Dr. Robert A. Branch, MD FRCP

1. “Guiding Community-Based Participatory Research in health for disadvantaged and minority high school students, focusing on science, math, health, and technology.” Dr. Robert A. Branch, MD FRCP

2. Objectives • The Problem • Health • Education • inadequate Literate Workforce • The solution • Pitt-Bridge • Salutogenesis(origin of health) • Micro-Community-Based Participatory Research (CBPR) • Uniqueness • Tiered Diffusion Communication • Application Psychology • Adolescents • Vehicles for Change • Knowledge Brokers • Continuous Self-Monitoring • Feasibility • Rural West Virginia • Career Development • Adolescent Health • Community Health Can We Apply These Concepts to Pittsburgh?

3. Who is Robert A. Branch? Call me ‘Bob’ Born in Nairobi , Kenya in 2nd world war  Father is a physician from St. Lucia Mother is a nurse from England Raised in Nigeria Schooled in England Bristol Medical School 17 years old qualified by 22 years Internal Medicine in UK Emigrated 1975 Vanderbilt for 17 years Clinical Pharmacologist Pittsburgh for 22 years Clinical Translational Scientist *An Educator for over 50 years*

4. The US Health: An International Perspective • Shorter Lives, Poorer Health • US National Research Council • Congress Requested Institute of Medicine • January 2013 • US Health Disadvantages “Knowing is not enough; we must apply. Willing is not enough; we must do.” -Johann Wolfgang von Goethe

5. The Cause “Even if health care plays some role, decades of research have documented health is determined by more than health care.” -2006 Report on Comparison of UK and US Social Gradient ---------------------------- Income Inequality United States “My right to choose.” Individualism United Kingdom “We are all in this together.” Collectivism At every social level UK>US

6. The Problem: Mal-Adaptive Behavior Related Diseases Worse outcomes than 17 other countries Spends greater than 2x per capita than other countries Acute Events Adverse Births Vehicular Accidents Violence STDs Chronic Events Obesity Type II Diabetes Cardiovascular Disease Chronic Pulmonary Disease AIDS Lung Cancer

7. Creating Change in Health Who is to create change? • Government • Incapable of Action • Philanthropy • Inadequate Funding • Advocacy • Inadequate Federal and State Funding We need to find a new way! Public health. Confronting the Sorry State of U.S. Health. Bayer R, Fairchild AL, Hopper K, Nathanson CA. Science. 2013 Aug 30;341(6149):962-3. doi: 10.1126/science.1241249. PMID: 23990546

8. Bridging the Gap Federal Institutional Community - Impact + - Time + Interpersonal Individual

9. Creating Change in Health How? Identify the Cause Misdistribution Money Knowledge of Community Behavior of Family Involve Everyone Community Educators Health Care Providers Policy Makers Target the Most Vulnerable Poverty Minorities Rural Urban Communities Use Adolescents Most Flexible Technologically Advanced Already Established in the Community Responsible

10. Seismic Changes in STEM Education • Need for change • National decrease in competitiveness • Concern of future high-tech work force • Disgrace over differential State Standards • Questions raised • What do we teach? What is learned? • When do we teach it? When is it learned? • How do we teach? How is it learned? • Mathematics • The Common Core State Standards • http://www.corestandards.org/resources/key-points-in-mathematics • Sciences • The New Generation State Standards • http://www.nextgenscience.org/next-generation-science-standards Pennsylvania conservative resistance to change

11. Pitt-Bridge Vision and Goals • Vision • Provide a “Bridge" Between Health Sciences and STEM Disciplines • Learn How to Learn • Learn How to Change Behavior • Goals • Motivate minority and low-income high school students to enter higher education • Pursue careers in STEM fields, particularly in health sciences-related occupations. • Family improvement of health • Self-improvement of health

