Jay Holloway:
Coming up we'll tell you about a unique partnership between 50 black churches, the state health department, three major academic institutions, and 20 local agencies, all to improve health for African Americans in North Carolina. I'm Jay Holloway, join us next on Black Issues Forum to find out more about Black Churches United for Better Health. [MUSIC]

Jay Holloway:
Good evening and welcome to Black Issues Forum, I'm Jay Holloway. On tonight's program, we discuss Black Churches United for Better Health. It's a multi-level, intervention research project funded by the National Cancer Institute and it's designed to promote the five-a-day message of eating a combination of at least five servings of fruits and vegetables daily. That's in an effort to reduce cancer risks. The project is a collaborative effort between the state department of h ealth, three major academic institutions, 20 local agencies, and 50 black churches in ten North Carolina counties. Tonight our guests are Dr. Brenda Motzinger - she's the principal investigator of Black Churches United for Better Health. Welcome to the program.

Dr. Brenda Motzinger:
Thank you very much.

Jay Holloway:
And Brenda Beatty, who is the project director for Black Churches for Better Health. Welcome to you, Brenda.

Brenda Beatty:
Thank you.

Jay Holloway:
I really want to thank both of you for coming out tonight because I know you both are a little under the weather. The weather has been down recently. So I really want to thank both Brendas for coming in and being with us tonight. So, if they cough a little bit, audience, don't worry about that, it's just natural. Tell us more about this project. It seems wonderful. I gave our audience a brief introduction about it. But, why was this thing needed so far and how did you beg in it? Either one of you.

Dr. Brenda Motzinger:
We began it with a group of researchers from Duke Comprehensive Cancer Center, from North Carolina State Cooperative Extension Agents, and UNC School of Public Health with the state health department really responding to a request for proposals from NCI, the Nation Cancer Institute, who were wanting to really look at different ways to increase fruits and vegetable intake. And they ultimately funded nine projects across the United States, of which we were one in North Carolina to receive that funding.

Jay Holloway:
How much did you all receive?

Brenda Beatty:
Actually, it's a 2.4 million dollar research grant over four years.

Jay Holloway:
Well that's great. And the primary purpose was to reduce the cases of cancer?

Brenda Beatty:
Exactly. We chose counties in North Carolina that had higher incidences of cancer and it was a major concern for African Americans, so you know, we specifically chose to work with this population.

Jay Holloway:
Whose idea - how did this idea come up to work with black churches, to reach African Americans and reduce these risks?

Dr. Brenda Motzinger:
Again, I think it was some collaborative discussion among the original grant-writing group. But, coming out, you know, the national data as well as North Carolina data, there's a real disparity between the incidence of cancer in our black community and the white community. And I think we were fortunate enough on staff at the state health department to have, within health education and nutrition, some African Americans who probably were ones that began to think about wo rking with black churches. And I can't actually say who had the original idea, but I think it sort of gelled within that group. And then we had some individuals who were pretty natural outreach. And we also had a large - when we looked at the counties in North Carolina, we selected those counties that had not only the highest rates of cancer, but also a large population of African Americans. And the churches, as we were working through - Dr. John Hatch over at the university had worked with black churches and others. And it was becoming discussed what an important institution it is in the black community for really reaching them. And then, you know, when Brenda came on board and after we had recruited them, I think we were really able, through focus groups, to find what the best way was for us to work together. So the researchers weren't trying to decide - we knew the message, but we didn't really know how to deliver that message, and that's where the churches and the focus groups were instrumental in telling us how to do that.

Jay Holloway:
Brenda Beatty, tell me more about this five-a-day and then I want to show a tape that you all have produced on that. But, what is the five-a-day message all about?

Brenda Beatty:
Well, the five-a-day message is actually encouraging Americans to eat at least five servings of fruits and vegetables daily. And this is in an effort to reduce cancer risk. So the whole project is designed to promote that message. And we have specifically chosen African Americans here, as Brenda has mentioned, because of the increased incidence. But we have done a number of activities throughout the county to promote the message to all citizens within the county. So we're really trying to encourage people to eat more fruits and vegetables.

Jay Holloway:
And tell me about this tape that you all have produced. What are we going to see when we take a look at this?

Brenda Beatty:
Well actually, this is just an overview of the project and it gives you just some idea about the partnership. You get a glimpse of the collaboration between the agencies as well as the local health department and the local cooperative extension agencies. And you also get an idea of how the community was involved and how they rallied around our message.

