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 Franklin Parish, LA, through community-based participatory research. Milestone a) The Franklin Parish NIRI community-based research team will be in place in LA. Milestone b) The Franklin Parish NIRI research worksite will provide a neutral site in Franklin Parish, LA, and enhance visibility of the Delta NIRI. Milestone c) An assessment of community resources and environmental conditions in Franklin Parish, LA, relevant to nutrition interventions will be complete. Objective 2. Design the nutrition intervention research for Franklin Parish, LA, 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 Franklin Parish, LA, 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 Pennington Biomedical Research Center (PBRC) scientists describing the CBPR/CPPE processes, development of the Franklin parish research worksite, community readiness, resource assessment, and other elements of the pilot testing and preparation for each intervention. Milestone e) PBRC will participate in the planning and implementation of one regional conference of scientific and lay communities. Objective 3A. Implement nutrition intervention strategies in Franklin Parish, LA. Milestone a) A well-written research protocol for a nutrition intervention in Franklin parish will be finalized. Milestone b) Appropriate data collection instruments and procedures necessary for the intervention research will be pre-tested if necessary. Milestone c) Franklin Parish residents and individuals from PBRC 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 Franklin Parish will be completed. Milestone e) Appropriate institutional review board approval for human subject's participation will be in place for PBRC. Milestone f) Manuscripts describing pilot testing intervention strategies, data collection procedures, and training of data collectors will be completed for peer reviewed journals by PBRC scientists. Year 2006 Objective 3A. Implement nutrition intervention strategies in Franklin Parish, LA. Milestone a) Implement nutrition intervention strategies specific to Franklin Parish. Milestone b) Monitor data collection and progress of intervention strategies. Milestone c) Evaluate process variables associated with nutrition interventions in Franklin Parish. Milestone d) PBRC scientists will prepare and submit manuscripts to peer reviewed journals for publication. Year 2007 Objective 3B. Evaluate nutrition intervention strategies implemented in Franklin Parish. Milestone a) Evaluate nutrition intervention strategies in place in Franklin Parish, LA. Milestone b) Develop measures to evaluate the impact of the CBPR/CPPE processes on the community of Franklin Parish, LA. Milestone c) Monitor the effects of other activities within Franklin Parish on the nutrition intervention. Milestone d) Utilize appropriate qualitative and quantitative statistical techniques to evaluate objectives and test hypotheses of the interventions in Franklin Parish. Milestone e) The participation of the Franklin Parish 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 Franklin Parish with regards to process and outcome variables will be completed by PBRC scientists and submitted to peer reviewed journals for publication. Milestone h) PBRC scientists will participate in the convening of a Delta NIRI national symposia for scientific and lay communities on CBPR/CPPE, and nutrition intervention strategies targeting high risk populations in rural communities. Year 2008. Objective 4. Initiate the process of adapting the successful nutrition intervention strategies from Franklin parish to other Lower Mississippi Delta communities. Milestone a) At least one additional community in LA 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 PBRC scientists and submitted to peer reviewed journals for publication. Milestone c) PBRC scientists will participate in the convening of a national Delta NIRI symposia for scientific and lay communities on CBPR, CPPE, and nutrition intervention strategies targeting high 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. People United to Sustain Health (PUSH) Intervention Launched in Franklin Parish, Louisiana Delta NIRI Consortium researchers working with the Franklin NIRI (Louisiana) evaluated the PUSH feasibility study, which addressed healthy weight, healthy food choices, food security, and physical activity. This successful study included nutrition education classes with access to fresh fruits and vegetables, with the ultimate objective to improve dietary intake and promote dietary strategies to ultimately result in prevention of weight gain. Positive changes, namely improvements in blood pressure, consumption of more fruits and vegetables, and prevention of additional weight gain and some weight loss in adults participating, set the framework and provided learning points to plan the larger PUSH study which was implemented in 2006. The PUSH study currently is designed in cohorts, some participants starting in late spring/summer and the next cohort will begin either in late summer or early fall. The total number of participants from the Delta NIRI Franklin Parish population will be between 100-120 for this intervention. 4b.List other significant research accomplishment(s), if any. None. 4c.List significant activities that support special target populations. None. 5.Describe the major accomplishments to date and their predicted or actual impact. Establishment of an active community research committee has been an important accomplishment to this project. While not a large group, the leaders are enthusiastic and dedicated, and project proposals have been initiated by local community residents (school-based obesity reduction proposal). PUSH subjects will be positively affected by this intervention by receiving important nutrition information to live a healthier life. Other accomplishments include the following: the fact that the Franklin NIRI office has been set up and staffed has had a positive impact on both the project and the community; The Franklin NIRI community has reacted positively to the launch of the larger PUSH study. The PUSH study has been extended to include more of the Franklin Parish community, which has a population of about 28,100, for further impact on community members at large. In addition the gardening project initiated by Southern has generated interest on the younger community members, and a planned snacking project in the schools will further that impact. It is our intention to launch a potential family-based intervention designed to address the problem of adult and childhood obesity in a family unit approach. All accomplishments made under this project are fully consistent with relevant milestones listed in the Delta NIRI Project Plan, and with the relevant research components as defined in the National Program 107 – Human Nutrition Action Plan. Accomplishments under this project contribute to the achievement of ARS Strategic Plan Goal 4, Objective 1, Performance Measure 1, in that project accomplishments contribute substantially to attainment of the Agency FY 2007 target of executing and reporting nutritional interventions. 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? Additional trainings were conducted for the larger PUSH study. Training of peer educator, assistant peer educator, community coordinator, and other personnel staff were conducted by both the Southern University and PBRC staff prior to the start up of the project. The honor student program in Franklin Parish has allowed students to participate in many aspects of the PUSH study and other community needs and has mandated that trainings be extended to those young individuals. 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). Kennedy, B., Champagne, C., Harsha, D., Newton, R. Jr., Volaufova, J., Ryan, D., Bogle, M. 2006. The "Rolling Store": An economical approach to the prevention of weight gain. The University of Alabama at Birmingham, Minority Health & Research Annual Conference, "Eliminating Health Disparities: Obesity & Diabetes from Discovery to Delivery", March 22-23, 2006, Birmingham, Alabama. Kennedy, B.M., Paeratakul, S., Champagne, C.M., Ryan, D.H., Harsha, D.W., McGee, B., Johnson, G., Deyhim, F., Forsythe, W., Bogle, M.L. Accepted invitation February 10, 2006, from the National Cancer Institute (NCI) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to submit program "A pilot church-based weight loss program for African American adults using church members as health educators: A comparison of individual and group intervention." The program will be disseminated on the Research-tested Intervention Programs (RTIPs) website (http://cancercontrolplanet.cancer.gov/rtips). The RTIPs is featured as a web resource on the Cancer Control PLANET web portal to promote the adoption of evidence-based intervention programs by public health practitioners.