sleep better, reduce stress, increase energy, and reduce feelings

of depression.

• Lower your chance for heart disease, diabetes, and cancer.

70 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

What is an activity that just about everyone can do?

• Brisk walking

What are simple ways to become more active throughout the day?

• Take a walk.

• Get off the bus early and walk.

• Dance to your favorite music.

What is the minimum amount of physical activity recommended for you to do every day?

• Adults need at least 30 minutes, and children and adolescents need at least

60 minutes daily.

Weekly Pledge

You have learned a lot today about how you can become more physically active. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to increase your level of physical activity. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Examples include:

• I will talk to family members and friends this weekend about taking regular

walks together.

• I will start walking for at least 20 minutes during my lunch break at work,

starting tomorrow.

Session 3. Get Energized! ! Say YES to Physical Activity. 71

Write your pledge on the “Take Heart––Say Yes to Physical Activity” handout on page 77–78. Keep this handout in a special place so you can review your pledges and keep your goal in mind.

Note: Allow 5 minutes for group members to think of a pledge and write it down.

Ask:

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional) Say:

Keeping a personal value in mind can help you make changes in your everyday life to become more physically active. Remember that a personal value is a quality that you consider important.

Remember today’s quote from Marian Wright Edelman: “It is time for every one of us to roll up our sleeves and put ourselves at the top of our commitment list.” Although challenges will come, you must stay focused on your physical activity goal. Today the value is perseverance. Perseverance helps you have the willpower to keep your pledge, even if it means starting again after a slip. It helps you set a routine to keep you focused on your goal to improve your health.

Ask:

How could you use perseverance or another value to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will talk about how you did with your pledge at the next session. Remember to keep working on your pledge to be prepared if a heart attack happens.

72 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be about how to cut back on salt and sodium to prevent and control high blood pressure. Please continue to work on your family health history.

Note: Think about today’s class. What worked? What didn’t work? Have you made any changes in your own life that were covered in today’s session?

Session 3. Get Energized! ! Say YES to Physical Activity. 73

Health Freedom Walk Role Play

The Harris Family has joined their community’s annual Health Freedom Walk. The 5-mile event honors the community’s role in the Underground Railroad—a vast network of people who helped slaves escape to freedom. Tina Harris; her husband James; and their children, Imani (age 10), Miles (age 8), and Elijah (age 13) are walking together.

Tina: I’m so glad we joined the walk today. Remember how we skipped the Health Freedom Walk last year because we thought we couldn’t make it to the end?

James: That was before you persuaded me to get in shape with you.

Tina: Look at us now. We take walks together on most evenings after dinner. On the weekends, we try to do activities with the kids that get us moving, like this Health Freedom Walk.

James: At first, it wasn’t easy to get the kids to turn off the TV. Imani and Miles took a little convincing. Elijah put up such a fight––13 can be a rough age. Now the kids spend most of their free time playing outside or at the community center.

Tina: What a difference!

James: You’ve made a lot of progress, too. When we started, you could only walk for 10 minutes. But each day, we walked a little farther. Now we walk for 30 minutes straight.

Tina: I did feel out of shape at first. Walking is the one physical activity I like to do, but I’ve always been afraid to walk in the neighborhood alone.

James: I’m glad your sister and your friend started walking with you on the days when I work late.

Tina: Me, too. Walking with a partner is safer and more fun. You hardly notice the time when you’re walking and talking. Wow, are we at the finish line already?

James: Yes, we are. Tina: We did it! We finished the Health Freedom Walk for the first time ever. I guess you could say we’re on the path to health freedom.

This story is based on the Health Freedom Walk—A Path to Wellness program of CHAMP (Community Health Awareness & Monitoring Program). For more information, contact CHAMP at 1–410–669–6340.

74 HAnDOuT—SESSIOn 3

Getting Started With Physical Activity

It’s very important to know when to talk with a doctor before starting a physical activity program.

In the list below, check which people should see a doctor before they begin a physical activity program.

q Charles is 65 years old and had a heart attack 10 years ago, but he is fully recovered.

q Vernita is 32 years old and had a healthy baby 8 months ago.

q Darius is 38 years old and has diabetes, but he controls his condition very well with medication.

q Corretta is 35 years old and wants to start being more physically active to lower her high blood pressure and help herself to quit smoking.

q Alicia is 27 years old and in good health, and she wants to start running.

q Terrance is 57 years old and broke his leg 2 years ago, but it healed very well. He walks every day but wants to start jogging.

HAnDOuT—SESSIOn 3 75

Getting Started With Physical Activity: Ms. Diane’s Answers

q Charles should see a doctor before starting a physical activity program because he has had a heart attack. Even though he is fully recovered, he should still check with his doctor.

q Vernita does not need to see a doctor before starting a physical activity program. Having a baby is not a risk factor, and she is young.

q Darius should see a doctor before starting a physical activity program because he has diabetes. Even though he is young and he controls his condition very well with medication, he should still check with his doctor.

q Corretta should see a doctor before starting a physical activity program because she has two risk factors: high blood pressure and smoking.

q Alicia does not need to see a doctor before starting a physical activity program. Even though she wants to start a harder activity, such as running, she is young and in good health.

q Terrance should see a doctor before starting a physical activity program. His broken leg is not a factor, but he should check with the doctor first because he wants to start a harder physical activity program, and he is more than 45 years old.

76 HAnDOuT—SESSIOn 3

Take Heart—Say Yes to PhysicalActivity

Regular physical activity can help your heart and lungs work better; lower your blood pressure, blood cholesterol, and blood glucose (blood sugar); and help you control your weight. It can also help you relax, feel less tense, sleep better, have more energy, and feel better about yourself. Physical activity can also reduce your risk for diabetes and some types of cancer.

Make staying active a lifelong habit.

Ms. Diane has learned that the more physical activity you do, the easier it gets.

I do not wait until the end of the day when I am too tired to do any physical activity. I am active throughout the day. I take the stairs instead of the elevators and walk everywhere I can. Now I am up to walking 60 minutes a day with my friend. It helps to walk with someone. We are so busy talking, we walk even longer.

HAnDOuT—SESSIOn 3 77

Take Heart—Say Yes to Physical

Keep moving. Start slowly and work your way up!

Strive to do at least 30 minutes of activity every day. If you’re short on time, try three or more 10-minute periods.

Start with light activities

Slow walking
Stretching
Vacuuming

Move to moderate activities

Walking at a brisk pace
Gardening (mowing, raking)
Dancing
Doing home repairs
Washing and waxing a car
Washing windows and scrubbing floors
Playing softball
Weightlifting

Increase to vigorous activities

Playing soccer, basketball, or baseball
Running or jogging
Bicycling fast or uphill
Doing aerobics
Swimming laps
Jumping rope
Skating
Doing heavy construction work

Other things to do to help you and your family get started:

Leave a pair of walking shoes in your car.
Set a date and time with a coworker to begin walking.

James, Tina, and Pam Harris have all increased their physical activity. They now walk and dance almost every day. And Jill rides a stationary bike nearly every day.

Make your personal pledge to exercise like the Harris family does!

Look at these examples:

Morning

Park the car a few blocks away and walk to work.

Noon

During lunch, take a walk with a coworker.

Evening

After dinner, take a walk with your family.

Write the changes you will try to make this week.

Your health and your family’s health are priceless. Make an investment in it!

HAnDOuT—SESSIOn 3

Stretching Activities

Do these stretches gently and slowly. Do not bounce.

Deep Breathing

Arms up, breathe in. Arms down, breathe out. Two times each.

Waist Stretches

Side to side three times in each direction.

Leg Stretch 1

Down and up five times.

Neck Stretching 3. Shoulder Stretches 4. Side Stretches

Side to side two times. Up and down five times on Up and down five times each side. in each direction.

Twists 7. Back and Leg 8. Back Stretch Side to side three times Stretches Arms through legs

in each direction. Down and up five times. six times.

Leg Stretch 2

Move heels up and down six times.

HAnDOuT—SESSIOn 3 79

How To Be Physically Active

Walk slowly for 5 minutes. Then do stretching exercises. (See handout on

1.

stretching exercises.)

3. Walk slowly for 5 minutes.

2. Walk briskly for 20 minutes.

4. Relax!

Make Physical Activity a Habit—

Example

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

My Personal Record

Name: _____________________________________________

Track your progress every day. Start out slowly.

Aim to reach 60 minutes or more each day!

Write down the number of minutes you are active each day.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

5minutes 5 10 10 15 15 15

HAnDOuT—SESSIOn 3 81

*

Sample Walking Program

Warm Up

Week 1 Walk slowly

5 minutes

Week 2 Walk slowly

5 minutes

Week 3 Walk slowly

5 minutes

Week 4 Walk slowly

5 minutes

Week 5 Walk slowly

5 minutes

Week 6 Walk slowly

5 minutes

Week 7 Walk slowly

5 minutes

Week 8 Walk slowly

5 minutes

Walk every day of the week.

Walk Cool Down Total Time

Walk briskly Walk slowly 15 minutes 5 minutes 5 minutes

Walk briskly Walk slowly 20 minutes 10 minutes 5 minutes

Walk briskly Walk slowly 25 minutes 15 minutes 5 minutes

Walk briskly Walk slowly 30 minutes 20 minutes 5 minutes

Walk briskly Walk slowly 35 minutes 25 minutes 5 minutes

Walk briskly Walk slowly 40 minutes 30 minutes 5 minutes

Walk briskly Walk slowly 45 minutes 35 minutes 5 minutes

Walk briskly Walk slowly 50 minutes 40 minutes 5 minutes

HAnDOuT—SESSIOn 3

The time is always right

“

to do what is right.

”

Rev. Dr. Martin Luther King, Jr.

Session 4

Help Your Heart: Control Your High Blood Pressure

sess i o n

Help Your Heart: Control Your High Blood Pressure

Objectives

By the end of this session, group members will learn:

What blood pressure is
That it is best to have a blood pressure below 120/80 mmHg (millimeters of mercury)
That blood pressure between 120/80 and 139/89 mmHg is prehypertension
That a blood pressure of 140/90 mmHg or greater is high
What a stroke is and what the warning signs are
That eating less salt and sodium can lower the risk of developing high blood pressure
That they can take steps to lower the amount of salt and sodium in their diet

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Blackboard and chalk or several large pieces of paper, a marker, and tape
Measuring spoons (1 teaspoon, ¼ teaspoon)

Session 4. Help Your Heart: Control Your High Blood Pressure 83

Small amount of salt
Ms. Diane’s seasoning mixture (page 116). Prepare enough to give a small sample to each group member in a plastic bag or cup.

(Optional) Note: Arrange for a health professional to come to the session to take blood pressure readings.

Handouts

Give these handouts to each group member during this session:

List of places where group members can get their blood pressure checked*
“Know the Stroke Signs. Act Quickly” (page 108)
“My Healthy Heart Wallet Card” (page 109)
“Take Steps—Healthy Habits To Lower High Blood Pressure!” (page 110)
“Read the Food Label for Sodium!” (page 111)
“Darnell’s Food Choices” (pages 112–114)
“Sodium in Foods” (page 115)
“Keep Your Heart in Mind: Eat Less Salt and Sodium” (pages 116–117)
“Tips for Taking Medicine for High Blood Pressure” (page 118)
“Use Herbs and Spices Instead of Salt” (page 119)
“Soul Food Makeover—Vegetable Stew Recipe” (pages 120)

______

Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

84 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

The Facts Don’t Lie
Facts About Blood Pressure and Stroke
Lowering High Blood Pressure
Salt and Sodium—How Much Do We Need?
Food Label Activity––Sodium
Shake the Salt and Sodium Habit
Easy on the Alcohol
Manage Your Blood Pressure With Medicine
Soul Food Makeover—Vegetable Stew Recipe

Review of Today’s Key Points

Weekly Pledge

(Optional) Blood Pressure Check

Closing

Session 4. Help Your Heart: Control Your High Blood Pressure 85

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

Last week, we talked about why you should be physically active. What do you remember about the benefits of being physically active?

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add the following benefits if they are not mentioned.

Physical activity:

• Strengthens your heart and lungs.

• Builds and maintains healthy bones, muscles, and joints.

• Helps you feel better about yourself.

• Helps you control your weight.

• Helps you lower your blood pressure.

• Helps you control your blood cholesterol.

• Helps you sleep better.

• Helps you reduce stress and feelings of depression and anxiety.

• Helps you have more energy.

• Helps lower your chances of developing diabetes, heart disease, and cancer.

86 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

At the end of our last session, everyone made a pledge to be more active.

Note: Share with the group what you did and what barriers you faced.

Ask:

Would any of you like to share with the group what you did? What problems did you face (such as not having time or not getting family support)? How did you solve them?

Note: Allow about 5 minutes for responses.

Ask:

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

Ask:

Does anyone want to share what you have learned about your family health history?

Note: Allow about 5 minutes for group members to respond.

3. About This Session

Rev. Dr. Martin Luther King, Jr., said, “The time is always right to do what is right.”

Ask:

What does this quote mean to you?

Note: Allow 5 minutes for group members to respond.

Session 4. Help Your Heart: Control Your High Blood Pressure 87

Today’s session is about blood pressure and the steps you can take to lower your blood pressure or keep it from rising.

Conducting the Session

1. The Facts Don’t Lie

• More than 65 million people (one in three) in the United States have high

blood pressure, which is also called hypertension. Nearly a third of these people don’t know they have high blood pressure.

• Another 59 million Americans have prehypertension, which means they are

at risk of developing high blood pressure.

• Four in 10 African Americans have high blood pressure.

• African Americans are more likely to have high blood pressure than any

other racial or ethnic group in this country. In fact, African Americans have one of the highest rates of high blood pressure in the world.

• High blood pressure tends to develop at an earlier age and to be more severe

in African Americans than in whites.

• African American women are especially at risk. Compared to white women,

African American women are three times more likely to die from heart disease or stroke before age 60.

• Each year, more than 19,000 African Americans die of stroke.

2. Facts About Blood Pressure and Stroke

Show picture card 4.1.

88 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Blood pressure is the force of blood against the walls of your arteries. Blood pressure is needed to move the blood through your body.

Note: Blood pressure is measured in millimeters of mercury, which is written as mmHg in this manual. When you see mmHg, you should say millimeters of mercury.

Show picture card 4.2.

Blood pressure is recorded as two numbers––the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats).

The measurement is written one above the other, with the systolic number on top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mmHg is expressed verbally as “120 over 80.”

It is important to keep track of your blood pressure numbers. Write down your numbers every time you have your blood pressure checked.

Ask:

Do you know your blood pressure numbers?

Note: Allow about 2 minutes for group members to respond.

Note: Copy this chart on the blackboard or on a large piece of paper taped to the wall.

Session 4. Help Your Heart: Control Your High Blood Pressure 89

Your Blood Pressure Numbers

Level First Number Second Number Results (mmHg) (mmHg)

Normal Below 120 Below 80 Good for you!

Prehypertension 120–139 80–89 Keep an eye on your blood pressure.

It is time to make changes in your eating and physical activity habits. Visit the doctor if you have diabetes.

High blood 140 or greater 90 or greater Ask your doctor or nurse pressure how to control it.

A normal blood pressure is less than 120/80 mmHg. Blood pressure between 120/80 and 139/89 mmHg is prehypertension. This means that you don’t have high blood pressure yet but are likely to develop it in the future, unless you make changes in your health habits. Blood pressure is high when it is 140/90 mmHg or greater.

Show picture card 4.3.

If you have high blood pressure—or hypertension—it means your heart has to pump harder than it should to get blood to all parts of your body. High blood pressure raises your chances for having a heart attack, a stroke, kidney problems, or becoming blind.

High blood pressure is also known as the “silent killer” because it often has no symptoms. Most people who have it don’t feel sick until they have a stroke, heart attack, or some other problem caused by high blood pressure.

90 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

High blood pressure is a major reason why African Americans are more likely than other racial or ethnic groups to die from stroke.

High blood pressure is a major risk factor for stroke. Other risk factors that increase your chances of having a stroke include heart disease, smoking, diabetes, obesity, and high blood cholesterol.

Ask:

Do you know anyone who has had a stroke?

Note: Allow a few minutes for group members to respond.

Give group members the handout “Know the Stroke Signs. Act Quickly” (page 108).
Show picture card 4.4.

A stroke is also called a brain attack. A stroke happens when blood suddenly stops going to the brain, and brain cells die. A stroke is very serious and can lead to disability and death.

The warning signs of a stroke happen suddenly. A person may have one or more warning signs.

The warning signs of a stroke include:

• Numbness of the face, arm, or leg (especially on one side of the body)

• Confusion, trouble talking, and difficulty understanding others

• Trouble seeing in one or both eyes

• Trouble walking, dizziness, and loss of balance or coordination

• Severe headache

Session 4. Help Your Heart: Control Your High Blood Pressure 91

Ministrokes, or transient ischemic attacks (TIAs), have the same symptoms as a stroke, but they do not last as long and usually do not cause brain damage. A ministroke is a warning that a stroke may happen in the future.

Ministrokes may last a few seconds or an entire day and then go away. These signs should not be ignored. As with a heart attack, act immediately if you or someone you know has stroke symptoms. Calling 9–1–1 right away will help prevent serious problems.

Show picture card 4.5.

Measuring blood pressure is easy and does not hurt. The best way to find out if you have high blood pressure is to have it checked at least once a year. Check it more often if you already have high blood pressure.

Give group members:

• A list of places (such as clinics and hospitals) to get blood pressure checked

• The “My Healthy Heart Wallet Card” handout (page 109)

Ask for your numbers each time you have your blood pressure checked. Keep a record of each reading on the wallet card.

92 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

3. Lowering High Blood Pressure

Ask group members to raise their hands if someone in their family has high blood pressure.

If a member of your family has high blood pressure, you are at greater risk of getting it, too. Even if you do not have high blood pressure now, you are still at greater risk if a family member has it.

The good news is that you can take steps now to lower your blood pressure or keep it from rising. Let’s find out how.

Give each group member the “Take Steps—Healthy Habits To Lower High Blood Pressure!” handout (page 110).
Read aloud the steps to lower high blood pressure or keep it from rising.
Ask:

Which steps could you and your family take to prevent or lower high blood pressure?

Note: Allow 3 minutes for group members to respond.

4. Salt and Sodium—How Much Do We Need?

Note: For this activity, you will need a ¼-teaspoon measuring spoon, a 1-teaspoon measuring spoon, and some salt. Use a colored plate or plastic test tube to show the sodium levels.

Eating less salt and sodium can help you prevent or lower high blood pressure. You know what salt is, but you may wonder what sodium is. Sodium is a part of salt. It is also part of mixtures used to flavor and preserve foods.

Session 4. Help Your Heart: Control Your High Blood Pressure 93

Some people, including many African Americans, are more sensitive to salt and sodium and may need to be especially careful about how much salt they eat.

Now let’s look at how much sodium we really need. The body needs only about 500 milligrams of sodium each day. That’s about ¼ teaspoon of salt.

Note: Use the measuring spoon to show ¼ teaspoon of salt.

Most people are eating much more than 500 milligrams of sodium every day.

You should cut back the amount of sodium you get from all foods and beverages to less than 2,300 milligrams of sodium, or about 1 teaspoon of salt per day.

Note: Now show 1 teaspoon of salt.

If you have high blood pressure, it would be helpful to decrease your sodium intake to 1,500 milligrams of sodium per day.

Note: Now show /3 teaspoon of salt.

Most people in the United States eat about 4,000 to 6,000 milligrams of sodium each day.

Note: Now show 2½ teaspoons of salt.

94 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

This is about 8 to 12 times more sodium than the body needs. Eating this much salt and sodium may lead to high blood pressure.

Show picture card 4.6.

Let’s talk about what foods are high in sodium. Most of the sodium that we eat comes from packaged foods, restaurants, and fast food. Examples of packaged foods are:

• Regular canned soups and vegetables

• Frozen dinners

• Macaroni and cheese

• Canned fish and meats, such as salmon, tuna, sardines, and vienna sausages

• Salty chips

• Regular lunch meats, such as bologna

• Meats high in sodium, such as hotdogs or bacon

When you eat out, most of the food will be high in sodium. If you have high blood pressure, you should eat out less often.

Sodium also comes from salt added during cooking or at the table.

5. Food Label Activity––Sodium

Show picture card 4.7.

The food label found on packaged foods is one of the best tools we have for choosing foods for a healthy diet. In this session, we will learn how to use the food label to choose foods that are lower in sodium.

Session 4. Help Your Heart: Control Your High Blood Pressure 95

Give group members the “Read the Food Label for Sodium!” handout (page 111).

The food label lists the serving size and number of servings in the container. It also gives the amount of calories, sodium, saturated fat, trans fat, and cholesterol in one serving of the food. We will talk about calories, saturated fat, trans fat, and cholesterol in the next two sessions.

Point out where the Percent Daily Value is located on the food label.

The Percent Daily Value helps you compare products. It tells you if a food is high or low in various nutrients. Remember—it is easy to take in more than 2,300 milligrams of sodium. Choose foods with a lower Percent Daily Value for sodium. A Percent Daily Value of 5 or less is low, and a Percent Daily Value of 20 or more is high. Once you get into the habit of looking at food labels, it will be easy.

Let’s take a close look at the Nutrition Facts on an actual label to find the amount of sodium. Let’s go back to the “Read the Food Label for Sodium!” handout.

Point again to picture card 4.7.

The food label found on packaged foods is one of the best tools we have for choosing foods for a healthy diet. The Percent Daily Value for sodium in packaged noodle soup is circled on the food label.

The sodium content of the same food can vary, depending on how it is packaged or what brand it is. Compare food labels to choose foods that are lower in sodium.

96 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Look at the bottom of the handout. Look at the Percent Daily Value for lowsodium soup and for packaged noodle soup. Which soup is lower in sodium?

Low-sodium soup is lower in sodium. One serving of low-sodium soup has only 9 percent of the Daily Value for sodium. One serving of packaged noodle soup has 34 percent of the Daily Value for sodium, which is almost four times more sodium than low-sodium soup.

More Information: Potassium, Calcium, and Magnesium

The latest research shows that foods rich in potassium are important in protecting against high blood pressure. Foods rich in calcium and magnesium may help, too. Eat foods that are a good source of these nutrients:

• Potassium: bananas, tomatoes, potatoes, oranges, prunes, spinach, and

dry beans

• Calcium: low-fat milk; low-fat, reduced-sodium cheese; low-fat yogurt;

calcium-fortified orange juice; leafy greens; and fresh or rinsed canned fish

• Magnesium: whole-grain breads and cereals, beans, nuts, seeds, okra,

and spinach

Session 4. Help Your Heart: Control Your High Blood Pressure 97

More Information: The DASH Eating Plan To Lower Your Blood Pressure

One eating plan that can lower blood pressure is Dietary Approaches To Stop Hypertension (DASH). By using the DASH plan, you can lower blood pressure by eating:

• Lots of fruits and vegetables • Fat-free or low-fat milk products • Whole-grain products • Fish, poultry, and lean meats • Nuts, seeds, and dry beans

The DASH eating plan also includes:

• Less salt and sodium • Small amounts of fats and oils • Small amounts of sweets and beverages that are high in sugar

People with high blood pressure will get extra benefits from following the DASH eating plan and eating foods low in salt and sodium. This combination also is heart healthy for people who don’t have high blood pressure.

Choosing and preparing foods that are lower in salt and sodium may help prevent or lower high blood pressure. Eating more fruits and vegetables, wholegrain breads and cereals, and fat-free or low-fat milk products also may help lower blood pressure.

If you have trouble eating milk products or have a problem digesting lactose, try using lactose-free products that are low in fat, such as low-fat soy milk.

98 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Let’s try an activity that will help us choose foods that are low in salt and sodium. First, I am going to describe a situation that may apply to you or to family members. Then, using food labels, we are going to learn how to choose lower sodium foods.

Give each group member the “Darnell’s Food Choices” handout (pages 112–114). Read or ask a volunteer to read the story below.

Darnell’s Food Choices

During a recent visit to the doctor, Darnell learned that he has high blood pressure. The doctor told him to cut back on the amount of sodium he eats. Use the food labels to help Darnell choose foods that will help him follow his doctor’s advice.

Let’s go over some questions. Use the food labels to choose food that is lower in sodium.

Ask these questions. Give the correct answer after group members guess.

Questions Correct Answers

When buying juice, should Darnell Orange juice choose tomato juice or orange juice?

At a neighbor’s picnic, should Darnell Herb-seasoned roasted chicken choose barbecued chicken or herb- (skinless and with no added salt) seasoned roasted chicken (skinless and with no added salt)?

Should Darnell buy frozen peas or Frozen peas canned peas?

Should Darnell eat a buttermilk biscuit English muffin or an english muffin?

Should Darnell snack on a handful Unsalted, dry roasted of salted mixed nuts or a handful of mixed nuts unsalted, dry roasted mixed nuts?

Session 4. Help Your Heart: Control Your High Blood Pressure 99

6. Shake the Salt and Sodium Habit

Give group members the “Sodium in Foods” handout (page 115).
Ask:

Does anyone see a food on the right side of the page that you eat often?

Ask the person to name a lower-sodium food on the left side that he or she could eat instead.

Let’s now review some practical tips that will help you cut back on salt and sodium.

Give each group member the “Keep Your Heart in Mind: Eat Less Salt and Sodium” handout (pages 116–117). Review the tips on how to cut back on salt and sodium when shopping, cooking, and eating.

Here is a sample of Ms. Diane’s secret recipe from the bottom of the “Keep Your Heart in Mind” handout. Fill an empty salt shaker with this seasoning mixture, and put it on your table. Tell your family to try it instead of salt.

Give each group member a sample of Ms. Diane’s seasoning mixture.
Ask:

Why is it hard for you to cut back on salt and sodium?

Note: Allow 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall. Then write down some possible solutions. See the “Salt Solutions Examples” box for some problems and solutions.

100 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Salt Solutions Examples

Problems You May Encounter Solutions

The food has no flavor. Use herbs or spices to add flavor to foods. See the “Use Herbs and Spices Instead of Salt” handout (page 119).

Family members will get upset. Cut back on salt slowly. Use less salt each time you cook so family members can get used to the taste.

Adding salt is a habit that is hard Give yourself time to get used to to break. using less salt. Choose brands that are lower in salt. Take the salt shaker off the table.

7. Easy on the Alcohol

Drinking too much alcohol can raise your blood pressure. It can also harm the liver, brain, and heart. Alcoholic drinks also contain calories. The extra calories can make it hard to control your weight.

If you don’t drink alcohol, don’t start. If you drink alcohol, drink only a moderate amount. That means:

• Men should have no more than two drinks a day.

• Women should have no more than one drink a day.

• Pregnant women should not drink any alcohol.

Ask:

What do you think counts as one drink?

Note: Allow 2 minutes for group members to respond.

Session 4. Help Your Heart: Control Your High Blood Pressure 101

One drink is:

• 12 ounces of beer (regular—150 calories; light—100 calories)

• 5 ounces of wine (100 calories)

• 1½ ounces of liquor (100 calories)

8. Manage Your Blood Pressure With Medicine

If you have high blood pressure, making the lifestyle changes we just discussed may not be enough to lower your blood pressure. Medications are available to lower blood pressure. They work in different ways.

Give group members the “Tips for Taking Medicine for High Blood Pressure” handout (page 118).
Ask:

Do any of you take medicines for high blood pressure?

Read aloud the “Tips for Taking Medicine for High Blood Pressure” handout.
Ask:

If you are taking medication for high blood pressure, what are some things you can do to help your medicines work better?

Note: Allow a few minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

102 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Add the following things if they are not mentioned:

• Ask your doctor the name of your medicine and how to take it.

• Take your medicine the way the doctor tells you.

• Tell your doctor the names of all other medicines, home remedies, herbs, or

supplements you take.

• Tell your doctor if the medicine makes you feel strange or sick.

• Refill your prescription before you run out of medicine.

• Have your blood pressure checked to see if the medicine is working for you.

• Keep taking the medicine as your doctor tells you, even if your blood

pressure is okay.

More Information

• Many people with high blood pressure may take more than one medicine to

control their blood pressure.

• Some medicines can cause side effects or reactions. If this happens, talk to

your doctor.

• Eating more fruits and vegetables, cutting back on salt and sodium, losing

weight, and being physically active can help your medicines work better.

9. Soul Food Makeover—Vegetable Stew Recipe

Give group members the “Use Herbs and Spices Instead of Salt” handout (page 119). Ask them to use some of the herbs and spices in place of salt when they cook this week.
Give group members the “Soul Food Makeover—Vegetable Stew Recipe” handout (pages 120). Ask them to prepare the recipe during the coming week. Tell them that using this recipe will give them a chance to practice some of the ideas from the session.

Session 4. Help Your Heart: Control Your High Blood Pressure 103

Review of Today’s Key Points

Let’s review what we learned today.

What is blood pressure?

• Blood pressure is the force of blood against the walls of your arteries. Blood

pressure is needed to move blood through your body.

What is a normal blood pressure?

• A normal blood pressure is below 120/80 mmHg.

What is prehypertension?

• Blood pressure between 120/80 and 139/89 mmHg is prehypertension. This

means that you don’t have high blood pressure yet, but you’re likely to develop it in the future unless you make changes in your health habits.

What is high blood pressure?

• High blood pressure is 140/90 mmHg or greater. Have your blood pressure

checked. If it is 140/90 mmHg or greater, see your doctor.

Why is high blood pressure dangerous?

• High blood pressure can lead to heart attack, stroke, kidney problems, eye

problems, and death.

What can you do to help make your blood pressure medicine work better?

• Eat more fruits and vegetables, cut back on salt and sodium, lose weight,

and be more physically active. Take your medicine as your doctor tells you. Talk to your doctor about side effects.

Why should you cut back on salt and sodium in your food?

• You should cut back on salt and sodium to help prevent or lower high

blood pressure.

104 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

What are some ways to cut back on salt and sodium?

• Use herbs and spices to season foods. Be careful! Some seasonings such as

garlic salt and onion salt are high in sodium. Check the food label to choose foods lower in sodium. Eat more fruits and vegetables for snacks instead of salty snacks such as nuts, pretzels, or chips.

How can drinking alcohol affect your blood pressure?

• Drinking too much alcohol can raise blood pressure.

What is a stroke?

• A stroke is a brain attack. A stroke happens when blood suddenly stops

going to the brain. This can happen for different reasons. One example is when a blood vessel bursts. Another way is when a clot blocks the arteries. Either way, the result is the same: blood stops going to the brain, and brain cells die. Both types of stroke are very serious and can lead to disability and death.

Weekly Pledge

You have learned a lot today about how to prevent and control high blood pressure. You also learned how to cut back on salt and sodium. Now let’s think about how you can practice what you have learned. Please think of one change you can make in your everyday life. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will get my blood pressure checked within the next month.

• I will read food labels the next time I go to the store to help me choose

canned soups that are lower in sodium, or I will prepare homemade soup without adding salt.

Session 4. Help Your Heart: Control Your High Blood Pressure 105

• I will rinse canned foods with water before I cook or eat them,

starting tomorrow.

• I will take the salt shaker off the table, starting tomorrow.

Write your pledges on the back of the “Keep Your Heart in Mind: Eat Less Salt and Sodium” handout. Keep this handout in a special place so you can review your pledges and keep your goals in mind.

Note: Allow 5 minutes for group members to think of a pledge and write it down.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional) Say:

Keeping a personal value in mind can help you make changes in your everyday life to prevent and control high blood pressure. Remember that a personal value is a quality that you consider important.

Today’s value is openness. Being open means you are willing to consider making changes to improve your health, such as cutting back on foods high in salt and sodium.

As today’s quote states, “The time is always right to do what is right.” I hope all of you will encourage your family and friends to grow wiser in heart health by learning how to prevent and control high blood pressure.

Ask:

How can you use openness, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

106 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

We will talk about how you did with your pledge at the next session. Remember to keep working on your pledge to be more physically active.

(Optional) Blood Pressure Check

(Optional—Try to get a health professional to come to your session.)

Tell group members that a health professional will now check everyone’s blood pressure.
Ask group members to write their blood pressure numbers on the wallet card.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Wait to see if group members have a response.

I am looking forward to seeing you at the next session. The next session will be about how to prevent and control high blood cholesterol. Please continue to fill out your family health histories.

Note: Think about today’s session. What worked and what didn’t work? Have you decided to make any changes in your own life based on what was covered in today’s session?

Session 4. Help Your Heart: Control Your High Blood Pressure 107

Know the Stroke Signs. Act Quickly.

A stroke happens when blood suddenly stops going to the brain, and brain cells die. A stroke is very Brain Eyes serious and can lead to disability and death.

Face

Signs of a stroke:

Arm

Numbness of the face, arm, or leg (especially on one side of the body)
Confusion, trouble talking, and difficulty understanding others
Trouble seeing in one or both eyes

Leg

Trouble walking, dizziness, and loss of balance or coordination
Severe headache

Stroke Is Serious. Every Second Counts.

• Learn the stroke signs and teach them to your family and friends.

• Call 9–1–1 immediately if you have any of these stroke warning signs.

• Treatment can reduce the risk of damage from a stroke. You must get help

within 3 hours of your first symptoms.

Adapted from the American Stroke Association, “Let’s Talk About Risk Factors for Stroke.” 1999–2003. A division of the American Heart Association.

108 HANDOuT—SESSION 4

My Healthy Heart Wallet Card

Check your:

Talk to your doctor about what these numbers mean!7% or lessA1CLess than 100Blood glucoseBlood tests to check sugar in blood for diabetesWomen: 35 inches or lessMen:Waist measurementsWeight

40 inches or less

(fasting)

ValueDateValueDate ValueDateValueDate

blood pressure, blood cholesterol, weight, waist measure, and blood glucose

_____________________________________

Name

(FOLD 1)

Take Care of Your Heart

(FOLD 2)

fat, cholesterol, and sodium trans

fruits, vegetables, whole grains, and fat-free or low-fatmilk products

+ + physical activity– calories, saturated and– weight and waist measure0 cigarettes= A healthy heart

Less than 150 mg/dLTriglyceridesMore than 40 mg/dLHDLLess than 130 mg/dL—Less than 100 mg/dL—idealLDLLess than 200 mg/dLTotal CholesterolLess than 120/80 mmHgBlood Pressure near ideal

Blood tests to measure fats in the blood

ValueDateValueDate ValueDateValueDate ValueDate

Try these tips for a healthy heart!

Cut along dotted lines. Fold the card in half and paste with a glue stick (fold 1).Fold in half again to make your own personal wallet card (fold 2).

Front "

Back "

SESSION

Take Steps—Healthy Habits To Lower High Blood Pressure!

To prevent high blood pressure:

Aim for a healthy weight.

Try not to gain extra weight. Lose weight if you are overweight. Try losing weight slowly, about 1 to 2 pounds each week until you reach a healthy weight.

Be active every day for at least 30 minutes.

You can walk, dance, play sports, or do any activity you enjoy.

Eat less salt and sodium.

Buy foods marked “sodium free,” “low sodium,” or “reduced sodium.” Take the salt shaker off the table.

Eat more fruits and vegetables, whole-grain breads and cereals, and fat-free or low-fat milk products.
Cut back on alcohol.

Men who drink should have no more than one or two drinks each day. Women who drink should have no more than one drink a day. Pregnant women should not drink any alcohol.

To lower high blood pressure:

Practice these steps:

• Maintain a healthy weight. • Be active every day for at least

30 minutes.

• Eat fewer foods high in salt

and sodium.

• Eat more fruits and vegetables,

whole-grain breads and cereals, and fat-free or low-fat milk products.

• Cut back on alcoholic beverages.

Take your medicine the way your doctor tells you.
Have your blood pressure checked often.

Read the Food Label for Sodium!

Food labels tell you what you need to know about choosing foods that are lower in sodium. Here’s a food label for packaged noodle soup.

Packaged Noodle Soup

Amount Per Serving

The nutrient amounts are for one serving. So, if you eat the whole block of noodles, you are eating two servings, and you need to double the nutrient amounts.

Nutrients

Listed are the amounts of sodium in one serving. These amounts are listed in milligrams (mg).

The Choice Is Yours— Compare!

Which one would you choose?

Low-sodium soup is lower in sodium than packaged soup. Read the food labels, and choose foods that are lower in sodium to help keep your heart strong.

Serving Size and Number of Servings

The serving size is ½ of the block of noodles. The package contains two servings. Remember, the numbers on the label are for one serving, not the whole package.

Percent Daily Value

The Percent Daily Value helps you compare products and quickly tells you if the food is high or low in sodium. Choose products with the lowest Percent Daily Value for sodium: 5 percent or less is low, and 20 percent or more is high.

Low-Sodium Soup One serving (1 cup) of lowsodium soup has 210 mg of sodium and 9 percent of the Daily Value for sodium.

Packaged Noodle Soup One serving, ½ block of the packaged noodle soup, has 820 mg of sodium and 34 percent of the Daily Value for sodium. This is nearly four times the amount of sodium in a serving of lowsodium soup.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDOuT—SESSION

4 111

Darnell’s Food Choices

1 – Tomato Juice

During a recent

visit to the doctor, Nutrition Facts

Darnell learned Serving Size 8 fl oz (240 mL)

Servings Per Container 8

that he has high

Amount Per Serving

blood pressure.

Calories 40 Calories from Fat 0

% Daily Value*

The doctor told

Total Fat 0g 0%

him to cut back

Saturated Fat 0g 0%

on the amount of

Trans Fat 0g

sodium he eats.

Cholesterol 0mg 0%

Sodium 750mg 31%

Use the food

Total Carbohydrate 10g 3%

labels to help Lower

Dietary Fiber 1g 4%

Darnell choose sodium

Sugars 8g

foods that choice

Protein 2g

will help him ______ follow his Vitamin A 22% Vitamin C 24%

Calcium 2% Iron 5%

doctor’s advice.

Mark the number of your choice for each pair in the 3 – Barbecue Chicken space between

the labels. Nutrition Facts

Serving Size 3 oz (85g) Servings Per Container 1

Amount Per Serving Calories 90 Calories from Fat 15

% Daily Value*

Total Fat 1.5g 2%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 30mg	10%
Sodium 345mg	14%
Total Carbohydrate 0g	0%

Lower

Dietary Fiber 0g 0%

sodium

Sugars 0g

choice

Protein 20g

___

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 4%

2 – Orange Juice

Nutrition Facts

Serving Size 8 fl oz (240 mL) Servings Per Container 8

Amount Per Serving Calories 110 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 5mg	0%
Total Carbohydrate 25g	8%
Dietary Fiber 1g	4%

Sugars 20g

Protein 1g

Vitamin A 9% Vitamin C 143%

Calcium 2% Iron 6%

4 – Herb-Roasted Chicken

Nutrition Facts

Serving Size 3 oz (85g) Servings Per Container 4

Amount Per Serving Calories 110 Calories from Fat 10

% Daily Value*

Total Fat 1g 2%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 75mg	25%
Sodium 30mg	1%
Total Carbohydrate 0g	0%
Dietary Fiber 0g	0%

Sugars 0g

Protein 25g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 4%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

112 HANDOuT—SESSION

Darnell’s Food Choices

5 – Frozen Peas

Nutrition Facts

Serving Size 1/2 cup (63g) Servings Per Container 3

Amount Per Serving Calories 50 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 45mg	2%
Total Carbohydrate 9g	3%

Lower

Dietary Fiber 2g 8%

sodium

Sugars 3g

choice

Protein 3g

___

Vitamin A 27% Vitamin C 10%

Calcium 2% Iron 5%

7 – Buttermilk Biscuit

Nutrition Facts

Serving Size 1 biscuit (2.2 oz) Servings Per Container 5

Amount Per Serving Calories 200 Calories from Fat 90

% Daily Value*

Total Fat 8g 12%

Saturated Fat 3g 15% Trans Fat 3g

Cholesterol 0mg	0%
Sodium 570mg	24%
Total Carbohydrate 23g	8%
Dietary Fiber 1g	0%

Lower

Sugars 3g

sodium

Protein 4g

choice ___

Vitamin A 0% Vitamin C 0%

Calcium 4% Iron 8%

6 – Canned Peas

Nutrition Facts

Serving Size 1/2 cup (85g) Servings Per Container 3

Amount Per Serving Calories 60 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 215mg	9%
Total Carbohydrate 12g	4%
Dietary Fiber 3g	12%

Sugars 4g

Protein 4g

Vitamin A 6% Vitamin C 10%

Calcium 2% Iron 8%

8 – English Muffin

Nutrition Facts

Serving Size 1 muffin (57g) Servings Per Container 6

Amount Per Serving Calories 120 Calories from Fat 10

% Daily Value*

Total Fat 1g 2%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 290mg	12%
Total Carbohydrate 25g	8%
Dietary Fiber 1g	4%

Sugars 4g

Protein 4g

Vitamin A 0% Vitamin C 0%

Calcium 15% Iron 8%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

SESSION

Darnell’s Food Choices

9 – Mixed Nuts

Nutrition Facts

Serving Size 30 pieces (28g) Servings Per Container 12

Amount Per Serving Calories 170 Calories from Fat 140

% Daily Value*

Total Fat 16g 25%

Saturated Fat 3g 15% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 120mg	5%
Total Carbohydrate 6g	2%

Lower

Dietary Fiber 3g 12%

sodium

Sugars 1g

choice

Protein 4g

___

Vitamin A 0% Vitamin C 0%

Calcium 4% Iron 4%

10 – Unsalted, Dry-Roasted Mixed Nuts

Nutrition Facts

Serving Size 30 pieces (28g) Servings Per Container 12

Amount Per Serving Calories 170 Calories from Fat 140

% Daily Value*

Total Fat 16g 25%

Saturated Fat 3g 15% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 0mg	0%
Total Carbohydrate 6g	2%
Dietary Fiber 3g	12%

Sugars 1g

Protein 4g

Vitamin A 0% Vitamin C 0%

Calcium 4% Iron 4%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

Sodium in Foods

Choose MORE Often

Foods LOWER in Sodium

• Chicken and turkey

(with skin removed)

• Fresh fish or rinsed

canned fish such as tuna* or sardines

• Canned foods packed in water

• Low-sodium or reduced-

sodium cheeses

• Low-salt or salt-free chips, nuts,

and pretzels

• Plain rice, noodles, or pasta

• Homemade, low-sodium, or reduced-

sodium soups

• Fresh, frozen, “no-salt-

added,” or rinsed canned vegetables

• Spices, herbs, and

flavorings such as cilantro, parsley, garlic powder, onion powder, vinegar, and chili powder

Choose LESS Often

Foods HIGHER in Sodium

• Smoked and cured meats such as

bacon, ham, sausage, hotdogs, bologna, fatback, ham hocks, scrapple, and liver pudding

• Canned fish* such as tuna and

sardines (that are not rinsed) and salted/dried codfish†

• Frozen TV dinners

†

• Canned foods packed in broth or salt

• Most cheeses

• Salty chips, crackers,

nuts, popcorn, and pretzels

• Quick-cooking rice and

boxes of mixed rice, potatoes, noodles, or macaroni and cheese

• Regular canned and instant soups

• Regular canned vegetables, pickles,

†

olives, and pickled vegetables

• Condiments and seasonings such

as soy sauce, ketchup, garlic salt, seasoning salt, bouillon cubes, meat tenderizer, monosodium glutamate (MSG), and commercial Cajun or seafood seasonings

Pregnant and nursing moms: Talk to your health care provider to find out the types of fish you can eat that are lower in mercury. † Rinse canned foods to reduce the sodium.

Keep Your Heart in Mind: Eat Less Salt and Sodium

Do you know your blood pressure numbers?

• A normal blood pressure is below 120/80 mmHg. • If your blood pressure is between 120/80 and 139/89 mmHg, you have

prehypertension. This means that you don’t have high blood pressure yet, but you’re likely to develop it if you don’t change your health habits.

• If your blood pressure is 140/90 mmHg or higher, you have high blood pressure. High

blood pressure does not go away by itself. Ask your doctor for help in lowering it.

• Ask your doctor what your blood pressure number is. Keep track of each reading on

your wallet card.

Write down your blood pressure reading here:

______/_____

Spice it up!

Discover how much flavor you can add by using spices and herbs.

Ms. Diane has learned that it’s To make food taste good

without salt, I use cilantro,

not hard to get your family to

cumin, fresh garlic, parsley, onion, green pepper,

eat less salt and sodium.

oregano, and even a dash of hot pepper

To break your family’s habit when I cook. Everyone

in my family got used

of using the salt shaker at to the taste of foods

with less salt.

the table, try Ms. Diane’s secret recipe!

Look for other salt-free seasonings in the grocery store. Fill the salt shaker 2 tablespoons black pepper

with these herbs 1 tablespoon cayenne pepper and spices, and use 1 tablespoon paprika it instead of salt to 1 tablespoon onion powder

1 tablespoon garlic powder

flavor foods.

1 bay leaf, ground

116 HANDOuT—SESSION 4

(continued)

Take the lead and try these simple changes:

When Shopping

1. Buy fresh, frozen, or no-salt-

added canned vegetables. Choose food packed in water instead of broth or salt.

2. Buy fresh garlic

or garlic powder instead of garlic salt.

3. Choose foods labeled “low

sodium,” “sodium free,” or “no salt added.”

When Cooking

1. Slowly cut back on the amount

of salt added when cooking until you don’t use any.

Add no salt to the water when

2.

cooking beans, rice, pasta, and vegetables.

Cut back on meats high in

3.

sodium, such as bologna, ham, hotdogs, and sausage.

Rinse all canned products to

4.

reduce the amount of sodium.

When Eating

1. Fill the salt shaker

with a mixture of herbs and spices.

2. Slowly cut back on

the amount of salt added at the table until you don’t use any.

3. Choose fruits and vegetables

instead of salty snacks like chips, fries, and pork rinds.

Darnell has learned to control his high blood pressure. He takes his blood pressure pills with breakfast every morning to make sure that he doesn’t forget to take them. He walks daily, has stopped smoking, and has found that food can still taste good with less salt and sodium.

Make your personal pledge to do what Darnell has done! Look at these examples:

Breakfast

Cook oatmeal with fat-free or low-fat (1%) milk, raisins, cinnamon, and no salt.

Lunch

Use leftover roasted chicken to make a sandwich instead of using luncheon meats.

Dinner

Make your own soup with vegetables and half the usual amount of salt.

Snack

Eat an orange instead of salty chips.

Write the changes you will try to make this week:

Your health and your family’s health are priceless. Make an investment!

HANDO

Tips for Taking Medicine for High Blood Pressure

Make sure you take medicine as your doctor tells you, not only on the days when you do not feel well.
Tell the doctor the names of all other medicines, home remedies, herbs, or supplements you take. Bring everything with you when you have a doctor’s appointment.
Tell the doctor right away if the medicine makes you feel strange or sick. Ask the doctor about changing the dosage or switching to another type of medicine.
Refill your presciption before you run out of medicine.
Have your blood pressure checked often to see if the medicine is working for you.
Don’t stop taking your medicine if your blood pressure is okay. That means the medicine is working.

