Hilda R' Heady, 2005 NRHA President Associate Vice President for Rural Health West Virginia Universi

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Community Connections Translating Research and
Rural Realities

• Hilda R. Heady, 2005 NRHA PresidentAssociate
  Vice President for Rural HealthWest Virginia
  University

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• Presented to the
• EXPORT National Conference
• June 26, 2007
• Wintergreen Resort
• Wintergreen, Virginia

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Todays Message

• Rural Health is special and our values make it
  special, not our disparities.
• Connecting to the community in meaningful ways is
  essential to successful translational research
  outcomes
• Our research should take place within the context
  of values and culture

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Rural is.

• Defined by tradition and history
• Defined by geography and politics
• Defined by culture and values
• Much more than her own health care disparities

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Rural is.

• both an objective quantitative measure
• and a subjective state of mind

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• Culture and
• Lifestyle
• Which has the greater impact?
• Larger societal culture or
• The sub- culture or
• The culture clash

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Rural Health Disparities According to NRHA

• Rural communities represent about 20 of
  Americas population however less than ten
  percent of physicians practice in those
  communities, 75 of nations health professions
  shortage areas
• More uninsured and less employer-provided health
  care coverage or prescription drug coverage

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Rural Health Disparities, cont.

• Rural poor are less likely to be covered by
  Medicaid benefits
• One-third of all motor vehicle accidents occur in
  rural areas however two-thirds of the deaths
  attributed to these accidents occur on rural
  roads

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Rural Health Disparities, cont.

• Fewer dentists practice in rural areas, more
  adults with lost teeth, more periodontal disease
• The majority of EMS first responders are
  volunteers
• Rural residents are poorer than their rural
  counterparts

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Rural Health Disparities, cont.

• Alcohol abuse is a significant problem among
  rural youth
• Rural residents are nearly twice as likely to die
  from unintentional injuries other than motor
  vehicle accidents

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Rural Health Disparities, cont.

• Suicide rates among rural males are significantly
  higher than in urban areas and the suicide rates
  among rural women are rapidly catching up to that
  of men
• Methamphetamine use and admission treatment rates
  are higher in rural, non-metro areas

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To address our current and future disparities We
must connect with our past And
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And learn how to appreciate our culture and
values and those of others
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Just Different?
or Special
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Rural Beatitudes
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Blessed are the rural for they are collaborators
and are self-reliant
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Blessed are the rural for they value their
families
and are friendly folks
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Valuing family means direct care of our family in
need and sharing challenges rewards, joys and
sorrows.
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Blessed are the rural for they value
individualism and are personable, independent,
and modest
Blessed are the rural for they are independent
and modest
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Blessed are the rural for they are
patriotic, and they go to war
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Blessed are the rural for they serve others
without being asked
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Blessed are the rural for they work the earth
And they make stuff for everyone else
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Rural hands touch all our raw products and
natural resources world wide.
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• Blessed are the rural for they have a deep sense
  of faith

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A Sense of Beauty
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• and a great sense
• of humor.

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• Blessed are the rural for they ALL
• deserve high quality health care!

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Examples of Community-based AND
Community-Connected Research

• WVRHEP/AHEC Backbone Platform
• State required rural rotations and rural health
  curriculum
• Includes community based research,
  interdisciplinary education, and service learning
• Infrastructure for various research projects
  addressing rural health outcome disparities

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• The Schools can do all the research they want to
  do as long as they
• call it something else and make it about the
  communities real problems!
• Dennis McCutcheon, Chairman
• WV State Rural Health Advisory Panel

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The West Virginia CARDIAC Project

• Coronary
• Artery
• Risk
• Detection
• In
• Appalachian
• Communities

To reduce cardiovascular disease mortality in
West Virginia through research and intervention
in children
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More American Children Are Overweight Than Ever
Before
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OBESITY IN WEST VIRGINIA

• 94 WV citizens consider obesity our most serious
  health problem
• Obese individuals have 67 more chronic disease
  than non-obese
• Annual cost to the state approximately
  558,000,000

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What happens when we visit the school on
Screening Day?

