Healthy People 2010, a comprehensive national health promotion and disease prevention initiative, has two overarching goals: increase quality and years of healthy life, and eliminate health disparities. The effort to eliminate health disparities weaves through all areas of research, service and education within the department. Our faculty are reaching out to many different communities and making a difference in the lives of people from diverse backgrounds, focusing their efforts on populations that are medically underserved including ethnic minority and rural populations. Our faculty serve people from the region who come from diverse racial/ethnic backgrounds including African American, American Indian, and Latino heritage with the goal of reducing health disparities.
One key "laboratory" in which we conduct much of our rural research is the Kansas Physicians Engaged in Prevention Research (KPEPR) rural practice-based research network. Two of our research programs are currently based in the KPEPR network primary care practices, the largest of which is KanQuit II, a program focused on smoking cessation efforts in rural Kansas communities. KanQuit II also serves as the basis for a registry of smokers (the first of its kind in the area) that will allow for long-term follow-up in this disease management program.
KPEPR network-based programs could not be completed, however, without the collaborative efforts of dedicated rural primary care physicians throughout the state and committed medical students. In our program, medical students engaging in a rural primary care summer research program actively participate in research activities while they shadow a rural primary care physician. From 2006 to 2010, 72 medical students have worked on the Healthy Living Kansas KPEPR network project focused on using touchscreen computer technology and tailored messaging to promote active engagement in colorectal cancer discussions between rural primary care physicians and their patients. The students were assigned across the entire state with some students more than 375 miles away from KU Medical Center. This unique experience allows students the opportunity to become immersed in issues endemic to rural communities, engage with a clinical care team, and gain clinic-based research experience. This model also allows our research teams to extend our programs into otherwise difficult-to-tap real-world rural primary care practices across the state of Kansas.
Our research in ethnic minority communities takes place in a variety of clinic and community settings. We have a long-term relationship with the Swope Health Services group of clinics in Missouri and Kansas. Swope clinics largely serve poor, underinsured patient populations, with some clinics serving primarily African American community members and other clinics serving Latino community members. Our work in the African American community focuses on smoking cessation, cancer screening, and obesity prevention and reduction. We have been successful in getting federal and private foundation grants to support our collaborative research efforts with Swope, totaling over $4 million in direct grant funding. More than 1500 African American participants from Swope have received no-cost pharmaceuticals or counseling for improving health behaviors. We have a long-standing series of clinical trials treating African American smokers, the "Kick It at Swope" or "KIS" projects, now in their third NIH-funded trial. We also have faculty examining the role of genetics and metabolism in tobacco use and smoking cessation outcomes. We have projects focused on helping African American women lose weight using both physical activity and dietary changes, as well as helping African American youth lose weight. Our efforts within the African American community are guided by our Community Advisory Board (CAB) consisting of healthcare professionals, political representatives, public servants, religious leaders, professionals and lay advisors within the African American community. We work closely with our CAB to ensure that our programs are culturally sensitive and address the health needs of the community.
We currently have faculty working with the Latino population, within the Swope clinics, the Wyandotte Health Department, and a variety of other safety-net clinics. An important part of our research with Latinos is our links to various community organizations, such as el Centro, a community center providing services to people living at or below the federal poverty level, and the Coalition of Hispanic Organizations – Health Initiatives, Coalition of Hispanic Women Against Cancer among others. Through this partnership the Department of Preventive Medicine and Public Health has actively collaborated in different Health Fairs and health promotion activities in the Latino community of greater Kansas City. Our faculty led two summits at the University of Kansas Medical Center to foster collaboration among organizations, coalitions, health care providers and health clinics committed to improving the health of the Latino community. These meetings occur every semester and are called Enhancing Health Initiatives in the Latino Community. Participants included state representatives, leaders of Hispanic organizations and community members. Our present research with Latinos focuses on smoking cessation, and our future efforts will expand to areas such as obesity, diabetes, cancer screening and vaccination, as well as using promotoras or patient navigators to help guide people through the health care system.
Our work with the Native community currently focuses on smoking cessation and cancer screening. Over the past three and one-half years, faculty in our department have received five national grants and two internal grants to address health disparities among American Indians, allowing us to build up a large research team (10 research staff, including five community members). The All Nations Breath of Life smoking cessation program, developed entirely through community-based participatory research methods is the first culturally-tailored smoking cessation program for a heterogeneous American Indian population to show effectiveness in pilot studies and is now beginning efficacy testing. Our most recent grant will allow us to develop a culturally-tailored Internet site about smoking and lung health and will collect data about the potential for an on-line smoking cessation program. We are also now beginning primary prevention efforts among Native youth in conjunction with one of our community partner organizations, the Heart of America Indian Center. In addition to our work in smoking cessation, we are conducting two needs assessment studies for mammography and colorectal cancer screening in the American Indian community. This formative work will allow us to create culturally-tailored interventions to promote screenings in this community, who historically have had the lowest screening rates of all ethnic groups.
We have an active Community Advisory Board (CAB) for our Native research program, made up of community members and leaders from urban areas and the four reservations in Kansas, which meets quarterly and also provides ongoing input by email and phone. Our CAB not only helps with current research projects but also identifies additional research needs and brings them to the table. Together with seven other academic and community organizations, we have formed the American Indian Health Research and Education Alliance (AIHREA), whose mission is to reduce health disparities faced by Native people through high quality participatory research and education. Our successful introduction to the community was through a health and wellness pow wow in May 2005 at AIHREA partner Johnson County Community College, where we provided health screenings and education to nearly 100 dancers and 750 visitors.
Our MPH program is also committed to serving disparate communities and educating community members to conduct public health research. We are currently working with Haskell Indian Nations University to develop an undergraduate course in Public Health to begin a pipeline for their students into graduate training in public health. A new course on community-based participatory research will be offered this spring, along with further courses in health disparities and rural health. In the medical school curriculum, we offer first-year students their first look at health disparities and underserved communities. We also have several faculty involved in the fourth-year elective in International Health, bringing our efforts to some of the most underserved communities in the world.
Partnerships in Prevention Award
Native American Tobacco Cessation Curriculum
Presented by the 2006 Oklahoma City Area Indian Health Summit, Health Challenges in Indian Country, Indian Health Service