12. CBPR Learning Program Health Science Clubs A Transformative Education Health Science Program: Requires Integration of Essential Core Concepts • Salutogenesis (origin of health- for community) • Adaptive Adolescent Hypothesis • Micro and macro CBPR • Application of cognitive psychology in scientific method • Community Research Knowledge Broker (CRKB) • Tiered Diffusion model of communication • Adolescents as family health care coaches

13. Salutogenesis *Origin of Health & Wellness for All* Prevention Vaccination Time Actionable Knowledge Concepts Prophylaxis of Chronic Disease

14. Adaptive Adolescent Hypothesis Brain Maturation • Burst of brain growth and change in structure • Pruning of dendrites • Development fast track neuronal connections. Wave of Brain Maturation • 1st Step: 12 years • Dexterity • 2nd Step:15-19 years • Concept Integration • Final Step: 21years • Executive Decision Making Source: J. Giedd, Nature 442, 865-867 (24 August 2006)

15. Adaptive Adolescent Hypothesis Implication confers evolutionary benefit  • Risk taking may be an advantage in times of peril Ability to use reasoned choice to not conform to culturally acquired mal-adaptive behavior’s may be our best option for survival.    

16. Community-Based Participatory Research Core Values • Mutuality • Sharing by Members • Equity • Governance • Accountability • Trust • Good Faith From All Partners Community-Based Participatory Research: A Capacity-Building Approach for Policy Advocacy Aimed at Eliminating Health Disparities Israel BA, Coombe CM, Cheezum RR, Schulz AJ, McGranaghan RJ, Lichtenstein R, Reyes AG, Clement J, Burris A. Am J Public Health. 2010 Nov;100(11):2094-102. doi: 10.2105/AJPH.2009.170506. Epub 2010 Sep 23. PMID: 20864728 PMCID: PMC2951933

17. Core Principles of CBPR • Long-Term Commitment • Equitable Partnership in All Phases • Emphasizes Local Relevance • Builds on community strengths and resources • Promotes Co-Learning and Capacity-Building

18. Micro-CBPR for Student Investigators My ‘FIRST’ Health Project Fun Innovative • Individual • Iterative Relevant • Respect • Relationships Scientific Transformative Micro-CBPR Scientific Project • Subject Area • Background • Question • Design & Approval • Implementation • Analysis & Inference • Presentation If a common data collection tool is used, the sum of multiple Micro-CBPR generates bonefide CBPR

19. Who are ‘WE’ in Micro-CBPR of Health? Can ‘WE’ do better? All Questions Require, Comparisons, Quantitation, Analysis Who are ‘WE’? Who is the We? Where do We live? What is our environment? What are our health problems? Why do ‘WE’ do what we do? How do We learn? How do We make decisions? How do We change?

20. Potential to Enhance Health A Community in Trouble Adverse, Culturally-Based, Behavior Adaption Behaviors Adolescent-Led Micro-CBPR Projects Improve Community Awareness Community Science Project Learning to Learn Change in Behavior Ausubel’s Theory of Meaningful Learning Prochaska’s Trans-Theoretical Model of Behavior Change The potential for the CBPR Learning Paradigm to enhance health

21. Clinical Research Knowledge Broker A New Community-Based Career Track Who are they? • Recruited from senior STEM teachers with higher pay • Live in  and know the local community • Receive special training in  • Ethics • principles of CBPR • study design • domains of health sciences interest What do they do? • Organize integration of club activities • Mentor club teachers • Organize club group symposia • Maintain and evaluate quality

22. Tiered Diffusion Bi-Directional Communication STEM Teachers Knowledge Brokers Science Club Students Academic Medical Centers Science Club Families Pitt-Bridge *Science Club= 1 Teacher / 10 Students

23. CBPR Learning Paradigm (Teacher Activity) Team Building Teach Learning Individual Student Project Selection Train Teachers Train Students Translate Teach KB Teach Teachers Track Symposia Presentation Study Inference Study Design Concept Integration Question Enquiring (Student Activity) July May November “Learning by Doing” Community Project Using Scientific Method Change In Behavior Learning Doing Evaluation & Feedback → New Challenge for Next Cycle

