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CDC Partners with Communities for Prevention Research

by Barbara Sajor Gray, M.I.A., M.Ln.
Atlanta Medicine, Volume 76, Issue 3
(Reprinted with permission.)

Writing in Public Health Reports, Scrimshaw and colleagues articulated the discipline of disease prevention as an approach that complements the traditional medical emphasis on treatment.1 This approach, the authors continued, seeks to decrease disease risk factors in people and promote their healthy behaviors—thereby shifting substantial responsibility for good health from the practitioner to the client.

Multidisciplinary work has long been exploring how to enable this shift while saving health care dollars and making acceptable health outcomes probable. This interest has contributed to the continuous unfolding of the field of prevention research.

Since 1986, the members of CDC’s Prevention Research Centers Program have helped define prevention research, adding to its purpose and scope. The program, which began as three research centers, is now an extensive extramural research activity. Funding of about $42 million currently supports a consortium of 28 academic research centers in cooperative agreement with CDC (Table 1). Each Prevention Research Center, including one at Atlanta’s Morehouse School of Medicine (first funded in 1998), uses core funds to conduct at least one main project in research, demonstration, intervention, or evaluation on a predetermined theme.

Table 1: Prevention Research Centers' Themes
Center
Research Theme
University of Washington at SeattleKeeping Older People Healthy & Independent Through Community Partnerships
University of California at BerkeleyEngaging Families, Neighborhoods, & Communities in Chronic Disease Prevention
University of California at Los AngelesPromoting the Health & Well-Being of Adolescents
University of ArizonaPromoting the Health of Multi-Ethnic Communities of the Southwest
University of ColoradoPromoting Healthy Lifestyles in Rural Communities
University of New MexicoPromoting Healthy Lifestyles in American Indian Communities
University of OklahomaPromoting Health & Preventing Disease in Native Americans
University of Texas Health Science Center at HoustonGrowing from Healthy Children to Healthy Adults
Tulane UniversityPreventing Environmental Diseases
Saint Louis UniversityPreventing Chronic Disease in High-Risk Communities
University of IowaImproving the Health of Rural Iowans Through Nutrition & Exercise
University of MinnesotaPreventing Teen Pregnancy & Promoting Healthy Youth Development
University of Illinois at ChicagoControlling Diabetes in Communities
University of MichiganImproving Health in Partnership with Families & Communities
University of KentuckyControlling Cancer in Central Appalachia
University of Alabama at BirminghamReducing Health Risks Among African Americans & Other Undeserved People
Morehouse School of MedicinePromoting Risk Reduction & Early Detection in African American & Other Minority Communities: Coalitions for Prevention Research
University of South FloridaUsing Community-Based Prevention Marketing For Disease Prevention & Health Promotion
University of South CarolinaPromoting Health Through Physical Activity
University of North Carolina at Chapel HillImproving Community Health Through Workplace Health Promotion
West Virginia UniversityPromoting Health & Preventing Disease in Rural Appalachia
Johns Hopkins UniversityPromoting the Health of Adolescents Through Families & Communities
University of PittsburghPromoting Health & Preventing Disease Among Older Adults
Columbia UniversityPutting Health Promotion into Action
State University of New York at AlbanyPreventing Chronic Disease Through Community Interventions
Yale UniversityCreating Innovative Public Health Initiatives
Boston UniversityImproving the Well-Being of Public Housing Residents
Harvard UniversityPromoting Nutrition & Physical Activity Among Children & Youth

At the same time, the centers build on the CDC-funded core expertise by conducting dozens of additional research projects in collaboration with not only each other but also a wealth of partners, which creates networks for prevention research that extend across the nation. Partners include federal agencies, such as the National Cancer Institute and the National Heart, Lung, and Blood Institute; state health departments and education agencies; state chapters of national organizations, such as the National Diabetes Association and the American Heart Association; and local and tribal governments and their agencies.

But no partners are as vital to prevention research as the community residents and representatives of community organizations who not only participate in the research projects but also help define them and disseminate their results, as well as advocate for social policies that can promote health.

