“Guiding Community-Based Participatory Research in health
for disadvantaged and minority high school students,
focusing on science, math, health, and technology.”
Dr. Robert A. Branch, MD FRCP
Objectives
• The Problem
o Health
o Education
o inadequate Literate Workforce
• The solution
o Pitt-Bridge
o Salutogenesis (origin of health)
o Micro-Community-Based
Participatory Research (CBPR)
• Uniqueness
o Tiered Diffusion
Communication
o Application Psychology
o Adolescents
• Vehicles for Change
o Knowledge Brokers
o Continuous Self-Monitoring
• Feasibility
o Rural West Virginia
• Career Development
• Adolescent Health
• Community Health
Can We Apply These Concepts to Pittsburgh?
Who is Robert A. Branch?
Call me ‘Bob’
• Born in Nairobi , Kenya
in 2nd world war
• Father is a physician
o from St. Lucia
• Mother is a nurse
o from England
• Raised in Nigeria
• Schooled in England
• Bristol Medical School
o 17 years old
o qualified by 22 years
• Internal Medicine in UK
• Emigrated 1975
• Vanderbilt for 17 years
o Clinical Pharmacologist
• Pittsburgh for 22 years
o Clinical Translational Scientist
*An Educator for over 50 years*
The US Health:
An International Perspective
• Shorter Lives, Poorer Health
o US National Research Council
o Congress Requested Institute of Medicine
o January 2013
• US Health Disadvantages
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
-Johann Wolfgang von Goethe
The Cause
“Even if health care plays some role, decades of
research have documented health is determined by
more than health care.”
-2006 Report on Comparison of UK and US
Social Gradient ---------------------------- Income Inequality
At every social level UK>US
United States
United Kingdom
• “My right to choose.”
• Individualism
• “We are all in this together.”
• Collectivism
The Problem: Mal-Adaptive
Behavior Related Diseases
Worse outcomes than 17 other countries
Spends greater than 2x per capita than other countries
Acute Events
• Adverse Births
• Vehicular Accidents
• Violence
• STDs
Chronic Events
• Obesity
• Type II Diabetes
• Cardiovascular Disease
• Chronic Pulmonary
Disease
• AIDS
• Lung Cancer
Creating Change in Health
Who is to create change?
• Government
o Incapable of Action
• Philanthropy
o Inadequate Funding
• Advocacy
o Inadequate Federal and State Funding
We need to find a new way!
Public health. Confronting the Sorry State of U.S. Health.
Bayer R, Fairchild AL, Hopper K, Nathanson CA.
Science. 2013 Aug 30;341(6149):962-3. doi: 10.1126/science.1241249.
PMID: 23990546
Bridging the Gap
-
+
Federal
Community
Time
Interpersonal
+
-
Impact
Institutional
Individual
Creating Change in Health
Identify the Cause
o Misdistribution
• Money
• Knowledge of Community
• Behavior of Family
Involve Everyone
o
o
o
o
Community
Educators
Health Care Providers
Policy Makers
Use Adolescents
•
•
•
Target the Most Vulnerable
o
o
o
o
Poverty
Minorities
Rural
Urban Communities
•
Most Flexible
Technologically
Advanced
Already Established in
the Community
Responsible
Seismic Changes in
STEM Education
• Need for change
o
o
o
National decrease in competitiveness
Concern of future high-tech work force
Disgrace over differential State Standards
• Questions raised
o
o
o
What do we teach? What is learned?
When do we teach it? When is it learned?
How do we teach? How is it learned?
• Mathematics
o
The Common Core State Standards
• http://www.corestandards.org/resources/key-points-in-mathematics
• Sciences
o
The New Generation State Standards
• http://www.nextgenscience.org/next-generation-science-standards
Pennsylvania conservative resistance to change
Pitt-Bridge Vision and Goals
• Vision
o Provide a “Bridge" Between Health Sciences and STEM Disciplines
o Learn How to Learn
o Learn How to Change Behavior
• Goals
o Motivate minority and low-income high school students to enter higher
education
o Pursue careers in STEM fields, particularly in health sciences-related
occupations.
o Family improvement of health
o Self-improvement of health
CBPR Learning Program
Health Science Clubs
A Transformative Education Health Science Program:
Requires Integration of Essential Core Concepts
•
•
•
•
•
•
•
Salutogenesis (origin of health- for community)
Adaptive Adolescent Hypothesis
Micro and macro CBPR
Application of cognitive psychology in scientific method
Community Research Knowledge Broker (CRKB)
Tiered Diffusion model of communication
Adolescents as family health care coaches
Salutogenesis
*Origin of Health & Wellness for All*
Vaccination
Prevention
Time
Actionable Knowledge
Concepts
Prophylaxis of Chronic
Disease
Adaptive Adolescent
Hypothesis
Brain Maturation
• Burst of brain growth and change in structure
o
o
Pruning of dendrites
Development fast track neuronal connections.