Questions to ask the doctor

When the doctor gives you medicine for high blood pressure, ask:

Name of medicine(s): _______________________________________________

Amount of medicine to take: _________________________________________

When to take it: ____________________________________________________

What to eat or drink with it: __________________________________________

If your other medicines can be taken safely at the same time: _______________

_________________________________

If problems occur, call this number immediately: _________________________

118 HANDOuT—SESSION 4

Use Herbs and Spices Instead of Salt

Allspice: Use in meats, fish, poultry, soups, stews, and desserts. Basil: Use in soups, salads, vegetables, fish, and meats. Cayenne Pepper: Use in meats, poultry, stews, and sauces. Celery Seed: Use in fish, salads, dressings, and vegetables. Chili Powder: Use in meats, poultry, and stews. Cilantro: Use in meats, sauces, stews, and rice. Cinnamon: Use in salads, vegetables, breads, and snacks. Clove: Use in soups, salads, and vegetables. Cumin: Use in meats and poultry. Curry Powder: Use in meats, shellfish, and vegetables. Dill Weed and Dill Seed: Use in fish, soups, salads, and vegetables. Garlic Powder: Use in meats, poultry, fish, vegetables, salads, soups,

and stews.

Ginger: Use in soups, salads, vegetables, and meats. Marjoram: Use in soups, salads, vegetables, beef, fish, and chicken. Nutmeg: Use in vegetables and meats. Onion Powder: Use in meats, poultry, soups, and salads. Oregano: Use in soups, salads, vegetables, meats, and chicken. Paprika: Use in meats, fish, poultry, and vegetables. Parsley: Use in salads, vegetables, fish, and meats. Rosemary: Use in salads, vegetables, fish, and meats. Sage: Use in soups, salads, vegetables, meats, and chicken.

Thyme: Use in salads, vegetables, fish, and chicken.

Note: To start, use small amounts of these herbs and spices to see if you like them.

HANDOuT—SESSION 4 119

Soul Food Makeover—Vegetable Stew Recipe

3 cups water (You can add your other favorite 1 cube vegetable bouillon, vegetables such as broccoli, cauliflower, low sodium or string beans.)

2 cups white potatoes cut in 1. Heat water and bouillon in a large pot, 2-inch strips and bring to a boil. 2 cups carrots, sliced

Add potatoes and carrots to the broth,

4 cups summer squash, cut in and simmer for 5 minutes. 1-inch squares

Cut the corn off the cob.

1 cup summer squash, cut in four chunks 4. Add the remaining ingredients, except for 2 ears fresh corn (1½ cups) the tomatoes, and continue cooking for

15 minutes over medium heat.

1 teaspoon thyme, ground 2 cloves garlic, minced 5. Remove the four chunks of squash, and

puree in a blender.

1 stalk scallion, chopped

½ small 1 cup 1 cup

hot red pepper, chopped onion, coarsely chopped tomatoes, diced

6. Return pureed mixture to pot, and let cook for 10 minutes more. 7. Add tomatoes, and cook for another

5 minutes.

Remove from heat, and let sit for 10 minutes to allow stew to thicken.

Make It a Meal. Makes 8 servings

Serving size: 1¼ cups

To make this dish a meal, serve it with a green salad that includes

Calories: 100

lettuce (romaine or spinach), cucumber, and other fresh vegetables. Use

Fat: 1 g

a light dressing, such as a vinaigrette, or a low-fat or fat-free dressing. Also serve with whole-grain bread or rolls. Saturated fat: 0 g

Cholesterol: 0 mg Sodium: 37 mg

The Makeover

Total Fiber: 5 g

In the past, the Harris family added cured and smoked meats—which have high amounts of sodium—to this recipe. This heart healthy vegetable stew doesn’t use cured or smoked meats. Instead, this recipe

Protein: 3 g Carbohydrates: 23 g Potassium: 607 mg

is low in sodium and uses plenty of herbs and spices to give this dish plenty of flavor! This recipe includes several vegetables, which will help you to meet the daily recommendation for vegetables. Try this stew for a great-tasting, low-sodium meal.

120 HANDOuT—SESSION 4

It is the mind that

“

makes the body.

”

Sojourner Truth

Session 5

Be Heart Smart:

Session 5

Keep Your Cholesterol in Check

sess i o n

Be Heart Smart: Keep Your Cholesterol in Check

Objectives

By the end of this session, group members will:

Know what cholesterol is and how it affects the body.
Know what healthy cholesterol levels are.
Learn the steps they can take to lower their blood cholesterol levels.

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Blackboard and chalk or several large pieces of paper, markers, and tape
How To Make an Artery Model (page 135–136)
How To Explain the Artery Model (page 137)
One empty paper towel roll
Scissors
Red construction paper and tape or red felt with sticky backing
Red and yellow modeling clay

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 121

Six paper plates
Set of measuring spoons
Can of shortening or lard
Bottle of vegetable oil*
Choice of three of the following foods:*

• Cooked beans

• Beef hotdog

• Orange

• Regular mayonnaise

• American cheese

• Fried chicken (wing and thigh)

• Snack cakes (packaged cupcakes)

Handouts

Give group members these handouts during this session:

List of places where group members can get their cholesterol levels checked†
“Take Action To Control Your Cholesterol” (pages 155–156)
(Optional) “Make Your Health a Regular Appointment: A Role Play at Ms. Faye’s Hair Salon” (page 157)
“Fats and Oils To Choose” (page 158)

_______________________

You can use pictures of these foods. †Prepare this list before the session. You may find information at your local health department,

hospital, or clinic.

122 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

“Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol” (page 159)
“Pam’s Breakfast Choices” (pages 160–162)
“Guess the Fat Activity” (page 163)
“Cooking With Less Saturated Fat” (pages 164–166)
“Recipe Substitutes” (page 167)
“Soul Food Makeover—Chicken Gumbo Recipe” (pages 168)

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

Facts About Blood Cholesterol
Cholesterol and Heart Disease
What Are Your Numbers?

A. What Are Triglycerides?

B. Metabolic Syndrome and Your Health

Healthy Arteries Activity
(Optional) Make Your Health a Regular Appointment: A Role Play at Ms. Faye’s Hair Salon

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 123

Facts About Saturated Fat, Trans Fat, and Cholesterol
Food Label Activity––Fats
Guess the Fat Activity
Cooking With Less Saturated Fat Activity
Making Your Favorite Family Recipes With Your Heart in Mind— Recipe Substitutions
Soul Food Makeover—Chicken Gumbo Recipe

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

Last week, we talked about salt and sodium.

Ask the questions below, and give the correct answers if group members do not.

Q: Who remembers why you should try to limit the amount of salt and sodium in your diet?

124 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

A: You should cut back on salt and sodium to help prevent or lower high blood pressure.

To cut back on salt and sodium, you can:

• Check the food label to choose foods lower in sodium.

• Use herbs and spices instead of salt to season foods.

• Eat more fruits, vegetables, and fat-free or low-fat milk products for

snacks. People who have trouble digesting lactose found in milk products can eat or drink lactose-free products, such as low-fat soy milk.

• Choose low-sodium or unsalted nuts, pretzels, and popcorn.

At the end of our last session, you made a pledge to choose foods lower in salt and sodium. Share with the group what you did. What problems did you have? How did you solve them?

Note: Allow 5 minutes for group members to respond.

Ask:

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

Ask:

Do any of you want to share what you have learned about your family health history?

Note: Allow 5 minutes for group members to respond.

3. About This Session

Sojourner Truth said, “It is the mind that makes the body.”

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 125

Ask:

What does this quote mean to you?

Note: Allow 5 minutes for group members to respond.

Today we are going to talk about high blood cholesterol as a risk factor for heart disease. You will learn what you can do to keep your blood cholesterol levels low. We will also do some group activities that show how much saturated fat is in some foods and how to cook with less saturated fat. We will also learn how to keep trans fat and cholesterol intake low.

Conducting the Session

1. Facts About Blood Cholesterol

If a person’s blood cholesterol level is too high, he or she is more likely to get heart disease. Here are some facts about blood cholesterol:

• Nearly half of African American women and more than one in three African

American men have a blood cholesterol level that is too high.

• African American adults are less likely than white adults to have their blood

cholesterol checked.

2. Cholesterol and Heart Disease

Note: This section explains what cholesterol is, why the body needs cholesterol, how much cholesterol the body needs, and where cholesterol comes from.

Cholesterol is a soft, waxy, fat-like substance found in the body. Your body uses cholesterol to produce hormones and some vitamins.

126 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Show picture card 5.1.

Cholesterol comes from two sources:

Your liver makes all the cholesterol your body needs to keep you healthy. When cholesterol is produced, it goes into the bloodstream. The cholesterol that travels in your bloodstream is called blood cholesterol.
Cholesterol also comes from the food you eat. Foods that come from animals have cholesterol. The cholesterol from foods you eat is called dietary cholesterol. Other types of fat in foods that raise cholesterol are saturated fat and trans fat. Today we will learn how to lower your intake of these fats.

When too much cholesterol is in the blood, it leads to increased risk of a heart attack, stroke, and other health problems.

Ask:

Do any of you know someone who has high blood cholesterol?

Note: Allow about 2 minutes for group members to respond.

Several things affect your blood cholesterol level. You cannot change some of these things, such as your age, gender, or family history (having family members with high blood cholesterol). But you can change the types of food you eat, the amount of physical activity you do, and your weight.

You can help prevent or lower high blood cholesterol by:

• Eating a heart healthy diet low in saturated fat, trans fat, and cholesterol

• Being active every day

• Maintaining a healthy weight

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 127

Show picture card 5.2.

Let’s look at how cholesterol travels through the blood.

Cholesterol travels through the bloodstream in the form of packages called “lipoproteins.” These packages are made of fat and protein.

Low-density lipoproteins, or LDL, carry the cholesterol to your blood vessels, clogging them like rust in a pipe. This is why LDL cholesterol is often called the “bad” cholesterol.

Cholesterol also travels in the blood in high-density lipoproteins, or HDL. HDL helps to remove cholesterol from your body. This is why HDL cholesterol is often called the “good” cholesterol. Picture it this way:

• The LDL person in the car (bad blood cholesterol) throws fat and cholesterol

into the street (blood vessels).

• The HDL person (good blood cholesterol) cleans up fat and cholesterol

deposited by the LDL and puts it in the trash (liver).

• Just remember the “L” in LDL for Lousy, and the Lower it is, the better.

Remember the “H” in HDL for Healthy, and the Higher it is, the better.

3. What Are Your Numbers?

Show picture card 5.3.
Ask:

How do you find out if you have high blood cholesterol levels or too much fat in your blood?

Your blood cholesterol levels are measured with a blood test. The test can be done at a doctor’s office or at a cholesterol screening (for example, at a health fair).

128 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• A lipid profile is the blood test done at the doctor’s office. It is a complete

test to measure the levels of each type of fat in the blood. It measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. (We will talk about triglycerides later.) You have to fast for 12 hours before this test. This test is recommended for adults age 20 or older.

• Screening sites may do only total cholesterol and sometimes HDL cholesterol.

If you are an adult age 20 or older, you may need to follow up with the doctor for a complete lipid profile.

Ask:

Have you ever had your blood cholesterol checked? If you have, do you remember your levels?

Note: Allow a moment for group members to respond.

Give group members the “Take Action To Control Your Cholesterol” handout (pages 155–156). Review the cholesterol levels.

Note: If participants should ask, explain that cholesterol is measured in milligrams per deciliter (mg/dL).

Show picture card 5.4.

Here are what the total cholesterol numbers mean:

Less than 200 mg/dL Desirable—Keep up the good work.

200 –239 mg/dL Borderline high

Depending on your other risk factors, you may be at a higher risk for heart disease.
It is time to change your eating habits, increase your physical activity, and lose weight if you are overweight.

240 or more mg/dL High

You are at a higher risk for clogged arteries and a heart attack.
Ask your doctor what your risk is for heart disease.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 129

Here is what your LDL and HDL cholesterol numbers mean:

LDL (bad) cholesterol: Keep it low!

Less than 100 mg/dL	Desirable
100–129 mg/dL	Near desirable
130–159 mg/dL	Borderline high
160 or more mg/dL	High

HDL (good) cholesterol: The higher the better!

Keep it above 40 mg/dL.

More Information

Heart Disease Risk and Your LDL Level

The goal for the LDL (bad cholesterol) level is different for everyone. It depends on the risk factors you have. The number of risk factors—such as high blood pressure, low HDL, family history of heart disease, age, gender, and smoking—affects your LDL goal. The higher your LDL level and the more risk factors you have, the greater your chances of developing heart disease or having a heart attack. Your doctor can help you set a goal for your LDL level.

130 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

A. What Are Triglycerides?

Have any of you heard of triglycerides?

Note: Allow 2 minutes for group members to respond.

Triglycerides are another type of fat in the blood. When you eat too many calories, drink alcohol, or smoke, your body makes more triglycerides. When your triglycerides are high, it puts you at increased risk for heart disease.

A healthy triglyceride level is less than 150 mg/dL.

People with high triglycerides often have low HDL cholesterol (good cholesterol). People with diabetes can also have high triglycerides and low HDL cholesterol.

To have a healthy triglyceride level:

• Maintain a healthy weight or lose weight if you are overweight.

• Be physically active on all or most days of the week.

• Eat a heart healthy diet that is low in saturated fat, trans fat, and cholesterol.

• Limit candy, sweets, regular soda, juice, and other drinks high in sugar.

• Avoid smoking cigarettes and drinking alcohol. Smoking raises triglycerides

and lowers HDL cholesterol. Excess alcohol also raises triglycerides.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 131

More Information

Here is what your triglyceride number (mg/dL) means:

Less than 150 mg/dL Normal

150–199 mg/dL Borderline high You may be at an increased risk for heart disease. To lower your level, aim for a healthy weight and be more physically active.

200–499 mg/dL High Weight control and physical activity are very important to lower your level. Watch out for other heart disease risk factors such as overweight and obesity, diabetes, low HDL, and high blood pressure.

500 or more mg/dL Very high See your doctor immediately! This level requires attention to prevent severe problems with your pancreas.

Ask:

Do you know what your triglyceride level is?

Note: Allow a few minutes for group members to respond.

Encourage group members to make an appointment to have their cholesterol and triglycerides checked.

• Tell them to be sure to ask for their results and to write the results on their

wallet cards.

• Give group members a list of clinics and hospitals where they can get low-

cost or free blood cholesterol testing.

132 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

B. Metabolic Syndrome and Your Health

• Now, we’re going to learn about metabolic syndrome. Metabolic syndrome is

a disorder that is made up of a group of five factors that affect heart health.

• Many people have this health problem and don’t know they have it.

• About one in five African American women has metabolic syndrome.

• About one in seven African American men has metabolic syndrome.

Let’s name the five factors that make up metabolic syndrome. Hold up your fist and raise one finger for each risk factor you have.

Show picture card 5.5.

The five risk factors that make up metabolic syndrome are:

A high waist measurement:

Greater than 35 inches for women
Greater than 40 inches for men

A triglyceride level of 150 mg/dL or more
A low HDL (good) cholesterol level:

Less than 50 mg/dL for women
Less than 40 mg/dL for men

A blood pressure of 130/85* mmHg or more (either number that is high counts as a risk)
Higher than normal fasting blood glucose levels (100 mg/dL or more)

The blood pressure level considered a risk factor for metabolic syndrome is 130/85 (mmHg). This level is different than the level that defines high blood pressure, which is 140/90 (mmHg).

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 133

Ask:

How many fingers (factors) do you have raised?

• If you have at least three of these risk factors, you have metabolic syndrome.

• Metabolic syndrome raises your chances of developing heart disease,

diabetes, or stroke.

• People with metabolic syndrome should lose weight and become

physically active.

If you think you have metabolic syndrome, talk to your doctor.

4. Healthy Arteries Activity

Note: This section uses the picture cards and an artery model to show how cholesterol can collect on the walls of the arteries and slow down and block the flow of blood. Blocked arteries can cause a heart attack or stroke.

Show picture card 5.6.

Blood flows freely to all cells of the body when arteries are normal and healthy.

When your LDL cholesterol is too high, cholesterol may become trapped in the walls of the arteries, causing them to harden. The opening of the arteries can become clogged and narrowed.

Show the artery model.

Note: See the next two pages to help you explain the artery model.

134 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Pass the artery model around so that group members can look at it closely.
Ask:

Have you ever seen someone fry food with lard and dump the hot lard down the sink?

Allow a moment for group members to respond. Then ask them why they should not do this.

You should not do this because the lard will clog the pipes. Foods high in saturated and trans fat will clog your pipes (arteries). So we want to treat our bodies just as well as we treat our pipes.

How To Make an Artery Model

What you will need:

one empty paper towel roll scissors red construction paper and tape or red felt with sticky backing

red modeling clay yellow modeling clay

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 135

How To Make an Artery Model

What you need to do:

Cut construction paper or felt to fit around the outside of the roll.
Tape construction paper or stick felt around the outside of the roll.
Roll out thin pieces of yellow and red clay into doughnut-shaped figures.

(continued)

Make one small round ball of the red clay.

With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

How To Explain the Artery Model

Place the doughnut-shaped pieces of red clay on the outside edge of both ends of the roll.

Say:

This is a healthy artery. The blood can flow through the opening easily.

Add pieces of the yellow clay to the inside edge of the red clay on one end of the roll.

Say:

This is the beginning of a clogged artery. Cholesterol is starting to build up.

Continue to add pieces of yellow clay to this end of the roll. Add pieces until you almost fill in the opening completely.

Say:

The opening of the clogged artery is getting smaller. Blood cannot flow through easily.

Put a red ball in the small opening that is left at the end of the roll.

Say:

When the inside of an artery becomes narrowed, a blood clot may block an artery going to the heart. This may cause a heart attack. If the blood clot blocks an artery going to the brain, it may cause a stroke, or “brain attack.” Other problems caused by narrowed arteries are angina (chest pain) and poor blood circulation.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 137

5. (Optional) Make Your Health a Regular Appointment: A Role Play at Ms. Faye’s Hair Salon

Note: Ask for two volunteers to be the actors in the role play. Give these two group members the “Make Your Health a Regular Appointment: A Role Play at Ms. Faye’s Hair Salon” handout (pages 157). As the trainer, you can read the introduction.

Ask:

• What are some of the lessons you learned from this role play?

• Is there any part of the role play that you can use in your own life?

Note: Allow 5 minutes for group members to respond.

6. Facts About Saturated Fat, Trans Fat, and Cholesterol

Today, we will talk about the different types of fat and how they affect heart health.

• There are two main types of fat—saturated fat and unsaturated fat. Most

foods contain some of both types. The total fat found in food is its saturated fat plus its unsaturated fat.

• Saturated fat is found in foods that come from animals, such as high-fat meat,

cheese, milk, and butter.

• A type of unsaturated fat called trans fat also raises cholesterol. Trans fat is

found in a variety of baked goods (such as cookies, pies, and pastries), fried foods, stick margarine, and vegetable shortening. Choose light margarine (soft tub) instead of stick (hard) margarine and look for trans fat-free spreads.

• Eating too much saturated fat and trans fat will raise your blood cholesterol

level more than anything else you eat. This will increase your chances of developing heart disease.

138 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

It’s important to limit the amount of saturated fat and trans fat you eat, but you need some dietary fat to be healthy. Fats are necessary because they are used by the body to:

• Store and provide energy.

• Help carry vitamins A, D, E, and K throughout the body.

Ask:

What types of fat do you use to cook your food?

Note: Allow 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Show group members a stick of butter (or a can of lard).

• Butter, shortening, and lard are examples of foods high in saturated fat.

• Saturated fat is usually solid at room temperature.

• Saturated fat is usually found in foods from animals.

Show picture card 5.7.

Here are some foods that are high in saturated fat:

• Whole milk and products made • Beef or pork hotdogs

from whole milk (regular cheeses,

• Foods fried in grease or

sour cream, evaporated whole milk) lard (such as chicken, fish,

• Ice cream and whipped cream shrimp, and french fries)

• Fatty cuts of meat, such as chuck steak, • Butter

regular ground beef, ribs, pork chops,

• Shortening

bacon, pork sausage, beef oxtail, Polish sausage (kielbasa), and liverwurst

• Lard

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 139

• Skin of chicken, turkey, and pig

• Smothered meat and poultry dishes,

such as smothered chicken or pork chops, made with animal fat or grease gravies

• Chitterlings, which are also

called chitlins (pork intestines); pickled pig’s feet; and hog maws (hog stomach)

Show picture card 5.8.

• Oils such as coconut, palm,

and palm kernel

• Doughnuts, pastries, cakes,

and cookies

• Cornbread, hushpuppies,

spoonbread, biscuits, and other breads made with lard, butter, or shortening

lower in saturated fat:

• Lean meats such as loin, round, and

extra lean ground beef

• Fish and seafood

• Turkey bacon

• Poultry without the skin

• Beans

• Rice

• Tub margarine

• Fat-free and low-fat milk,

cheese, yogurt, and evaporated milk (or lactose-free products for people who have trouble digesting lactose found in milk products)

• Vegetable oil

• Breads (made without butter

or lard)

• Fruits and vegetables

You want to limit the amount of saturated fat in your diet.

group members a bottle of vegetable oil.

Unsaturated fats are usually liquid at room temperature. As mentioned before, a few oils (coconut, palm, and palm kernel) are high in saturated fat.

With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

(Optional) Say:

The types of unsaturated fats are polyunsaturated and monounsaturated.

More Information

Polyunsaturated fat is found in:

Vegetable oils
Safflower oil
Corn oil
Sunflower oil
Soybean oil
Some types of fish

Monounsaturated fat is found in:

Vegetable oils
Canola oil
Olive oil
Peanut oil
Avocados
Nuts
Give group members the “Fats and Oils To Choose” handout (page 158).

The graph will quickly show you which products have the least amount of saturated fat.

Ask:

What three oils have the least amount of saturated fat?

Canola, safflower, and sunflower oils have the least amount of saturated fat.

Although polyunsaturated and monounsaturated fats are better for our health than saturated fat, we need to eat less of all types of fat. Fats are high in calories, and all fats have the same number of calories. Cutting back on calories helps us lose weight. We will talk about this at the next session.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 141

Show picture card 5.9.

Foods high in cholesterol also can raise your blood cholesterol and increase your risk of heart disease. Dietary cholesterol is found only in foods that come from animals.

Foods that are highest in cholesterol are:

• Egg yolks

• Organ meats, such as liver, gizzards, and chitterlings (chitlins)

• Pig’s feet

• Whole milk products including butter, cream, ice cream, and cheese

• Shrimp

Show picture card 5.10.

Foods that come from plants do not contain cholesterol. Foods that do not contain cholesterol include:

• Fruits, such as bananas, pineapple, mangos, and apples

• Vegetables, such as tomatoes, green peppers, lettuce, and corn

• Beans of all varieties

• Rice, such as brown rice

• Grains, such as those in corn tortillas and whole-grain bread

• Cereals, such as oatmeal

Plant foods that are prepared with an animal product (for example, greens cooked with fatback or bacon grease) have cholesterol.

142 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Plant foods are generally lower in saturated fat and don’t have cholesterol. They also contain a type of dietary fiber (soluble) that is beneficial for lowering cholesterol.

Show picture card 5.11.

Soluble fiber is found in foods such as oats, barley, fruits, vegetables, and cooked dry beans and peas. So this gives you one more reason to eat a variety of fruits and vegetables in addition to some whole-grain cereals such as oatmeal and oat bran.

Fruits and vegetables that are a good source of soluble fiber are citrus fruits (oranges and grapefruits), pears, apples, peaches, bananas, brussels sprouts, green beans, broccoli, cauliflower, peas, baked or sweet potatoes (with skin), corn, okra, cabbage, spinach, collard and mustard greens, and carrots.

For great sources of soluble fiber, try to include a variety of cooked dry beans. Avoid canned beans that contain high amounts of salt and sodium. Prepare beans at home, flavoring them with celery, garlic, and spices instead of salt.

7. Food Label Activity––Fats

Give group members the “Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol” handout (page 159) and the “Pam’s Breakfast Choices” handout (pages 160–162).
Point out on the food label where to find saturated fat, trans fat, and cholesterol.
Show picture card 5.12.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 143

For a healthier heart, use the Nutrition Facts labels to choose the foods with a lower Percent Daily Value for saturated fat and cholesterol. If you have high cholesterol, you may need to aim for a lower amount of saturated fat and cholesterol. Try to keep trans fat as low as possible. A doctor or registered dietitian can help you with this.

Show group members where the Percent Daily Value for saturated fat, trans fat, and cholesterol is found on the food label for whole milk.

Look at the bottom of the “Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol” handout. Look at the Percent Daily Value for whole milk and fat-free milk. Which is lower in saturated fat?

Fat-free milk is lower in saturated fat. One cup of fat-free milk has no saturated fat. One cup of whole milk has 25 percent, or one-fourth, of the Percent Daily Value of saturated fat.

Note: If group members should ask, explain that people who have trouble digesting milk products may use lactose-free products (such as soy milk). Although some of these alternatives may be lower in fat, they may not provide all of the other nutrients found in milk products. Recommend that they use calcium-fortified, lactose-free products.

Trans fat is now listed on all food labels. It is listed on a line below saturated fat, as seen here. Compare labels to choose the food lowest in saturated fat, trans fat, and cholesterol.

Now look at “Pam’s Breakfast Choices.” We are going to use the food label to practice choosing foods that are lower in fat. First, I’m going to tell you about a problem for many busy people. Then, we will use food labels to find some solutions.

144 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Pam’s Problem

Pam has little time in the morning to prepare breakfast. She often has a honey bun or a doughnut. Look at the food labels. Help Pam select some breakfast foods that are lower in saturated fat than her usual choices. Which should she choose? It is important to also compare labels for trans fat and cholesterol amounts.

Note: The correct answer is underlined.

• A honey bun or a plain bagel?

• A jelly doughnut or an english muffin?

• A banana muffin or a banana?

• Toast with butter or toast with light, soft tub margarine?

• Canadian bacon or pork sausage links?

• Low-fat American cheese or regular American cheese?

Ask for a volunteer to describe:

• What he or she usually eats for breakfast

• Which foods are higher in fat

• What lower fat foods can be chosen to replace them

Note: Write the answers on the blackboard or on a large piece of paper taped to the wall. Help the volunteer select some substitutes, if needed.

8. Guess the Fat Activity

Before the session

Buy a can of shortening or a stick of margarine. Also buy paper plates and three foods from this list (or use pictures of the foods).

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 145

• 2 ounces American cheese (about the • 1 beef hotdog

size of a 9-volt battery)

• 1 cup cooked beans • 2 tablespoons regular mayonnaise • 1 orange • 2 pieces of fried chicken (wing and • 2 snack cakes (1 package)

thigh)

Write the name of each food you brought on a separate plate.
Look at the following chart. Find the amount of fat for each food you brought.

Note: You do not have to use all the food in the chart. Choose the foods that are eaten most often in your community.

Foods Teaspoons of Fat (Grams of Fat)

2 ounces American cheese About 5 teaspoons (20 grams)

(about the size of a 9-volt battery)

2 tablespoons of regular mayonnaise About 21/2 teaspoons (10 grams)

(about the size of a ping-pong ball)

2 pieces of fried chicken (wing and thigh)	About 81/2 teaspoons (34 grams)
1 beef hotdog (1½ ounces)	About 4 teaspoons (16 grams)
1 cup of cooked beans	About 1/4 teaspoons (1 grams)
1 orange	None
2 snack cakes (1 package)	About 41/4 teaspoon (18 grams)

Using the can of shortening, spoon the amount of fat listed in the chart onto the plate labeled for that food.
Take the remaining plates, and place each food item (or a picture of food) on the separate plates.
Put all the plates away until you are ready to do the activity.

146 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Group Activity

We are going to play a guessing game that will help you learn about the total fat content of several foods. Learning which foods are higher in fat and how to replace them with foods that contain less fat will help you make healthier choices. Decreasing your total fat intake can help you reduce your saturated fat, trans fat, and calorie intake.

Give group members the “Guess the Fat Activity” handout (page 163).
Show group members the plates of foods (or pictures of food) you prepared ahead of time.

Guess the number of teaspoons of fat that are found in one serving of each of these foods. Write your guess on the “Guess the Fat Activity” handout.

Ask group members to tell you the amount of fat they guessed for the first food item. After group members have shared the amount they guessed, tell them the actual number of teaspoons of fat the food contains. Tell them to write this amount on their handout, too. Bring out the plate of fat you made ahead of time for that food to show them how much it is. Then do this for the other foods.

As you can see, it is easy to go over the limit for fat when we eat foods higher in fat, such as fried foods, some fast foods, hotdogs, chips, and ice cream. Eating foods lower in total fat will also help you reduce your saturated fat, trans fat, and cholesterol intake. To make it easier to cut back on fat, eat more foods that are lower in fat, such as fruits, vegetables, rice, whole-grain cereals and breads, beans, and fat-free or low-fat milk products. People who have trouble digesting lactose found in milk products should eat lactose-free products.

Ask:

How do you feel about the true amount of fat in the foods you guessed?

Note: Allow 3 to 5 minutes for group members to talk about their reactions.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 147

There are lower-fat substitutes for some of the higher fat foods we often eat.

Review the following list.

Foods

Regular Cheese

Whole milk

Regular sour cream

Pork rinds

Beef hotdog

Lower-Fat Substitutions

Fat-free or low-fat cheese*

Fat-free or low-fat milk*

Fat-free or low-fat sour cream or plain yogurt*

Low-salt crackers

Low-fat hotdog

You can also reduce the amount of fat you eat by simply eating foods higher in fat less often or in smaller amounts.

9. Cooking With Less Saturated Fat Activity

Note: This section gives information to help group members cut back on the amount of saturated fat in their diets. This activity will help them understand that they can cut back on the fat in their diets without giving up their traditional foods.

Ask:

Before we do the next activity, can you tell me what you can do to cook with less saturated fat?

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

The next activity shows how to prepare foods with less saturated fat.

Or lactose-free products

148 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Give group members the “Cooking With Less Saturated Fat” handout (pages 164–166). Review each of the dishes listed. Ask volunteers to read each recipe out loud.
Ask:

Why are the recipes on the handout lower in saturated fat?

Note: Allow a few minutes for group members to respond.

Add the following reasons if they are not mentioned:

• Beans are naturally low in fat, and no fat (lard, shortening, or oil) is added.

• Boiled brown rice is naturally low in fat, and no fat is added.

• The potato salad is made with low-fat or fat-free mayonnaise. A little

mustard is added for great flavor.

• The meats selected are lean and are loin or round cuts. Before cooking, the

poultry skin is removed and all visible fat is trimmed. The meat and poultry dishes are baked, broiled, stewed, roasted, or grilled instead of fried or prepared with fat such as lard or grease.

• The fish and seafood dishes are baked, braised, stewed, or grilled without

using fat such as lard or grease.

• The fat is drained from the cooked ground meats.

• The fruit shake is made with fat-free milk instead of whole milk.

10. Making Your Favorite Family Recipes With Your Heart in Mind—Recipe Substitutions

Many of us have favorite recipes that have been in our families for generations. We don’t have to give up cooking these recipes altogether if we want to be heart healthy.

Give each group member the “Recipe Substitutes” handout (page 167).

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 149

Let’s read the recipe substitutions that provide some heart healthy options for ingredients and measurements common to many recipes.

Ask for a volunteer to read the handout aloud.

Try these substitutions the next time you are preparing one of your favorite dishes.

11. Soul Food Makeover—Chicken Gumbo Recipe

Give group members the “Soul Food Makeover—Chicken Gumbo Recipe” handout (page 168).
Ask:

How has saturated fat been reduced in this recipe?

Note: Allow a moment for group members to respond.

Add the following answers if they are not mentioned:

• The dish is made with chicken without the skin.

• It uses chicken breasts, which are lower in fat than chicken thighs.

Remember that foods lower in fat still contain calories. Check the portion size. If you eat these foods in large quantities, you may gain weight.

Ask if there are any questions. Encourage group members to try this recipe at home this week.

150 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Review of Today’s Key Points

Let’s review what you’ve learned today.

What may cause your arteries to become clogged?

• Cholesterol buildup will clog the arteries.

What is considered a desirable total blood cholesterol level?

• Less than 200 mg/dL

What steps can you take to keep your cholesterol level low?

• Eat foods lower in saturated fat, trans fat, and cholesterol.

• Maintain a healthy weight.

• Stay physically active.

• Eat a variety of whole grains, fruits, and vegetables.

Can you name some foods that are high in saturated fat?

• Fatty meat, including certain types of meat or animal cuts such as fatback,

beef oxtail, and chitterlings (also called chitlins); poultry with skin; whole milk and cheese; butter; lard; and shortening

What are some things that you can do to make foods lower in fat?

• Trim the fat from meat before cooking.

• Take the skin off poultry and throw it away.

• Bake, boil, broil, or grill food instead of frying it.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 151

• Skim the fat off soups before serving.

Can you name some foods that are high in soluble fiber?

• Oats, cooked dry beans, and peas

• Fruits and vegetables such as citrus fruits (oranges and grapefruit), pears,

apples, peaches, bananas, broccoli, baked or sweet potato (with skin), carrots, and collard greens

Weekly Pledge

You have learned a lot today about preventing high blood cholesterol and how to eat less saturated fat, trans fat, and cholesterol. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to keep your blood cholesterol in check. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will take the skin off chicken and throw it away.

• I will bake fish instead of frying it in lard or grease.

• I will try low-fat milk or fat-free, lactose-free products, starting this week.

Note: Allow 5 minutes for group members to think of a pledge.

Write your pledges on the “Take Action To Control Your Cholesterol” handout on page 155–156. Keep this handout in a special place so you can review your pledges and keep your goals in mind.

152 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional) Say:

Keeping a personal value in mind can help you make changes in your everyday life to prevent and control high blood cholesterol. Remember that a personal value is a quality that you consider important.

Today, the value is self-control. Before making lifestyle changes, it helps to prepare mentally to take control of your health. This is stated in today’s quote, “It is the mind that makes the body.” Self-control increases your ability to make healthy choices and to take responsibility for the habits you need to change. Self-control also helps you improve your eating habits. For example, it can help you limit portion sizes and stop yourself from going back for second servings.

Ask:

How could you use self-control, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Remember to continue to work on your pledge to be physically active and to reduce salt and sodium in your diet. Please continue to work on your family health history.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Wait to see if group members have a response.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 153

I am looking forward to seeing you at the next session. The next session will be about maintaining a healthy weight.

Note: Think about today’s session. What worked and what didn’t work? Have you decided to make any changes in your own life based on what was covered in today’s session?

154 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Take Action To Control Your Cholesterol

Do you know your cholesterol numbers?

Get Checked • A lipid profile is a blood test that measures your cholesterol and triglyceride levels. • Adults age 20 and older should have a lipid profile test at the doctor’s office.

Take Action • Eating foods lower in saturated fat, trans fat, and cholesterol can help you reduce your blood cholesterol level, reduce your weight, and prevent heart disease.

Here is what your cholesterol numbers mean:

Total cholesterol

Less than Desirable. Good for you! Keep up the good work! 200 mg/dL

200–239 mg/dL Borderline high. Depending on your other risk factors, you may be at a higher risk for heart disease. It is time to change your eating habits, increase your physical activity, and lose weight if overweight. Ask your doctor what your risk is for heart disease.

240 mg/dL or High. You are at a higher risk for clogged arteries and a heart attack. higher Ask your doctor what your risk is for heart disease.

LDL (lousy, bad) cholesterol: Keep it low!

Less than 100 mg/dL Desirable Write Your Numbers Here

100–129 mg/dL Near desirable

Total: _____________________

130–159 mg/dL Borderline high

LDL: _____________________

160 mg/dL or more High

HDL: _____________________

HDL (healthy, good) cholesterol (mg/dL): Triglycerides: ______________ The higher the better! Keep it above 40.

Triglycerides: Keep your triglycerides below 150 mg/dL.

How I switched my family from whole milk to fat-free milk

Ms. Diane has

I slowly changed the milk my family

learned that it’s

drinks from whole milk to fat-free milk.

The first month I served reduced-fat (2%) milk. During the next month I served low-fat (1%) milk. Finally, I made the switch to fat-free milk. The change

not difficult to get one’s family to eat foods lower in saturated fat, trans was so slow that they couldn’t even

fat, and cholesterol.

taste the difference.

HANDOuT—SESSION 5 155

(continued)

Try some of these simple changes

When Shopping

Buy fat-free or low-fat (1%)

1.

milk and cheese.*

Buy vegetable oil spray. Spray

2.

it on baking pans and skillets instead of using a lot of fat to grease pans.

3. Use the food label to help

you choose foods lower in saturated fat, trans fat, and cholesterol.

When Cooking

Trim the fat from meat, and

1.

remove the skin and fat from chicken and turkey before cooking.

Cook ground meat, drain the

2.

fat, and rinse with hot tap water. This removes half the fat.

3.

Cool soups, and remove the layer of fat that rises to the top.

When Eating

Use fat-free or low-fat

1.

salad dressing, mayonnaise, or sour cream.

Use small amounts of tub

2.

margarine instead of butter.

Choose fruits and vegetables

3.

instead of high-fat foods like chips or fries.

Or lactose-free products

Pam has learned that eating foods high in saturated fat can raise her blood cholesterol level. So she’s modified her favorite cobbler recipe by using soft margarine and fat-free milk. Now the cobbler is lower in saturated fat, trans fat, and cholesterol, and it still tastes great.

Make your personal pledge to do what Pam has done! Look at these examples:

Breakfast

Use fat-free or low-fat milk in coffee and on cereal.

Lunch

Use leftover roasted turkey to make a sandwich. Eat it with some raw carrots and a banana for dessert.

Dinner

Steam fish with allspice, garlic powder, cayenne pepper, lemon, and tomatoes.

Snack

Eat an apple instead of tortilla chips that are high in fat.

Write the changes you will try to make this week:

The health of you and your family is priceless. Make an investment in it!

HANDOuT—SESSION 5

Make Your Health a Regular Appointment

A Role Play at Ms. Faye’s Hair Salon

Ms. Faye is a community health worker and the owner of a hair salon. Ms. Faye talks to Pam, a family friend, while she styles her hair. Pam has an appointment with Ms. Faye every Saturday morning.

Faye: Are you coming to my cholesterol screening next Sunday at the church’s health fair? I’ll be giving a talk about eating foods lower in fat and cholesterol.

Pam: I don’t know if I believe all the fuss about high cholesterol. I think what’s really hurting us is all the chemicals put into foods.

Faye: I had my doubts, too. Then I learned where cholesterol comes from. It comes from our body, the types of foods we eat, and the way we cook food. I also learned that high cholesterol can clog your arteries, and that can cause a heart attack.

Pam: How do you know whether you have high blood cholesterol?

Faye: That’s what Sunday’s screening is about. We do a simple blood test to measure your total blood cholesterol level. When I was screened, I found out that my cholesterol level was too high. That’s when I started making changes in my diet.

Pam: Is that why you switched from your regular sausage, egg, and cheese biscuit to a bagel with low-fat cream cheese and a banana? I was wondering why you stopped asking me to pick up the breakfast special on the way to my appointments with you.

Faye: That’s right. I started eating foods with less fat and cholesterol and being more physically active to keep my weight down. At first, I also had to take medicine prescribed by my doctor. Now I’ve lowered my cholesterol enough that my doctor said I could stop taking the medicine––as long as I keep up the healthy eating and physical activity.

Pam: Okay, Ms. Faye. I’ll get my cholesterol checked, and I’ll even listen to your healthy eating tips.

Faye: Now you can look good on the outside, and be healthy on the inside.

HANDOuT—SESSION 5 157

Fats and Oils To Choose

When you do use fats and oils, choose those with less saturated fat.

Lower in Saturated Fat—

Choose More Often

♥ Canola, corn, olive, safflower,

soybean, and sunflower oils

♥ Tub margarine

(especially light margarine)

Higher in Saturated Fat—

Choose Less Often

Butter
Solid shortening
Lard
Fatback
Stick margarine

Read the Food Label To Choose Foods

Lower in Saturated Fat, Trans Fat, and Cholesterol!

Percent of Saturated Fat

Use this handy graph to help you choose products with the least amount of saturated fat. Look for the ♥.

Adapted from Canola Council of Canada, “Canola Oil Dietary Fat” (www.canola-council.org/PDF/ dietarychart.pdf#zoom=100). July 19, 2007.

158 HANDOuT—SESSION 5

Read the Food Label To Choose Foods Lower in Saturated Fat,

Food labels tell you what you need to know about choosing foods that are lower in saturated fat,

Amount Per Serving The nutrient amounts are for one serving. So, if you have more than one serving, you need to add nutrient amounts. For example, if you drink 2 cups of whole milk, you are drinking two servings. You would need to double the amount of calories, saturated fat, trans fat, and cholesterol.

Nutrients Here are the amounts of saturated fat, trans fat, and cholesterol in one serving. These amounts are given in grams (g) or milligrams (mg).

The Choice Is Yours— Compare!

Which one would you choose?

Except for calories and saturated fat, fat-free milk has all the nutrients of whole milk, including the calcium. That makes fat-free milk a better choice! Read food labels, and choose products to keep your heart strong. Calciumfortified, lactose-free alternatives such as soy milk have lower fat and provide calcium; however, they may not provide the other nutrients found in milk.

whole milk. The label tells you:

Whole Milk

Nutrition Facts Serving Size and

Serving Size 1 cup (8 fl oz) Number of Servings

Servings Per Container 8

The serving size is 8 fluid Amount Per Serving ounces (1 cup). There are

Calories 150 Calories from Fat 70

eight servings in this carton.

% Daily Value*

Total Fat 8g 12%

Percent Daily Value

Saturated Fat 5g 25%

The Percent Daily Value

Trans Fat 0g

helps you compare products.

Cholesterol 35mg 12%

Choose products with

Sodium 125mg 5%

the lowest Percent Daily

Total Carbohydrate 12g 4%

Value for saturated fat and

Dietary Fiber 0g 0%

cholesterol. If you have

Sugars 11g

high blood cholesterol, you

Protein 8g

should eat less saturated fat, Vitamin A 6% Vitamin C 4% trans fat, and cholesterol. A Calcium 30% Iron 0% Vitamin D 25% doctor or registered dietitian can help you with this.

Whole Milk

Calories 150 Calories from Fat 70

% Daily Value* One cup of whole milk Total Fat 8g 12% has 25 percent of the Daily Saturated Fat 5g 25% Value of saturated fat. This Trans Fat 0g is one-fourth of the total Cholesterol 35mg 12% amount of saturated fat that Sodium 125mg 5% you should have in 1 day. This is too much!

Calories 90 Calories from Fat 0

Fat-Free Milk

% Daily Value*

Total Fat 0g 0% One cup of fat-free milk has Saturated Fat 0g 0% no saturated fat. You can Trans Fat 0g learn a lot from a food label.

Cholesterol 5mg 2%

Sodium 125mg 5%

Percent Daily Values are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDO

Pam’s Breakfast Choices

1 – Honey Bun

Pam has little

time in the Nutrition Facts

morning to Serving Size 1 bun (85g)

Servings Per Container 6

prepare breakfast. She often has a Amount Per Serving

Calories 360 Calories from Fat 170

honey bun or

% Daily Value*

a doughnut.

Total Fat 19g 29%

Look at the food Saturated Fat 5g 25% labels. Help Trans Fat 0g

Cholesterol 0mg 0%

Pam select some

Sodium 280mg 12%

breakfast foods

Total Carbohydrate 43g 14%

Lower

that are lower in

Dietary Fiber 1g 4% saturated

saturated fat than

Sugars 18g fat choice

her usual choices.

Protein 4g ______

Which should she Vitamin A 0% Vitamin C 0% choose? Write Calcium 15% Iron 10% the number of your choice for each pair in the

3 – Jelly Doughnut

space between the labels.

Nutrition Facts

Serving Size 1 doughnut (85g) Servings 1

Amount Per Serving Calories 300 Calories from Fat 140

% Daily Value*

Total Fat 16g 24%

Saturated Fat 4g 20% Trans Fat 5g

Cholesterol 5mg	2%
Sodium 130mg	5%
Total Carbohydrate 38g	13%

Lower

Dietary Fiber 0g 0%

saturated

Sugars 22g

fat choice

Protein 3g

___

Vitamin A 0% Vitamin C 2%

Calcium 8% Iron 8%

2 – Plain Bagel

Nutrition Facts

Serving Size 1 bagel (75g) Servings Per Container 6

Amount Per Serving Calories 210 Calories from Fat 5

% Daily Value*

Total Fat 1g 0%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 390mg	16%
Total Carbohydrate 43g	14%
Dietary Fiber 2g	8%

Sugars 2g

Protein 8g

Vitamin A 0% Vitamin C 0%

Calcium 6% Iron 15%

4 – English Muffin

Nutrition Facts

Serving Size 1 muffin (57g) Servings Per Container 6

Amount Per Serving Calories 130 Calories from Fat 10

% Daily Value*

Total Fat 1g 2%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 290mg	12%
Total Carbohydrate 25g	8%
Dietary Fiber 1g	4%

Sugars 4g

Protein 4g

Vitamin A 0% Vitamin C 0%

Calcium 15% Iron 8%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

160 HANDOuT—SESSION

Pam’s Breakfast Choices

5 – Banana Muffin

Nutrition Facts

Serving Size 1 muffin (128g) Servings Per Container 1

Amount Per Serving Calories 420 Calories from Fat 180

% Daily Value*

Total Fat 20g 31%

Saturated Fat 4g 20% Trans Fat 1g

Cholesterol 65mg	22%
Sodium 380mg	16%
Total Carbohydrate 55g	18%

Lower

Dietary Fiber 1g 4%

saturated

Sugars 29g

fat choice

Protein 5g

___

Vitamin A 2% Vitamin C 4%

Calcium 2% Iron 8%

7 – Butter

Nutrition Facts

Serving Size 1 Tbsp (14g) Servings Per Container 32

Amount Per Serving Calories 100 Calories from Fat 100

% Daily Value*

Total Fat 11g 17%

Saturated Fat 8g 40% Trans Fat 0g

Cholesterol 30mg	10%
Sodium 85mg	4%
Total Carbohydrate 0g	0%
Dietary Fiber 0g	0%

Lower

Sugars 0g

saturated

Protein 0g

fat choice ___

Vitamin A 8% Vitamin C 0%

Calcium 0% Iron 0%

6 – Banana

Nutrition Facts

Serving Size 1 medium (126g) Servings 1

Amount Per Serving Calories 110 Calories from Fat 0

% Daily Value*

Total Fat 0.5g 1%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 0mg	0%
Total Carbohydrate 29g	10%
Dietary Fiber 1g	4%

Sugars 21g

Protein 1g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 0%

8 – Light Margarine (Soft Tub)

Nutrition Facts

Serving Size 1 Tbsp (14g) Servings Per Container 80

Amount Per Serving Calories 50 Calories from Fat 50

% Daily Value*

Total Fat 6g 9%

Saturated Fat 1.5g 8% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 55mg	2%
Total Carbohydrate 0g	0%
Dietary Fiber 0g	0%

Sugars 0g

Protein 0g

Vitamin A 10% Vitamin C 0%

Calcium 0% Vitamin E 8% Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

SESSION

Pam’s Breakfast Choices

9 – Canadian Bacon

Nutrition Facts

Serving Size 2 slices (2 oz) Servings Per Container 6

Amount Per Serving Calories 90 Calories from Fat 35

% Daily Value*

Total Fat 4g 6%

Saturated Fat 1g 5% Trans Fat 0g

Cholesterol 30mg	10%
Sodium 800mg	33%
Total Carbohydrate 1g	0%

Lower

Dietary Fiber 0g 0%

saturated

Sugars 0g

fat choice

Protein 12g

___

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 2%

11 – Low-fat American Cheese

Nutrition Facts

Serving Size 1 oz Servings Per Container 8

Amount Per Serving Calories 50 Calories from Fat 15

% Daily Value*

Total Fat 1.5g 2%

Saturated Fat 1g 5% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 220mg	9%
Total Carbohydrate 1g	0%
Dietary Fiber 0g	0%

Lower

Sugars 0g

saturated

Protein 8g

fat choice ___

Vitamin A 4% Vitamin C 0%

Calcium 10% Iron 0%

10 – Pork Sausage Links

Nutrition Facts

Serving Size 3 links (2.5 oz) Servings Per Container 8

Amount Per Serving Calories 190 Calories from Fat 150

% Daily Value*

Total Fat 16g 25%

Saturated Fat 6g 30% Trans Fat 0g

Cholesterol 20mg	7%
Sodium 380mg	16%
Total Carbohydrate 1g	0%
Dietary Fiber 0g	0%

Sugars 1g

Protein 10g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 4%

12 – Regular American Cheese

Nutrition Facts

Serving Size 1 oz Servings Per Container 7

Amount Per Serving Calories 120 Calories from Fat 90

% Daily Value*

Total Fat 10g 15%

Saturated Fat 7g 35% Trans Fat 0g

Cholesterol 30mg	10%
Sodium 180mg	8%
Total Carbohydrate 0g	0%
Dietary Fiber 0g	0%

Sugars 0g

Protein 6g

Vitamin A 6% Vitamin C 0%

Calcium 20% Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

SESSION

Guess the Fat Activity

Try to guess the amount of fat (in teaspoons) that is found in each food. Write your answers on the “My Guess” line.

