Taking Care of Your Diabetes: 958 Kentuckians have participated since the program began in June 2011; 400+ saw their health professional as means of managing their diabetes, had their A1C checked and participated in physical activity for 30 or more minutes at least five days a week; 300+ checked their blood glucose levels at least once a day, utilized a meal and set and accomplished goals for themselves; 200+ said they've moved into action and maintenance stages.




































"To many people,

poor mental health

is seen as an

embarrassment or

a failing on their part.

We wanted

to help get rid

of that stigma."

by Katie Pratt


It's no secret that Kentucky ranks near the top or leads the nation in some health statistics that it would rather not.
A high prevalence of obesity, a high rate of cancer deaths, and a high number of poor mental and physical health days each month are just some of the reasons the state ranked 44th in the nation in the 2010 America's Health Rankings.
















Centers for Disease Control and Prevention: National Diabetes Surveillance System.Available online at: (Retrieved 11/11/2011)




FOR YEARS, University of Kentucky Cooperative Extension Service agents have been implementing grassroots efforts to target these unflattering health statistics, and they are making a difference in the lives of many.

"Family and consumer sciences extension agents are trusted and respected members of their communities," said Ann Vail, UK assistant director of Family and Consumer Sciences Extension. "When they promote certain health behaviors, they have a great deal of credibility, so people tend to listen."


Lives Saved

A fellow Crittenden County Extension Homemaker urged Micki Crider and other club members to go to a free UK HealthCare ovarian cancer screening in 2004. Her screening showed stage 1 ovarian cancer, and within a short time, she had surgery to remove it.

"I don't think I would have known I had the disease had it not been for the screening," she said. "Ovarian cancer is such a silent disease, often with no symptoms. Because of this, many times the cancer is too far advanced by the time it is found."

According to UK HealthCare, ovarian cancer accounts for 3 percent of all cancer diagnoses in women and 6 percent of cancer-related deaths in women.


Micki Crider (l) and Nancy Hunt believe in the value of exercise.
For Crider, it's an important tool in helping to control her Type 2 diabetes.


Now, Crider is tested annually for ovarian cancer; she remains cancer free.

Even before she was diagnosed, Crider, like many Kentucky Extension Homemakers, donated to the Kentucky Ovarian Cancer Research Fund. Homemakers started contributing to the fund in 1977 at the request of the late Virginia McCandless, who was State Health Chair of the Kentucky Extension Homemaker's Association and battling ovarian cancer. The original goal was for Homemakers to donate $1 per member. Fundraising efforts have continued since then with total donations reaching $1.1 million in 2011.

In addition to research, the Extension Homemaker donations help fund UK's free ovarian screening program. UK began offering screenings in 1987 and since has detected 80 cases of ovarian cancer, 70 percent of which were like Crider's—in the early stages and treatable.


Support Helps

Around the same time she was diagnosed with ovarian cancer, Crider discovered she had Type 2 diabetes. As a Kentuckian, she isn't alone. Statistics from the Centers for Disease Control and Prevention show that the percentage of Kentucky adults diagnosed with diabetes has steadily increased each year since 1994. All but 25 Kentucky counties have an age-adjusted estimate of more than 10 percent of the adult population being diabetic.

To help people come to terms with and control their diabetes, Ingrid Adams, assistant extension professor for nutrition and weight management, developed the Taking Control of Your Diabetes curriculum that focuses on many issues related to diabetes including how to eat and manage blood glucose levels.

"We are really concerned with Type 2 diabetes because a greater percentage of people have Type 2, and it is directly related to obesity," Adams said. "What's really alarming is we're starting to see a lot of children develop Type 2 diabetes."

When Nancy Hunt, Crittenden County family and consumer sciences extension agent, partnered with the local health department to offer Taking Control of Your Diabetes, Crider knew she wanted to attend.

As a result of the classes, Hunt and interested participants formed a diabetes support group that meets each month. Crider regularly attends these meetings.

"At each meeting, I learn some little point or tip about controlling diabetes that I never knew before," she said. "I like the group setting too, because you get to hear someone else's experiences, receive feedback and ideas."

The impacts of the class have extended beyond the extension office; Extension has formed the Crittenden County Diabetes Coalition in partnership with the local health department.


