To reduce exposure to physical and psychosocial environmental stressors associated with childhood asthma severity and exacerbation, and strengthen protective factors modifying the effect of these stressors.

Community organizers work with CBOs/environmental groups to lower environmental asthma triggers. Community mobilization; policy advocacy; networking.

Asthma-related health status; changes in perception of neighborhood environment; changes in local/state environmental policies.

Analysis will explore effect of neighborhood intervention on HH intervention. Qualitative data to assess change in perceptions/policy.

Data not available.

To increase the enrollment of eligible east side Detroit children in Medicaid/MI Child health insurance programs.

Organizational change/ quality improvement process to improve customer service and staff effectiveness at local FIA offices.

Enrollment of children in Medicaid/MI Child; changes in local welfare staff attitudes and behavior; raised knowledge about Medicaid/MI child; improved customer satisfaction

To test a conceptual model of the stress process for understanding social determinants of health affecting women living in an urban community, using a community-based lay health advisor intervention.

Detroit Health Department, Eastside Parish Nurse Network, Friends of Parkside, Henry Ford Health System, Islandview Department Corporation, Village Health Workers, Warren/Conner Development Coalition, UM School of Public Health.

Detroit Health Department, East Side Parish Nurse NEtwork, Friends of Parkside, Henry Ford Health System, University of MIchigan School of Public Health, Warren/Conner Development Coalition, Community Members at Large and the Village Health workers.

Approximately 20 community members trained as HEED advocates on topics related to diabetes risk factors, access barriers. Activities include fruit/veggie mini-markets, walking clubs, information fairs, healthy cooking demonstrations.

Raised knowledge about diabetes risk factors and prevention; raised social support; raised access to information about diabetes/healthy foods; expanded resources for fitness/exercise activities.

CDC $1.5 million; 9/02-9/05 Michigan Dept. of Community Health &60,000 (one year pilot program – 2002-03)

Expand neighborhood mini-markets; increase stores/restaurants with healthy foods; develop markets; conduct healthy food demonstrations; establish healthy eating support groups and health food tip sheets and meeting policies; educational materials.

This CBP prospective, population-based cohort study used standardized interviews, anthropometry, metabolic assays, and medical record reviews for data collection. Relationships among maternal sociodemographic, prenatal care, anthropometric, and metabolic characteristics and birth weight were assessed with analysis of variance, and bivariate and multivariate linear regression analyses.

Women’s beliefs about diabetes, including factors influencing diabetes risk during and after pregnancy in mothers and babies; factors influencing their participation in regular physical activity during pregnancy and postpartum and recommendations for interventions.

Women believed that diabetes was primarily related to heredity and diet but not to physical activity.  Exercise was believed to reduce stress and improve general health. Women suggested an organized group program, in a respected location, that offered safe physical activities within the context of a variety of activities for women and children.  This strategy reduced concerns about safety and social acceptability, while addressing their primary interest in social support. [Kieffer E., Willis S., Arellano N., Guzman R.  Perspectives of Pregnant and Postpartum Latino Women on Diabetes, Physical Activity and Health. Health Education and Behavior. (29;5): 542-556; October 2002].

To use CBPR approaches to develop and pilot test and evaluate materials and methods for a social support group healthy lifestyle intervention for pregnant Latino and African American women and conducted with trusted community organizations in southwest and eastside Detroit.

All outcomes met.  Recruitment low in eastside but retention was very good in both communities.  Materials and methods subsequently used, with revisions based on process evaluation, for Healthy Mothers on the Move.

There were two studies conducted in association with this project.  One study examined the prevalence and risk factors for gestational diabetes (GDM) and one study examined the impact of maternal glucose tolerance on birth weight. 

Gestational diabetes.
Maternal weight, glucose tolerance and infant birth weight.

Gestational Diabetes in Latino and African American women:  Almost 47% of African Americans and 37% of Latinas were overweight or obese; 53% of African Americans and 38% or Latinas had excessive pregnancy weight gain. The prevalence of GDM was 3.9% among African Americans and 5.4%  among Latinas. After adjusting for other risk factors, Latinas were 2.5 times more likely to develop GDM than African American women.  Independent risk factors were family history of diabetes, age, body mass index and gestational weight gain prior to 28 weeks. [Kieffer E, Carman W, Gillespie B, Nolan G, Worley S, Guzman R.  Obesity and Gestational Diabetes among African-American and Latino Women:  Implications for Disparities in Women’s Health. Journal of the American Medical Women’s Association; 56: 181-187; 2001.

Birth Weight among Latino infants:   Abnormal glucose screens were evident in 27% of women; GDM prevalence was 5.1%.  There was a significant relationship between increasing screening glucose value and adjusted birthweight  (p<0.005). As glucose value increased, there was a significant trend toward increasing large-for-gestational age (LGA) (macrosomic) infants. In multivariate analyses, among women without diabetes, there was a 30.5 gram increase in birthweight;; a 17% increased risk of LGA and a 31% decreased risk of SGA.

Additional studies are possible using the large data set from these studies and combined with data from studies subsequently conducted.