Teaspoons of Fat

Food My Guess True Amount

2 ounces American cheese

2 tablespoons regular mayonnaise

2 pieces of fried chicken (wing and thigh)

1 beef hotdog

1 cup cooked beans

2 snack cakes (1 package)

1 orange

HANDOuT—SESSION 5 163

Cooking With Less Saturated Fat

New Orleans Red Beans

In a 5-quart pot, combine red beans, water, onion, celery, and bay leaves. Bring to boiling, then reduce heat.
Cover and cook over low heat for 4½ hours or until beans are tender.
If desired, stir and mash beans against the side of the pan

don’t add oil!

(New Orleans style). Add green pepper, garlic, parsley, thyme, and black pepper.

Cook uncovered over low heat until creamy, about 30 minutes.
Remove bay leaves before serving.

Boiled Brown Rice

Bring 2 cups of water to a boil, and add 1 cup of brown rice.

+

Cover well, and cook over low heat for

Water riCe

20 minutes.

don’t add oil!

Potato Salad

Wash 2 pounds of potatoes, cut in half, and place in cold water in a saucepan.
Cook covered over medium heat for 25 to 30 minutes or until tender.
Chop celery, scallion, and red and green bell peppers, if desired.
Chop one hard-boiled egg.
Drain and dice potatoes when cool.
Add vegetables and egg to potatoes, and toss.
Blend together low-fat or fat-free mayonnaise, mustard, pepper, and dried dill weed.
Pour blended mixture over potato mixture and stir gently to coat evenly.
Chill for at least 1 hour before serving.

164 HANDOuT—SESSION 5

Cooking With Less Saturated Fat (continued)

Poultry and Meat

Remove the skin from chicken and turkey, and throw it away. Cut off chunks of fat from beef and pork, and throw it away.
Add your favorite seasonings, such as garlic, onion powder, sage, or cracked black pepper.
Cook meat by baking, broiling, or grilling—not frying.

Fish and Seafood

For fresh seafood and fish, clean as desired. If your seafood or fish is canned, rinse thoroughly to reduce the amount of sodium.
Season with seafood spices such as basil, chili powder, dill, marjoram, parsley, rosemary, and thyme to taste. Lemon juice or fresh lemon wedges will add a nice flavor to many seafood dishes.
Cook fish and seafood by baking, broiling, braising, stewing, or grilling—not frying—and use vegetable oil spray to coat pans.

Spaghetti With Turkey Meat Sauce

Coat a large skillet with vegetable oil spray. Preheat over high heat. Add ground turkey (1 pound). Cook, stirring occasionally, for 5 minutes. Drain off fat.
Stir in a 28-ounce can of diced tomatoes (low- or no-sodium variety), chopped green peppers, onion, garlic, oregano, and black pepper. Bring to boiling, then reduce heat. Simmer covered for 15 minutes, stirring occasionally.
Remove cover, and simmer for an additional 15 minutes.
Meanwhile, cook spaghetti (or other whole-grain pasta variety) according to package directions, and drain well. Serve sauce over spaghetti with crusty, wholegrain bread.

HANDOuT—SESSION 5 165

Cooking With Less Saturated Fat

Fruit Shake

FAT- FREE MILK

Or use lactose-free alternative.

Cut your favorite fruit—such as bananas, oranges, or strawberries—into chunks.
Place in a blender along with fat-free milk,* vanilla, and ice.
Blend until smooth.

HANDOuT—SESSION 5

Recipe Substitutes

When the recipe calls for:

1 whole egg

1 cup butter

1 cup shortening or lard

1 cup whole milk

1 cup cream

1 cup sour cream

Use these heart smart picks instead:

2 egg whites or /4 cup egg substitute

1 cup soft margarine or /3 cup vegetable oil

1 cup fat-free milk

1 cup evaporated fat-free milk

1 cup fat-free sour cream

HANDOuT—SESSION 5 167

Soul Food Makeover—Chicken Gumbo Recipe

1 teaspoon	vegetable oil	1.
¼ cup	flour	2.
3 cups	low-sodium chicken broth	3.

1½ pounds chicken breast, skinless 4. and boneless, cut into 1-inch strips 5.

1 cup 1 cup 1 cup

white potatoes, cubed onions, chopped carrots, coarsely chopped ¼ cup celery, chopped 6.

½ medium 4 cloves 2 stalks

carrot, grated garlic, finely minced scallions, chopped 7. 1 whole bay leaf ½ teaspoon black pepper, ground 8. 2 teaspoons hot (or jalapeno) pepper 9. 1 cup (½ pound) okra, sliced into ½-inch pieces

The Makeover

In the past, the Harris family would have used chicken parts that are high in fat, such as chicken thighs. They also would have used chicken skin, which is very high in saturated fat and

Add oil to a large pot.

Heat pot over medium flame.

Stir in flour.

Cook, stirring constantly, until flour begins to turn golden brown.

Slowly stir in all the broth using a wire whisk, and cook for 2 minutes. The mixture should not be lumpy.

Add all ingredients except okra. Bring to a boil, then reduce heat and let simmer for 20 to 30 minutes.

Add okra and let cook for 15 minutes.

Remove bay leaf.

Serve hot in a bowl or over rice.

Makes 8 servings Serving size: ¾ cup Calories: 165 Total fat: 4 g Saturated fat: 1 g Cholesterol: 51 mg Sodium: 81 mg Total fiber: 2 g Protein: 21 g Carbohydrates: 11 g Potassium: 349 mg

cholesterol. This made-over recipe has great flavor, and it uses chicken breasts, which are lower in fat than chicken thighs.

SESSION

Session 6

If you can somehow think and

“

dream of success in small steps, every time you make a step, every time you accomplish a small goal, it gives you confidence to go on from there.

”

John H. Johnson

Session 6

Embrace Your Health! Aim for a Healthy Weight

sess i o n

Embrace Your Health! Aim for a Healthy Weight

Objectives

By the end of this session, group members will learn that:

Being overweight is a risk factor for high blood cholesterol, high blood pressure, diabetes, heart disease, and stroke.
Healthy weights are given in ranges.
Losing weight or keeping a healthy weight means making lifelong changes.
Fad diets usually do not work over the long term and can be harmful.

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Blackboard and chalk or several large pieces of paper, a marker, and tape
Two bathroom scales
A tape measure you can attach to the wall (to measure height)
A cloth tape measure (to measure the waist)

Session 6. Embrace Your Health! Aim for a Healthy Weight 169

(Optional) Curling ribbon (to measure the waist)*
A food label (from a can or package)
Ten serving dishes
Four measuring cups
Five spoons
One knife
Food

• A 16-ounce box of cereal

• A 15-ounce can of fruit or vegetables

• A block of American cheese (about ½ pound)

• Three cups of cooked rice

• A 15-ounce can of beans

Handouts

Give group members these handouts during this session:

(Optional) “Tina’s Story About Losing Weight: Role Play” (pages 191–192)
“Body Mass Index (BMI) Chart” (page 193)
“Do You Need To Lose Weight?” (page 194)
“Ms. Diane’s Healthy Lifestyle” (page 195)
“Tina’s Habits and Her Weight” (page 196)
“Tips To Help You Control Your Weight” (page 197)
If you choose to use ribbon instead of measuring tape, cut one ribbon at 35 inches for women and one ribbon at 40 inches for men.

170 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

“Serving Sizes” (page 198)
“Read the Food Label for Calories!” (page 199)
“Tina’s Snack Choices” (pages 200–201)
“Soul Food Makeover—Smothered Greens Recipe” (page 202)

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

Facts About Overweight and Obesity
(Optional) Tina’s Story About Losing Weight: Role Play
Your Weight and Your Health
What Is a Healthy Weight? Activity
The Healthy Way To Lose Weight
Beat Weight-Loss Barriers
Serving Size Activity
Food Label Activity––Calories
Soul Food Makeover—Smothered Greens Recipe

Session 6. Embrace Your Health! Aim for a Healthy Weight 171

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

Last week, we talked about why it is important to cut back on saturated fat, trans fat, and cholesterol in our diets. Can you list three things you can do to make food lower in fat?

Add these answers if not mentioned by group members:

• Trim the fat from meat before cooking.

• Take off the skin from chicken before cooking and throw it away.

• Bake, boil, broil, or grill food instead of frying it.

Ask:

At the end of the last session, you made a pledge to eat less saturated fat, trans fat, and cholesterol. What went well? Did you have any problems?

Note: Allow 5 minutes for group members to respond.

172 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

Ask:

Do any of you want to share what you learned about your family health history?

Note: Allow about 5 minutes for group members to respond.

3. About This Session

I want to start today’s session with the words of John H. Johnson of Johnson Publishing, publisher of Ebony and Jet magazines. He said, “If you can somehow think and dream of success in small steps, every time you make a step, every time you accomplish a small goal, it gives you confidence to go on from there.”

Ask:

What does this quote mean to you?

Note: Allow about 5 minutes for group members to respond.

Today, we will discuss why keeping a healthy weight is important to heart health.

Session 6. Embrace Your Health! Aim for a Healthy Weight 173

Conducting the Session

1. Facts About Overweight and Obesity

Overweight and obesity increase the risk of heart disease and stroke. Losing even 10 pounds can make a difference.
Nearly 8 in 10 African American women are overweight or obese.
About one in four African American men is overweight or obese.
About one in four African American children is overweight.

2. (Optional) Tina’s Story About Losing Weight: Role Play

Note: Ask for two volunteers to be the actors in the role play. Give these two group members the “Tina’s Story About Losing Weight: Role Play” handout (page 191–192). As the trainer, you can read the one-line introduction. After the activity is completed, ask the following questions.

Ask:

• What are some of the small changes Tina made that helped her lose weight?

• Have any of you made changes recently to your eating and exercise habits

that are different from those mentioned in the role play?

Note: Allow about 5 minutes for group members to respond.

3. Your Weight and Your Health

Being overweight or obese increases your risk of heart disease and stroke. It also can contribute to the development of high blood cholesterol, high blood pressure, and diabetes, which can also cause heart disease.

174 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Being overweight can increase the risk of developing some types of cancer, and it can make other health problems worse, such as arthritis and sleep disorders.

Losing a small amount of weight can improve many health problems that come from being overweight.

4. What Is a Healthy Weight? Activity

Note: Before beginning this activity, place the scales where group members can weigh themselves in private. Write the following information on the blackboard or on a large piece of paper taped to the wall.

James weighs 180 pounds. He is 6 feet tall.

Tina weighs 170 pounds. She is 5 feet, 5 inches tall.

Give group members the “Body Mass Index (BMI) Chart” handout (page 193).

We are going to do an activity to find out if you have a healthy weight or if you should lose weight.

Show picture card 6.1.

We’re going to work together to find out if James and Tina have healthy weights, using the BMI chart. The BMI chart lets you measure the weight of a person in relation to his or her height.

Session 6. Embrace Your Health! Aim for a Healthy Weight 175

James weighs 180 pounds, and he is 6 feet tall. First, look for James’ height on the left side of the chart and circle it. Put your finger on the circled number and move your finger to the right until you find the number that corresponds to his weight. The shade of your square will show you if James’ weight is healthy, overweight, or obese. His BMI is 24, so James is at a healthy weight.

Note: Allow 2 or 3 minutes for group members to look for the answer on the chart.

Now we will find Tina’s BMI (following the same steps). Tina weighs 170 pounds, and she is 5 feet, 5 inches tall. Tina’s BMI is 28, which means she is overweight.

Note: Allow 2 or 3 minutes for group members to look for the answers on the chart.

Now we are going to find out if you have a healthy weight. If you do not know how much you weigh, use the scale to weigh yourself. If you do not know your height, use the wall measure.

Note: Allow 15 minutes for group members to use the scales and wall measure.

Give group members the “Do You Need To Lose Weight?” handout (page 194).

Now we’re going to take three simple steps to learn if we need to lose weight, and then we’re going to find out what actions we should take.

The first step is to find out our BMI, using the chart on the handout that I gave you. We will follow the same process that we used with James and Tina.

Find your height on the left side of the chart, and circle it. Put your finger on the circled number and move your finger to the right until you find the number

176 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

that corresponds to your weight. The shade of your square will show you if your weight level is healthy, overweight, or obese. You do not have to share your BMI with the group. Just check off your weight level on the handout.

Please raise your hand if you are having trouble, and I will help you.

The second step is to measure your waist.

Show picture card 6.2.

Ask group members to measure their waists using the measuring tape.

Waist Measurement

Note: Have group members measure their waists by placing a tape measure around the waist just above the hipbone. Be sure the tape is snug but not too tight on the stomach. Ask them to relax, exhale, and then measure their waists.

(Optional) Note: Some people may be sensitive about measuring their waists with a tape measure. To make this activity friendlier, you can use curling ribbon. Cut one ribbon at 35 inches for women and one ribbon at 40 inches for men, and give the ribbon to group members. Tell them how long the ribbon measures. If the ribbon does not go all the way around the waist, their waist measurements are high.

Write down your waist measurement, and check off what level it is: healthy or high. A waist measurement of greater than 35 inches for women and greater than 40 inches for men is high. A high waist measurement increases your risk for heart disease.

Session 6. Embrace Your Health! Aim for a Healthy Weight 177

In the third step, we will find out if you need to lose weight. Look at your weight and waist measurement.

If both are healthy, then you are at a healthy weight and do not need to lose weight. Good for you! Try not to gain weight.

Note: Copy the box onto a large piece of paper.

Risk Factors

High blood pressure
High LDL cholesterol (bad

cholesterol)

Low HDL cholesterol (good
High triglycerides
High blood glucose
Family history of heart disease
Not being physically active

cholesterol)

Cigarette smoking

Let’s review the risk factors. How many of these factors do you have?

Note: Give group members a moment to think about this question.

If your BMI is in the overweight range, and you have two of the factors we just listed, you should lose weight. It is important not to gain more weight. You should also lose weight if you are overweight and have a high waist measurement.

If your weight is in the obese range, you also need to lose weight. It is important to lose weight slowly—about 1 to 2 pounds a week. Ask your doctor or a registered dietitian for help.

178 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Note: Ask group members to look at the handout to see what actions they should take for their weight levels.

Level

Healthy Weight

Overweight

Action

Good for you! Try not to gain any weight.
It is important not to gain more weight.

• You need to lose weight if you are overweight

and:

Have two or more risk factors. or
Have a high waist measurement.

• Ask your doctor or a registered dietitian for help.

Obese • You need to lose weight. Lose weight slowly—

about 1 to 2 pounds a week.

• Ask your doctor or a registered dietitian for help.

Give group members the “Ms. Diane’s Healthy Lifestyle” handout (page 195).

Please review the handout to find out how Ms. Diane found success managing her weight.

5. The Healthy Way To Lose Weight

Let’s talk about the healthy way to lose weight.

The measure of energy that the body gets from food is called a calorie. People gain weight when they eat more calories than their body uses for energy.

Session 6. Embrace Your Health! Aim for a Healthy Weight 179

If you need to lose weight, you must choose foods with fewer calories or become more physically active. It’s best to do both.

To lose weight, you must burn more calories than the calories you eat.

Pregnant women should not try to lose weight.

Give group members the “Tina’s Habits and Her Weight” handout (page 196).

This handout is about how decreasing calorie intake and adding small amounts of daily activity can lead to weight loss over time.

Ask for volunteers to read each scene aloud.
Show picture card 6.3.

Like Tina, you can lose weight in a healthy way if you eat smaller portions, eat a variety of foods lower in fat and calories, and increase your activity level.

Most people who lose weight and keep it off do so by losing the weight slowly. They learn to make lasting changes. They eat fewer calories and stay physically active. You should try to lose 1 to 2 pounds each week until you reach a healthy weight.

Give group members the “Tips To Help You Control Your Weight” handout (page 197). Review the tips for losing weight.

180 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

6. Beat Weight-Loss Barriers

Ask:

Have any of you ever tried to lose weight?

Ask people to share their experiences with the group. Ask them to tell what kept them motivated to lose weight.
Ask:

Why do you think it is difficult for some people to lose weight or keep off the weight they lose?

Note: Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add some of the following answers if they are not mentioned.

Some people have a hard time losing weight because:

• They lack support from family members or friends.

• They do not know how to cook without fat or how to use a recipe.

• They believe that healthy foods are too expensive.

• Fruits and vegetables cost more than junk food at the local store.

• The neighborhood is too dangerous for people to walk in for physical activity

because it lacks well-lit areas.

• Working parents are often short on time and energy.

• Changing behavior is difficult and takes time and effort.

• They think that being heavy means that a person is healthy.

• Family activities center around food.

• Friends give the wrong message. For example, “You’re better off with some

extra weight.”

Session 6. Embrace Your Health! Aim for a Healthy Weight 181

Ask:

Have you found ways to beat the barriers to losing weight?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add some of the following answers if they are not mentioned:

• Find another person who also wants to lose weight. You can talk with this

person to stay motivated.

• Walk or plan other activities with another person. This makes it more fun,

and the time will pass quickly.

• Find activities that the whole family can enjoy. That way, everyone can work

together to control their weight.

• Look for free or low-cost physical activity facilities at local community

centers or parks and recreation programs.

• Share cooking chores and recipes with a friend. For example, if family

members will not eat lower calorie dishes, make a dish and share it with a friend. Your friend can make a dish and share it with you.

Ask your doctor or a registered dietitian to help you develop a plan if you need to lose weight.

Show picture card 6.4.

Losing weight has become a moneymaking business. You hear about miracle diets that claim to help you lose weight quickly and easily. These products make only one thing lighter—and that’s your wallet. Be careful about ads that promote diets and exercise products using personal testimonies.

182 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Diets that promise quick weight loss rarely work. Many of these diets include only a few foods. People get bored with them quickly. These diets do not provide all the nutrients and energy your body needs. They are not healthy.

7. Serving Size Activity

In Session 8, “Make Heart Healthy Eating an Everyday Family Reunion,” we will look at how many servings you should eat.

Before the session

Check the “Serving Sizes” handout (page 198) for the serving size of each food. Measure one serving of each food, and put each in a separate dish or other container.
Place the dishes with these premeasured foods out of sight.
Place the box of cereal, a large bowl of cooked rice, a bowl of fruit or vegetables, a block of cheddar cheese, and a bowl of beans on a table with five dishes, four serving spoons, and a knife.

Ask for five volunteers to come to the table. Ask each person to do one of the following:

Spoon out a serving of cereal and put it on a dish.
Spoon out a serving of cooked rice and put it on a dish.
Cut a serving of cheese and put it on a dish.
Spoon out a serving of the fruit or vegetable and put it on a dish.
Spoon out a serving of beans and put it on a dish.

Session 6. Embrace Your Health! Aim for a Healthy Weight 183

Bring out the foods you measured before the session. Compare the volunteers’ serving sizes with the true amounts.
Give group members the “Serving Sizes” handout (page 198). Ask for volunteers to read aloud the serving sizes for each. Tell them to use this handout at home.

8. Food Label Activity––Calories

Note: This activity will help group members choose foods that are lower in calories.

We have learned that, to lose weight, a person must eat fewer calories than the body burns for energy. In the last session, you learned how to use the food label to choose foods that are lower in saturated fat, trans fat, and cholesterol. Today, we are going to learn how to use the food label to choose foods that are lower in calories.

Show picture card 6.5.

Here’s where you can look to find the number of calories in one serving on the food label. This food label shows the number of calories in a can of regular soda.

Give group members the “Read the Food Label for Calories!” handout (page 199).

Look at the food labels at the bottom of the handout for a can of regular soda and a can of diet soda. Which type of soda has fewer calories?

Note: Allow 1 or 2 minutes for group members to respond.

184 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

A can of diet soda has zero calories. There are 140 calories in a can of regular soda.

“Fat-free” does not mean free of calories. You need to watch the calories and fat when comparing food labels.

Here are a few examples:

Calories in reduced-fat food Calories in regular-fat food

Reduced-fat chocolate chip cookies, 118 Regular chocolate chip cookies, 142

3 cookies (30 grams)	calories	3 cookies (30 grams)	calories
Fat-free potato chips,	107	Regular potato chips,	151
1 ounce	calories	1 ounce	calories

Let’s try another group activity. I will tell you about a common problem for families today. Then we will learn how to use food labels to help solve the problem.

Give group members the “Tina’s Snack Choices” handout (pages 200–201). Read “Tina’s Problem” (page 186). Ask group members which foods Tina should serve.

Session 6. Embrace Your Health! Aim for a Healthy Weight 185

Tina’s Problem

Tina and her family like to have snacks when they watch television. Recently, Tina has noticed that her family members have gained weight. Use the food labels to choose some tasty snacks that are lower in calories. What should Tina serve? Write the number of your choice for each pair on the line. Then write the number of calories saved by this choice.

Note: The choices that are lower in calories are underlined below. The number of calories saved by making the right choice is given below each choice.

Potato chips or light microwave popcorn? Choosing popcorn saves 130 calories.

Cantaloupe or butter cookies? Choosing the cantaloupe saves 65 calories.

Canned peaches in fruit juice or canned peaches in heavy syrup? Choosing the peaches canned in fruit juice saves 50 calories.

A chocolate candy bar with caramel and nuts or a cereal bar with fruit and nuts? Choosing the cereal bar saves 140 calories.

Ask:

• What is an example of a snack that is higher in calories that your family eats?

• What is an example of a snack that is lower in calories that your family

would enjoy?

Note: Allow a few minutes for group members to respond.

186 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

9. Soul Food Makeover—Smothered Greens Recipe

Give group members the “Soul Food Makeover— Smothered Greens Recipe” handout (page 202).

This recipe makes a good side dish that you can bring to a family gathering or other event. Try the smothered greens with a chicken or fish dish and baked potatoes. The recipe has only 80 calories and 2 grams of fat per serving and is easy to make.

Review of Today’s Key Points

Let’s review what we learned today.

Why is it important to maintain a healthy weight?

• Being overweight may increase your risk of heart disease, high blood

pressure, high blood cholesterol, diabetes, and some types of cancer.

What is the healthiest way to lose weight?

• Eat smaller portions of a variety of foods lower in fat and calories, and

increase your physical activity.

How can the food label help you if you need to lose weight?

• The food label tells you the serving size and the number of calories per

serving. You can compare calories on different packages to choose foods that are lower in calories.

Session 6. Embrace Your Health! Aim for a Healthy Weight 187

Weekly Pledge

You have learned a lot today about losing weight the healthy way. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to reach or maintain a healthy weight. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will buy vegetable oil spray when I go to the grocery store next week. I

will use the vegetable oil spray instead of butter when I make scrambled eggs for breakfast.

• I will walk for 30 minutes for 3 days each week during my lunch break at

work, starting tomorrow.

• I will eat only half of my entree the next time I eat out to cut down on my

food portion. I will take the other half home and save it for another meal.

Write your pledges on the “Ms. Diane’s Healthy Lifestyle” handout on page 195. Keep this handout in a special place so you can review your pledges and keep your goals in mind.

Note: Allow 5 minutes for group members to think of a pledge.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

188 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

(Optional) Say:

Keeping a personal value in mind can help you make changes in your life to reach and keep a healthy weight. Remember that a personal value is a quality that you consider important.

Today, the value is honesty. Honesty can help you think about what makes you overeat, such as feelings of boredom, stress, or anger, or a lack of time or willpower. Honesty can also free you to talk about your struggles and successes with the friends or loved ones who can support you. Finally, honesty can guide you to choose goals that are realistic for you as you work to change your eating and activity habits for the better.

Today’s quote states, “If you can somehow think and dream of success in small steps, every time you make a step, every time you accomplish a small goal, it gives you confidence to go on from there.”

Ask:

How can you use honesty, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Don’t forget to continue working on your pledges to be more physically active and to cut back on salt, sodium, saturated fat, trans fat, and cholesterol.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

Session 6. Embrace Your Health! Aim for a Healthy Weight 189

I am looking forward to seeing you at the next session. The next session will be about diabetes and how it relates to heart disease. Please continue to fill out your family health histories.

Note: Think about today’s session. What worked and didn’t work? Have you made any changes in your own life that were covered in today’s session?

190 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Tina’s Story About Losing Weight: Role Play

Two friends meet at their church picnic and stop to talk.

Jill: Have you lost weight? You look good!

Tina: Yes, I have. I knew that I had gained some weight over the years, but I never thought I was overweight. I realized after my last checkup that those extra pounds really add up! My doctor told me that being overweight raises your risk for heart disease, stroke, and diabetes.

Jill: I’ve tried a lot of different diets, but I always gain all the weight back and more.

Tina: I didn’t diet. I just made some small changes in my eating habits. I also started being physically active for at least 30 minutes every day.

Jill: I just don’t have the energy right now to try and lose weight. Besides, everyone in my family is overweight. That’s just the way we’re built.

Tina: At first, I wasn’t sure if I could do it either. I didn’t know what to do when I found out that I had to lose 21 pounds to reach a healthy weight. I talked to my husband, James, about my worries. He told me that I could do it and that he would change some of his habits, too. My doctor also gave me some tips.

Jill: So what changes did you make? Could I make them, too?

Tina: Sure you can! I started by watching how much food I put on my plate. Also, I stopped going back for second helpings. I used to eat until I was too full.

Jill: Don’t you feel hungry?

Tina: I give my body about 15 minutes to get the message that I’m full. If I still feel a little hungry, I eat a piece of fruit or drink water. Juice and soda are very sugary and can really add to your weight.

Jill: Sometimes I eat when I’m not hungry, like when I feel bored, stressed, or worried.

Tina: I can relate. Whenever James worked late, I used to eat big bags of cookies and chips while watching TV. Now I try to do something other than eating, like calling a friend.

HAndOuT—SeSSIOn 6 191

Tina’s Story About Losing Weight: Role Play (continued)

Jill: How much weight have you lost so far?

Tina: I’ve lost 10 pounds, and I’m still working to lose the rest. I have my hard days when I feel like giving up. But then I remember how much more energy I have these days and how good I feel overall.

Jill: I know I should lose some weight, too. Heart disease runs in my family, and I need to stick around for my girls. Do you think you can help me?

Tina: Sure. How about joining me on a walk this weekend?

Jill: Just tell me when and where.

192 HAndOuT—SeSSIOn 6

Body Mass Index (BMI) Chart

HAndOuT—SeSSIOn 6 193

Do You Need To Lose Weight?

Let’s follow these steps to find out if you need to lose weight.

1. Learn if your weight is healthy. My weight is:

Weigh yourself. Use the BMI chart to find out whether your Healthy weight is in the healthy range for people of your height. Find Overweight your height on the left of the chart, and circle it. Put your finger on the circled number, and move your finger to the right Obese until you find the line that corresponds to your weight. The shade of your square will show you if your weight level is healthy, overweight, or obese.

2. Measure your waist.

Measure your waist by placing

the measuring tape snugly

Write down your waist measurement: _________

Your waist measurement is high if:

Women—Measurement is greater than 35 inches. around your waist. A high waist

• Men—Measurement is greater than 40 inches.

measurement increases your risk My waist measurement is: for heart disease.

Healthy High

3. Find out if you need to lose weight.

Check off your weight level below to find out if you need to lose weight.

Level Action

Healthy Weight • Good for you! Try not to gain any weight. Overweight • It is important not to gain more weight. • You need to lose weight if you are overweight and:

Have two or more heart disease risk factors or
Have a high waist measurement

• Ask your doctor or a registered dietitian for help. Obese • You need to lose weight. Lose weight slowly—about 1 to 2 pounds

a week. Ask your doctor or a registered dietitian for help.

194 HAndOuT—SeSSIOn 6

Ms. Diane’s Healthy Lifestyle

Losing weight means making long-term changes.

I have had diabetes for 25 years. I used to weigh 200 pounds. I was able to lose

Here’s how

weight by eating smaller portions of

Ms. Diane the foods I like. I also eat fewer fatty

foods and sweets and more fruits and

found success. vegetables. After I lost my first 25

pounds, my back and foot problems went away. Now I stay at a healthy weight and control my diabetes while still enjoying what I eat.

Try these tips to get started.

♥ Eat fewer foods that are high in ♥ Make stews with lean meat saturated fat—such as fried chicken, and vegetables. pork rinds, and sausage. ♥ Serve small portions, and eat

♥ Cut down on cakes, pastries, candy, and soft drinks. ♥ Eat more fruits, vegetables, and whole grains. Make your personal pledge to do what the Harris family is doing!

salad if you are still hungry. Don’t skip meals. ♥ Aim for 60 minutes of physical activity each day. Write the changes you will try to make this week. Look at these examples:

When shopping

Read labels to choose foods lower in calories.

When cooking

Bake fish instead of frying it. Use vegetable oil spray instead of greasing the pan with oil.

When eating

Have green beans and rice with one piece of chicken instead of three pieces of chicken alone.

Get active

The health of you and your

Walk for 10 minutes three times a

day. Dance with your family for 20 family is priceless. Make an

minutes. Lift weights before work

investment in it!

for 10 minutes.

HAndOuT—SeSSIOn 6 195

Tina’s Habits and Her Weight

Eat big portions. Be physically inactive. Gain weight.

Eat moderate portions. Be physically active most days. Maintain weight.

Eat small portions. Be physically active most days. Lose weight.

196 HAndOuT—SeSSIOn 6

Tips To Help You Control Your Weight

1. Choose foods low in fat and low in calories. Try:

♥ Fat-free or low-fat (1%) milk

♥ Cheeses labeled “fat free” or “low fat” on the package

♥ Fruits and vegetables without butter or sauce.

♥ Rice, beans, cereals, corn tortillas, and whole-grain pasta

♥ Lean cuts of meat and fish and skinless turkey and chicken

♥ Water or low-calorie drinks instead of soft drinks and sugar-filled fruit drinks

2. Make foods the healthy way.

♥ Bake, broil, boil, or grill instead of frying foods.

♥ Cook beans and rice without lard, bacon, or fatty meats.

♥ Use less high-fat cheese, cream, and butter when cooking.

♥ Use vegetable oil spray or a little bit of vegetable oil or tub margarine when cooking.

♥ Flavor salads with fat-free or low-fat mayonnaise or salad dressing.

3. Limit your portion size.

♥ Serve smaller portions, and don’t have second helpings. Have a salad if you are still hungry.

♥ Eat smaller meals and snacks throughout the day instead of having one big meal.

♥ When eating out, watch your portion sizes. Many restaurants now serve food portions that are too big. Share an entree, or bring half home.

♥ If you drink fruit juice, make sure it is 100% fruit juice. Keep an eye on the portion size. The calories in beverages add up quickly.

4. Get active! Say goodbye to excuses!

♥ Do your favorite physical activity for at least 60 minutes each day. You can do 20 minutes of activity three times a day.

Try this: If you are pressed for time, walk for 20 minutes three times a day.

5. Aim for a healthy weight.

♥ Try not to gain extra weight. If you are overweight, try to lose weight slowly. Lose about 1 to 2 pounds a week. Losing even 10 pounds can help reduce your chances of developing heart disease.

Serving Sizes

Food Group

Grains*

Vegetables

Fruits

Fat-free or low-fat milk and milk products

Lean meats, poultry, and fish

Nuts, seeds, and legumes

Fats and oils

Sweets and added sugars

Serving Sizes

1 slice bread 1 ounce dry cereal†

½ cup cooked rice, pasta, or cereal

1 cup raw leafy vegetable ½ cup cut-up raw or cooked vegetable ½ cup vegetable juice

1 medium fruit ¼ cup dried fruit ½ cup fresh, frozen, or canned fruit ½ cup fruit juice

1 cup of fat-free or low-fat milk or yogurt ‡ 1½ ounces of lowfat cheese

1 ounce cooked meats, poultry, or fish 1 egg§

/3 cup or 1½ ounces nuts 2 tablespoons peanut butter 2 tablespoons or ½ ounce seeds ½ cup cooked legumes (dry beans and peas)

1 teaspoon soft margarine 1 teaspoon vegetable oil 1 tablespoon lowfat mayonnaise 2 tablespoons lowfat salad dressing

1 tablespoon sugar 1 tablespoon jelly or jam ½ cup sorbet, gelatin 1 cup lemonade

Source: “Your Guide to Lowering Blood Pressure With DASH,” 2006. National Heart, Lung, and Blood Institute, NIH Publication No. 06–4082

Whole grains are recommended for most grain servings as a good source of fiber and nutrients.

1 1

cups, depending on cereal type. Check the product's Nutrition Facts label. ‡ Lactose-free alternatives for people who are lactose intolerant. § Limit the number of egg yolks to four per week.

Read the Food Label for Calories!

Food labels tell you what you need to know about choosing foods that are lower in calories. Here’s a food label for a can of regular soda.

Regular Soda

Nutrition Facts

Serving Size 1 can (12 fl oz) Servings Per Container 1

Amount Per Serving

Calories 140

Serving Size and Number of Servings The serving size is one can (12 ounces).

Calories from Fat 0

The nutrient amounts are for

% Daily Value*

one serving. So, if you eat

Total Fat 0g

more than a serving, you need

Saturated Fat 0g

to add nutrient amounts. For

Trans Fat 0g

example, if you drink two cans

Cholesterol 0mg

of soda in a day, you need to

Sodium 50mg

double the amount of calories

Total Carbohydrate 39g

on the label.

Dietary Fiber 0g

Sugars 39g

Protein 0g

0% Calories The amount of calories in 0% one serving is given here.

13%

Sugar The amount of sugar is shown here.

Vitamin C 0%

Iron 0%

The Choice Is Yours—

Calories 140

Regular Soda

Calories from Fat 0

A can of regular soda has

% Daily Value*

Compare!

Total Fat 0g

Which one would you

Saturated Fat 0g

choose? Trans Fat 0g

Cholesterol 0mg

Drinking soda adds many

Sodium 50mg

calories that all come from sugar. Read the food label to

Calories 0

0% 140 calories and 39 grams 0% of sugar.

Diet Soda

A can of diet soda has 0 calories and no sugar.

Calories from Fat 0

find beverages that are sugar Drinking diet soda or water

% Daily Value*

free and reduced in calories.

Total Fat 0g

Saturated Fat 0g

Trans Fat 0g

Cholesterol 0mg

Sodium 35mg

instead of regular soda

saves a lot of calories,

which is important when trying to lose weight or

maintain a healthy weight.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HAndOuT—SeSSIOn 6

Tina’s Snack Choices

1 – Potato Chips

Tina and her family like to have

Nutrition Facts

snacks when they

Serving Size 1 oz (28g/about 12 chips)

watch television. Servings Per Container 20 Recently, Tina has

Amount Per Serving

noticed that her Calories 160 Calories from Fat 90 family members % Daily Value* have gained Total Fat 10g 15% Lower

Saturated Fat 3g 15% calorie

weight.

Trans Fat 1g choice

Use the food Cholesterol 0mg 0% ______ labels to choose Sodium 660mg 28%

Total Carbohydrate 7g 2% Number

some tasty

Dietary Fiber 1g 0% of calories

snacks that are

Sugars 6g saved

lower in calories.

___

Protein 1g

What should Tina serve? Vitamin A 6% Vitamin C 0%

Calcium 0% Iron 5%

Write the number of your lower calorie choice for

3 – Cantaloupe

each pair in the space between

Nutrition Facts

the labels. Then

Serving Size 1 cup (156g)

write the number of calories saved

Amount Per Serving

by this choice. Calories 55 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Lower Trans Fat 0g calorie Cholesterol 0mg 0% choice Sodium 25mg 1% ______

Total Carbohydrate 13g 4%

Dietary Fiber 1g 4% Number of calories

Sugars 12g

saved

Protein 1g

___

Vitamin A 106% Vitamin C 95%

Calcium 1% Iron 2%

2 – Microwave Popcorn (Light Butter)

Nutrition Facts

Serving Size 1 cup (11g) Servings Per Container 4

Amount Per Serving Calories 20 Calories from Fat 10

% Daily Value*

Total Fat 1g 2%

Saturated Fat 1g 5% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 50mg	2%
Total Carbohydrate 4g	1%
Dietary Fiber 0g	0%

Sugars 0g

Protein 0g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 0%

4 – Butter Cookies

Nutrition Facts

Serving Size 3 cookies (28g) Servings Per Container 8

Amount Per Serving Calories 120 Calories from Fat 45

% Daily Value*

Total Fat 5g 8%

Saturated Fat 3g 15% Trans Fat 0g

Cholesterol 20mg	7%
Sodium 80mg	3%
Total Carbohydrate 18g	6%
Dietary Fiber 1g	4%

Sugars 5g

Protein 2g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 2%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

n 6

Tina’s Snack Choices

5 – Canned Peaches (in Fruit Juice)

Nutrition Facts

Serving Size 1/2 cup (110g) Servings Per Container 3.5

Amount Per Serving Calories 50 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Lower Trans Fat 0g calorie Cholesterol 0mg 0% choice ___

Sodium 25mg 1%

Total Carbohydrate 13g 4%

Number

Dietary Fiber 1g 4%

of calories

Sugars 9g

saved

Protein less than 1g

___

Vitamin A 8% Vitamin C 2%

Calcium 0% Iron 0%

7 – Chocolate Candy Bar With Caramel and Nuts

Nutrition Facts

Serving Size 1 bar (56g) Servings Per Container 1

Amount Per Serving Calories 280 Calories from Fat 126

% Daily Value*

Total Fat 14g 22%

Saturated Fat 5g 25% Lower Trans Fat 0g calorie Cholesterol 10mg 3% choice Sodium 160mg 7% ______

Total Carbohydrate 35g 12%

Dietary Fiber 1g 4% Number of calories

Sugars 29g

saved

Protein 5g

___

Vitamin A 0% Vitamin C 0%

Calcium 4% Iron 2%

6 – Canned Peaches (in Heavy Syrup)

Nutrition Facts

Serving Size 1/2 cup (110g) Servings Per Container 3.5

Amount Per Serving Calories 100 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 10mg	0%
Total Carbohydrate 24g	8%
Dietary Fiber 1g	4%

Sugars 23g

Protein 0g

Vitamin A 2% Vitamin C 2%

Calcium 0% Iron 0%

8 – Cereal Bar With Fruit and Nuts

Nutrition Facts

Serving Size 1 bar (24g) Servings Per Container 6

Amount Per Serving Calories 140 Calories from Fat 25

% Daily Value*

Total Fat 3g 5%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 110mg	5%
Total Carbohydrate 27g	9%
Dietary Fiber 1g	4%

Sugars 11g

Protein 2g

Vitamin A 15% Vitamin C 0%

Calcium 20% Iron 10%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

SSIO

Soul Food Makeover— Smothered Greens Recipe

3 cups water ¼ pound smoked turkey breast, skinless 1 tablespoon hot pepper, freshly chopped ¼ teaspoon cayenne pepper 1 teaspoon cloves, ground 2 cloves garlic, crushed ½ teaspoon thyme 1 stalk scallion chopped 1 teaspoon ginger, chopped ¼ cup onion, chopped 2 pounds greens (collard, mustard, turnip, kale, or mixture)

The Makeover

Prepare greens by washing thoroughly and removing stems.
Tear or slice leaves of greens into bite-sized pieces.
Place all ingredients except greens into large saucepan and bring to a boil.
Add greens to turkey stock. Cook 20 to 30 minutes until tender.

Makes 5 servings Serving size: 1 cup Each serving provides: Calories: 80 Total Fat: 2 g Saturated fat: less than 1 g Cholesterol: 16 mg Sodium: 378 mg Total Carbohydrate: 9 g Dietary Fiber: 4 g Protein: 9 g Potassium: 472 mg

In the past, the Harris family would have used meats that are higher in fat and sodium. By using smoked turkey breast that is skinless, they add flavor and reduce added fat.

Session 7

Just don’t give up trying

“

to do what you really want to do. Where there is love and inspiration, I don’t think you can go wrong.

”

Ella Fitzgerald

Session 7

Protect Your Heart: Take Good Care of Your Diabetes for Life

sess i o n

Protect Your Heart: Take Good Care of Your Diabetes for Life

Objectives

By the end of this session, group members will learn:

What diabetes is and how it affects the body
The symptoms of diabetes
That diabetes is a major risk factor for heart disease
The levels of blood glucose and what they mean
How to prevent and control diabetes
The amount of sugar in common beverages

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Blackboard and chalk or several large pieces of paper, a marker, and tape
Two bottles of water
Red food coloring

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 203

One cup of corn syrup
A box of sugar cubes
Three manila file folders for activity display*
Pictures of drinks listed on page 225
Glue

(Optional) Note: Arrange for a health professional or a diabetes educator to come to the session to measure group members’ blood glucose levels.

Handouts

Give group members these handouts during this session:

List of places where group members can get their blood glucose checked†
“What Is Diabetes?” (page 234)
“Are You at Risk for Type 2 Diabetes?” (page 235)
“Symptoms of Diabetes” (page 236)
“Tender Care for Your Feet” (page 237)
“Be Smart About Your Heart: Control the ABCs of Diabetes” (page 238)
“Read the Food Label for Sugar!” (page 239)
“Pam’s Food Choices” (pages 240–241)
“Think Before You Drink: Hidden Sugar in Common Beverages” (page 242)
“How Much Sugar and Calories Are in Your Favorite Drink?” (page 243)
Prepare before the session. † Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

204 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

“Staying Healthy With Diabetes: Real-Life Stories” (pages 244–246)
“Soul Food Makeover: Strawberry and Pineapple Delight Recipe” (page 247)

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

The Facts Don’t Lie
What Is Diabetes?
Types of Diabetes
Risk Factors for Diabetes
Symptoms of Diabetes
Blood Glucose Levels

A. Hypoglycemia

B. Hyperglycemia

Complications of Diabetes
ABCs of Diabetes Control
Food Label Activity––Sugar

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 205

Think Before You Drink––Hidden Sugar in Drinks Activity
Staying Healthy With Diabetes––Group Activity
Soul Food Makeover: Strawberry and Pineapple Delight Recipe

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about aiming for a healthy weight.

Ask these questions:

Q: Does anyone remember why a healthy weight is important to your heart health?

A: Keeping a healthy weight reduces your risk of heart disease, stroke, high blood pressure, high blood cholesterol, diabetes, and some cancers.

206 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Q: What is the healthiest way to lose weight?

A: The healthiest way to lose weight is to eat smaller portions of a variety of foods lower in fat and calories. You also need to do at least 60 minutes of physical activity on all or most days of the week.

Q: How does the food label help people who are trying to lose weight?

A: The food label tells you the serving size and the number of calories in a serving.

At the end of the last session, you made a pledge to do something to help you keep or reach a healthy weight. What problems did you have? How did you deal with any problems?

Note: Allow 2 minutes for group members to respond.

Ask:

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

Does anyone want to share what you have learned about your family health history?

Note: Allow 5 minutes for group members to respond.

3. About This Session

Singer Ella Fitzgerald said, “Just don’t give up trying to do what you really want to do. Where there is love and inspiration, I don’t think you can go wrong.”

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 207

Ask:

What does this quote mean to you?

Note: Allow a moment for group members to respond.

In today’s session, we will learn what we can do to prevent and control diabetes. If you have diabetes, you will need to work closely with a doctor, a registered dietitian, or a certified diabetes educator to help you monitor and control your blood glucose (blood sugar).

Conducting the Session

1. The Facts Don’t Lie

• Diabetes is a serious problem for African American families. It affects men,

women, and children.

• Diabetes is increasing among African Americans. About one in eight adult

African Americans has diabetes.

• Diabetes is a chronic disease that slowly damages the body. Although it has

no cure, complications can be prevented.

• Diabetes is a major risk factor for heart disease.

• Heart disease is the leading cause of death for people with diabetes. About 3

in 10 African Americans age 35 or older with diabetes also have heart disease.

• African Americans are more likely to have diabetes and to die from diabetes

than whites of a similar age.

208 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

2. What Is Diabetes?

Now we will talk about what diabetes is and the types of diabetes.

Give group members the “What Is Diabetes?” handout (page 234).

Diabetes happens when the body does not make enough insulin or cannot use it well, causing glucose to build up in the blood. Too much glucose in the blood is not good for your health. As a result, the body does not function well.

Show picture card 7.1.

In a healthy body, the food we eat goes to the stomach where it is digested. The food is broken down into glucose. Blood glucose is also called blood sugar.

The blood takes the glucose to the cells of your body, where it is turned into the energy needed for daily life. However, glucose cannot enter the cells alone. Insulin, a hormone made in the pancreas, helps glucose enter the cells.

Show picture card 7.2.

Diabetes happens when the body does not produce enough insulin, or when the cells cannot use the insulin well. This means that the glucose cannot enter the cells and builds up in the blood. People who have high levels of glucose in their blood have diabetes.

What Is Prediabetes?

Ask:

What is prediabetes?

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 209

Note: Allow a minute for group members to respond.

Add these answers if they are not mentioned:

• Prediabetes is a condition in which blood glucose levels are higher than

normal, but not high enough to be diabetes.

• People with prediabetes are more likely to develop diabetes within the next

10 years.

• People with prediabetes are also more likely to have a heart attack or stroke.

3. Types of Diabetes

Show picture card 7.3.

When a person does not have diabetes, the pancreas produces a healthy amount of insulin, which the body can use. This is shown in the first picture.

There are two main types of diabetes.

Type 1 diabetes:

• Happens when the pancreas no longer produces insulin. This is shown in the

second picture.

• Requires insulin pump or shots every day.

• Is usually found in children, adolescents, or young adults.

• Affects about 5 to 10 percent of those with diabetes.

210 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Type 2 diabetes:

• Happens when some insulin is produced, but the body cannot use it well.

This is shown in the third picture.

• Happens more often in people who are overweight and physically inactive.

• Is usually treated with pills or, sometimes, insulin shots.

• Can occur at any age, but it is more common after age 40.

• Is common among African Americans.

• Is increasing among children, especially if they are overweight and

African American.

• Affects 90 to 95 percent of people with diabetes.

Gestational diabetes is a special class of type 2 diabetes.

