Racial And Ethnic Approaches To Community Health Research Articles

The COVID-19 Movement Restrictions and Impact on Shelter Accessibility: Central African Republic

Abstract Background The coronavirus disease(COVID-19) has been spread worldwide since 2019, posing significant challenges to the socio-economies and healthcare system of many countries. During COVID-19, sanitation facilities such as water, shelter, food, and health service are required to prevent the spread of coronaviruses and others. However, The multiple factors of Central African Republic(CAR) such as low human development index, limitation of health resources, and unstable financial capacity are a barrier to stopping the spread of the COVID-19. Also the government conducting the COVID-19 vaccination campaign since 2021, experiencing difficulties due to poor road conditions and insecurity. These cannot appropriately response to the coronavirus spread. Therefore, this study was conducted to investigate the effect of COVID-19 movement restrictions on shelter accessibility in CAR. Methods This study analyzed 11,723 crisis-affected households from the 2020 Central African Republic Multi-Cluster Needs Assessment survey data. This survey was conducted between June to August 2020 by the Racial and Ethnic Approaches to Community Health(REACH) Initiative and geographically covered all sub-prefectures of the country. Complex sampling design weighted multivariable binary logistic regression analysis was performed. Results It was found that shelter accessibility was possible when there was a movement restriction (p < 0.05). In the case of IDPs compared to HOST (p < 0.01), and the higher the number of household members (p < 0.05), the more difficult it was to access shelter. Conclusions In response to the spread of COVID-19 in CAR, humanitarian actors have conducted a variety of preparedness activities. Relief agencies have also adjusted operations to continue the delivery of shelter, food, health, livelihoods, and including movement restrictions. Therefore, although movement restrictions were implemented, the other activities such as increasing accessibility to shelter was also conducting. Key messages • This study was conducted to investigate the effect of COVID-19 movement restrictions on shelter accessibility in CAR. • There are many preparedness activities for stop the spread of COVID-19 in CAR. So even if the covid-19 movement restriction was conducting, the relief work (delivery of shelter) also implemented.

Factors influencing access to water, sanitation, and hygiene among crisis-affected populations

Abstract Background The Central African Republic is suffering a long and complex humanitarian crisis. Population access to water, sanitation, and hygiene (WASH) services remain a challenge in the context of protracted conflicts. However, research on access to WASH in this population is limited. The purpose of the study was to investigate factors associated with access to WASH among crisis-affected populations in the Central African Republic. Methods This study analyzed 11,723 crisis-affected households from the 2020 Central African Republic Multi-Cluster Needs Assessment survey data. This survey was conducted between June to August 2020 by the Racial and Ethnic Approaches to Community Health (REACH) Initiative and geographically covered all sub-prefectures of the country.Sampling weighted multivariable binary logistic regression analysis was performed. Results Internally displaced persons (IDPs) were more likely to affect their access to WASH than their host families.Movement restricted due to COVID-19, household members with difficulties in self-care (e.g., washing, dressing), education level, and monthly household income were significantly associated with access to WASH. Discussion This study suggests that certain factors place the crisis-affected populations in the Central Africa Republic a thigh risk for access to WASH, especially among IDPs. The findings in this study can inform public health professionals to develop support and education programs and shape health care policies. In addition, the results highlight the importance of access to safely managed WASH services during infectious disease outbreaks, including the current COVID-19 pandemic Key messages • The findings in this study can inform public health professionals to develop support and education programs and shape health care policies. • The results highlight the importance of access to safely managed WASH services during infectious disease outbreaks, including the current COVID-19 pandemic.

S10-2 U.S. CDC’s Active People Health Nation: Michigan’s Story for Promoting Physical Activity in Local Communities

