Overall goal: To extend community voices into the policy-making arena in order to have an impact on local, state, regional and national level policies aimed at creating healthy, safe, and supportive neighborhoods for children and families.
Objectives:

• To strengthen the capacity and increase the effectiveness of the partners involved in the URC and affiliated projects and key organizations/individuals involved in The Skillman Foundation's Good Neighborhoods Initiative (GNI) to train others to engage in policy change efforts, and to carry out policy-related work.
• To enhance the capacity and skills of youth, community residents and members of community organizations residing in the GNI  and URC neighborhoods to conduct effective policy-related work.

Detroit URC and affiliated projects will join with PolicyLink, a national policy consulting and capacity building organization based in Oakland, California, to implement training and technical assistance (TA) activities to be carried out in the GNI and URC neighborhoods, including: conducting a train-the-trainer workshop series for community and academic "core trainers" and organizational representatives; development of a policy training toolkit ; conducting a series of community-based training sessions for residents and organizational representatives in the GNI and URC neighborhoods; and providing ongoing TA to those who have completed the training. 

Short-term: Increased awareness and understanding of  the policy making process among community residents, including youth, and members of community organizations; and increased knowledge, skills/capacity and aspirations among community residents to engage in policy solutions to community-identified concerns. 

Mid-term: Youth, community residents and members of community organizations: extend and strengthen social networks for policy change; mobilize and educate for policy change at the local, state, regional and national levels; and engage in policy change at the local, state, regional and national levels

A participatory and formative evaluation, using both quantitative and qualitative methods, will examine the process and outcomes of the project.  The process evaluation will address questions related to project implementation and understanding how and why various aspects of the project were or were not effective (e.g., barriers and facilitating factors in conducting the training).  The outcome evaluation will address questions related to the impact of the  project on the short-term and mid-term outcomes (e.g., to what extent did the participants gain knowledge and skills through the training?; to what extent were the knowledge and skills developed applied by participants to policy change efforts?).

N/A

Household Intervention: 15 month intervention. All homes will receive home visits by Community Environmental Specialists including education materials (e.g., pest control, cleaning). Half of the homes will receive the air filters and air conditioner intervention.
Vehicular Exhaust Assessment: N/A

Intervention: Asthma health status (medication use, health care utilization, quality of life, lung function);  indoor air quality (PM2.5 ,elemental and organic carbon, carbon monoxide, carbon dioxide, bioaerosols, nitrogen dioxide, ozone, volatile and semivolatile organic compounds, behavior changes related to environmental triggers (cleaning, smoking).
Vehicular Exhaust Assessment: Asthma health status (lung function, asthma symptoms, asthma medication use, health care utilization; quality of life); outdoor air quality (e.g. PM 2.5, PM 10, ozone, meteorological variables).

Intervention Longitudinal analysis of relationship between presence of air filters/air conditioners and health outcome indicators (e.g. asthma symptoms, indoor PM 2.5 levels) controlling for demographic and potential confounding factors. Qualitative partnership evaluation.
Vehicular Exhaust Assessment: Longitudinal analysis of relationship between air quality and health outcome indicators, controlling for demographic and potential confounding factors.

Household Intervnetion: Prior MCECH/CAAA household intervention with lay outreach workers was effective in increasing some of the measures of lung function (daily nadir Forced Expiratory Volume at one second [p =.03] and daily nadir Peak Flow [p =.02]), reducing the frequency of two symptoms (“cough that won’t go away,” “coughing with exercise”), reducing the proportion of children requiring unscheduled medical visits and reporting inadequate use of asthma controller medication, reducing caregiver report of depressive symptoms, reducing concentrations of dog allergen in the dust, and increasing some behaviors related to reducing indoor environmental triggers.
Environmental Exposure and Health Assessment: Prior MCECH/CAAA study results showed that higher levels of Detroit ambient air pollutants were associated with acute reductions in lung function, especially among susceptible subgroups of asthmatic children (those on corticosteroids and those experiencing a respiratory infection).  Analysis ongoing.

The HEP Lean and Green in Motown (LGM) project aims to better understand relationships between the built environment, physical activity and dietary practices, and to assess the impact of interventions that include environmental change efforts on increasing physical activity and promoting healthy diets. LGM objectives are:

• To assess residents’ use of green spaces in selected neighborhoods to understand the relationship of the built environment to obesity.
• To d evelop and implement an intervention that includes modifications to the built environment along with social and behavioral approaches to promote physical activity.
• To conduct evaluation to determine the impact of the intervention.
• To d isseminate findings broadly throughout Detroit and elsewhere.

Brightmoor Community Center, Detroit Department of Health & Wellness Promotion,
Detroit Hispanic Development Corporation, Friends of Parkside, Henry Ford Health System/AIMHI, Rebuilding Communities Incorporated, and University of Michigan School of Public Health and A. Alfred Taubman College of Architecture and Urban Planning.

• Work with greenway organizations to identify greenway enhancements to promote use by residents for physical activity.
• Work to establish physical activity classes for northwest Detroit residents.
• Support ongoing physical activity classes for eastside and southwest Detroit residents.
• Support physical activity instructor training and certification for community residents.

Data collection and analysis in progress.

For more information on the Healthy Environments Partnership and its programs, visit http://www.sph.umich.edu/hep/.

