UAB Forges Healthy Bonds
By Charles Buchanan
It’s known worldwide as the home of the samba, but in recent years Brazil has been showing off some bold new moves. South America’s biggest country now has one of the world’s largest economies and it is stepping further into the spotlight with increased exports and investments.
The nation’s ascent to the economic stratosphere is being helped by puffs of smoke. As the global tobacco industry has shifted to developing countries, Brazil has become the world’s second largest producer of tobacco. In the south of the country, where most tobacco farms are located, small growers are often “totally dependent” on tobacco companies that co-sign their loans, says UAB preventive medicine expert Isabel Scarinci, Ph.D. In this atmosphere, tobacco use is prevalent, she explains, and girls are taking up the habit in particularly high numbers.Scarinci, a native of Brazil, says it can be hard to convince women there of the dangers of smoking and other risky health behaviors; it doesn’t help that tobacco-company advertisements portray smoking as a form of empowerment. But Scarinci’s work in Birmingham and in Alabama’s Black Belt has taught her effective methods for reaching out to at-risk populations. Now she is leading two major UAB research initiatives in her home state of Parana, and amid the farmland of that southern region she is finding fertile ground for more partnerships in research and education.
To address the factors fueling Brazil’s smoking problem, UAB has partnered with the Federal University of Parana, Pontifical Catholic University of Parana, Brazil’s national cancer institute, the state health department, and municipal health authorities to adapt some ideas with Alabama roots.
At UAB, Scarinci coordinates several successful initiatives to promote healthy lifestyles and disease prevention among Latino immigrants and African Americans in underserved rural communities. In these programs, Scarinci and her colleagues identify the natural leaders in each community—from soccer coaches and hairstylists to the heads of church groups—and teach them to share crucial health information with their families, friends, and neighbors. These leaders, or “community health advisors” (CHAs), essentially direct the programs, providing input on the community’s needs and developing solutions that best fit them.
In Parana, “we’re establishing a network with smokers, former smokers, youth, education and health leaders, media representatives—all of the segments of society in the state,” Scarinci explains. A key element in both Alabama and Brazil is the empowerment of women, she says. “We try to counterbalance the image the tobacco industry is using of independent women who smoke and engage women as catalysts of change.”
Members of the network “decide what needs to be done—if we should focus on smoking prevention, cessation, or both,” Scarinci adds. “We as researchers become consultants, in a way. For example, if they say they want to do a media campaign, we ask how its effect will be measured. It’s research in collaboration with the community.”
It’s also research that has attracted the attention of the U.S. National Institutes of Health. Scarinci’s initiative was one of only 11 international tobacco-control projects to receive NIH funding last year, winning a five-year, $1.5-million grant.
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Scarinci’s second project in Brazil focuses on the city of Curitiba, Parana’s capital, and targets another vital issue: encouraging underserved women to get screened for breast cancer. Though Brazil’s national health system offers every resident access to care, “more than half of women 40 and older are not getting their mammograms,” Scarinci says. “It’s not a priority for them. So they don’t go to their appointment, they need to reschedule, and they’re at the end of the line.”
Isabel Scarinci discusses potential partnerships with a representative of Pontifica Universidade Catolica do Parana. In addition to research collaborations, the connection may lead to faculty and student exchanges.
The screening study, which has received $300,000 in funding from Susan G. Komen for the Cure, is in its early stages. Working with their Brazilian partners, UAB researchers are identifying key issues by gathering three sets of focus groups: women who have had mammograms, women who have never had the tests, and breast cancer patients. As their next step, researchers will present those findings to the community—and following the CHA model, get direction from the community on solutions that will encourage women to take advantage of the life-saving screenings.
CHAs may prove to be especially influential in Brazil, notes Scarinci. For one thing, community is enormously important in Brazilian culture. “They rely on each other; they trust each other rather than institutions,” Scarinci says. “The motivation to have a mammogram is to be a good example for other women. To do it for yourself is selfish. To do it for others, as a sacrifice, is a motivator.”
In addition, the CHA model is treading somewhat familiar ground in Brazil, where the underserved populations of Parana share similarities with those of Alabama. “A common denominator is poverty,” Scarinci says. “And if you look at the barriers for screening, they are very similar to those for Latinos in Birmingham and African Americans in the Black Belt. It’s a fear of results—fear that the doctor will find something.”
Bom Dia Birmingham
Scarinci’s two research projects may help build stronger links between Birmingham and Brazil, including faculty exchanges and study abroad opportunities for UAB students. The growing collaboration has attracted the attention of Brazil’s new consul general in Atlanta, Adalnio Senna Ganem, who discussed potential partnerships—and their economic benefits—with UAB president Carol Garrison, Ph.D., on his first visit to Birmingham last October.
“We’re not just going there, doing an isolated project, and leaving,” Scarinci says. “We are training the next generation and building a capacity for research.” This is especially important to collaborating Brazilian universities, which traditionally emphasize teaching over field study. Scarinci and her UAB colleagues already serve as mentors for junior faculty in Brazil, sharing information about research design and methodologies through frequent visits and videoconferences. Training those young investigators and cultivating their interest in research will enable them to earn their own funding and eventually launch their own health-care initiatives, Scarinci says.
Likewise, UAB scientists can learn a lot from the Brazilian experience and points of view—and gain knowledge that could benefit communities close to home, she says. In May, UAB Comprehensive Cancer Center director Edward Partridge, M.D., accompanied Scarinci to Parana “to learn how the health system works there so that we might implement it to help underserved populations in Alabama,” she says. “As we expand and open up to other countries, that knowledge, in turn, comes back.”
Scarinci notes that her Brazilian heritage has been useful as she navigates the different regulations and practices for conducting research in the country. “Knowing the culture helps,” she says. “I can understand the nuances.” But the most gratifying aspect has been the chance to help the people who remained at home when she moved to Alabama in 1989. “I can’t forget where I came from. Twenty years have gone by, and their needs haven’t changed. For me, it’s personal.”