by Jeanie Davis
On this weekday afternoon, a handful of girls is sweating it out at an Atlanta health club, right along with the 30-something crowd. Despite an hour-long aerobics session she just finished, 11-year-old Joycelyn Kelly, the youngest of the group, has energy to burn on the rowing machine, bicycle, and a stair climber. The visit by Kelly and her friends to this upscale health club is a special field trip in a six-month research project in which they are enr olled. Called Go Girls, the study seeks to motivate adolescents like Kelly, who are overweight, to make healthy changes.
Led by principal investigator Ken Resnicow, associate professor of behavioral sciences and health education, Go Girls is one of several efforts under way at the Rollins School of Public Health designed to test behavioral strategies not only for teens b ut also adults. While the message is an old one--eat healthier and exercise more--researchers are looking for new ways to drive it home.
The Go Girls obesity prevention study, for example, addresses the well-known fact that overweight adolescents are at greater risk for many chronic diseases as they grow older. However, the project uses motivational strategies that are particularly tail ored to teens. "We want to develop culturally appropriate interventions that fit a population," says Resnicow. "When you're trying to change long-standing cultural attitudes, you have to get the community involved right from the start."
European American girls often fall prey to TV and advertising messages that "thin is good," which sometimes leads to anorexia and bulimia, Resnicow says. African-American girls, by contrast, are socialized to think that "big" is OK.
"We've known for years that black adolescents and adults hold a different standard of beauty than their white counterparts," says Resnicow. "Being overweight is considered attractive, and in some ways, black teens have a more positive body image than m any white girls. On the other hand, they are more at risk for obesity and the health problems that follow."
Go Girls--a collaboration of the school, the National Foundation for the Centers for Disease Control and Prevention (CDC), and the International Life Science Institute--is a testing ground for behavioral strategies. "So little is known about what healt h promotion strategies work with this age group," Resnicow says. "Even less is known about reaching innercity, black adolescents."
Typically, the Go Girls meet on their home turf, in one of Atlanta's federally funded housing developments. "We believe it is important to take our program to the community rather than have the members of community have to come to us," Resnicow says. So far, four housing developments are participating in Go Girls, with ten to 14 girls enrolled in each neighborhood. As many as three additional sites may be added to the study.
"The communities have welcomed us with open arms," says Resnicow. "They've helped us recruit, paving the way for staff to go into the girls' homes to talk with parents. That has been a key factor in the program's success."
The girls participating in the study range in age from 11 to 17. While some are slightly overweight, others weigh in from 50 to 100 pounds heavier than recommended for their age and height.
To participate in the study, girls must sign a contract, agreeing to attend the after-school, twice-a-week meetings regularly, to be well-mannered, and to make an effort to change eating and exercise habits. They also undergo dietary and behavioral hea lth assessments, physiologic measurements (including skin fold measurements for body fat and cholesterol readings), treadmill tests, and evaluations that examine behaviors and attitudes. "We emphasize behavioral change, not weight loss," says project coor dinator Anissa Davis. "We don't want girls to get tied to the scales. Self-esteem is a big component."
Self-esteem is a major component of the Go Girls study.
The group of girls at Englewood Manor is nearly halfway through the Go Girls program. So far, they've studied the food pyramid, had lessons on moderate eating, and learned to make low-fat substitutions for high-calorie foods. They have tried tandoori chicken, Thai food, even star fruit. "The fear of new foods is one of the things we're fighting," explains Amy Lazarus Yaroch, who also coordinates Go Girls. "We hear a lot of 'eeeeeeeyooooo' and 'what is that,' but they loved the star fruit. They've come a long way."
For this age group, nutrition lessons have to be creative--and graphic. By scooping shortening, these girls see the fat equivalent of their favorite foods. They've counted every chip in a bag and then added up the calories.
Gourmet chef Damon Sheppard, who also grew up in a housing development, not only teaches the girls how to make low-fat versions of meals they like but also serves as a role model, say the Go Girls coordinators. "He gets them involved in the preparation s, and he teaches them how to cook healthy gourmet meals on a budget, an important consideration for these girls," Davis says.
Exercise routines keep the Go Girls moving. They enjoy funk-aerobics, a dance routine choreographed to hip-hop music, along with Afrobics, movements based on traditional African and Caribbean dances that are set to drum music.