Jay Holloway:
Well let's take a look at that tape right now, and we'll be right back to talk more about this Black Churches United for Better Health after we take a look at this. [VIDEO TAPE PLAYING] [MUSIC/SINGING IN CHURCH SETTING]

Female Voice:
The Black Churches United for Better Health project is a result of funding received from the National Cancer Institute. The department of environmental health and natural resources division of health promotion received funding to implement a project designed to encourage Americans to eat five servings of fruits and vegetables a day. This project was started because of the concern about the increased incidence of cancer among Americans. And we specifically chose to work with t he African American population because of their even larger incidence of cancer in this population. We chose to work the black church because it's really an effective method of trying to reach a large segment of the African American Population.

Male Voice:
[SPEAKING TO CHURCH AUDIENCE] We are trying to eat better. We are trying to do what we can to eat better and live a little longer.

Female Voice:
I'm really pleased to say that with this project we have actually taken the problem to the community and we have solicited their support in terms of what they think are some possible solutions. So it's an exciting project. We have actually formed nutrition action teams in the churches. They work with the pastors and the congregation to tell us what's going to be effective in trying to resolve this problem. So we're really excited about that.

Male Voice:
July 21st to August 21st. We mentioned cabbage, we've got that. Chinese cabbage, you want to try some of that? You have to stir fry it, Chinese cabbage. It's very good.

Male Voice:
As a result of this project, we have been able to provide fruit and vegetables to some of the elderly and handicapped and some of the sick and shut-ins. We usually go visit them, but now we can take them some fresh fruit and vegetables. As a result of this program, we're able to grow a garden. We haven't had a garden in the past, but now we've got a garden and we have numbers that are able to come out and volunteer and work the garden. We have people to harvest it and then we have people to deliver it to some of the shut-ins. And we hope in the future we can set up something where we can have somebody to gather it daily and we have it back there in the kitchen and they can call and say what they want and we can deliver it to them. As a result of the five-a-day, we have been able to purchase a storage building. Because you know if you've got a garden you got to have tools. So we've been able to purchase a utility building.

Female Voice:
But it's not really hard to get five servings of fruits and vegetables. You can eat them at meal time, they can be eaten as snacks. Maybe a bottle of juice for a snack rather than a cola. Fruits and vegetables can be packed in a lunch box. They can be served for refreshments at parties. There are just any number of ways. And I think the key here, too, is serving size. Because many people may not realize that 1/2 cup of cooked fruit or vegetable is a serving.

Female Voice:
First of all, we encourage our members to eat five servings of five vegetables and five fruits every day. During our special programs or any type of programs, we coordinate by serving vegetables, fruits and also we are encouraging them to drink more fruit juices, that is 100% fruit juices. We have an exercise program here in aerobics and walking.

Female Voice:
I am a cancer victim myself and I found out that I feel better by not eating a lot of things like I used to eat. I feel a whole lot better.

Female Voice:
There are a number of things that we're especially proud of. And I think the first thing has to be the partnership. We have truly entered a partnership and I think that's the direction that Public Health is really trying to go into is teaming up with other agencies and teaming up with the community to address Public Health Issues. It is a partnership between our department and other institutions. It's a partnership between the local agencies, it's a partnership between the c hurches. I think that has attributed to the success of the program.

Jay Holloway:
Can't help but get hungry after watching that.

Dr. Brenda Motzinger:
That okra looked good, didn't it?

Jay Holloway:
It did. That really seems to be a wonderful project. And you really get a sense of what you all have done. And I guess I can't help but wonder, this project has to be very unique and I wonder, were the churches really skeptical in coming to seeing the government and three major academic institutions and health departments coming into their community? And how did you deal with it?

Dr. Brenda Motzinger:
You know, interestingly enough, I think we found out at the celebration that we had this weekend that they were probably even more skeptical than we realized. I think they were apprehensive. Particularly it being a "research project," and there's been, as we all know, some pretty bad experiences with African Americans and research projects. And we really had to go out and recruit. At first we had to do a randomization by counties in assigning which counties would be intervention, which counties would be delayed -

Jay Holloway:
Now, tell me what you mean by intervention and delayed.

Dr. Brenda Motzinger:
Okay. I apologize for my lingo. Obviously this was a research project, so we needed a group that we were going to conduct the interventions, the activities, the different things that we were going to do to increase fruits and vegetable intake with one group and then another group we needed to not do anything with so that we could do a comparison at the end, so that we would know - you know, we did a baseline to begin with to ensure that these groups are similar, and th en we did - with five counties and 25 churches within those five counties were what we referred to as our intervention counties. And we had five counties, with five churches in each county, were our delayed intervention. We had to go out and actually visit. We'd get folks in the community, local health departments to go with us to visit the black churches, we had get-acquainted times to pull them together and I think they were so gracious in participating even though they really were skeptical. More so than I think I realized. It was interesting as we heard the pastors make mention of it over the weekend.

