Healthy Environments Partnership Research Articles

Urban HEART Detroit: the Application of a Health Equity Assessment Tool.

The Urban Health Assessment Response Tool (Urban HEART) was developed by the World Health Organization. In 2016, the Urban HEART was adapted and used by the Healthy Environments Partnership, a long-standing community-based participatory research partnership focused on addressing social determinants of health in Detroit, Michigan, to identify health equity gaps in the city. This paper uses the tool to: (1) examine the geographic distributions of key determinants of health in Detroit, across the five Urban HEART specified domains: physical environment and infrastructure, social and human development, economics, governance, and population health, and (2) determine whether these indicators are associated with the population health indicators at the neighborhood level. In addition to the Urban HEART matrix, we developed various tools including graphs and maps to further examine Detroit’s health equity gaps. Although not required by Urban HEART, we statistically analyzed the associations between each indicator with the health outcomes. Our results showed that all the domains contained one or more indicators associated with one or more health outcomes, making this an effective tool to study health equity in Detroit. The Urban HEART Detroit project comes at a critical time where the nation is focusing on health equity and understanding underlying determinants of health inequities in urban areas. A tool like Urban HEART can help identify these areas for rapid intervention to prevent unnecessary burden from disease. We recommend the application of the Urban HEART, in active dialog with community groups, organizations, and leaders, to promote health equity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-020-00503-0.

Urban HEART Detroit: a Tool To Better Understand and Address Health Equity Gaps in the City.

The Urban Health Equity Assessment Response Tool (Urban HEART) combines statistical evidence and community knowledge to address urban health inequities. This paper describes the process of adopting and implementing this tool for Detroit, Michigan, the first city in the USA to use it. The six steps of Urban HEART were implemented by the Healthy Environments Partnership, a community-based participatory research partnership made up of community-based organizations, health service providers, and researchers based in academic institutions. Local indicators and benchmarks were identified and criteria established to prioritize a response plan. We examine how principles of CBPR influenced this process, including the development of a collaborative and equitable process that offered learning opportunities and capacity building among all partners. For the health equity matrix, 15 indicators were chosen within the Urban HEART five policy domains: physical environment and infrastructure, social and human development, economics, governance, and population health. Partners defined the criteria and ranked them for use in assessing and prioritizing health equity gaps. Subsequently, partners generated a series of potential actions for indicators prioritized in this process. Engagement of community partners contributed to benchmark selection and modification, and provided opportunities for dialog and co-learning throughout the process. Application of a CBPR approach provided a foundation for engagement of partners in the Urban HEART process of identifying health equity gaps. This approach offered multiple opportunities for discussion that shaped interpretation and development of strategies to address identified issues to achieve health equity.

Does territoriality modify the relationship between perceived neighborhood challenges and physical activity? A multilevel analysis

PurposeIndividuals who perceive more neighborhood challenges are less physically active. Territoriality, an observable positive marker of social presence and defensible space in the neighborhood, may influence the association between neighborhood challenges and physical activity (PA). We hypothesized that greater territoriality would reduce the negative effects of neighborhood challenges on PA levels. MethodsData were collected by the Healthy Environments Partnership in an urban Midwestern city. Multilevel regressions were used to test associations in a sample of 696 white, black, and Hispanic adults older than 25 years. ResultsTerritoriality moderated associations between residents' perceptions of neighborhood challenges and PA. Contrary to our hypothesis, individuals who perceived more neighborhood challenges and lived in areas with more territoriality markers (e.g., buildings with decorations, buildings with security signage, and neighborhood watch signs) were less physically active than other respondents (b = −2.41, standard error = 0.84, P < .01). ConclusionsOur findings suggest that associations between perceived neighborhood challenges and PA are shaped by the context in which the individual lives. Our study provides empirical evidence that individual perceptions and observed neighborhood characteristics are joint contributors to PA and suggest the need for continued research to characterize the complexity of individual and contextual factors that contribute to PA.

Fine particulate matter air pollution and blood pressure: The modifying role of psychosocial stress

BackgroundConsensus is growing on the need to investigate the joint effects of psychosocial stress and environmental hazards on health. Some evidence suggests that psychosocial stress may be an important modifier of the association between air pollution respiratory outcomes, but few have examined cardiovascular outcomes. ObjectivesWe examined the modifying effect of psychosocial stress on the association between fine particulate matter air pollution (PM2.5) and blood pressure (BP). MethodsOur data came from the Detroit Healthy Environments Partnership (HEP) 2002–2003 survey. Of 919 participants, BP was collected at two time points in a subset of 347. Building on previous work reporting associations between PM2.5 and BP in this sample, we regressed systolic (SBP) and diastolic (DBP) BP and pulse pressure (PP), in separate linear models, on the interaction among psychosocial stress, PM2.5, and HEP neighborhood (Southwest, Eastside, Northwest). ResultsThe association between PM2.5 and SBP was stronger for those who reported high levels of stress, but this interaction was significant only in the Southwest Detroit neighborhood. Southwest Detroit residents who reported low stress showed 2.94mmHg (95% CI: −0.85, 6.72) increase in SBP for each 10μg/m3 increase in 2-day prior PM2.5 exposure. Those who reported high stress showed 9.05mmHg (95% CI: 3.29, 14.81) increase in SBP for each 10μg/m3 increase in PM2.5 exposure. ConclusionsThese results suggest that psychosocial stress may increase vulnerability to the hypertensive effects of PM2.5. This work contributes to an understanding of the ways in which the social and physical environments may jointly contribute to poor health and to health disparities.

