Building healthier futures: Raynor’s work to make research accessible

Building healthier futures: Hollie Raynor’s work to make research accessible

“Translation requires a lot of thought regarding settings, implementers, and patients,” said Hollie Raynor, Ph.D., during the Forge AHEAD December seminar. Raynor, a leader in nutrition and behavior research, works to ensure solutions to childhood obesity don’t remain confined to research papers but reach families and communities in need. She focuses on adapting programs to real-world settings, training the people who deliver them, and designing solutions that work for families in their everyday lives.

At the seminar hosted by the Pennington Biomedical Research Center in Baton Rouge, LA, Raynor discussed the challenges of addressing childhood obesity. “When I started to walk into this space, my interest was thinking about how we can take our family-based intervention—highly intensive at the time—and begin moving it out of specialty care clinics to more primary care settings to enhance access,” she explained. This change, she noted, is essential to helping families—especially those in communities with limited access to care—benefit from programs without the obstacles of specialized healthcare.

Raynor stressed the importance of tailoring interventions to community needs and delivery methods. “As researchers, we need to really describe the site of delivery and the providers involved, so we build a more representative research base to understand how best to impact translation,” she said.

Her work with Federally Qualified Health Centers in Tennessee exemplifies this approach, focusing on scalable models for delivering obesity programs through non-specialist providers, such as primary care physicians and behavioral health consultants.

Breaking Down Barriers

Raynor simplifies evidence-based programs into practical, actionable steps. For example, she has explored ways to reduce contact time in family-based obesity programs while focusing on core behaviors, such as reducing sugary drinks and increasing fruit and vegetable consumption. In a recent study, her team tested a model with just 2.5 hours of contact over six months, alternating in-person and phone sessions to address transportation and accessibility challenges.

These changes come from working closely with community partners and understanding their needs. “It’s so important for us to hear our partners,” Raynor said. “Researchers might say, ‘This is the measure I need,’ but a community partner may say, ‘That’s not feasible.’”

Her work addresses systemic challenges like food insecurity, which affects many families her programs serve. In one project, she modified interventions for food-insecure households by focusing behavior-change goals solely on the child, reducing the burden on parents struggling to make dietary changes for the entire family. “Agility in addressing barriers without sacrificing rigor is key,” she said.

“As researchers, we need to really describe the site of delivery and the providers involved, so we build a more representative research base to understand how best to impact translation.”

Turning Knowledge Into Action

Raynor’s work goes beyond program delivery to creating systems that last. “It’s not just about creating new knowledge,” she said. “If your goal is to impact health or translate research, you must avoid creating barriers to implementation.” She highlighted the need to design programs that fit into existing payment models and training systems, allowing healthcare providers to use them without requiring extra resources.

Raynor remains hopeful despite the challenges. “There are many types of research questions,” she said. “What’s important is applying a high degree of rigor to address those questions while considering equity and real-world application.” Her work exemplifies a commitment to practical, impactful research that helps families access care and addresses health disparities.

At the end of the seminar, Raynor described her vision of a future where all families have the tools and support that they need to live healthier lives. “We need to ensure the research base we’re building is representative and actionable,” she said, calling researchers, practitioners, and communities to collaborate on turning proven strategies into lasting solutions.

By focusing on translation, Raynor is working to reduce childhood obesity and ensure all families have the opportunity for healthier lives.

For more on upcoming Forge AHEAD events and resources, visit our website. You can also watch the seminar recording here.

Embracing values-based self-care during the holidays

As the holiday season picks up, it’s easy to get caught in the hustle and bustle. In the November 13 webinar, “Values-based Self Care for the Holiday Season and Beyond,” Kaylee Crockett, Ph.D., Forge AHEAD scholar and assistant professor of Family and Community Medicine, shared invaluable insights on aligning self-care practices with personal values.

Key Takeaways from Dr. Crockett

Crockett emphasized that self-care goes beyond just relieving daily stresses. “Self-care includes all the things we do to live well, support health and well-being, and manage stress. We must consider self-care not only as an escape from the things that ail us, but as a resource to connect to what matters most to us (i.e., our values). Values include our deepest desires for how we want to treat ourselves, others, and the world around us. Unlike goals, values are things that we achieve, but they give us direction for our actions.”

Here are some of her key tips for incorporating values into your self-care routine:

Kaylee Crockett, Ph.D.

Forge AHEAD Center Scholar, Assistant Professor, Family and Community Medicine, UAB Heersink School of Medicine

Identify Your Values: Reflect on the type of person you want to be. Consider qualities you want to foster and how you wish to be perceived by others. Write down 4-5 words that resonate with you and describe what they mean to you.
Make Values Identification Social: Engage in discussions with family and friends about shared values. Support each other in staying accountable to what matters most.
Prioritize Values in Self-Care Activities:Use your values as a guide to cultivate activities for self-care.For more exercises on identifying your values, check out this resource here.