Wave of Brain Maturation
• 1st Step: 12 years
o
Dexterity
• 2nd Step:15-19 years
o
Concept Integration
• Final Step: 21years
o
Executive Decision Making
Source: J. Giedd, Nature 442, 865-867 (24 August 2006)
Adaptive Adolescent
Hypothesis
Implication confers
evolutionary benefit
• Risk taking may be an
advantage in times of peril
Ability to use reasoned
choice to not conform to
culturally acquired maladaptive behavior’s may
be our best option for
survival.
Community-Based
Participatory Research
Core Values
• Mutuality
o Sharing by Members
• Equity
o Governance
o Accountability
• Trust
o Good Faith From All Partners
Community-Based
Participatory Research: A
Capacity-Building
Approach for Policy
Advocacy Aimed at
Eliminating Health Disparities
Israel BA, Coombe CM, Cheezum RR,
Schulz AJ, McGranaghan RJ, Lichtenstein
R, Reyes AG, Clement J, Burris A. Am J
Public Health. 2010 Nov;100(11):2094-102.
doi: 10.2105/AJPH.2009.170506. Epub
2010 Sep 23. PMID: 20864728 PMCID:
PMC2951933
Core Principles of CBPR
• Long-Term Commitment
• Equitable Partnership in All Phases
• Emphasizes Local Relevance
• Builds on community strengths and resources
• Promotes Co-Learning and Capacity-Building
Micro-CBPR for Student
Investigators
My ‘FIRST’ Health Project
Micro-CBPR Scientific Project
Fun
Innovative
• Individual
• Iterative
Relevant
• Respect
• Relationships
Scientific
Transformative
a) Subject Area
b) Background
c) Question
d) Design & Approval
e) Implementation
f) Analysis & Inference
g) Presentation
If a common data collection tool is used,
the sum of multiple Micro-CBPR generates bonefide CBPR
Who are ‘
’ in
Micro-CBPR of Health?
Who are ‘WE’?
• Who is the We?
• Where do We live?
• What is our environment?
• What are our health
problems?
Why do ‘WE’ do what we do?
• How do We learn?
• How do We make
decisions?
• How do We change?
Can ‘WE’ do better?
All Questions Require, Comparisons, Quantitation, Analysis
Potential to Enhance Health
A
Community
in
Trouble
Adverse,
Culturally-Based,
Behavior
Adolescent-Led
Micro-CBPR Projects
Adaption
Behaviors
Improve
Community
Awareness
Learning to Learn
Ausubel’s Theory
of Meaningful Learning
Community Science
Project
Change in Behavior
Prochaska’s Trans-Theoretical
Model of Behavior Change
The potential for the CBPR Learning Paradigm to enhance health
Clinical Research Knowledge
Broker
A New Community-Based Career Track
Who are they?
• Recruited from senior STEM teachers with higher pay
• Live in and know the local community
• Receive special training in
o
o
o
o
Ethics
principles of CBPR
study design
domains of health sciences interest
What do they do?
•
•
•
•
Organize integration of club activities
Mentor club teachers
Organize club group symposia
Maintain and evaluate quality
Tiered Diffusion BiDirectional Communication
STEM
Teachers
Knowledge
Brokers
Science Club
Students
Academic
Medical
Centers
Science Club
Families
Pitt-Bridge
*Science Club= 1 Teacher / 10 Students
CBPR Learning Paradigm
(Teacher Activity)
Teach
KB
Teachers
Train
Students
Teach
Teachers
Individual
Student
Project
Selection
Symposia
Presentation
(Student Activity)
Change
In
Behavior
“Learning by Doing”
Community Project Using Scientific Method
Learning
Doing
Evaluation & Feedback → New Challenge for Next Cycle
Concept Map Networking
Approach
Study Hypothesis
Study Rationale
Sociology of
Family
Home
Economics
Diabetes
Intervention
Structure
Conduct
Nutrition
Pre/Post
Cohort
Of
Mothers
Logistics
Portion
Size
Endpoint
Measures
Energy
Balance
Exercise
Complications
CBPR
Food
Labels
Energy
Cardiovascular
Disease
Heart
Attack
Ethics
Research
Regulation
Obesity
Epidemic
Metabolic Syndrome
Design & Conduct
Training
Education
Program
Diet
Stroke
Protein
Data
Collection
Data
Analysis
Carbohydrate
Fat
Data
Organization
CBPR Learning Paradigm
• Educational Perspective
o Integrate Common Core State Standards (CCSS) and the Next
Generation Science Standards (NGSS) by expanding into health sciences
• Student Perspective
o Involve hands-on experiences in ethics, science-based problem-solving,
leadership, team-building, decision-making, and concept presentation in
health sciences
• Community Perspective
o These students will gain the knowledge, skills, and ability to become family
health care educators to promote wellness.