Does the Go Girls program make a difference? This study is incomplete, but one participant, 16-year-old Crystal Mahaffey, thinks so. "I pull the fat off the pork chops now," Mahaffey proudly reports. "I don't fry them in all that grease any more." Her much-beloved fried chicken is virtually a thing of the past. Exercise? "I don't have time for much," Mahaffey says. But she's making an effort. Every day, to and from school, she gets off the bus a few blocks early. "I like to walk a bit," she says. "I feel good about myself."
The Eat for Life study offers health fairs after church on Sundays, where congregants can receive serum cholesterol tests and eat a meal drawn from the program's cookbook.
A church member has her blood pressure checked at a recent health fair.
But how to reach black adults? Resnicow's four-year, randomized study called Eat for Life tackles just that population. Funded by the National Cancer Institute, the project seeks to prevent disease in Afri can Americans by improving their nutrition--specifically by increasing their consumption of fruits and vegetables.
Again, as in the Go Girls study, Eat for Life takes its message to the community, this time through the church. During the next four years, some 15 church congregations in the Atlanta area will participate in the research study. Working through churche s is a good place to carry out such an effort, says Resnicow, who has successfully carried out a similar partially church-based smoking-cessation program in Harlem.
Funded by the National Cancer Institute, Harlem Health Connections enrolled close to 2,000 participants through churches and other community organizations. The program was successful in reaching many people, according to Resnicow. However, on that part icular project, the church population had one drawback: churchgoers tended to be nonsmokers. With the Eat for Life study, however, most of the participants the researchers will encounter can benefit from a healthier approach to Sunday dinner-on-the-ground s.
"Black churches have a long tradition of offering blood pressure screenings and other health promotion programs to their members," Resnicow says. Therefore, the infrastructure for health promotion is already in place. "Now we just need to convince them that healthful eating is a role of the church," he adds.
The coordinator of Eat for Life is Alice Jackson, herself a minister and veteran community organizer. In other words, she knows her audience. Good-tasting food is key, she says. To cook up new versions appealing to congregants, she first collected trad itional Southern recipes from church members, then had a dietitian transform the recipes into heart-healthy variations.
The cookbook the Eat for Life staff created bears blessings from several ministers and is part of a well-packaged educational supplement that includes a short video that explains Eat for Life and inspires participation. "We've learned the importance of production values," says Resnicow. "A program's image has much to do with its acceptance."
Motivational telephone calls, made by the project director Debbie Wallace and a staff of registered dieticians, are another important component of the program. "The Harlem project showed that those phone calls were instrumental in keeping people involv ed," Resnicow says.
Health fairs are the centerpiece of the Eat for Life project. In addition to testing serum cholesterol levels at these fairs, samples for carotenoid levels will be tested in a CDC laboratory, marking the first time such tests have been used in a large- scale, community-based intervention. "If we can actually show changes in carotenoid levels," Resnicow says, "we'll have real, measurable data of behavioral changes about nutrition. The potential of this test is tremendous because, unlike self-reporting qu estionnaires where participants might be biased to overreport their answers, we'll get more objective data."
Sensitive to lingering negative attitudes about public health research such as the infamous Tuskegee Project, Jackson has spent much time in meetings with pastors to receive their endorsements. "We asked pastors to explain our program in their Sunday m orning service," she says, "to let the congregation understand the commitment it's making to the study."
According to Jackson, the health fairs held after worship are "jubilant events." People enjoy a full meal taken from the Eat for Life cookbook, and they've been frank on their appraisals of the recipes. "Some they like, some they don't," Jackson says, laughing.
In addition to health screenings, a physician is on-site to provide counseling, and Chef Sheppard, who also cooks for the Go Girls, presents heart-healthy food alternatives. On the way out, each person receives an armload of fresh fruits and vegetables to take home.
Through community-based interventions that involve the community members themselves, researchers hope to hit on the behavioral strategies to make for a healthier population. However, nutrition and physical activity are areas that have been understudied in the African-American community, Resnicow says. "We're trying to develop programs that can be disseminated and used as models for wide-scale interventions. But for now, we are concerned with efficacy. First, we have to figure out what works."
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