Moving Forward with Values-Based Self Care

By aligning your self-care practices with your values, you can enhance your well-being during the holiday season and beyond. Remember, self-care is not just about what you do to relax but about connecting with your deepest desires and living in a way that reflects them.

Let’s continue to prioritize our well-being by making values-based self-care a part of our daily lives.

For more about Crockett’s Forge AHEAD research, see this page.

Forge AHEAD Center welcomes new staff dedicated to advancing health equity

Meet Carol Agomo, Ph.D., MBA, MPH, program director in the Division of General Internal Medicine and Population Science at the University of Alabama at Birmingham (UAB) and director for community outreach and engagement in Alabama for Forge AHEAD.

With more than 15 years of experience in higher education and community engagement, Carol specializes in public health, health literacy, health equity, and reducing health disparities. She describes herself as a “community-engaged scholar-practitioner” and has developed numerous professional initiatives that strengthen partnerships between communities and academic institutions nationwide. Her research offers deep insights into the experiences of Community Health Workers in the Deep South, enriching her understanding of how local health infrastructure impacts outcomes for under-resourced communities.

Carol’s role at Forge AHEAD enables her to “bridge the gap between research and practice” in Alabama. She said, “I look forward to collaborating with community members and researchers to advance health equity knowledge and action.” Recognizing the urgent need for interventions that are culturally relevant, context-sensitive, and sustainable, Carol is committed to co-creating solutions for conditions like diabetes, obesity, and hypertension, which are prevalent in the Deep South. Her dedication to this work stems from her belief in education’s power to empower both individuals and communities—a foundation she sees as essential for lasting change.

Personally, Carol’s move from Chicago to the Deep South has fostered a deep connection with the region. She is raising her family here and feels driven to contribute to a healthier future for her community. Outside of work, Carol, a self-described “foodie,” enjoys exploring local restaurants and experimenting with new recipes at home. She balances her culinary interests with an active lifestyle, often participating in 5K runs, outdoor walks, and other fitness activities that help her “recharge and find fulfillment” in both her personal and professional commitments.

Visitors to Carol’s office might catch her “theme song of the day” playing softly in the background—a small reflection of her passion for music and its role in her life.

Carol’s enthusiasm, commitment to community, and holistic approach to health equity make her an invaluable addition to the Forge AHEAD team.

Carol Agomo, Ph.D., MBA, MPH

Director for Community Outreach and Engagement in Alabama, Forge AHEAD Center

Jared Ball, MPH, brings a strong background in public health and extensive experience in population health to his role as Program Evaluator for Forge AHEAD.

Jared earned both his BS in public health and MPH in health policy from UAB. His professional journey has included roles in Medicaid population health, where he supported individuals with chronic conditions, such as diabetes and hypertension, through transitional care services. Additionally, he served as a patient navigator in Birmingham’s public health community and led education and training efforts for the UAB Center for Palliative and Supportive Care. These experiences, along with his commitment to health equity, brought him to Forge AHEAD, where he is driven to make a positive impact.

In his current role, Jared sees an opportunity to “capture the work that has already been accomplished by Forge AHEAD and its members, while also exploring new directions for growth.” His work in program evaluation will be crucial for assessing Forge AHEAD’s progress, responding to emerging community needs, and strengthening the Center’s impact in addressing health disparities across the Deep South.

Jared’s dedication to public health is deeply personal. Reflecting on his father’s kidney transplant, he shares, “The treatment my dad received during his transplant when I was very young” profoundly influenced his motivation to contribute to health in the region. Growing up aware of the barriers facing many communities in the Deep South, Jared brings a deeply informed, empathetic perspective to his work with Forge AHEAD.

Outside of work, Jared is a dedicated family man with two children—a 4-year-old son and a 2-month-old daughter. He enjoys staying active through running, hiking, and building Lego sets, a hobby he hopes to share with his son. Jared also finds joy in exploring new places, watching sports, and spending quality time with family and friends.

Jared’s combination of professional expertise, personal connection to the region, and commitment to continuous improvement makes him a key asset to the Forge AHEAD team.

Jared Ball, MPH

Program Evaluator, Forge AHEAD Center

Rikki Tanner, Ph.D., is an epidemiologist specializing in cardiometabolic diseases and health disparities, now serving as a scientific writer with the Forge AHEAD Center.

With a strong foundation in public health research and a passion for reducing health disparities, Rikki is committed to advancing health equity through community collaboration and engagement. She is enthusiastic about her role in communicating Forge AHEAD’s research to the broader scientific community.

Growing up in the Deep South with parents who worked as a paramedic and a nurse, Rikki became keenly aware of pressing public health issues, including mental health stigma, racial disparities in healthcare, and limited access to services. Reflecting on her early experiences, she recalls a transformative college course, History of American Medicine, which deepened her understanding of the advancements in medical science and the persistent challenges marginalized communities face in accessing these benefits. “In parts of the Deep South and marginalized communities, we still have a long way to go to equitably distribute those gains,” she said. This awareness drives her commitment to making Forge AHEAD’s research impactful and accessible.