Jay Holloway:
Now Brenda Beatty, I would assume - a lot of people know in America that Sunday mornings at 11:00 are one of the most segregated times. And just from an assumption that you probably attend a black church and that you probably had more of an insight that your colleagues did, I mean, what was your observation in what we're talking about here?

Brenda Beatty:
We were fortunate with this project in that we had quite a number of people who are very comfortable and familiar with the population. And I think that was one of our assets. So we were familiar with the kind of dos and don'ts and we knew the historical significance of the church and we knew that it was very important to establish a level of trust. We knew it was important to allow the church members to hear what we had to say, but then give them some flexibility in determin ing what was appropriate. So I think one of the unique things about our project was, unlike maybe a lot of programs where we come in with the message and we come in with it all planned out exactly how we want it to be implemented, here we pretty much just went to the church members and said, "This is a problem. Here's what we're trying to do." And I think, as was mentioned with the video, had them establish nutrition action teams. We worked with health advisors, we worked with the pastors. And each church was very unique in how they determine how they would address the problem. So they were very creative. We were very surprised at some of the acitivities that came out from the church members.

Jay Holloway:
So some of the materials that you all develop were sensitive to that culture and to the community and to the church community?

Dr. Brenda Motzinger:
It really was. We had Ethel Jackson, she's an African American researcher, who did focus groups and we would get groups of the church members together and ask them questions about what their beliefs and attitudes were towards cancer. What did they think caused cancer? What did they think would help prevent cancer? And we also did interviews with the pastors. And we took that information from those focus groups and from those interviews to shape not only the question naire where we could really do the survey of all the members to assess what their fruits and vegetable intake was. But we also used that to develop interventions and to be very sensitive to some of their beliefs in how they wanted things presented and how they didn't want it presented. And who they wanted to deliver the message. They were, as Brenda was indicating, they wanted us to say, you know, "Give us the information that needs to be distributed and then we know the best ways to do it." And they really did. They had gospel feasts where they would have the food there. They came up with some really good poems and raps and things that were far beyond anything that we could have imagined.

Jay Holloway:
Well tell me, I can imagine that the benefit of this - or really I'm talking about the results, are the results out yet? I know from your program recently you have some preliminary data, but what were the real results? What have you gotten out of this project so far? Can you share with us?

Dr. Brenda Motzinger:
You know, we laugh because in research you have to do all these rituals over your data and you've got to be sure -

Jay Holloway:
It's preliminary.

Dr. Brenda Motzinger:
Yeah. Exactly. So, it's very preliminary but it's very, very promising. We really do feel like we've seen an increase in fruits and vegetables and we feel pretty sure that's gonna hold when we get through with, you know, massaging the data and actually publishing it. So we think we're really going to be able to demonstrate a difference. And then we're going to be looking at different aspects of what we did to see if we can put our fingers on which of the interventio ns and activities may have had more of an impact than others. But I think there are a lot of other lessons learned, too. I think just the networking, the relationships that we've established will live far beyond some of the other things that we've done. I think they were really important.

Brenda Beatty:
I concur and I think, as Brenda alluded to, we saw a lot of leaders arise in working in the community and I think, if nothing else, our collaboration with the churches allowed them to be able to see that there's a lot that can be done within the church in terms of a health ministry. A lot of them have adopted that as a ministry now whereas maybe prior to this point they didn't have a specific ministry for health. Health may have been incorporated in other ways, but a lot of them have indicated that they will continue to meet on a regular basis and address health in some type of way. So I think there were a lot of advantages. Also, the communication between the church members and the local agency. There were some partnerships established there whereas prior to this point they may not have been working in collaboration. Not that closely with maybe Cooperative Extension or the health department. So we have a lot of things that we're really proud of about this project.

Jay Holloway:
What would you say to the church members now and pastors that may be watching that say, "I'd like to do something like that in my church."

Brenda Beatty:
Well, I would just say that this has really proven to be a good avenue. I think we were all pleased with how things turned out in terms of the church being an effective channel for nutrition interventions. And I think all of the churches who have been involved with the project could testify to the fact that it did end up being a really good partnership and there's a lot that can be done. We're certainly available to provide information and feedback as to how something like t his could be set up in their church. But, you know, it is part of the entire ministry and I think the pastors have shown us, really easily, how health fits into what they're trying to promote. So we were fortunate in that it was a very easy message to integrate. The pastors often, from the pulpit, talked about the importance of good health. So it was just a real easy message to tie in. And there didn't seem to be any controversial issues as far as health and then just what the ministers were most concerned about as far as their ministry.