Among the Prevention Research Centers, “community” encompasses somewhat different constituents. For example, the University of Minnesota’s prevention center defines its community as the professionals of youth-serving organizations and associations. Similarly, the University of South Carolina has built a community of practitioners to which it transfers knowledge and skills in physical activity. The University of Washington at Seattle partners largely with senior-serving organizations and institutions. For most of the Prevention Research Centers, however, a community comprises people, often members of a racial or ethnic minority group, at high risk for disease in a distinct geographic area. Examples include African Americans and Latinos in Harlem, Mexican Americans on the border, American Indians in New Mexico, below-poverty-level residents in rural Missouri and Alabama, public housing residents in Boston, and women working in blue-collar jobs in North Carolina’s textile industry.

Regardless of a prevention research community’s composition, input from it and from professionals who serve its constituents is critical for several reasons. Many interventions for chronic diseases require individual behavioral changes, and the motivation for change is often associated with knowledge, attitudes, and beliefs. In designing research and interventions, researchers need to address these nonclinical factors and therefore need to know how people think and why, and what kinds of barriers they encounter that discourage change. Such information does not come from guesswork or stereotyping but from what is learned from people themselves and from associates and representatives who know them well. Further, some activities require broad community support; for example, efforts to increase physical activity may mean that local government agencies, merchants, and organizations must collaborate to create safe areas where physical activity measures can be assessed. In fact, the willingness of a community’s residents to participate in a research project at all may depend on the residents’ experience or anticipated experience with the research community. To engage and retain willing participants over time, researchers are encouraged to cultivate trusting relationships with communities that produce mutual benefits.2

To ensure community input, CDC requires each Prevention Research Center to establish a community advisory board for its core research. In Atlanta, the Morehouse School of Medicine-Southside Atlanta Community Partnership is a fifteen-year-old coalition that advises the Prevention Research Center. The partners include Neighborhood Planning Unit Y and adjacent neighborhood organizations, including the Joyland-Highpoint Community Coalition, the Lakewood Heights Community Civic Association, and the South Atlanta Redevelopment Corporation. In May 2002, the coalition was one of two recipients of the first annual Community-Campus Partnerships for Health Award in recognition of the exemplary research bond forged between the academic institution and the community. This bond helps ensure the research is sensitive to cultural distinctions, acceptable to participants, and likely to be sustained—characteristics that can contribute to high-quality results.

Further, some of the earliest Prevention Research Centers report being asked by community representatives to undertake new or expanded projects. For example, community health educators and the Navajo Agency on Aging approached prevention researchers at the University of New Mexico about testing the effects of nutrition and physical activity interventions not only in children and their families, as the center was doing, but also among elders. The center responded by offering training and technical assistance on healthy eating and activity for seniors to staff of senior centers across the Navajo Nation through Healthy Path: A Nutrition and Physical Activity Program for Navajo Elders.

Similarly, the Morehouse prevention center’s Community Coalition Board set research priorities and listed the community values that would guide the research. Current research projects include assessing the effect of perceived racism on hypertension, the impact of social stressors on the clustering of risk factors for cardiovascular disease, HIV risk behavior among African American women, and prevention of youth violence.

Like other academic researchers in the Prevention Research Centers network, the Morehouse scientists believe in developing the partner community’s capacity for local interagency cooperation, data interpretation, the development of services and facilities, advocacy, and other empowering skills.3 Moreover, some projects result in employment for community residents who conduct surveys, serve as peer educators or health advisors, and assess materials before they are widely distributed.

Prevention researchers focus simultaneously on the local research community and on the broader communities to which research results also may apply. To achieve a broad perspective, research protocols are designed to elicit replicable approaches and best practices. Prevention researchers explore how research tools can be adapted for use in different populations, assess which techniques are most cost-effective, and record intangible factors that can predict research success. These activities make the Prevention Research Centers a resource for the public health research and practice community.