Outside of work, Rikki enjoys exploring historical fiction, practicing fiber crafts like crochet and embroidery, and watching British panel shows. An avid pub trivia enthusiast, she’s always up for testing her knowledge in a friendly challenge.

Rikki’s dedication to health equity, her background in public health, and her passion for storytelling make her an invaluable addition to the Forge AHEAD team. We’re excited to see how her unique perspective and skills will amplify our mission for a healthier, more equitable South.

Rikki Tanner, Ph.D.

Scientific Writer, Forge AHEAD Center

Locher emphasizes inclusive language in scientific research

“Language is the primary way we convey meaning and culture,” said Julie Locher, Ph.D., professor emerita at the University of Alabama at Birmingham, as she opened the Forge AHEAD seminar on the power of language in scientific communication in November at the University of Mississippi Medical Center.

Locher emphasized the responsibility of researchers to communicate with accuracy and respect, highlighting how word choice in research can shape relationships with communities and influence research outcomes. “When we use language that resonates and respects,” she added, “we open doors to trust and engagement that can transform the impact of our work.”

The seminar “Words Matter: Effective and Appropriate Scientific Communication” focused on practical strategies for using inclusive and respectful terminology, particularly in studies involving diverse communities.

A leading sociologist in health communication, Locher urged the audience to avoid outdated, problematic, or offensive terms, offering guidance on fostering cultural humility throughout the research process. “I approach every interaction with the assumption that no one intends to do harm,” Locher remarked, “but by becoming aware, we can choose words that respect and uplift others.”

Key takeaways included:

Person-first language: Locher advocated for using language that acknowledges people as individuals rather than defining them by their health conditions. For instance, instead of “diabetics,” researchers should refer to “people living with diabetes.” This shift reduces stigma and emphasizes the person over the condition.
Cultural humility: Locher described cultural humility as a “a lifelong process of self-reflection and self-critique”, adding that it helps mitigate bias. She encouraged researchers to reflect on their beliefs and assumptions, which can inadvertently influence their views of study populations. “Cultural humility isn’t something we check off a list; it’s a lifelong journey of understanding our own biases and assumptions so that we can meet others where they are.”

“Language is the primary way we convey meaning and culture.”

Locher emphasized the vital role of language in scientific research, stressing that using inclusive and respectful terminology fosters trust, strengthens community engagement, and ultimately enhances the impact of research.

Considerate demographic terminology: Locher emphasized the importance of using precise terms when describing diverse populations, noting, “The term ‘minority’ often generalizes experiences and can obscure individual identities. We should avoid broad terms like ‘minorities’ and instead be specific, referring directly to the racial or ethnic groups relevant to our studies.” This approach, she explained, “preserves distinctions and respects the diversity within each community.”
Inclusive descriptions for disability and socioeconomic status: In discussing language around disabilities and socioeconomic status, Locher stated, “Using phrases like ‘wheelchair-bound’ or ‘the homeless’ can unintentionally define individuals by their challenges rather than their humanity.” She recommended alternatives, such as “individuals who use a wheelchair” and “people without housing,” which emphasize personhood and avoid stigmatization. She reminded the audience, “Our choice of words should uplift and respect, not reduce people to their circumstances or needs.”

Locher concluded her presentation by encouraging scientists to see language as an evolving tool. “Words that are appropriate today may not be tomorrow,” she said, advocating for continuous learning and adaptation. She also shared resources for scientists wanting to stay updated on recommended language, including guidance from the National Institutes of Health and major health organizations.

The Forge AHEAD Center thanks Dr. Locher for thoughtfully equipping researchers with tools to communicate in ways that respect and accurately represent all individuals. Her seminar reinforces the importance of language in building trust, improving engagement, and advancing health equity across diverse populations.

For more on upcoming Forge AHEAD events and resources, visit our website. You can also watch the seminar recording here.

Schneider Worthington receives recognition for maternal nutrition research

Camille Schneider Worthington, Ph.D., a scholar at the Forge AHEAD Center, is leading groundbreaking research on maternal nutrition. Her project, “Use of Home-Delivered Meals to Manage Cardiometabolic Health during Pregnancy among Predominantly Black, Low-Income Women in Alabama,” aims to improve pregnancy outcomes by providing healthy meals to Medicaid-eligible women.

Schneider Worthington emphasizes the critical role of nutrition during pregnancy, noting that poor dietary choices can lead to serious health risks for both mothers and babies. With alarming statistics showing that 70% of pregnant women exceed recommended intakes of added sugars and sodium, her research focuses on innovative solutions to ensure access to nutritious foods.

By delivering ten free healthy meals each week to participating mothers, Schneider Worthington hopes to demonstrate that improved nutrition can lead to better maternal and infant health outcomes. “Healthy meal delivery can support healthier pregnancies, which supports healthier babies and ultimately healthier communities,” she states.

Read the full story here.