Jay Holloway:
I would imagine that over the years when people, whether it's within the black community or not, when you talk about addressing problems in the black community that the church is often a vehicle that many think about, but there have been very few times where black churches really unite like that. So I guess you all need to be commended for doing that. You talked about how you initially got this, but are there some other things that you think that were unique about this that ma de it so successful?

Brenda Beatty:
Well one thing that I'm thinking about, Brenda, is the fact that from the very beginning we were adamant about this being a true partnership. And even though we didn't have it all down perfectly, we worked really hard to as much as possible share the responsibility, to share it in a number of ways. And we also shared resources. We mentioned earlier that it was a 2.4 million dollar research grant. But we made sure that we shared some of those resources with the church members. So while we were asking them to set up programs and do different things to promote the message, we provided the funds. And often the funds are limited and by the time you get to that point, there's not enough to go around. So I think that's another way that we proved that we were committed to the project, that we were invested. And we made numerous visits and we often joked a lot about how much time we traveled, but we were right there. When we were asking them to work with us, we were there showing that we were concerned and interested. So we made a lot of church visits and so I think we built a level of trust and mutual responsibility, I think, was the key.

Jay Holloway:
At your banquet, just recently, you had an opportunity I guess to see a lot of the faces that maybe a lot of people didn't meet. Was that one of the first times? And tell us about, you came together at the end to just celebrate the end of the project? Or what was that occasion about?

Dr. Brenda Motzinger:
Well, it really was to celebrate the successes together. And I would say we've met a lot of them over the four years, though, because as Brenda said, there was a lot of visiting out to the counties, there were gatherings when we would bring them together. We brought them together for sort of a feedback session in January to say, "Tell us what we're doing right, tell us what we're doing wrong." And this one was really more, we wanted to share first and foremost with ou partners, the churches and the local agencies, what we felt like were our successes, even though we couldn't give exact numbers at that time. And then have them tell us what they felt about it, too. I really enjoyed hearing from the pastors and the church members there, their perspective of what it was like. And we're still learning. I mean, we want to take this beyond a research stage so we still very much need to know, what did we do right, what did we do wrong? Keep training us. We keep asking th em - they're really the teachers, they need to train us in how to best work with black churches.

Jay Holloway:
We really have just over a minute left here, but I hope that you all with share with UNC-TV and this program specifically, the results of the project, if it will be public information, and we have a web site where we make information available. And anything you have on that five-a-day, we'd like to also share that and put that on our web site. We'll tell our audience how they can find out more about that. Any final remarks, Brenda Beatty, you'd like to make before we conclude?

Brenda Beatty:
Well, no. I think other than the fact that it was a collaborative effort and I think that was one of our assets in the project and that if you're really interested in trying to work with the community that it's really important to become involved and make sure that they are involved and that you are able to provide culturally sensitive appropriate materials.

Jay Holloway:
Speaking of that, you all have put out a recipe booklet, right?

Dr. Brenda Motzinger:
Yes, we sure have.

Jay Holloway:
How could people get that?

Dr. Brenda Motzinger:
Well, we're trying to come up with a distribution method at this point because what we did was get enough to get back to the church members. But I would say contact us at the state health department as we work out a mechanism, because we really do want to get it out and distribute it as well as a lot of the other materials that we've done.

Jay Holloway:
Any other materials? You've got a recipe book and wasn't there something else?

Brenda Beatty:
It was a project guide called "Up Where We Belong" and it pretty much gives an overview of our nutrition messages. We identified six major objectives that we were trying to get across and so all of that information is in there. So, that in addition to all of the other things we've developed, if you give us a call we'll be happy to share.

Dr. Brenda Motzinger:
We're wanting to put together a module for working with black churches so we're looking for resources and ways to do that.

Jay Holloway:
Well, congratulations to you both and I think you've done a tremendous job. And we'll be happy to share that information with our audience as well. Thank you for coming.

Brenda Beatty:
Thank you.

Dr. Brenda Motzinger:
Thank you.

Jay Holloway:
And thank you for watching our program tonight. And we invite you to watch Black Issues Forum every Friday night at 11:00. We hope that you are now more informed about how black churches in North Carolina have been uniting with government and academia for better health, particularly the five-a-day message of eating a combination of at least five servings of fruits and vegetables daily in an effort to reduce cancer risks. Please contact us with your comments and if you would like to use this program or this series as a discussion guide in your community, civic group, classroom or church, our telephone number is (919) 549-7167. Or you may e-mail us at bif@unctv.org or visit us on the worldwide web at www.unctv.org/bif. you'll find information on past episodes and additional information of concerns to African Americans. Thank you for watching Black Issues Forum. I'm Jay Holloway, you have a blessed evening and a good night.