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One of the most significant ways in which the Mid-South TCC connects with communities is through its pilot projects. A pilot project is a small scale research study, usually conducted to examine the feasibility of a project or to gain information to determine the direction of a larger study. Within the context of the Mid-South TCC, pilot projects often yield practical useable data as well. 

Mid-South TCC Pilot Project Funding Recipients

2016 Pilot Project Winners

Gabriela Oates, PhD
University of Alabama at Birmingham
{slide=Project Title: Bikeshare for Low-Income Urban Communities: A Mixed Methods Feasibility Study.} This mixed methods study will explore the feasibility of bikeshare programs in low-income urban neighborhoods as an innovative approach to reducing obesity and improving health. Findings will inform the development, implementation, and evaluation of a culturally appropriate community-based intervention that is extramurally funded through an R21 mechanism. The project will add to the evidence base for improving community health, connectivity, and livability through active modes of transportation. {/slide}

Caroline Compretta, PhD
University of Mississippi Medical Center
{slide=Project Title: Kid Koders for Health: Promoting Physical Activity among Underserved Youth.} This project seeks to increase the physical activity levels and positive perceptions of exercise for marginalized youth using a newly developed socially interactive mobile health app. Building upon social cognitive theories demonstrating that social interactions affect behavior changes, this study will engage youth at risk for obesity in the development and testing of a group-based fitness application through participation in app development classes, feedback sessions, and intervention testing using an Apple Watch. {/slide}

Ariane Rung, PhD
Louisiana State University Health Sciences Center
{slide=Project Title: Mobile Mindfulness Training to Reduce Chronic Health Disparities in Louisiana Women.} With support from the Mid-South TCC Social Determinants of Health Measurement Core, we will test whether the practice of mindfulness using a smartphone app can mitigate some of the effect of individual and environmental stressors on proximal determinants of obesity and other chronic diseases (stress & depression) and whether this association is moderated by neighborhood disadvantage in a vulnerable population of women from Louisiana. {/slide}

2015 Pilot Project Winners

Patrick Packer, Jerri Haslem, Yu-Mei Schoenberger, PhD
Community partner: Black People Run Bike Swim
{slide=Walk to Smartphone Application}The project will enhance the "Walk To App" Smartphone technology that motivates individuals through giving a reward to users to increase their walking, running or cycling to meet recommended physical activity guidelines. The "Walk to App" combines four commonly used smartphone technologies including GPS tracking, social media (e.g., Facebook, Instagram), the check-in location-based social networking process (Foursquare) and discount coupon/reward programs into an innovative and simple to use, rewards based app. {/slide}
Henry Nuss, PhD, Melinda Sothern, PhD
Community partner: The Hollygrove Market and Farm
{slide=Growing Healthy Roots: A Social Marketing Campaign to Increase the Amount of Fruit and Vegetable Purchases in the Hollygrove Neighborhood in New Orleans, Louisiana.}The goal of this study is to implement and evaluate the feasibility of a six-month internet-based social marketing intervention designed to increase HMF use among 120 SNAP participants residing within a five mile radius. 
The project will examine the feasibility of the adaptation of existing evaluation tools to an internet-based social marketing campaign in an underserved population.  It will e valuate social media activity, purchasing behaviors, attitudes and perceptions of shopping in the Market, and fruit and vegetable consumption in study participants through a series of internet-based questionnaires, faith-based focus groups and internet traffic data before and after the intervention.{/slide}
Gareth Dutton, PhD, Susan Davies, PhD
Community partner:   Health and Wellness Education of Livingston, AL
{slide=Stop Obesity Now (SONNY): A Family-Based Intervention to Reduce Obesity in the Black Belt.}Preliminary work suggests that Black Belt families are good targets for a family-based intervention to reduce obesity since family ties are strong and several generations commonly live nearby and often in the same household, increasing the reach of family-based interventions. The project proposes to collaboratively develop a theory-driven, family-based intervention to optimize healthy eating and physical activity in family members of individuals with type 2 diabetes.{/slide}

