"Kids today believe that a 'Grab Size' bag of chips is a regular size," says Stephenie Bickham, deputy director of the City of New Orleans Health Department. "It's really two-and-a-half servings. It's within their mind that they're supposed to consume that bag instead of recognizing it's more than a serving. We're setting people up for bigger health failure. We're killing them with a fork."
The best way to get people to put that fork down, researchers say, is to focus on reaching women, who often serve as the driving force behind a family's health and lifestyle decisions. According to statistics, women -- particularly minority women -- also are most in need of preventative measures.
Cardiovascular and coronary heart diseases are higher in women than men, and higher still among African-American women. Statistics from the American Heart Association show that more than 53 percent of American women die from cardiovascular disease and coronary heart disease each year. In 1998, for example, nearly 300 of 100,000 white women died of cardiovascular diseases; the numbers were significantly higher for black women -- approximately 400 of 100,000. Black women also suffer high incidences of stress-related diseases, hypertension and diabetes.
Recognizing that such desperate numbers call for innovative measures, researchers and medical professionals are reaching out to the African-American community in a unique effort to champion a change. A new program -- REACH 2010: At the Heart of New Orleans -- is gearing up this month in a setting most people don't think of when they think "medical advice": 31 churches of all denominations across the city. The target audience? Women.
"When you were growing up, who was the person making decisions about whether to go to the doctor?" asks Dr. Jeanette H. Magnus, head of the Tulane/Xavier Center of Excellence for Women's Health, one of only 15 such centers in the United States. "Who is the one you call up for a second opinion even now? If you didn't have a mother available, you would seek out another woman for advice."
The health project hopes to nurture a return to an atmosphere of kitchen-table talks and invaluable exchange of information, as well as an empowerment of women with the knowledge they need to make decisions and the support to carry through. Plus, tracking the project's programs and determining which programs work best will help organizers implement similar programs in other places.
The program is administered by the local chapter of the National Black Women's Health Project (NBWHP), which has partnered with the Tulane/Xavier Center for Excellence in Women's Health, the City of New Orleans Health Department and the Louisiana Department of Health and Hospital's Office of Public Health. The four-year program is funded by a grant from the national Centers for Disease Control and Prevention (CDC) as part of the federal REACH 2010 initiative -- Racial and Ethnic Approaches to Community Health -- aimed at eliminating the health disparities of minorities in the areas of infant mortality, cardiovascular disease, cancer, diabetes, HIV and immunizations by the end of the decade. At the Heart of New Orleans, with its faith-based component and its focus on African-American church women, is currently the only CDC-funded study of its kind.
Little by little, organizers hope to chip away at misconceptions about nutrition and health and focus more closely on preventing illnesses and changing bad habits. "We've gotten away from old-time prevention," says Rudy Macklin, director of the Bureau of Minority Health Access in the state Department of Health. "Programs administered through the public go in with a one-framework-fits-all concept, but that doesn't work the same for all populations. You have to go where they are, get to know that community, get to see what their needs are and how they interpret the information. You need to spend some time in these areas, talk to the people they listen to. You need to walk like they walk."
The crux of the local program is the establishment of education programs within the church setting, with volunteers running the show so that the heart-healthy programs can continue even after initial research is completed. The project's goal is to reach 3,000 women in Jefferson and Orleans parishes, according to June Marshall, NBWHP president.
Each participant undergoes a health screening in which professionals take a medical history, check blood pressure and cholesterol, and establish other baseline factors. Throughout the course of the study, participants will attend seminars, workshops, demonstrations and exercise classes; discussions will range from ways of approaching and questioning a physician about health care treatments to outlining available health care options and assistance making appointments. Not only are the women given information, they also learn to coach and support each other in their efforts to change habits such as smoking, methods of food preparation, physical activity and coping with stress.
Working through churches gives researchers confidence they can maintain participation throughout the length of the study and that church members will learn how to assimilate health information into their daily lives. "We know that the church is an important part of African-American life," says Bickham. "The thing I like most about the REACH 2010: At the Heart of New Orleans project is that it is a common-sense approach."
The church also provides a built-in support group -- and audience. "With this program, they're learning the skills, you have that knowledge and can train other people within the church," says NBWHP's Marshall.
"We need to nurture our spiritual health as well as our physical health," says Hazel Feltus, a minister's wife and supervisor of the First Ladies, a group of women who serves as a liaison between church members and researchers and are key in keeping the REACH 2010 programs running. "Women need to understand that they are important themselves and that it is important for them to stay healthy so they can do all the things they need to do."
To help sustain the program, organizers are forming partnerships with businesses and community organizations, pairings that can stay in place after the formal research study is over. "Many of the churches already had set up health fairs for their members and other programs," says Dr. Cheryl Taylor, principal investigator for the project. "We are supplementing those and setting up new ones."
The partners can include businesses that supply blood pressure kits for health screenings, health care professionals who donate their time to conduct screenings and counseling, or local chefs who give participants heart-healthy recipes and conduct cooking demonstrations.
"The whole purpose of the project is not just to help the women, but to bring together community partnerships to help the community as a whole," says Taylor. "There is a learning and support and growth that takes place within the group. We all have the same inspiration and goals."
Still, researchers recognize that they have their work cut out for them. "It's not going to be done overnight," Bickham says. "Over the first year, most of that will be spent just to get them educated on what changes need to be made -- and how to make those changes -- to have a healthier lifestyle and decrease the risk of cardiovascular disease. Within a generation, it could have an impact on the younger generations of families."