Camille Schneider- Worthington, Ph.D.

Assistant professor, Division of General Internal Medicine and Population Science, UAB Marnix E. Heersink School of Medicine

Learn more about Worthington.

Feeding Hope: How One Researcher is Transforming Lives in the South

When Christopher Long, Ph.D., steps up to the microphone at the Forge AHEAD Center seminar, there’s a quiet urgency in his voice. It’s the conviction of someone who’s spent years researching how food impacts health outcomes and development of chronic diseases with a focus on the people living in the Southern U.S.

For Long, a principal research scientist at the Center for Nutrition and Health Impact, this lecture goes beyond presenting information. It’s a call to action — one grounded in a simple yet powerful idea: food is more than just something to eat; it’s medicine. Real medicine.

“I’m a psychologist,” he begins with a grin, his tone light. “Why the heck is a psychologist talking about food as medicine?”

It’s an unexpected opening, and Long knows it. Behind his friendly approach lies a more serious message: people in the South are dying — years earlier than they should be. The problem isn’t only about lacking healthcare; it’s about limited access to the food they need to survive.

A Personal Mission

Long’s journey didn’t begin in a lab or a hospital. It began in the early hours, and often out the door lines, where community members were waiting for the food pantry to open. Back in 2015, he found himself in food pantries across Arkansas, clipboard in hand, evaluating the quality of the food people were receiving. Through his work, Long realized the food itself was just one piece of a much bigger problem.

These were people whose needs weren’t being met by the overwhelmed healthcare system, people for whom a single bag of food might be all they had for days.

Long could see the cycle — poverty, illness, hunger — and he knew something had to change. Instead of simply treating patients, he wondered: why not feed them too?

From Local Roots to National Impact

“Walmart will bring groceries to my front porch,” Long says with a laugh, recalling the idea that sparked his research. “What if we started bringing groceries to food-insecure households? Not very creative, but people wanted to fund that research.”

“The problem isn’t only about lacking healthcare; it’s about lacking access to the food they need to survive.”

Dr. Long emphasizes that access to healthy food is as crucial as access to medical care, especially in food deserts where fresh produce is scarce.

For six years, Long’s team studied the impact of delivering groceries paired with disease-management education. The results spoke for themselves. People welcomed the food, grateful to avoid food pantry lines, and, more importantly, they began managing their chronic conditions better.

By 2023, Long had established himself as a leader in Arkansas. But as the national Food is Medicine movement began picking up steam, he saw an opportunity to contribute on a larger scale. Across the country, healthcare systems and food programs were partnering to deliver healthy food to those who needed it most.

“This thing is really taking off,” Long recalls thinking. “There are national opportunities to change how we connect healthcare and communities with food systems.”

In 2023, Long joined the Center for Nutrition and Health Impact. His work now focuses on evaluating partnerships between food and healthcare systems at every level — local, regional, and national — to better serve food-insecure populations.

“I spend five days a week, 40 hours a week, talking to folks about partnerships between food systems and healthcare systems like clinics, hospitals, and even Medicaid and insurance payers,” Long says. “How can we understand the effectiveness of these partnerships? That’s what I do every day.”

For the families he works with, these partnerships are a lifeline. But for Long, they’re much more — they’re a way to chip away at the deep-rooted disparities that have plagued the Southern U.S. for too long.

Food, Poverty, and Disparity in the South

The numbers are staggering. In Mississippi, nearly one in five households is food insecure. Louisiana, Arkansas, and Alabama are close behind. These states also lead the nation in obesity, diabetes, and heart disease rates.

“We are dying faster,” Long says bluntly, his tone shifting with urgency. “You live in Mississippi? You should expect to live ten years less than someone in Hawaii.”

The statistics are chilling, but they’re not what drives Long. It’s the faces behind the numbers — the mothers stretching a bag of food across three days, elderly patients splitting medication costs with groceries, children eating whatever their parents can find.

And it’s not just about hunger. Food insecurity in the South is intricately tied to race and socioeconomic status. Black and Hispanic communities are hit hardest, living in neighborhoods where fresh produce is scarce and affordable groceries are a luxury. These “food deserts” become breeding grounds for chronic diseases, creating a cycle that’s tough to break.

“Food is Medicine directly addresses two of these systems,” Long says, pointing to healthcare and food access. “The reason why our states and our neighbors are facing these disparities in food insecurity and lifespan — it’s rooted in our neighborhoods, our communities.”

A Movement for Change

Long knows that solving these issues will take more than just one person or program. But he believes that the South, with its strong sense of community, can rise to the challenge. He points to the faith-based organizations, small businesses, and agricultural communities already stepping up, working alongside him to build local food systems and distribute healthy meals.

“It’s not easy,” Long admits. “But it’s necessary. Our communities have the heart. They have the passion. They just need the support.”

The fight is long, but the wins are already coming. Data from his programs show that those receiving medically tailored meals and groceries are eating better and managing their diseases more effectively. Fewer hospital readmissions, fewer emergency room visits, better control of chronic conditions. The evidence is building, catching the attention of policymakers and healthcare providers alike.