Abstract Purpose Being physically active is one of the most important ways people of all ages and abilities can improve their health. Survey data show that 76 percent of Asian Americans in Michigan USA do not meet the federal physical activity minimum guidelines. Guided by Active People, Healthy Nation (APHN), a national initiative to help 27 million Americans become more physically active, the Eastern Michigan University (EMU) Racial and Ethnic Approaches to Community Health (REACH) initiative promotes physical activity through local partnerships in geographic areas where the priority population (Asian Americans) lives. Methods Working with the state department of transportation, local municipalities, public schools, faith-based organizations, local businesses, and community health partners, EMU REACH used the following strategies to increase physical activity: 1) implement policies and activities to connect pedestrian, bicycle, or transit transportation networks (i.e., activity-friendly routes) to everyday destinations. 2) launch safe routes to school programs to increase walking and bicycling to and from school and 3) promote equitable park programs and policies that make it safe and easy for residents to be physically active. The team adopted the action planning guide and assessment modules in the Active Communities Tool (ACT) to facilitate cross-sector collaborations in developing an action plan to improve the community built environments that promote physical activity. Results The EMU CHDIS has successfully reached 24,510 people impacted by new/improved policies and plans in 2018-22. In the process, our environment scan showed that people living in underserved areas and from racial and ethnic minority groups are less likely to have access to these places due to historical land use, housing, and transportation policies. Based on the results from project implementation, it is recommended that creating or modifying streets, parks, and trails to connect activity-friendly routes to everyday destinations and offer access to safe places for physical activity for people of all ages and abilities can promote active lifestyles and provide physical-active environment. Conclusion While celebrating wins through the APHN initiative in Michigan, we advocate for new supportive policies and engage with more community members to raise awareness about the new resources to maintain the active momentum.

Impact of COVID-19 on a Community Health Coalition and Its Residents in Allegheny County, Pennsylvania: Insights Into Adaptation From Focus Groups and Evaluation Reports.

Live Well Allegheny: Lifting Wellness for African Americans (LWA2) is a coalition in Allegheny County, Pennsylvania, funded by the Centers for Disease Control and Prevention's (CDC) Racial and Ethnic Approaches to Community Health (REACH) initiative. LWA2 consists of partner organizations addressing chronic disease prevention in six Black communities through nutrition, physical activity, and community-clinical linkage strategies. This analysis focuses on qualitative data exploring the influence of COVID-19 on coalition functioning and communities. We conducted focus groups with residents in REACH communities and collected evaluation reports from partner organizations. Three focus groups assessed awareness of and participation in the REACH initiative, feedback, and the impact of COVID-19 when applicable. An additional focus group included questions related to flu vaccine messaging and the COVID-19 vaccine. These data sources provided insight regarding how COVID-19 affected planned tasks. Evaluation team members analyzed focus groups and collated summaries as part of a larger comprehensive evaluation. Partner organizations experienced an increase in food stamp applications, delays in opening farmers' markets, a shift to virtual preventive health programs, canceled in-person events, and programmatic interruptions that shifted long-term goals. Community resident concerns included difficulty accessing public transportation, decreased physical activity, fear of in-person interactions, and increased wait times for mental health services. Coalition members developed methods to continue functioning and sustaining program activities. Residents were able to engage differently with chronic illness prevention techniques. Reports from the ongoing analysis will be used to adapt coalition functioning.

Challenges and Successes in Health Communication Messaging With Asian Americans.

Asians are the fastest growing racial and ethnic group in the United States, and in Michigan, Asians represent 3.4% of the state's population. Asians have long been aggregated as a homogeneous group and stereotyped as a "model minority." Asians, however, are very diverse, and each subgroup has different values, histories, beliefs, and dialects. The diversity among populations and variations in chronic disease risks demonstrate the importance of disaggregating Asian American ethnicities with respect to health promotion, which must be culturally and linguistically tailored to make the biggest impact. This article describes our challenges and successes in health communication messaging with Asian Americans during the 4 years of our Racial and Ethnic Approaches to Community Health (REACH) Cooperative Agreement.

Implementing Locally Tailored Strategies to Promote Redemption of Farmers' Market Nutrition Program Vouchers Among WIC Participants in Central Pennsylvania.

