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The Kate B. Reynolds Charitable Trust of Winston-Salem has awarded $10 million in grants to fund 16 projects designed to lower chronic disease rates in low-income areas across North Carolina through an initiative called the SELF (Smoking, Education, Lifestyle, Fitness) Improvement Program.

The program, which is administered by Duke University Medical Center, targets populations at greatest risk for chronic disease and seeks to prevent these diseases by educating groups about the dangers of tobacco use, poor nutrition and physical inactivity.

"Chronic diseases, such as heart disease, asthma and diabetes, are tremendous problems in North Carolina," said John H. Frank, director of the Health Care Division, Kate B. Reynolds Charitable Trust. "Through SELF Improvement, we hope to offer new ideas in chronic disease prevention that can be replicated in future years.

"This is a diverse group of 16 projects in 21 counties statewide. We established the initiative in hopes that it would be a catalyst for developing creative and innovative projects in areas with low-income populations and high chronic disease rates. We are very pleased with the projects selected for funding."

Projects considered were submitted by community organizations or existing community coalitions. Funding for the approved projects will be for five years.

"When the Trust originally brought together an advisory committee to discuss health care across the state, one message was loud and clear -- chronic disease in the state is a huge problem, and a program that focuses on prevention is needed," Frank said. Following that meeting, Frank began organizing what would become the SELF Improvement Program.

According to Dr. Lloyd Michener, chairman of Community and Family Medicine at Duke, seven out of every 10 Americans die from chronic disease, and preventable chronic illness accounts for 70 percent of all medical spending in the United States. He said 80 percent of all chronic disease is caused by three health behaviors: physical inactivity, poor nutrition and smoking.

Other statistics show the particular relevance of these behaviors among North Carolinians:

Fewer than 20 percent of North Carolina adults exercise regularly;

North Carolina youth are three to four times more likely to be obese than youth in other states;

Thirty-six percent of North Carolina's current high school students are smokers.

In addition to administering the project for the trust, Michener said his department serves as a resource for the communities in which the projects are being developed.

"We didn't want to go into these communities and tell people what to do," Michener said. "Diet and exercise are woven into people's lives, so it can be very hard to effectively intervene. Instead, we attempt to help the communities identify what they want to work on, and we help them figure out what would work best."

Frank and Michener emphasized that while prevention is critically important in cutting chronic disease rates, it is very hard to accomplish and takes a substantial amount of time and money. "This accounts for the trust's willingness to invest five years and $10 million in this program," Frank said.

"We are pleased that the medical center is involved in the program," Michener said. "SELF Improvement is a great example of the way a private foundation or trust can work with an academic medical center to help keep communities healthy. Health care is not just about treating disease. It's not only about people coming to an academic medical center, such as Duke. It is important that Duke reaches out to people this way. Both Duke and the trust are committed to working with our communities to help prevent disease."

The Kate B. Reynolds Charitable Trust was created in 1947 by the will of Mrs. William N. Reynolds of Winston-Salem. Three-fourths of the income of the trust is designated for use for health-related programs and services across North Carolina. One-fourth is designated for the poor and needy of Winston-Salem and Forsyth County. The trust, which has assets of over $600 million, distributed over $18 million for health care projects across the state last year.

Projects receiving SELF Improvement Program funding in North Carolina include:

Burlington: Improving Nutritional Behavior and Physical Activity for the Prevention of Chronic Disease in the Hispanic Community in Alamance County, Elon University. This project will provide community-based services to the Hispanic community of Alamance County to improve access to nutritional resources and physical activity. Exercise centers will be established in local churches under the supervision of Elon University.

Bryson City: Swain County Project SELF Improvement, Swain County Health Department.

This group will advocate to provide a non-smoking section at sporting events and will analyze nutrition policies at local schools for vending machines and school menus. They also will purchase ovens to replace fryers in the school cafeteria. A one-mile walking trail will be created for area residents.

Elizabethtown: Healthwatchers, Bladen County Hospital. This project will provide prevention services at public school sites in a rural isolated setting utilizing teen/peer encouragers, professionals, school-based staff and volunteers. Targets are students in after-school care, middle school education classes and high school courses.

Gastonia: Community Outreach Program, Gaston County Health Department. This project will provide 50 community-based walking programs in low-income neighborhoods. Project participants will receive additional information on community resources for nutrition and smoking cessation.

Greenville: Growing Up Fit: Building Healthy Lifestyles for Pitt County School-Aged Children, N.C. Agromedicine. Growing Up Fit will develop a school-based program in four rural schools to increase physical activity and improve nutrition education and practice in children from kindergarten to fifth grade. Funding will extend the current pilot program that has support from the American Cancer Society.

Hendersonville: SELF Improvement Project, Partnership for Health. Through volunteers and peer education, this group will reach out to low-income youth and pregnant women in Henderson County. They will also construct a greenway linking public housing neighborhood to parks and the Boys and Girls Club.

Jacksonville: Health Watch, Onslow County Health Department. In addition to education and screening, this project will attempt to recruit additional physicians in the area to serve uninsured and underinsured low-income people.

Kannapolis: CHURCH, Cabarrus Health Alliance. CHURCH will establish a community-based program to train community health advocates. Advocates will provide behavioral modification classes in physical activity, smoking cessation and nutrition. Community wellness coordinators will provide training and support to health advocates in the community.

Manteo: Peer Power, Dare County Health Department. Peer Power will develop a school-based program for low-income students in partnership with the Dare County Health Department. Increased physical activity, smoking cessation and nutrition will be emphasized utilizing peer health educators and the Internet to conduct training and follow-up activities.

Morganton: Pathways to Wellness, Burke County United Way. The project will attempt to decrease the number of public school students and adults using tobacco products by providing classes and support groups to students and their parents. In addition, nutrition will be improved by providing healthy meals at the local soup kitchen, establishing a heart healthy food section at the local food pantry, training in gardening, and evaluating lunches and nutrition education classes in schools.

New Bern: Mission Triangle E, City of New Bern. This project will convene action teams to assist the local health department as well as the parks and recreation department to increase physical activity, improve nutrition and decrease the use of tobacco products in low-income neighborhoods.

Plymouth: MTW Project Self Improvement, Martin-Tyrell-Washington District Health Department. Through a community-wide effort in churches, schools, government agencies and with the help of local grocery owners and physicians, this project is designed to provide screening and referrals to appropriate community agencies and increase the number of adults and students engaging in physical activity. Another goal is to work with local vendors on a Point of Purchase program to increase low-fat/high-fiber foods for sale at their establishments.

Raleigh: Faith and Health Initiative, General Baptist State Convention. Lay leaders will be utilized to motivate and mobilize the membership in associated churches in Granville, Franklin, Vance and Warren counties. In addition to nutrition, physical activity and overall health education, the group hopes to form an advisory committee at every church and provide nutritionally appropriate food choices at church events.

Raleigh: Project SELF Improvement, Strengthening the Black Family. This project will reach out to residents of Pine Acres, Riley Hill and southeast Raleigh. In addition to training lay health leaders and increasing nutrition awareness, this group will implement a Passport to S.E.L.F. Health to help participants monitor their progress.

Warrenton: Power Up, Vance-Warren Comprehensive Health Plan. Through nutrition classes and one-on-one instruction, this project will reach out to middle school children and adults, raising their awareness about obesity and the need for physical activity.

Winton: Hertford Healthy Heart Program, Hertford Gates Health Department. This program will target smoking cessation in elementary schools and offer health advisers in local churches. In addition to walking trails, the program will recruit 15 area restaurants to participate in the Winner's Circle Program to increase the number of healthy items offered on their menu.