New project to tailor health messages for African Americans based on their ethnic identity

Ken Resnicow has worked with Black churches for more than a decade to foster healthy behavior among their members, including quitting smoking, getting more physical activity and eating healthier.

Churches often hold strong sway in Black communities, not only offering religious teachings but also social services and political advocacy. Resnicow recognized that and teamed with Black pastors to use their influence from the pulpit to help people live healthier lives.

Now with a deeper understanding of how race and ethnicity influence behavior, Resnicow is embarking on a new project to tailor health messages for African Americans based on their ethnic identity.

Beginning this fall, Resnicow, a professor of health behavior and health education at the University of Michigan School of Public Health, will begin testing a questionnaire to assess racial and ethnic beliefs. For example, the survey will ask for a reaction to the statement "Being Black is an important part of my self-image."

The goal is to use responses to determine the role that ethnicity and culture play in the lives of participants.

"To date, when we have developed health programs for African Americans, we have not adequately accounted for the variability within the community, particularly around ethnic and racial identity. Historically, if we were to deliver a health program to African Americans, Oprah Winfrey would receive the same messages as Louis Farrakhan. Dr. Dre would get the same brochure as Bill Cosby," Resnicow said. "We believe that effective health programs should take ethnic identity into account. Our survey responses will be used to match educational materials to each person's ethnic and cultural beliefs."

Study participants who score high on Afro-centric questions might receive information on healthy traditional diets or cancer rates in African countries. Those who score high on positive Black items, but low on Afro-centric items, might get information infused with quotes from American civil rights leaders, he said.

The basic premise is that different people are motivated by different things---what works to encourage one person to quit smoking or eat healthier might not resonate at all with another. Resnicow's study uses race as one dimension to understand personal motivation as it relates to health.

Because of the country's troubled racial history, and ongoing sensitivity about conversations of race, Resnicow said that even asking direct questions about racial attitudes must be done with great care.

"If it wasn't difficult, it wouldn't be worthwhile," Resnicow said. Even the methodology of the phone interviews is delicate, Resnicow said, because of such concerns as whether the interviewers should sound discernibly Black and whether even asking such questions will offend some survey participants.

Resnicow works closely with Victor Strecher, a national leader in tailored health behavior interventions, to help people change their ways. They are part of the U-M Center for Health Communications Research, funded through a $10 million grant from the National Cancer Institute. Both are members of the U-M Comprehensive Cancer Center.

The Center for Health Communications Research has three primary research projects: promoting fruit and vegetable consumption among African Americans; helping people quit smoking; and helping women decide whether to take the drug tamoxifen for breast cancer prevention.

Resnicow will work with the Center for Health Communications Research's partners, Group Health Cooperative of Seattle and Henry Ford Health System of Detroit to conduct phone interviews in Detroit.

"These are HMOs that are on the cutting edge," Resnicow said of the partners, "because they are recognizing the heterogeneity of African-American culture and doing something to improve quality of life among their members."

Eventually Resnicow plans to involve 1,000 people, categorized into five ethnic identity groups. They will receive health information emphasizing their cultural identity, and Resnicow will track their behavior to see if they are more successful in changing habits than those who get standard, non-tailored messages.

He has a solid track record. In two projects with Black churches, which included brochures, videos, cookbooks and professional counseling, participants increased their fruit and vegetable consumption by about one serving a day; they moved from an average of three to four servings a day as compared to the government's recommendation of five. That's compared to most previous projects that netted an improvement of about half a serving.

Based on those results, the National Institutes of Health asked Resnicow to make the program available nationally, funding a training kit for Black churches.

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