The Pennsylvania Farmers' Market Nutrition Program (FMNP) provides vouchers to participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to purchase locally grown fruits, vegetables (F&V), and herbs every year from June to November. Voucher redemption is suboptimal among WIC participants in Lebanon County, a community with high numbers of low-income and Hispanic families. Supported by a Racial and Ethnic Approaches to Community Health (REACH) award, our community-academic coalition partnered with the local WIC provider to implement locally tailored strategies to promote redemption of FMNP vouchers. In 2019, we surveyed FMNP participants (n = 100) to examine opportunities for improved voucher redemption. Increasing sites for voucher use (47%) and a larger variety of F&V (27%) were the most commonly selected improvements participants identified. Participants also supported improvements to increase awareness of available seasonal produce (14%), text/phone reminders to redeem vouchers (13%), and having recipes to cook meals with FMNP-approved F&V (12%). These findings led us to implement a weekly, Farm-to-WIC "grab bag" program in 2020/2021. We partnered with a local farmer to offer a variety of FMNP-approved produce in $3 and $6 grab bags at the local WIC provider. Each grab bag included healthy recipes using the included produce. In 2021, we launched a text/phone reminder intervention to encourage voucher redemption among FMNP participants (n = 57). Our work demonstrates the value of community-academic partnerships to identify and implement feasible strategies that are responsive to local needs as well as supporting existing programs providing greater access to affordable produce.

Abstract P206: Modeling The Impact Of The Tobacco 21 Policy In El Paso, Texas

Introduction: On December 20, 2019, the federal Tobacco 21 (T21) law was passed. This new legislation raised the minimum legal purchase age for tobacco products from 18 to 21 years. Thirty-three states in the US have implemented the law, but 19 states have yet to enact it. Public health practitioners and policymakers need more evidence on the impact of the T21 Policy at the local level to encourage adequate enforcement. Objective: To project the health and economic impact of the T21 Policy in El Paso, Texas, which is the focus area of the Heart Racial and Ethnic Approaches to Community Health (REACH) Program implemented by the American Heart Association. Methods: Using an agent-based model of smoking behavior and a microsimulation model of cardiovascular disease, we projected the long-term effects of the T21 Policy on smoking prevalence and cardiovascular health outcomes in El Paso, Texas. Population characteristics and model parameters were estimated based on data from the National Health Interview Survey, US Life Tables, and the National Health and Nutrition Examination Survey. Annual smoking prevalence was derived from the Texas Behavioral Risk Factor Surveillance System and County Health Rankings. The policy effects were determined from established effect sizes from published literature. Results: The estimated prevalence of smoking in El Paso, Texas decreased by 2.7% among 18-24 year olds and by 5.2% among 25-44 year olds in 20 years with the implementation of the T21 policy; these results are statistically significant (p<0.01 for both population groups). Our results also revealed that the T21 Policy could prevent cardiovascular disease such as coronary heart disease (CHD) and stroke. Specifically, compared to the no-policy situation, the policy would prevent 5.4 CHD events (from 305.2 to 299.8) per 1,000 adults and 10.8 stroke events (from 232.6 to 221.8) per 1,000 adults over lifetime. The model also projected a reduction in health care costs due to the T21 Policy, as the estimated lifetime health care costs decreased from $425,672 per person without the T21 Policy to $423,376 per person with the policy. Conclusions: This study provides important information for policymakers to understand the potential impacts of the T21 Policy in El Paso, Texas. The projected decreases in tobacco use, cardiovascular disease, and health care costs as a result of the T21 Policy could assist in advocating for T21 Policy enactment in other areas of the US.

Pharmacist Involvement in Addressing Public Health Priorities and Community Needs: The Allegheny County Racial and Ethnic Approaches to Community Health (REACH) Project

Community–clinical linkages are connections between community and clinical sectors to improve population health, and community-based pharmacists are well positioned to implement this strategy. We implemented a novel approach to community–clinical linkages in African American communities in which community-based pharmacists implement screenings for chronic disease and social determinants of health, make referrals to clinical and social services, and follow up with patients to support linkage to care in nontraditional health care settings. The community-based pharmacist navigation program works with multisector partners to increase referrals and access to existing health and social service programs. We used a mixed-methods evaluation approach to collect and analyze data on program characteristics and the linkage intervention. From February 2019 to March 2020, 702 African American community members received preventive health screenings, and 508 (72%) were referred to clinical and social services. Pharmacists demonstrated the ability to implement clinical preventive services in nontraditional health care settings and improve access to care through the provision of community–clinical linkages.