• Some pregnant women develop this kind of diabetes, but it usually disappears

after the baby is born.

• Overweight women and women who have a family history of diabetes are

also at higher risk for gestational diabetes.

• Women who have had gestational diabetes have a much higher chance of

developing type 2 diabetes later in life. Their children are also at a higher risk for becoming overweight and developing diabetes.

We have talked about healthy living throughout the sessions. Type 2 diabetes can be prevented and controlled by making healthy food choices, being physically active, and taking medication as prescribed by your doctor. If you have diabetes, it is important to be under a doctor’s care and to check your blood glucose as your doctor tells you.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 211

Now we are going to do an activity to better understand what diabetes is. We will see the difference between normal blood and blood with a high blood glucose level.

Before the session:

Prepare the Blood Glucose Demonstration

Put two clear plastic bottles on the table.
Add 1 cup of water and 3 drops of red food coloring into one of the bottles. This represents blood with normal blood glucose.
Add 1 cup of corn syrup and 3 drops of red food coloring into the other bottle. This represents blood with high blood glucose.

Show the plain water bottle, and slowly tilt it from side to side to show the smooth movement of the liquid.

Notice how the blood moves easily and freely. This represents the blood of someone with normal blood glucose.

Show the bottle with corn syrup, and slowly tilt the bottle from side to side to show the slow movement of the liquid.

Notice how slowly the blood moves and how thick it is when the blood glucose level is high. This represents the blood of someone with high blood glucose. The glucose stays in the blood instead of being used by the body’s cells and muscles. This shows high blood glucose.

212 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

4. Risk Factors for Diabetes

Ask:

What are some risk factors that increase your chances of getting diabetes?

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Show picture card 7.4.

Give group members the “Are You at Risk for Type 2 Diabetes?” handout (page 235). As you read each risk factor, ask group members to make a check mark next to the risk factors that they have.

Your risk of getting diabetes increases if you:

• Are overweight––especially extra weight around the waist. Nearly 8 out of

10 African American women are overweight or obese.

• Are fairly inactive (exercise fewer than three times a week).

• Have a parent, brother, or sister with diabetes.

• Are African American, Latino, American Indian, Asian American, or

Pacific Islander.

• Have had gestational diabetes or have given birth to a baby weighing more

than 9 pounds. African American women are more likely to have had gestational diabetes than white women.

• Have blood pressure that is 140/90 mmHg (millimeters of mercury) or higher

or have been told by a health care provider that you have high blood pressure.

• Have cholesterol levels that are not normal—HDL (high-density lipoprotein)

cholesterol (“good” cholesterol) is 35 mg/dL (milligrams per deciliter) or lower, or triglyceride level is 250 mg/dL or higher.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 213

The good news is that, if you are at risk for diabetes, you can prevent or delay getting diabetes by being physically active and having a healthy weight.

It is important to be physically active for 30 minutes on most days and to lose even a small amount of weight. For example, someone who weighs 200 pounds would benefit from losing 10 to 15 pounds.

5. Symptoms of Diabetes

Ask:

Does anyone know the signs or symptoms of diabetes?

Note: Allow 3 to 5 minutes for group members to respond.

Give group members the “Symptoms of Diabetes” handout (page 236).
Show picture card 7.5.

Now let’s review the symptoms of diabetes:

• Feeling tired

• Increased thirst

• Frequent urination

• Increased hunger

• Unexplained weight loss

• Sores that don’t heal

• Very dry skin

• “Pins and needles” feeling in feet

• Blurry vision

• Feeling irritable

214 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Often, people with type 2 diabetes have no symptoms. If you have one or more symptoms, see your doctor right away.

6. Blood Glucose Levels

Show picture card 7.6.

To find out if you have diabetes, you can take a fasting blood glucose test at the doctor’s office or at a lab.

• A fasting blood glucose level below 100 mg/dL is normal. You are in

good shape.

• A fasting blood glucose level of 100 to 125 mg/dL is prediabetes. This is a

warning that you are at risk for developing type 2 diabetes. It is time to lose weight and be physically active at least 5 days a week.

• A fasting blood glucose level of 126 mg/dL or higher means that you have

diabetes. If you have diabetes, you should work with your doctor and other health care providers to learn to control it. It is important to work with your doctor to learn the ABCs (A1C test, blood pressure, and cholesterol) of controlling diabetes. We will learn about the ABCs of diabetes control later in this session.

You can also get a nonfasting glucose test at health fairs and other sites in your community. This is done using a glucometer and a small amount of blood. A nonfasting blood glucose level of 200 mg/dL or higher could mean that you have diabetes. See your doctor to get a fasting blood glucose test. You must fast for at least 8 hours before the test.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 215

More Information: Fasting Blood Glucose Levels

Fasting Blood 1 –2 Hours Level Glucose After Meals Results

Normal 70–99 mg/dL 70–139 mg/dL Good for you!

Prediabetes 100–125 mg/dL 140–199 mg/dL This is a warning that you are at risk for type 2 diabetes. A blood glucose level in this range is higher than normal, but not high enough to be diabetes. You need to take action to prevent diabetes.

Diabetes 126 mg/dL or 200 mg/dL or You have diabetes. Work with higher higher your doctor and other health care providers to control the ABCs of diabetes (A1C, blood pressure, and cholesterol).

People with diabetes may experience problems if their blood glucose levels get too low or too high.

A. Hypoglycemia

Hypoglycemia is a condition that develops when a person’s blood glucose level is too low. People with diabetes may develop hypoglycemia.

People with diabetes may develop hypoglycemia when they:

• Skip or delay a meal or eat very little.

• Take too much insulin or oral diabetes medicine.

216 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• Do too much physical activity.

• Drink alcohol.

The symptoms of hypoglycemia are:

• Having a headache

• Feeling shaky

• Feeling anxious

• Feeling dizzy

• Feeling weak

• Feeling irritable

People with diabetes should talk to their health care providers to learn what to do for low blood glucose.

People with diabetes may suffer from hypoglycemia. If your blood glucose is less than 70 mg/dL, your health care provider may tell you to do one of the following:

• Drink ½ cup of fruit juice.

• Drink 1 cup of milk.

• Take two to three glucose tablets.

• Eat 2 teaspoons of sugar or honey.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 217

B. Hyperglycemia

Hyperglycemia is a condition that occurs when a person’s blood glucose level is too high. People with diabetes develop hyperglycemia when they:

• Eat too much food.

• Are less active than usual.

• Have not taken their medicine.

• Are sick or feel tension and stress.

The symptoms of hyperglycemia are:

• Increased thirst

• Frequent urination

• Dry skin

• Increased hunger

• Blurry vision

• Feeling tired

• Nausea

People with diabetes should talk to their health care providers about what to do if they experience the effects of high blood glucose.

If your blood glucose is too high, your health care provider may need to change your medication or eating plan.

218 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

7. Complications of Diabetes

Diabetes can cause changes in the body. These changes can cause problems, called complications. Can anyone name any complications of diabetes?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Over time, diabetes can affect the large blood vessels in the brain, heart, legs, and feet. It also can affect the small blood vessels in the kidneys and eyes. Diabetes can lead to:

• Heart attack

• Stroke

• Amputations of the feet or legs—Diabetes can cause nerve damage. The

first sign of nerve damage is to lose sensation in the feet or legs. If you have nerve disease, you may lose feeling or have tingling or pain in the toes, feet, or legs.

• Kidney disease—With diabetes, the excess glucose in the blood damages the

blood vessels inside the kidneys. African Americans are four times more likely than whites to develop kidney failure, the final stage of kidney disease.

• Eye disease—Diabetes can harm your vision or even cause blindness. People

with diabetes need to have their eyes examined by a medical eye doctor once a year.

• Dental problems—An increase in cavities and tooth infections is common in

people with poor diabetes control. To prevent tooth decay, brush and floss your teeth every day. See your dentist every 6 months.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 219

Over time, diabetes can affect all parts of the nervous system. This can lead to:

• Loss of strength in muscles

• Changes in digestion, bladder control, and sexual function

• Loss of feeling in the feet—This is why you need to keep your feet clean,

dry, soft, and protected.

Give and review the “Tender Care for Your Feet” handout (page 237).

8. ABCs of Diabetes Control

If you have diabetes, controlling your blood glucose levels can help prevent or delay complications.

We’ve learned that people with diabetes have a greater chance of having a heart attack or stroke. Let’s find out how to take care of the heart with the ABCs of diabetes control.

Give and review the “Be Smart About Your Heart: Control the ABCs of Diabetes” handout (page 238).

Be sure to ask your doctor:

• What are my ABC numbers?

• What should my ABC numbers be?

• What actions should I take to control my ABC numbers?

220 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Knowing about diabetes can help prevent or delay it. For those who already have diabetes, diabetes education can help reduce the complications the disease can cause.

9. Food Label Activity––Sugar

People with diabetes should control their sugar intake because sugar is high in calories and contributes to weight gain. Eating too much sugar can also lead to increased blood glucose levels in those with diabetes.

Now let’s do an activity that will help us use food labels to find foods that have less sugar.

Give group members the “Read the Food Label for Sugar!” handout (page 239).

This handout shows the amount of sugar in some drinks and food. Look at the bottom of the handout. Which drink has fewer grams of sugar—grape juice or unsweetened iced tea?

Answer:

The unsweetened iced tea has less sugar. The grape juice has 32 grams of sugar in 1 cup, compared to 0 grams of sugar in 1 cup of iced tea.

Note: Unlike other nutrients, sugar does not have a Percent Daily Value on the food label.

Let’s try another activity. Pam needs our help.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 221

Give group members the “Pam’s Food Choices” handout (pages 240–241).

First, I am going to read about Pam’s problem. Then we will use the food labels to find some solutions.

Pam’s Food Choices

Pam has offered to go grocery shopping for her mother, Ms. Diane, who is home sick with the flu. Ms. Diane also has diabetes. Pam wants to buy foods that are lower in calories and sugar to help her mother. Look at the food labels. Help Pam select foods that are lower in sugar. Which foods should Pam buy? Write the number of your choice for each pair in the space between the labels. Then write the number of grams of sugar saved by this choice.

Note: The correct answers to the questions are underlined.

Cooked oatmeal or a toaster pastry

Choosing the cooked oatmeal saves 16 grams of sugar.

Gelatin or sugar-free gelatin

Choosing the sugar-free gelatin saves 19 grams of sugar.

Regular ice cream or fat-free, no-sugar-added ice cream

Choosing the fat-free, no-sugar-added ice cream saves 13 grams of sugar.

Diet soda or regular soda

Choosing the diet soda saves 39 grams of sugar.

222 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

10. Think Before You Drink––Hidden Sugar in Drinks Activity

Now let’s do an activity to learn the sugar content in some common drinks.

Before the session

Look at the box that appears below. Use drawings or empty cans or bottles to represent these drinks.
Prepare five separate displays for each of the five drinks.
Follow these instructions to prepare each display:

• Cut a file folder in half and fold each part in half to make a card (tent).

• Write the name of the drink on one side. On the other side, write the number

of calories, grams of sugar, and teaspoons of sugar in the drink. Glue the cubes of sugar onto the folder to show the number of teaspoons of sugar in each drink. To find the number of teaspoons, divide the grams of sugar on the nutrition label by four. Examples of the displays are shown on page 443.

Hide the displays until it is time to do the activity.

Serving Size Drink Amount of Sugar

12 ounces Powdered drink mix 9 teaspoons (36 grams) with sugar

12 ounces	Diet soda	0 teaspoons (0 grams)
12 ounces	Grape juice	8 teaspoons (32 grams)
12 ounces	Regular soda	9¼ teaspoons (39 grams)
12 ounces	Lemonade	6¼ teaspoons (25 grams)

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 223

Group Activity

We are going to play a guessing game to learn how much sugar is in some common beverages.

Give group members the “Think Before You Drink: Hidden Sugar in Common Beverages” handout (page 242).
Show group members the front of each of the five cards that you prepared before the session, showing them the names of the beverages.

Guess how many teaspoons of sugar are in each drink. Write your answers on the handout I gave you.

Note: Allow 2 minutes for group members to write down their answers.

Ask group members to share the amounts of sugar that they guessed. After the group members have shared the amounts they guessed, show them the actual number of teaspoons of sugar that are in each drink. Pass around the cards one by one.

During the second part of this activity, you will learn how much sugar and calories are in your favorite drink.

Give group members the “How Much Sugar and Calories Are in Your Favorite Drink?” handout (page 243).

Find your favorite drink on the list. Look to see how much sugar and calories are in it. Many drinks have a high amount of sugar and calories.

224 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

As you can see, it is easy for people who choose drinks with sugar to get too many calories. Getting too many calories leads to weight gain. Try to drink more water or unsweetened drinks instead of drinks with sugar or regular sodas.

11. Staying Healthy With Diabetes––Group Activity

Note: This activity will help group members think about ways they can help their relatives and friends with diabetes stay healthy. You may select one or more stories to review.

Give group members the “Staying Healthy With Diabetes: Real-Life Stories” handout (pages 244–246).
Divide group members into groups of three to five people and give each group a different story (handout) to discuss.

Each group will read the story on the handout and think about ways to solve the problems described. Please choose one member of your group to read the story and the corresponding questions aloud to the group. Write down the group’s answers to each of the questions.

Note: Allow 5 to 7 minutes for group members to do the activity.

I would like one volunteer from each group to read the story and the answers to the questions aloud.

Note: After each volunteer reads the story and answers, ask the entire group if they have any other solutions to share.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 225

Staying Healthy With Diabetes: Real-Life Stories

Scene 1: Harris Family Reunion

Saturday is the Harris family reunion. Many relatives will bring lots of tasty foods and desserts such as cakes, ice cream, and pies. Harold has not been to a potluck meal since his doctor told him he has diabetes. He has worked hard to make changes in his eating habits. Now, Harold wonders what he and his wife Faith should bring to the family reunion and what foods he should eat while he’s there.

Note: Add the following answers to each question if they are not mentioned.

What can Harold bring to the reunion?

• Water and diet soft drinks • Vegetables seasoned with lemon, a little bit of olive oil, and some herbs

or spices

• Steamed corn on the cob • Homemade dessert with fat-free and sugar-free ingredients • Fresh fruit salad

How can Harold stick to his new eating plan while he’s at the reunion?

• Eat smaller portions. • Do not have second helpings of high-calorie foods. Eat salad or fresh

fruit if he is still hungry.

• Cut back on sweet foods, high-fat foods, white sauces, gravies, and

alcohol.

What else can Harold do?

• Eat a healthy snack before the party, so he is not hungry. • Take a walk after eating. • Check his blood glucose 2 hours after eating to see how his food

choices affected it.

226 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Staying Healthy With Diabetes: Real-Life Stories (continued)

Scene 2: Connie’s New Shoes

Connie bought a new pair of shoes a week ago. She wore them 2 days in a row because her feet felt fine. When she took off her shoes at the end of the second day, however, Connie noticed some red spots on both of her feet and blisters on the big toe of her right foot. She wonders what she needs to do about the red spots and blisters on her feet. Connie is concerned that she did not feel the sores on her feet. She also worries that her diabetes is not under control.

Note: Share the answers to each question if they are not said.

What can Connie do about the sores on her feet?

• People with diabetes need to see a health care provider if they see a cut,

blisters, or signs of infection on their feet.

• Connie should go for a foot screening, which includes inspection, testing for

feeling, and other tests.

• Because she can’t feel sensation in her feet, Connie needs to practice

personal foot care every day to look for changes and infections.

What should people with diabetes consider when buying shoes?

• Medicare provides coverage of special shoes for people with diabetes.

Check with your doctor to see if you qualify.

• Buy new shoes carefully. • Choose shoes that fit well and are made of leather or canvas, with laces or

straps, a smooth lining inside, rounded toes, low and firm heels, and soft insoles.

• Have the salesperson measure both feet. Test the shoes by wearing them for

at least 5 minutes in the store.

• If the shoes hurt, don’t buy them. • Break in new shoes slowly by wearing them for only 1 or 2 hours a day.

Check for irritation or redness every time you remove your shoes and socks. Never wear new shoes all day long.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 227

Staying Healthy With Diabetes: Real-Life Stories (continued)

Scene 3: What’s Wrong With Angela?

First visit: Angela and her cousin, Dawn, go shopping together on a Saturday afternoon. Angela has to stop frequently to use the restroom during the shopping trip, so Dawn, who is a community health worker, asks her if anything is wrong. Angela says she has been feeling tired and thirsty lately and she has been urinating often. Even though she is physically active, Angela wonders if she could have diabetes. She asks Dawn what she should do.

Note: Add the following answers to each question if they are not mentioned.

What can Dawn tell Angela during this first visit?

• Advise Angela to go to the clinic and have her blood glucose checked. If

she has diabetes, she needs to be treated right away. Dawn cannot make a diagnosis.

• Explain that people are more likely to have diabetes if they are

overweight and inactive. Other risk factors that make someone more likely to have diabetes include having a parent or other family members with diabetes and being age 40 or older.

Second visit: When Angela talks to her cousin again, she tells Dawn that she went to the doctor. The doctor confirmed that Angela has diabetes. Angela is afraid.

How can Dawn help Angela overcome her fear during this second visit?

• Tell Angela that most people with diabetes may feel scared, depressed, or

angry at one time or another.

• Mention that some people with diabetes overcome their fears when they

learn what they can do to control diabetes and stay healthy.

• Tell Angela that she can prevent or slow down diabetes problems with

good control of her blood glucose, blood pressure, and blood cholesterol. Advise her to visit the eye doctor to check for eye problems.

228 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Staying Healthy With Diabetes: Real-Life Stories (continued)

Scene 3: What’s Wrong With Angela? (continued)

• Encourage Angela to attend classes at the clinic and to join a support

group that helps people with diabetes to stay healthy. It helps to talk with others who are living with diabetes.

• Tell Angela that there is a close link between diabetes and heart disease.

Encourage her to ask her doctor to check her blood pressure and cholesterol, and encourage Angela to learn ways to lower her chances for heart attack and stroke.

12. Soul Food Makeover: Strawberry and Pineapple Delight Recipe

Note: This activity will give group members a chance to try heart healthy recipes at home.

Give group members the “Soul Food Makeover: Strawberry and Pineapple Delight Recipe” handout (page 247).

This recipe makes a dessert dish that you can bring to a family gathering or other event. The recipe has only 40 calories and 0 grams of fat per serving.

Ask group members to prepare the recipe during the coming week. Tell them that using the recipe will give them a chance to practice some of the ideas from the session.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 229

Review of Today’s Key Points

Let’s review what we learned today.

What is diabetes?

• Diabetes happens when the body does not make enough insulin or cannot use

it well, causing glucose to build up in the blood. As a result, the body does not function well.

What are risk factors for diabetes?

• Overweight

• Family members with diabetes

• Age 40 or older

• Physical inactivity

• Being African American, Latino, American Indian, Asian American, or

Pacific Islander, because diabetes occurs more often in people from these groups than in whites

• Having had gestational diabetes or given birth to at least one baby weighing 9

pounds or more

• High blood pressure

• Cholesterol levels are not normal—HDL cholesterol is low, or triglycerides

are high

How can you prevent or delay type 2 diabetes?

• Be physically active for 30 minutes on most days.

• Lose a small amount of weight. For example, losing 10 to 15 pounds is

helpful for someone who weighs 200 pounds.

230 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

What are the ABCs of diabetes control?

• A is for the A1C test. If you have diabetes, take the A1C blood test at least

two times every year. This test measures how well a person’s blood glucose level has been controlled over the past 3 months. People who have diabetes should aim for an A1C number that is below seven.

• B is for blood pressure. High blood pressure makes your heart work too

hard. It increases your risk for a heart attack, stroke, or damage to your kidneys and eyes. A person with diabetes should have a blood pressure below 130/80 mmHg.

• C is for cholesterol. Keep cholesterol at normal levels. Bad cholesterol

(LDL) can build up and clog your arteries. It can cause a heart attack. People with diabetes need to keep their LDL cholesterol below 100 mg/dL.

How does diabetes affect your body?

• Diabetes can cause damage to the heart, brain, kidneys, and eyes. It can

cause nerve damage, which reduces sensation in your feet. Diabetes may also affect blood flow in your legs and feet. This can lead to sores that don’t heal and amputation. Good control of your blood glucose can prevent this damage.

Weekly Pledge

You have learned a lot today about diabetes prevention and control. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to prevent or control diabetes. This will be your pledge for the week.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 231

• Be specific about what you plan to do, how you plan to do it, and when you

will start. Here are some examples:

— I will talk to my doctor about my risk for diabetes and see if I need to

get my blood glucose level checked.

— If I have diabetes, I will check my blood glucose levels as my doctor

tells me.

— I will compare food labels the next time I go to the store to help me

choose packaged foods that are lower in sugar.

— I will drink water with my lunch this week instead of regular sodas or

other drinks with sugar.

Write your pledge on the “Be Smart About Your Heart: Control the ABCs of Diabetes” handout. Keep this handout in a special place so you can review your pledges and keep your goals in mind.

Note: Allow 5 minutes for group members to think of a pledge.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional) Say:

Keeping a personal value in mind can help you reduce your risk for diabetes or control your diabetes if you already have it. Remember that a personal value is a quality that you consider important.

Today the value is joy. Joy can help you replace boredom, indifference, and depression with a positive outlook. As today’s quote states, “Just don’t give up trying to do what you really want to do. Where there is love and inspiration, I don’t think you can go wrong.”

232 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Joy can help you enjoy preparing foods the healthy way. Joy is contagious, and others may follow your example!

Ask:

How could you use joy, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Don’t forget to continue working on your pledges to be more physically active; to cut back on salt, sodium, saturated fat, trans fat, and cholesterol; and to reach and keep a healthy weight.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be about making heart healthy eating an everyday family reunion. Please continue to fill out your family health history.

Note: Think about today’s session. What worked? What didn’t work? Have you had changes in your own life as a result of today’s session?

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 233

What Is Diabetes?

Diabetes happens when the body does not make enough insulin or cannot use it well. This causes glucose to build up in the blood. As a result, the body does not function well.

Know your body

The food we eat goes to the stomach,

Insulin where it is digested. The food is turned Glucose

The pancreas

into glucose in the body. Glucose is The stomach makes the

digests the insulin.

also called blood sugar. The body uses food. glucose for energy needed for daily life.

The blood takes the glucose to the cells where it is turned into energy. However, glucose cannot enter the cells alone: it needs help. Insulin helps the glucose enter the cells. Insulin is a hormone that is made in the pancreas.
If the body does not produce enough insulin, or if the cells cannot use the insulin well, then the glucose cannot enter the cells and builds up in the blood.
People who have high levels of glucose in their blood

have prediabetes or diabetes.

234 HAnDOuT—SeSSIOn 7

Are You at Risk for Type 2 Diabetes?

Name:

Check the risk factors you have. The more risk factors you check, the higher your risk for developing type 2 diabetes. Only your health care provider can determine if you have diabetes. On your next visit, find out for sure.

o I am overweight (especially if I have extra weight around the waist).

o I have a parent, brother, or sister with diabetes.

o My family background is African American, Latino, American Indian, Asian American, or Pacific Islander.

o I have had gestational diabetes, or I gave birth to at least one baby weighing 9 pounds or more.

o My blood pressure is 140/90 mmHg or higher, or I have been told by a health care professional that I have high blood pressure.

o My cholesterol levels are not normal. My HDL cholesterol (“good” cholesterol) is 35 mg/dL or lower, or my triglyceride level is 250 mg/dL or higher.

o I do very little physical activity. I exercise fewer than three times a week.

HAnDOuT—SeSSIOn 7 235

Symptoms of Diabetes

The symptoms of type 2 diabetes develop over time. Some people have symptoms, and others do not. Here are some symptoms of diabetes.

Feeling tired

Increased thirst

Frequent urination

Sores that don’t heal

Very dry skin

“Pins and needles” feeling in the feet

Increased hunger Blurry vision

Unexplained weight loss Feeling irritable

236 HAnDOuT—SeSSIOn 7

Tender Care for Your Feet

Diabetes can cause nerve damage, which reduces sensation in your feet. Diabetes may also affect blood flow in your legs and feet, making it harder for cuts or sores to heal. Small injuries may become infected and can become very serious.

Daily care

Wash your feet in warm water every day. Dry them carefully, especially between your toes.
Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. If you cannot bend over or pull your feet up to check them, use a mirror, or ask someone else to check your feet.
If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.
Smooth corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower. Do not use a pocketknife or razor blade that can cut your skin.
Cut your toenails once a week after a bath.

Periodic foot exam

Remind the health care provider to check your feet at every visit.
Get a complete foot exam once a year. If you have problems with your feet, have the health provider check them every 3 to 6 months.

Footwear

Wear well-cushioned shoes and socks at all times. Do not go barefoot.
Change your socks every day, and make sure they are clean and soft.
Buy shoes that are roomy and allow your feet to “breathe.”
Medicare provides coverage of special shoes for people with diabetes. Check with your doctor to see if you qualify.

HAnDOuT—SeSSIOn 7 237

Be Smart About Your Heart: Control the ABCs of Diabetes

Some people have prediabetes, which is when blood glucose levels are higher than normal but not in the diabetes range. People with this condition can reduce the risk of developing diabetes by losing a small amount of weight and increasing their physical activity.

If you have diabetes, controlling your blood glucose levels will help prevent complications.

The ABCs of Diabetes Be sure to ask your doctor:

If you have diabetes, three key steps can ■ What are my ABC numbers? help you lower your risk of heart attack and

stroke. Follow these ABCs:	■ What should my ABC target numbers be?
■ A is for A1C test, which is short for	■ What actions should I take to reach my
hemoglobin A1C. This test measures	ABC target numbers?

your average blood glucose over the

past 3 months. It lets you know if your blood glucose level is under control. Get this test at least twice a year.

Write the changes you will make this week to control your blood glucose, blood pressure, or

cholesterol.

Number to aim for: below 7

B is for blood pressure. The higher your blood pressure, the harder your heart has to work. Get your blood pressure measured at every doctor’s visit.

Numbers to aim for: below 130/80 mmHg

C is for cholesterol. Maintain a normal cholesterol level. “Bad” cholesterol, or LDL, builds up and clogs your arteries. Get your LDL cholesterol tested at least once a year.

Number to aim for: below 100 mg/dL

238 HAnDOuT—SeSSIOn 7

Read the Food Label for Sugar!

Food labels tell you what you need to know about choosing foods that are lower in calories and sugar. Here is a food label for 100% grape juice. The label provides lots of useful information

100% Grape Juice

Nutrition Facts

Serving Size 1 cup (8 fl oz) Servings Per Container 8

Amount Per Serving Amount Per Serving

Calories 150

Serving Size and Number of Servings The serving size is 1 cup. There are eight servings in

Calories from Fat 0

The nutrient amounts

% Daily Value*

provided on the label are for

Total Fat 0g 0%

one serving. If you have

Saturated Fat 0g 0%

more than one serving, you

Trans Fat 0g

will get more calories and

Cholesterol 0mg 0%

other nutrients. For example,

Sodium 15mg 1%

if you drink two servings (2

Potassium 170mg 5%

cups) of grape juice, you will

Total Carbohydrate 37g 12%

take in 300 calories and 64

Dietary Fiber 0g 0%

grams of sugar.

Sugars 32g

Calories and Sugar Protein 0g Here are the amounts of calories

this container.

Percent Daily Value The Percent Daily Value helps you compare nutrient amounts in products. There is no Percent Daily Value for calories or sugar. Choose foods with the lowest amount of calories and sugar.

Vitamin C 120%

and sugar in one serving.

Calcium 2% Iron 2%

The Choice is Yours— Calories 150 Calories from Fat 0

% Daily Value*

Compare!

Total Fat 0g 0%

Which one would you Saturated Fat 0g 0%

Trans Fat 0g

choose?

Cholesterol 0mg 0%

Sodium 15mg 1%

The unsweetened iced tea has

Potassium 170mg 5%

fewer calories and no sugar.

Total Carbohydrate 37g 12%

That makes the iced tea a better

Dietary Fiber 0g 0%

choice! Read food labels and Sugars 32g choose products to keep your heart strong. 100% Grape Juice One cup of grape juice has 150 calories and 32 grams of sugar.

Calories 5 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0%

Trans Fat 0g

Cholesterol 0mg	0%
Sodium 0mg	0%
Potassium 0mg	0%
Total Carbohydrate 0g	0%
Dietary Fiber 0g	0%

Sugars 0g

Unsweetened Iced Tea One cup of unsweetened iced tea has 5 calories and no sugar. You can learn a lot from a food label.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HAnDOuT—SeSSIOn 7

Pam’s Food Choices

1 – Cooked Oatmeal

Pam has offered to go grocery

Nutrition Facts

shopping for

Serving Size ½ cup (41g dry)

her mother, Ms. Servings Per Container 13 Diane, who is

Amount Per Serving

home sick with Calories 130 Calories from Fat 20 the flu. Ms. Diane % Daily Value* also has diabetes. Total Fat 2g 3% Lower

Saturated Fat 0g 0% sugar

Pam wants to buy Trans Fat 0g choice foods that are Cholesterol 0mg 0% ______ lower in calories Sodium 0mg 0%

Total Carbohydrate 22g 7% Grams

and sugar to help

Dietary Fiber 4g 16% of sugar

her mother. Look

saved

Sugars 0g

at the food labels.

___

Protein 5g

Help Pam select foods that are Vitamin A 0% Vitamin C 0% lower in sugar. Calcium 0% Iron 0%

Which foods should Pam

3 – Gelatin

buy? Write the number of

Nutrition Facts

your choice for

Serving Size 1/4 cup

each pair in the

Servings Per Container 8

space between

Amount Per Serving

the labels. Then Calories 80 Calories from Fat 0 write the number % Daily Value* of grams of Total Fat 0g 0% sugar saved by Saturated Fat 0g 0% Lower this choice. Trans Fat 0g sugar

Cholesterol 0mg 0% choice Sodium 100mg 4% ______

Total Carbohydrate 19g 6%

Dietary Fiber 0g 0% Grams of sugar

Sugars 19g

saved

Protein 2g

___

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 0%

2 – Toaster Pastry

Nutrition Facts

Serving Size 1 pastry (52g) Servings Per Container 8

Amount Per Serving Calories 180 Calories from Fat 45

% Daily Value*

Total Fat 5g 8%

Saturated Fat 1.5g 8% Trans Fat 1g

Cholesterol 0mg	0%
Sodium 170mg	7%
Total Carbohydrate 31g	10%
Dietary Fiber 1g	4%

Sugars 16g

Protein 2g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 10%

4 – Sugar-Free Gelatin

Nutrition Facts

Serving Size 1/4 cup Servings Per Container 8

Amount Per Serving Calories 10 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 55mg	2%
Total Carbohydrate 0g	0%
Dietary Fiber 0g	0%

Sugars 0g

Protein 1g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

SSIO

Pam’s Food Choices

5 – Fat-Free, No-Sugar-Added Chocolate Ice Cream

Nutrition Facts

Serving Size 1/2 cup (66g) Servings Per Container 16

Amount Per Serving Calories 80 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Lower Trans Fat 0g sugar Cholesterol 0mg 0% choice ___

Sodium 50mg 2%

Total Carbohydrate 19g 6%

Grams

Dietary Fiber 5g 20%

of sugar

Sugars 4g

saved

Protein 3g

___

Vitamin A 6% Vitamin C 0%

Calcium 8% Iron 0%

7 – Diet Soda

Nutrition Facts

Serving Size 1 can (12 fl oz) Servings Per Container 1

Amount Per Serving Calories 0 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Lower Trans Fat 0g sugar Cholesterol 0mg 0% choice Sodium 35mg 1% ______

Total Carbohydrate 0g 0%

Dietary Fiber 0g 0% Grams of sugar

Sugars 0g

saved

Protein 0g

___

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 0%

6 – Chocolate Ice Cream

Nutrition Facts

Serving Size 1/2 cup (66g) Servings Per Container 16

Amount Per Serving Calories 170 Calories from Fat 80

% Daily Value*

Total Fat 9g 14%

Saturated Fat 6g 30% Trans Fat 0g

Cholesterol 20mg	7%
Sodium 40mg	2%
Total Carbohydrate 21g	7%
Dietary Fiber 1g	4%

Sugars 17g

Protein 2g

Vitamin A 4% Vitamin C 0%

Calcium 6% Iron 0%

8 – Regular Soda

Nutrition Facts

Serving Size 1 can (12 fl oz) Servings Per Container 1

Amount Per Serving Calories 140 Calories from Fat 0

% Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 50mg	2%
Total Carbohydrate 39g	13%
Dietary Fiber 0g	0%

Sugars 39g

Protein 0g

Vitamin A 0% Vitamin C 0%

Calcium 0% Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

SSIO

Think Before You Drink: Hidden Sugar in Common Beverages

Try to guess the amount of sugar (in teaspoons) that is found in each drink.

Drink

Powdered drink with sugar

Diet soda

Grape juice

Regular soda

Lemonade

Write your answers on the “My Guess” line.

Teaspoons of Sugar

My Guess

______

True Amount

______

HAnDOuT—SeSSIOn 7

How Much Sugar and Calories Are in Your Favorite Drink?

Drink (12-ounce serving)

Bottled Water

Cola

Diet Cola

Root Beer

Orange Soda

Powdered Drink Mix With Sugar

Sugar-Free Drink Mix

Lemonade

Sugar-Free Lemonade

Grape Juice

Orange Juice

Fruit Punch

Sports Drink

Sweet Tea

Unsweetened Tea

Approximate Number

Grams of Sugar	of Teaspoons of Sugar	Calories
0 grams	0 teaspoons	0
41 grams	101/4 teaspoons	150
0 grams	0 teaspoons	0
46 grams	11½ teaspoons	170
52 grams	13 teaspoons	210
36 grams	9 teaspoons	145
0 grams	0 teaspoons	0
25 grams	6¼ teaspoons	105
0 grams	0 teaspoons	0
32 grams	8 teaspoons	150
20 grams	5 teaspoons	105
46 grams	11½ teaspoons	195
8½ grams	2 teaspoons	75
33 grams	8½ teaspoons	120
0 grams	0 teaspoons	0

HAnDOuT—SeSSIOn 7 243

Staying Healthy With Diabetes: Real-Life Stories

What can you do?

Scene 1: Harris Family Reunion Saturday is the Harris family reunion. Many relatives will bring lots of tasty foods and desserts such as cakes, ice cream, and pies. Harold has not been to a potluck meal since his doctor told him he has diabetes. He has worked hard to make changes in his eating habits. Now, Harold wonders what he and his wife should bring to the family reunion and what foods he should eat while he’s there.

What can Harold bring to the reunion?

How can Harold stick to his new eating plan while he’s at the reunion?

What else can Harold do?

244 HAnDOuT—SeSSIOn 7

Staying Healthy With Diabetes: Real-Life Stories (continued)

What can you do?

Scene 2: Connie’s new Shoes

Connie bought a new pair of shoes a week ago. She wore them 2 days in a row because her feet felt fine. When she took off her shoes at the end of the second day, however, Connie noticed some red spots on both of her feet and blisters on the big toe on her right foot. She wonders what she needs to do about the red spots and blisters on her feet. Connie is concerned that she did not feel the sores on her feet. She also worries that her diabetes is not under control.

What can Connie do about the sores on her feet?

What should people with diabetes consider when buying shoes?

HAnDOuT—SeSSIOn 7 245

Staying Healthy With Diabetes: Real-Life Stories (continued)

What can you do?

Scene 3: What’s Wrong With Angela?

What can Dawn tell Angela to do if she is wondering if she might have diabetes?

Second visit: When Angela talks to her cousin again, she tells Dawn that she went to the doctor. The doctor confirmed that Angela has diabetes. Angela is afraid.

How can Dawn help Angela overcome her fear of having diabetes?

246 HAnDOuT—SeSSIOn 7

Soul Food Makeover: Strawberry and Pineapple Delight Recipe

2 cups

1 package

½ teaspoon

1 large can (20 ounces)

1 can (11 ounces)

16 large

boiling water 1. Pour boiling water in a large bowl. Add the

gelatin and cinnamon to the water. Stir for

sugar-free, low-

at least 2 minutes, making sure the gelatin

calorie strawberry

is completely dissolved.

gelatin

Drain pineapple chunks and save the juice.

cinnamon

Add ice (or cold water) to the leftover juice

pineapple chunks to measure 1½ cups. Add gelatin. Stir until in fruit juice, ice is completely melted. not drained

Refrigerate about 45 minutes or until

mandarin orange gelatin is slightly thickened (consistency of segments in fruit an unbeaten egg white). juice, drained

Reserve ¼ cup each of the pineapple and

ice cubes orange. Add the remaining pineapple and

orange segments to thickened gelatin. Pour into a 1½-quart serving bowl.

Refrigerate for 4 hours or until firm. Garnish with the reserved pineapple and orange segments.

Makes 12 servings Serving size: ½ cup Each serving provides: Calories: 40 Total fat: 0 g Saturated fat: 0 g Trans fat: 0 g Cholesterol: 0 g Sodium: 23 g

The Makeover

10 g Dietary fiber: 1 g Sugar: 9 g Protein: 1 g Potassium: 94 mg

Previously, the Harris family ate high-calorie desserts made with a lot of added sugar. This tasty recipe is low in sugar because it uses sugar-free gelatin as well as pineapple and mandarin oranges canned in fruit juice instead of heavy syrup. The cinnamon in the recipe provides the extra flavor without the added sugar. Try this delicious, low-fat dessert for your next social gathering.

HAnDOuT—SeSSIOn 7 247

In every conceivable manner,

“

the family is the link to our past, bridge to our future.

”

Alex Haley

Session 8

Make Heart Healthy Eating an Everyday Family Reunion

sess i o n

Make Heart Healthy Eating an Everyday Family Reunion

Objectives

By the end of this session, group members will learn:

How to plan and prepare traditional African American and soul food meals in a heart healthy way
How to choose foods for a heart healthy diet

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Set of measuring cups (1 cup, ½ cup, ¼ cup)
Blackboard and chalk or several large pieces of paper, a marker, and tape

Handouts

Give group members these handouts during this session:

(Optional) “Serving Sizes” (from Session 6, page 198)
“Heart Healthy Eating Plan” (page 270)

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 249

“Cooking With Children” (pages 271–272)
“Soul Food Makeover—Six Traditional African American Dishes for an Everyday Family Reunion” (pages 273–278)

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

Eat a Variety of Heart Healthy Foods
African American and Soul Food Dishes
A Heart Healthy Eating Plan for African American Families
How To Choose Heart Healthy Foods
Cooking With Children
Soul Food Makeover—Six Traditional African American Dishes for an Everyday Family Reunion (pages 273–278)

Review of Today’s Key Points

Weekly Pledge

Closing

250 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about what you need to know about diabetes.

Review these questions:

Q: What is diabetes?

A: Diabetes results when the body does not make enough insulin or cannot use it well, causing glucose (sugar) to build up in the blood. As a result, the body does not function well.

Q: What are risk factors for diabetes?

• Overweight

• Family members with diabetes

• Age 40 or older

• Physical inactivity

• History of gestational diabetes or giving birth to at least one baby

weighing 9 pounds or more

• High blood pressure

• Cholesterol levels are not normal: HDL cholesterol is low, or

triglycerides are high

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 251

Q: What are the ABCs of diabetes control?

• A is for the A1C test. This simple lab test shows a person’s average

blood glucose level over the past 3 months. The A1C number to aim for is below seven.

• B is for blood pressure. The higher your blood pressure, the harder your

heart has to work. High blood pressure increases your risk for a heart attack, stroke, and damage to your kidneys and eyes. Your blood pressure should be below 130/80 mmHg (millimeters of mercury).

• C is for cholesterol. Keep cholesterol at normal levels. Bad cholesterol

or LDL can build up and clog your arteries. It can lead to a heart attack or stroke. People with type 2 diabetes need to keep their LDL cholesterol below 100 mg/dL (milligrams per deciliter).

Q: How does diabetes affect your body?

A: Diabetes can cause damage to the heart, brain, kidneys, and eyes. It can cause nerve damage, which reduces feeling in your feet. Diabetes can also affect blood flow in your legs and feet, which can lead to sores that don’t heal and amputation.

At the end of last session, you made a pledge to prevent or control diabetes.

Please share what you did. What went well? Did you have any problems? How did you solve the problems?

Note: Allow 2 minutes for group members to respond.

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

252 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

Does anyone want to share what you have learned about your family health history?

Note: Allow about 5 minutes for group members to respond.

3. About This Session

Alex Haley, Pulitzer Prize-winning African American author of “Roots,” said, “In every conceivable manner, the family is the link to our past, bridge to our future.”

Ask:

What does this quote mean to you?

Note: Allow 2 to 3 minutes for group members to respond.

What you choose to eat can make a difference in your heart health. During this session, you will learn how to:

• Choose a variety of foods for heart health.

• Learn how to make some traditional African American and soul food dishes

more heart healthy.

• Identify serving sizes and the number of recommended servings for each

food group.

• Learn about the history of some traditional African American dishes and foods.

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 253

Conducting the Session

1. Eat a Variety of Heart Healthy Foods

Ask:

Why is it important to eat a variety of heart healthy foods?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add the answers below if the group

members do not say them. • Eating a variety of foods that are lower in saturated fat, trans fat, cholesterol, salt and sodium, sugar, and calories can

More Information Nutrients in the foods we eat include: Carbohydrates help you have a healthy heart. Protein Fats

• One food cannot give all the nutrients in

Fiber the amounts your body needs. Vitamins Minerals

2. African American and Soul Food Dishes

Note: This session will help group members think about the foods they eat. Some favorite traditional African American and soul food dishes are very nutritious. Other dishes can be prepared in more heart healthy ways.

Soul food combines traditional African food and food preparation methods with the African American experience in the United States, from slavery through today.

Let’s take some time to talk about soul food by answering these three questions:

254 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• What does soul food mean to you?

• What foods would you call soul food?

• What are some of the soul food dishes that you and your family like to eat?

Note: Allow 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Ask:

What are some foods that you think are native to our African ancestors?

Note: Allow 2 to 3 minutes for group members to respond.

Add the foods below if they are not mentioned:

• Grains, legumes, yams, and sorghum

• Watermelon, pumpkin, okra, wild lemons, and oranges

• Dates, figs, eggplant, cucumber, onion, garlic, and leafy greens

Ask:

What kind of cooking methods do you think were used by the ancestors of African Americans in Africa?

Note: Allow 2 to 3 minutes for group members to respond.

Add the methods below if they are not mentioned:

• Dishes such as stews and soups were cooked in one pot over an open fire.

• Spices and seasonings were used to flavor meals and prevent spoilage.

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 255

More Information

• The ancestors of African Americans often told stories and recited oral

history while traditional dishes cooked for hours. This oral tradition is still a part of African American family gatherings, such as Sunday dinners or family reunions.

• African Americans were resourceful during slavery and created filling and tasty

meals with the small provisions provided. Some of these resourceful cooking skills are part of African American food traditions today.

• African Americans were skilled at recreating leftovers, such as salmon

croquettes. Today, salmon croquettes are a special dish on their own and are not reserved for leftovers only.

Examples of common foods and dishes prepared and eaten by African Americans include:

• Breads and grains, such as cornbread, biscuits, and cornbread

stuffing (dressing)

• Pea, bean, and nut dishes, such as succotash (a corn and lima bean dish), black-

eyed peas, butterbeans, “Hoppin’ John” (a dish usually made with black-eyed peas, a meat, and rice), field peas, and peanuts

• Rice and pasta dishes, such as red beans and rice, jambalaya, and baked

macaroni and cheese

• Vegetable dishes, such as green beans, collard greens, carrot and raisin

salad, coleslaw, candied yams, potato salad, cabbage, okra, squash, and sweet potato pie

• Fruits, such as peaches and bananas • Meat and poultry dishes, such as chicken gumbo, meatloaf, pork chops (loin or

lean varieties), and chicken creole

• Fish and fish dishes, such as catfish stew, whiting, porgie, salmon croquette,

and mackerel

256 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

To make lasting life changes you need to start slowly. The “Soul Food Makeover” recipes in the “With Every Heartbeat Is Life” manual can help you prepare traditional African American family meals in heart healthy ways. I will give you more recipes later in the session. Try each recipe to see how you like it, and then put them all together for a delicious and heart healthy family feast.

More Information

• African American soul food dishes tend to be prepared differently by each

family. In the African American tradition, families and communities used the foods and ingredients that were available to them.

• African American traditional dishes were passed down orally, so there is no

“correct” way to prepare dishes. Just keep in mind the heart healthy cooking skills we have been learning, and apply them to your family recipes.

3. A Heart Healthy Eating Plan for African American Families

We can take steps to improve the way we eat and still enjoy our traditional dishes. The first step is to learn which foods we should eat more often. The second step is to learn the amount of these foods that we should eat each day.

Show picture card 8.1. (Keep it in view throughout this activity.)

A heart healthy eating plan is useful. It shows both the types and amounts of foods that we can choose for better health.

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 257

Note: Give group members the “Heart Healthy Eating Plan” handout (page 270).

The food choices you make each day affect your health. We will talk about ways to choose healthy foods. We also will discuss the recommended number of servings for each food group for a 2,000-calorie diet.

Grains (6 to 8 servings a day)

• Make at least half of your grains whole grains. Eat at least three servings of

whole grain cereals, breads, rice, or pasta every day.

• Look at the food label, and choose grain products that have whole grains as

the first ingredient. Some examples of whole grain ingredients are whole wheat, whole oats, oatmeal, and whole rye.

• For a change, try brown rice or whole wheat pasta instead of white rice

or pasta.

• Snack on ready-to-eat, whole grain cereal, such as toasted oat cereal. Also

try popcorn with little or no salt or butter as a snack.

Note: One ounce of grains is one serving. In general, 1 ounce of grains is one slice of bread, about 1 cup of ready-to-eat cereal, or ½ cup of cooked rice, cooked pasta, or cooked cereal.

Vegetables (4 to 5 servings a day)

• Eat more green vegetables, such as green beans, broccoli, okra, and dark

leafy greens.

• Eat more orange vegetables, such as carrots, squash, and sweet potatoes.

• Eat more nuts and legumes, such as lima beans and black-eyed peas.

• Stock up on frozen vegetables for quick and easy cooking in the microwave.

258 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• Buy fresh vegetables in season. They cost less and are likely to be at their

peak flavor.

• Plan some meals around a vegetable main dish, such as vegetable stirfry

or soup.

• Choose no-salt-added canned vegetables.

Fruits (4 to 5 servings a day)

• Choose fresh, frozen, canned, or dried fruit.

• Go easy on fruit juices because they contain a lot of calories and sugar. Try

to eat whole fruit (oranges, apples, mangos) more often than fruit juice.

• Keep a bowl of whole fruit on the table or counter or in the refrigerator.

Fat-free or low-fat milk and milk products (2 to 3 servings a day)

• Get your calcium-rich foods.

• Choose fat-free or low-fat milk, yogurt, and other milk products.

• If you usually use whole milk, switch gradually to fat-free milk. Try

reduced-fat (2%) milk, then low-fat (1%) milk, and then fat-free milk.

• Have fat-free or low-fat yogurt for a snack.

• If you are lactose intolerant, try lactose-free products, such as yogurt, cheese,

and lactose-free milk.

Lean meats, poultry, and fish (6 or fewer servings a day)

• Choose low-fat or lean meats and poultry. Select meat cuts that are low in fat

and ground beef that is extra lean.