HEP Community Approaches to Cardiovascular Health in Detroit (CATCH) aims to address the disproportionate risk of heart disease among residents of eastside, northwest and southwest Detroit. CATCH objectives are:

• To e xpand and maintain the Healthy Environments Partnership to strengthen the ability of the Detroit communities to reduce differences in cardiovascular disease.
• To i mplement a community assessment that engages community residents and community based organizations to examine strategies to reduce differences in cardiovascular disease.
• To e ngage community residents and community based organizations in designing a community intervention plan to reduce differences in cardiovascular disease.
• To c onduct and evaluate a pilot intervention using a CPBR approach to reduce differences in cardiovascular disease.
• To e valuate the partnership process to determine the effectiveness of using a CBPR approach.

Brightmoor Community Center, Detroit Department of Health & Wellness Promotion, Detroit Hispanic Development Corporation, Friends of Parkside, Henry Ford Health System/AIMHI, Rebuilding Communities, Inc., community members at-large, and the University of Michigan School of Public Health

• Evaluate the HEP Partnership
• HEP Sterring Committee (SC), CBOs and community residents and staff implement a community assessment.
• HEP SC and staff conduct a Youth Photovoice project.
• HEP SC and staff design, implement, and evaluate a CBPR pilot intervention aimed at increasing physical activity.

Data collection and analysis in progress.

For more information on the Healthy Environments Partnership and its programs, visit http://www.sph.umich.edu/hep/.

Healthy lifestyle intervention (HLI):   Culturally and environmentally tailored, English and Spanish language programs conducted by community resident Women’s Health Advocates (WHAs) that includes group social support/activity and curriculum-based meetings and home visits and that develop social support, knowledge and skills needed for healthy eating, regular exercise and stress management and healthy pregnancy, childbirth, postpartum maternal and infant development.
Healthy pregnancy (control) intervention (HPE): Culturally tailored, English and Spanish language pregnancy, childbirth, postpartum and stress management education; usual care materials; conducted by community partner staff in both communities.

Primary outcomes: increased physical activity, fruit, vegetable and fiber consumption; decreased simple sugar, trans and saturated fat consumption.
Secondary outcomes: Improved anthropometric, metabolic, social support and psychological measures; positive changes in beliefs and attitudes regarding weight, eating and exercise.
Process outcomes: program fidelity, adequate recruitment and retention; participant, host site, WHA and Steering Committee satisfaction; replicable materials and methods.

• To a dapt and demonstrate integration of Healthy MOMs culturally tailored, Spanish-language, Women’s Health Advocate-led healthy lifestyle intervention with prenatal and postpartum care and community activities provided by a federally qualified health center (CHASS) in southwest Detroit.
• To achieve increased physical activity; increased fruit, vegetable and fiber consumption; decreased simple sugar, trans and saturated fat consumption.
• To achieve recommended pregnancy weight gain and weight loss at 6 months postpartum.
• To disseminate results and implement sustainability strategies in clinics and programs.

Women’s Health Advocates (WHAs) lead culturally tailored, English and Spanish language home and group curriculum and social support/activity meetings, and team with CHASS clinicians and participants at key clinic visits, to develop social support, sense of empowerment, knowledge and skills needed for healthy eating, regular exercise and stress management and healthy pregnancy, childbirth and postpartum outcomes.

Behavioral and weight outcomes:  At 6 months, postpartum, Increased physical activity, fruit, vegetable and fiber consumption; decreased simple sugar, trans and saturated fat consumption; appropriate pregnancy weight gain and postpartum weight loss; positive changes in beliefs and attitudes regarding weight, eating and exercise; increased social support and improvements on markers of stress and depression.
Process outcomes: program fidelity; adequate recruitment and retention; participant, host site and WHA satisfaction; replicable and sustainable materials and methods.

To reduce risks associated with type 2 diabetes and its complications by increasing diabetes awareness, reducing barriers to, and increasing resources for, healthy lifestyles and promoting increased diabetes self-management and control, healthy eating, physical activity and appropriate health care.

Community and Social Support Interventions: REACH partners and staff are influencing national, state and local policy and program development through national, state and community committee membership and presentations.Scores of trained community residents (e.g. diabetes awareness presenters and group leaders, physical activity instructors, community and family health advocates, social support and walking group leaders); hundreds of new programs and resources, many sustained by community organizations (e.g. community produce markets, physical activity classes, physical activity and food handler train-the-trainer programs leading to national certification); thousands of group sessions (e.g. diabetes support groups, physical activity classes, walking groups, “Dance For Life”, physical activity and healthy food demonstrations and diabetes awareness presentations and events; culturally and linguistically tailored curricula, health and healthy lifestyle education and promotion materials (e.g. healthy eating tip sheets, healthy meeting pamphlets, recipe cards, train-the-trainer manuals, community sustainability manuals).  REACH community organization sustainability models including policies, procedures, and manuals oped sustainability models for physical activity classes in community organizations. REACH hosts the Detroit Community Food Collaborative that is working to increase the supply of and demand for healthy foods. 
Family Intervention: REACH participants with diabetes have achieved statistically significant improvement in hemoglobin A1c, blood pressure and HDL cholesterol and mental health, reduced consumption of high sugar and fatty foods, and increased fruit and vegetable consumption at 6 and 12 months from baseline.  Diabetes-related emotional distress dropped significantly from baseline to 12 month follow-up and improved in receipt of foot exams.  Recruitment and retention has been acceptable and participant, provider and FHA satisfaction has been excellent.
Health System Intervention: Providers indicated that health care providers feel they do not have enough support to meet the needs of patients with type 2 diabetes and are often frustrated in their practices meeting the needs of cultural groups.  CME evaluations have been positive. Further analyses of in depth interviews with REACH providers and clients are ongoing. FHAs serving as a bridge in clinic visits with many clients have also been positively received by providers and clients.