A Community-Academic Partnership to Reduce Environmental
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Transcript A Community-Academic Partnership to Reduce Environmental
A Community-Academic Partnership to Reduce
Environmental Barriers to Healthy Lifestyles for
Pregnant and Postpartum Women in Detroit
Edith C. Kieffer
University of Michigan School of Public Health
Department of Health Behavior & Health Education
Interviewers: Kelly Baber, Kira Banks, Jackie Bussey, Karina Celaya, Maria Cervantes, Ann Ellingson, Monica
Rosie Garcia, Marilyn Lugo, Leah McNair, Wizdom Powell, Elsa Reyes, Yamir Salabarria-Pena, Carina Signori,
Stanback, Bessie Steward, Rose Thomas, Kiyomi Tsuyuki, Tracee Washington
PROJECT SUPPORTED BY: CENTERS FOR DISEASE CONTROL AND PREVENTION,
DIVISION OF NUTRITION AND PHYSICAL ACTIVITY
HIGH AND RISING PREVALENCE OF OBESITY
AND TYPE 2 DIABETES, ESPECIALLY LOW
INCOME AND MINORITY WOMEN
PREGNANCY AND POSTPARTUM
PERIODS: UNDERESTIMATED
OPPORTUNITY FOR EARLY INTERVENTION
AND RISK REDUCTION
EXCESSIVE PREGNANCY WEIGHT GAIN AND
POSTPARTUM WEIGHT RETENTION
ALMOST UNIVERSAL AND FREQUENT CONTACT
PRENATAL AND POSTPARTUM CARE
PREVALENCE OF PRE-PREGNANCY OVERWEIGHT/
OBESITY AND EXCESSIVE PREGNANCY WEIGHT
GAIN AMONG AFRICAN-AMERICAN AND LATINO
WOMEN IN DETROIT
Pre-pregnancy overweight and obesity
African American women:
47%
Latino women:
37%
Excessive pregnancy weight gain
African American women:
53%
Latino women:
37%
Key Aim: Community participation in planning
program and policy interventions
Women, influential people and program/policy
leaders discussed:
weight, pregnancy-related weight gain,
weight retention
diet and exercise
barriers to healthy eating and regular exercise
strategies/recommendations
PROMOTING HEALTHY LIFESTYLES
AMONG WOMEN
COLLABORATION MODEL
DETROIT ACADEMIC URBAN RESEARCH CENTER
MATERNAL HEALTH AND PREGNANCY OUTCOMES
ACADEMIC
U OF M SPH
Faculty, Postdocs
Students
PHLAW STEERING COMMITTEE
COMMUNITY
CHASS, Latino Family Serv.
Butzel Family Ctr.
Kettering/Butzel Health Initiative
WOMEN
Individual interviews
Focus group interviews
REACH DETROIT PARTNERSHIP
HEALTH SERVICES
Detroit Health Dept.
MI DCH
St. John, Henry Ford
Steering Committee
Community members, community agencies, faculty & postdoctoral fellows
Activities: Planning study methods and interview content; identifying and
screening potential interviewers; problem-solving; analyzing data; planning
interventions
Community Members
Steering Committee participants
Interviewers, moderators, notetakers
Debriefing and data analysis
Key Program and Policy Leaders
Focus group participants
Learning, sharing strategies,
discussing future roles
CHARACTERISTICS OF PARTICIPANTS
INDIVIDUAL AND FOCUS GROUP INTERVIEWS
Low income; recruited from WIC, prenatal clinics
Eastside/African-American Women
most from Detroit; similar neighborhoods, lifestyles
most not married/without partner; several children
influential person most often female
Southwest/Latino Women
most from Mexico; half from rural areas
different communities and lifestyles
most married/with partner; some had children
influential person most often male partner
POLICY FOCUS GROUP PARTICIPANTS
Eastside group:
majority African-American, long or life-time Detroit residents;
many women with children; many shared experiences
Southwest group:
diverse ethnicity; some Latinos; most not lifetime residents;
mostly women, some with children; some shared experiences
ENVIRONMENTAL INFLUENCES ON
EATING AND EXERCISE
POOR ACCESS TO HEALTHY FOODS
Inadequate stores in community
• few or no larger stores within community
• neighborhood stores: dirty environment; liquor, cigarettes, junk food; costly, poor
quality, outdated foods, including little or no produce
Policy focus group participants added:
• few stores (none, Eastside) stock fruits and vegetables, whole-grain and lower-fat
foods; only suburban markets offer food tasting, recipe demonstrations that
expose shoppers to new foods and preparation methods
Limited access to cheaper, well-stocked suburban stores and produce markets
• lack of private transportation, poor public transportation
Neighborhood safety (Latinas) barrier to walking to stores
• Traffic, crime
ENVIRONMENTAL INFLUENCES ON
EATING AND EXERCISE
BARRIERS TO REGULAR EXERCISE
Inadequate public facilities/lack of safe, clean parks and recreation centers
Inadequate sidewalks
Heavy traffic (especially Southwest Detroit
Cracked sidewalks
Air pollution (especially Southwest Detroit)
Men, prostitutes on streets
Crime
Weather (extreme heat, cold/ice)
INTERACTIONS OF PHYSICAL AND
SOCIAL ENVIRONMENTAL BARRIERS
Poverty increases impact of environmental barriers
Community Level Poverty
Inadequate community resources for healthy eating
and exercise
few public facilities, programs
inadequate transportation
poor maintenance of parks and sidewalks
poor lighting
Fewer private facilities
poorer quality
higher cost: income ratio
fewer amenities such as child care
Crime
Heavy traffic
Air and waste pollution
Family/Individual Level Poverty
Reduced access to community resources and to
alternatives outside of the neighborhood
fewer resources (income, transportation, knowledge, skills)
social isolation (language, culture, child/family care
responsibilities, transportation)
WOMEN’S STRATEGIES FOR REDUCING
ENVIRONMENTAL BARRIERS
Programs designed for pregnant/postpartum women
Center and group activities reduce environmental
barriers by providing:
Safety
Facilities – space, shelter, equipment
Exposure to new experiences, skills, people
Social support
Child care, transportation, appropriate facilitators essential (culture, language, experiences,
skills)
Locations: recreation centers/parks, schools,
churches, health centers
Mobile, community “mini-marts” and vans –
produce in the neighborhood
POLICY/PROGRAM LEADERS’ STRATEGIES
FOR REDUCING ENVIRONMENTAL BARRIERS
Concurred with women and added:
Community organization activities
advocate for improved public and private services
meeting with grocers to encourage improvements
neighbors working together to improve neighborhood
physical and social environment)
neighborhood recipe exchanges, potlucks, activity
groups
Gardening
exercise
healthy food
neighborhood improvement
social support
Extend concept of prenatal care services/eligibility for
support services like transportation to promoting healthy
eating and exercise