Elizabeth Baker, PhD
Irena Stepanikova, PhD
University of Alabama at Birmingham
Investigating the Relationship between Perceived Discrimination and Obesity among African Americans in Mississippi

Jonathan Daw, PhD
University of Alabama at Birmingham
The Role of Behavioral, Family, and Community Effects on Racial/Ethnic Disparities in Comorbidity in Obesity, Chronic Kidney Disease, Diabetes, Hypertension, and All-Cause Mortality

Irena Stepanikova, PhD
University of Alabama at Birmingham
Exploring Social and Lifestyle Factors in Minority Aging: Obesity, Perceived Discrimination, and Chronic Systemic Inflammation

William C. Cockerham, PhD
University of Alabama at Birmingham
A Comparison of Black and White Racial Differences in Health Lifestyles and Cardiovascular Disease

Meifang Chen, PhD
University of Alabama at Birmingham
Association of Food Environment and Mediterranean Diet Adherence and Obesity in the US: A Geographic Information System (GIS) Analysis

Robert Collins, PhD
Dillard University
Segregation and the Disparities in the Built Environment

2014 Pilot Project Winner

Richard Scribner, MD
Louisiana State University Health Sciences Center
{slide=Monitoring Social Determinants of Obesity Outcomes for a Community Clinic}The overall goal of the project is to reduce health disparities in the Mid-South TCC region through the identification of modifiable factors in the neighborhood and community environments (i.e., social determinants) that can lead to reductions in overweight and obese individuals. To accomplish this goal, the project proposes the internal geocoding of an automated patient record of a community-based health provider in Louisiana (Daughters of Charity) for conducting repeated multilevel analyses over time characterizing the role of the social determinants on hypothesized obesity-related outcomes. The Daughters of Charity (DOC) Louisiana is one of the largest networks of community-based health care centers in Louisiana serving over 30,000 participants in the greater New Orleans area. 

Recently they have automated their patient records, making internal geocoding of patients by residence location feasible. By locating DOC participants within their respective neighborhoods (census tracts), the social determinants of health for DOC participants can be characterized and the many strengths of analyzing an automated patient record can be brought to bear on a number of outstanding issues in the obesity literature related to the role of social determinants of obesity-related outcomes. 

The specific aims with regard to achieving the aforementioned goals and objectives for the project include: Specific Aim 1: Generate a DOC-controlled database of patients linked by their residence location to a contextual database organized at the neighborhood (i.e., census tract) and community (i.e., zip code) levels that characterizes the various aspects of the social, food, and physical activity environments obtained from the Mid-South TCC Social Determinants Core. Specific Aim 2: Conduct a variety of multilevel analyses to explain significant clustering in obesity-related outcomes and chronic disease outcomes in terms of social, food, and physical activity environments at the neighborhood and community levels. {/slide}

2013 Pilot Project Winners

Andrea Cherrington MD, MPH
University of Alabama at Birmingham
{slide=Assessing Social Determinants of Obesity for Latino immigrants in an Emerging Community}Obesity is a leading risk factor for the development of diabetes, cardiovascular illness, cancer and other chronic conditions that cause significant morbidity and mortality as well as increased health care costs. Social determinants of health, defined as the economic, environmental, political and social conditions in which people live, substantively contribute to health inequities, including differences in obesity rates across populations. Obesity rates are disproportionately high among Latinos, now the largest and fastest growing minority group in the US. While Latino immigrants often arrive in the U.S. at a healthy weight, time in the U.S. and changes in lifestyle are associated with weight gain. As of 2010, roughly one quarter of Latinos live outside the 9 traditional settlement states, in what are considered "emerging Latino communities". 

Latino immigrants living in these emerging communities face distinct barriers when it comes to healthy lifestyles, including underdeveloped social networks, isolation and discrimination, as well as limited access to health education programs and quality health services. The overarching goal of this study is to understand the social determinants of health that contribute to the growing obesity epidemic among Latinos living in emerging communities and to identify potential targets for intervention. 

