The CEHS Community Outreach and Education Core's efforts focus on improving public understanding of how susceptibilities and environmental factors interact to cause disease, with a goal of enabling people to make informed decisions about reducing disease risk and hazard exposure. In our work, we rely on CEHS and other peer-reviewed environmental health science research, and we focus on reaching populations most susceptible to the diseases studied by CEHS and those who provide services to these populations. The COEC's specific aims are to: 1. Increase CEHS members'understanding of stakeholder needs through interactions with a Community Advisory Committee. 2. Enhance the capacity of susceptible populations and public health practitioners to understand environmental health risks and to reduce disease risk and hazard exposure in homes and communities. 3. Raise awareness of emerging research and environmental health concepts among children participating in summer camps and among broad community-based audiences through our web site and other media. Target Audiences We strive to engage the populations most susceptible to the diseases being studied by CEHS. Certain vulnerable populations (e.g., children, specific minority groups, and people living in poverty) are not only susceptible to these diseases but also have more serious health outcomes, making them logical target audiences. For instance, in North Carolina, childhood lifetime asthma prevalence and current asthma prevalence exceed the national median, and African- and Native-Americans have significantly greater mortality rates due to asthma than Caucasians (Jensen, 2006). Similar mortality trends have been documented for African-American women with breast cancer, and recent studies by CEHS investigators have found more lethal cancer subtypes appearing in younger African-American women (Carey, 2006). Although melanoma is largely a disease of older Caucasians, five-year survival rates are significantly higher for Caucasians than African-Americans (ACS, 2005), and incidence in children, adolescents, and young adults increased by almost 3% per year from 1973-2001 (Strouse, 2005). Further, evidence suggests that sunburn during childhood may raise the risk of adult melanoma (Noonan, 2001). To reach a cross-section of these susceptible populations, we propose to work with faith- and community-based organizations, particularly in African- and Native-American communities, in several North Carolina counties. Church-based health promotion interventions have been shown to be effective at impacting health behavior, especially in addressing some of the specific health issues reflected in the CEHS research foci (such as breast cancer and obesity) (Campbell, 2007). Examples of successful strategies include family programs, lay health advisors, pastor leadership, church-sponsored education events, and increasing access to health care and low-cost screening and follow-up. The COEC already employs some of these strategies with predominantly black churches in the rural counties surrounding the Triangle area. For instance, the COEC partnership with local Breast and Cervical Cancer Control Program (BCCCP) coordinators has enabled low income women who attend our church-hosted Breast Cancer, Genes, and the Environment workshops to enroll in the BCCCP to acquire free mammograms and other services associated with diagnosing and treating breast cancer. This initial breast cancer outreach to a small group of churches also served as a catalyst for relationships with multiple congregations and interfaith councils and provided opportunities to introduce other environmental health topics to these groups, in response to their requests. One of the specific areas of interest of these congregations was youth environmental health outreach. For this reason, we are partnering with a local science center to develop a summer camp program that introduces CEHS science to middle school students and can serve as a template for youth outreach in our target communities. The middle school years are a time of tremendous change and development for students and also a pivotal time in their understanding of and enthusiasm for science. Research has shown that if educators do not capture student interest in science by middle school, students may lose interest altogether (NSTA, 2003). We also propose to work with public health practitioners in a set of target counties and across the state to prepare them to educate their clients/patients on environmental health and healthy homes issues. A number of recent studies underscore the need for health promotion involvement in environmental health practice (Howze, EH, 2004;Kreuter, MW, 2004;Freudenberg, 2004). At least one has shown that public health professionals can strengthen community capacity by increasing access to accurate science and building strong relationships between communities and local health departments, among other factors (Freudenberg, 2004). Furthermore, in COEC outreach to health practitioners in the previous grant cycle we heard a strong desire for environmental health education. Participating professional associations stressed the need for such education among their members, and the health departments that participated in an evaluation of educational materials on effectively engaging communities in environmental health/hazard issues requested follow-up training for larger groups of their employees. Initially, our efforts will be focused in Chatham, Wake, and Craven Counties and, to a lesser extent, the counties that border them. In later years, we hope to add a county in eastern North Carolina with a substantial Native American population (e.g., Robeson Co.). In addition to population demographics, our choices were influenced by existing relationships with community partners, a desire to work in multiple regions of the state, and the relative proximity of these counties to UNC-Chapel Hill, enabling us to have more active and sustained relationships.
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