A recipe for a healthy community
A UF Health program helps North Florida eat well, access health care and participate in research
By Doug Bennett
Qwamel Hanks puts the question to the group of women in her cooking class: What are the challenges to healthy eating?
The answers come in a flurry. It’s all about money or taste or pleasing the whole family, or even having fun with food.
For Hanks, an extension program assistant with the University of Florida Institute of Food and Agricultural Sciences Extension Family Nutrition Program, the question is a lead-in to a series of classes on healthy, budget-friendly meals at the UF HealthStreet program.
Lori Sawyer explains how she likes the healthier food options at Trader Joe’s, but budget realities also mean shopping at Dollar Tree.
“It’s hard to find a balance between cost and nutrition when you’re on a budget – a very limited budget,” Sawyer says.
She can’t afford complicated recipes with fancy ingredients, and that’s where the Cooking Matters class comes in. Everyone in the group goes home with a grocery bag full of healthy food and a wealth of knowledge about planning nutritious, affordable meals.
The group shifts to the HealthStreet kitchen, where they chop chicken, celery, jalapeno peppers and other vegetables for a healthy stir-fry. Hanks keeps the conversation going with information about the benefits of brown rice.
The small-group setting for the cooking class typifies HealthStreet’s broader mission: engaging residents in ways that improve the well-being of the community by bridging gaps in health care and health research. HealthStreet is very much a two-way avenue. Its members receive referrals to medical and social services as well as opportunities to participate in research based on their needs and concerns. UF researchers engage a diverse group of people who otherwise might not participate in clinical trials and other important research.
HealthStreet’s effort to connect UF researchers with the community in a way that benefits everyone takes diligence and persistence. Community health workers spend every day in neighborhoods from Alachua County to Duval County assessing community members with a 95-item questionnaire. The community health workers link people to the often fragmented network of social services. Later, HealthStreet’s two navigators use the data from the health assessments to link residents to UF research studies.
Some 7,300 people in Alachua and Duval counties are HealthStreet members. More than 3,600 of them have been linked to research studies, and many others have used HealthStreet’s programs and services.
Linda Cottler, Ph.D., founded the HealthStreet program in St. Louis. She brought the program to Gainesville when she joined the University of Florida in 2011as chair of the department of epidemiology in the College of Medicine.
Remarkably, HealthStreet didn’t exist in Florida just five years ago. In early 2011, Linda Cottler, Ph.D., was being recruited to join UF Health as chair of the department of epidemiology in the UF College of Public Health and Health Professions and the UF College of Medicine. After starting HealthStreet during her time at the Washington University School of Medicine in St. Louis, Cottler asked if she could expand the program in Gainesville through the UF Clinical and Translational Science Institute. UF Health’s senior leaders quickly embraced the idea, she says.
The Gainesville area was in need of a HealthStreet program, Cottler says. Nearby Union County typically ranks among the worst in Florida for health indicators such as premature death, healthy births and quality of life.
“We can and must do something to improve health and we think this must include giving everyone a voice in the research enterprise,” Cottler says.
That’s exactly what has happened: In addition to Gainesville, HealthStreet has 2,000 members in Jacksonville and a presence there on the campus of Edward Waters College. Now, a new grant is allowing HealthStreet to also engage people living in Union and Putnam counties. HealthStreet staff found that one of the biggest barriers to medical care for rural residents is transportation. The three-year, $300,000 grant from the Florida Blue Foundation will allow HealthStreet to assess the health needs of at least 1,000 more people, especially those in these two counties who are uninsured or food insecure. They will be provided referrals to medical and social services. The grant will also provide transportation for at least 250 older adults who need help getting to medical and social services.
HealthStreet’s mission to help others is one reason why Vicki Piazza jumped at the chance to become its manager early last year. She traded a career in workforce development for an opportunity to improve the community’s health. More than 40 percent of the people who are HealthStreet members report not having enough money to buy food at some point in the past 12 months.
“I’m really an advocate for healthy eating and taking better care of yourself. It’s everything I believe in,” Piazza says.
Vicki Piazza, HealthStreet manager
That passion helps propel many HealthStreet efforts. Piazza says one of her biggest jobs in the past year has been drawing on UF Health’s many resources to provide health education in the community. Likewise, researchers who work with HealthStreet members on research projects come back to explain the impact of their findings and answer questions as part of an innovative town hall series called Our Community, Our Health.
“HealthStreet is a bridge between our community members and research at the University of Florida. It’s a way to provide health education and access to low- or no-cost medical and social services with a goal of improving the health of our community,” Piazza says.
