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Transformations in Research: Community Collaboration Key in CDC Extramural Research Projects

This is the second installment in a 2004 series of columns highlighting new methodologies, approaches, and technological innovations in academic research.

By Whitney L.J. Howell

"The community needs to be involved at the outset, not in a 'down the line' position."

- Larry Green, M.D., director, CDC's Office of Sciences and Extramural Research

Research funding at the Centers for Disease Control and Prevention (CDC) has undergone a facelift in the past year - intramural (internal) research projects are not the only ones securing grant monies anymore. Instead, extramural projects conducted around the United States have secured CDC funding to investigate various health interests, such as asthma in children or obesity.

According to Larry Green, M.D., the director of the CDC's office of sciences and extramural research, his office received over 300 applications in April 2002 and 26 grants have been awarded since Oct. 2002. Each project is designed to conduct community-based participatory research, meaning the project will be funded only if it actively includes the surrounding community in the investigative process.

"By the CDC not doing the research itself, we've given the investigators lots of latitude with one requirement - they engage the community in a significant way," Dr. Green says. "The community needs to be involved at the outset, not in a 'down the line' position."

Including the local community helps alleviate the research-to-practice gap that Dr. Green says haunts the medical community. Too often there is a breakdown between valuable research and relevant applications in society. By making the community part of the project, not only does the research become immediately relevant to one location, but it is also more likely to have an impact on other geographic areas.

When selecting which programs to fund, Dr. Green likens the CDC's grant selection to the peer review process employed at the National Institutes of Health. Each application was scrutinized by 105 reviewers and was ranked based on three criteria: scientific rigor, relevance to current medical/health needs, and the depth to which the community would be involved. Each project selected receives up to $500,000 a year for three years to conduct research.

"We didn't want to replicate what has been done with existing grants," Dr. Green says. "So we encouraged applicants to address cross-cutting issues, such as obesity in children."

For example, one study at the University of Michigan's School of Public Health is examining asthmatic children while assessing collaborative and innovative approaches to control the affliction through family education. The information gathered will be used for the Head Start program that will provide guidance on managing chronic illnesses.

So far, the Head Start centers involved with the program are motivated to learn more about asthma because they work with a large population of children with the chronic disease. But the work and research wouldn't be possible without the CDC, says Belinda Nelson, the program's coordinator.

"We wouldn't be able to do anything without the funding - it allows us to do everything we need," she says. "The money lets us spend time developing surveys for parents and providing training for Head Start workers. All our funding comes from the CDC."

Another program, conducted by the University of Washington, focuses on preventing teenage suicide through mood-management education and teaching parents how to constructively and effectively talk to their children about healthy decision-making and dealing with anger.

So far, the reaction to the community-based participatory research projects has been good, Dr. Green says. Most of the positive feedback has come from the grantees themselves, but several of the community members involved in research efforts have expressed approval of these collaborations.

"There's been a lot of enthusiasm for the projects," he says. "We pulled the grantees together for two meetings. Both times they were very excited, but they had more experiences to discuss at the second meeting."

However, the road to collaborative, community-based research has not been completely smooth. Researchers had to overcome the longtime perception that they use communities for information and never give anything back. The leaders of the participatory groups had to convince communities they were not going to be exploited for data gathering but were instead going to be the initial beneficiaries of any medical findings.

This issue was particularly sensitive to some predominantly minority communities whose participation in research projects has resulted in some embarrassing findings, such as the study that found a high rate of alcoholism among Native Americans, says Dr. Green. To avoid any potential mistrust or misgiving individuals may have about being part of a study, each research center disseminated guidelines to address this frequent problem.

But what is the future for community-based participatory research at the CDC? It's still too early to say, even though the outlook appears bright.

Dr. Green says CDC Director Julie Gerberding, M.D., MPH, is contemplating building upon the expertise developed in this round of projects and making the program a feature of the "Futures Initiative," designed to improve the public health system. However, Dr. Green hastens to emphasize that no continued work with the participatory research projects has been finalized.