September 27, 2024 | Erin Bluvas, bluvase@sc.edu
2024 has been a banner year for the USC Prevention Research Center. Not only has the Arnold School mainstay received its highest funding award to date – nearly $5 million to support the center in its seventh consecutive funding cycle – but its researchers have been awarded additional funding for two special interest projects.
Led by director and exercise science professor Sara Wilcox, the PRC’s core project over the next five years will be to study how African Methodist Episcopal (AME) churches implement a program known as Walk Your Heart to Health, an evidence-based walking intervention. The project will focus on African American adults ages 50 and older. In parallel, exercise science associate professor Christine Pellegrini will lead a Collaborating Center at USC within the Arthritis Management and Wellbeing Research Network. Swann Adams, a professor of both epidemiology and nursing, will continue the administration of the South Carolina Cancer Prevention and Control Research Network, which has been funded through the PRC since 2009.
“The Prevention Research Center conducts applied public health research that is unique and important because it advances science and improves the health of communities most impacted by chronic disease,” Wilcox says. “We are starting our 31st year of continuous funding from CDC, making USC one of the longest-funded Prevention Research Centers in the U.S.”
The PRC was established in 1993 with funding by the Centers for Disease Control and Prevention. Wilcox, who took on the director role in 2011, has now written successful grant applications for three of its five-year funding cycles. Over the years, more than 40 studies have been conducted through the center.
Physical inactivity is a leading cause of preventable death and a strong risk factor for heart disease, cancer and COVID-19 – the three leading causes of death in the U.S. These conditions disproportionately impact older adults from ethnic and racial minority groups.
In the last 10 years, the USC PRC’s core research project has focused on scaling up an intervention called Faith, Activity, and Nutrition (FAN). Other projects range from walking programs in rural communities to mHealth interventions; all focus on physical activity and healthy eating to improve health through community-engaged interventions. Many of their studies aim to advance health equity by working with under-resourced populations.
“Physical inactivity is a leading cause of preventable death and a strong risk factor for heart disease, cancer and COVID-19 – the three leading causes of death in the U.S., which also happen to disproportionately impact older adults from ethnic and racial minority groups,” Wilcox says. “Older adults who increase their physical activity experience aging-related benefits, such as enhanced cognitive ability, improved sleep, reduced risk of falls, and improved physical functioning and mobility.”
Though the PRC has a history of developing highly effective interventions, where they really shine is in their ability to make these programs available and easy-to-apply on a broader scale – something scientists refer to as dissemination and implementation. They do this by providing training and education along with any other supports needed to make the interventions successful.
Many of the lessons learned in scaling up interventions come from the FAN program – an initiative Wilcox launched in 2006 in partnership with the 7th Episcopal District of the AME church (i.e., South Carolina). After proving FAN to be an effective initiative that promotes organizational change within the church to be more supportive of physical activity and healthy eating in two later studies in South Carolina, Wilcox and her team designed a dissemination and implementation study to make the program available to communities across the nation. Their efforts earned FAN a spot on the National Cancer Institute’s Evidence-Based Cancer Control Program index.
Ten years later, FAN has laid the foundation and helped inform the PRC’s next major dissemination and implementation project. Walk Your Heart to Health is also indexed with NCI and is the perfect program for the center’s goals to prevent chronic disease through physical activity and/or healthy eating. And the perfect opportunity for the PRC to apply their dissemination and implementation methods to another evidence-based intervention.
“Researchers have developed many effective interventions, yet most never make it to real-world settings,” Wilcox says. “Thus, it’s critical to study the process of translating and scaling up of evidence-based programs so we can reach far more people, and thus have a greater public health impact.”
Once again, the center will partner closely with Black churches, which are vital but often overlooked public health partners that hold great promise for promoting health equity. Seventy-eight percent of African American adults are affiliated with religious institutions, and these organizations have a long history of supporting the holistic needs (including health) of its members.