Abstract P103: Tobacco-21 Policy Implementation In A Texas Community: Utilizing Interorganizational Network Analysis To Evaluate Tobacco Coalition Dynamics

Introduction: In El Paso County, TX, a local tobacco coalition is working in partnership with the American Heart Association’s (AHA) Heart Racial and Ethnic Approaches to Community Health (REACH) program to focus efforts on aligning local activities with the new, statewide Tobacco-21 policy. As coalitions have been on the forefront of spearheading policy implementation efforts, understanding and quantifying coalition dynamics is necessary to increase collaboration and leverage resources. The purpose of this study is to highlight the findings of a baseline Interorganizational Network (ION) analysis of a tobacco coalition in El Paso County, TX in order to determine current levels of collaboration between organizations and strength of relationships. Hypothesis: We assessed the hypothesis that by using ION analysis, we can characterize relationships between organizations, identify organizations that are working in silos, and leverage ties between organizations to implement new, tobacco control initiatives that support the Tobacco-21 policy. Methods: Evaluators from Texas A&M University worked in conjunction with the AHA to conduct an ION survey that assessed information sharing and joint planning of organizations involved in the tobacco coalition (n=18). Using UCINET© network analysis software, density and centrality scores at the network-level were calculated. Network diagrams were then developed to depict relationships among partners using Gephi© visualization software. Results: Network collaboration related to information sharing had a network density score of 0.340 (SD=0.474) while joint planning had a network density score of 0.297 (SD=0.457). The centralization index for information sharing was 0.055 and 0.0729 for joint planning with the coalition as the most central for both domains. Conclusion: This study shows how determination of organizational relationships within a coalition can be leveraged for strategic planning. Density measures were useful to understand the connectedness of the network, and centrality measures at the network-level were helpful in determining network structure. In conclusion, results from this study informed program implementers on how to better foster collaboration among organizations. Subsequent iterations of the survey will allow for documentation of changes in the strength of relationships over the project period.

Urban Minority Community Safety and its Impact on Physical Activity: The Center for Promoting Health and Health Equity-Racial and Ethnic Approaches to Community Health (CPHHE-REACH) Initiative

Background/PurposeDaily physical activity is known to improve personal health and well-being and can often be influenced by one's living environment. A qualitative secondary data analysis of a focus group study, performed by the Creighton University Center for Promoting Health and Health Equity (CPHHE) – Racial and Ethnic Approaches to Community Health (REACH), assesses behavioral changes in individuals who participated in newly established physical activities in faith-based organizations, local residential towers, and the local community health center. MethodApplying thematic analysis within the Health Belief Model framework, the investigators further investigated the relationships between its constructs and levels of physical activity in urban minority neighborhoods. ResultsResults indicated that residents who perceived their neighborhoods as unsafe had a negative attitude toward physical activity. In contrast, building social relationships and camaraderie that enhanced social cohesion were major themes that increased participants' self-efficacy, resulting in positive changes in health behavior. ConclusionCommunity partnerships had a positive impact on motivating individuals to live healthier lifestyles. An interesting concept was that of community efficacy, which reflects the community's confidence in its ability to generate behavioral changes in individuals.

LEADing together: Partnerships for a Healthier DeKalb

Background: In 2014, the DeKalb County Board of Health (DCBOH) received a three-year Racial and Ethnic Approaches to Community Health (REACH) grant to work with community partners to address health disparities among African Americans in DeKalb County. The project, called Local Efforts toward Addressing Disparities in DeKalb (LEAD DeKalb), relies on a network of partnerships to implement community-based interventions that promote healthy eating and physical activity among African Americans throughout low-income parts of DeKalb County.

Improving actions to control high blood pressure in Hispanic communities — Racial and Ethnic Approaches to Community Health Across the U.S. Project, 2009–2012

BackgroundCompared with the general population in the United States (U.S.), Hispanics with hypertension are less likely to be aware of their condition, to take antihypertensive medication, and to adopt healthy lifestyles to control high blood pressure. We examined whether a multi-community intervention successfully increased the prevalence of actions to control hypertension among Hispanics. MethodsAnnual survey from 2009–2012 was conducted in six Hispanic communities in the Racial and Ethnic Approaches to Community Health (REACH) Across the U.S. project. The survey used address based sampling design that matched the geographies of intervention program. ResultsAge- and sex-standardized prevalences of taking hypertensive medication, changing eating habits, cutting down on salt, and reducing alcohol use significantly increased among Hispanics with self-reported hypertension in REACH communities. The 3-year relative percent increases were 5.8, 6.8, 7.9, and 35.2% for the four indicators, respectively. These favorable (healthier) trends occurred in both foreign-born and U.S.-born Hispanics. ConclusionThis large community-based participatory intervention resulted in more Hispanic residents in the communities taking actions to control high blood pressure.