• We measure height and weight
• (in private)
• We calculate Body Mass Index (BMI)
• We check blood pressure
• We measure blood cholesterol
• We examine neck for Acanthosis Nigricans (AN)
• Parents of children with abnormal cholesterol
  eligible for free screening

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Health Care Professionals
Health Science Students
School Nurses
WVRHEP/AHEC Coordinators
School Principals and Teachers
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CARDIAC Surveillance

• Screened by CARDIAC in 8 years
• 676 9th graders
• 49,632 5th graders
• 627 2nd graders
• 1844 kindergarteners
• 214 school personnel

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CARDIAC Impact 2005-2006 Weight Status of WV
Children

• 5 of kindergarteners were at-risk for overweight
  and 16 were overweight.
• 17 of 2nd graders were at-risk for overweight
  and 17 were overweight.
• 19 of 5th graders were at-risk for overweight
  and 29 were overweight.
• 20 of 9th graders were at-risk for overweight
  and 24 were overweight.

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CARDIAC ImpactCardiovascular Disease Risk Factors
High Risk is defined by the individual having 2
or risk factors for CVD
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Health Beliefs Among Parents of CARDIAC
Participants

• Increased perceived behavioral control
• Fewer perceived barriers to their own health
• Household dietary changes (68) and physical
  activity (50)
• 94 satisfaction rate

Ref Harris, Bradlyn and Neal NHLBI
Dyslipidemia Detection In West Virginia
5ROIWL070120-02
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Attitudes of Child Participants in CARDIAC Project

• More concerned about diabetes than heart disease
• Intention to eat healthier
• No child/parental anxiety related to cholesterol
  screening

Ref Harris, Bradlyn and Neal NHLBI
Dyslipidemia Detection In West Virginia -
5ROIWL070120-02
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Relevance of CARDIAC to Stakeholders

• Identifies children at greatest risk of chronic
  disease
• Sets stage for interventional strategies
• Provides data supporting grant applications
• Promotes healthy lifestyle
• Informs policy making process

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CARDIAC KidsSign up today!

• CARDIAC is a project for 5th grade students. We
  start by checking the child's height, weight and
  blood pressure and then we check the blood for
  cholesterol. Depending on what your school has
  decided, blood tests might be done in the school.
  You can have a blood test too, and all of this
  is FREE!
• Heart disease begins when we are young. We want
  to help you and your children live longer and
  healthier lives. The CARDIAC Project will help
  you and your family learn about heart disease and
  what you can do to prevent it or at least slow
  the process.
• Here is how to get started
• ? Read the letter from Dr. Neal on the next page.
  It gives all the details of the CARDIAC
  Project.
• ? Complete the short family history form.
• ? Write your child's name and sign your name on
  the lines.
• ? Have your child sign his or her name on the
  line.
• ? Tear off the history form that you just signed
  and send it back to school with your child.
• ? It is that easy. We will do the rest!

• It's fun and easy!
• Just send the white sheet back to school.
• A current IRB is available in the CARDIAC office.

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COMMUNITY-BASED RESEARCH PROTOCOLS

• Investigators are encouraged to describe
  procedures broadly
• Multiple amendments to a protocol are discouraged
• Service learning encourages community input.
  Thus inconsequential changes in the protocol may
  not require an amendment.

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Center for Oral Health in Rural Appalachia

• Dental Health in Families Project
• Funded Natl Inst. Dental and Craniofacial
  Research (NIH)
• Partnerships WVU, U Pitt, WVRHEP/AHEC
• 300 WV Families
• Two rural southeastern WV counties

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Services AND Research

• For each family member
• Oral cancer check
• Full dental, gum disease
• Orthodontic screenings

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Services AND Research

• Blood and saliva samples are also taken from
  participants
• An interview with each of the family members
  helps establish their dental history, and their
  attitudes toward dental care
• Oral health and hygiene education

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Individual RO 1s and other studies

• Oral microbiology
• Cardiovascular risk
• The link between genetics and cavities
• Fear of dentistry
• Other barriers to oral health care access

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Overall Findings

• 34 children age one to six have at least one
  cavity
• West Virginia leads the country in having the
  highest rate of adults age 65 and older who have
  lost all of their natural teeth
• 43 of older West Virginians compared to the
  national average of 20.5

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Oral Health Access Changes

• Increased referrals to local dentists and
  hygienists
• Exams and collections done in local dental
  offices
• Dental and DH students provide uncompensated
  dental services
• 15 million in uncompensated care since 1995
  (independent of study)

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Work with Cultural Strengths..
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And develop meaningful interventions
with Cultural Weaknesses
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Our efforts to define community are less
important than our search for common
unity. Hilda R. Heady
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Look for your inspiration, the source of your
passion in the simple and common places first.
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