Cultural Crusade
By Kecia Anrio Johnson
UF Psychology Professor Promotes Healthy Lifestyles In African-American communities
Carolyn Tucker grew up in a culture where hog jowl, collard greens and ribs were the center of celebrations and the solution to problems.
"For many African-Americans, food is a way of expressing our love and affection and honoring our past," says Tucker.
But with all that love came plenty of salt, cholesterol and saturated fats, and by the time she was a young adult Tucker weighed more than 200 pounds. And so did many of the friends and relatives she would see at church each Sunday.
After earning a doctorate in psychology and settling into a career at the University of Florida, Tucker began to recognize the role culture played in her own weight issues and in the dietary challenges of other African-Americans.
She conquered her own obesity and today is trim and fit, but she knew she needed help to convince members of her community to do the same. So she turned to the churches.
"Although African-Americans understand the importance of a healthy diet and health-smart behaviors such as exercising, it's difficult to translate that knowledge into their everyday lifestyles," Tucker says.
Testifying is a staple of the African-American church, and it seems to come naturally for Tucker. You can almost hear the "Amens" in church sanctuaries and fellowship halls when Tucker gives personal testimony about her struggles with obesity.
"Being responsible for your own health is difficult and challenging because of the economic and social barriers you may face," Tucker recently told Gainesville-area church leaders at the kickoff for the Health-Smart Church Program, which she developed with a $100,000 grant from The Blue Foundation for a Healthy Florida, the philanthropic arm of Blue Cross and Blue Shield of Florida.
Tucker speaks with conviction about how a diet low in salt, cholesterol and processed foods, a lifestyle of healthy food preparation techniques as well as increased vegetable consumption and other behaviors can produce immediate and long-term health benefits.
This message of self-empowerment and practical health strategies for minorities and low-income families is not unique to Tucker's latest research intervention -- it's a thread that runs throughout her 32-year career.
When the statistics screamed that African-American women were at higher risk of developing hypertension and obesity than all other racial and gender groups in the United States, Tucker responded.
"I just felt like somebody needed to do something about this. And I decided 'I think I can.' Now I know I can," says Tucker, who was recently named Richard and Thelma O.C. Barney Term Professor in Health Disparities in the College of Medicine.
Doctors and nurses alone can't get families to be healthy, Tucker says, so she has tapped into the influential power of churches.
During the two-year program, Tucker and a team of students are training selected pastors and parishioners from 10 Gainesville-area churches to be health promotion coaches. Their job is to encourage consumption of healthy vegetables, healthy cooking practices and exercise among 120 targeted women and later among entire congregations.
A supplemental grant from the UF College of Medicine also provides each church with a treadmill, exercise and stretching programs, and balance beam scales.
"Traditional food choices and preparation may contribute to the disproportionately high number of African-Americans who are obese and suffer from hypertension," says Tucker, who will validate the results of her efforts by comparing participants' and a control group's before-and-after blood pressures, body mass indexes, cholesterol and other measures. "These variables will be monitored to see if any change occurs as a function of participating in the program."
Ultimately, Tucker hopes the churches will be able to carry on as independent health promotion centers. Tucker has also created a DVD version of the workshop to make it accessible to people in other communities.
It is just this kind of grassroots research that makes Tucker so successful, says UF psychology department Chair Neil Rowland.
"We like to think that most of our research is very relevant," Rowland says, "but her research really has relevance because it's right out there dealing face to face with people."
The Health-Smart Church Program is just the latest in a succession of empowerment programs Tucker has conducted over her career, and for which she has garnered more than $10 million in support from numerous public and private funding agencies.
While kicking off the Health-Smart Church Program, Tucker and another team of students were wrapping up The Family Health Self-Empowerment Program, supported by $1.1 million from the PepsiCo Foundation.
For that project, Tucker's team interviewed lower-income families across the nation about social and family influences on their health behaviors and then developed a survey of motivators and barriers to healthy behaviors and a workshop to address them.
Tucker tested the workshop's effectiveness with 300 families from Ocala and Gainesville and found that families who participated lowered their blood pressures and body mass indexes and improved their lifestyles.
"There was a 45-year-old woman in the study who had been eating spare ribs for breakfast and suffered from disabling obesity," Tucker recalls. "Seeing people like her change their food philosophy is what makes the effort worthwhile."