Examples of this contribution come from the seven Prevention Research Centers that conducted the community prevention component of the National Institutes of Health’s Women’s Health Initiative from 1995 to 2001. The centers designed and tested interventions and developed evaluation methods concerning the health needs of primarily minority women age forty or older. This work produced over fifty research instruments and assessment tools (such as surveys, rating scales, focus group guides, and log books) and more than twenty instructional materials and training guides.4 Thus, the researchers produced results for the communities of women around the country who participated in the studies, and at the same time contributed to a body of scientific materials for further study by future researchers interested in understanding diabetes management, osteoporosis prevention, hysterectomy and hormone replacement therapy, physical activity, and cardiovascular risk reduction.

Some centers have insufficient means to respond to the hundreds of requests they receive for materials and training. Nevertheless, all the Prevention Research Centers strive to disseminate the products and results of their research so that they can be immediately put into practice. The University of Texas Health Science Center at Houston has achieved one of the Prevention Research Centers Program’s best successes in dissemination. In the 1990s, researchers there developed the Coordinated Approach to Child Health (CATCH), a program to help schools, children, and families adopt healthy eating and physical activity habits that can reduce the risk for cardiovascular disease and diabetes.5 CATCH is now reaching nearly half a million children in more than 800 elementary schools in Texas, and further dissemination is anticipated. In May 2001, the Texas legislature, responding to the growing epidemic of obesity and diabetes among youths, enacted a law allowing the state board of education to require schoolchildren’s daily participation in physical activity. Moreover, the law specifies a health education program that incorporates—as CATCH does—a classroom curriculum, physical activities, a food service component, and parental involvement. Many educators in Texas say CATCH’s good reputation helped spark a groundswell of support for a statewide health policy, which can only bode well for the future of Texas’s children.

The long-term nature of prevention research is also reflected in the Prevention Research Centers’ commitment to preparing future generations of scientists to conduct community research. By law, every Prevention Research Center (selected through a competitive, peer-reviewed process) is housed within a school of medicine, osteopathy, or public health—a structure offering several benefits. Research projects draw together faculty from disciplines such as nursing, pharmacy, anthropology, health policy, and other areas of study that enhance prevention research. Students and training residents at the schools can become directly involved in community research and be mentored by leaders in prevention research. To encourage these relationships, CDC and the Association of Schools of Public Health collaborated to establish a two-year fellowship for four doctoral-level students of ethnic or racial minority origin who began in September 2002 to work on projects directed by Prevention Research Centers.

The Morehouse School of Medicine Prevention Research Center, like other research centers in the network, has taken additional initiative to merge research and service for community-based prevention research. Enrollment in an interdisciplinary community health course, conducted in partnership with several Southside Atlanta neighborhood organizations and agencies, is required of all Morehouse’s first-year medical students. (For further information about the Morehouse School of Medicine’s Prevention Research Center, consult www.msm.edu/prc.)

CDC hopes to expand prevention research to additional academic centers and the communities with which they have developed partnerships. Additional geographic areas, research themes, specialists, and community participants can only enrich the search for ways to reduce Americans’ risks for injury, environmental hazards, and chronic diseases.

Acknowledgements

The author acknowledges contributions to this article from Lynda Anderson, PhD, Sally Davis, PhD, Nancy Murray, DrPH, and Elleen Yancey, PhD.

References

  1. Scrimshaw SC, White L, Koplan JP. The meaning and value of prevention research. Public Health Reps 2001;116 Suppl 1:4–9.
  2. Green L, Daniel M, Novick L. Partnerships and coalitions for community-based research. Public Health Reps 2001;116 Suppl 1:20–31.
  3. Braithwhite RL, Lythcott N. Community empowerment as a strategy for health promotion for black and other minority populations. JAMA 1989;261:282–3.
  4. Women’s Health Initiative Community Prevention Study Collaborators. Community Prevention Study: contributions to women’s health and prevention research. J Womens Health Gender Based Med 2001;10:913–20.
  5. Luepker RV, Perry C, McKinlay SM, et al. Outcomes of a field trial to improve children’s dietary patterns and physical activity. JAMA 1996;275:768–76.

 

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