by Christiaan Abildso, PhD

---

Dr. Perry on the Continental Divide Trail in the Wind River Range, Wyoming

In the fifth episode of Views from the Front Porch, my guest is Dr. Cindy Perry, the Elizabeth N. Gray Distinguished Professor and an Associate Professor at the Oregon Health and Science University School of Nursing in Portland, Oregon. She loves backpacking, especially her annual two-week off-the-grid wilderness area trip. Much of her year is devoted to maintaining her aerobic and muscle strength with a regiment of yoga, resistance training, walking, and other aerobic training activities. Cindy’s interest in rural physical activity is a result of this very active lifestyle, her experience as a community organizer, and a 30-year Family Nurse Practitioner career. As an FNP in rural Oregon she was a first-hand witness to the disparities in heart disease risk factors and treatment experienced by rural women.

Cindy has blended her personal and professional interests to weave together an extensive line of community-based participatory research with predominantly Latinx communities in Oregon to address health disparities with physical activity. She has answered the Rural Active Living Call to Action paper led by Dr. Renée Umstattd Meyer published by JPHMP in 2016 in multiple ways: (1) acknowledging the unique social, cultural, and environmental contexts of rural communities; (2) recognizing and planning for the diversity that exists in rural communities; and (3) using valid, rural-specific environmental assessment measures (ie, the RALA).

Cindy is a very skilled researcher and thoughtful, respectful listener. This is reflected in the story she tells in the podcast about an NIH K23 career development award she received to promote PA in middle school youth to address chronic disease via a community-academic partnership. As the project evolved, so did the focus. The community was grappling with gang violence, so Cindy and her team adapted their work to assess and address that as a risk behavior preventing PA and park use. They also adapted and incorporated Brian Saelens’ EAPRS audit tool as well. As expected, through truly hearing the community she built trust and ongoing CBPR activity. Because of this trust and mutual respect, the results were used by local advocates to secure sustained funding from local government for a parks and recreation center that previously had been closed!

In a survey of middle school students in the area, Dr. Perry and colleagues found out that respondents that were more active at the park and those that participated in an organized after school activity were less likely to be in a gang, and that the students that were in an organized activity were more likely to be active while at the park. Using these findings, Cindy and her partners developed “Go Active!” after-school PA program for middle schools that grew into a girls-only middle- and high school program at the recreation center. This expanded geographically into additional areas and added broader community built environment change to go along with programming. In this case Cindy and her team used the Rural Active Living Assessment (RALA) tools. This grew into one of the first ever Ciclovía events for a rural Latinx community that very successfully drew people out to be active on a local street. Again, she adapted urban-centric evidence and tools to structure the intervention and evaluation.

Recently, Cindy has been working to adapt, disseminate, and implement evidence-based PA and nutrition programming from the NCI’s Research Tested Intervention Programs with middle- and older-aged rural Latinas to combat chronic disease. Many of the adaptations focused on cultural relevance but adaptations were also related to nutrition knowledge, health knowledge, and skills and strategies. A pilot study of the adapted program, Mujeres Fuertes y Corazones Saludables, showed strong promise, with improvements in weight, waist circumference, and cardiorespiratory fitness among participants. She and her colleagues are now working on obtaining funding for large dissemination and effectiveness trial of Mujeres Fuertes.

As I reflect on the chat with Cindy, I am so impressed at how much CBPR activity she has done and how hard she has worked to embed herself in these often overlooked and underestimated communities. Developing trust with rural communities is a difficult process because many of them have experienced multiple forms of “extraction” historically, losing their natural resources to outsiders for decades, and more recently losing their well-educated youth to urban areas, and their data to well-intentioned researchers. She has embraced her experience in community development and used her academic research skills to lift up communities. It took her over a decade to create a true, trusting relationship with her community partners by listening and adjusting, while retaining research rigor. Cindy and her colleagues should be applauded for all they’ve done. She is truly a Mujer Fuerte!

---

Dr. Christiaan Abildso is an associate professor in the Department of Social and Behavior Sciences in the West Virginia University School of Public Health in Morgantown, WV where he’s lived since 2004 with his wife and two children since. His research interests include health promotion program evaluation and social-ecological determinants of physical activity, including policy and the built environment. Dr. Abildso has multiple peer-reviewed publications about rail-trails, health impact assessment, physical activity planning, and evaluation of state-level health promotion programming. Christiaan is also active in local and state active transportation policy decisions, pedestrian and bicyclist safety, and national research on physical activity in rural areas. When not in the office, you’ll usually find him riding his bike (very safely) on the beautiful trails and country roads of West Virginia.