Tucker says that understanding a community's unique challenges is vital to developing effective health-promotion programs.
"If foul-smelling water is a barrier to drinking enough water, then the community can work on getting water treatment," she says.
Tucker's message of cultural awareness was also echoed in the Patient-Centered Culturally Sensitive Health Care Project, a 2001 project funded by $236,000 from the Robert Wood Johnson Foundation.
For that project, Tucker wanted to see if there was a relationship between positive health outcomes and health-care providers' responsiveness to the wants and needs of diverse groups of patients.
To better understand how patients see health-care providers, Tucker asked a racially diverse national sample of adults to identify what provider behaviors, attitudes and health-care site characteristics were most important to them.
A study using the resulting survey showed a clear link between culturally sensitive provider behaviors and patients' satisfaction with health care, adherence to medication and treatment plans, and engagement in healthy behaviors.
Mentor To Many
Tucker relies heavily on graduate and undergraduate students to administer her often labor-intensive projects, and she tries to bring a sense of family to the team.
She remembers vividly the loneliness she felt when she arrived in Gainesville as a young assistant professor in 1979: "One of the things that was hard initially was just feeling so alone as a minority person here. Finding my place here and just feeling comfortable and establishing a support system within the university were major challenges."
Each semester Tucker takes about 10 graduate and 60 undergraduate students under her wing, forming them into teams of "research associates" in various aspects of her projects. A high percentage of her research teams are ethnic minority students who benefit by working as professionals long before they earn a degree. She has mentored more than 40 doctoral students through their degrees and has been honored with UF's Doctoral Dissertation Advisor and Mentoring Award in 2003 and 2010.
Chris Mack arrived in Florida from Michigan in 2001 knowing little about the culturally and racially diverse state, but he says Tucker welcomed him professionally and as a mentor.
"Where I'm from there were only three predominate cultures: White, African-American and Arabic," Mack says. "Dr. Tucker taught me about being more accepting and open and about adapting to your environment."
Mack served as co-director of a 2003 project for Tucker called the Children's Health Self-Empowerment Program, which provided him clinical experience and data for his dissertation in multiculturalism and health empowerment.
"As a researcher, I don't know anyone who works harder than Dr. Tucker," says Mack, who now works as a forensic psychologist with juvenile and adult offenders.
Manuel Lopez, a doctoral candidate in counseling psychology, has supervised administrative aspects of several research projects during the seven years he has worked with Tucker. Their research relationship developed when Tucker served as chair for his undergraduate senior thesis and as his McNair Scholar mentor.
"Even though I was volunteering on her research project, I had my own little research study. I had the idea, but she helped me pick the variables I was going to look at and get my idea into an executable plan on paper," Lopez says.
Then Tucker helped Lopez explore research in psychology as a possible career.
"In order to do anything in psychology you really need to have a Ph.D.," Lopez says. "Dr. Tucker was helpful in preparing me to learn about the research process."
Tucker also has a strong presence in the Gainesville community. Soon after she settled in Gainesville she became involved in a project to address widespread behavior and academic problems among the community's minority children.
Tucker helped establish education centers, starting with the church she attended, and she preached that children had to take responsibility for their learning and control of their behavior.
"It's about what you can do to achieve health and academic success under whatever conditions that exist in your life," she says. "I know we're not going to change poverty overnight, we're not going to move that crack house on the corner overnight. So it's how can these kids achieve in spite of all those things? So it has to be you having some behaviors, skills and knowledge to achieve against every single odd."
Retired teacher Deloris Rentz has worked with Tucker since the early 1990s, when she participated in Tucker's Community-Based Research Partner in Education Program, an academic self-empowerment program. Rentz and others not only helped students academically but taught them about self praise, praising others and using alternatives to deal with problems.
"In her personal life and in her research she wants to demonstrate to people and help them understand that they too have control to make whatever changes they want to make or to go into whatever directions they choose," says Rentz, who is now a community research coordinator for the Health-Smart Church Program and a member of the Blue Foundation Team.
"A passion of mine is conducting research aimed at health promotion and reducing health disparities, and preparing the next generation of researchers -- both minority and majority students -- who are committed to minority health and reducing health disparities. If I have any kind of legacy, I hope it will be this research and mentoring. Right now there is such a strong need for both."