“In Mississippi, nearly one in five households is food insecure.”

Southern states face some of the highest rates of food insecurity and chronic diseases like diabetes, heart disease, and obesity.

Source

“We are dying faster. You live in Mississippi? You should expect to live ten years less than someone in Hawaii.”

Source

But for Long, the real victory will come when programs like his are no longer needed — when food insecurity is no longer part of life in the South.

The Why Behind the Work

As Long finishes his presentation, he scans the room one last time. The weight of the situation is clear to everyone listening. He knows that Food is Medicine is more than a project or a catchy slogan. It’s a lifeline for millions of people in the South, trapped in a web of poverty, illness, and hunger.

“I’m trying to sell you on doing this research,” he says, his voice softening. “But really, I’m trying to show you the power of what we can do together.”

For Long, this work is all about people. It’s about dignity. It’s about giving people the most basic of human rights — the right to eat, the right to live.

Because in the end, food isn’t just food. It’s medicine. And in the South, it might just be the most powerful medicine of all.

View the recording of the September seminar here.

Our Scholars’ stories: Caldwell bridges the gap of genetics and nutrition to enhance health outcomes among African American communities in Baton Rouge

Disparities in health outcomes for African American adults involve both biological and social health determinants. Jennifer Caldwell, Ph.D., a researcher at Pennington Biomedical Research Center, is exploring the combined influence of a biological determinant (a person’s genes), and a social health determinant (food insecurity) to understand the impact on African American adults’ health outcomes in Baton Rouge, Louisiana. Genetics are known to play a role in 9 of 10 leading causes of death in the U.S. including heart disease, stroke, and diabetes. North Baton Rouge is a predominantly made up of African American households where 20-30% of households are food insecure compared to only 8-10% of households in South Baton Rouge.

Inspired by the North Baton Rouge community, Caldwell is researching how food insecurity affects the body’s ability to heal. This community, which lacks grocery stores and fresh produce and relies solely on convenience stores, is classified as a “food desert.”

Additionally, she aims to start a conversation with African American communities in this area about how genes influence their health.

“I wanted an intervention that would close that knowledge gap,” she says. “We titled the project Linking GAINS; it aims to combine the analyses of genetics and nutrition to enhance health behaviors among participants undergoing a behavioral intervention.”

Linking GAINS focuses on community engagement to share information on how genetics and health behaviors impact a person’s health. Caldwell’s goal is for residents in the African American communities in North Baton Rouge to understand their genetic makeup and use that knowledge to make informed health decisions. By bridging the gap between genetics and nutrition, Caldwell hopes to foster healthier behaviors and improve overall health outcomes in these underserved areas.

Jennifer Caldwell, PhD, MPH

Assistant Professor, Public Health Genomics and Health Equity Laboratory, Pennington Biomedical Research Center

Learn more about Caldwell.

A history of inequity in Louisiana

Longstanding geographical segregation issues contribute to health disparities in Louisiana. “This initiative is crucial due to the historical segregation within Baton Rouge, Louisiana, where disparities exist between the south and north sides of the city,” Caldwell explains.

“In the past, African American communities were primarily located near industrial plants or railroad tracks on the north side. Currently, the southern side is characterized by institutions like Louisiana State University (LSU), situated close to the medical corridor and areas with better access to fresh produce and economic development.”

Did you know?

A food desert is a community with limited resources and fresh produce

As a result, there remains a significant social and economic gap in the city that is linked to racial issues from Louisiana’s historical background and antebellum past, Caldwell says.

The disparity lies in the city’s economic systems,social systems and structures, and transportation is a significant contributing factor to these discrepancies.

“One critical aspect of the disparity between residents living on the north and south sides of Baton Rouge, particularly in the area near Louisiana State University, is the issue of food deserts and its impact on health equity, compounded by transportation challenges.”

As a result, there remains a significant social and economic gap in the city that is linked to racial issues from Louisiana’s historical background and antebellum past, Caldwell says.

The disparity lies in the city’s economic systems,social systems and structures, and transportation is a significant contributing factor to these discrepancies.

Caldwell’s ‘why’

Caldwell says she is very motivated to tailor her program to the community. “As a young professor, I am very interested in genetics, and it has been one of my top priorities. Engagement and health literacy is another one of my top priorities.”

“I realized if I am going to build this lab, I have to build trust with the community and empower them to build their health literacy. We wanted to build a project that could meet the need of underdeveloped areas in Baton Rouge. North has no actual grocery stores or medical corridors.”

Engaging African American community members

To build trust and meet the community’s needs, Caldwell and her team are focused on maximizing recruitment efforts and engaging a diverse range of often marginalized participants.

“Our collaboration includes the Southern University Agriculture and Extension Center alongside various community outreach partners, organizations, and local churches. By situating the project in North Baton Rouge, we aim to eliminate transportation barriers and ensure accessibility for the community members.”

