2006 Annual Report 1.What major problem or issue is being resolved and how are you resolving it (summarize project aims and objectives)? How serious is the problem? Why does it matter? The Lower Mississippi Delta (LMD) area of Arkansas, Louisiana, and Mississippi is characterized by high rates of poverty, low education attainment, and food insecurity. There is a high prevalence of hypertension, diabetes, obesity, anemia, and heart disease, all of which are influenced by nutrition. We are attempting to resolve these problems through the efforts of the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI). The Delta NIRI Consortium consists of the original partners: scientists from Alcorn State University, Alcorn State, MS (ASU); Arkansas Children's Hospital Research Institute, Little Rock, AR (ACHRI); Pennington Biomedical Research Center, Baton Rouge, LA (PBRC); Southern University and A&M College, Baton Rouge, LA (SU); The University of Arkansas at Pine Bluff, Pine Bluff, AR (UAPB); The University of Southern Mississippi, Hattiesburg, MS (USM); and the Agricultural Research Service (ARS) of USDA, Little Rock, AR. The Delta NIRI Consortium also now includes representatives from the Arkansas, Louisiana, and Mississippi Cooperative Extension Service; the College of Public Health of the University of Arkansas for Medical Sciences, Little Rock, AR; a private researcher, Jackson, MS; and members from the Delta communities of Marvell, AR; Hollandale, MS; and Franklin Parish, LA. The ARS has initiated agreements with other scientists with needed expertise for specific research requirements. For example, the Children's Nutrition Research Center (CNRC) in Houston is collaborating with a Baylor College of Medicine scientist that has nutrition epidemiology skills, and the Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston is providing expertise on the development of an original adult food frequency questionnaire. These scientists, Extension, and community members participate fully in the Delta NIRI Consortium. The Consortium is diverse in its composition: including minorities, many research disciplines (nutrition, food science, family economics, sociology, medicine, community development, community grass root, agriculture, etc.), and a variety of professionals (nutritionists, pediatricians, nurses, food scientists, sociologists, agriculture economists, etc.). This diversity is necessary because of the complexity of the food concerns, poverty, isolation, and low educational attainment in parts of the Delta region. The Delta NIRI Consortium is evaluating the nutritional health in the LMD, to identify nutritionally responsive problems, and to design and evaluate interventions using a community participatory research model. Use of this model will promote capacity-building and sustainability at the community level. Lessons learned about successful intervention approaches will be disseminated in order to facilitate implementation on a larger scale in similar areas of the United States. Rates of rural poverty and nutrition-related chronic diseases in the LMD are among the Nation's highest. Arkansas, Mississippi, and Louisiana traditionally rank at or near the bottom in health rankings of the United States and continue to worsen compared with other states. Food insecurity, adult and child obesity, and high blood pressure and diabetes among adults are higher in each of these states than for the national average. The area is underserved by food and nutrition and other health professionals, thus the burden of food-related health problems is carried by minority, low-income, and educationally disadvantaged individuals and families in the Delta communities. The presence of these problems severely limits the quality of life, productivity, and the future of this rural, at-risk population, while propelling them into the high-user category for nutrition assistance programs and high-cost health care and treatment of nutrition-related disease. The Lower Mississippi Delta Nutrition Intervention Research Initiative falls under the National Program 107 - Human Nutrition, and addresses ARS Strategic Plan performance goal 4.1.1 through developing and transferring effective nutrition intervention strategies. 2.List by year the currently approved milestones (indicators of research progress) Year 2005 Objective 1. Develop nutrition interventions in Marvell, AR, public school district through community-based participatory research. Milestone a) The Marvell NIRI community-based research team will be in place in AR. Milestone b) The Marvell research worksite will provide a neutral site in Marvell, AR, and enhance visibility of the Delta NIRI. Milestone c) An assessment of community resources and environmental conditions in Marvell, AR, relevant to nutrition interventions will be complete. Objective 2. Design the nutrition intervention research for Marvell, AR, public school district using a Comprehensive Participatory Planning and Evaluation (CPPE) process. Milestone a) Potential interventions and strategies will be identified and evaluated. Milestone b) A research protocol for each of the selected interventions in Marvell, AR, will be written. Milestone c) New and modified data collection instruments will be developed as needed for each intervention. Milestone d) Manuscripts will be completed by University of Arkansas for Medical Science, College of Public Health (COPH) scientists describing the CBPR/CPPE processes, development of the Marvell NIRI research worksite, community readiness, resource assessment, and other elements of the pilot testing and preparation for each intervention. Milestone e) COPH will participate in the planning and implementation of one regional conference of scientific and lay communities. Objective 3A. Implement nutrition intervention strategies in Marvell, AR, public school district. Milestone a) A well-written research protocol for a nutrition intervention in Marvell, AR, will be finalized. Milestone b) Appropriate data collection instruments and procedures necessary for the intervention research will be pre-tested if necessary. Milestone c) Marvell residents and individuals from COPH will be trained to collect data and to monitor data collection. Milestone d) A detailed operational plan for the implementation process for the intervention in Marvell, AR, will be completed. Milestone e) Appropriate institutional review board approval for human subject's participation will be in place for COPH. Milestone f) Manuscripts describing pilot testing intervention strategies, data collection procedures, and training of data collectors will be completed for peer reviewed journals by COPH scientists. Year 2006 Objective 