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 259

• Eat a variety of foods with protein. Choose more fish.

• Choose lean turkey, roast beef, or ham instead of fatty lunch meats, such as

regular bologna or salami.

• Bake, broil, or grill meat.

Nuts, seeds, and legumes (4 to 5 servings a week)

Choose cooked and dry beans, nuts, seeds, and peas for rich sources of protein and fiber.

Fats and oils (2 to 3 servings a day)

• Get most of your fat from food sources such as fish, nuts, and vegetable oils.

• Limit solid fats, such as butter, stick margarine, shortening, and lard, as well

as foods that contain these fats.

Sweets and added sugars (5 or fewer servings a week)

• Choose foods and beverages that are low in calories and sugar. Use the

Nutrition Facts label to compare the calorie and sugar content of foods and beverages.

• Choose water, fat-free milk, or other unsweetened beverages most often.

• Select unsweetened cereal and add fruit.

Ask these questions, and hold up the correct measuring cup for each answer.

Q: What is one serving of a cooked vegetable?

A: ½ cup

260 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Q: How much milk or yogurt is considered one serving?

A: 1 cup

Q: Can you give an example of a 1-ounce serving from the grains group?

A: 1-ounce servings from the grains group include:

• One slice of bread

• About 1 cup of ready-to-eat cereal or ½ cup of cooked cereal, such

as oatmeal

• ½ cup of cooked rice or pasta

Q: What counts as one serving of fruit?

A: 1 medium apple, banana, or orange

• 1 cup of raw or canned fruit or 100% fruit juice

• ¼ cup dried fruit

Q: What is a serving of cooked beans?

A: ½ cup

4. How To Choose Heart Healthy Foods

We are going to do a group activity. During this activity, we will learn how to make better food choices.

Note: Write Tina’s breakfast on the blackboard or on a large piece of paper taped to the wall. Fill in the “Tina’s Breakfast” and “Portion Size” columns. Leave the “Food Group” and “Better Choices” columns blank. (Optional) Repeat the game with the lunch and dinner meals.

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 261

Ask:

Which group does each food belong to? What changes would make Tina’s breakfast more heart healthy?

the suggestions beside the foods they are replacing on the blackboard or on a large piece of paper taped to the wall. mentioned by group members.

Fill in the correct answers for any items not

Tina’s Food Group Breakfast (Leave blank for activity)

Scrambled egg made Meats with bacon fat

Bacon

Biscuit

Butter

Meats

Grains

Fats

Grapefruit with sugar Fruit

Coffee with Milk whole milk

Portion

Size

1 egg

Better Choices

(Leave blank for activity)

Boiled or poached egg, ¼ cup egg substitute, or 2 egg whites. Scramble eggs with vegetable oil spray.

3 ounces Lean turkey bacon (or 3 strips)

1 biscuit Whole grain toast or english muffin

1 teaspoon 1 teaspoon of low-fat tub margarine or jam with no added sugar

½ grapefruit Grapefruit

1 cup of coffee Coffee with fat-free milk (or with 1 tablespoon of evaporated 1 tablespoon fat-free milk) of milk

With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

(Optional)

Tina’s Breakfast Large cheeseburger with mayonnaise

Food Group (Leave blank for activity) Meats, grains, milk, vegetables, fats

Super-size french fries Vegetables, oils

Large soft drink Sweets

(Optional)

Tina’s Breakfast Fried pork chop with onions

Food Group (Leave blank for activity) Meats, vegetables, fats, oils

White rice and gravy Grains, fats, oils

Collard greens with

ham hocks

Sweetened iced tea

Sweet potato pie

Vegetables, meats, fats,

oils

Sweets

Fats, oils, and sweets; vegetables

LuNCH

Portion Size 1 large cheeseburger

Better Choices (leave blank for activity) Small hamburger without mayonnaise or grilled

chicken sandwich with mustard or ketchup

1 large serving Small order of fries or a side of fries salad with reduced-calorie salad dressing

1 large soft Water, diet soft drink, or fatdrink free milk

DINNER

Portion Better Choices Size (Leave blank for activity)

Baked pork chop with 1 pork chop with sauteed onions ¼ cup of onions

½ cup of Brown rice with peas and cooked rice with carrots 1 teaspoon of gravy

Collard greens cooked with 1 cup of collard skinless smoked turkey greens with breast 1 piece of ham hock

1 cup Unsweetened iced tea or tea with sugar substitute

1 slice Fresh fruit cup or heart healthy sweet potato pie (See Soul Food Makeover recipe on page 276.)

Session 8. Make Heart Healthy Eating an Everyday Family Reunion

Ask:

What are some ways to eat less saturated fat, trans fat, cholesterol, sodium, and calories?

Add the following answers if they are not mentioned:

• When shopping:

Choose a variety of whole grains, fruits, and vegetables.
Choose low-fat or fat-free milk products, salad dressings, and mayonnaise.
Choose lean cuts of meat. Trim away extra fat.
Use food labels to choose foods lower in saturated fat, trans fat, cholesterol, sodium, sugar, and calories.

• When cooking:

Use vegetable oil or soft tub margarine instead of butter or lard.
Cook with low-fat methods, such as baking, broiling, or boiling (without added fat), rather than frying.

• When eating:

Cut back on fats, oils, and sweets.
Remove skin from poultry. Throw away the skin, and do not eat it.
Choose low-fat or fat-free milk products, salad dressings, and mayonnaise.
Eat no more than four egg yolks each week.
Eat fewer high-calorie foods without much added nutrition value, such as high-fat lunch meats, pies, cakes, cookies, crackers, and chips. Drink fewer sodas.
Eat smaller portion sizes.

264 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Thank you for participating in this activity! You did great! Now you can make healthier choices for you and your family.

5. Cooking With Children

Give group members the “Cooking With Children” handout (pages 271–272).
Ask for volunteers to read the handout out loud.

As parents, you can teach your children how to develop healthy eating habits that will last a lifetime.

For good health and proper growth, children need to eat a variety of different foods every day. When children are offered a balanced diet daily, they will develop good eating habits.

Ask:

Can you think of other ways to get children involved in helping to prepare healthy meals?

Write group members’ suggestions on the blackboard or on a large piece of paper taped to the wall.

More Information

We Can! (Ways To Enhance Children’s Activity and Nutrition) is an education program to help children ages 8 to 13 maintain a healthy weight. The program includes tips and activities for parents on how to keep the family healthy by improving food choices, increasing physical activity, and reducing screen time. Visit http://wecan.nhlbi.nih.gov.

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 265

6. Soul Food Makeover—Six Traditional African American Dishes for an Everyday Family Reunion

Note: This activity will give group members a chance to try heart healthy recipes at home.

Give group members the “Soul Food Makeover—Six Traditional African American Dishes for an Everyday Family Reunion” handouts (pages 273–278).

These six traditional recipes have been “made over” for your heart. These recipes contain several heart healthy changes and substitutions.

• Vegetable oil and fat-free milk replace butter and whole milk in the sweet

potato pie recipe.

• Evaporated fat-free milk and vegetable oil spray replace whole milk and

butter in the baked macaroni and cheese dish.

• Soft tub margarine is used instead of butter in the candied yams recipe.

• The chicken is baked, not fried, in the crispy oven-fried chicken recipe. The

skin is taken off the chicken, and this reduces the fat.

• There is no salt added to the green beans, and vegetable oil spray is used to

saute onions and garlic instead of cooking oil or grease. High-fat meats or oils, such as fatback, salt-pork, ham hocks, or bacon grease, were not used to season the green beans.

• Fat-free or low-fat (1%) buttermilk replaces whole buttermilk in the

cornbread recipe. Soft margarine is used instead of butter.

These six recipes show how small changes can make traditional dishes more heart healthy. Try these traditional recipes, or experiment with your own recipes using these ingredient substitutions.

266 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Review of Today’s Key Points

Let’s review what we learned today.

Ask:

What is heart healthy about the traditional African American diet?

• The traditional African American diet provides a variety of foods that are

lower in fat and sodium, such as bread, peas, greens, rice, vegetables, fruits, poultry, fish, and milk products.

What are some foods that we should eat less often?

• We should limit foods that are high in saturated fat, trans fat, sodium, sugar,

and calories, including:

High-fat foods, such as fried fish, fried chicken, fatty meats, and high-fat cheeses
Salty foods, such as potato chips and cured meats
High-fat and high-sugar foods, such as pastries, pies, honey buns, cookies, and chocolate
Sugary foods, such as candy and soft drinks

How can the heart healthy eating plan be used to choose foods that are heart healthy?

• Use the heart healthy eating plan to choose foods that are lower in saturated

fat, trans fat, cholesterol, sodium, and sugar from each of the five food groups. The eating plan also shows the number of servings that you need from each group every day.

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 267

Why is it helpful to know how much you need to eat from each food group each day?

• When you know the amount of food you need to eat every day, it can help

you get the right amount of calories you need.

Weekly Pledge

You have learned a lot today about how to make your favorite dishes in a heart healthy way. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to eat in a heart healthy way with your family. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will make baked chicken instead of fried chicken for the next family meal.

• I will eat one more vegetable and one more fruit each day, starting tomorrow.

Note: Allow 5 minutes for group members to think of a pledge.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional) Say:

Keeping a personal value in mind can help you make heart healthy eating a part of your family life. Remember that a personal value is a quality that you consider important.

268 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Today’s value is fun. Fun can help you stay positive in your efforts to improve your health and the health of your family. As stated in today’s quote, “In every conceivable manner, the family is the link to our past, bridge to our future.”

Fun can help you overcome challenges, allowing you to laugh when you want to cry. Fun can also motivate you to turn your pledges into permanent habits.

Ask:

How could you use fun or another value to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you again at the next session. We will talk about eating in a heart healthy way—even when time or money is tight.

Note: Think about today’s session. What worked and what didn’t work? Have you made any changes in your own life that were covered in today’s session?

Session 8. Make Heart Healthy Eating an Everyday Family Reunion 269

Heart Healthy Eating Plan

Whole Grains

Bread, cereal, starchy vegetables, rice, and pasta (6 to 8 servings a day)*

Vegetables

(without added fat) (4 to 5 servings a day)*

Fruits

(4 to 5 servings a day)*

Fat-free and low-fat milk and milk products

Milk, yogurt, and cheese (choose fat-free or low-fat more often) (2 to 3 servings a day)*

Lean meats, poultry, and fish

Meat, poultry, fish, and eggs (6 or fewer servings a day)*

Nuts, seeds, and legumes

(4 to 5 servings a week)*

Fats and oils

(2 to 3 servings a day)*

Vegetable Oil

Sweets and added sugars

(5 or fewer servings a week)*

♥ Sliced whole grain bread (such as wheat, rye, or white), sandwich buns, dinner rolls, pita bread, english muffins, and bagels ♥ Unsalted, low-fat crackers (such as graham crackers); unsalted pretzels, and plain popcorn ♥ Cooked hot cereals (not instant) and whole grain cold cereals ♥ Rice and pasta (such as whole-grain noodles, spaghetti, and macaroni)

♥ Fresh, frozen, or no-salt-added canned vegetables (such as green beans, string beans, carrots, cabbage, tomatoes, squash, broccoli, and okra)

♥ Fresh, frozen, canned (packed in fruit juice), or dried fruits (such as oranges, grapefruit, bananas, apples, pineapples, watermelons, peaches, fruit cocktail, and raisins)

♥ Fat-free or low-fat (1%) milk ♥ Fat-free or low-fat yogurt ♥ Cheeses lower in fat and sodium

♥ Chicken or turkey without the skin ♥ Fish ♥ Lean cuts of meat Beef: round, sirloin, chuck, loin, and extra lean ground beef Pork: leg, shoulder, tenderloin, and lean ham ♥ Eggs (no more than four yolks a week)

♥ Cooked dry beans and peas (such as field peas, crowder peas, black-eyed peas) ♥ Frozen butter beans and lima beans ♥ Nuts and seeds

♥ Margarine (liquid, soft tub, or reduced-calorie) ♥ Oils (canola, corn, safflower, olive, peanut, or sesame)

♥ Frozen treats (such as frozen juice pops, low-fat frozen yogurt, or ice cream) ♥ Low-fat cake and cookies (such as angel food cake, fig bar cookies, gingersnaps, animal crackers, vanilla wafers, and graham crackers)

The amount of food from each food group that is right for you depends on how many calories you need. This is based on your age and gender, and how physically active you are.

HANDOuT—SESSION 8

Cooking With Children

Get Them Interested

Cooking with your children is a good way to help them develop healthy eating habits. Most children enjoy helping in the kitchen. While they help you prepare a meal, you can talk to them about healthy foods. Children like to eat the food they make. This is also a good way to get them to try new healthy foods.

Let Them Help

You can show your children how to help you prepare meals. Here are ways that children of different ages can help in the kitchen:

2-year-olds can:

Wipe tabletops. • Tear lettuce or greens.
Scrub and rinse fruits • Break cauliflower.

and vegetables.

Bring ingredients from one place to another.

3-year-olds can:

Wrap potatoes in foil for baking.
Knead and shape dough.
Mix ingredients.
Shake liquids in a covered container.
Apply soft spreads.
Put things in the trash.
Pour liquids.

4-year-olds can:

Peel oranges or hard-boiled eggs. • Cut parsley and green onions with

kid-safe scissors.

Mash bananas or cooked beans with a fork. • Set the table.

5- to 6-year-olds can:

Measure ingredients. • Use an egg beater.

Be sure to have children wash their hands before and after helping in the kitchen.

Be patient with spills and mistakes. Remember that the goal is to help your children learn about healthy eating.

HANDOuT—SESSION 8 271

Cooking With Children (continued)

Let Them Be Creative

Set out three or four healthy foods, and let your children make a new snack or sandwich from them. Use foods your children can eat without choking.

Start with:

A new kind of bread (whole grain or rye)
Whole grain crackers or graham crackers
Mini rice cakes or popcorn cakes
Small bagels
Small pieces of pita bread

Spreads could include:

Low-fat cream cheese or cheese spread • Bean dip
Low-fat peanut butter • Jelly or jam with no sugar added

Toppings could include:

• Slices of apple or banana • Raisins or other dried fruit • Strawberries

• Slices of cucumber or squash • Cherry tomatoes cut in small pieces • Slices of cheese or hard-boiled egg

As you help your children make the new snack or sandwich talk about why it is healthy.

Point out the different food groups that are included in the snack or sandwich. Explain that eating a variety of foods is healthy.

Ask why the snack or sandwich tastes good. Is it sweet, juicy, chewy, or crunchy?

Adapted from U.S. Department of Agriculture. “Tips for Using the Food Guide Pyramid for Young Children 4 to 6 Years Old,” 1999.

272 HANDOuT—SESSION 8

Soul Food Makeover

Six Traditional African American Dishes for an Everyday Family Reunion

Good for You Cornbread Recipe

1 cup 1 cup ¼ cup

cornmeal flour white sugar

1 teaspoon baking powder

1 cup 1 ¼ cup

fat-free or low-fat (1%) buttermilk egg, whole margarine, regular, tub vegetable oil spray (to coat baking pan)

Makes 10 servings

Serving size: 1 piece

Each serving provides:

Calories: 178 Total fat: 6 g Saturated fat: 1 g Cholesterol: 22 mg Sodium: 94 mg Total fiber: 1 g Protein: 4 g Carbohydrates: 27 g Potassium: 132 mg

HANDOuT—SESSION

Preheat oven to 350 ºF.
Mix together cornmeal, flour, sugar, and baking powder.
In another bowl, combine buttermilk and egg. Beat lightly.
Slowly add buttermilk and egg mixture to the dry ingredients.
Add margarine and mix by hand or with a mixer for 1 minute.
Spray vegetable oil spray to coat an 8-inch by 8-inch baking dish. Bake 20 to 25 minutes. Cool. Cut into 10 servings.

8 DRAFT 273

Soul Food Makeover

Heart Healthy Sweet Potato Pie Recipe

Crust Ingredients:

1/4 cups flour /4 teaspoon sugar /3 cup fat-free milk 2 tablespoons vegetable oil

Filling Ingredients:

/4 cup white sugar /4 cup brown sugar /2 teaspoon salt /4 teaspoon nutmeg 3 large eggs, beaten /4 cup evaporated fat-free milk, canned 1 teaspoon vanilla extract 3 cups sweet potatoes (cooked and mashed)

Vegetable Oil

The Makeover:

These two classic soul food recipes, cornbread and sweet potato pie, have been made over for your heart. They substitute lower fat ingredients, such as fat-free or low-fat (1%) buttermilk, fat-free milk, and soft tub margarine. Cooking and eating these tried and true classic dishes occasionally—the heart healthy way—will put you and your family on the road to heart healthy living while honoring your African American culinary heritage. It’s good for you and tastes good, too. You can’t beat that!

Crust Preparation:

Preheat oven to 350 ºF.
Combine the flour and sugar in a bowl.
Add milk and vegetable oil to flour mixture.
Stir with fork until mixed. Then form pastry into a smooth ball with your hands.
Roll the ball between two 12-inch squares of waxed paper using short, brisk strokes until pastry reaches edge of paper.
Peel off top of paper and invert crust into 9-inch pie plate.

Filling Preparation:

Combine sugars, salt, spices, and eggs.
Add milk and vanilla. Stir.
Add sweet potatoes and mix well.
Pour mixture into pie crust.
Bake for 60 minutes or until crust is golden brown.
Cool and cut into 16 slices.

Makes 16 servings

Serving size: 1 slice

Each serving provides:

Calories: 147 Total fat: 3 g Saturated fat: 1 g Cholesterol: 40 mg Sodium: 98 mg Total fiber: 2 g Protein: 4 g Carbohydrates: 27 g Potassium: 293 mg

HANDO

Soul Food Makeover

Crispy Oven-Fried Chicken Recipe

/2 cup fat-free milk or buttermilk 1. 1 teaspoon poultry seasoning 2. 1 cup cornflakes, crumbled (or breadcrumbs) 3.

1/2 tablespoons onion powder 1/2 tablespoons garlic powder 2 teaspoons black pepper 4.

2 teaspoons dried hot pepper, crushed 1 teaspoon ginger, ground 8 pieces chicken, skinless 5. (4 breasts, 4 drumsticks) 6. /4 teaspoon paprika vegetable oil spray 7. (use to coat baking pan) 8.

Makes 6 servings

Serving size: /2 breast or 2 small drumsticks

Each serving provides:

Calories: 256 Total fat: 5 g Saturated fat: 1 g Cholesterol: 34 mg Sodium: 286 mg Total fiber: 1 g Protein: 30 g Carbohydrates: 22 g Potassium: 339 mg

HANDOuT—SESSION

Preheat oven to 350 ºF. Add ½ teaspoon of poultry seasoning to milk. Combine all other spices except paprika with corn flake crumbs (or breadcrumbs), and place in a plastic bag. Wash chicken, and pat dry. Dip chicken into milk, shake to remove excess liquid, then quickly shake chicken in a bag with seasoning and crumbs. Refrigerate for 1 hour. Remove from refrigerator and sprinkle lightly with paprika for color. Coat baking pan with vegetable oil spray and evenly space chicken in pan. Cover with aluminum foil and bake 40 minutes. Remove foil and continue baking for an additional 30 to 40 minutes or until the meat can be easily pulled away from the bone with a fork. The drumsticks may require less baking time than the breasts. Crumbs will form a crispy “skin.” (Do not turn chicken during baking.)

8 275

Soul Food Makeover

Flavorful Green Beans Recipe

2 pounds fresh green beans /3 cup chopped onions 2 cloves garlic, chopped /2 teaspoon black pepper 1 teaspoon dried basil /2 cup water vegetable oil spray

The Makeovers:

These classic and traditional African American dishes are made over with your heart health in mind. The chicken is baked, not fried, and only a small amount of oil is used to coat the pan. With the special batter on the chicken, your taste buds will not be deprived of a great tasting soul-food-inspired chicken dish. This easy recipe for green beans has no added salt—a definite plus when cooking for your heart. By slow cooking the green beans in a small amount of water with the addition of flavorful herbs and vegetables, the green beans are firm, tender, and have plenty of taste. Adding the dried basil flakes over the green beans when they are served is a great herb complement for this dish. Your taste buds will jump for joy!

Rinse green beans, and snap tips off.
Place green beans in a large pot, and add ½ cup of cold water.
Cook green beans on stovetop with medium heat for 10 minutes.
Saute chopped onions and garlic, using vegetable oil spray, for 5 minutes or until they are tender and very lightly browned.
Add sauteed chopped onions and garlic and ground black pepper to green beans. Spray vegetable oil spray over mixture, and cook on medium heat for another 30 minutes or until green beans are tender but not soft. Mix occasionally.
Sprinkle dried basil flakes over green beans, and serve.

Makes 7 servings

Serving size: 1 cup

Each serving provides:

Calories: 40 Total fat: 0 g Saturated fat: 0 g Cholesterol: 0 mg Sodium: 12 mg Total fiber: 4 g Protein: 2 g Carbohydrates: 9 g Potassium: 179 mg

HANDO

Soul Food Makeover

Classic Baked Macaroni and Cheese Recipe

2 cups macaroni /2 cup chopped onions /2 cup evaporated, fat-free milk 1 medium egg, beaten /4 teaspoon black pepper 1/4 cups (4 oz.) sharp cheddar cheese, finely shredded vegetable oil spray

Makes 8 servings

Serving size: /2 cup

Each serving provides:

Calories: 200 Total fat: 4 g Saturated fat: 2 g Cholesterol: 34 mg Sodium: 120 mg Total fiber: 1 g Protein: 11 g Carbohydrates: 29 g Potassium: 119 mg

Cook macaroni according to package directions. (Do not add salt to the cooking water.) Drain and set aside.
Lightly coat a casserole dish with vegetable oil spray.
Preheat oven to 350 ºF.
Lightly coat a saucepan with vegetable oil spray.
Add onions to saucepan and saute for about 3 minutes.
In another bowl, combine macaroni, onions, and the remaining ingredients and mix thoroughly.
Transfer mixture into casserole dish.
Bake for 25 minutes or until bubbly. Let stand for 10 minutes before serving.

Soul Food Makeover

Candied Yams Recipe

3 medium yams (1½ cups) /4 cup brown sugar, packed 1 teaspoon flour, sifted /4 teaspoon salt /4 teaspoon ground cinnamon /4 teaspoon ground nutmeg /4 teaspoon orange peel 1 teaspoon soft tub margarine /2 cup orange juice

The Makeovers

These classic and traditional African American dishes are made over with your heart health in mind. The macaroni and cheese is lower in fat because fat-free milk and lowfat vegetable oil spray are used. The yams are also heart healthy because they are cooked with soft tub margarine instead of butter. The spices and a touch of orange juice add flavor you and your family will surely savor!

Preheat oven to 350 ºF.
Cut yams in half, and boil until tender but firm (about 20 minutes). When cooled enough to handle, peel and slice into /4-inch thickness.
Combine sugar, flour, salt, cinnamon, nutmeg, and grated orange peel.
Coat a medium-sized casserole dish with vegetable oil spray. Place half of the sliced yams in the dish. Sprinkle with spiced sugar mixture.
Dot with half the amount of margarine.
Add a second layer of yams, using the rest of the ingredients in the same order as above. Add orange juice.
Bake uncovered in oven for 20 minutes.

Makes 6 servings

Serving size: /4 cup

Each serving provides:

Calories: 110 Total fat: less than 1 g Saturated fat: less than 1 g Cholesterol: 0 mg Sodium: 115 mg Total fiber: 2 g Protein: 1 g Carbohydrates: 25 g Potassium: 344 mg

HANDOuT—SESSION 8

If people learn something better,

“

they will do better.

”

Juanita Green, Community Health Worker

Session 9

Eat in a Heart Healthy Way— Even When Time or Money Is Tight

sess i o n

Eat in a Heart Healthy Way—Even When Time or Money Is Tight

Objectives

By the end of this session, group members will learn:

Quick and easy food preparation and mealtime tips
How to eat out in a heart healthy way
How to save money on food bills

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Examples of advertisements from magazines*
Blackboard and chalk or several large pieces of paper, markers, and tape
Pencils
Prepare before the session.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 279

Handouts

Give each group member these handouts during this session:

“Tips for Busy Families” (page 299)
“Jill’s Dilemma––A Real-Life Story” (page 300)
“Tips for Eating Out the Heart Healthy Way” (page 301)
“Jill’s Monthly Food Budget” (pages 302–303)
“Money-Saving Tips” (page 304)
“Shopping List” (page 305)
“Soul Food Makeover—Catfish Stew and Rice Recipe” (page 306)

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

Eat in a Heart Healthy Way When There Is Little Time

A. Busy Times

B. Quick and Easy Meal Tips

C. Eating Out

Save Money on Your Food Bill

A. Food Budget

B. Money-Saving Tips

280 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Food Advertising Activity
Soul Food Makeover—Catfish Stew and Rice Recipe

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

During the last session, we talked about how to make traditional African American dishes in a heart healthy way.

Ask:

What is heart healthy about the traditional African American diet?

• The traditional African American diet provides a variety of foods that are

lower in fat and sodium, such as bread, peas, greens, rice, vegetables, fruits, poultry, fish, and milk products.

What are some foods that we should eat less often?

• We should limit foods that are high in saturated fat, trans fat, sodium, sugar,

and calories, including:

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 281

High-fat foods, such as fried fish, fried chicken, fatty meats, and high-fat cheeses
Salty foods, such as potato chips and cured meats
High-fat and high-sugar foods, such as pastries, pies, honey buns, cookies, and chocolate
Sugary foods, such as candy and soft drinks

How can the heart healthy eating plan be used to choose foods that are heart healthy?

• Use the heart healthy eating plan to choose foods that are lower in saturated

fat, trans fat, cholesterol, sodium, and sugar from each of the five food groups. The eating plan also shows the number of servings that you need from each group every day.

Why is it helpful to know how much you need to eat from each food group each day?

• When you know the amount of food you need to eat every day, it can help

you get the right amount of calories you need.

Ask:

How are you doing on your pledges to include a variety of heart healthy foods in your diet? What went well? What kinds of problems did you have (such as family not liking the change or showing a lack of interest)? What did you do to solve these problems?

Note: Allow about 4 minutes for group members to respond.

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

282 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

Does anyone want to share what you have learned about your family health history?

Note: Allow 5 minutes for group members to respond.

3. About This Session

Juanita Green, a community health worker from Baltimore, Maryland, said that, based on her community health education experience, “If people learn something better, they will do better.”

Ask:

What does this quote mean to you?

Note: Allow 2 to 3 minutes for group members to respond.

Today, you will learn how to eat in a heart healthy way—even when you have very little time and are on a tight budget. During this session, you will learn:

• Quick and easy ways to prepare heart healthy meals

• How to eat right when eating out

• How to make smart food-buying choices that meet your family’s needs

and budget

• How advertising can cause us to buy things that cost more or things that we

don’t need

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 283

Conducting the Session

1. Eat in a Heart Healthy Way When There Is Little Time

A. Busy Times

Many people have little time to shop, prepare food, and clean up after meals. This session will help you eat in a heart healthy way, even when you are in a rush.

Busy people may think they don’t have time to eat in a heart healthy way. These people may:

• Skip breakfast and lunch, and eat one big meal in the evening.

• Eat out several times a week.

• Buy boxed, instant, or already prepared foods.

• Buy food from vending machines.

Ask:

What foods do you eat when you don’t have time to cook?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

284 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Eating on the run often means that we are eating foods that are higher in fat, sodium, and calories. For example, we eat snacks and candies from vending machines or high-fat hotdogs and french fries from fast food restaurants.

People often eat these foods because they are easy to buy or quick to prepare. When people are in a hurry, they don’t often think about what kinds of foods are heart healthy.

They may also eat bigger portions of foods that are higher in fat and calories when there is no time to prepare healthy side dishes, such as salad, vegetables, or rice.

B. Quick and Easy Meal Tips

Note: This part of the session will help group members to think about ways to prepare meals in less time.

Give each group member the “Tips for Busy Families” handout (page 299).
Show picture card 9.1 while you review the “Plan Your Meals” and “Use a Shopping List” sections of the handout.

People often find that they are too tired to prepare the kinds of meals they would like their families to eat. Today, we will learn some ways to save time and make meal preparation easier. Some tips include:

• Plan weekly meals based on your family’s schedule.

• Save money and time by making only one trip to the store.

• Make and use a shopping list.

• Teach your family how to shop for groceries.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 285

Show picture card 9.2 when you review the “Cook in Advance” section.

There are some things families can do to enjoy heart healthy meals when time is limited. Some tips include:

• Prepare some foods in advance, such as spaghetti sauce. Use these foods for

quick meals. For example, you can add chicken or turkey to the sauce and serve it over spaghetti or rice with vegetables.

• Prepare part of a meal the night before. For example, marinate chicken in the

refrigerator overnight.

• Pack your lunch the night before.

• Cook two or three dishes on your day off, then freeze them.

Ask for volunteers to read the tips aloud, one at a time. Allow group members to comment as the tips are read.
Ask:

Would you find any of these tips difficult to do?

Note: Allow 3 to 5 minutes for group members to respond.

Group Activity

Note: This activity will help group members think about creative ways a family can enjoy heart healthy meals even when time is limited.

Divide participants into groups of three or four people. Give group members the “Jill’s Dilemma––A Real-Life Story” handout (page 300).

I am going to read a real-life situation, while you follow the story on the handout. Think about how Jill can solve her problem.

286 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Jill’s Dilemma––A Real-Life Story

Jill is a friend of the Harris family. She has two daughters, Tamika (age 3) and Shandra (age 10 months). She is also raising her two nephews, 8-year-old Devon and 10-year-old Jamar. Jill’s aunt, Ms. Connie, watches the younger children from 8 a.m. to 5 p.m. while Jill works part-time and goes to a job training program. Jill receives food assistance monthly and needs to watch her budget.

After picking up the kids, Jill doesn’t feel like making dinners that require a lot of preparation and cooking time. She usually feeds the kids prepackaged noodle mixes or spaghetti from a can. Sometimes she picks up fast food, such as fried chicken or hamburgers.

Jill has to ride a bus to shop at a supermarket with a large selection of foods. It’s hard to carry the heavy bags of groceries home from the bus stop. So she often buys her groceries from neighborhood stores that are more costly and carry fewer healthy foods.

Ask each small group to discuss ways that Jill can make sure that her family eats in a heart healthy way and write down their answers.

Note: Allow about 5 minutes for the groups to come up with suggestions.

Ask one person from each group to present his or her group’s suggestions to the entire group.
Add these ideas if they are not mentioned:

• Jill could cook two or three meals over the weekend and store them in

the freezer.

• She could make meals in a slow cooker, which saves time during the

evenings. Meals cook during the day and are ready when the family gets home.

• Jill could bring her nephews with her to the supermarket to help carry the

grocery bags home.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 287

• Jill’s family could help her by putting casseroles (from the freezer or made

the night before) into the oven before she gets home.

• Several families could get together and share meals.

• Jill’s family could help her by setting the table and doing the dishes.

• Jill could buy roasted chicken instead of fried chicken or hamburgers.

• Jill could make heart healthy homemade spaghetti and meat sauce (with

turkey or lean beef) instead of canned spaghetti. She could save time by preparing the sauce a day earlier.

C. Eating Out

Note: This activity will teach group members how to make heart healthy choices at fast food restaurants.

Ask:

Where do you eat when you eat out?

Note: Allow about 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Many people eat at fast food restaurants because:

• The food is served quickly

• The food tastes good

• The food is less expensive than food at sitdown restaurants

• Special food and toys appeal to children

• There may be a playground for children

288 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Show picture card 9.3. Keep it on display while you review the handout.

Many fast foods can be higher in saturated fat, sodium, and calories, but you can choose healthier foods from the menu. Some tips include:

• Ordering small, plain hamburgers instead of deluxe sandwiches.

• Choosing grilled chicken sandwiches instead of breaded chicken sandwiches.

• Sharing a small order of french fries instead of eating a large order

by yourself.

• Ordering a green vegetable or salad instead of two or more starches, such as

potatoes, rice, pasta, and cornbread.

• Choosing water instead of a soft drink or milkshake.

Give each group member the “Tips for Eating Out the Heart Healthy Way” handout (page 301).
Ask for volunteers to read the suggestions on the handout aloud.

Do you have other ideas for making heart healthy choices at restaurants?

Note: Allow 2 or 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Let’s talk briefly about buffet-style and “all-you-can-eat” restaurants. They may seem like moneysaving restaurant choices that allow you to enjoy your favorite dishes at one time. But you may be tempted to overeat at these restaurants in order to get “the most” for your money. Try choosing buffet and “all-you-caneat” restaurants less often.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 289

If you do go to a buffet-style restaurant, make heart healthy choices, such as baked, broiled, and grilled lean meats and fish and steamed or sauteed vegetables without sauces. Also, watch your portions. It isn’t a good deal to overeat because eventually you may pay a price with your health.

2. Save Money on Your Food Bill

A. Food Budget

Ask:

How many of you have trouble stretching a limited food budget until your next paycheck or until the end of the month? What kinds of problems do you face?

Note: Allow 3 to 5 minutes for group members to respond.

The first step to healthy eating with limited food dollars is to make a monthly food budget. A budget is a plan for the amount of money you can afford to spend on certain items.

Give each group member the “Jill’s Monthly Food Budget” handout (pages 302–303).

Let’s see how Jill made her monthly food budget.

Ask a group member to read the handout aloud.
Ask:

Does anyone have other tips to help plan a monthly food budget?

Note: Allow 3 to 5 minutes for group members to respond. Write their tips on the blackboard or on a large piece of paper taped to the wall.

290 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

B. Money-Saving Tips

Ask:

What do you do to save money on food?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

There are things you can do to save money on your food bill. Let’s go over a list of ideas.

Give each group member the “Money-Saving Tips” handout (page 304). Ask for volunteers to read the tips aloud.
Give each group member the “Shopping List” handout (page 305).

You can use this shopping list when you go to the store. Just check off or write on the blank lines what you want to buy.

3. Food Advertising Activity

Note: This section will help group members become more aware of how advertising plays into their food-buying decisions.

Food advertising is big business.

• Advertisements try to get adults and children to buy a certain product.

• Advertising costs money. Billions of dollars are spent on food advertising.

The people buying the food—the consumers—pay for this.

• Nationally advertised items usually cost more than store brands and

local brands.

• Most people are more likely to buy items with fancy, eye-catching packaging.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 291

• People, especially African Americans, can be very loyal to certain brands.

They will often buy these products even if they cost more.

Ask group members to describe advertisements that have prompted them to buy certain products.

Note: Allow about 3 minutes for group members to respond.

Review different advertising themes that are used to get people to buy food products. (Show or describe an example of the following advertising themes. Prepare these examples before the session.)

Note: As you discuss the six themes, write them on the blackboard or on a large piece of paper taped to the wall. You will need these themes for the group activities.

Popular advertising themes often focus on family, health, sex appeal, humor, appearance, or famous people.

• Family

Advertisers try to get you to use their product based on your love for your family. This works well with African Americans because the family plays an important role in their lives. Advertisements with a family theme often target African American women because of their role as family caregivers.

• Health

Some advertisements focus on the positive health effects of using certain products. This works because people care about their health.

• Sex appeal

Sex appeal sells products. Many people want to believe that they also will be beautiful and sexy if they use the advertised product.

• Humor

A funny advertisement often helps people remember a product.

• Appearance

292 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Food advertisers show food that may look better than the real thing. This makes people want to try the product.

• Famous people

Famous people are used to sell products. Advertisers also can have a celebrity use a product in a television show or movie.

Group Activity

Note: This activity will help group members think about how advertising affects how we buy food.

Divide group members into smaller groups of three or four people. Give each group two to three advertisements that you have collected.

I have given you real advertisements. Discuss with your group which themes are used in the ads.

Note: Allow about 5 minutes for the groups to come up with their ideas.

Ask one person from each group to present his or her group’s ideas to the others.

Advertising can be helpful because it tells people about different products they can buy. But ads also can get people to buy products that they do not need or cannot afford or products that appear better than they really are.

Ask:

What can you ask yourself when you are trying to decide what brand to buy?

Note: Allow 4 to 5 minutes for group members to respond.

Add the following questions if they are not mentioned.

• Do I really need it?

• Is there a less expensive product that serves the same purpose?

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 293

• Have I compared the product’s nutrition label with an item that costs less?

• Am I buying the product because it comes in a nice package?

• Am I buying the product because the advertisement says it will make me look

better or help me lose weight?

• Am I buying it because I have a coupon or because it’s on sale?

• Can I afford it, even with a coupon?

• Can I wait until it goes on sale?

Even if you want to buy name brands, you can still save money by buying the products when they are on sale.

4. Soul Food Makeover—Catfish Stew and Rice Recipe

Give group members the “Soul Food Makeover—Catfish Stew and Rice Recipe” handout (page 306). Ask them to try this dish sometime this week.
Ask:

How can this dish help us eat in a heart healthy way when we have little time?

Add these answers if they are not mentioned.

• This dish can be prepared in advance and frozen, so you can save time.

• It includes a lot of vegetables.

• It is lower in fat and sodium because it is cooked with moist heat, low-

or reduced-sodium canned products are used, and no additional salt or oil is added.

294 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Review of Today’s Key Points

Let’s review what we learned today.

What can you do to save time in meal preparation?

• Get help from your family members.

• Cook several dishes at one time and freeze part of them to eat later.

• Make larger quantities and use the leftovers for lunch.

• Pack lunches the night before.

• Learn simple, fast recipes.

• Use a slow cooker.

What can you do to eat healthier when eating out?

• Order sandwiches without mayonnaise or sauces (or with low-fat mayonnaise

or sauces).

• Order small, plain hamburgers, or try lean roast beef, roasted chicken, or

turkey sandwiches instead of deluxe sandwiches.

• Ask for low-fat salad dressing or bring your own.

• Choose water, 100 percent fruit juice, unsweetened iced tea, or fat-free or

low-fat (1%) milk instead of a soft drink or a milkshake.

• Order smaller portion sizes.

• Choose baked or grilled foods instead of fried foods.

• Remove the skin from chicken, and do not eat it.

• Choose vegetarian pizza, and ask for less cheese.

• Order a green vegetable or salad instead of two or more starches (such as

rice, a potato, pasta, bread, and corn).

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 295

What can you do to stretch a limited food budget and still eat healthy?

• Make a monthly food budget.

• Plan healthy meals in advance.

What can you do to save money when shopping?

• Plan weekly meals, and make a shopping list of what you need to buy for

the week.

• Check the food sale ads.

• Choose prepared foods less often.

• Buy only the amount of food that your family needs.

• Try not to shop when you are hungry.

• Check your receipt for errors at the cash register.

• Try not to shop at convenience stores.

• Try store brands, and use them as often as possible.

Weekly Pledge

You have learned a lot today about eating in a heart healthy way even when you are on a tight budget and have little time. As today’s quote states, “If people learn something better, they will do better.” Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to eat in a heart healthy way while sticking to your budget. This will be your pledge for the week.

296 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will use a shopping list the next time I go to the grocery store.

• I will try a store-brand product the next time I go grocery shopping to see if

my family likes it.

• I will choose a restaurant that is not buffet-style the next time I go out to eat.

• I will plan my dinners for the next week so that I do not eat fast food.

Note: Allow 5 minutes for group members to think of a pledge.

Ask:

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional) Say:

Keeping a personal value in mind can help you eat in a heart healthy way when you are on a tight budget or have little time. Remember that a personal value is a quality that you consider important.

Today’s value is gratitude. Gratitude can help you appreciate all of your own efforts to change, no matter how small they may be. Gratitude helps you to be thankful for those who help you change old habits and show you how to have a healthier lifestyle.

Ask:

How could you use gratitude or another value to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 297

We will discuss the results of your pledges next week. Don’t forget to work on your pledges to be more physically active; to cut back on salt and sodium, saturated fat, trans fat, and cholesterol; to reach and keep a healthy weight; to prevent or control diabetes; and to make heart healthy eating a part of your family life.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be on living smoke free.

Please continue to work on your family health history.

Note: Think about today’s session. What worked and what didn’t work? Have you decided to make any changes in your own life that were covered in today’s session?

298 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Tips for Busy Families

Plan Your Meals

♥ Plan weekly meals based on your family’s schedule.

Use a Shopping List

♥ Save money and time by making only one trip to the store. Make and use a shopping list.

Share Meal Preparation Tasks

♥ Teach your family how to shop for groceries. ♥ Include children and other members of your family in preparing meals and cleaning up. ♥ Clean up as you cook—you will have less to clean up after you finish cooking. ♥ Share cooking duties with other family members or neighbors. For example, your family can cook enough food to share with another family.

Cook in Advance

♥ Prepare some foods in advance (such as spaghetti sauce). Use these foods for quick meals. You can add chicken or turkey to the sauce and serve it over spaghetti or rice. ♥ Prepare parts of a meal the night before (for example, marinate chicken in the refrigerator overnight). ♥ Pack your lunch the night before. ♥ Cut and wash vegetables, and make enough salad for 2 days. Do not add dressing until serving time. ♥ Cook two or three dishes on your day off, and freeze some of them. Use the frozen dishes on the days when you don’t have time to cook. ♥ Prepare for recipes the night before by cutting and trimming meats. ♥ Prepare meals in a slow cooker.

Cook Simply

♥ Steam vegetables, and serve them without sauces. ♥ Use frozen vegetables without sauces. ♥ Broil, grill, bake, or roast meats. ♥ Make one-pot meals, such as stews and casseroles. ♥ Use frozen chopped vegetables (such as carrots, peas, and broccoli). ♥ Use the microwave for cooking or defrosting. ♥ Learn simple recipes that can be made in less than 30 minutes.

Use Herbs and Spices

♥ Chop fresh herbs and place in ice cube trays. Fill trays with water and freeze. Store the frozen cubes in a plastic bag. Use when you need fresh herbs. ♥ Grow oregano, basil, or thyme on a sunny windowsill. ♥ Keep dried herbs on hand. One teaspoon of dried herbs is equal to 3 teaspoons of fresh herbs.

Keep Quick Snacks on Hand

♥ Try these healthy snacks:

Fresh fruits and vegetables
Whole-grain, ready-to-eat dry cereal
Fat-free and low-fat yogurt
Fat-free and low-fat cheese
Whole-grain breads

SESSIO

Jill’s Dilemma––A Real-Life Story

What can Jill do to make sure that her family eats in a heart healthy way?

Write down some ideas for Jill to try:

Adapted from an original story created by Maxine Vance, community health worker, CHW Advisory Group (2002).

300 HAndOuT—SESSIOn 9

Tips for Eating Out the Heart Healthy Way

You don’t have to give up eating fast foods to eat right. Here are some tips on how to make heart healthy choices at fast food restaurants.

Sandwiches

♥ Order sandwiches without mayonnaise, tartar sauce, or special sauces. Or try mustard or low-fat mayonnaise. Ask for vegetables to be added to your sandwich. ♥ Order small, plain hamburgers instead of deluxe sandwiches. ♥ Order sandwiches made with lean roast beef or turkey. Chicken salad and tuna salad made with regular mayonnaise are high in fat. ♥ Choose grilled chicken sandwiches instead of breaded chicken sandwiches.

Main dishes

♥ Choose rotisserie-style chicken rather than fried chicken. Always remove the skin. ♥ Order pizza with vegetable toppings, such as peppers, mushrooms, or onions. Ask for half the usual amount of cheese. ♥ Choose grilled, steamed, or baked fish instead of deep-fried fish. ♥ Leave off all butter, gravy, and sauces.

Side dishes

♥ Share a small order of french fries instead of eating a large order by yourself. ♥ Ask that no salt be added to your serving. ♥ Order a baked potato instead of fries.

Try salsa or vegetables as a potato topping.
Ask that high-fat toppings be served on the side, and use fewer toppings.

♥ Use low-calorie, low-fat salad dressing on salad. Bring your own if the restaurant does not offer a low-fat dressing. You can buy packets at some stores. Ask that dressings be served on the side, and use less. ♥ Order a green vegetable or salad instead of two or more starches, such as potatoes, rice, pasta, bread, and corn. ♥ Ask for low-fat cheese and low-fat sour cream.

Beverages

♥ Choose water, 100 percent fruit juice, unsweetened iced tea, or fat-free or low-fat (1%) milk rather than a soft drink or a milkshake. ♥ If you really want to have a soft drink, order a small one.

Desserts

♥ Buy the smallest size of fat-free frozen yogurt, low-fat ice cream, or sherbet instead of cakes or pies.

HAndOuT—SESSIOn 9 301

Jill’s Monthly Food Budget

Jill needs to plan how much money she can spend on food each month to feed her family of five. Follow Jill’s steps as she makes her first monthly food budget.

Step 1. Jill figures out how much she can spend on food each month.

month.

Step 2. Jill writes down what she spends on food and keeps all her receipts.

Jill writes down how much she spends at the grocery store and at restaurants in her Food Money Log. She keeps the log clipped to an envelope where she keeps all her receipts.

Step 3. Jill checks her expenses each week to make sure she sticks to her monthly food budget.

Jill adds up her food expenses each week. Then she adds up what she has spent during the month so far and compares the amount with her total monthly food budget.

Now that you know how Jill planned her monthly food budget, let’s plan your monthly food budget. First, determine your food budget for the month. Second, list the cost of each item in the Week 1 column, add the costs together, and put the total on the Weekly Total Spent line. Second, put your monthly food budget on the Monthly Budget line and subtract the amount spent from Week 1 to get your Remaining Monthly Budget. Third, copy the remaining amount from Week 1 to Week 2 Remaining Monthly Budget line. Fourth, repeat the steps.

Note: Try to plan for the entire month, so you don't run out of money. You have a good plan

♥ if you spend less or do not go over your monthly food budget.

302 HAndOuT—SESSIOn 9

Jill’s Monthly Food Budget

Food Money Log

_____________

Week 1

Cost of each item $_______

$_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______ $_______

Weekly Total Spent $_____

Monthly Budget $_______

$_______ Subtract amount spent from Week 1

Remaining = $_______

Week 2 Week 3 Week 4

Cost of each item	Cost of each item	Cost of each item
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______
$_______	$_______	$_______

Weekly Total Spent $_____ Weekly Total Spent $_____ Weekly Total Spent $_____

Remaining Remaining Remaining Monthly Budget $_______ Monthly Budget $_______ Monthly Budget $_______

$_______ – $_______ – $_______

Subtract amount spent from Week 2 Remaining = $_______

Subtract amount spent from Week 3 Remaining = $_______

Subtract amount spent from Week 4 Remaining = $_______

HAndOuT—SESSIOn 9 303

Money-Saving Tips

You can save money on groceries. Follow these simple suggestions.

Before Going to the Store

♥ Plan weekly meals. Your family can help you plan the menu.

♥ Make a shopping list based on your meal plan.

♥ Check the food sale ads.

♥ Use coupons. Check the Sunday newspaper, and clip coupons for foods you

Lowest

normally buy or need. Ask your children or another family member to help you.

Prices!

Remember—coupons do not save you money if you buy products that you don’t need. Always compare the price of the item with the coupon with the price of other items on the shelf.

♥ Make fresh foods at home instead of using prepared items such as frozen entrees, bakery cakes, or salads.

Choosing a Store

♥ Shop at the store that has the lowest prices for the items you need. That may be a different store every week.

♥ Remember that convenience stores have higher prices and less variety than supermarkets.