Keeping it local shows Caldwell’s determination to build a program in partnership with the community, making it easy and welcoming for people to join. “We have made sure to incorporate things that are culturally centered, like cooking classes,” she says, “Louisiana has such a rich culture and food culture.”

The study: Enhance health behaviors through community

Throughout the Linking GAINS study, participants will learn the impact that genetic factors that contribute to developing chronic diseases.

They will be able to understand and effectively communicate their genetic results to their primary care providers. Additionally, participants will receive guidance on adopting healthier lifestyles and modifying behaviors to improve overall well-being.

“We are establishing clinic groups within the community,” Caldwell says, “And meetings are to be held at a local church.” It is important to Caldwell that participants feel safe and that trust is built in a trustworthy space during the study.

Did you know?

North Baton Rouge faces more health challenges than the south due to historical segregation.

Participant-centered approach

Linking GAINS intervention focuses on the participants, giving them choices and flexibility to keep them engaged. “Participants will benefit from a comprehensive 14-week behavioral intervention program, coupled with the groundbreaking inclusion of genetic testing,” Caldwell explains.

“This unique initiative offers participants the opportunity to receive their genetic results and engage in one-on-one sessions with a genetic counselor for a detailed review of these findings.”

Early on, Caldwell says she spoke with a therapist about using interventions in the project. The therapist gave great advice on group counseling sessions, especially about myths and stress management. Based on the therapist’s advice, Caldwell says they have included group counseling sessions that will cover these topics.

Group sessions will help participants feel engaged with their peers and keep them from feeling alone or singled out.
The groups will discuss health disparities, nutrition, and healthy cooking, as well as what foods to buy and how to cook fresh produce. Sessions on heart health and similar topics will also be held. The interventions focus on lifestyle and behavior changes and are tailored to the community’s needs.

Caldwell explains that community engagement is a big challenge in clinical research with African American communities. By making this project community-based and a group effort, they hope to get people involved and keep them engaged.
Interventions include health behavior programs and weekly sessions, not just on weekends. There will also be weekly physical activity programs.

Making it easy to participate

Along with situating the study in the heart of the community, Caldwell wants to ensure participants have time to join. “The project is designed to take place on weekdays after 5:30 p.m., providing flexibility for participants so they do not have to worry about leaving work early.”

To that end, Caldwell wants to ensure participants feel valued for their time. “I understand that committing to research is challenging. For this reason, we compensate participants for their time, whether they need to leave work or make other adjustments. One of the key aspects of this project is its timing. We aim to accommodate participants’ schedules to ensure they do not have to take time off work to engage in research.”

Participation will involve individuals from two different communities. “This demographic is crucial for us to understand the impact of our interventions on a diverse group. We have collaborated with non-profits that possess valuable insights about the communities we are studying. Their contributions have been instrumental in shaping the project.”

Caldwell’s project, Linking GAINS, addresses crucial health disparities at the intersection of genetics and nutrition in North Baton Rouge. By focusing on empowering African American communities to learn about the combined impact of how genetics and food insecurity influences health outcomes, this intervention aims to empower community members to make informed health decisions and improve long-term health outcomes. By focusing on community engagement and culturally relevant intervention, Caldwell’s work exemplifies a holistic approach to advancing health equity and can serve as a model for similar efforts nationwide.

Our scholars’ stories: Andrabi seeks to fill a gap in care for stroke survivors in Alabama’s Black Belt

African American communities have a higher prevalence of both hypertension and stroke than any other ethnicity. Alabama is among one of 11 states makes up part of the region known as the Stroke Belt where death from stroke is from 2 to 4 times greater than other states.

“Stroke is especially prominent among African American adults living in the Black Belt of rural Alabama,” says Mudasir Andrabi, Ph.D., Forge AHEAD Center scholar.

Andrabi, who is researching the needs and preferences of individuals living in rural Alabama on their post-stroke life management and blood pressure management.

A gap in post-stroke care

Data shows that seventy percent of stroke survivors are discharged from health care facilities, out of which, 40% are released without any community-based services.

“These rates worsen in rural areas due to the socio-demographics of persons living in these areas, including unavailability of services, unaffordable care, lack of transportation, and low socioeconomic status,” says Andrabi, who is an assistant professor at the University of Alabama’s Capstone College of Nursing.

“Lack of health services makes post-stroke self-management for these individuals more challenging, leading to hypertension and recurrence of stroke.”

Mudasir Andrabi, Ph.D.

Assistant Professor, Capstone College of Nursing, University of Alabama

Learn more about Andrabi.

“Stroke is especially prominent among African American adults living in the Black Belt of rural Alabama.”

Andrabi’s research study aims to address the critical gaps in managing stroke-related challenges among African American individuals aged 50 and above who have a documented diagnosis of chronic stroke and high blood pressure condition with mild to moderate disability. Approximately 15% to 20% of individuals will experience a stroke recurrence. According to a recent study, risk of stroke recurrence at 3 years is higher for Black individuals (17.4%) compared with non-Black individuals (14.7%) in the U.S.