24. Concept Map Networking Approach Study Hypothesis Study Rationale Design & Conduct Training CBPR Sociology of Family Ethics Home Economics Intervention Structure Conduct Research Regulation Nutrition Pre/Post Cohort Of Mothers Obesity Epidemic Logistics Food Labels Portion Size Metabolic Syndrome Energy Endpoint Measures Diabetes Cardiovascular Disease Energy Balance Education Program Exercise Data Collection Data Analysis Diet Complications Heart Attack Stroke Protein Carbohydrate Data Organization Fat

25. CBPR Learning Paradigm • Educational Perspective • Integrate Common Core State Standards (CCSS) and the Next Generation Science Standards (NGSS) by expanding into health sciences • Student Perspective • Involve hands-on experiences in ethics, science-based problem-solving, leadership, team-building, decision-making, and concept presentation in health sciences • Community Perspective • These students will gain the knowledge, skills, and ability to become family health care educators to promote wellness.

26. Feasibility Model • Encourage • Entrepreneurship • Self-Reliance • Team Work • Learn How To Learn • Self Expectation • Mission • Go To College • Succeed in Career Development • Improve Community Health Health Science & Technology Academy (HSTA) • Community organizations in 26 counties • 76 Science clubs for high school • 4 Community Research Associates • Links to WVU and Pitt

27. HSTA Club Enrollment

28. HSTA College Entry Success

29. Obesity in West Virginia Subjects enrolled in 2007

30. Prevalence of Obesity and Diabetes (2007) Projected Mean BMI for Adolescent Cohort BMI in HSTA family sample populations of West Virginia in subjects as they age from the present time. The slope of projections is estimated assuming the linear increase observed from the BRFFS study results from WV between 1985-2007 remains unchanged

31. Community-Based Participatory Research CDC Reported 6% increase in adult BMI 2007-2012

32. Lessons Learned in Community Health • Transition of HSTA coordinator to Community Research Knowledge Broker • Adolescents can conduct Micro-CBPR • Integration of related Micro-CBPR permits Community CPBR • Multiple Micro-CBPR projects influences community behavior for health care condition

33. Proposed Plan of Action The Pittsburgh Bridge Stakeholders Community Pittsburgh Public Schools Academia Governance Community Leadership Advisory Committees Evaluation Funding Phased Introduction Phase 1: Initiate and Learn Phase 2: Refine and Consolidate Phase 3: Expansion

34. Publications • Branch RA, Paulsen S, Hanks S, Obesity Management Organized by Adolescents in Rural Appalachia, JHUP Fall 2014 (in press) • Branch, R., Chester, A., Morton-McSwain, C., Hanks, S. Udin Al Ayubi, S., Bhat Shelbert, K., Brimson, P., Buch, S., et al. A Novel Approach to Adolescent Obesity in Rural Appalachia of West Virginia: Educating Adolescents as Family Health Coaches and Research Investigators. Topics in the Prevention, Treatment and Complications of Type 2 Diabetes." Mark B. Zimering (ED) (2011). ISBN:9780953-307-590-7, InTech. • Bardwell, G., Branch, R.A.,Buch, S., Cecchetti, A.,Chester, A., Groark, S.,Morton, C., Pancoska, P., Paulsen, S.,Vecchio, M." (2009, October).Feasability of Adolescents to Conduct Community Based Participatory Research on Obesity and Diabetes in Rural Appalachia." Clinical Translation Science.2(5) • Chester, A, and R.A. Branch. Community Based Participatory Clinical Research in Obesity by Adolescents; Pipeline for Researchers of the Future. Clinical Translation Science. (2009). • Pancoska P, Branch RA, Buch S, Cecchetti A, Parmanto B, Vecchio M et al. (2009) Family Networks of Obesity and Type 2 Diabetes in Rural Appalachia. Clinical and Translational Science 2(6):413-421. http://www.wiley.com/bw/journal.asp?ref=1752-8054