Ann Chester

Family Networks of Obesity and Type 2 Diabetes in Rural Appalachia

The prevalence of obesity and diabetes has been studied in adolescent and adult populations in poor, medically underserved rural Appalachia of West Virginia. A web‐based questionnaire about obesity and diabetes was obtained in 989 family members of 210 Community Based Clinical Research (CBPR) trained adolescent members of a network of 18 science clubs, incorporating 142 families. After age‐correction in < 20 years old, 50% of both adolescents and adults were obese. The frequency distribution of obesity was trimodal. In the overall population 10.4% had type 2 diabetes, while 24% of adult, obese subjects had type 2 diabetes. A new metric, the family diabetes risk potential, identified a trimodal distribution of risk potential. In the lowest most common distribution 43% of families had a diabetic family member. In the intermediate distribution, 69% had a diabetic family member, and in the distribution with highest scores all the families had a diabetic member. In conclusion, the poorest counties of rural Appalachia are at crisis level with the prevalence of obesity and diabetes. The distribution of age‐corrected obesity and family diabetes risk potential are not normally distributed. We suggest that targeting individual family units at greatest risk offers the most efficient strategy for ameliorating this epidemic.

Community-Based Participatory Clinical Research in Obesity by Adolescents: Pipeline for Researchers of the Future

We propose a novel, untapped opportunity, challenging cultural and man‐power barriers to transferring advances in biomedical science knowledge that will improve community health care (Type II Clinical Translational Research) in a medically underserved community. We describe a pilot model in which adolescents apply principles of Community‐Based Participatory Research (CBPR) at the epicenter of the obesity diabetes epidemic in rural Appalachia in West Virginia. The model invites minority, financially disadvantaged, and educationally disadvantaged adolescents to become educated on ethics, then provides infrastructure to support study design and conduct of CBPR. This experience demonstrates that these adolescents can effi ciently, with quality and integrity, reach into the most vulnerable of communities and their own families to show that the prevalence of obesity is at 50% and diabetes 10.4% (n= 989). Our experience illustrates the infrastructure requirements for this strategy to be successful and emphasizes the substantial benefit that could accrue if the model is successfully sustained. The benefit includes not only the translation of knowledge to influence community lifestyle behavior but also the creation of a pipeline of new biomedical scientists for the future.

Feasibility of Adolescents to Conduct Community-Based Participatory Research on Obesity and Diabetes in Rural Appalachia

Community‐Based Participatory Research (CBPR) has been advocated to translate advances in health care sciences to the community. We describe a novel approach applied to obesity management and diabetes prevention. This takes advantage of a network of science clubs organized by the Health Sciences and Technology Academy (HSTA) for extracurricular activity of disadvantaged high school students in rural Appalachia. Physician scientists and educators provided an intensive summer course on CBPR, ethics, and study design on obesity management and diabetes prevention. Ethical certification for CBPR investigation was obtained for 210 students and 18 mentors for a study on the prevalence of obesity and Type II diabetes within their community. Over a 6‐month period, 989 had a collection of complete analyzable data, of which 103 had diabetes. The proportion with obesity (BMI ≥ 30) was over 50%. The frequency of diabetes was related to increasing BMI. When BMI ≥ 40, the frequency approached 50%, and exhibited a clear familial distribution. We conclude that trained adolescents can effectively conduct CBPR, and obesity and diabetes are more prevalent than previously reported in this community. This experience provides encouragement to conduct future studies to infl uence weight management from high‐risk populations in this medically disadvantaged community.

The health sciences and technology academy: utilizing pre-college enrichment programming to minimize post-secondary education barriers for underserved youth.

West Virginia is considered one of the most rural states in the nation, with over 60% of its population classified as rural. The state experiences relatively high unemployment, and it ranks among the lowest (49th) of all states in median household income. Fifty-eight percent of the students in West Virginia counties are eligible for free or reduced-price lunch. Furthermore, only 14.7% of adult residents 25 years and over have attained a bachelor’s degree or higher, putting the state 50th in higher education. The rural nature of the state coupled with economically depressed communities has limited the availability of secondary-level science courses required for health sciences majors in college. Additionally, most counties in West Virginia are considered medically underserved, and therefore it is important to increase the number of health care providers in rural areas of the state. However, if the state’s under-represented students do not receive adequate preparation in pre-college math and science, the proportion who can attend college and succeed will continue to be limited, and the pool for the health professions will be too small. To overcome some of these barriers, West Virginia University and 21 West Virginia counties have come together in the Health Sciences and Technology Academy (HSTA) in a community–campus partnership. Its web site is ^http://www.wv-hsta.org\&. A precollege enrichment program, HSTA helps students learn tools to enable them to progress through high school, college, and professional school. The HSTA program consists of an on-campus (WVU) Summer Institute at West Virginia University where students and science teachers are engaged in learning activities facilitated by science and education faculty. These science teachers also facilitate HSTA community-based science clubs during the school year. The HSTA model uses the inquiry-based theory that encompasses problem posing, problem solving, and persuasion. Research suggests that inquiry activities emphasizing problem solving enhance middle-level students’ self-confidence in mastering science and their attitudes towards the discipline. Furthermore, inquirybased learning is considered fundamental to students’ understanding of science concepts and processes. The National Science Education Standards (NSES) call for greater emphasis on ‘‘inquiry into authentic questions generated from student experiences [which] is the central strategy for teaching science.’’ As a follow up to the NSES, a practical guide has been developed for educators who wish to emphasize inquiry-based instruction. A principal thrust within the community science clubs is inquiry-based learning of science through extended investigations and community service projects. The model also engages students in authentic learning processes (i.e., real-world problem-solving circumstances), which are both fun and challenging. Students’ projects often target health-related topics and may potentially inform and benefit various communities through dissemination at local and state levels.