With the right tools, self-management interventions can prevent 80% of stroke recurrences.

Andrabi’s why

During her previous work with African American individuals living in rural counties of Alabama, Andrabi says the community key leaders and participants “anecdotally mentioned a lack of services for individuals who have stroke and high blood pressure.”

Did you know?

African American communities have a higher prevalence of both hypertension and stroke than any other ethnicity.

They were reported to have poor management for high blood pressure and engaged in limited preventive behaviors like physical activity and adherence to the treatment.

“Moreover, there is minimal to no rehabilitation services available to these individuals’ post-stroke due to unaffordable co-pays and lack of insurance.”

Due to scarce resources, these individuals have poorer outcomes, including poor body balance, avoidance of physical activity due to fear of falling, and lack of knowledge and skills for alternate other suitable physical activities. Andrabi shared that they typically become dependent on family for their activities of daily living. They also seem to have poor control over their blood pressure in general.

“Since high blood pressure is a major risk factor for stroke, these individuals often end up having a recurrence of stroke. Therefore, it was found to be a priority to help them manage their high blood pressure and post-stroke life as much as possible.”

Andrabi says she wants to empower individuals post-stroke to engage in health behaviors to reduce likelihood of stroke recurrence including reducing sedentary activities, appropriate exercise and medication adherence.

Interventions that prevent stroke recurrence and save lives

Interventions help stroke patients manage and improve their high blood pressure symptoms, physical and emotional stress, taking medication consistently, activities of daily living, and quality of life.

However, intervention strategies are not widely tested among older African American stroke survivors for the management of their post-stroke life and their high blood pressure management.

“We aim to develop a need-based intervention that will be tailored to the social determinants of health and culture of the African American aging populations of rural Alabama,” explains Andrabi.

The group plans to utilize basic technology and other resources available in Alabama’s rural counties. The intervention will be minimally expensive and can be delivered using a minimum health workforce.

Creating a program unique to the community

“Our study involves the community’s key members throughout the entire study including the needs assessment, intervention development, and delivery of intervention.”

To Andrabi’s knowledge, this study is a unique and innovative culturally tailored intervention that would be accessible and affordable for these underserved populations in Alabama at high risk for stroke recurrence.

Developing a cost-effective and accessible self-management program will aim to overcome barriers to health care accessibility and increase equity in the distribution of health care services within these geographically disadvantaged areas.

The overall study focuses on improving stroke survivors to manage their high blood pressure and challenges related to their post-stroke life to improve their health outcomes and quality of life.

Andrabi’s post-stroke self-management program

The post-stroke self-management program includes teaching important information via teleconferences, creating a unique exercise plan based on the severity of the stroke survivor’s disability, sending reminders through texts or calls depending on participant preference, and problem solve to address barriers that may prevent them from engaging in preventive health behaviors.

Andrabi says the main research question is to assess the needs of stroke survivors and develop the best intervention to address those needs. Components will be tailored to the specific needs and preferences of participants, such as:

Delivery of education to build learning related to management of high blood pressure and post-stroke life
Accessibility of the program in participants’ homes to overcome their lack of transportation and long distance from the health care facilities
Simplicity and the social relevance of the educational content
Reminders for educational sessions for their ease of understanding, especially among elderly individuals

Did you know?

Alabama is part of the Stroke Belt, where death is 2-4 times higher than other states.

Use of existing resources in counties, such as existing social groups, existing teleconference system, local produce, community halls, or church halls for indoor physical activity during unfavorable weather

All these components focus on overcoming the barriers of lack of insurance and unaffordability of care.

Testing a post-stroke self-management program

Ultimately, the goal of this project is to assess the feasibility, acceptability, and effectiveness of a newly developed intervention for African American stroke survivors in rural Alabama.
In addition, the study involves the community members in every phase, building their capacity to run the program independently and enabling them to control their health.

Presley Visits Primary Care Practices in the Black Belt

Caroline Presley, M.D., MPH, Forge AHEAD project principal investigator, along with Macie Craft, RN, MSN, program manager in the Division of Preventive Medicine at UAB, recently visited primary care practices in the Black Belt area as part of Presley’s project on remotely-delivered Mindfulness-Based Diabetes Education for rural adults with uncontrolled diabetes and elevated distress.

Marion Health Center

Whatley Health Services Staff in Eutaw, AL

Whatley Health Services, Inc. in Eutaw, AL

Edmund Pettus Bridge in Selma, AL

Macie Craft, RN, and Caroline Presley, M.D.

Mural in Eutaw, AL

Presley’s Research on Emotional Distress and Diabetes Management Highlighted at the ADA Scientific Sessions

At the 84th Scientific Session of the American Diabetes Association (ADA), Caroline Presley, M.D., project principal investigator at Forge AHEAD and assistant professor in Preventive Medicine at the University of Alabama at Birmingham, delivered a presentation titled “Emotional Distress and Insulin Initiation in the GRADE Trial.” Her presentation showcased findings from the Emotional Distress Substudy (EDS) of the GRADE (Glycemia Reduction Approaches in Diabetes) trial.