Reduced Disparity in Vegetable Consumption in 16 Disadvantaged Black Communities: A Successful 5-Year Community-Based Participatory Intervention.

Data on large scale community-level interventions on fruit and vegetable consumption targeting minority communities are lacking. This study examined whether a multicommunity intervention decreased disparities in fruit and vegetable consumption. The Racial and Ethnic Approaches to Community Health (REACH) 2010 program was conducted among 16 black communities. Five-year trends (2001-2006) in self-reported fruit and vegetable consumption among the target population were compared with trends among white and black populations in 14 states where communities were located. The geometric mean of combined fruit and vegetable consumption in the REACH communities increased 7.4 % (P0.001) but did not change among white and black populations in comparison states (P0.05). Increased consumption in REACH communities was higher in the lower quintiles of consumptions. The disparity in fruits and vegetables consumption between comparison white population and blacks in REACH communities decreased by 33 %-from 0.66 to 0.44 times per day. The target population of 1.2 million people consumed fruits and vegetables about 21.9 million additional times per year as a result of the REACH program. This large community-based participatory intervention successfully reduced isparities in fruit and vegetable consumption between comparison white population and 16 disadvantaged black communities.

Community health workers as an integral strategy in the REACH U.S. program to eliminate health inequities.

Mounting evidence indicates that community health workers (CHWs) contribute to improved behavioral and health outcomes and reductions in health disparities. We provide an overview (based on grantee reports and community action plans) that describe CHW contributions to 22 Racial and Ethnic Approaches to Community Health (REACH) programs funded by the Centers for Disease Control and Prevention from 2007 to 2012, offering additional evidence of their contributions to the effectiveness of community public health programs. We then highlight how CHWs helped deliver REACH U.S. community interventions to meet differing needs across communities to bridge the gap between health care services and community members, build community and individual capacity to plan and implement interventions addressing multiple chronic health conditions, and meet community needs in a culturally appropriate manner. The experience, skills, and success gained by CHWs participating in the REACH U.S. program have fostered important individual community-level changes geared to increase health equity. Finally, we underscore the importance of CHWs being embedded within these communities and the flexibility they offer to intervention strategies, both of which are characteristics critical to meeting needs of communities experiencing health disparities. CHWs served a vital role in facilitating and leading changes and will continue to do so.

Hepatitis B testing and access to care among racial and ethnic minorities in selected communities across the United States, 2009-2010

Hepatitis B virus (HBV) infection is widely prevalent among racial and ethnic minorities in the United States; however, few data have been available regarding HBV testing and referral to care for these populations. Using survey data collected in 2009-2010 from the Racial and Ethnic Approaches to Community Health (REACH) across the U.S., we assessed rates and determinants of hepatitis B testing and access to care in 28 minority communities in the U.S. Of 53,896 respondents, 21,129 (39.2%) reported having been tested for hepatitis B. Of the 1,235 who reported testing positive, 411 (33.3%) reported currently receiving specialty care. After controlling for demographic and socioeconomic characteristics, the likelihood of having been tested for hepatitis B and receiving care if infected was higher among males, non-English speaking persons, and those having health insurance compared to their counterparts. Compared to college graduates, respondents without a college education were less likely to get tested for hepatitis B. These data indicate that more than half of racial/ethnic minority persons in these communities had not been tested for hepatitis B, and only about one-half of those who tested positive had ever received treatment. More state and federal efforts are needed to screen racial/ethnic minorities, especially foreign-born persons, for HBV and link those with infection to care.