At the Store

♥ Buy what is on your list. You are more likely to buy too much or buy items that you do not need when you do not use a list.

♥ Convenience can cost more. Some examples include:

Canned beans
Boneless chicken breasts
Precut vegetables

♥ Buy fruits and vegetables that are in season.

♥ Buy only the amount of food your family can use, even if a larger size costs less.

♥ Shop alone when possible. Family members or friends may try to get you to buy items you do not need.

♥ Do not shop when you are hungry.

♥ Watch for errors at the cash register. Sometimes sale items do not ring up on sale. Some stores give customers free items if they are charged the wrong amount.

♥ Look for cheaper store brands of products. They usually are just as nutritious as more expensive name brands.

304 HAndOuT—SESSIOn 9

Shopping List

Make a shopping list. Include the items you need for your menus and any basic items you need to restock in your kitchen.

Produce ___ Fresh fruits (bananas, apples, oranges, grapes)

Milk Products† ___ Fat-free or low-fat (1%) milk

___ Fresh vegetables (cabbage, ___ Fat-free or low-fat lettuce, onions, tomatoes, (1%) cottage cheese squash, sweet potatoes, ___ Fat-free or low-fat cheeses green peppers, okra) ___ Fat-free or low-fat yogurt

Whole-Grain Breads,

Muffins, and Rolls

___ Bread, bagels, biscuits

___ English muffins

___ Dinner rolls

___ ____________________

___ Light or diet tub margarine

___ Fat-free sour cream

___ Fat-free cream cheese

___ Eggs

___ ______________________

___ ______________________ ___ ____________________

Meats

___ ____________________ ___ Chicken ___ Turkey

Cereals, Rice, Crackers,

___ Fish (salmon, catfish, whiting,

Pasta, and Noodles

flounder) ___ Cereal, dry or cooked ___ Beef (round or sirloin) ___ Brown rice ___ Extra-lean ground beef ___ Whole-grain pasta ___ Pork tenderloin, leg, shoulder (noodles, spaghetti) ___ Lower fat lunch meats ___ Other _______________ (turkey, chicken, and lean

___ Soda crackers*

___ Graham crackers

___ Other crackers*

___ ____________________

roast beef)*

___ Dry beans and peas

___ Unsalted roasted nuts

___ ___________________

___ ___________________ ___ ____________________

Baking Items

___ ____________________ ___ Flour ___ Sugar ___ Vegetable oil spray ___ Fat-free canned evaporated milk ___ Fat-free dry milk powder ___ Unsweetened cocoa powder ___ Baking powder

Canned Fruits, Vegetables, Beans, and Soups

___ Canned fruit in juice ___ Applesauce ___ Canned tomatoes (no salt added) ___ Low-sodium tomato sauce or paste ___ Other canned vegetables (no salt added) ___ Canned broth (fat-free, low-sodium)* ___ Other canned soups* ___ Canned beans or peas (no salt or seasoning added) ___ _____________________ ___ _____________________ ___ _____________________ ___ _____________________ ___ _____________________ ___ _____________________ ___ _____________________

Fats and Oils

___ Margarine (liquid, tub, or diet)* ___ Vegetable oil

Frozen

___ Fat-free or low-fat frozen yogurt and desserts* (sherbet) ___ Frozen vegetables without sauces ___ Frozen fruit juices

Other

___ Herbs and spices (oregano, cumin, red pepper, garlic, parsley, paprika, sage)

fat, cholesterol, sodium, and calories. †Or lactose-free milk and milk products, such as low-fat or fat-free soy milk

HAndOuT—SESSIOn 9

Soul Food Makeover— Catfish Stew and Rice Recipe

2 medium potatoes 1 can (14½ ounces) tomatoes (reduced- or low-sodium), sliced

1 cup 1 cup 1 cup 2 cloves ½ head

chopped onion clam juice or water water garlic, minced cabbage (coarsely chopped) 1 pound catfish fillets 1½ tablespoons Hot ’N Spicy Seasoning (recipe below) 1 sliced green onion for garnish (optional) 2 cups hot cooked rice (brown or white)

Hot ’N Spicy Seasoning

¼ cup paprika 2 tablespoons dried oregano, crushed 2 teaspoons chili powder 1 teaspoon garlic powder 1 teaspoon black pepper ½ teaspoon red (cayenne) pepper ½ teaspoon dry mustard

Preparation Instructions:

Mix together all seasoning ingredients. Store in airtight container. Makes about 1/3 cup of seasoning.

The Makeover:

In the past, the Harris family prepared battered and deep-fried catfish. This Soul Food Makeover makes use of moist heat cooking; a great spicy, no-salt seasoning; and no added oil or fat. Try it in place of a fish fry! You won’t miss the frying, and cleanup will be a snap!

Peel potatoes, and cut into quarters.
In a large pot, combine potatoes, tomatoes and juice from can, onion, clam juice, water, and garlic.
Bring to boiling. Reduce heat.
Cook, covered, over medium-low heat for 10 minutes.
Add cabbage. Return to boiling. Reduce heat; cook, covered, over medium-low heat for 5 minutes, stirring occasionally.
Meanwhile, cut fillets into 2-inch lengths. Coat fillets with Hot ’N Spicy Seasoning.
Add fish to vegetables. Reduce heat; simmer, covered, for 5 minutes or until fish flakes easily with fork.
Ladle stew over hot cooked rice in soup plates and garnish with green onion.

Makes 4 servings Each serving provides:

Calories: 363 Total fat: 8 g Saturated fat: 2 g Cholesterol: 87 mg Sodium: 355 mg Dietary fiber: 4 g Potassium: 1,079 mg Carbohydrates: 44 g Protein: 28 g Potassium: 1,079 mg

Freedom is never given; it is won.

“ ”

A. Philip Randolph

Session 10

Take Control of Your Health:

Session 10

Enjoy Living Smoke Free

sess i o n

Take Control of Your Health: Enjoy Living Smoke Free

Objectives

By the end of this session, group members will learn:

How cigarette smoking harms smokers
How secondhand smoke harms people who are near smokers
Tips that can help smokers who want to quit
Ways to ask people not to smoke around you

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Blackboard and chalk or several large pieces of paper, markers, and tape

Handouts

Give group members these handouts during the session:

List of places where smoking cessation programs are offered*

______

Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 307

“Smoking Harms You” (page 328)
“Smoking Harms Infants and Children” (page 329)
“Costs of Smoking” (page 330)
“Role Play: Someone Is Smoking. What Can You Do?” (page 331–333)
“Smoke-Free Family Sign” (page 334)
“Tips To Quit Smoking” (pages 335–336)
“Help Your Heart—Don’t Smoke” (page 337)
“Break Free From the Smoking Habit” (page 338)

Note: Posters and other materials may be ordered from the following organizations:

• National Cancer Institute—1–800–4–CANCER (1–800–422–6237) or

www.cancer.gov/

• American Lung Association—1–800–LUNGUSA (1–800–586–4872) or

www.lungusa.org

• American Cancer Society—1–800–ACS–2345 (1–800–227–2345) or

www.cancer.org

• American Heart Association—1–800–AHA–USA–1 (1–800–242–8721) or

www.americanheart.org

Note: The Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services has created a quit-smoking, self-help program for African Americans. The publication is available for free download at www.cdc.gov/tobacco/quit_smoking/how_to_quit/pathways/.

308 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

Facts About Smoking
Smoking Harms Infants and Children
Youth and Smoking
Smoking and Your Wallet
Secondhand Smoke

A. Secondhand Smoke Can Harm You and Those Around You

B. Secondhand Smoke Role-Playing Activity

Quitting Smoking

Review of Today’s Key Points

Weekly Pledge

Closing

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 309

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about ways to save money on our food bills. Who can name some of them?

Note: Allow 3 to 5 minutes for group members to respond. Write their ideas on the blackboard or on a large piece of paper taped to the wall.

Add these ideas if they are not mentioned:

• Plan weekly meals, and shop with a list.

• Check the food sale ads.

• Use fewer packaged foods.

• Buy only the amount of food your family needs.

• Try not to shop when you are hungry.

• Check your receipt for errors at the register.

• Clip coupons for products you use.

• Shop at convenience stores less often.

• Use store brands as often as possible.

310 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

How are you doing with your pledge to eat in a heart healthy way even when time or money is tight? What went well? Did you have problems? If so, what did you do to solve them?

Note: Allow 5 to 8 minutes for group members to respond.

Ask:

Has anyone completed the family health history?

Note: Give a prize to group members who have completed the family health history.

Ask:

Does anyone want to share what you have learned about your family health history?

Note: Allow about 5 minutes for group members to respond.

3. About This Session

Civil rights and labor activist A. Philip Randolph said, “Freedom is never given; it is won.”

Ask:

What does this quote mean to you?

Note: Allow 2 to 3 minutes for group members to respond.

This session is about the importance of not starting to smoke and quitting smoking. During this session, you will learn:

• How cigarette smoking harms smokers

• How secondhand smoke can harm you and those around you

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 311

• Ways to ask people not to smoke around you

• Tips to stop smoking (for you and others)

Ask:

• How many of you smoke?

• How many of you live with a smoker?

• How many of you would like to live smoke free?

Tobacco is used in a variety of ways—cigarettes, cigars, pipes, and chewing tobacco. This session focuses on cigarette smoking because it’s the most common use of tobacco.

Note: Other names for cigarettes include “smokes,” “cigs,” and “butts.”

Conducting the Session

1. Facts About Smoking

There are many reasons why you should quit smoking or not start smoking. Let’s go over these reasons:

• In the United States, about 440,000 people die each year from diseases

related to smoking. This is more than 1,200 people each day. Smoking causes about one in every five deaths.

• Health care costs due to smoking are about $75 billion each year in the

United States.

312 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• More African Americans die from smoking-related diseases than from car

accidents, murders, AIDS, and drug and alcohol abuse combined.

• About one in every four African American men smokes. About one in five

African American women smokes.

• Smokers use tobacco regularly because they become addicted to nicotine,

which is a powerful drug. Nicotine is found in all tobacco products. Most cigarettes contain 10 milligrams or more of nicotine. Through inhaling smoke, the average smoker takes in 1 to 2 milligrams of nicotine per cigarette.

• Smoking can harm those around you! Cigarette smoking puts the health of

your family, children, and friends at risk.

Show picture card 10.1.

Today, we are going to talk about what can happen when you smoke. Smoking can cause heart attack, stroke, and cancer. It can also cause asthma attacks and chronic obstructive pulmonary disease (COPD), such as emphysema and chronic bronchitis. Other unpleasant effects include yellow stains on teeth and fingers, bad breath, gum disease, early wrinkling of the skin, and decreased sense of smell and taste.

Give group members the “Smoking Harms You” handout (page 328), and review the information.

Note: Ask for volunteers to read the handout aloud. Keep the picture card on display while you review this handout.

Let’s take a moment to talk briefly about menthol cigarettes.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 313

Ask:

Did you know that three out of four African American smokers buy menthol cigarettes? Can you think of reasons why some people choose menthol cigarettes over regular cigarettes?

Note: Allow 2 to 3 minutes for group members to respond.

Add the following answers if they are not mentioned:

• To some, menthol cigarettes taste better.

• Some believe menthol cigarettes feel cooler when you inhale.

• Menthol cigarettes may make the smoke feel less harsh to the throat.

• Some people believe that smoking menthol cigarettes is safer than smoking

other types of cigarettes.

The fact is that menthol cigarettes are as dangerous for your health as all other cigarettes. They still have just as many harmful chemicals as regular cigarettes.

In fact, menthol cigarettes have extra chemicals that give them a cool, minty taste and numbing effect. The extra chemicals in menthol cigarettes also seem to make it easier for smokers to inhale more smoke and to hold it longer in the lungs. Smoking this way may allow more of the harmful chemicals in cigarettes to enter the body.

2. Smoking Harms Infants and Children

Show picture card 10.2.
Ask:

Do you think that pregnant women should smoke?

Note: Allow a moment for group members to respond.

314 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Pregnant women should not smoke because it will affect their babies’ health and well-being. They also should stay away from others who smoke because of the harm that secondhand smoke causes.

Let’s go over some problems that can happen if pregnant women smoke.

Give group members the “Smoking Harms Infants and Children” handout (page 329).

Note: Ask for volunteers to read the handout aloud, or you can cut out the facts, following the dotted lines on the handout, and put them in a box. Let group members draw slips of paper and read the facts aloud. Keep picture card 10.2 on display while you review the handout.

3. Youth and Smoking

Note: Review the “More Information” box (page 324) about tobacco companies’ advertisement practices.

Show picture card 10.3.
Ask:

Why do you think many people begin smoking as teenagers?

Note: Review the picture card to show the reasons that teens smoke.

These are the reasons many people begin smoking as teenagers:

• Teens want to be like their friends.

• Young people smoke to try to look older.

• Some teens want to be like celebrities who smoke in movies or on television.

• Some teens are influenced by advertisements that make smoking look “cool”

or glamorous.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 315

• Some teens may want to be like their parents or other family members

who smoke.

• Some teens will smoke just to do something their parents don’t want them to do.

• Young people downplay the harm smoking can do, or they think they will not

be harmed.

• Teens may like the jackets, hats, and other prizes tobacco companies offer.

Let’s look at some of the facts about young people and smoking, especially African American youth.

• Each day about 2,000 young people under age 18 become regular

smokers. That’s nearly 750,000 teens per year. If this continues, more than 6 million young people who are regular smokers could die from a tobacco-related disease.

• African American teens start off with lower rates of smoking than other racial

and ethnic groups. But by the age of 18 to 24 years, 40 percent of African Americans have become regular smokers. By adulthood, smoking rates among African Americans are similar to those of other groups.

• Young people who use tobacco may find it hard to play sports. Smoking

causes shortness of breath and dizziness. Chewing tobacco causes dehydration.

• Use of spit tobacco can cause cracked lips, white spots, sores, and bleeding in

the mouth.

• People who start smoking at a young age are likely to smoke all their lives.

• The longer a person smokes, the more likely he or she will develop the

problems caused by smoking.

• Young people who smoke cigarettes are also more likely to try other drugs,

especially marijuana.

• It is illegal in all states to sell cigarettes and other tobacco products to persons

under age 18.

316 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Let your children know that most teens, especially African American teens, do not smoke. Tell your children that most teens who do smoke say they wish they had never started.

If you smoke, set an example for your family by quitting. Be honest. Admit that you’re having trouble kicking the habit. Let young people know that it is best not to start smoking, rather than trying to quit later. Try not to smoke in front of your children. Never ask your children to bring you cigarettes or to light a cigarette. Asking them to do those things can send the message that smoking is okay for them to do.

4. Smoking and Your Wallet

Smoking costs a lot in other ways. Let’s look at some things a smoker could buy with the money that he or she spends on cigarettes.

Give out and review the “Costs of Smoking” handout (page 330).

5. Secondhand Smoke

A. Secondhand Smoke Can Harm You and Those Around You

Ask:

What have you heard about secondhand smoke?

Note: Allow 3 to 5 minutes for group members to respond.

Secondhand smoke is the smoke that you breathe in from someone else’s cigarette or cigar. Even nonsmokers can be harmed if they are near secondhand smoke.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 317

Let’s take a look at some facts about secondhand smoke.

• Secondhand smoke contains poisons, such as arsenic, cyanide, ammonia,

and formaldehyde.

• Breathing secondhand smoke may cause eye irritation, nose and throat

discomfort, headaches, and coughing.

• Secondhand smoke causes nearly 1 in 10 smoking-related deaths.

• Each year, about 3,000 nonsmokers die of lung cancer caused by

secondhand smoke.

• Infants and children who live with someone who smokes are twice as likely

to have respiratory illness, bronchitis, and pneumonia, as children who do not live with someone who smokes.

• Secondhand smoke can bring on an asthma attack. This danger is especially

common in African American communities. African American children are more likely than white children to have asthma, but less likely to have it under control.

B. Secondhand Smoke Role-Playing Activity

Let’s try role playing. Some people have a hard time telling smokers not to smoke around them or their children. This activity will let you practice what to say when someone smokes around you or your family.

Divide group members into groups of three. Give each group a scene from the “Role Play: Someone Is Smoking. What Can You Do?” handouts (pages 331–333) to act out. Ask them to act out a solution to the problem, too.

Note: Read the scenes one at a time or hand out copies to each group. Allow about 5 minutes for each group to role play a solution.

318 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Scenes for Role-Playing Activity: Someone Is Smoking. What Can You Do?

Scene 1

You have hired a babysitter to take care of your young child while you are at work. One evening, you walk into your home and find the babysitter sitting at the kitchen table and smoking a cigarette while watching your child play. The babysitter is highly qualified, and you have been very happy with her, but you do not want her to smoke when she is watching your child. What do you do?

Solutions:

• Ask the babysitter not to smoke while caring for your child. • Tell the babysitter that your home is smoke free and that secondhand smoke

is a major health risk for your child.

• Find another babysitter.

Scene 2

You and your family go to a friend’s house to celebrate her son’s birthday. There are many adults and children inside the house. A few of the guests are smoking, which is making the house very smoky. The smoke is hurting your eyes and making it difficult for your daughter to breathe. You promised your friend you would help her, so you don’t want to leave. What can you do?

Solutions:

• Tell your friend ahead of time that you can help her if she has a smoke-free party. • Help your friend make a “Thank You for Not Smoking” sign. • Tell your friend that you are very sorry, but you cannot help her during the party.

You must leave because the smoke is affecting the health of you and your child.

Scene 3

You go out to eat with a friend to celebrate a special occasion. You ask to sit in the nonsmoking section of the restaurant. The nonsmoking area is in a corner of the restaurant. There are no walls separating the smoking section from the nonsmoking section. As you order your meal, four people sit down a few tables away from you in the smoking section. They begin to smoke cigarettes. After a minute or two, you begin to smell their smoke at your table. You tell the waiter the smoke is not good for your health. He says he can’t ask them to stop because they are in the smoking section. What do you do?

Solutions:

• Ask to be moved to another table farther away from the smokers. • Ask the waiter to wrap up your food, and then leave the restaurant. • Tell the manager that you cannot be around smokers.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 319

Ask group members if they have any comments or questions about the role play.

One thing we all can do in our homes to prevent these situations is to post a sign that says “Thank You for Not Smoking” or “This Is a Smoke-Free Home.” This lets guests know your home is smoke free.

Give group members the “Smoke-Free Family Sign” handout (page 334).

This sign can be used on a tabletop or taped to the wall or refrigerator.

6. Quitting Smoking

Quitting smoking is not easy, but it can be done. To quit smoking for good, some smokers need help to overcome their urges to smoke. They also need encouragement and support to help them break the habit.

Have any of you quit smoking? Or do you know anyone who has quit smoking? What are the benefits of quitting smoking?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add the following answers if they are not mentioned:

• You will live longer and have better health.

• You will lower your chance of having a heart attack, stroke, cancer, and

respiratory problems.

• If you are pregnant, quitting smoking will improve your chances of having a

healthy baby.

320 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• The people you live with or spend a lot of time with, especially children and

older adults, will be healthier.

• You will have extra money to spend on things other than cigarettes.

• You will be free of morning cough.

• Your clothes, hair, and breath will smell better, and your home and car will, too.

To quit smoking, you need to know your personal feelings or situations that trigger your urge to smoke. This will help you to overcome the urge to smoke.

Ask:

What are some of these feelings or situations that bring on the urge to smoke?

Note: Allow 3 to 5 minutes for group members to respond.

Write their answers on the blackboard or on a large piece of paper taped to the wall.
Add the following answers if they are not mentioned:

• Drinking coffee

• Drinking alcohol

• Talking on the phone

• Watching someone else smoke

• Attending social and community gatherings

• Feeling stressed

• Feeling bored

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 321

Let’s review what smokers can do to overcome the urges to smoke.

Find ways to relax. If stress causes you to want to smoke, try deep breathing to calm you. Let’s try it now. Take a slow, deep breath in, hold it and count to five, and release it.
Keep busy. Do activities that require the use of your hands, such as sewing, arts and crafts, or a project around the house.
Keep moving. Try going for a walk, cleaning the house or doing yard work, doing stretching exercises, or practicing your favorite dance steps.
Know what to expect. The nicotine that is in cigarettes and other tobacco products causes addiction. When smokers try to cut back or quit, the lack of nicotine in their bodies makes them have withdrawal symptoms. You may experience withdrawal symptoms. These symptoms are:

• Headaches

• Feeling irritable

• Feeling tired

• Having trouble concentrating

Although withdrawal symptoms are not pleasant, it is important to know that they are signs that your body is recovering from smoking. Most symptoms will go away in 2 to 4 weeks.

Give group members the “Tips To Quit Smoking” handout (pages 335–336). Ask for volunteers to read the tips aloud.

322 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

These tips have helped other people. If you are a smoker, they can help you quit. If you’re not a smoker, share the tips with a family member or friend who would like to quit. Studies have shown that these steps will help you quit smoking for good.

Nagging people about their smoking can make them become angry or defensive. Try these positive ways to help family members or friends who want to quit:

• Say things such as “Quitting is hard, but I know you can do it.”

• Help them stay away from smokers in the beginning, when it is the hardest

to quit.

• Suggest other activities that will help them beat the urge to smoke. For

example, ask them to take a walk with you.

It’s important to choose a quit day as soon as possible, preferably within 2 weeks after deciding to quit smoking. Choosing a special day, such as a birthday or holiday, can motivate you to take this important first step to being smoke free.

Ask:

Do you have any questions about the information we covered today?

Note: Allow a moment for group members to respond.

Give group members the “Help Your Heart––Don’t Smoke” (page 337) and the “Break Free From the Smoking Habit” handouts (page 338).
Ask for volunteers to read the suggestions aloud.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 323

More Information

Tobacco companies spend billions of dollars advertising their products to get people to smoke. They do this through advertising in magazines, on billboards, and on posters in stores.
Tobacco ads usually show happy, attractive people enjoying life while they smoke cigarettes. Many individuals want to be like those people, so they start smoking.
Tobacco companies also advertise their products by supporting special sporting events such as tennis tournaments and car racing events. They go to dances, festivals, and other community events to promote their products by giving away free merchandise and cigarettes.
Tobacco companies pay movie companies to have actors smoke on screen. This allows them to get around the law that bans cigarette advertising on television or in movie theaters.
Tobacco companies attract new smokers to make up for the thousands of people who die each day of diseases related to cigarette smoking. They target young people because young smokers are likely to be lifelong smokers. Teenage smokers are important for the tobacco companies because teens will continue to buy cigarettes for many years.
The advertising programs from tobacco companies influence young people. The number of youth who began smoking increased when tobacco companies introduced cartoon-like characters to sell cigarettes. Tobacco companies also give away gifts that appeal to youth to get them to smoke a certain brand.

324 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Review of Today’s Key Points

Let’s review what we learned today.

When people smoke, which diseases are they likely to develop?

• Smoking contributes to heart disease, cancer, stroke, and respiratory diseases

(such as asthma and COPD—emphysema and chronic bronchitis).

Should pregnant women smoke?

• Pregnant women should not smoke. Smoking reduces the oxygen the baby

receives, contributes to lower birth weight and increases the chance of a baby being born dead.

What is secondhand smoke?

• Secondhand smoke is smoke that you breathe in from someone else’s

cigarette. It is filled with harmful chemicals.

What can you do if someone is smoking around you, and you don’t like it?

• Ask the person not to smoke inside, or leave the area yourself. Post a sign

in your home that says “Thank You for Not Smoking” or “This Is a Smoke- Free Home.”

What should you know about menthol cigarettes?

• Menthol cigarettes are not safer than other types of cigarettes. No matter

what kind or brand of cigarette you smoke, quitting smoking will be one of the best things that you can do for your health.

Why is it important not to smoke in front of the children you care for?

• Secondhand smoke is harmful to the health of children and can increase

asthma. Children who are around smokers are more likely to smoke.

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 325

Weekly Pledge

You have learned a lot today about living smoke free. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to quit smoking or to avoid secondhand smoke. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Let’s take a look at some examples:

• If I smoke, I will choose a quit day within the next 2 weeks and quit smoking

on that day.

• I will ask my children to make a sign to let people know that our home is

smoke free.

Note: Allow 5 minutes for group members to think of a pledge. Tell group members to write their pledges on the “Break Free From the Smoking Habit” handout (page 338).

Ask:

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

(Optional) Say:

Keeping a personal value in mind can help you quit smoking for good. Remember that a personal value is a quality that you consider important.

Today’s value is peace. When you feel at peace with your life, you can overcome the fears that may try to prevent you from breaking the smoking habit. Peace helps you to trust in yourself and remain optimistic in spite of the problems you may face. Quitting smoking is hard, but you can win if you believe that you can. Remember today’s quote, “Freedom is never given; it is won.”

326 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

How could you use peace or another value to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Don’t forget to work on your pledges to be more physically active; to cut back on salt, sodium, saturated fat, trans fat, and cholesterol; to reach and keep a healthy weight; to prevent or control diabetes; to make heart healthy eating a part of your family life; and to eat in a heart healthy way, even when you are rushing or have a tight budget.

Closing

Thank you for coming today. What did you think of today's session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you next week. The next session will be a review and graduation celebration. Please continue to work on your family health history.

Ask group members if they want a potluck dinner at the final session. If so, ask for volunteers to bring heart healthy dishes. Don’t forget nonfood items, such as paper plates, cups, and plastic forks and spoons.

Note: Think about today’s session. What worked and what didn’t work? Have you made any changes in your own life that were covered in today’s session?

Session 10. Take Control of Your Health: Enjoy Living Smoke Free 327

Smoking Harms You

Smoking can cause:

Heart attack and stroke
Cigarette smokers are two to four times more likely to develop heart disease than

are nonsmokers.

Smoking doubles your chances for having a stroke.
One year after a person stops smoking, the risk of having a heart attack or stroke will drop

by more than half.

Cancer
Smoking increases your risk of developing cancers of the bladder, kidney, larynx (voice

box), lung, pancreas, stomach, and uterus.

Smoking causes about 80 to 90 percent of lung cancer.
The cancer death rate for men who smoke cigarettes is more than double that

of nonsmokers.

Men who smoke are 22 times more likely to develop lung cancer than are men who have

never smoked.

Women who smoke are 12 times more likely to develop lung cancer than are women who

have never smoked.

Smoking and secondhand smoke can cause:

Serious respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD)—

emphysema and chronic bronchitis

More colds, sore throats, and respiratory infection
Asthma attacks

Unpleasant effects of smoking include:

Yellow stains on teeth and fingers
Bad breath
Gum disease
Early wrinkling of the skin
Decreased sense of smell and taste

328 HAndOuT—SeSSIOn 10

Smoking Harms Infants and Children

Each time a pregnant woman smokes, her baby’s heart rate increases.

When a pregnant woman smokes, her baby gets less oxygen.

The birth weight of babies born to smokers is lower than the birth weight of babies born to nonsmokers.

Smoking during pregnancy increases the chance of the baby being born dead.

Babies whose mothers smoke have a greater risk of dying from SIDS (sudden infant death syndrome).

Harmful chemicals from smoking pass through the placenta and directly into the baby’s blood.

If the mother continues to smoke after the baby is born, the baby is more likely to get chest colds, ear infections, bronchitis, pneumonia, and asthma.

Babies who are exposed to secondhand smoke are more likely to cry, sneeze, and cough than are babies who are not.

Children who grow up in a home with smokers are more likely to become smokers.

HAndOuT—SeSSIOn 10 329

Costs of Smoking

1 Week =

1 Month =

6 Months =

1 Year	=
2 Years	=
3 Years	=
4 Years	=

the family

system

furniture set

the family

down payment

HAndOuT—SeSSIOn 10

Role Play: Someone Is Smoking. What Can You Do?

Scene 1

Solutions:

HAndOuT—SeSSIOn 10 331

Role Play: Someone Is Smoking. What Can You Do?

Scene 2

Solutions:

332 HAndOuT—SeSSIOn 10

Role Play: Someone Is Smoking. What Can You Do?

Scene 3

You go out to eat with a friend after church to celebrate her recent retirement. You ask to sit in the nonsmoking section of the restaurant. The restaurant is crowded, and after a long wait, you are finally seated. The nonsmoking area is in a corner of the restaurant. There are no walls separating the smoking section from the nonsmoking section. As you order your meal, four people sit down a few tables away from you in the smoking section. They begin to smoke cigarettes. After a minute or two, you begin to smell their smoke at your table. You tell the waiter the smoke is not good for your health. He says he can’t ask them to stop because they are in the smoking section. What do you do?

Solutions:

HAndOuT—SeSSIOn 10 333

Smoke-Free Family Sign

Thank You for Not Smoking.

Smoke-Free Family. We Are a

We Are a Smoke-Free Family.

Thank You for Not Smoking.

334 HAndOuT—SeSSIOn 10

Tips To Quit Smoking

Cigarette smoke contains more than 4,000 chemicals, and 200 of these are poisonous.

Get ready.

Set a quit date. Pick a date within the next 2 weeks. Think about

choosing a special day to you, such as your birthday or a holiday, if it’s within 2 weeks.

Throw away ALL cigarettes, lighters, matches, and ashtrays in your

home, car, and place of work.

Don’t let people smoke in your home.
Don’t try to cut back on cigarettes by buying one at a time instead of buying the pack. This costs

more money, and you can lose count and end up smoking more cigarettes.

Review your past attempts to quit. Think about what worked and what didn’t.
Once you quit, don’t smoke—NOT EVEN A PUFF! One cigarette can cause you to start

smoking again.

Line up support.

Tell your family, friends, and coworkers that you are going to quit smoking and want their help.

Ask them not to smoke around you and not to offer you cigarettes.

Get individual, group, or telephone counseling. The more counseling you have, the better your

chances are of quitting.

Meditate, chant, or think positively about quitting and breaking the smoking habit for good.
Find out whether your church, faith community, or other community organizations sponsor quit-

smoking clinics or other activities that will support you in quitting smoking.

Find ways to relax.

Try to distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy

with a task.

Change your routine. Use a different route to work. Drink tea instead of coffee.
Do something to reduce your stress. Listen to music, do aerobics, or dance to your favorite music.
Plan something enjoyable to do every day.
Drink a lot of water when you feel the urge to smoke.

HAndOuT—SeSSIOn 10 335

Tips To Quit Smoking (continued)

Use other quitting aids.

Talk to your doctor or other health care providers. Consider using the nicotine patch, nicotine

gum, nicotine nasal spray, or nicotine inhaler to help you stay off cigarettes.

Check with your doctor about a medicine called bupropion SR. This medicine can help reduce

your cravings for smoking.

Use quit-smoking, self-help programs developed for African Americans, such as “Pathways

to Freedom: Winning the Fight Against Tobacco.” This program is available from the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (www.cdc.gov/tobacco/quit_smoking/how_to_quit/pathways/).

Be prepared if you do not have immediate success.

Avoid drinking alcohol. Drinking alcohol lowers your chances of success.
Spend more time with friends who do not smoke. Being around smokers can make you

want to smoke.

Many smokers will gain weight when they quit, usually fewer than 10 pounds. Eat a healthy diet,

and stay active. Don’t let weight gain distract you from your main goal—quitting smoking.

If you’re in a bad mood or feel depressed, try a new activity. Take a walk, talk to a friend, or

meditate to improve your mood.

Be kind to yourself. Remind yourself of the reasons you want to quit. If you slip, do not be dis-

couraged. Try again!

336 HAndOuT—SeSSIOn 10

Help Your Heart—Don’t Smoke

Smoking cigarettes is harmful. It becomes an addiction that

leads to serious health problems. Quitting smoking will lower your risk of heart attack, stroke, and chronic obstructive pulmonary disease (known as COPD or lung disease). It will help you breathe easier and have more energy. In addition, your clothes, hair, and breath will smell fresher, and you will save money by not buying cigarettes. Most important, when you quit smoking, your children won’t be exposed to your secondhand smoke. They will have your good example to follow.

Even if you don’t smoke, it is important that you Even if you don’t smoke, it is important that you learn about the best ways to quit. Help those around you, and keep your children smoke free. Help those around you, and keep your children smoke free.

Quit smoking and add years to your life!

James and Darnell decided to quit smoking. Darnell made a firm pledge one morning, threw away his cigarettes, and used his willpower to quit for good. James used the following three tips and also quit.

1. 2. 3.

Learn how to handle Get support. Use the nicotine patch

urges to smoke. or gum.

“I also attended a quit- “The doctor at the “Every time I felt stressed, smoking program in the clinic suggested that I wanted to smoke. clinic every Thursday I use the patch. The Instead of smoking, I said night, and I got a lot of patch helped me control a prayer to ask for courage help from my family the urge to smoke.”

and strength, talked to a friend, or walked around the neighborhood.”

and the support group. Even my children are encouraging me.”

HAndOuT—SeSSIOn 10 337

Break Free From the Smoking Habit

Ms. Diane’s tips to make your home smoke free

Protect your children!

When a friend comes to our house and lights up a

Talk to your children about the harm that

cigarette, I say very politely,

smoking will do to their health. Help them

“I’m sorry, we have a smoke-

practice saying, “No, thanks. I don’t smoke.” free home. Please smoke

outside.” And I keep a sign

If your children already smoke, the way

in my home that says, “Thank

you react can make a difference. Tell your You for Not Smoking.” children that you really care about them and what happens to them. Listen to their thoughts and feelings. Give them facts that can help them choose good health over smoking. Make your personal pledge to protect your family from cigarette smoke.

Here are some examples: Write the changes you will try to make this week.

If you smoke—

I will set a quit date today. (The important thing is for you to pick the date—not your doctor, not your family, not your kids. It’s your decision.)

To help your children stay smoke free—

I will talk to my children about the harmful effects of smoking cigarettes and cigars. I will encourage them to create a sign that says, “We are proud to be smoke-free kids.”

To protect your family, friends, and others from

smokers— I will let my family, friends, and others know that I do mind if they smoke around me. I will put a “No Smoking” sticker or sign in my house and car.

To help your community—

I will encourage my neighbors to have smoke-free homes. I will give them “Thank You for Not Smoking” signs.

The health of yourself and your family is priceless. Make an investment in it!

338 HAndOuT—SeSSIOn 10

Session 11

Success doesn’t come

“

to you...you go to it.

”

Marva Collins

Session 11

Review and Graduation

sess i o n

Review and Graduation

Objectives

This session is designed to:

Review information learned in Sessions 1 through 10 using games and activities.
Recognize the group members’ efforts and accomplishments.

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual and picture cards
Heart Health Bingo Facts (pages 347–348)
Heart Health Bingo Cards (pages 349–363)
Bingo card markers (pennies, dry beans, or other items)
Pens
Stamped envelopes
(Optional) Food (if having a potluck)
(Optional) Small gift or certificate for each group member

Session 11. Review and Graduation 339

Handouts

Give group members these handouts during this session:

“Heart Health Bingo Facts” (pages 347–348)
“Heart Health Bingo Cards” (pages 349–363)
(Optional) “Letter to Myself: Sample” (page 364)
“Letter to Myself” (page 365)
“Certificate of Achievement” (page 366)*
Prepare the certificates (write in the name of each participant) before the session. You may photocopy the “Certificate of Achievement” handout (page 366), or you can buy certificates at an office supply store. Give each participant a certificate during the recognition part of this session.

Session Outline

Introducing the Session

Welcome
Review of Last Week’s Session
About This Session

Conducting the Session

Heart Health Bingo†
Letter to Myself Activity

Recognition for Completing the With Every Heartbeat Is Life Project (Optional) Potluck Meal

Closing

† Prepare the bingo cards and facts before the session.

340 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Introducing the Session

1. Welcome

Welcome group members to the session.

2. Review of Last Week’s Session

Note: If group members went on a grocery store tour, ask them to share what they learned from the tour. If not, review Session 10.

During Session 10, we talked about how cigarette smoking can harm you. Who can name some of the harmful effects of smoking?

Note: Allow 3 to 5 minutes for group members to answer. Write their answers on the

♥ blackboard or on a large piece of paper taped to the wall.

Add these effects if they are not mentioned:

• Cigarette smoking can cause health problems, such as:

Heart disease — Stroke — Asthma
Cancer — COPD (chronic bronchitis and emphysema)

• Cigarette smoking irritates the eyes and can trigger asthma attacks.

• Less serious, but very unpleasant, effects of smoking include:

Yellow stains on teeth and fingers
Bad breath
Poorer sense of smell and taste
Early wrinkling of the face
Many colds and sore throats

Session 11. Review and Graduation 341

Ask:

How did you do with your pledge? Did you do one thing to quit smoking or to protect your family from secondhand smoke? Did anything work very well? Did anything cause a problem?

Note: Allow 5 to 8 minutes for group members to comment.

3. About This Session

Educator Marva Collins said, “Success doesn’t come to you . . . you go to it.”

Ask:

What does this quote mean to you?

Note: Allow 2 to 3 minutes for group members to answer.

During this session, we will go over information we learned in Sessions 1 through 10. Thank you all for taking part in the sessions. Congratulations on making the effort to learn how to lower the risk—for you and your families—of developing heart disease, stroke, and diabetes.

Conducting the Session

1. Heart Health Bingo

Note: Make one copy of the “Heart Health Bingo Facts” handout (pages 347–348) on stiff paper, and cut the paper on the dotted lines. Mix the pieces, and place them in a box. Also make one copy of each of the Heart Health Bingo Cards (pages 349–363) on stiff paper, and cut them out.

342 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Give one card to each person. Give each group member nine pennies, dry beans, or other items that can be used to mark the cards.

We are going to play a bingo game to review facts about preventing heart disease, stroke, and diabetes. Here’s how to play:

• To start, place a marker on the free space in the center of the card.

• Listen as the bingo caller reads facts about heart health. These facts will be

drawn from a box.

• If the fact that is read matches a fact on your card, place a marker on it.

• If you get three markers in a row, call out “Bingo.” The row can be up and

down, across, or diagonal.

Hold up a card to show the group how the rows can look.

Note: Play two or three games as time permits. At the end of each game, have the group members turn in their cards for new ones. If possible, you may want to award small prizes to the winners.

2. Letter to Myself Activity

Note: Bring a stamped envelope and pen for each group member. If you have group members who do not write well, let them tell you the information, and you can write it down for them.

Give each group member a pen, the “Letter to Myself” handout (page 365), and a stamped envelope.

Note: You may want to show or read aloud the “Letter to Myself: Sample” handout (page 364) to give group members ideas.

Ask the group members to use the handout to list healthy changes they will continue to work on until these changes become habits.
Tell them to address the envelope to themselves and place the letter inside. Collect the sealed, self-addressed envelopes.

Session 11. Review and Graduation 343

I will mail your letter to you in about 3 months. Getting this letter will help remind you to keep using what you’ve learned in these sessions to care for your heart health.

Recognition for Completing the With Every Heartbeat Is Life Project

Show picture card 11.1.

Thank you for taking the time to attend and actively participate in the sessions. Now you are equipped with the knowledge and skills to live a heart healthy lifestyle. I hope you will use the information to help improve the heart health of you and your family.

(Optional) Give each group member a small gift of recognition.

Now, I would like to give each of you a certificate to honor your efforts and your achievements.

Call each group member’s name and give each person a “Certificate of Achievement” (page 366) and, if you choose, a small gift of recognition.

I would also like to recognize you for completing your family health history activity during this training. Knowing your own family health history will help you take action to prevent and control your risk for heart disease and stroke.

Ask:

Does anyone want to share what you have learned about your family health history? Did you think the activity was helpful?

344 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Note: Allow a moment for group members to respond.

Now, you have a chance to talk about what you have found helpful during this course. Would anyone like to share a short story about your family’s reactions to your pledged activities?

Note: Allow a moment for group members to respond.

I would also like to know if you have done any activities from the “Tender Care for a Happy Heart” list that we saw in Session 2, Act in Time to Heart Attack Signs. How did you do with the actions for a happy heart? Are you listening to soft music? Have you planted a garden? Have you learned to breathe deeply? Have you shown gratitude to others? Which of these actions has affected you the most? Have you done any of these actions as a daily activity?

Note: Allow 2 to 3 minutes for group members to respond.

(Optional) Potluck Meal

Now is the time for the potluck meal. Place the dishes you brought on the table. We will begin the celebration.

Closing

Each of you has demonstrated today’s quote: “Success doesn’t come to you . . . you go to it.” Throughout the course, you have remained dedicated to making healthy lifestyle changes for you and your family.

Session 11. Review and Graduation 345

Thank you for coming and for completing the course. I wish everyone well, and I hope you continue your journey toward good health and a healthy heart.

Note: Think about today’s session and about all of the experience and knowledge you have gained during this training over the last few months. What do you think worked and what didn’t work? What changed in your own life as a result of what you learned during these sessions?

346 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Heart Health Bingo Facts

(Photocopy and cut on the dotted lines.)

Protect your heart. When the heart stops, life stops.

Physical activity makes your heart and lungs stronger.

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

A blood pressure reading of 140/90 mmHg or greater is high.

Hypertension is another term for high blood pressure.

Use herbs and spices instead of salt.

Being overweight increases your risk of heart disease and diabetes.

People with diabetes can die from heart disease or stroke.

To lose weight, cut down on portion size and be more active.

A BMI (body mass index) tells you if you are

If your waist measurement is high, you are at risk for heart disease.

Each day, do at least 30 to 60 minutes of physical activity and encourage your children to be active for 60 minutes.

It is best to have a blood pressure reading below 120/80 mmHg.

Eat less salt and sodium to help prevent high blood pressure.

Heart attack warning signs are pain in the chest, arms, back, neck, or jaw; difficulty breathing; light-headedness; cold sweat; and feeling sick to your stomach.

If you are prescribed blood pressure or cholesterol medication, take it as the doctor tells you.

Being overweight increases your risk of high blood pressure and high blood cholesterol.

If someone is having a heart attack or stroke, do not drive them. Call 9–1–1 right away.

The food label gives the serving size and the number of calories in a serving.

Eat more fruit each day. Have a banana with overweight. A BMI under 25 is a healthy weight.

HAndOuT—S

eSSiOn 11 347

Heart Health Bingo Facts

(Photocopy and cut on the dotted lines.)

Eat more vegetables each day. Have a salad for lunch.

To save food dollars, plan weekly menus. Shop with a list!

Smoking causes serious health problems such as heart disease and lung cancer.

Children of smokers are more likely to become smokers.

Prediabetes means that you are on the way to developing diabetes. Act now—lose weight if overweight and become active.

The signs of diabetes are increased thirst, hunger, and urination; fatigue; weight loss; blurred vision; and sores that don’t heal.

Use the food label to choose foods lower in saturated fat, trans fat, and cholesterol.

High blood pressure makes your heart work harder.

Vegetables and fruits are naturally low in fat.

A healthy triglyceride level is less than 150 mg/dL.

When eating out, order baked, broiled, or grilled foods to cut down on fat and calories.

Try fruit and fat-free yogurt for snacks.

Pregnant women should not smoke.

A desirable LDL (bad) blood cholesterol level is below 100 mg/dL.

Cholesterol can clog your arteries and cause a heart attack or stroke.

Trim visible fat from meat before cooking.

Saturated fat is found in high-fat meat, cheese, milk, and butter.

Cook more food than you need and freeze part to use when you don’t have a lot of time to cook.

Drain meat after it is cooked to get rid of some of the fat.

To prevent diabetes, keep your weight down and be physically active.

Heart Health Bingo Card 1

Heart Health Bingo

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

Trim visible fat from meat before cooking.

Nutrition Facts

Serving Size _ block Servings Per Container 2

Amount Per Serving Calories 190 Calories from Fat 70

% Daily Value*

12% Total Fat 8g 20%

Saturated Fat 4g Trans Fat 0g 0% Cholesterol 0mg 34% Sodium 820mg 26g 9% Total Carbohydrate 4% Dietary Fiber 1g

Sugars 1g Protein 5g

Percent Daily Values (DV) are based on a 2,000 calorie diet.

Use the food label to choose foods lower in saturated fat, trans fat, and cholesterol.

Use herbs and spices instead Children of smokers are more of salt. likely to become smokers.

FREE

The signs of diabetes are increased thirst, hunger, and

SPACE

urination; fatigue; weight loss; blurred vision; and sores that don’t heal.

Cook more food than you need Eat more vegetables each day. and freeze part to use when you Have a salad for lunch. don’t have a lot of time to cook.

HAndOuT—SeSSiOn 11 349

Heart Health Bingo Card 2

Heart Health Bingo

High blood pressure makes Vegetables and fruits are your heart work harder. naturally low in fat.

FREE SPACE

If someone is having a heart attack or stroke, do not drive them. Call 9–1–1 right away.

Danger! 140/90 or more

If your waist measurement A blood pressure reading of is high, you are at risk for 140/90 mmHg or greater is high. heart disease.

350 HAndOuT—SeSSiOn 11

Nutrition Facts

Serving Size _ block Servings Per Container 2

Amount Per Serving Calories 190 Calories from Fat 70

% Daily Value*

12% Total Fat 8g 20%

Saturated Fat 4g Trans Fat 0g 0% Cholesterol 0mg 34% Sodium 820mg 26g 9% Total Carbohydrate 4% Dietary Fiber 1g

Sugars 1g Protein 5g

Percent Daily Values (DV) are based on a 2,000 calorie diet.

Use the food label to choose foods lower in saturated fat, trans fat, and cholesterol.

Saturated fat is found in high-fat meat, cheese, milk, and butter.

Pregnant women should not smoke.

Heart Health Bingo Card 3

Heart Health Bingo

Cook more food than you need To prevent diabetes, keep Children of smokers are more and freeze part to use when you your weight down and be likely to become smokers. don’t have a lot of time to cook. physically active.

FREE SPACE

Protect your heart. When the Eat less salt and sodium to help heart stops, life stops. prevent high blood pressure.

Less than 100 mg/dL

Prediabetes means that you are on the way to developing dia- To lose weight, cut down on Eat more vegetables each day. betes. Act now—lose weight if portion size and be more active. Have a salad for lunch. overweight and become active.

HAndOuT—SeSSiOn 11 351

Heart Health Bingo Card 4

Heart Health Bingo

Cholesterol can clog your Eat more fruit each day. Have arteries and cause a heart attack a banana with your cereal Hypertension is another term or stroke. for breakfast. for high blood pressure.

Nutrition Facts

Serving Size 4 oz Servings Per Container 2

Amount Per Serving Calories 190 Calories from Fat 70

% Daily Value*

Total Fat 8g 12%

Saturated Fat 4g 20% Trans Fat 0g

♥ Cholesterol 0mg

Sodium 820mg	34%
Total Carbohydrate 26g	9%
Dietary Fiber 1g	4%

Sugars 1g

FREE Protein 5g

Percent Daily Values (DV) are based on a 2,000 calorie diet.

SPACE

Smoking causes serious health problems such as heart disease and lung cancer.

The food label gives the serving size and the number of calories in a serving.

Body Mass Index (BMI) Chart

Healthy Weight Overweight Obese

BMI Height 4’10” 4’11” 5’0” 5’1” 5’2” 5’3” 5’4” 5’5” 5’6” 5’7” 5’8” 5’9” 5’10” 5’11” 6’0” 6’1” 6’2” 6’3”

19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Weight (in pounds) 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 256 144 151 159 166 174 182 189 197 294 212 219 227 235 242 250 257 265 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279

Heart attack warning signs

LDL below 6’4” 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287

are pain in the chest, arms, 100 mg/dL back, neck, or jaw; difficulty A BMI (body mass index) breathing; light-headedness; A desirable LDL (bad) tells you if you are overweight. cold sweat; and feeling sick to blood cholesterol level is below A BMI under 25 is a your stomach. 100 mg/dL. healthy weight.