Feasibility Model
• Encourage
o
o
o
o
o
Entrepreneurship
Self-Reliance
Team Work
Learn How To Learn
Self Expectation
• Mission
Health Science & Technology
Academy (HSTA)
o Community organizations in 26
counties
o 76 Science clubs for high school
o 4 Community Research Associates
o Links to WVU and Pitt
o Go To College
o Succeed in Career Development
o Improve Community Health
HSTA Club Enrollment
2011 Enrollment Statistics
1st Generation College
53%
Food Voucher Aid
40%
Rural
73%
African American
30% (3% Statewide)
Total
786 Students
HSTA College Entry Success
Analysis of 1267 HSTA Graduates
HSTA Graduates
WV High School
Graduates
Enrolled in College
96%
59%
Matriculated from
College
92%
56%
STEM Degree
49%
38%
In College
745
4 Year Degree
354
Masters Degree
62
PhD, PharmD, MD
40
MD
10
Obesity in West Virginia
Subjects enrolled in 2007
Prevalence of Obesity and
Diabetes (2007)
Projected Mean BMI for Adolescent Cohort
BMI in HSTA family sample populations
of West Virginia in subjects as they age
from the present time. The slope of
projections is estimated assuming the
linear increase observed from the BRFFS
study results from WV between 1985-2007
remains unchanged
Community-Based
Participatory Research
2007
2008
2009
2010
2011
2012
2013
Adults
648
56
356
40
125
103
100
% Obese
(BMI>30)
40
35
41
42
42
39
40
29 +/- 6
29 +/- 7
29 +/- 7
32 +/- 12
29 +/- 7
29 +/- 7
31 +/- 9
300
253
132
53
57
40
52
15 +/- 2.7
14 +/- 3.4
14 +/- 3.2
16 +/- 2.2
14 +/- 3.2
14 +/- 3.2
14 +/- 3.3
23 +/- 6
23 +/- 6
24 +/- 6
24 +/- 6
23 +/- 5
23 +/-6
24 +/- 7
BMI
(mean +/- SD)
Adolescents
Age
(mean +/- SD)
BMI
(mean +/- SD)
CDC Reported 6% increase in adult BMI 2007-2012
Lessons Learned in
Community Health
• Transition of HSTA coordinator to Community
Research Knowledge Broker
• Adolescents can conduct Micro-CBPR
• Integration of related Micro-CBPR permits
Community CPBR
• Multiple Micro-CBPR projects influences community
behavior for health care condition
Proposed Plan of Action
The Pittsburgh Bridge
• Stakeholders
o Community
o Pittsburgh Public Schools
o Academia
• Governance
o Community Leadership
o Advisory Committees
• Evaluation
• Funding
Phased Introduction
• Phase 1: Initiate and
Learn
• Phase 2: Refine and
Consolidate
• Phase 3: Expansion
Publications
•
Branch RA, Paulsen S, Hanks S, Obesity Management Organized by Adolescents in Rural
Appalachia, JHUP Fall 2014 (in press)
•
Branch, R., Chester, A., Morton-McSwain, C., Hanks, S. Udin Al Ayubi, S., Bhat Shelbert, K.,
Brimson, P., Buch, S., et al. A Novel Approach to Adolescent Obesity in Rural Appalachia
of West Virginia: Educating Adolescents as Family Health Coaches and Research
Investigators. Topics in the Prevention, Treatment and Complications of Type 2 Diabetes."
Mark B. Zimering (ED) (2011). ISBN:9780953-307-590-7, InTech.
•
Bardwell, G., Branch, R.A.,Buch, S., Cecchetti, A.,Chester, A., Groark, S.,Morton, C.,
Pancoska, P., Paulsen, S.,Vecchio, M." (2009, October).Feasability of Adolescents to
Conduct Community Based Participatory Research on Obesity and Diabetes in Rural
Appalachia." Clinical Translation Science.2(5)
•
Chester, A, and R.A. Branch. Community Based Participatory Clinical Research in Obesity
by Adolescents; Pipeline for Researchers of the Future. Clinical Translation Science. (2009).
•
Pancoska P, Branch RA, Buch S, Cecchetti A, Parmanto B, Vecchio M et al. (2009) Family
Networks of Obesity and Type 2 Diabetes in Rural Appalachia. Clinical and Translational
Science 2(6):413-421. http://www.wiley.com/bw/journal.asp?ref=1752-8054