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When
Pastor Calvin Wells Sr. and Deacon Tommy Adams heard about a church-oriented
program to teach people how to eat healthier, they knew they wanted
to bring it to their congregation. “We know our health is
kind of bad,” says Adams, who attends New Beginning Missionary
Baptist Church in Sylvester, Georgia. “We’re just looking
to better ourselves, have healthier, longer lives, and set good
examples for our kids, so they can live healthier, longer lives.” |
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As part of the initiative, Nutrition Programs That Work, New Beginning
now serves baked chicken with plenty of vegetables and fruits at
its monthly dinners, instead of the usual fried chicken, mashed
potatoes, and gravy. Church volunteers call members or chat at church
about healthy eating, offering suggestions and answering questions.
New Beginning leaders also plan to visit other area churches to
share the good news about proper nutrition.
“There’s a lot we don’t
know about our own health, like all the things vegetables can do
for your body,” says Adams. “When you eat better, you
tend to feel a little better, and then you might get out and get
some exercise. The Bible
talks about good eating and good health habits. If you are not a
healthy, alert person, you are not going to be able to be aware
of what is going on around you in church.”
The nutrition program at New Beginning
is sponsored by the Emory Prevention Research Center (EPRC), a partnership
between Emory and the Southwest Georgia Cancer Coalition. Housed
in the Rollins School of Public Health (RSPH), the EPRC brings together
the considerable resources of Emory—with representatives from
Winship Cancer Institute, the medical school, and the nursing school—with
a consortium of colleges, public health agencies, medical centers,
and businesses in Southwest Georgia. Funded by the CDC, the EPRC
is one of 33 Prevention Research Centers (PRCs) nationwide that
engage academic researchers, public health agencies, and community
members to conduct applied research in disease prevention and control.
Emory’s PRC seeks to devise community-based cancer prevention
research and interventions to help reduce the burden of the disease
in Southwest Georgia’s rural communities. Specifically, the
center focuses on three behaviors that directly contribute to increased
cancer risk—tobacco use, lack of physical activity, and poor
nutrition.
In its third of five years of CDC
funding, the center and the coalition have covered a lot of ground.
It has wrapped up the first phase of its research agenda, interviewing
Southwest Georgians about how home, church, and work environments
influence tobacco use, physical activity, and nutrition. It has
launched the second phase, a survey to weigh the influence of personal
versus environmental factors in these behaviors. And it has awarded
mini-grants to area work sites and churches like New Beginning to
implement evidence-based nutrition programs.
“This has proven to be a very
successful partnership, both for Emory and for the Southwest Georgia
Cancer Coalition,” says Karen Glanz, director of the EPRC.
“We both brought considerable strengths to the table, and
by putting them together, we are accomplishing a lot.” |
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In
the beginning
It’s highly unusual for a community research partner to actively
look for a university team to work with, but that’s just what
happened at the RSPH. As 2003 was winding down, Glanz had just joined
Rollins from the University of Hawaii’s Cancer Research Center,
and the CDC announced it was awarding another PRC grant. “This
isn’t the sort of opportunity that happens very often, since
PRCs are five-year grants,” says Glanz. “The partnership
aspect is at the heart of the these centers. So when universities
compete for these grants, they have to identify a primary community
partner.”
RSPH happened to have such a partner
waiting in the wings—the Southwest Georgia Cancer Coalition.
Created in 2002 in response to a directive from then-Governor Roy
Barnes to devise grassroots programs for cancer control, the coalition
brought together a couple hundred people from 33 counties and as
many walks of life. “Everyone put aside their own agendas
and formed a working group to go after the grant,” says Diane
Fletcher, CEO of the coalition. “People were willing to do
that because the need is so great here.”
Indeed, the incidence of cancer in
Southwest Georgia is 35% higher than for more rapidly developing
areas in the
state, and 21 of the counties in this area have a much higher cancer
death rate than the state average. Nearly half of all cancers diagnosed
in the area are in later stages. Several factors likely contribute
to the disparity. Of the region’s 700,000 population, 40%
are African American, and 22% live below the poverty line. Many
residents smoke, eat high-fat diets, and suffer from obesity. They
often lack health insurance and live far from doctor’s offices
and hospitals, so getting appropriate medical care is often a challenge.
“We know that many Southwest
Georgians do not live healthy lives, and we believe that contributes
to our high cancer rates,” says Fletcher. “The coalition
came together to try to learn, in a systematic way, why people make
the choices they do and what interventions could improve those choices
to hopefully prevent cancer in the first place.”
To answer those questions, the coalition
would need a research partner, and one of the coalition’s
founding members, James Hotz, approached Emory. Hotz, who served
as the model for the main character in the film “Doc Hollywood,”
completed his residency at Emory and maintained close ties with
the medical school. RSPH faculty members were interested and had
begun working with Hotz and other coalition members to hammer out
a research proposal when the CDC announced plans to establish another
PRC.
“It was instantly clear that
this could be a perfect partnership for Emory’s PRC,”
says Michelle Kegler, deputy director of the center. “Karen
had the cancer expertise. We needed a community partner outside
the metro Atlanta area, because Morehouse University already had
a PRC in downtown Atlanta. The coalition had a ready-made population
in place and ready to go. And we were interested in studying the
same things.” |
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Healthy
rural communities
From the outset, the research has been the result of a true collaboration.