Effects of leaf nitrogen availability and leaf position on nitrogen allocation patterns in Vaccinium vitis-idaea and Vaccinium uliginosum

SummaryNitrogen allocation patterns from leaves of Vaccinium vitis-idaea (evergreen) and Vaccinium uliginosum (deciduous) were assessed using a foliar application of 15N labeled ammonium sulfate. These are wild perennial shrubs inhabiting arctic and subarctic regions. More label was transported from labeled leaves of Vaccinium uliginosum then Vaccinium vitis-idaea. In Vaccinium uliginosum, the amount of label transported from the labeled leaf increased as the concentration of nitrogen in the label increased. Current growth in Vaccinium uliginosum was a strong sink for nitrogen because most of the 15N transported from the labeled leaf was contained in this region. In addition, when greater quantities of nitrogen were applied, larger quantities were retained in current growth. Current growth of Vaccinium vitis-idaea, on the other hand, was not as strong a sink because regardless of the nitrogen available thru various label concentrations, the enrichment of current growth was not affected and was not significantly different from older stems or leaves. Yet, in both species, nitrogen was transported freely from leaves of all positions along the stem to all parts of the plant including roots and rhizomes. The position of the leaf along the stem had no effect on the patterns of allocation to other organs.

A NOTE ON JULY SENESCENCE IN TUNDRA PLANTS AT EAGLE CREEK, ALASKA, U.S.A.

Widespread senescence of leaves was observed on many tundra plant species as early as 15 July 1981 at three elevations near Eagle Creek, Alaska. This early senescence truncated an already-short growing season of between 44 and 87 d by 15 to 30 d. Correlative evidence assembled in this report indicated that cold overall temperatures may have been responsible. Heavy frost, drought, photoperiod, and low light levels-all factors which have previously been implicated as causing senescence of leaves-were discounted as possible explanations. The present data underscore the need for experiments under controlled conditions to determine the operative cues for onset of senescence in tundra plants.

The Health Sciences and Technology Academy: an educational pipeline to address health care disparities in West Virginia.

Health and educational disparities are national issues in the United States. Research has shown that health care professionals from underserved backgrounds are more likely than others to work in underserved areas. The Association of American Medical Colleges’ Project 3000 by 2000, to increase the number of underrepresented minorities in medical schools, spurred the West Virginia School of Medicine to start the Health Sciences and Technology Academy (HSTA) in 1994 with the goal of supporting interested underrepresented high school students in pursuing college and health professions careers. The program was based on three beliefs: (1) if underrepresented high school students have potential and the desire to pursue a health professions career and are given the support, they can reach their goals, including obtaining a health professions degree; (2) underserved high school students are able to predict their own success if given the right resources; and (3) community engagement would be key to the program’s success. In this Perspective, the authors describe the HSTA and its framework and philosophy, including the underlying theories and pedagogy from research in the fields of education and the behavioral/social sciences. They then offer evidence of the program’s success, specifically for African American students, including graduates’ high college-going rate and overwhelming intention to choose a health professions major. Finally, the authors describe the benefits of the HSTA’s community partnerships, including providing mentors to students, adding legislative language providing tuition waivers and a budgetary line item devoted to the program, and securing program funding from outside sources.

A Novel Approach to Adolescent Obesity in Rural Appalachia of West Virginia: Educating Adolescents as Family Health Coaches and Research Investigators

“Transformation happens less by arguing cogently for something new than by generating active ongoing practices that shift culture’s experience of the basis of reality.” – R.S. Zander (a psychologist) B. Zander (a conductor, in the Art of Possibility). (Zander & Zander, 2002) The pandemic of obesity, with its attendant downstream complications of Type II, Diabetes (DM) and Cardiovascular disease (CD) is emerging as an international challenge to public health. (Adams et al., 2007; Grubb, 2002) Despite increased understanding of the complexity of the biology of energy balance, and evidence of how to maintain sustained weight reduction in the context of a randomized clinical trial, (Knowler et al., 2002) the actual epidemic is still inexorably increasing. (USBRFSS, 2002) Each advance in our understanding of the biology of energy balance provides further evidence for the complexity of multiple interactive processes, and the amazing ability of the human body to auto regulate to counter external interventions and maintain what the body perceives as the ideal basis for competing in its environment. Thus, our perception of the dangers of obesity, based on future predictions of adverse events run counter to biological self-perception of the immediate present. We have, however, found that perfection is not required to ameliorate an adverse future, as relatively modest reductions in weight, when sustained, provide disproportionate reduction in the risk of DM and CD. (Knowler et al., 2002) This perspective provides the basis for the belief that we can reverse the epidemic. The authors’ opinion, mirrored by others, is that the primary root cause for the current dilemma of, ‘knowing what to do, but not doing it’ is a clash of biological and cultural

An application of a generalised assignment problem: assigning recruiters to geographical locations

In order to increase the number of underrepresented students pursuing college degrees in health sciences fields in the state of West Virginia, the Health Sciences and Technology Academy (HSTA), a pre-college enrichment programme, was established. Due to a limited budget, a limited number of recruiters are available to recruit as many West Virginia High School students who satisfy the programmes selection criteria. As a result, recruiters are assigned to geographical locations (populations of potential HSTA students) such that the total value of the student populations assigned is maximised with respect to the programme selection criteria. This problem is defined as a generalised assignment problem (GAP), since more than one student population can be assigned to a recruiter such that the capacity of the recruiter is not exceeded. In this paper, a mathematical model, a construction algorithm, and a tabu search heuristic are presented for the proposed GAP.