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Partners for a Healthy Georgia: Emory joins with rural communities in Southwest Georgia to promote practices that prevent disease and improve health
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.”
Sally Brown completes a Healthy Rural Communities survey
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 BibleDiane Fletcher 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.”
Michelle Kegler and Darrell Sabbs exemplify collaborative relationship between RSPH and communities in Southwest Georgia.
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 theKaren Glanz 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.”
The Body and Soul program promotes healthy eating habits at New Beginning Missionary Baptist Church.
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 thingDarrell Sabbs 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.”
Employees and costumers at Ed's Truck Stop are taking part in research that will provide interventions to promote healthy eating, exercise and smoking cessation.
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 improveTommy Adams 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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