352 HAndOuT—SeSSiOn 11

Heart Health Bingo Card 5

Heart Health Bingo

Each day, do at least 30 to 60 minutes of physical activity, and encourage your children to be active for 60 minutes.

When eating out, order baked, broiled, or grilled foods to cut down on fat and calories.

Trim visible fat from meat before cooking.

Being overweight increases your risk of heart disease Try fruit and fat-free yogurt and diabetes. for snacks.

FREE SPACE

A healthy triglyceride level is below 150 mg/dL.

If you are prescribed blood pressure or cholesterol medication, take it as the doctor To save food dollars, plan tells you. weekly menus. Shop with a list!

HAndOuT—SeSSiOn 11 353

Heart Health Bingo Card 6

Heart Health Bingo

The signs of diabetes are increased thirst, hunger, and urination; fatigue; weight loss; blurred vision; and sores that don’t heal.

People with diabetes can die from heart disease or stroke.

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

Below 120/80

It is best to have a blood Drain meat after it is cooked to pressure reading below get rid of some of the fat. 120/80 mmHg.

FREE SPACE

Use herbs and spices instead of salt.

If your waist measurement is high, you are at risk for Hypertension is another term heart disease. for high blood pressure.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 7

Heart Health Bingo

LDL below 100 mg/dL

A desirable LDL (bad) blood cholesterol level is below 100 mg/dL.

Eat more vegetables each day. Have a salad for lunch.

Pregnant women should not smoke.

Physical activity makes your Hypertension is another term heart and lungs stronger. for high blood pressure.

FREE SPACE

A healthy triglyceride level is below 150 mg/dL.

Danger! 140/90 or more

Use herbs and spices instead A blood pressure reading of of salt. 140/90 mmHg or greater is high.

HAndOuT—SeSSiOn 11 355

Heart Health Bingo Card 8

Heart Health Bingo

Vegetables and fruits are naturally low in fat.

Smoking causes serious health problems such as heart disease and lung cancer.

Danger! 140/90 or more

A blood pressure reading of 140/90 mmHg or greater is high.

Being overweight increases your risk of high blood pressure Physical activity makes your and high blood cholesterol. heart and lungs stronger.

FREE SPACE

Saturated fat is found in high-fat meat, cheese, milk, and butter.

To save food dollars, plan To lose weight, cut down on weekly menus. Shop with a list! portion size and be more active.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 9

Heart Health Bingo

Pregnant women should not smoke.

Cook more food than you need and freeze part to use when you don’t have a lot of time to cook.

If someone is having a heart attack or stroke, do not drive them. Call 9–1–1 right away.

Eat more vegetables each day. Drain meat after it is cooked to Have a salad for lunch. get rid of some of the fat.

FREE SPACE

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

When eating out, order baked, broiled, or grilled foods to cut Protect your heart. When the down on fat and calories. heart stops, life stops.

HAndOuT—SeSSiOn 11 357

Heart Health Bingo Card 10

Heart Health Bingo

High blood pressure makes your heart work harder.

Cook more food than you need and freeze part to use when you don’t have a lot of time to cook.

If your waist measurement is high, you are at risk for heart disease.

Saturated fat is found in high-fat Eat less salt and sodium to help meat, cheese, milk, and butter. prevent high blood pressure.

FREE

Heart attack warning signs are pain in the chest, arms,

SPACE back, neck, or jaw; difficulty

breathing; light-headedness; cold sweat; and feeling sick to your stomach.

If someone is having a heart Children of smokers are more attack or stroke, do not drive him likely to become smokers. or her. Call 9–1–1 right away.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 11

Heart Health Bingo

Body Mass Index (BMI) Chart

Healthy Weight Overweight Obese

BMI	19 20 21 22 23 24 25 26 27 28 29 30 31
Height	Weight (in pounds)
4’10”	91 96 100 105 110 115 119 124 129 134 138 143 148
4’11”	94 99 104 109 114 119 124 128 133 138 143 148 153
5’0”	97 102 107 112 118 123 128 133 138 143 148 153 158
5’1”	100 106 111 116 122 127 132 137 143 148 153 158 164
5’2”	104 109 115 120 126 131 136 142 147 153 158 164 169
5’3”	107 113 118 124 130 135 141 146 152 158 163 169 175
5’4”	110 116 122 128 134 140 145 151 157 163 169 174 180

Below 5’5” 114 120 126 132 138 144 150 156 162 168 174 180 186

5’6” 118 124 130 136 142 148 155 161 167 173 179 186 192

5’7” 121 127 134 140 146 153 159 166 172 178 185 191 198

120/80 5’8” 125 131 138 144 151 158 164 171 177 184 190 197 203

5’9”	128 135 142 149 155 162 169 176 182 189 196 203 209
5’10”	132 139 146 153 160 167 174 181 188 195 202 209 216
5’11”	136 143 150 157 165 172 179 186 193 200 208 215 222
6’0”	140 147 154 162 169 177 184 191 199 206 213 221 228
6’1”	144 151 159 166 174 182 189 197 294 212 219 227 235
6’2”	148 155 163 171 179 186 194 202 210 218 225 233 241
6’3”	152 160 168 176 184 192 200 208 216 224 232 240 248
6’4”	156 164 172 180 189 197 205 213 221 230 238 246 254

32 33 34 35

153 158 162 167

158 163 168 173

163 168 174 179

169 174 180 185

175 180 186 191

180 186 191 197

186 192 197 204

192 198 204 210

198 204 210 216

204 211 217 223

210 216 223 230

216 223 230 236

222 229 236 243

229 236 243 250

235 242 250 256

242 250 257 265

249 256 264 272

256 264 272 279

263 271 279 287

A BMI (body mass index) It is best to have a blood tells you if you are

Smoking causes serious health problems such as heart disease overweight. A BMI under pressure reading below 120/80 mmHg. 25 is a healthy weight.

and lung cancer.

FREE SPACE

To save food dollars, plan weekly menus. Shop with a list!

Eat more fruit each day. Have a banana with your cereal for breakfast.

If your waist measurement To prevent diabetes, keep is high, you are at risk for your weight down and be physically active. heart disease.

portion size and be more active.

n 11

Heart Health Bingo Card 12

Heart Health Bingo

Being overweight increases your risk of heart disease and diabetes.

Cholesterol can clog your arteries and cause a heart attack or stroke.

Hypertension is another term for high blood pressure.

Each day, do at least 30 to 60 minutes of physical activity, and encourage your children to Try fruit and fat-free yogurt be active for 60 minutes. for snacks.

FREE SPACE

To lose weight, cut down on portion size and be more active.

Heart attack warning signs are pain in the chest, arms, back, neck, or jaw; difficulty Cook more food than you need breathing; light-headedness; and freeze part to use when you cold sweat; and feeling sick to don’t have a lot of time to cook. your stomach.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 13

Heart Health Bingo

High blood pressure makes Vegetables and fruits are your heart work harder. naturally low in fat.

FREE SPACE

If someone is having a heart attack or stroke, do not drive him or her. Call 9–1–1 right away.

Danger! 140/90 or more

If your waist measurement A blood pressure reading of is high, you are at risk for 140/90 mmHg or greater is high. heart disease.

HAndOuT—SeSSiOn 11

Nutrition Facts

Serving Size _ block Servings Per Container 2

Amount Per Serving Calories 190 Calories from Fat 70

% Daily Value*

12% Total Fat 8g 20%

Saturated Fat 4g Trans Fat 0g 0% Cholesterol 0mg 34% Sodium 820mg 26g 9% Total Carbohydrate 4% Dietary Fiber 1g

Sugars 1g Protein 5g

Percent Daily Values (DV) are based on a 2,000 calorie diet.

Use the food label to choose foods lower in saturated fat, trans fat, and cholesterol.

Saturated fat is found in high-fat meat, cheese, milk, and butter.

Pregnant women should not smoke.

Heart Health Bingo Card 14

Heart Health Bingo

If your waist measurement is high, you are at risk for heart disease.

Being overweight increases your risk of high blood pressure and high blood cholesterol.

Nutrition Facts

Serving Size 4 oz Servings Per Container 2

Amount Per Serving Calories 190 Calories from Fat 70

% Daily Value*

Total Fat 8g 12%

Saturated Fat 4g 20% Trans Fat 0g

Cholesterol 0mg	0%
Sodium 820mg	34%
Total Carbohydrate 26g	9%
Dietary Fiber 1g	4%

Sugars 1g

Protein 5g

Percent Daily Values (DV) are based on a 2,000 calorie diet.

The food label gives the serving size and the number of calories in a serving.

If you are prescribed blood pressure or cholesterol medication, take it as the High blood pressure makes doctor tells you. your heart work harder.

FREE SPACE

Smoking causes serious health problems such as heart disease and lung cancer.

Less than 100 mg/dL

Prediabetes means that you are on the way to developing diabetes. Act now—lose Children of smokers are more weight if overweight and likely to become smokers. become active.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 15

Heart Health Bingo

Trim visible fat from meat Pregnant women should before cooking. not smoke.

FREE SPACE

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

A healthy triglyceride level is Use herbs and spices instead below 150 mg/dL. of salt.

HAndOuT—SeSSiOn 11

Nutrition Facts

Serving Size _ block Servings Per Container 2

Amount Per Serving Calories 190 Calories from Fat 70

% Daily Value*

12% Total Fat 8g 20%

Saturated Fat 4g Trans Fat 0g 0% Cholesterol 0mg 34% Sodium 820mg 26g 9% Total Carbohydrate 4% Dietary Fiber 1g

Sugars 1g Protein 5g

Percent Daily Values (DV) are based on a 2,000 calorie diet.

Use the food label to choose foods lower in saturated fat, trans fat, and cholesterol.

Saturated fat is found in high-fat meat, cheese, milk, and butter.

Drain meat after it is cooked to get rid of some of the fat.

Letter to Myself: Sample

I have learned that I can do many things to improve my health and lower my risk of developing heart disease. I can help my family members make healthy choices, too. During the next 3 months, I will try to do these things to care for my heart:

At work, I will use the stairs instead of taking the elevator.

_____________________________________

I will eat 2 cups of fruit (an orange and an apple) every day.

_____________________________________

When eating out, I will choose foods that are baked, broiled, or grilled.

_____________________________________

I will switch to reduced-fat (2%) milk for 1 month, then to low-fat (1%) milk for 1 month,

and finally to fat-free milk.

_____________________________________

I will have my blood pressure checked at the local clinic.

_____________________________________

Signed Robert Hall

Date 8/15/2007

364 HAndOuT—SeSSiOn 11

Letter to Myself

I have learned that I can do many things to improve my health and lower my risk of developing heart disease. I can help my family make healthy choices, too. During the next 3 months, I will try to do these things to care for my heart:

__________________________________________________________________________

_____________________________________

__________________________________________________________________________

_____________________________________

__________________________________________________________________________

_____________________________________

__________________________________________________________________________

_____________________________________

__________________________________________________________________________

_____________________________________

Signed

Date

HAndOuT—SeSSiOn 11 365

Community Health Worker

Awarded to:

For Completing the

Date

With Every Heartbeat Is Life Project

Certificate of Achievement

366 HAndOuT—SeSSiOn 11

Session 12

I believe that every person

“

is born with talent.

”

Maya Angelou

Session 12

Use Evaluation To Track Your Progress (Especially for Community Health Workers)

sess i o n

Use Evaluation To Track Your Progress (Especially for Community Health Workers)

Objectives

By the end of this session, community health workers will learn how to:

Create a vision for a With Every Heartbeat Is Life project for your community
Learn the basics of evaluation
Choose strategies that can be used to implement the With Every Heartbeat Is Life project in your community
Learn the role of a community health worker in the evaluation process
Collect data to show the results of the project
Participate as a team member in the project’s evaluation process
Create an evaluation workplan for the project’s activities

Materials and Supplies

To conduct this session, you will need:

“With Every Heartbeat Is Life” manual

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 367

Blackboard and chalk or large pieces of paper, markers, and tape
Color markers and sheets of poster board

Handouts

Give these handouts to each group member during the session:

“Examples of Project Evaluation” (page 392–393)
“Types of Evaluation” (page 394)
“With Every Heartbeat Is Life: Three Strategies To Offer in Your Community” (pages 395–397)
“Outcome Evaluation Form” (page 398)
“Community Health Worker Train the Trainer Pretest and Posttest” (pages 399–403)
“Feedback Form—What Did You Think About the Training? (for Strategy 1)” (pages 404–405)
“My Health Habits Pretest and Posttest” (pages 406–413)
“Screening Form” (page 414)
“Clinical Measures and Followup Form” (pages 415–417)
“Community Health Worker Activities Form” (pages 418–419)
“Recording Log (for Strategies 1, 2a, 2b, and 3)” (pages 420–422)
“Develop an Evaluation Workplan for Your Project” (pages 423–425)

368 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Session Outline

Introducing the Session

Welcome
About the Session

Conducting the Session

Develop a Vision for the With Every Heartbeat Is Life Project for Your Community
Basic Information on Evaluation
With Every Heartbeat Is Life: Three Strategies To Offer in Your Community
Data Collection
The Role of Community Health Workers in the Evaluation Process
How To Work as a Member of the Evaluation Team
Group Activity: Develop an Evaluation Workplan for Your Project

Review of Today’s Key Points

Closing

Introducing the Session

1. Welcome

Welcome group members to the session.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 369

2. About the Session

You have learned a lot of information during this training. You have gained new skills and shown great progress and motivation. Now, you are ready to put the With Every Heartbeat Is Life training into action in your community. Congratulations!

This session is especially for community health workers. It will teach you how to participate as a team member to evaluate your project.

Conducting the Session

1. Develop a Vision for the With Every Heartbeat Is Life Project for Your Community

During this session, you will develop a vision for a With Every Heartbeat Is Life project for your community.

Ask:

Can someone tell me what a vision is?

Note: Allow 2 to 3 minutes for group members to respond. Write their answers on the blackboard or a large piece of paper taped to the wall.

370 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Add the following answers if they are not mentioned:

• A vision is your dream, an image, or a picture of what you want

to do and what you imagine your community project will do for the people you serve.

• It is the direction or goal of your project.

• It is what inspires, motivates, and engages people to take action.

A vision can be written as a statement or expressed as a drawing.

Some examples of vision statements are:

• “A heart healthy and stroke-free community.”

• “An active, healthy, and informed community.”

Now it’s time for you to create a vision for a community project. Think of this question when you create your vision: What would you like your community to be like after implementing your heart health project?

Note: Divide the participants into small groups.

Choose one person from your group to share your group’s vision.

Note: Give each small group a set of color markers and a large piece of paper or poster board. Allow 20 minutes for groups to come up with their visions.

Now, a member of each group will present each vision to the rest of the group members.

Note: Allow 2 to 3 minutes for each group to share its vision. Congratulate the community health workers for their enthusiasm and a job well done.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 371

2. Basic Information on Evaluation

When you offer the With Every Heartbeat Is Life project in your community, you will want to know if your project helped you to achieve your vision. Evaluation can help you do this. Now let’s talk about what evaluation is and some important steps you need to know when you evaluate a project.

Evaluation is a well-thought-out process to assess the value of your project.

Ask:

What are some benefits of evaluation?

Note: Allow about 2 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Add the following answers if they are not mentioned.

Evaluation offers you a way to:

• Find out if your project is working or is successful.

• Learn if you are meeting the goals of the project.

• Find out which project areas need to be changed or improved.

• Gather information about your project that you can share with the community

and those who fund your project.

• Learn if your project activities are helping people make healthy choices.

372 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Give each group member the “Examples of Project Evaluation” handout (pages 392–393).

Now we will look at how evaluation is used in a few projects.

Ask volunteers to read aloud each example and tip.

Examples of Project Evaluation

Example 1

During the month of May, doctors from a community clinic referred 45 patients to the heart health sessions conducted by community health workers. Thirty participants attended all of the heart health sessions. The other 15 participants only attended a few sessions.

After the classes ended, the community health workers conducted followup visits. These visits revealed that the 30 participants who attended the classes were using the project’s heart healthy recipes, participating in physical activities, and taking their medicines as the doctor told them. The other 15 participants who did not attend the classes were not using the recipes, most were not doing any physical activity, and several were taking their medicines only when they remembered.

The community health workers saw that the project had a greater positive impact on participants who took part in all of the heart health sessions.

Tip: Plan to track participants at every stage of your project—(1) referrals, (2) class attendance, and (3) followup after the classes.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 373

Example 2

A community health worker is a member of the health promotion team working on a project to increase the physical activity of community members. Participants attended a series of heart health sessions. The community health worker reviewed the results of the project. She found that 15 out of 20 participants who went to at least 6 of the training sessions were now walking for 30 minutes or more per day.

The community health worker learned that people who attended the heart health sessions increased their physical activity.

Tip: Learn your project goals and review them throughout your project. Make sure that project activities are making sense and are helping you to reach the goals of your project.

Example 3

A group of community health workers posted flyers in the community about an upcoming cholesterol screening event. They held the screening, but only a few people showed up. After the poor turnout, the community health workers thought about different ways to get the word out. They met with community leaders, got their input, and developed a new strategy. The new strategy was to go door to door to talk about the importance of cholesterol screening and to ask people to share the information they learned with friends and family. Then, the community health workers held a second screening and had a much better turnout.

By finding out what didn’t work and getting input from the community, the community health workers were able to make changes in the way they recruited participants.

Tip: Don’t focus only on the positive results of the project. You can learn a great deal by looking at what went wrong and what did not work.

374 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Example 4

Community health workers conducted several heart health sessions for community members. One participant shared her high blood pressure story. She described how her doctor told her that she had high blood pressure and about all the healthy changes she made. After 3 months, she had lost 10 pounds, and her blood pressure was under control.

The community health workers asked this participant to share her story at a community gathering. More community members are now interested in taking part in the heart health sessions.

Tip: Be creative. Project evaluation is about more than just numbers. Participants’ stories, pictures, or journals can be very powerful tools that describe how your project has affected them.

You have learned examples of project evaluation. Now, let’s go over the seven steps to create a plan for implementing and evaluating your project.

Choose the activities. Work with your agency to choose the activities that you want to do. For example, your project may offer the sessions from the “With Every Heartbeat Is Life” manual.
Implement project activities. Perform the activities of your project as planned. For example, you can recruit 20 parents from a local school and conduct the With Every Heartbeat Is Life project at the school.
Collect data. Collect data to show if your project is helping parents. For example, you can use questionnaires to find out how parents used the information, what they learned in the sessions, and if they made heart healthy lifestyle changes.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 375

Enter data. Enter information from the completed questionnaires into a database. This task can be done by trained community health workers or trained staff.
Analyze the data. An evaluator can analyze the data and summarize the findings. For example, an evaluator may find that parents who walk for 60 minutes daily have lower blood pressures and have lost weight.
Write a report about the results. A report can show how the community has changed as a result of the project. For example, the evaluator may describe how parents’ eating habits and physical activity patterns have changed as a result of their participation in the project.
Share the results. Community health workers can share results with community members. For example, sharing results can increase community members’ interest in the project and motivate them to take personal action to improve their health.

You have seen how evaluation can help you. Now, let’s take a look at the types of evaluation: process, outcome, and other evaluation methods.

Give each group member the “Types of Evaluation” handout (page 394).
Ask volunteers to read aloud the types of evaluation and each example.

376 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Types of Evaluation

Process Evaluation

Process evaluation tells you about the content of project activities. You can learn if you are doing the activities as they were planned. It also tells you who is participating in your project activities. You can track the specifics on how you carry out your project, such as the time spent on activities and how many participants attended the activities. The results of process evaluation help you to know which activities are more successful than others. It also gives you the feedback you need to improve your project.

Example: You can collect information about the number of sessions that you taught from the “With Every Heartbeat Is Life” manual and how much time you spent on activities during the training sessions.

Outcome Evaluation

Outcome evaluation describes the effect your project had on your participants. You can learn how the participants changed or are changing after completing the course. You can track how participants’ knowledge, feelings (attitudes), or actions (behaviors) have changed after taking part in the project. You also can track the changes in clinical values. (For example, you can check to see if participants’ blood pressure or weight has decreased.)

Example: A questionnaire is given to participants before the first class. The same questionnaire is given after the last class. The results of the two questionnaires are compared, which will tell you how much participants learned.

Other Evaluation Methods

You can use other methods to evaluate your project. You can ask participants for their stories (testimonials) about how the project has affected them, and you can collect the stories as the project evolves. Participants also can submit photographs and journals about the changes they have made during the project.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 377

3. With Every Heartbeat Is Life: Three Strategies To Offer in Your Community

Note: Before the session, read the charts on pages 395–397 that serve as a guide. These charts list the three strategies in more detail. Each strategy includes: goals, description of activities, setting, and target audience.

You can offer the With Every Heartbeat Is Life project in your community using three strategies. These strategies are:

Train the Trainer. This strategy consists of using the “With Every Heartbeat Is Life” manual to train a group of community health workers, who then go back to their communities and train other community health workers.
Community Education. In this strategy, trained community health workers use the manual and picture cards to teach community members by using one of the following options:

• Teach all lessons from the manual to community members.

• Teach all lessons from the manual and screen community members.

Screenings can include the height, weight, and waist measurements of participants. Blood pressure, blood cholesterol, and blood glucose screenings also can be conducted with the help of other agencies and health professionals. If needed, community health workers can refer participants with elevated values to a medical setting for followup.

Ask:

When you do screenings as part of your community education, why do you think it is necessary to partner with other agencies such as a clinic?

Note: Allow about 2 minutes for group members to respond.

Add the following answers if they are not said:

• To secure trained health care staff to screen participants for high blood

pressure, high blood cholesterol, or blood glucose.

378 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• To get an authorized agency to obtain permission forms from participants

before they are screened for high blood pressure, high blood cholesterol, or blood glucose.

• To refer participants with elevated numbers to a health care professional at

the clinic to confirm if their levels are high and to get health information.

Lifestyle and Clinical Management. In this strategy, community health workers work in a clinic as part of a health care team. Trained community health workers: (1) teach the manual to patients, (2) monitor patients’ clinical measures (blood pressure, blood cholesterol, body mass index (BMI), waist measurements, and blood glucose levels) in collaboration with a health care provider, and (3) follow up with patients to offer support and encouragement in addition to making sure that patients are following their treatment.

Note: Some community health workers may be working in clinical settings, and they may teach patients about conditions such as HIV/AIDS, substance abuse, or prenatal care. Community health workers can use these skills to work with patients who have risk factors for heart disease, such as high blood pressure, high blood cholesterol, or diabetes.

Give each group member the “With Every Heartbeat Is Life: Three Strategies To Offer in Your Community” handout on pages 395–397.

First, let’s review the three strategies to plan how you could offer them in your community.

Ask:

Does anyone have questions about the strategies?

Note: Allow about 2 minutes for group members to respond.

4. Data Collection

Note: Before the session, read the chart on page 398 that serves as a guide. The outcome evaluation chart describes each strategy, the forms needed to collect outcome data for each strategy, when the forms should be used, and the type of information you can collect to evaluate your project.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 379

Once you have figured out which strategy or strategies you want to offer in your community, then you need to collect data for each strategy.

Give each group member the “Outcome Evaluation Form” handout on page 398.

Note: Give group members copies of the data collection forms (pages 399–422) and describe each form. The data collection forms are:

“Community Health Worker Train the Trainer Pretest and Posttest” (pages

399–403)

“Feedback Form—What Did You Think About the Training? (for Strategy 1)”

(pages 404–405)

“My Health Habits Pretest and Posttest” (pages 406–413)
“Screening Form” (page 414)
“Clinical Measures and Followup Form” (pages 415–417)
“Community Health Worker Activities Form” (pages 418–419)
“Recording Log (for Strategies 1, 2a, 2b, and 3)” (pages 420–422)

Let’s look at the data collection forms for the three strategies. We will start with the Train the Trainer strategy. This strategy uses the “Community Health Worker Train the Trainer Pretest and Posttest” forms. The pretest form was used at the beginning of the training, and you will use the posttest form at the end of the training.

The changes in responses from pretest to posttest will help you find out if you learned new information or skills. After the training, you will also complete the “Feedback Form—What Did You Think About the Training?” questionnaire. This form provides information on your likes and dislikes of the training, how confident you feel about training others, and suggestions for improving the training.

380 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

For the second strategy—Community Education—you can use the “My Health Habits Pretest and Posttest” forms to find out if participants are changing their health habits. If you add screenings to your community education strategy, then you can use the “Screening Form” to record the clinical values of participants.

Using the third strategy—Lifestyle and Clinical Management—you can use the “My Health Habits Pretest and Posttest” to record how patients are changing their health habits. You also can use the “Clinical Measures and Followup Form” to record the patients’ changes in clinical values.

The “Community Health Worker Activities Form” can be used to keep track of the followup activities that help patients stay on their treatment plan.

The “Clinical Measures and Followup Form” is useful for community health workers who work in a clinical setting.

Ask:

How many of you work in a clinic, hospital, or other medical setting?

Note: Allow 2 minutes for group members to respond.

Ask each group member to look at the “Community Health Worker Activities Form” handout again (pages 418–419).

When you work with patients, it is very important to keep track of your followup activities to help patients stay on the medicines prescribed by their doctors. You should also keep track of the followup activities you do to help patients make lifestyle changes.

Note: Since you have already reviewed the “Community Health Worker Activities Form”

handout, ask volunteers if they have any questions or comments about the activities listed on the handout. Allow 2 minutes for group members to respond.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 381

Collecting information on followup activities can highlight the important role that community health workers have in helping patients stay on their treatment plans and control their risk factors.

The last form that we will talk about is the “Recording Log.” This log tells you which form to use for each strategy and what type of information to gather for each strategy. The recording log focuses on process evaluation activities.

Let’s review the “Recording Log” handout. The information you will gather for the Train the Trainer strategy is:

• Number of participants trained

• Number of sessions taught

• Number and percentage of participants who rate the training “good” or higher

• Number and percentage of participants who report that they “will” or “most

likely will” change their health habits

• Number and percentage of participants using the “With Every Heartbeat Is

Life” manual 30 days after the training

• Types of activities that participants are completing 30 days after the training

Ask a volunteer to read aloud the information for the community education strategy.
Ask a volunteer to read aloud the information for the lifestyle and clinical management strategy.
Ask:

Does anyone have questions?

382 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

The “Recording Log” form is important because the results can help you to know which activities are being implemented and how. It also gives you the feedback you need to improve your project.

Before using these data collection forms, we recommend that you review the “More Information” box below. This box contains tips for gathering information for your community project.

More Information

Here are some tips for gathering information for your community project.

Before you offer a questionnaire to others:

• Check with your agency. Your agency may need to approve the

questionnaire before you use it. Privacy and consent of project participants are important when doing evaluation. You will want to follow the policies of your organization and your funding agency.

• Make sure you understand how to fill out the questionnaire before you

hand it out. Know the form well, so you can answer any questions participants may have.

The day you administer the questionnaire:

• Bring plenty of forms and pens with you.

• Ask participants to answer each question completely. Missing

information will make it hard for you to analyze the data.

• If the budget allows, give a small prize to people who sign up for the

program or fill out your form.

• Always remember to thank participants.

Note: During the pretest and posttest, the community health workers or volunteers may ask the questions aloud if people need help with their forms. Questions may be read aloud, but the answers to the questions should not be given.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 383

5. The Role of Community Health Workers in the Evaluation Process

Some of you may be thinking that evaluation is too complicated and that there is no role in it for you. But that is not true.

Ask:

Has anyone already worked on an evaluation of a project? Can you share what you did?

Note: Allow 3 minutes for group members to respond.

Here are some examples of the role that community health workers can have in the evaluation process.

Community health workers can:

• Help to decide which activities should be conducted.

• Hand out questionnaires and other instruments to participants.

• Collect the forms.

• Enter data into a computer.

• Provide feedback on what worked and what didn’t work and how the

activities can be improved.

• Share results of the evaluation with the community.

• Attend training meetings about project evaluation.

Remember that your involvement in the evaluation process can help show the value of having community health workers on the project team. The actions of community health workers are key in tracking project activities in the community.

384 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Ask:

If you have not been a part of an evaluation team, would you be interested in having a role in the evaluation process of the With Every Heartbeat Is Life project?

Note: Allow 5 minutes for group members to respond.

Thank you for sharing your experiences about being part of an evaluation team. With time and practice, your confidence level will increase. Just as you have been trained in how to conduct the sessions of the “With Every Heartbeat Is Life” manual, you will be trained in how to conduct evaluation activities for your project. In less time than you think, you will be making great contributions to your evaluation team.

6. How To Work as a Member of the Evaluation Team

People who evaluate projects need to work as a team. Community health workers can be an important part of this team.

A community project team may include:

• A project manager

• An evaluator

• Community health workers

• Health professionals

Ask:

Do you have an evaluator on your project team or in your agency?

Note: Allow 2 minutes for group members to respond.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 385

Ask:

What are some things you can do to get involved with project evaluation when you return to your agency?

Note: Allow 2 to 3 minutes for group members to respond. Write their responses on the blackboard or a large piece of paper taped to the wall.

Add any of these answers if they are not said:

Community health workers can:

• Find out who does evaluation in their agencies.

• Share this session on evaluation with supervisors.

• Ask their supervisors how they can be involved in evaluating the project.

• Ask their supervisors if they can attend trainings on project evaluation.

If your agency does not have an evaluator, you can try to link with an outside evaluator who supports community health worker projects.

An evaluator can help to:

• Develop an evaluation plan for the project.

• Make sure that the project is carried out as intended.

• Conduct an analysis.

• Write a report on the data collected.

386 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

More Information

Your agency can get the services of an outside evaluator by contacting:

• Other community health worker projects

• A university that has a school of public health

• A foundation that has community health projects and can refer you to

an evaluation consultant

• Your state health department

7. Group Activity: Develop an Evaluation Workplan for Your Project

The purpose of this activity is to develop an evaluation workplan for a community project.

Divide group members into the same three groups that they were in when they developed the vision for their community projects. Give each group a different project from the “Develop an Evaluation Workplan for Your Project” handout (pages 423–425).

Note: Group 1 will work on project 1; group 2 will work on project 2; and group 3 will work on project 3.

This handout on evaluation includes the project descriptions and a blank chart with questions to help you develop a plan on how to evaluate your activities. The questions are:

Who will be your target audience?
What strategy will you use?

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 387

Which forms will you use to collect data?
Describe the activities you will use to conduct the strategy.

• How will you recruit participants?

• When will you schedule the classes?

• Who will teach the classes?

Decide who will manage the data.

• Who will collect the data?

• Who will enter the data?

• Who will analyze the data?

Determine who will write the evaluation report.

388 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Community Projects

Note: Discuss your project and the evaluation workplan using the guide on pages 423–425.

Project 1: Training Community Health Workers To Promote the With Every Heartbeat Is Life Project in Their Communities

Your agency has agreed to conduct the With Every Heartbeat Is Life Train the Trainer workshop for 25 community health workers from community agencies that have requested it.
Your supervisor asks you and two other community health workers to plan the Train the Trainer workshop and to develop the education program.

Note: Discuss your project and the evaluation workplan using the guide on pages 423–425.

Project 2: Helping Community Members Make Heart Healthy Lifestyle Changes

Your community-based organization is in Baltimore, MD.
Your supervisor asks you to help develop the evaluation plan for the With Every Heartbeat Is Life community education project.
The course is for adults age 30 to 60.
The goal is to recruit, teach, and increase the knowledge, positive attitudes, and skills of the community members attending your classes.

Note: Discuss your project and the evaluation workplan using the guide on pages 423–425.

Project 3: Helping Patients Manage Their Risk Factors for Heart Disease and Make Lifestyle Changes

Your clinic is located in southeast Washington, DC.
Your clinic has decided to get involved in a project on heart health to help patients change their behaviors and lower their clinical measures.
You and two other community health workers attended a community health workers conference to receive the With Every Heartbeat Is Life training.
Now, your supervisor wants your group to develop activities and an evaluation plan for the project.

Note: Allow about 30 minutes for each group to come up with their evaluation plans.

Note: Ask one person from each group to present the group’s evaluation plan to the entire group. Allow about 5 minutes for each presentation.

Thank you for doing such a wonderful job!

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 389

Review of Today’s Key Points

Let’s review what we learned today.

What is evaluation?

Evaluation is a well-thought-out process to assess the value of your project. It helps you check to see if you are meeting the goals of the project.

What are the benefits of evaluation?

• Finding out if your project is working as planned or is successful

• Learning if you are meeting the goals of the project

• Finding out which project areas need to be changed or improved

• Gathering information about your project that you can share with the

community and those who fund your project

• Learning if your project activities are helping people make healthy choices

What is the role of community health workers in the evaluation process?

• Helping to decide which activities should be carried out

• Administering questionnaires and other instruments

• Collecting the instruments

• Entering data into computers

• Providing feedback on the ways the activities are done and how they can be

improved

• Sharing results of the evaluation with the community

• Attending training meetings about project evaluation

390 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

What strategies can you evaluate using the “With Every Heartbeat Is Life” manual?

• You can evaluate the training of community health workers to promote heart

health in the community.

• You can evaluate what community members have learned and which changes

they have made to have heart healthy lifestyles.

• You can evaluate how patients have been helped in managing their risk

factors for heart disease and making changes in their lifestyles.

Who forms the community project evaluation team?

• A project manager

• An evaluator

• Community health workers

• Health professionals

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

Community health workers play an important role in the evaluation of a community project. We hope this session helps you achieve positive results in your work with the community. I wish you success in implementing the With Every Heartbeat Is Life project in your community.

Session 12. Use Evaluation To Track Your Progress: Especially for Community Health Workers 391

Examples of Project Evaluation

Example 1

The community health workers saw that the project had a greater positive impact on participants who took part in all of the heart health sessions.

Tip: Plan to track participants at every stage of your project. You should track referrals, class attendance, and followup after the classes.

Example 2

A community health worker is a member of the health promotion team that is working on a project to increase the physical activity of community members. Project participants attended a series of heart health sessions. The community health worker reviewed the results of the project. She found that 15 out of 20 participants who went to at least 6 of the training sessions were walking for 30 minutes or more per day.

The community health worker learned that people who attended the heart health sessions increased their physical activity.

Tip: Learn your project goals and review them throughout your project. Make sure that project activities are making sense and are helping you to reach the goals of the project.

HANDOUT—SES

Examples of Project Evaluation

Example 3

By finding out what didn’t work and getting input from the community, the community health workers were able to make changes to how they recruited participants.

Tip: Don’t focus only on the positive results of the project. You can learn a great deal by looking at what went wrong and what did not work.

Example 4

Community health workers conducted several heart health sessions for community members. One participant shared her high blood pressure story. She described how her doctor told her that she had high blood pressure and about all of the healthy changes that she made. After 3 months, she had lost 10 pounds, and her blood pressure is now under control.

The community health workers asked this participant to share her story at a community gathering. More community members are now interested in taking part in the heart health sessions.

Tip: Be creative. Project evaluation is about more than just numbers. Participants’ stories, pictures, and journals can be very powerful tools that describe how your project has affected them.

HANDOUT—SES

Types of Evaluation

Process Evaluation

Process evaluation tells you about the content of project activities. You can learn if you are doing the activities as they were planned. It also tells you who is participating in your project activities. You can track the specifics on how you carry out your project, such as the time spent on activities and how many participants attended the activities. The results of process evaluation help you to know which activities were more successful than others. Evaluation also gives you the feedback you need to improve your project.

Outcome Evaluation

Outcome evaluation describes the effect your project had on your participants. You can learn how the participants have changed after completing the course. You can track how participants’ knowledge, feelings (attitudes), or actions (behaviors) have changed after taking part in the project. You also can track changes in clinical values. (For example, you can check to see if participants’ blood pressure or weight has decreased.)

Other Evaluation Methods

394 HANDOUT—SESSION 12

With Every Heartbeat Is Life: Three Strategies To Offer in Your Community

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HANDOUT—SESSION 12 395

With Every Heartbeat Is Life: Three Strategies To Offer in

(continued)

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HANDOUT—SES

With Every Heartbeat Is Life: Three Strategies To Offer in Your Community (continued)

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HANDOUT—SESSION 12 397

Outcome Evaluation Form

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398 HANDOUT—SESSION 12

Number • Number• Number• Number

the deliveringcollecting baseline baseline encounter after after after after followupfollowupfollowup and delivering followup months months months the manualinitial data (baseline data)manual (baseline)(after the manual is taught)

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FOR INTERNAL USE ONLY (For Strategy 1)

Participant identification (ID) number:

Name of person teaching the manual:

p Pretest p Posttest p 30-day followup

Start Date (MM/DD/YYYY): _____/_____/_____ End Date (MM/DD/YYYY): _____/_____/_____ Date of contact (MM/DD/YYYY): _____/_____/_____

Was the participant contacted 30 days after training ended to get information about how she or he is using the “With Every Heartbeat Is Life” manual? p1Yes p2No

What activities is the participant doing?

Participant Information

Please tell us some information about yourself by completing this form before the training. Ask for assistance if you need it.

Today’s date (MM/DD/YYYY): _____/_____/_____
Date of birth (MM/DD/YYYY): _____/_____/_____
Age (in years): ______
Gender: p1Male p2Female
Do you consider yourself Latino or Hispanic?

p1Yes p2No

Which race do you consider yourself to be?

p1Alaska Native p2American Indian p3Asian p4Black or African American p5Native Hawaiian or other Pacific Islander p6White

HANDOUT—SESSION 12 399

Community Health Worker Train the Trainer Pretest and Posttest (continued)

How many years of school have you completed?

p1Some elementary school p2Finished elementary school p3Some high school p4Graduated from high school or received high school equivalency diploma (GED) p5Some technical/vocational school p6Graduated from technical/vocational school p7Some college/university p8Graduated from college/university p9Some postgraduate school p10Graduated from postgraduate school

Have you worked as a community health 9. If yes, for how long?

worker before? p1Yes p2No _____ years _____ months

What health topics have you taught? (You may select more than one answer.)

p1None p2Asthma p3Diabetes p4Cancer p5HIV/AIDS p6Cardiovascular p7Others (please specify): ____________________

Have you used manuals to teach community members?

p1Yes p2No

If yes, please write the name(s) of the manual(s) that you have used. ________________________________

Is this your first training with the “With Every Heartbeat Is Life” manual? p1Yes p2No

400 HANDOUT—SESSION 12

Community Health Worker Train the Trainer Pretest and Posttest (continued)

Please circle only one answer for each question.

Mrs. Jones, who is 65 years old, is Gloria’s mother. Mrs. Jones has diabetes and her blood pressure is 148/98 mmHg (millimeters of mercury). Her blood cholesterol is 250 mg/dL (milligrams per deciliter). Mrs. Jones always has a salt shaker at her table and likes salty food.

What are the risk factors that put Mrs. Jones at risk for heart disease?
Using small amounts of salt, being physically inactive, and being overweight
Having high blood pressure, having high blood cholesterol, and having low blood sugar
Being a female older than age 55, having high blood pressure, having high blood cholesterol, having diabetes, and eating foods high in sodium
Having high blood cholesterol, having low blood pressure, using lots of salt, and being physically inactive
A community health worker explains to Mrs. Jones what high blood pressure is:
High blood pressure is the number that you get when you add 100 to your age.
High blood pressure is when the body circulates more blood based on your height and weight.
High blood pressure is a measurement of 140/90 mmHg or greater.
High blood pressure is when the blood suddenly stops going to the brain.

Gloria, the daughter of Mrs. Jones, is 30 years old. She cooks with a lot of fat, and she is 15 pounds overweight. She prepares fried chicken and likes nachos with lots of cheese. When Gloria does not have time to cook, she buys a super-sized hamburger, french fries, and a regular soda. Instead of walking, Gloria drives her car, even to the corner. Her “best friends” are the remote control for her television and her green chair. Gloria’s cholesterol level is 240 mg/dL.

Gloria’s risk factors and lifestyle habits that put her at risk for developing heart disease are:
Having high blood cholesterol, walking, and being age 30 and overweight
Being overweight, having high blood pressure, and having a family history of heart disease
Being overweight, physically inactive, and cooking and buying foods high in fat
Being age 30, having had a heart attack before, and having low blood pressure

HANDOUT—SESSION 12 401

Community Health Worker Train the Trainer

(continued)

Pretest and Posttest

Which of these lifestyle changes can help people prevent heart disease? Mark your answer with an X.

Reading the food label to choose foods with p Yes

less than 5 percent of the Percent Daily Value for sodium

Preparing foods by baking, broiling, or boiling, p Yes

instead of frying

Drinking a lot of whole milk p Yes
Stocking the kitchen with lots of snacks like p Yes

potato chips

Cooking with lard p Yes
Eating large portions of food p Yes

p2No p3Don’t know

p2No p3Don’t know p2No p3Don’t know p2No p3Don’t know p2No p3Don’t know p2No p3Don’t know

This question is about food serving sizes. Mark your answer with an

Is 1 cup of cooked rice one serving? p Yes
Is ½ cup of strawberries one serving? p Yes
Is 1 cup of orange juice one serving? p Yes
Is ½ cup of cooked beans one serving? p Yes
Is 1 slice of bread one serving? p Yes

p2No p3Don’t know p2No p3Don’t know p2No p3Don’t know p2No p3Don’t know p2No p3Don’t know

Do you think that the following actions help you take steps toward a healthier lifestyle? Mark your answer with an X.

Removing the skin from chicken p Agree
Cooking with lard instead of canola, olive, p Agree

or corn oil

Buying canned vegetables instead of fresh p Agree

or frozen vegetables

Choosing regular sandwiches instead of p Agree

super-sized sandwiches when eating out

Adding fruits and vegetables to your meals p Agree

402 HANDOUT—SESSION 12

p2Disagree p3Don’t know p2Disagree p3Don’t know p2Disagree p3Don’t know p2Disagree p3Don’t know p2Disagree p3Don’t know

Community Health Worker Train the Trainer

(continued)

Pretest and Posttest

for the following statements.

Secondhand smoke is not dangerous to your heart health.
The desirable level for LDL, bad cholesterol, is less than 100 mg/dL.
Having a waist measurement greater than 35 inches is healthy for a woman.
Adults need about 60 minutes of moderate to vigorous physical activity on most days to prevent weight gain.
The hemoglobin A1C (Hb A1C) test shows the average blood glucose level during the last 24 hours.
People know when they have high blood cholesterol because they begin to gain weight.
A heart healthy diet should be followed by:

p1Agree p2Disagree p3Don’t know p1Agree p2Disagree p3Don’t know p1Agree p2Disagree p3Don’t know p1Agree p2Disagree p3Don’t know

p1Agree p2Disagree p3Don’t know

(Circle the answer below that you think correctly completes this statement.)

Only people who have high blood cholesterol
Only adults who have heart disease Everyone older than 2 years of age for their lifetimes
Everyone between 40 and 65 years old

How important is it to you to reduce your risk of heart disease? Mark your answer with an

Important

How confident are you about teaching the “With Every Heartbeat Is Life” manual to community members? Mark your answer with an X.

p1I am not confident. p2I am somewhat confident. p3I am confident. p4I am very confident.

N 12

Feedback Form––What Did You Think About the Training? (for Strategy 1)

Participant identification (ID) number (optional): Date (DD/MM/YYYY): ______ / ______ / ______ City: ___________________ State: ___________________

Circle only one answer for each question.

Poor Fair Good

1. The training you attended was:	1	2	3
2. The handouts in the manual were:	1	2	3
3. The picture cards were:	1	2	3
4. The demonstrations were:	1	2	3
5. The audiovisuals were:	1	2	3
6. The content presented was:	1	2	3
7. The educational materials were:	1	2	3
8. The trainer’s knowledge of the manual	1	2	3

content was:

The way the trainer taught the manual 1 2 3 was:
The activities you participated in (e.g., 1 2 3 role plays and pledges, etc.) were:

Write your answers to the following questions.

What did you like best about the training?
What did you like least about the training?
Are there any areas that should be improved for future trainings?

404 HANDOUT—SESSION 12

Very Good Excellent N/A

4	5	0
4	5	0
4	5	0
4	5	0
4	5	0
4	5	0
4	5	0
4	5	0
4	5	0
4	5	0

Feedback Form––What Did You Think About the

(continued)

Training? (for Strategy 1)

Circle only one answer for each question.

I will Most likely not I will not

Will you teach the With Every Heartbeat Is Life course to 1 2 community members?
Will you change your health 1 2 habits?
Will you share the information from the training with your 1 2 family?
Will you share the information 1 2 from the training with friends?
Will you share the information from the training with 1 2 community health workers?
Are there other ways that you can share the information? p

Most Don’t likely

know	I will	I will
3	4	5
3	4	5
3	4	5
3	4	5
3	4	5

Yes p2No

19a. If yes, please explain:

What changes will you make as a result of participating in the training?

Other comments:

HANDOUT—SESSION 12

My Health Habits Pretest and Posttest

FOR INTERNAL USE ONLY (For Strategies 2a, 2b, and 3)

p1Pretest Start Date (MM/DD/YYYY): _____/_____/_____ p2Posttest End Date (MM/DD/YYYY): _____/_____/_____

Name of person administering the “My Health Habits” questionnaire:

Project Location:

p1Clinic

Patient identification (ID) number:

p2Community-based organization

Participant identification (ID) number:

p3Other:

Participant identification (ID) number:

Participant Information

Today’s date (MM/DD/YYYY): ______ / ______ / ______
Age (in years): ______________
Gender: p1Male p2Female
Do you consider yourself Latino or Hispanic? p1Yes p2No
What race do you consider yourself to be?

p1Alaska Native p2American Indian p3Asian p4Black/African American p5Native Hawaiian or other Pacific Islander p6White

Have you been told by a health care professional that you have diabetes?

p1Yes p2No p3Don’t know

Does your family have a history of heart disease? p1Yes p2No p3Don’t know

406 HANDOUT—SESSION 12

My Health Habits

(continued)

Pretest and Posttest

Salt and Sodium How often do you do the following things? Mark your answer with an

Do you buy fresh vegetables instead of canned vegetables?
Do you use bouillon cubes when you cook?
Do you read labels to choose foods with a low-sodium content?
Do you add salt to fruit?
Do you add salt to the water when you cook beans, rice, pasta, or vegetables?
Do you buy meats such as ham, bologna, hotdogs, or sausage?
Do you use a salt shaker at the table?
Do you fill the salt shaker with a mixture of herbs and spices instead of salt?
Do you choose fruits and vegetables instead of potato chips, french fries, and pork rinds?

Cholesterol and Fat

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

How often do you do the following things? Mark your answer with an

Do you drink fat-free milk or 1% milk?
Do you eat low-fat cheese?
Do you use vegetable oil spray to grease baking pans and skillets instead of using lard or butter?

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

p1Never p2Sometimes p3 Most of p4All the time

the time

HANDOUT—SES

My Health Habits

(continued)

Pretest and Posttest

Do you read the food label to p Never p Sometimes

1 2

help you choose foods lower in saturated fat, trans fat, and cholesterol?

Do you remove the skin before p Never p Sometimes

1 2

cooking chicken?

Do you drain the fat and p Never p Sometimes

1 2

throw it away when you cook ground meat?

Do you choose fat-free or low-fat p Never p Sometimes

1 2

salad dressing or mayonnaise?