This is relevant as the economic, environmental, political and social conditions faced by Latinos in emerging communities present unique challenges relative to established, traditional settlement states. The Community Energy Balance (CEB) is a framework developed to guide research on the social determinants of health and obesity that addresses individual, interpersonal and community levels of influence and incorporates cultural and contextual factors relevant to minority communities and immigrants to the U.S. Using the CEB framework as a guide, we propose a mixed-methods study to examine social determinants of obesity among Latino immigrants living in Albertville, AL. We will triangulate data from three separate sources including questionnaires, GIS mapping and focus groups with photovoice. This study will provide novel pilot data to inform a future study that will systematically assess social determinants effecting Latino immigrants in the southeast region more broadly.{/slide}

James Hempe, PhD
Louisiana State University
{slide=Metabolic Determinants of Racial Disparity in Hemoglobin Glycation}It recently became standard clinical practice to diagnose type 2 diabetes based on fixed cut points for standardized glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), or oral glucose tolerance tests. We and others have questioned this practice based on evidence of inter-individual and racial variation in the quantitative relationship between HbA1c and blood glucose in both diabetic and non-diabetic populations. Because HbA1c is proportionally higher in blacks than whites independent of variation in blood glucose concentration, the prevalence of diabetes is greater in blacks if HbA1c is used to diagnose diabetes. 

Moreover, because blacks have relatively higher HbA1c at any blood glucose level, they conversely have lower blood glucose at any HbA1c level. This means that intensive management of type 1 or type 2 diabetes patients to low HbA1c target levels can unintentionally lead to lower than expected blood glucose levels in blacks and increased risk for hypoglycemia. Racial variation in the relationship between HbA1c and FPG clearly complicates the identification of optimal and safe HbA1c target levels in multi-ethnic diabetes populations. It also means the current one-size-fits-all clinical use of HbA1c is obsolete and detrimental to some ethnic minorities. These critical problems with how HbA1c is used clinically will not be resolved until we understand the underlying reasons why blacks have higher glycated hemoglobin levels than whites. This project will determine if racial variation exists in how glucose spontaneously reacts with hemoglobin amino groups to form glucosylamines - unstable hemoglobin complexes formed early in the series of chemical events that constitute the Maillard reaction between glucose and hemoglobin amino groups. 

Our overarching hypothesis is that genomic variation produces relatively anti- or pro-glycation environments inside red blood cells (RBC). We will test the specific hypothesis that RBC from black and white diabetes patients have inherently different capacity to produce glucosylamines. Specific Aim 1 will confirm our preliminary evidence of higher glucosylamine synthesis in RBC from white subjects using an in vitro kinetic bioassay system that is uniquely able to detect and quantify unstable hemoglobin complexes. Specific aim 2 will compare endogenous glucosylamine levels with other metrics of metabolic control in black and white children with diabetes. 

We will accomplish these aims in a one year study using blood samples from 50 black and 50 white type 1 diabetes patients. Results will be interpreted based on a theoretical model of hemoglobin glycation which suggests that glucosylamines could play a biologically important role in Vitamin C metabolism. If our hypotheses and models are correct, we expect that this research will identify biochemical mechanisms associated with racial disparity in both HbA1c and diabetes outcomes. Elucidation of mechanisms could lead to the development of novel therapies to reduce microvascular and macrovascular complications in high-risk individuals and ethnic groups.{/slide}
Douglas Moellering, PhD
University of Aalabama at Birmingham
{slide=Adverse effects of life stress on obesity and disease risk are mediated by diet quality and oxidative stress}The primary objectives of this pilot proposal are to 1) evaluate the association of psychosocial 'Life' stress with diet, cortisol, insulin, oxidative stress and the microbiome on the development and retention of increased body mass (obesity) in 40 African American and European American women and 2) obtain data for calculation of sample size for a subsequent NIH grant, which will include a randomized clinical trial of behavioral and dietary supplements vs placebo with a strong interdisciplinary team. We will explore the intensity of life stress and collect main outcomes on measures of depression, social support, perceived stress & discrimination, and hostility in African American (AA) and European American (EA) women in the southeast. It is hypothesized that these psychosocial 'Life' stress measures will be elevated in both AA women and EA women with higher BMI, and with concomitantly decreased social support. This is in line with and addresses the MHRC's Mid-South TCC goals and objectives to investigate mechanisms of health disparities in obesity and related chronic diseases including Type 2 Diabetes and cardiovascular disease. 