Weight Loss that Clicks

Positive healthy changes don't happen overnight though—just ask Norma Jean Yankey of Springfield. Prompted by seeing a vacation photo of herself, Yankey first enrolled in Washington County Cooperative Extension Service's Weigh Down Washington County five years ago. Like many people, she found herself on a weight rollercoaster for the next four years. Most years, she reached her "Weigh Down" goal of losing 7 percent of her body fat, but by the time the annual program rolled around again, she had regained most of it.

"I finally realized I had to make a year-round lifestyle change and not just a 2 1/2 month lifestyle change," she said. "The one program that really had a lasting effect on me was the one that encouraged me to keep a food diary. It made me aware of all the unnecessary calories I was eating."

Yankey said she's lost about 30 pounds total in the five years she's participated in "Weigh Down." In addition to keeping a food diary, she has switched from 2 percent to 1 percent milk, increased her intake of whole grains, fresh fruits and vegetables, and cut back on processed foods and sweets.


Norma Jean Yankey (l) and Kay Kennedy display the bike Yankey won
at the completion of Weigh Down Washington County. "I finally realized
I had to make a year-round lifestyle change," Yankey said.


Kay Kennedy, family and consumer sciences extension agent, started Weigh Down Washington County nearly a decade ago to help reduce Washington Countians' expanding waist lines. During the 10-week program, Kennedy partners with representatives of local health-related organizations and uses Extension's Weight: The Reality Series curriculum to help participants learn how to eat healthier and increase their physical activity.

"Issues with overweight and obesity affect all ages. It's not just the elderly, and it's not just the young," Kennedy said. "I've had three generations participate in the program before. A lot of wives drag their husbands in, and sometimes men are our biggest losers."

Yankey's story isn't unique to the program. Kennedy estimated about 25 percent of "Weigh Down" participants each year have attended before, which is one of the reasons she continues to host it every January through March.

"Each year I tell the 'Weigh Down' participants that this program is no quick fix. It's a lifetime change that includes portion control, healthy eating, and physical activity," Kennedy said. "Norma Jean didn't give up. It was her persistence that paid off, and like she said, it finally clicked for her."


Breaking Down Stigmas

According to the 2010 America's Health Rankings, Kentuckians reported more days of poor mental health per month than any other state population.

Individuals aren't as open to discussing mental health issues compared to physical health problems, because there tends to be a stigma associated with poor mental health. Another barrier is the limited access to mental health professionals and services in many rural areas, said Martha Perkins, Bath County family and consumer sciences extension agent.

"To many people, poor mental health is seen as an embarrassment or a failing on their part," Perkins said. "We wanted to help get rid of that stigma."

A few years ago, Perkins was Rowan County's family and consumer sciences agent. The county's Extension Homemakers approached her to conduct a lesson about Alzheimer's. After that presentation, they began requesting more information about general mental healthiness and, the following year, chose the topic of mental health in aging for a lesson.

She approached Debbie Murray with UK's Health Education through Extension Leadership about available mental health resources. Through a partnership with Faika Zanjani, UK assistant professor in the Graduate Center for Gerontology, and funding from the U.S. Department of Agriculture's Rural Health and Safety Education Program, the Mental Healthiness in Aging Initiative was formed.


Faika Zanjani (l) and Debbie Murray developed the curriculum for
HEEL's Mental Healthiness in Aging Initiative.


They piloted the initiative in 11 northeastern Kentucky counties during 2008. Agents recruited community members to participate in focus forums about mental healthiness and taught Extension Homemakers and others ways to recognize mental healthiness and to provide assistance to those who may be mentally struggling.

The agents also used social marketing, newspaper columns, and calendars to reach a larger audience. An additional 29 Eastern and Central Kentucky counties received the initiative's television marketing campaign.

In February 2009, a UK random phone survey found that individuals in the 11 pilot counties were able to better assist those with mental health issues compared to other parts of the state.

Murray and Zanjani took the results from the initiative and developed a curriculum on mental healthiness. In 2010 and 2011, it was piloted in Bath and Floyd counties, two rural Eastern Kentucky counties that were not a part of the initial pilot.

Individuals were tested before and after receiving the curriculum and then again three and six months later.

"The findings were statistically significant and indicated enduring improvement in their awareness and knowledge about mental health and substance abuse issues and aging," Murray said.

The curriculum will be released statewide this spring.

Success stories like these keep piling up as extension agents continue to implement programs to help community members improve their health and quality of life. While it can take many years for a population to make healthy lifestyle changes, extension agents will keep working toward a healthier, happier Kentucky.◆


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