Do you use oil to prepare your p Never p Sometimes

1 2

food instead of using lard?

Weight Management

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

How often do you do the following things? Mark your answer with an

Do you read labels to choose p Never p Sometimes

1 2

foods lower in calories?

Do you bake or grill chicken p Never p Sometimes

1 2

or other foods instead of frying them?

Do you serve more vegetables on p Never p Sometimes

1 2

your plate than you do meat?

Do you serve yourself large p Never p Sometimes

1 2

portions of food?

Do you drink water instead of p Never p Sometimes

1 2

regular soda?

Do you drink lemonade with p Never p Sometimes

1 2

sugar or powdered drinks with sugar?

Do you eat fruits instead of p Never p Sometimes

1 2

desserts or snacks that contain high amounts of sugar?

Do you eat more when you p Never p Sometimes

1 2

feel stressed?

408 HANDOUT—SESSION 12

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

p3 Most of p4All the time

the time

My Health Habits

(continued)

Pretest and Posttest

Physical Activity Mark your answer with an X.

Do you do any type of physical activity at your job?

p1Yes p2No

Not including what you do at your job, do you do any other physical activity?

p1Yes p2No (GO TO SMOKING)

If yes, answer the following questions.

2a. What type of physical activity do you do? (You may select more than one answer.)

p1Walking p2Aerobic exercise p3Playing sports

Other (please specify): __________________________

2b. How often do you do physical activity?

p1Rarely (1 day a week) p2Several times a week (2 to 6 days a week) p3Every day

2c. How many minutes per day do you do physical activity?

p1Less than 30 minutes p230 to 59 minutes p360 minutes or more

Smoking Mark your answer with an X.

Do you smoke?
Does anyone else smoke in your family?
Do you allow people to smoke in your home?

p1Yes p1Yes p1Yes

p2No p2No p2No

N 12

My Health Habits

(continued)

Pretest and Posttest

Alcohol Mark your answer with an X.

one glass of wine (5 ounces) spirits (liquor or whiskey, straight or in a mixed drink). Drinking may occur every day, some days, or just on the weekend.

Do you drink alcohol?

p1Yes p2No (GO TO KNOWLEDGE)

If yes, answer the following questions.

1a. How often do you drink?

p1Rarely (on special occasions) p2Occasionally (once a month) p3Once a week p4Regularly (several times a week) p5Every day

1b. When you drink, how many drinks do you have per occasion?

p1One to two drinks p2Three to four drinks p3Five or more drinks

1c. How often do you drink more than three drinks in one day?

p1Never p2Once or twice a week p3Three to six times per week p4Every day

Knowledge Mark your answer with an X.

Can your waist measurement indicate that you have a p Yes

high risk of heart disease?

Can the Body Mass Index (BMI) chart tell you if you p Yes

are overweight?

Does your liver make all of the cholesterol your body p Yes

needs to be healthy?

Can eating foods that are high in sodium increase p Yes

your risk of high blood pressure?

Does lard have a low amount of saturated fat? p Yes

410 HANDOUT—SESSION 12

p2No p3Don’t know

My Health Habits Pretest and Posttest

Can eating too much saturated fat and trans fat raise your cholesterol?
Is a blood pressure of 140/90 mmHg considered high?
Do people know that their cholesterol is high because they have gained weight?
Is being physically active a way to reduce your risk for heart disease?
Only people with high blood cholesterol should follow a heart healthy diet.
Can nonsmokers die from secondhand smoke?
Is having a fasting blood sugar of 126 mg/dL or higher considered diabetes?
Is having a waist measurement greater than 35 inches healthy for a woman?

(continued)

p1Yes p2No p3Don’t know

How confident are you in your ability to cook heart healthy foods?

p1I am not confident. p2I am somewhat confident. p3I am confident. p4I am very confident.

N 12

My Health Habits Pretest and Posttest (continued)

A Day With the Harris Family

People act in different ways when they learn that they need to make lifestyle changes to lower their chances of getting heart disease.

Read about how the members of the Harris family react to the news about their risks for heart disease. Then place an X next to the name of the family member with whom you identify the most.

p The Disbeliever

Darnell learns that he is at risk for heart disease, but he is not concerned about it. He gets upset when reminded about changing his unhealthy habits. He does not intend to make lifestyle changes for better health. “Nothing’s going to happen to me,” he says.

p The Frustrated

James is frustrated because he’s aware of his risk factors for heart disease but has been unable to control them. He feels trapped by life situations and wonders whether he can overcome the obstacles that prevent him from maintaining a heart healthy lifestyle. “Sometimes you can try as hard as you can, but if there’s a brick wall standing between you and your goal, what can you do?” says James.

p The Well Intentioned

Pam learns that she’s at risk for heart disease and intends to take action, but every day she puts off making changes. She feels guilty because she knows she should take steps to improve her health. “Walking the walk is harder than talking the talk,” says Pam.

p The Active

Ms. Diane (Grandma Harris) learns that she is at risk for heart disease and quickly draws an action plan. She gets information and attends classes to learn how to improve her health. Ms. Diane practices what she learns and feels optimistic and enthusiastic. She makes healthy lifestyle changes, sets reasonable goals, and helps others to do the same. “Once you know better, you owe it to yourself to do better,” says Ms. Diane.

p The Believer

Tina is very motivated to make changes to improve her health. She knows it’s easy to fall back into old habits. She makes plans to prevent setbacks, and she starts over again when necessary. Tina believes that she and her family can achieve a heart healthy lifestyle. She has a positive attitude toward life, asks for help when needed, and does not give up. “If I just believe it, then I can do it!” says Tina.

412 HANDOUT—SESSION 12

My Health Habits Posttest Only (continued)

Please answer these questions after completing all of the sessions of the “With Every Heartbeat Is Life” manual. Mark your answer with an X.

How satisfied are you with the With Every Heartbeat Is Life sessions presented by community health workers?

p1I am not satisfied.

p2I am somewhat satisfied.

p3I am satisfied.

p4I am very satisfied.

With whom have you shared the information from the sessions? Mark your answer with an X. You may select more than one answer.

p1Friends p2Family p3Coworkers p4Other (please specify): ________________________________________

HANDOUT—SESSION 12 413

Screening Form

FOR INTERNAL USE ONLY

Participant identification (ID) number:

Name of person completing the form:

(For Strategy 2b)

Community health worker identification (ID) number:

Project Location:

p2Community-based organization:

p3Other setting (please specify):

Name of partnering organization:

Use this chart to record the screening information from each project participant.

Blood Pressure Average of two readings: Systolic (top number) Diastolic (bottom number)

Overweight and Obesity Height Weight Body Mass Index (BMI) Waist measure

Blood Cholesterol Total LDL HDL Triglycerides

Blood Glucose Hb A1C Blood glucose level (nonfasting) Blood glucose level (fasting)

Pretest Date

(MM/DD/YYYY):

_____/_____/_____

__________mmHg

Posttest Date

(MM/DD/YYYY):

_____/_____/_____

__________mmHg

_____feet _____inches ____feet _____inches

_____pounds

_____BMI

_____inches

______mg/dL

______%

______mg/dL

_____pounds

_____BMI

_____inches

______mg/dL

______%

______mg/dL

All participants with elevated levels are to be referred for further evaluation. Does participant have elevated level(s)?

p1Yes p2No

If yes, participant was referred to: _____________________________

p1Yes p2No

Did the participant go for followup care?

HANDOUT—SES

Clinical Measures and Followup Form

FOR INTERNAL USE ONLY (For Strategy 3)

Participant identification (ID) number:

Name of person completing the form:

Community health worker identification (ID) number:

Project Location:

p1Clinic

Participant Information

Today’s date (MM/DD/YYYY): ______/______/______
Age (in years): _____
Gender: p1Male p2Female
Do you consider yourself Latino or Hispanic? p1Yes
What race do you consider yourself to be?

p1Alaska Native p2American Indian p3Asian p4Black/African American p5Native Hawaiian or other Pacific Islander p6White

Does your family have a history of heart disease? p1Yes

p2No

p2No p3Don’t know

12 Months 6 Months After After Baseline Baseline Date: __/__/__ Date: __/__/__ Date: __/__/__

Blood cholesterol

Have you ever been told p Yes p No p Yes

1 2 1

by a doctor or other health professional that you have high blood cholesterol?

Are you on medication? p Yes p No p Yes

1 2 1

HANDOUT—SESSION 12

p2No p1Yes p2No

Clinical Measures and Followup Form

Baseline

Date: __/__/__

Total

LDL

HDL

Triglycerides

______ mg/dL

Blood pressure

Have you ever been told p Yes p No

1 2

by a doctor or other health professional that you have prehypertension?

Have you ever been told p Yes p No

1 2

by a doctor or other health professional that you have high blood pressure?

Are you on medication? p Yes p No

1 2

Average of two readings

Systolic ______ mmHg

Diastolic ______ mmHg

Diabetes

Have you ever been told p Yes p No

1 2

by a doctor or other health professional that you have prediabetes?

Have you ever been told p Yes p No

1 2

by a doctor or other health professional that you have high blood glucose?

Are you on medication? p Yes p No

1 2

Hb A1C ______%

Blood glucose level ______ mg/dL (fasting)

6 Months After

Baseline

Date: __/__/__

______ mg/dL

p1Yes p2No

______ mmHg

p1Yes p2No

______%

______ mg/dL

12 Months

After Baseline

Date: __/__/__

______ mg/dL

p1Yes p2No

______ mmHg

p1Yes p2No

______%

______ mg/dL

HANDOUT—SES

Clinical Measures and Followup Form

Baseline

Date: __/__/__

Overweight and obesity

Weight

Height

Body mass index (BMI)

Waist measure

_____ pounds

___feet ____inches

_____BMI

_____ inches

6 Months After

Baseline

Date: __/__/__

_____ pounds

12 Months

After Baseline

Date: __/__/__

_____ pounds

___feet ____inches ___feet___inches

_____BMI _____BMI

_____ inches _____inches

Medication (If the patient is on medication[s], ask the question below.)

Do you take your p Yes p No

1 2

medication as prescribed by the doctor?

p1Yes p2No p1Yes p2No

If the answer to question 11 is “no,” please ask the patient: (Based on the patient’s response, please check all the answers that apply.)

6 Months After 12 Months Baseline Baseline After Baseline Date: __/__/__ Date: __/__/__ Date: __/__/__

I believe that taking medication every p Yes

day is not good for me.

I forget to take my medication. p Yes
I did not understand what the doctor p Yes

told me.

I stopped taking medication when I p Yes

felt better.

I feel sick when I take the p Yes

medication.

I do not have anyone to help me. p Yes
I do not have money to buy the p Yes

medication.

p2No p1Yes p2No p2No p1Yes p2No p2No p1Yes p2No p2No p1Yes p2No p2No p1Yes p2No p2No p1Yes p2No p2No p1Yes p2No

p1Yes p2No p1Yes p2No p1Yes p2No p1Yes p2No p1Yes p2No p1Yes p2No p1Yes p2No

___________ ___________

N 12

Community Health Worker Activities Form

FOR INTERNAL USE ONLY (For Strategy 3) Please complete this form after the manual is taught to record the encounters with the patient.

Participant identification (ID) number:

Name of person completing the form:

Community health worker identification (ID) number:

Name of person who taught the manual:

Project Location:

p1Clinic

Which of the following activities do you do? Mark your answer with an

First Followup 3-Month Encounter Followup

ACTIVITIES Date: __/__/__ Date: __/__/__

Listen to the patient’s p Yes p No p Yes p No

1 2 1 2

concerns.

Make an appointment for p Yes p No p Yes p No

1 2 1 2

the patient.

Remind the patient to keep p Yes p No p Yes p No

1 2 1 2

the appointment.

Make transportation p Yes p No p Yes p No

1 2 1 2

arrangements for the patient.

Serve as interpreter for p Yes p No p Yes p No

1 2 1 2

the patient.

Provide counseling/ p Yes p No p Yes p No

1 2 1 2

educational materials to the patient.

Go over counseling/ p Yes p No p Yes p No

1 2 1 2

educational materials with the patient.

Ask the patient if he or she p Yes p No p Yes p No

1 2 1 2

has any questions about the medication.

418 HANDOUT—SESSION 12

6-Month 12-Month Followup Followup

Date: __/__/__ Date: __/__/__

p1Yes p2No p1Yes p2No

Community Health Worker Activities Form

Encourage the patient to p Yes p No

1 2

stay on treatment plan.

First Followup Encounter

Give suggestions to p Yes p No

1 2

the patient on how to remember to take the medication.

Ask the patient about p Yes p No

1 2

difficulties in changing his or her lifestyle habits.

Explain benefits of p Yes p No

1 2

changing lifestyle habits to patient.

Encourage patient to p Yes p No

1 2

participate in support groups.

Refer patient to health and p Yes p No

1 2

community services.

Conduct followup p Yes p No

1 2

home visit.

Conduct followup p Yes p No

1 2

phone call.

Write down what you p Yes p No

1 2

discussed during the home visit or phone call.

Meet with supervisor on a p Yes p No

1 2

regular basis.

File notes in patient’s chart. p1Yes p2No
Other:_________________ p1Yes p2No

p1Yes p2No p1Yes p2No p1Yes p2No

3-Month 6-Month 12-Month Followup Followup Followup

p1Yes p2No p1Yes p2No p1Yes p2No

p1Yes p2No p1Yes p2No p1Yes p2No p1Yes p2No p1Yes p2No p1Yes p2No

HANDOUT—SES

Recording Log (for Strategies 1, 2a, 2b, and 3)

Information

Number of participants trained ______Number of sessions taught ______Number and percentage of participants who rate thetraining “good” or higher ______Number and percentage of participants who report thatthey “will” or “most likely will” change their healthhabits ______Number and percentage of participants using the “WithEvery Heartbeat Is Life” manual 30 days after thetraining ________Types of activities participants are completing 30 daysafter the training ______

Use This Form Attendance RecordFeedback Form Community HealthWorkers Train theTrainer Posttest Only

Strategy

Train the Trainer 1.

420 HANDOUT—SESSION 12

Recording Log (for Strategies 1, 2a, 2b, and 3) (continued)

Information

Number of participants counseled/taught ______Number of sessions taught ______Number of participants satisfied with project ______Number of participants who shared information aboutthe project ______Number of participants counseled/taught ______Number of sessions taught ______Number of participants satisfied with project ______Number of participants who shared information aboutthe project ______Number of participants screened ______Number of participants with elevated clinical values______Number of participants referred to a health careprofessional ______Number of participants who actually followed up with ahealth care professional ______

Use This Form

Attendance RecordMy Health HabitsPosttestAttendance RecordMy Health HabitsPosttestScreening Form

Strategy educationalmanual only. educational manualand screen programparticipants. Community Educationa. Teach the b. Teach the 2.

HANDOUT—SESSION 12 421

Recording Log (for Strategies 1, 2a, 2b, and 3) (continued)

12 months________________________________________________________________________________________________

6 months________________________________________________________________________________________________

Baseline________________________________________________________________________________________________

Information

PrehypertensionHigh blood pressureHigh blood cholesterolPrediabetesHigh blood glucoseBody mass index (BMI) of 25 or moreWaist measurement greater than 35 inches for womenWaist measurement greater than 40 inches for menHigh blood pressureHigh blood cholesterolDiabetes

Number of patients counseled/taught ______Number of sessions taught ______Number of participants satisfied with project _______Number of participants who shared information about the project ______Number of patients screenedNumber of patients with:ppppppppNumber of patients who are taking medications for:pppNumber of patients contacted at first encounter ______Number of patients contacted at 3 months ______Number of patients contacted at 6 months ______Number of patients contacted at 12 months ______Listed the activities community health workers conducted at first encounter, at 3 months, at6 months, and at 12 months

Form Use This AttendanceRecordMy HealthHabitsPosttestClinicalMeasuresandFollowupForm CommunityHealthWorkerActivitiesForm

Strategyand Clinical Management

Lifestyle

422 HANDOUT—SESSION 12

Develop an Evaluation Workplan for Your Project

Write your workplan to evaluate each project using the guide below.

Project 1: Training Community Health Workers To Promote the With Every Heartbeat Is Life Project in Your Community

Your agency has agreed to conduct the With Every Heartbeat Is Life Train the Trainer workshop for 25 community health workers from community agencies that have requested it.
Your supervisor asks you and two other community health workers to plan the Train the Trainer workshop and to develop the evaluation plan.

Setting:

Who will be What strategy Which forms Describe the Decide who Determine your target will you use? will you use activities you will manage who will write audience? to collect the will use to the data. the evaluation data? conduct the report. strategy.

How will Who will you recruit collect the participants? data?

When will you Who will enter schedule the the data? classes?

Who will teach the classes?

Who will analyze the collected data?

HANDOUT—SESSION 12 423

Develop an Evaluation Workplan for Your Project

Write your workplan to evaluate each project using the guide below.

Project 2: Helping Community Members Make Heart Healthy Lifestyle Changes

Your community-based

organization is in Baltimore, MD.

you Heartbeat Is Life community project.

adults teach, the community members attending your classes.

Setting:

Who will be What strategy your target will you use? audience?

Which forms Describe the Decide who Determine will you use activities you will manage who will write to collect the will use to the data. the evaluation data? conduct the report. strategy.

How will you recruit participants?

When will you schedule the classes?

Who will teach the classes?

HANDOUT—SESSION 12

Develop an Evaluation Workplan for Your Project

Write your workplan to evaluate a project using the guide below.

Project 3: Helping Patients Manage Their Risk Factors for Heart Disease and Make Lifestyle Changes in decided health to help patients change their behaviors and lower their clinical measures.

community workers conference to receive the With Every Heartbeat Is Life training.

Now, your supervisor plan for the project.

Setting:

Who will be What strategy your target will you use? audience?

wants your group to develop activities and an evaluation

Which forms Describe the Decide who Determine will you use activities you will manage who will write to collect the will use to the data. the evaluation data? conduct the report. strategy.

How will you recruit participants?

When will you schedule the classes?

Who will teach the classes?

HANDOUT—SESSION 12 425

Growing is the reward of learning.

“ ”

Malcolm X

Appendix

AppendixBe Heart Smart:

Activities for Training Community Health Workers

appe n d i x

Activities for Training Community Health Workers

The “With Every Heartbeat Is Life” manual can be used to train community health workers about heart health. Instructors can model training techniques for community health workers on sessions for community members. Trained community health workers can conduct community education activities by using the manual or completing special projects in the community.

The first part of this appendix contains activities to help community health workers develop skills that are needed to prepare presentations for community groups. This part of the appendix also contains activities to help participants learn how to become more involved during the training. These activities offer suggestions for leading a group, as well as opportunities for community health workers to practice the topics during the training.

In the second part of the appendix, community health workers will find activities that can be completed as part of the project using the manual or conducted at community events, such as health fairs and health festivals.

This appendix also includes a flyer and teaching tips to help you promote the project. For example, you can publicize your community health worker training using the flyer on page 436. Post the flyer in local clinics and organizations, and ask community leaders for help in finding people for your training.

Part 1 Preparing To Make a Presentation

Effective community health workers must have good presentation skills. This section gives information on how a community health worker can prepare to teach the With Every Heartbeat Is Life training.

Appendix 427

At the end of Session 1

When you complete the With Every Heartbeat Is Life training, you will be able to conduct your own project for groups in your community. As a community health worker, you will not be giving medical advice. You will give information and support to encourage others to live healthier lives and to use health services that are available in their communities.

Note: Give each community health worker the “Tips To Teach the ‘With Every Heartbeat Is Life’ Manual” handout (page 433) and the “Seven Golden Rules for Teaching Groups” handout (page 434).

You will have the opportunity to practice teaching the material in the manual during a later session. I will give you more information on these presentations later.

Now we will review some steps that will help you prepare an effective and interesting presentation of the With Every Heartbeat Is Life project.

Let’s review the “Tips To Teach the ‘With Every Heartbeat Is Life’ Manual” and the “Seven Golden Rules for Teaching Groups” handouts. I recommend that you use these materials when you prepare your presentation and teach the “With Every Heartbeat Is Life” manual.

Teaching Practice

Community health workers can gain confidence as presenters by practicing how to teach a session. Listed below are two ways that your group can practice during the training: (1) group members can present a complete session, or (2) they can make short presentations on topics from each session. Choose the method that works best for your group.

428 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Presenting a Session

This activity gives community health workers the opportunity to practice teaching the sessions of the “With Every Heartbeat Is Life” manual. At the end of Session 7, divide participants into two groups. Assign one group to present Session 9 and one group to present Session 10.

Allow the groups 30 minutes to practice at the end of Sessions 7 and 8. Give each group the handouts and other supplies needed to teach each session. The group that is not teaching will offer suggestions to the presenters about what was done well and what can be improved.

At the end of Session 7

Now each of you will have the chance to be the trainer. Let’s divide into two groups. One group will practice teaching Session 9, “Eat in a Heart Healthy Way—Even When Time or Money Is Tight.” The other group will practice teaching Session 10, “Take Control of Your Health: Enjoy Living Smoke Free.”

Each group now has 30 minutes to review the assigned session and decide how to present the activities. You can use this time to divide the sections of the session among the members of your group.

You will also have 30 minutes at the end of Session 8, which is next week, to continue practicing. After this, you will teach Sessions 9 and 10. Each group will have 1 hour to teach each session.

Presenting a Topic

For this second method, group members will make presentations on specific topics from each session. Each participant may make a 5- to 10-minute presentation individually, or in a team of two, on a session topic covered during the training. Present this activity at the end of Session 7 by asking the community health workers to choose the topic they will present and by giving them time to practice.

Appendix 429

At the end of Session 7

At the end of Sessions 8, 9, and 10, each of you will make a short presentation on your own or with another group member. Each presentation will cover a topic from the manual and will last 5 to 10 minutes.

Give participants the “With Every Heartbeat Is Life: Topics for Practice” handout (page 435).

Here is a list of topics you can choose. I will give you a few minutes to select your topic and choose a partner if you decide to work in pairs. Then we’ll make a list of the topics and presenters. Don’t be nervous. We are all here to learn and practice in a safe environment.

Note: A list of topics to include appears below.

With Every Heartbeat Is Life: Topics for Practice

• How the Heart Works (Session 1)

• Heart Disease Risk Factor Activity (Session 1)

• What Are the Warning Signs of a Heart Attack? (Session 2)

• Types of Physical Activity (Session 3)

• Benefits of Physical Activity (Session 3)

• Lowering High Blood Pressure (Session 4)

• Shake the Salt and Sodium Habit (Session 4)

• Facts About Blood Pressure and Stroke (Session 4)

• Food Label Activity—Fats (Session 5)

• Facts About Saturated Fat, Trans Fat, and Cholesterol (Session 5)

• Metabolic Syndrome and Your Health (Session 5)

430 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

• Cooking With Less Saturated Fat Activity (Session 5)

• What Is a Healthy Weight? Activity (Session 6)

• The Healthy Way To Lose Weight (Session 6)

• ABCs of Diabetes Control (Session 7)

• Think Before You Drink: Hidden Sugar in Common Beverages (Session 7)

• African American and Soul Food Dishes (Session 8)

• Eating in a Heart Healthy Way Even When There Is Little Time: Busy Times

(Session 9)

• Eating in a Heart Healthy Way Even When There Is Little Time: Eating Out

(Session 9)

• Save Money on Your Food Bill (Session 9)

• Smoking Harms You (Session 10)

• Quitting Smoking (Session 10)

Ask:

Have you decided which topics you want to present?

Will one person from each team tell me what topic you will present?

Write each group member’s name (and his or her partner’s name, if applicable) beside the topic.

Note: If too many people choose the same topics, you should ask them to choose others.

Remember to use the “Tips To Teach the ‘With Every Heartbeat Is Life’ Manual” (page 433) and the “Seven Golden Rules for Teaching Groups” handouts (page 434) when you present your topics.

Note: Decide which group members will present their topics at the end of Session 8, at the end of Session 9, and at the end of Session 10. Now allow 30 minutes for group members to review their topics, ask questions, or practice their presentations.

Appendix 431

At the end of Sessions 8, 9, and 10

Note: When you finish presenting each of Sessions 8, 9, and 10, assigned group

♥ members should present their topics.

Now we will present our topics. Each person or team will present for about 5 minutes. This exercise will give you a chance to practice your teaching skills and get feedback. Each time you present, you will become more comfortable and learn new ways to get people involved. So relax and let’s have fun.

Ask a group member or pair to make the first presentation. After the presentation, allow 3 to 5 minutes for questions or comments about what was done well and what can be improved. Thank group members, and give positive comments. Politely correct any wrong information. Finalize your comments with something positive. Then ask another group member or pair to present. Follow these instructions for each presentation, until all group members have finished presenting their topics.

Your presentations have shown how much you have learned about heart health. I hope you will use every opportunity to spread the word––African American families can make changes now to reduce their risk for heart disease. Community health workers, like you, are important to helping our families and communities live healthy lifestyles.

You May Want To Practice More

Here are some ideas to build your confidence and give you more practice:

• Observe an experienced trainer or community health worker while he or she

teaches a session or the entire training.

• Schedule an opportunity for each health worker to present a full session to

other community health workers.

• Team-teach a session or the entire course to a community group with the help

of a more experienced trainer.

432 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Tips To Teach the “With Every Heartbeat Is Life” Manual

Before Each Session

Review the manual carefully several times.
Review information about your audience (for example, their levels of education, years as community health workers, areas of expertise, or how open they are to new health information).
Practice teaching in front of family or friends using all your materials.
Gather materials and equipment you will need (posters, music, videotapes, handouts, extension cords, television monitor, VCR, picture cards, markers, measuring tape, masking tape, and food items). If the room has a blackboard, make sure there is plenty of chalk and an eraser. If no blackboard is available, you also will need flipchart-size pieces of paper and additional markers.

The Day of the Session

Arrive at least 30 minutes before the start of the session.
Set up chairs and tables in a U-shape so you can get the group more involved.
Find electrical outlets and light switches.
Set up audiovisual equipment.
Set videotapes to the place on the tape where you need to start.
Place posters where the audience can see them. Make sure not to damage the walls.
Put the handouts in the order that you will give them out. Make sure you have enough copies for everyone.
Set up any activities or snacks that you have planned.

After the Session

Thank everyone for coming.
Collect all forms.
Leave the room clean and arranged the way you found it.

handouT—aPPEndIX 433

Seven Golden Rules for Teaching Groups

Maintain eye contact with everyone.
Speak so that everyone can hear. Talk with a clear, strong, and kind voice.
Show your enthusiasm. Move around, and use hand gestures.
Keep track of time. Wear a watch or have a clock in the room. Plan your presentation so that you do not have to rush. Do not let the class run too long.
Show interest in the group members.

• Greet them when they come in.

• Tell them you value their time and attendance.

• Listen to what people say.

• Talk simply and to the point, and give clear, short answers.

• Help them to set goals.

• Stay calm and use humor. Focus on the positive.

• End with a review of the most important points. Thank them for coming.

Try to have everyone participate. People tend to learn more when they are involved. Try not to lecture.

• Ask questions. Praise correct answers. Politely correct wrong information.

• Answer questions. Be honest. Find answers to questions you cannot answer.

Pay attention to content. Your presentation must provide correct information.

434 handouT—aPPEndIX

With Every Heartbeat Is Life: Topics for Practice

How the Heart Works (Session 1)
Heart Disease Risk Factor Activity (Session 1)
What Are the Warning Signs of a Heart Attack? (Session 2)
Types of Physical Activity (Session 3)
Benefits of Physical Activity (Session 3)
Lowering High Blood Pressure (Session 4)
Shake the Salt and Sodium Habit (Session 4)
Facts About Blood Pressure and Stroke (Session 4)
Food Label Activity—Fats (Session 5)
Facts About Saturated Fat, Trans Fat, and Cholesterol (Session 5)
Metabolic Syndrome and Your Health (Session 5)
Cooking With Less Saturated Fat Activity (Session 5)

handouT—a

What Is a Healthy Weight? Activity (Session 6)
The Healthy Way To Lose Weight (Session 6)
ABCs of Diabetes Control (Session 7)
Think Before You Drink: Hidden Sugar in Common Beverages (Session 7)
African American and Soul Food Dishes (Session 8)
Eating in a Heart Healthy Way Even When There Is Little Time: Busy Times (Session 9)
Eating in a Heart Healthy Way Even When There Is Little Time: Eating Out (Session 9)
Save Money on Your Food Bill (Session 9)
Smoking Harms You (Session 10)
Quitting Smoking (Session 10)

PPEndIX 435

Join the Fight Against Heart Disease in the African American Community

Participate in a With Every Heartbeat Is Life Training Workshop for Community Health Workers

Learn About Heart Health

The With Every Heartbeat Is Life training workshop will help you gain the knowledge, skills, and motivation to help you take action against heart disease.

Teach Others About Heart Health

The training workshop will also help you learn teaching methods. You will be introduced to educational materials that you can use to lead sessions about heart health in your community using the “With Every Heartbeat Is Life” manual.

The next training will be held:

Date: ___________________________________________ Time:_________________ Location: ______________________________________________________________ To register, contact:______________________________________________________

Upon completion of training, each participant will receive a certificate.

436 handouT—aPPEndIX

Part 2 additional Information and activities

Community health workers may add activities to the “With Every Heartbeat Is Life” manual sessions to help with training. This section of the appendix offers instructions on how to present five additional activities to the group members.

activity 1: Face The heart Truth

Note: You can review the following information about The Heart Truth with group members and tell them how they can participate. The Heart Truth is a national awareness campaign for women about heart disease.

The Heart Truth for Women

One in four African Americans dies of heart disease. It is the #1 killer of women, regardless of race. It affects women at younger ages more than most people think, and the risk rises in middle age.
Heart disease can diminish health and the ability to do even simple activities like climbing stairs. It can decrease your quality of life. Two-thirds of women who have heart attacks never fully recover. If you have a heart attack, your risk of having another one increases.

Act Now To Protect Your Heart

Start protecting your heart now by learning about The Heart Truth at www.hearttruth.gov. You’ll find out how and why women everywhere are embracing The Heart Truth’s Red Dress, the national symbol for women that raises awareness of heart disease, which is the #1 killer of women.
The first Friday of February is National Wear Red Day. Promote this event in your community. Participate by showing off your favorite red dress, shirt, or tie and by wearing the Red Dress pin. Visit www.hearttruth.gov to order your own official Red Dress pin.

Appendix 437

activity 2: how To organize a Walking Club

Walking is an excellent form of physical activity. It is fun and easy, and it builds good health and well-being. Walking is inexpensive, and you do not need special equipment. To ensure group members will participate it is important to plan ahead, organize activities, and promote the benefits of a walking club.

Promote the benefits of walking as a group.

It is more fun to walk as a group.
Team members help each other to keep the pace and stick to the program.
Walking gives you time to spend with friends and meet new friends who are also interested in being active.
You can develop goals and work together to achieve them.
Your club can plan fun activities and themes, which will increase participation.
Walking is an easy activity to begin.

How to plan a walking club

Form a group of people who are interested in starting a walking club that promotes the benefits of walking with a group.
Get the group together to share ideas and set goals.
Organize your program. Use a calendar to mark the day, place, and time when you will meet. Also, write down the distance you want to walk each day. Remember to make changes from time to time and to keep your activities fun and challenging.
Announce the start of the club during the With Every Heartbeat Is Life training, and invite the group members to bring their friends and family. Besides word of mouth, use interesting ways to advertise, including posters, church bulletins, calendars, and newsletters.
Ask club members to help you create a slogan or catchy name for your club.

438 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Where To Start

Pick a location where your club will walk, perhaps in the surrounding neighborhood where you hold your classes. You may change the route to keep it fun, but you should always meet at the same time and in the same place.
Look for well-lit areas with sidewalks. If there is a school nearby, tracks are usually open to the public.
You can also walk inside a mall when it’s too cold or too hot outside.

What To Expect

Plan your activities, and use your imagination!
Encourage different members to lead the group.
Have special walk days each month to highlight themes, such as American Heart Month, Mother’s Day, and other traditional celebrations.
Create daily or weekly theme walks, such as nature walks, discovery walks, and fitness walks.
Encourage participants to warm up, stretch, and cool down to avoid injuries. (See the “Stretching Activities” handout in Session 3 on page 79.)
Use a calendar or notebook to record personal walks and distances.
Motivate group members to keep personal records and to challenge themselves to improve.

When To Begin

Decide when to walk (for example, before or after class or during weekend mornings or afternoons).

Don’t Forget

Stay alert. Be familiar with your surroundings.
Encourage walkers to dress appropriately and to bring a bottle of water.

Appendix 439

Advise participants of the dangers of wrapping themselves with plastic. Tell them not to do this because it is dangerous. (See Session 3, page 64, for more information.)
Make sure that chatting does not interfere with the walking pace. Encourage group members to socialize, but also encourage them to keep moving.

activity 3: nutrition displays

Nutrition displays are a great way to teach about nutrition. They visually encourage participants to learn about healthy food choices. Nutrition displays make a class or presentation more interesting, and they can be used with this manual. Three nutrition displays that you can create and use along with the nutrition activities in Sessions 4 through 9 are on pages 441–447.

Three nutrition displays are recommended for use in the following sessions of the manual.

Fat Matters—But Calories Count Use during Session 5, “Be Heart Smart: Keep Your Cholesterol in Check.”
How Much Sugar and Calories Are in Your Favorite Drink? Use during Session 7, “Protect Your Heart: Take Good Care of Your Diabetes for Life.”
Making the Best Choice in Fast Food Places Use after Session 8, “Make Heart Healthy Eating a Family Affair.”

Prepare displays to teach participants about their food choices. Use displays in settings such as health fairs, waiting room areas, schools, worksite cafeterias, community health centers, and sites of Women, Infants, and Children (WIC) programs.

440 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

What you need:

One sheet of poster board (20 inches by 30 inches)
Food pictures or food models
Plastic spoons, preferably colored
White clay, Velcro, glue, markers
Sugar cubes and manila file folders (for use in the sugar displays, as shown in the picture on page 443)

Fat Matters––But Calories Count

This nutrition display demonstrates the actual number of teaspoons of fat in foods. For example, you can compare fried chicken with baked or grilled chicken with the skin removed. Calculate the number of teaspoons by dividing the number of fat grams by four. For example, a food with 20 fat grams has 5 teaspoons of fat.

Some foods that can be compared are:

3 ounces of pork sausage .................. 8½ teaspoons of fat (34 grams)

3 ounces of lean pork tenderloin ............ 1½ teaspoons of fat (5 grams)

3½ ounces of chicken breast

3½ ounces of skinless chicken breast (broiled)........................... 1 teaspoon of fat (4 grams)

Appendix 441

442 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

How Much Sugar and Calories Are in Your Favorite Drink?

This display is used to demonstrate how much sugar and calories are in common drinks.

Cut a manila file folder in half and fold each portion in half to make a card.
Write the name of the drink on one side. On the other side, write the number of calories, grams of sugar, and teaspoons of sugar in the drink. Glue the sugar cubes onto the folder to show the number of teaspoons of sugar in each drink.
Use the “How Much Sugar and Calories Are in Your Favorite Drink?” handout (in Session 7, page 243) to find the number of calories and grams and teaspoons of sugar in common drinks.

Appendix 443

Rethink Your Drink

If you drink one 12-ounce can of regular soda every day for a year, how much sugar is that in a year?

30 pounds of sugar

5 POUNDS 5 POUNDS 5 POUNDS 5 POUNDS 5 POUNDS 5 POUNDS

Q: How much weight would a person lose in a year after switching from regular soda to water or calorie-free beverages?

A: About 15½ pounds*

Based on 150 calories for an average can of soda.

444 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Making the Best Choice in Fast Food Places

This display shows you how to make healthy choices at fast food restaurants. Nutrition information can be found on most company Web sites, and most fast food places have nutrition brochures available.

Two sample meals are shown below.

Calorie and HIGH-Fat Menu Choices

Food Items	Calories
Double meat cheeseburger	1,120
Medium french fries	360
Medium chocolate shake	500
Total	1,980

102 grams of total fat = 25½ teaspoons of fat

Total Fat (g)	Saturated Fat (g)
76	30
18	5
8	5
102	40

Fat Menu Choices

Food Items Calories

Grilled chicken sandwich,

no mayonnaise	330
Garden salad	25
Light dressing	50
Low-fat (1%) milk	110
Total	515

14 grams of total fat = 3½ teaspoons of fat

Total Fat (g)	Saturated Fat (g)
7	1
0	0
5	1
2	2
14	4

The food choice sign on page 446 can be made into a table tent sign by gluing the sign to a media folder.

Appendix 445

Making the Best Choice:

How To Choose a Healthier Fast Food Meal

High-Calorie Menu Choice:

102 grams of total fat = 251/2 teaspoons of fat

Food Items Calories Total Fat Saturated Fat

Double meat cheeseburger	1,120	76 g	30 g
Medium french fries	360	18 g	5 g
Medium chocolate milkshake	500	8 g	5 g
Total	1,980	102 g	40 g

Lower-Calorie Menu Choice:

14 grams of total fat = 31/2 teaspoons of fat

Food Items Calories Total Fat Saturated Fat

Grilled chicken sandwich,

no mayonnaise	330	7 g	1 g
Salad, low-fat dressing	75	5 g	1 g
Low-fat (1%) milk	110	2 g	2 g
Total	515	14 g	4 g

446 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Making the Best Choice

How To Choose a Healthier Fast Food Meal

Choose your sandwich without mayonnaise or special sauce.
Order sandwiches without cheese.
Choose not to supersize.
Have water, unsweetened iced tea, or a diet soft drink instead of a regular soft drink or a milkshake.
Choose low-fat or fat-free dressing.
Plan ahead—have a healthy, low-fat breakfast and lunch if you plan to eat out for dinner.

activity 4: Take Time for Sleep––additional Presentation

Most adults need 7 to 8 hours of sleep each night. School-aged children and teens need at least 9 hours of sleep a night. Like eating healthy and being physically active, getting a good night’s sleep is important to your heart health and your mood, and it is important when you are completing your daily activities. Not getting enough sleep can cause problems.

Sleep disorders, such as sleep apnea, can disturb how well you sleep and leave you sleepy the next day. In people with sleep apnea, breathing stops briefly or becomes very shallow during sleep. They usually snore loudly and often.

If you don’t get enough sleep each night, or if you have sleep apnea that is not treated, you may be at increased risk of becoming overweight or developing high blood pressure, heart disease, and diabetes.

Appendix 447

The Dos and Don’ts of Getting a Good Night’s Sleep

Do go to bed and wake up at the same time each day—even on the weekends.

Do physical activity, but not too late in the day.

Do relax before bed—read or listen to music.

Do take a hot bath before bed—it can help you relax.

Do get rid of things that might distract you from sleep—noises, bright lights, an uncomfortable bed, or a TV or computer in the bedroom.

Do keep the room temperature cool.

Do see a doctor if you have trouble sleeping. If you are tired during the day, even after spending enough time in bed at night, you may have a sleep disorder.

Don’t have caffeine or nicotine after 3 p.m.

Don’t eat large meals or drink beverages late at night.

Don’t take medicines that delay or disrupt your sleep. Check with your doctor about your prescribed medicines if you have trouble sleeping.

Don’t take naps after 3 p.m.

Don’t lie in bed awake. Get up and do some relaxing activity until you feel sleepy.

To learn more about sleep and sleep disorders, visit the National Heart, Lung, and Blood Institute (NHLBI) Web site at www.nhlbi.nih.gov and click on “sleep.”

activity 5: heart healthy Cooking demonstrations

Cooking demonstrations can be an important part of group discussions. A cooking demonstration can show group members how to prepare foods that still taste good but include less saturated fat, trans fat, cholesterol, and salt and sodium. Most people like to eat, and they will be interested in learning how to prepare food in a heart healthy way. This section gives you more information about how to use cooking demonstrations as a part of the training and how to make sure they go smoothly.

448 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Recruiting a Food Demonstration Facilitator

If you are not going to conduct the food demonstration yourself, you can recruit a registered dietitian by contacting the local health department, the local American Dietetic Association, or the local Cooperative Extension Service office.

How To Plan the Demonstration

Choosing the Facility

Is food permitted? Make sure the site where you will be presenting the group discussion allows cooking demonstrations. If food may be brought in for tasting but not cooking, you may be limited to bringing a prepared dish. You also may be limited in the type of food you can bring. Some organizations have special dietary restrictions. Check these out beforehand. If you are doing a cooking demonstration at a festival or outdoor fair, you may need a special permit to use cooking equipment. Most important, be sure to visit the site beforehand to look at the facilities.
Is water accessible? You will need to wash your hands frequently. You may need large amounts of water for the recipes. Having a sink behind you or in the same room as the demonstration is ideal.
Is electricity accessible? This is necessary if you plan to cook onsite. If electricity is in the room, but not close by, be sure to bring heavy-duty extension cords with multiple outlets. If the demonstration is outside, you may need extension cords to bring the electricity outside, or you may need a generator or gas stove.
Is lighting adequate? Make sure there is enough light for participants to see what is being demonstrated.
Is location convenient? Make sure the building is accessible by public transportation and parking is available.
Are tables and chairs available? You will need at least one table for your demonstration. If you demonstrate several recipes, you may need more. If the demonstration is long, you will need chairs for participants.

Appendix 449

Choosing the recipes

The recipes you choose depend on which principle of heart healthy cooking you want to show, the amount of time you have to prepare for the session, the amount of time you have for the demonstration, your budget, the facilities available at the presentation site, and the equipment you have available. Make sure you are familiar with your recipes and that you have prepared them at least once before the demonstration. For recipe ideas, see “Heart Healthy Home Cooking African American Style” from NHLBI. The “Strawberry-Banana Yogurt Parfait Recipe” (page 452) is a simple and tasty demonstration.

Consider your message. If you want to demonstrate how to reduce the saturated fat in food, look for a recipe that uses ground beef (to show how to drain the fat), uses skinless chicken, or uses low-fat (1%) or fat-free milk or milk products. If you want to demonstrate low-sodium cooking, look for recipes that use small amounts of salt, low-sodium ingredients, or lots of herbs and spices for flavor.
Consider your time. If you have limited time before the food demonstration, look for very simple recipes that do not require a lot of ingredient preparation, such as chopping or slicing, or bring ingredients that are already prepared.
Determine total cooking time. Consider the total time it takes to prepare the recipes. Read through the recipes, and look for those in which the preparation and cooking times are less than the total time you have for the demonstration. If you want to demonstrate more than one dish, determine the total cooking time for each one. Start with the dish that has the longest cooking time and then go to the next longest cooking time, and so on. That way, all the food will be done at the same time or as close to the same time as possible.
Demonstrate just one concept. If you don’t have the time or resources to demonstrate a whole recipe, consider demonstrating just one concept. For example, to demonstrate skimming the fat off soup, open a can of soup and use a spoon to skim the fat off. Or to demonstrate draining the fat from ground beef, cook ground beef in a skillet and drain off the fat after it is browned.
Prepare in advance. Make a list of what you need to buy from the store, and buy the food, equipment, or other things you need. Buy foods as close to the demonstration date as possible.

450 With Every Heartbeat Is Life: A Community Health Worker’s Manual for African Americans

Consider food safety. Wash your hands frequently with soap and water. You need to wash your hands whenever you touch an unclean surface, raw meats, or any part of your body. Cover your mouth and nose if you cough or sneeze, and immediately wash your hands in hot, soapy water. Keep all food that needs to be cold or frozen in a refrigerator or freezer until you are ready to go to the site. Gather and pack all other equipment you will need first. Fill a cooler with ice or freezer packs, put the food into the cooler last, and go to the site as quickly as possible.
Wrap prepared dishes and ingredients tightly. Do not let raw ingredients touch or run onto cooked ingredients. For example, keep raw meats, poultry, and fish separate from other raw or cooked vegetables. Use separate utensils, bowls, and cutting boards for these foods. Wash all utensils and cutting boards in hot soapy water when used to cut raw ingredients.
Have a handy supply of wet paper towels to wipe up spills as they happen. Use a vinyl tablecloth as a table covering so spills can be wiped up easily. Keep a trash can nearby so you can easily toss in used items (such as empty cans and plastic wrap) and keep the table clear.
Make sure your appearance is neat and clean. Remember that participants will be eating the food you are preparing. Keep your hands clean. You may want to wear an apron to protect your clothes and a hairnet or scarf to keep your hair off your face.

Setting Up the Food Demonstration

Give yourself enough time. Allow more time than you think you will need to set up.
Set up the room. Consider the best arrangement to make sure everyone can see and hear you, and make sure you have access to electricity and water. Be sure all food contact surfaces are clean.
Set up the food. At the latest possible time before the demonstration, place out all food according to which skillet or container you will use and the order in which you will prepare it. Put all food together for each recipe.
Keep cool. If you forget an ingredient or a pot doesn’t boil quickly enough, let group members know. Give them examples of ingredients that can be used in place of the one you forgot. While the pot boils, go over the changes that you made to the recipe to make it more heart healthy.
You can begin the cooking demonstration, finally! Explain how easy it is to prepare a recipe. Relax and have fun!

Appendix 451

Strawberry-Banana Yogurt Parfait Recipe

This recipe can be used as a part of a

Ingredients

cooking demonstration. For variety, substitute fruit yogurt or sugar-free 4 cups pudding for the vanilla yogurt. If fresh strawberries are not available, 2 cups try thawed frozen fruit or canned fruit packed in fruit juice. If time permits, invite the group members to make 2 cups their own parfait. Line up the bowls, and supply a measuring cup for the 32 amount to be used for each layer. 1 tablespoon Group members will enjoy making their own desserts and eating the tasty treat!

To make the parfait, spoon 1 tablespoon of pudding into the bottom of each of four 8-ounce parfait glasses. Top the pudding with 1 tablespoon of sliced bananas, 1 tablespoon of sliced strawberries, and ¼ cup of graham crackers.
Repeat the banana, strawberry, wafer, and pudding layer.
Serve with a rounded tablespoon of whipped topping, if desired. Serve the parfait immediately, or cover each glass with plastic wrap and chill for up to 2 hours before serving.

452 handouT—aPPEndIX

light (no-sugar-added) vanillapudding or yogurt sliced bananas (about 2 large bananas)p fresh strawberries reduced-fat vanilla wafers whipped topping (Optional)

Yield: 8 servings

Serving size: 1 cup Calories: 179 Total fat: 2 g Saturated fat: 1 g Cholesterol: 3 mg Sodium: 190 mg Total fiber: 2 g Protein: 6 g Carbohydrates: 36 g Potassium: 438 mg

For More Information

The National Heart, Lung, and Blood Institute (NHLBI) Health Information Center (HIC) is a service of the NHLBI of the National Institutes of Health. The NHLBI HIC provides information to health professionals, patients, and the public about the treatment, diagnosis, and prevention of heart, lung, and blood diseases and sleep disorders. For more information, contact:

Appendix 453

DISCRIMINATION PROHIBITED: Under provisions of applicable public laws enacted by Congress since 1964, no person in the United States shall, on the grounds of race, color, national origin, handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with respect to any education program and activity) receiving Federal financial assistance. In addition, Executive Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federal contracts, and Executive Order 11246 states that no federally funded contractor may discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung, and Blood Institute must be operated in compliance with these laws and Executive Orders.

NIH Publication No. 08-5844 November 2007

Archived page, reproduced from a 2009 copy. It is reference material, not current guidance.