We will also test associations between life stress, obesity, metabolic stress, oxidative stress and inflammation by collecting main outcomes on anthropometrics and body composition, chronic metabolic (cortisol, insulin, c-peptide) and oxidative stress markers. The Higher Life stress measures are hypothesized to be positively associated with higher cortisol, a lower circulating ratio of reduced to oxidized glutathione (GSH/GSSG), and a decreased lag time to oxidation of LDL-C as direct measures of oxidative stress. A diet enriched in processed carbohydrates (CHO) as measured with three, 24hr dietary recalls, is posited to be associated with higher fasting insulin and insulin AUC during the OGTT and with altered salivary and gut microbiomes.

Diet and even mild stress are suggested to influence the microbial balance which could make the host more vulnerable to infectious disease, anxiety, or depression and obesity has been correlated with a decrease in the amount of gut Bacteroidetes and a proportional increase in Firmicutes. Increased life stress is hypothesized to be positively associated with proportional decreases in 'Bacteroidetes' and increases in 'Firmicutes' microbiota, obesity, and a diet enriched in processed CHO.

RELEVANCE: The relevance of this project is to see how feelings of life stress affect our bodies' responses to these stressors, our eating habits, and our overall health. When we are unable to adequately respond either through behavior or physically to these stressors, we initiate a cascade of harm that can lead to many chronic diseases including obesity, hypertension, atherosclerosis, and Type 2 Diabetes.{/slide}
Amanda Willig, PhD, RD
University of Alabama at Birmingham
{slide=Behavioral and social factors impact mitochondrial dysfunction and obesity in HIV-infected women}Infection with human immunodeficiency virus (HIV) is now a manageable, chronic condition with an improved life expectancy due to the use of antiretroviral therapy (ART). However, a rapid convergence between the epidemics of HIV and obesity (BMI ≥ 30) has occurred, and racial disparities in obesity prevalence are evident in black versus white HIV-infected women. Mitochondrial function influences obesity risk and is worsened with HIV infection and ART use. Sociological determinants of psychosocial stress can increase obesity risk directly and via changes in mitochondrial function. 

This project aims to test the novel and provocative hypothesis that psychosocial stress (from stigma and discrimination) mediates the relationship between race and mitochondrial function, which, in turn, contributes to the disproportionate prevalence of obesity among HIV-infected black women. The long-term objective of this research is to develop interventions aimed at decreasing obesity risk in HIV-infected black women by focusing on the interplay of social (stress, race), biological (mitochondria), and behavioral (diet, physical function) factors. Specific Aim 1: To determine the extent to which cellular mitochondrial function in platelets, monocytes and lymphocytes differs in HIV-infected black versus white and obese versus lean women. We will measure mitochondrial function and body fat levels among 80 HIV-infected women (40 black, 40 white) in a cross-sectional study. Women will be further categorized as normal weight (BMI 20-23) or obese (BMI ≥ 30).

Body fat will be quantified via dual-energy x-ray absorptiometry. Mitochondrial function will be assessed using a real time cellular energetics platform. Specific Aim 2: Evaluate the direct, indirect, and total effects of psychosocial factors, in particular, race and stress, in mitochondrial function and obesity among HIV-infected women. Women will complete the Perceived Stress Scale, HIV Stigma Scale, Rosenberg's Self-Esteem Scale, Perceived Racial/Ethnic Discrimination Scale, Spirituality/Religion in HIV, and Patient Health Questionnaire (PHQ-9). Sociodemographic, dietary, and physical function data will also be obtained. This project will help scientists understand how stressful life events in HIV-infected women interact with the way cells produce energy (mitochondrial function) to increase obesity risk. It will also show how stress can contribute to higher levels of obesity seen in black versus white HIV-infected women. This information has the potential to reveal new opportunities for weight management, and to alter clinical treatment guidelines for obesity in the context of HIV infection.{/slide}