The Walk Your Heart to Health program centers around community health promoters who lead group members in walking sessions three times per week. These promoters are trained to lead stretching, warm-ups and cool-downs, and encourage peer support, discussion of challenges, celebration of accomplishments and more. The PRC team will build on this effective intervention by working with church leaders and other community organizations to develop methods for scaling it up while ensuring cultural relevance, factoring in social determinants of health, and addressing any other relevant issues. They will also study successes and challenges churches experience when they put the program into place in their congregations.
The USC Prevention Research Center is also funded for core center activities, including communication, dissemination, translation, and community engagement.
Co-Investigators for the University of South Carolina Prevention Research Center are
Andrew Kaczynski, Ruth Saunders, Caroline Rudisill, Courtney Monroe, Jennifer Trilk (USC Greenville SOM), and Brooke McKeever (University of Alabama).
Researchers like Pellegrini have already proven that physical activity is beneficial to individuals who have arthritis. Symptoms like physical function, quality of life, pain and fatigue improve in step with movement. But how much is enough?
More than 50 million Americans have arthritis, yet 64 percent of them do not meet the recommended levels of moderate-to-vigorous physical activity.
People with arthritis, which includes 50 million Americans and counting, have concerns that exercise might exacerbate symptoms and pain. This means that 64 percent of adults with arthritis don’t meet the recommended 150-300 minutes/week of moderate-to-vigorous activity, and 41 percent of them do not engage in any of this type of activity each week.
“The current recommendation for adults with arthritis is that they should engage in regular physical activity according to their abilities and avoid inactivity, but this guideline is vague and does not help patients who seek specific instructions from their health care providers on appropriate activities,” Pellegrini says. “A major gap – and one we plan to fill with this study – is to identify the minimal dose of activity necessary to see clinical improvements in arthritis-attributable outcomes.”
Pellegrini’s prior studies have already shown that even lower doses (i.e., amounts) of physical activity can benefit individuals with arthritis – even when they are not meeting the recommended levels of physical activity. These patients can see significant improvements in symptoms despite their difficulties in engaging at the recommended levels while experiencing fewer negative side effects that may accompany higher levels of activity.
So, in addition to collaborating with other Prevention Research Centers across the country within the Arthritis Management and Wellbeing Research Network – this new project will conduct a randomized controlled trial to find out how much physical activity (e.g., 45 vs 90 vs 150 minutes/week) is needed to improve arthritis symptoms. In other words, what is the lowest dose?
USC Co-Investigators for the arthritis project are Sara Wilcox and Jason Yang.
For 15 years, the South Carolina Cancer Prevention and Control Network has worked to eliminate the state’s cancer-related health disparities, which are among the largest in the nation. The network collaborates with the eight other Prevention Research Centers in the U.S. that collectively make up the Cancer Prevention and Control Research Network. Their goal is to reduce the burden of cancer, especially among those disproportionately affected.
“We work closely with academic, public health and community partners to reduce cancer-related health disparities among disenfranchised and medically underserved populations by advancing dissemination and implementation science,” Adams says. “These collaborations include a strong partnership with the South Carolina Cancer Alliance, federally qualified health centers, and other academic, clinical, community and faith-based partners to employ evidence-based prevention and control messages, guidelines and interventions. Without these critical partners, we would not be able to do this important work, both past and future.”
During the next funding cycle, the South Carolina network will work toward three specific aims that build on and extend their previous work. The team will disseminate, implement, and evaluate efficacious, multi-level, multi-site, public health cancer prevention and control interventions. They will engage community and clinical partners in training and technical assistance. Finally, the network will increase the capacity of community and clinical partners to more effectively reach underserved, minority and rural populations.
Co-Investigators for the South Carolina Cancer Prevention and Control Network are James Hébert, Shaun Owens, Tisha Felder, Ciaran Fairman, Karen Wickersham, Lauren Workman, and Jason Yang.