P6.018 Participatory Action Research, Evidence-Based Public Health, and Cooperative Agreements: Adverse Effects

<h3>Background</h3> Racial and Ethnic Approaches to Community Health (REACH) 2010 was an ambitious multi-sector, multilevel, multicenter, and multi-phased community demonstration project designed to reduce health disparities in the United States. Requirements for a cooperative agreement with the Centers for Disease Control and Prevention were enumerated in Program Announcement 99064. Applicants had to represent coalitions of predominantly minority community members that would propose community action plans (CAPs) to address one or more serious health problems affecting one or more minority populations. The Broward Coalition to Eliminate Disparities in HIV Disease was one of 32 (out of 206) eligible applicants to receive a competitive award in Fiscal Year 2000 to develop a CAP. The CAP was one of 24 to be approved by CDC for implementation in Fiscal Year 2001. The primary goal was to eliminate disparities in new HIV infections reported among Black and Hispanic residents of Broward County by 2010. <h3>Methods</h3> A case study to illustrate how competing models of disease prevention can inhibit successful outcomes in public health. <h3>Results</h3> The participatory action research (PAR) programme designed, developed, and implemented by the Broward Coalition contained four interventions chosen by members after systematically working through the PRECEDE Health Promotion Planning Model. From 1999 through 2006, rates of new HIV infections among non-Hispanic Black residents of Broward declined from 193/100,000 to 81/100,000. On April 5, 2005, CDC site visitors informed the Coalition that funding for Broward would be cut in half in Fiscal Year 2006. They urged that only interventions recommended by CDC experts as “high impact” be continued. Subsequently, educational outreach efforts considered essential by local community members were curtailed and rates of new HIV infections among Blacks in Broward began to rise. <h3>Conclusion</h3> Project shortcomings were linked to the decrement of resources and reinterpretation of PAR interventions by evidence-based criteria.

Genesee County REACH Windshield Tours: Enhancing Health Professionals Understanding of Community Conditions that Influence Infant Mortality

The Genesee County Racial and Ethnic Approaches to Community Health (REACH) program is a community-based program designed to reduce African American infant mortality rates in Flint, Michigan. Genesee County REACH activities address three core themes: fostering community mobilization, reducing racism, and enhancing the maternal-infant health care system. The REACH Community Action Plan was generated using a community-based participatory approach, and is based on a socio-ecological model with interventions focused at the individual, organizational, health system, and community levels. Genesee County REACH's Community Windshield Tours were developed to raise awareness of social and environmental barriers to health promotion among health care system staff in Flint, Michigan. These tours provide a close-up examination of the community's environmental conditions and the experiences of mothers, children, and families at risk for poor birth outcomes. In this article, we report our findings from pre-/post-tour surveys, as well as long-term follow-up surveys, to assess the impact of this REACH activity on participants' knowledge and beliefs about Genesee County residents, and to determine any resultant individual, policy, system, or environmental changes. We used t tests to compare participants' responses before and after the tours. We found that several individual- and systems-level changes have resulted from these tours, reflecting greater cultural sensitivity and increased understanding of patients' circumstances. African American infant mortality rates in Genesee County declined to a historic low in 2005, and they remain lower than in previous years. Although REACH coalition partners recognize that this reduction cannot be attributed to a single intervention or activity, REACH activities such as the Community Windshield Tours addressing multiple levels of the socio-ecological model may have had a synergistic effect.

Community‐Based Approaches to Prevention and Management of Hypertension and Cardiovascular Disease

Community hypertension (HTN) outreach seeks to improve public health by identifying HTN and cardiovascular disease (CVD) risks. In the 1980s, the National Heart, Lung, and Blood Institute (NHLBI) funded multiple positive community studies. Additionally, the Centers for Disease Control and Prevention's (CDC's) Racial and Ethnic Approaches to Community Health (REACH) program addresses CVD risks. In 1978, in Baltimore, MD, the Association of Black Cardiologists (ABC), organized barbershops and churches as HTN control centers, as in New Orleans, LA, since 1993, the Healthy Heart Community Prevention Project (HHCPP). Also, the NHLBI Community Health Workers and Promotores de Salud are beneficial. The American Society of Hypertension (ASH) Hypertension Community Outreach program provides free HTN and CVD screenings, digital BP monitors, multilingual and literacy-appropriate information, and videos. Contemporary major federal programs, such as the Million Hearts Initiative, are ongoing. Overall, the evidence-based Logic Model should enhance planning, implementation, and dissemination.