3A. Implement nutrition intervention strategies in Marvell, AR, public school district. Milestone a) Implement nutrition intervention strategies specific to Marvell, AR. Milestone b) Monitor data collection and progress of intervention strategies. Milestone c) Evaluate process variables associated with nutrition interventions Marvell, AR. Milestone d) COPH Scientists will prepare and submit manuscripts to peer reviewed journals for publication. Year 2007 Objective 3B. Evaluate nutrition intervention strategies implemented in Marvell, AR, public school district. Milestone a) Evaluate nutrition intervention strategies in place in Marvell, AR, public school district. Milestone b) Develop measures to evaluate the impact of the CBPR/CPPE processes on the community of Marvell, AR. Milestone c) Monitor the effects of other activities within the Marvell, AR, public school district on the nutrition intervention. Milestone d) Utilize appropriate qualitative and quantitative statistical techniques to evaluate objectives and test hypotheses of the interventions in Marvell, AR. Milestone e) The participation of the Marvell NIRI (community group) in the analytical process will be documented. Milestone f) A data monitoring and evaluation system will be in place for continuous monitoring of data collection and quality of processes used. Milestone g) Manuscripts describing the status of interventions in Marvell, AR, with regards to process and outcome variables will be completed by COPH scientists and submitted to peer reviewed journals for publication. Milestone h) COPH will participate in the convening of a Delta NIRI national symposia for scientific and lay communities on CBPR/CPPE, and nutrition intervention strategies for at-risk populations in rural communities. Year 2008 Objective 4. Initiate the process of adapting the successful nutrition intervention strategies from Marvell, AR, public school district to other Lower Mississippi Delta communities. Milestone a) At least one additional community in AR will be targeted and recruited for community-based nutrition intervention research to duplicate the successful strategies and interventions. Milestone b) Manuscripts describing the research process and intervention outcomes will be prepared by COPH scientists and submitted to peer reviewed journals for publication. Milestone c) COPH will participate in the convening of a Delta NIRI national symposia for scientific and lay communities on CBPR, CPPE, and nutrition intervention strategies for at-risk populations in rural communities. 4a.List the single most significant research accomplishment during FY 2006. This accomplishment is aligned with National Program 107 – Human Nutrition: Component 7. Health Promoting Intervention Strategies for Targeted Populations. Action Plan Problem Statements: Identify, implement and test nutrition and physical activity interventions in low-income communities. Research Process Curriculum: A curriculum was developed to train community members on the research process, research methods, and research ethics. The curriculum was used initially in a community research workshop for the Marvell NIRI. Preliminary results of the pre-post workshop questionnaire suggest the workshop had positive impact on the participants' perceptions and attitudes toward participating in research (both as a research subject and a research partner). Additional workshops will be held in LA and MS communities. Key informant interviews will be conducted 6-8 months after the workshop to provide evidence of the long-term impact of the workshop. 4b.List other significant research accomplishment(s), if any. Marvell NIRI Promotes Walking for Health: The Marvell NIRI (including COPH), in collaboration with the mayor of Marvell, prepared a grant for funds from the Arkansas Department of Transportation to refurbish an existing walking trail. The Marvell NIRI working group expressed interest in understanding how to promote the use of this resource to benefit the health of the community. Subsequently, a research protocol was developed by the Walking Trail working group and submitted to Institutional Review Boards at partner institutions to examine factors that impede or promote walking and use of a walking trail. What is learned will provide rationale for designing subsequent research interventions supporting physical activity (as well as healthy eating) in the Marvell community. 4c.List significant activities that support special target populations. None. 5.Describe the major accomplishments to date and their predicted or actual impact. We have partnered with Marvell NIRI community groups in the following ways: (1) to obtain funding to refurbish the walking trail for the City of Marvell (in collaboration with the Office of the Mayor, Delta NIRI partners, USDA-ARS), and to conduct research examining how to promote use of this new community resource with the goal of reducing chronic disease risk through increasing physical activity; (2) to develop and plan an evidence-based, culturally tailored intervention that promotes healthy eating among households in the Marvell community, referred to as Delta DASH, in an attempt to translate evidence-based nutrition research for use in rural-low income communities, targeting healthy food availability among households; (3) to provide training for community capacity building in community-based participatory research; and (4) to begin establishing a partnership with the Phillips County faith community to address healthy weight. 6.What science and/or technologies have been transferred and to whom? When is the science and/or technology likely to become available to the end-user (industry, farmer, other scientists)? What are the constraints, if known, to the adoption and durability of the technology products? None 7.List your most important publications in the popular press and presentations to organizations and articles written about your work. (NOTE: List your peer reviewed publications below). M. Kate Stewart, S. Dianne Colley, Holly C. Felix, Anna Huff, Beatrice Clark Shelby, Greg A. Davis, T. Elaine Prewitt, Beverly J. McCabe-Sellers, Bonnie Bradley, Karen Kim, Margaret L. Bogle, Dianne D. Simms. 2006. Building community capacity through community research workshops. American Public Health Association, Annual Meeting. (Community-based Public Health Caucus) ROUNDTABLE. Prewitt, T. E., McCabe-Sellers, B., Strickland, E., Bogle, M., Hyman, E., McGee, B., Day, O., Seals, L., Williams, G., Von Kanel, M. 2006. Linking service and nutrition research: An approach to community engagement in community based participatory research. National Obesity Action Forum, June 5-6, 2006, Bethesda, Maryland.