Break it down: Drop guns, wear condoms

Anthony Atkins, MD, a family physician working in the poverty-stricken neighborhoods of Lima, Ohio, wanted a way to reach the young African-American males who came to his office with bullet wounds and the 13-year-old girls arriving for prenatal care. He also wanted to find a way to reduce the number of adolescents he saw who had not just one sexually transmitted disease, but multiple types simultaneously.

And then he settled on music.

"These kids listen to hip-hop. They vibe to that. I needed to find a rapper and write out what I saw in a way that the kids would listen," said the staff physician at the Lima Community Health Center.

So, even though he prefers jazz, the 49-year-old doctor started writing lyrics for hip-hop songs and turned them over to local rappers as well as those from Detroit, Chicago and New York. They refined the songs to make them even more relevant for the audience Dr. Atkins wanted to reach.

"They said, 'You're old school, but we know what you're trying to say.' They made it flow better. They made it rhyme," he said.

The result is "LifeStoryz: State of Emergency," a 16-track compact disc that is probably one of the few, if not only, hip-hop releases with a physician credited on the cover. He hands it out to patients or refers them to his MySpace page where four of the songs are posted. He and his rappers also performed at the local high school in September 2006 with the support of the county health department.

"Adolescents think they're bulletproof and invincible. Dr. Atkins makes them stop and think, and he's found a way to do it through music," said Becky Dershem, a nurse practitioner and director of nursing for the Allen County Health Dept. in Lima. "The patients love him, and teenagers respect him a great deal. He's been a real asset to our community."

The music is refreshing. The songs have explicit messages without profanity. The public health themes are clear, but in a language that speaks directly to the intended audience. "Put the gun away," is a song performed by 20-year-old Chicago rapper J-Verse that outlines the consequences -- jail and death -- of being armed. "Strap it up," sung by the 21-year-old Toledo, Ohio-based Miss Behavin, urges women to have enough pride in themselves to demand that men practice safe sex and for men to respect their partners enough to do so.

An eye on making a difference

According to public health officials, it's unclear yet what kind of impact this music has had on the area's health status. Lima, with a 2006 population of 38,219, is nestled in the fairly rural, central-northwest portion of the state. The jurisdiction in general, and particularly the south-side area where the clinic is based, is one of Ohio's poorer locales. Nationally, more than 12% of people live below the poverty line, but it's more than 22% in Lima. The city and the surrounding county's percentage of adults experiencing violence in the past year, 9.3%, is more than double the state's rate of 4.3%, and the region has some of the state's higher rates of HIV and STDs.

But anecdotal evidence suggests that the project may have found real traction.

"Some of the parents say, 'What did you show my kids? Whatever you did, my daughter now says she's not going to have sex,' " Dr. Atkins explained.

Those who have worked with him suspect he is having success because, although he is decades older than those to whom he wants to communicate these messages, he's not so far removed from their world. He grew up in inner-city Detroit and, when faced with a decision about what to do with his life, chose the U.S. Air Force over joining a gang and selling drugs. Both options, he realized, involved the possibility of getting shot, but one would provide his mother with a flag and other compensation if that happened.

After an honorable discharge in 1988, he ended up in a Health Resources and Service Administration program at Ohio State University College of Medicine that aimed to draw students from disadvantaged backgrounds into the health professions. This path led him to medical school. He graduated in 1999. He then completed his family medicine residency in 2002 at Flower Hospital in Sylvania, Ohio, where he received an award for his communication skills and was known for frank talk.

"He could always ask the difficult questions, use real words and get away with it," said Jeanine Huttner, MD, director of the residency program. "He relates incredibly well to people."

The local health status may or may not be improving because of Dr. Atkins musical endeavors, but it is clear that his medical work is making a difference.

In 2003, when he was looking for an underserved area to work in, Allen County Health Partners, which at that time was developing the Lima Community Health Center, was looking for a primary care physician. He's been working there ever since. The facility now has 10 physicians.

Since the clinic opened, the overall death rate in the county has dropped by slightly more than 12%. The African-American death rate was cut by 20%.

"LifeStoryz" has cost Dr. Atkins $7,500 thus far, paid by his extra weekend shifts in the emergency department at Lima Memorial Heath System. He is hunting for ways to distribute his music more widely and working on a second album. He hasn't yet planned for what he'll do if his CDs ever top the charts or even make any money, although local schools would be a likely beneficiary.