U A B C O M P R E H E N S I V E C A N C E R C E N T E R 13

T hat s exactly the challenge that faces many residents in the rural areas of the Alabama Black Belt and the Mississippi Delta, and it s one reason that obesity and health disparities are a major prob- lem among these underserved primarily African- American populations.

To address this issue, the UAB Comprehensive Cancer Center, through its Deep South Network for Cancer Control (DSN), in 2012 launched the Journey to Better Health Research Project, a five-year, random- ized study funded by the National Cancer Institute examining weight-loss strategies and maintenance in overweight and obese African-American women in the Black Belt and Delta regions.

Specifically, the trial will target eight rural counties (four in Alabama and four in Mississippi). Participants will be randomly assigned to one of two groups for two years. The first group will follow a weight-loss pro- gram, including weekly sessions for six months followed by another year of sessions and motivational phone calls as part of a weight-loss maintenance program. The second group will follow the same weight-loss program, but the DSN will also provide seed money to the com- munities to help them provide greater opportunities for increased physical activity and better access to healthier foods.

The communities receive seed grants to, for instance, modify their parks and recreational areas, such as adding an indoor walking track, or to provide discounts to existing farmers markets for people to purchase fresher produce, says Monica Baskin, Ph.D., Cancer Center associate scientist and principal inves- tigator on the project. We can provide education and talk to people about doing the right thing, but the physical environment around them can make it very difficult even when they re motivated to do the right thing. That s the piece where the community strategies come in.

Needs of the Many Part of those strategies required the DSN to con-

duct needs assessments in the targeted communities to identify the various issues faced, such as access and walkability. The data was presented to community lead- ers and nonprofits to challenge them to compete for the available funds to make improvements. The strategy is paying off. One of our grantees is partnering with the local grocery store to connect smaller stores with farm- ers and make sure farmers can provide produce even in settings where we typically don t see a lot of it, such as convenience stores and mom and pop stores, Dr. Baskin says.

Access to produce is a key component of the proj- ect s weight-loss program, Dr. Baskin says. The pro- gram encourages high consumption of fresh fruits and vegetables coupled with 30 minutes of moderate to vig- orous physical activity at least five days a week, while limiting high-calorie beverages, high-fat dairy products and foods high in sugars and fats. However, the DSN team stresses taking a realistic approach to the program. We talk to people about not making the program so restrictive that it s impossible to maintain, Dr. Baskin says. The overall goal is long-term lifestyle change.

Women participating in the program are provided with journals to keep track of everything they eat and drink and to record their physical activity levels. The weight-loss sessions are led by local women who live in the community, which has been a key component in the success of the DSN s other initiatives. This program isn t run by dietitians and behavioral psychologists at UAB. It s a locally run program, Dr. Baskin says. In each county, there s one person who works with a regional coordinator for the first six months. After that, the local coordinator runs the remainder of the pro- gram. So there s a person within the community who has the resources and the tools to continue this even after the research study portion is over.

As of early 2013, half of the targeted counties had completed their first phase of sessions, and the remain-

In each county,

there s one

person who

works with

a regional

coordinator

for the first six

months. After

that, the local

coordinator runs

the remainder of

the program.

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outreach for health