Pioneers in Health Equity: Lessons from the REACH Communities

Pioneers in Health Equity: Lessons from the REACH Communities David Satcher, MD, PhD Despite substantial improvements in life expectancy over the last century, U.S. racial and ethnic disparities in health continue to persist, are well documented, and increasing.1 Communities of color fare far worse than their White counterparts across a range of health indicators including life expectancy, infant mortality, rates of heart disease, diabetes, cancer, and stroke, self-rated health status, insurance coverage and a number of other health indicators.1 Between 2003 and 2006, racial and ethnic disparities in health cost the United States an estimated $1.24 trillion.2 As the nation’s population becomes increasingly diverse—people of color will comprise 54% of the U.S. population by 20501—the likelihood that the nation’s previous improvements in health will continue will be greatly diminished. Over the last 10, years the Centers for Disease Control and Prevention has supported over 40 communities to address racial and ethnic disparities in health through the Racial and Ethnic Approaches to Community Health (REACH) program. REACH uses community engagement and empowerment to develop and tailor interventions to meet the unique needs of communities of color. REACH communities decide the area of health disparities to address (asthma, breast and cervical cancers, diabetes, heart disease and stroke, hepatitis B, , immunizations, infant mortality, and tuberculosis) and the racial and ethnic group (African American, American Indian/Alaska native, Asian, Native Hawaiian/other Pacific Islander, Hispanic) to target. The 12 articles in this special issue of Progress in Community Health Partnerships: Research, Education and Action document how REACH communities have highlighted, implemented, and advocated for evidence and practice-based strategies across the social determinants of health to eliminate racial and ethnic health disparities. These strategies have included creating and sustaining community coalitions, obtaining baseline data to document racial and ethnic health disparities, and implementing and evaluating interventions that address the root causes of disparity. Building strong coalitions includes developing and sustaining a number of partnerships; partnerships between community-based organizations and academic institutions are a key component to building a strong coalition. VanDevanter et al.,3 Kleinman et al.,4 and Trinh-Shevrin et al.5 used mixed-methods approaches including surveys, key informant interviews, and direct observation to evaluate community–academic partnerships. The authors concluded that although the partnerships seemed to be stable over time, there were consistent differences in community and academic perspectives; academic partners were more satisfied with the partnerships than their community counterparts. All three articles stressed the importance of ongoing evaluation of community coalitions in order to enhance and strengthen the relationship between partners. In addition to evaluating coalitions, it is also important to evaluate interventions. Holden et al.6 described how the Brownsville Action Community for Health Equity used data from structured interviews to evaluate their community interventions to reduce high rates of infant mortality among African Americans and Puerto Ricans in Brooklyn New York’s Brownsville community. Factors associated with intervention success included highly capable partners, a strong coalition, internal champions, and an understanding and appreciation of policy and community involvement. For many communities, baseline data highlighting health disparities are lacking. Brega et al.7 described their process of obtaining baseline data related to cardiovascular disease among American Indian/Alaska Natives. [End Page 215] The lack of regular physical activity is an important social determinant of health and cause of health disparities, particularly among young children. Whitt-Glover et al.8 described the impact of the evidence-based school intervention, short recess, which provides children with 10-minute bouts of moderately intense physical activity during the school day. The authors reported that both the school administration and students were enthusiastic about the program but recommended more research related to the long-term impact of the intervention. One highly effective strategy in addressing disparities in the treatment of cervical cancer is enhanced case management. Clarke et al.9 with the Boston REACH community developed a case management intervention for African American women in primary care settings. Case managers provided patient navigation to prompt screenings and follow-up along with referrals to address patient-identified social concerns (e.g., housing, transportation). The authors reported that lack of child...

Personal Stories: Voices of Latino Youth Health Advocates in a Diabetes Prevention Initiative

The YMCA-Silicon Valley Racial and Ethnic Approaches to Community Health (REACH) U.S. Proyecto Movimiento (PM) Action Community project is a community-based partnership that aims to reduce the prevalence of diabetes among Latinos in the Greater Gilroy, California, area by delivering a prevention campaign across generations. A critical component of PM has been the creation of a Youth Health Advocate (YHA) afterschool club at three public high schools in Gilroy. The YHAs, who are trained on health, nutrition, diabetes, basic leadership skills, and digital storytelling, are at the forefront of the campaign targeting Gilroy youth. In their own words, the YHAs describe why they decided to become a YHA, the positive health impact of YHA activities on themselves and their family, and the positive impact on burgeoning leadership skills. The voices of YHAs in this prevention campaigns have brought value to the PM evaluation, and this qualitative element bears further examination in other community-based prevention campaigns.