EPRC members, including Glanz, Kegler, Johanna Hinman, Kathleen
Miner, Jo Ellen Stryker, and Iris Smith, meet often with the coalition’s
Community Advisory Board to decide every aspect of the research
project—what behaviors to look at, what environments to consider,
which counties to include, how to frame the questions. And these
meetings weren’t held on Clifton Road. “You had powerful
PhDs from Atlanta coming down to Camilla to meet in a local municipal
building,” says Hotz. “That really told everyone on
the Southwest Georgia end that they were valued members of the team.”
That type of team building has proven
to be critical to the center’s success. “When a group
of Atlanta researchers comes down to do a study in South Georgia,
the first thing
that pops into peoples’ minds here is ‘Tuskegee,’
” says Hotz, referring to the infamous syphilis experiment
in Alabama during the 1930s. “But our coalition is made up
of all local people, many African Americans, including ministers,
county commissioners, and health officials. We were able to say
to people who might participate in these studies, ‘Look, we’ve
sat down with these folks and we trust them. You can too.’
”
In another wise move, Emory hired
and trained local residents to conduct the surveys. “These
people are asking some pretty sensitive questions,” says Hotz.
“It makes sense that people are going to speak more freely
to ‘one of their own’ than to an ‘outsider.’
”
For the first part of the study—Healthy
Rural Communities 1—residents interviewed about 60 people
in two counties, asking 17 pages of open-ended questions. The aim
was to find out how families, churches, and work sites support and/or
hinder healthy eating, regular physical activity, smoking cessation,
and exposure to second-hand smoke.
As the Emory researchers continue
to pore over the results, they have begun to work with their Southwest
Georgia partners on Healthy Rural Communities 2, a questionnaire
study of more than 400 residents to discover the influence of individual
characteristics versus social environments in choices about physical
activity and tobacco choices. “We’re asking things such
as a person’s perceived risk of getting cancer and his or
her level of confidence about engaging in healthy behaviors, the
availability of places to walk in the neighborhood, or the selection
of fresh fruits and vegetables in a nearby store,” says Kegler.
In the third and final phase of the
research, EPRC will focus on one environment—home, church,
or work—and devise an intervention to make it more health
promoting. “We’ll let the data and our Community Advisory
Board help us decide which environment to focus on in phase three,”
says Kegler. “Then we’ll implement an intervention and
test it rigorously. If we prove that it works, we have the potential
to replicate it elsewhere. We are just laying the groundwork for
that now.” |
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Value
added
The Emory partnership brings many “extras” to the Southwest
Georgia region. In February, the EPRC and the coalition launched
Nutrition Programs That Work. Four churches, including New Beginning
Missionary Baptist Church, and three work sites were awarded up
to $4,000 each to implement an evidence-based initiative shown to
improve
healthy eating. The grant program grew out of a need to translate
research into practice in the short term.
“In the survey results, we saw
that people in the area know about cancer, heart attacks, and stroke,”
says Darrell Sabbs, community benefits coordinator for Phoebe Putney
Memorial Hospital in Albany and a member of the coalition’s
Community Advisory Board. “What they don’t know is what
to do about it. Diet is a huge contributor to cancer risk, so we
started looking for some programs that can change people’s
eating behaviors.”
They found two research-tested intervention
programs from the National Cancer Institute—church-based Body
and Soul and work site-based Treatwell 5-a-day. Both programs strive
to get participants to eat more fruits and vegetables—ideally
at least five servings a day. “Each of these programs has
a handful of core components, such as making a policy or practice
change regarding nutrition,” says Kegler. “So we would
work with the kitchen committee at a church, for example, to get
them to serve baked chicken instead of fried chicken and a green
vegetable instead of baked beans.”
The EPRC also competed successfully
for supplemental funds from the CDC, which are available to Emory
researchers outside the center’s core faculty for additional
studies in Southwest Georgia and elsewhere. Joseph Lipscomb, RSPH
professor of health policy and management, received such a grant
to study what causes cancer patients to drop out of treatment. Recent
studies have shown that, at least at the major cancer centers where
such data is tracked, cancer patients often don’t complete
their prescribed therapy. What researchers don’t know is why,
and if more or fewer patients drop out of treatment in other treatment
settings, such as small or rural communities.
The Southwest Georgia Cancer Coalition
was the key to unlocking the answers. “You really have to
have on-the-ground support to be able to do a study like this,”
says Lipscomb. “It’s not a mandated study, so participation
is totally voluntary. Thanks to the coalition, we were able to get
cooperation from all four of the cancer centers in the area and
gather data on nearly every person diagnosed with one of the four
highest incidence cancers—breast, prostate, lung, or colorectal—in
Southwest Georgia.”
That’s exactly what Sabbs was
hoping for when the Southwest Georgia Cancer Coalition teamed up
with EPRC. “Being down here in the ‘Other Georgia,’
we need an Emory to contact, which has a CDC to contact,”
says Sabbs. “We were hoping this partnership would bring much
needed research down here, and it has. But the need here is so tremendous,
and there is so much more to be done.”
Martha Nolan McKenzie is an Atlanta freelance
writer.
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