Key Findings from Presley’s GRADE EDS analyses:

Long-Term Study: Researchers followed 1,739 participants with Type 2 Diabetes (T2DM) over three years, checking in with them every six months. During the three-year follow-up, 525 participants were expected to start long-acting insulin and 325 participants were expected to start rapid-acting insulin after reaching Hemoglobin A1c levels of higher than 7.5%.
Insulin initiation was lower than expected: One-third of participants did not start long-acting insulin and two-thirds of participants did not start rapid-acting insulin.
Emotional Distress was not associated with insulin initiation: The study found that emotional distress, including feelings of depression and specific worries about diabetes, was not related to a person’s decision about whether to start insulin.
Support is Key: Other strategies are needed to support individuals who need to start insulin to achieve better blood glucose control; these may include demonstrations and examples about insulin use, discussion about benefits of insulin therapy, and collaborative decision-making.

Presley’s research is a collaborative effort that includes contributions from Forge AHEAD MPI Andrea L. Cherrington, M.D., MPH, a renowned expert in diabetes care. Their joint work showcases the collaborative nature of the Forge AHEAD Center, bringing together diverse expertise to tackle complex health issues.

Richard R. Rubin Lecture and Award

Presley’s presentation was part of the prestigious Richard R. Rubin Lecture. During the ADA conference, Paula M. Trief, Ph.D., received the 2024 Richard R. Rubin Award for her outstanding contributions to understanding the behavioral aspects of diabetes.

Presley’s Work at Forge AHEAD

In addition to her impactful presentation at the ADA Scientific Sessions, Presley is leading a core FAC project. Her project, “Remotely-delivered Mindfulness-Based Diabetes Education for Rural Adults with Uncontrolled Diabetes and Elevated Distress,” aims to test the feasibility and acceptability of an integrated Mindfulness-Based Stress Reduction (MBSR) and Diabetes Self-Management Education (DSME) program.

MBSR has been adapted to focus conditions, including hypertension and prediabetes, with a focus on relating mindfulness to specific behaviors or behavior change activities. However, few research studies have focused on rural populations with limited access to DSME. By combining MBSR and DSME, the project aims to help participants manage both their diabetes and their stress, improving their overall health and well-being.

Caroline Presley, M.D., MPH

Assistant Professor, Division of Preventive Medicine, UAB Heersink School of Medicine

Learn more about Presley.

Type 2 Diabetes and Emotional Distress

Adults living with type 2 diabetes who are experiencing emotional distress, including feelings of depression and specific worries about diabetes, may experience poor health outcomes compared to those not experiencing emotional distress.
Source

Presley presenting at the ADA Scientific Sessions.

Project Highlights:

Primary Aim: To evaluate how well this new approach works for rural Black adults with Type 2 Diabetes who also experience high levels of distress.
Study Locations: The program is being tested at Federally Qualified Health Centers in Alabama’s Black Belt region.
Participants: The study will enroll 80 Black adults with Type 2 Diabetes, high blood sugar levels (hemoglobin A1c of 8.0% or higher), and high levels of stress related to diabetes.
Community Partners: The Alabama Primary Health Care Association is helping to support and implement the study.
Outcome Measures: Researchers are looking at how practical and acceptable the program is, with evaluations at the beginning and six months into the study.

The Forge AHEAD Center is at the forefront of advancing health equity through innovative research and community engagement. Presley’s work at the ADA Scientific Sessions and her ongoing projects exemplify our commitment to improving health outcomes in underserved communities.

To learn more Presley’s impactful research on remotely-delivered diabetes education and support, and to get involved, visit her project page here. Together, we can forge ahead towards a healthier, more equitable future.

What are MBSR and DSME?

Mindfulness-Based Stress Reduction (MBSR): This program teaches mindfulness meditation, helping people focus on the present moment. It reduces stress by making them more aware of their thoughts and feelings without getting overwhelmed. Source
Diabetes Self-Management Education (DSME): This ongoing program helps people with diabetes learn how to take care of themselves. It teaches important skills like checking blood sugar, eating healthy, staying active, taking medicine the right way, and avoiding problems. Source

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Presley Visits Primary Care Practices in the Black Belt

Marion Health Center

Whatley Health Services Staff in Eutaw, AL

Whatley Health Services, Inc. in Eutaw, AL

Edmund Pettus Bridge in Selma, AL

Macie Craft, RN, and Caroline Presley, M.D.

Mural in Eutaw, AL

Presley’s Research on Emotional Distress and Diabetes Management Highlighted at the ADA Scientific Sessions

Caroline Presley, M.D., MPH

Type 2 Diabetes and Emotional Distress

What are MBSR and DSME?