While surpassing 7,300 members in Alachua and Duval counties and expanding HealthStreet’s presence in north Florida is rewarding, Piazza takes special pride in its personal touch. The detailed health assessments collected by HealthStreet staff help guide UF researchers’ efforts, but sometimes do a lot more. One HealthStreet community health worker met a man at a local social services center. The man had cancer but wasn’t getting treatment, so HealthStreet helped him get care at UF Health and a room at a free lodge for cancer victims, according to Piazza. That’s far from the only story. At a local senior center, a HealthStreet worker did a health assessment on an older woman. The woman had no idea she was suffering from extremely high blood pressure.
“She says that we saved her life, or from having a stroke,” Piazza recalls. “HealthStreet is about meeting people you can trust and talk to — people who can advocate for you. That’s what our community health workers do.”
Other HealthStreet staff work just as hard at helping researchers succeed. Lauren Light, a study navigator, works with UF researchers and the CTSI Recruitment Center to link HealthStreet members to relevant studies. This is why having a broad, diverse group of participants in research matters: A 2015 study published in the journal PLOS One found that diversity in biomedical research differs greatly from the U.S. population. Just 2 percent of cancer studies have enough minorities to provide useful information, researchers at the University of California-San Francisco found. Genetic differences can affect how drugs work, and racially and ethnically diverse research participants are one way to study those differences. HealthStreet also has a study navigator specifically working to educate the community about cancer clinical trials and to increase participation among minorities.
“It’s important that research is reflective of our community to make it more applicable. That way, treatments can be applied to a wide variety of individuals,” Light says.
Lakeshia Hobdy, a community health worker with HealthStreet, talks with Ronnie Boykin.
HealthStreet navigators have been deployed to find participants for research spanning 13 colleges at UF and including topics such as how Internet use affects health. The HealthStreet database of 7,300 people and their detailed health conditions makes that search faster and easier.
“We can find people with almost any condition that researchers might want to study,” Light says.
Catherine Striley, Ph.D., HealthStreet’s co-director and an assistant professor in the department of epidemiology, has been deeply involved with HealthStreet since its inception. She’s understandably proud of the cohort that brings diversity to research work at UF, but gets just as much satisfaction from the many ways HealthStreet helps its members. When a group of UF students once worked with HealthStreet to offer concussion screening for young athletes, Striley recalls how rewarding it was to see coaches bringing their entire team in for evaluations.
“We have worked very hard to build trust among our community members. It’s a huge accomplishment because when we contact them about a study, they have confidence in us that we are matching their interests and needs with a study,” she says.
The plenitude of HealthStreet’s offerings is what keeps Robert Stevens coming back. Stevens, a 63-year-old veteran and Gainesville resident, had his first contact with HealthStreet four years ago at a church’s food pantry. Since then, he has attended HealthStreet’s cooking class and gotten a free bathing suit from its clothing closet. He still uses the cooking tips and the bathing suit — one without pockets — has helped him swim faster during the Gainesville Senior Games.
Stevens has participated in a nutrition research project and was hoping in early March to get into a pending study about smoking cessation. In addition to the compensation that comes with participating in research, Stevens says it feels good to contribute to the advancement of science.
HealthStreet’s many programs are one reason he stays in Gainesville instead of heading farther south.
“HealthStreet has done a lot for me. When I meet someone who needs help, I know where to send them,” Stevens says.
Those testimonials drive Cottler and Piazza to keep finding new and better ways to connect residents to medical and social services as well as research studies.
Piazza said she particularly appreciates that while HealthStreet’s mission never changes, the means to achieve it are always evolving. That includes everything from listening to a member’s idea about finding space for yoga classes to deploying community health workers to a pilot program aimed at evaluating the effectiveness of reducing hospital readmissions. Expanding HealthStreet, especially to rural locations in the region, is never far from Piazza’s mind.
HealthStreet Cooking Matters class teaching low-income families how to cook nutritious meals and make positive eating behavior changes.
“It’s really about listening to what the issues are in our communities, and going from there,” she says.
It’s an idea that’s catching on around the world: HealthStreet has drawn interest from people who want to replicate the program in other parts of Florida, as well as in Thailand, India and Australia. From its humble beginnings in a neighborhood storefront in St. Louis in 1989, Cottler says launching a program that benefits both residents and scientists is immensely satisfying, adding that it can be a model for community improvement.
“We have really given everyone a voice in the research enterprise, and you can’t do research without the people in your community,” Cottler says.
Inclusiveness has driven HealthStreet from its start, according to Striley, who encourages her family and friends to become members of HealthStreet to take advantage of the opportunities it offers.
“When we ask people why they want to participate in research, the majority always say that they want to benefit the health of their families, friends and communities. We all want to make a difference and give back. HealthStreet provides an easy way to do so.”
