A Community-Academic Partnership to Reduce Environmental

Report
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

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