The One-Pager: A Practical Policy Advocacy Tool for Translating Community-Based Participatory Research Into Action

The multiple and diverse perspectives, skills, and experiences inherent in community-academic partnerships make them uniquely positioned to educate policy makers and advocate for health equity. Effective communication tools are critical to successfully engage in the policy-making process. Yet few resources emphasize the development and use of practical tools for translating community-based participatory research (CBPR) findings into action. The purpose of this article is to describe a CBPR process for developing and using a one-page summary, or "one-pager," of research findings and their policy implications. This article draws on the experience of the Healthy Environments Partnership (HEP), a community-academic partnership in Detroit, Michigan. In addition to describing these processes, this article includes a template for a one-pager and an example of a one-pager that was written for and presented to federal policy makers.

Piloting interventions within a community-based participatory research framework: lessons learned from the healthy environments partnership.

Community-based participatory research (CBPR) partnerships experience unique opportunities and dilemmas when implementing pilot interventions. We describe challenges and opportunities associated with conducting a pilot intervention within a longstanding CBPR partnership, lessons learned for use of a participatory process to pilot community interventions, and recommendations to funders on mechanisms for funding pilot interventions to help address these challenges. We conducted key informant interviews and convened a group discussion with host organization leaders and project personnel. Findings highlight the opportunities and challenges related to needs and desires of community constituents and the ability of pilot interventions to meet those needs, and the importance of ongoing communication to address anticipated and unanticipated challenges that arise in the context of short-term pilot interventions in community settings. We suggest several funding mechanisms for supporting the implementation of larger scale interventions following promising pilot efforts in community settings.

A community-based participatory approach to personalized, computer-generated nutrition feedback reports: the healthy environments partnership.

Computer tailoring and personalizing recommendations for dietary health-promoting behaviors are in accordance with community-based participatory research (CBPR) principles, which emphasizes research that benefits the participants and community involved. To describe the CBPR process utilized to computer-generate and disseminate personalized nutrition feedback reports (NFRs) for Detroit Healthy Environments Partnership (HEP) study participants. The CBPR process included discussion and feedback from HEP partners on several draft personalized reports. The nutrition feedback process included defining the feedback objectives; prioritizing the nutrients; customizing the report design; reviewing and revising the NFR template and readability; producing and disseminating the report; and participant follow-up. Application of CBPR principles in designing the NFR resulted in a reader-friendly product with useful recommendations to promote heart health. A CBPR process can enhance computer tailoring of personalized NFRs to address racial and socioeconomic disparities in cardiovascular disease (CVD).

Handheld Computers for Direct Observation of the Social and Physical Environment

This article evaluates the use of handheld computers for systematic observation of the social and physical environments. Handheld computers, also known as personal digital assistants (PDAs), make the advantages of computer-assisted data collection (CADC) more accessible to field-based researchers. In particular, CADC with handheld computers may improve data quality, reduce turnaround time, and enhance research capacity for community-academic partnerships. Here, we describe our experiences using handheld computers for the Healthy Environments Partnership's Neighborhood Observational Checklist, an instrument for systematic observation of the social and physical environments. We discuss hardware and software considerations, observer training and implementation strategies, and observer attitudes toward using handhelds in the field. We conclude that handheld computers are a feasible alternative to pen-and-paper forms, and we identify ways that future researchers can maximize the advantages of CADC with handheld computers to advance our understanding of how neighborhood context relates to individual-level outcomes.

Engaging Urban Residents in Assessing Neighborhood Environments and Their Implications for Health

Researchers have worked to delineate the manner in which urban environments reflect broader social processes, such as those creating racially, ethnically and economically segregated communities with vast differences in aspects of the built environment, opportunity structures, social environments, and environmental exposures. Interdisciplinary research is essential to gain an enhanced understanding of the complex relationships between these stressors and protective factors in urban environments and health. The purpose of this study was to examine the ways that multiple factors may intersect to influence the social and physical context and health within three areas of Detroit, Michigan. We describe the study design and results from seven focus groups conducted by the Healthy Environments Partnership (HEP) and how the results informed the development of a survey questionnaire and environmental audit tool. The findings from the stress process exercise used in the focus groups described here validated the relevance of a number of existing concepts and measures, suggested modifications of others, and evoked several new concepts and measures that may not have been captured without this process, all of which were subsequently included in the survey and environmental audit conducted by HEP. Including both qualitative and quantitative methods can enrich research and maximize the extent to which research questions being asked and hypotheses being tested are driven by the experiences of residents themselves, which can enhance our efforts to identify strategies to improve the physical and social environments of urban areas and, in so doing, reduce inequities in health.