Addressing Economic and Social Determinants of Health Among Low Income, Ethnically Diverse Women in Rural North Carolina University of North Carolina Center for Health Promotion and Disease Prevention Funded by the Centers for Disease Control and Prevention and the Center for Minority Health and Health Disparities, National Institutes of Health 1

HOPE Accounts for Women  Salli Benedict, MPH HOPE Projects Director  Marci K. Campbell, PhD, Principal Investigator  UNC School of Social Work: Michal Grinstein-Weiss Andréa Taylor Clinton Key 2

Project Partners North Carolina Assets Alliance FDIC Money Smart Community bank branches NC Dept. of Labor

HOPE Accounts for Women Counties Percentage of North Carolina Adults Who Are Overweight or Obese 4

Project History Nearly 17 years of working on economic and health promotion in these communities Cotton-producing region, heavily dependent on textile industry Closing of textile mills + Hurricane Floyd economically devastated the area UNC’s work in the community led to the founding of the Community Action Council in 1999

Community Action Council

Poverty is hazardous to women’s health Clear and robust relationship between individual income and individual health: poorer people have a disproportionate amount of health problems. Stair-step pattern of worsening outcomes from rich to poor for almost all risk factors, diseases, and causes of death, which persists within racial and ethnic groups. The link between health and poverty 7

Poverty is hazardous to women’s health Low-income Americans are significantly more likely than those with high incomes to have health risk factors including smoking, being overweight, and sedentary lifestyle; higher prevalence of disability and chronic illness and shorter life expectancy. African Americans, Native Americans and Hispanic Americans are more likely to be low income. Women are more likely to be low income. The link between health and poverty 8

9 NIH ARRA Challenge Grant Center for Minority Health and Health Disparities

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Threadsofhopenc.org 11

HOPE Accounts for Women Building Financial Assets HOPE Circles model: goal setting and social support o Financial literacy and health education o Hands-on diet and physical activity skill training Matched savings account (1:1 match up to $600) o Savings can be used for education, job skills and small business development Website for tracking savings, progress on goals, & feedback on their Health and Life Goals. Individual monthly tailored newsletters 12

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HOPE Accounts for Women Building Financial Assets Randomized Control Trial Primary Measure: Weight loss Secondary Measures: Assets Building Financial Literacy Physical Activity Fruits and Vegetable 400+ women 15 UNC Center for Health Promotion and Disease Prevention Coharie Tribal Center BB&T Duplin/Samps on Counties 60 Circle Participants The Healing Lodge New Century Bank Robeson County 80 Circle Participants CommWell Health BB&T Lenoir County 80 Circle Participants

Data Analysis Weight (BMI) Fruit & Vegetable Intake Physical Activity Psychosocial Measures- Goal setting, self-efficacy, barriers, hope scale, depression, social support Financial Measures Asset building through savings Financial literacy Demographics

Sub Study: Behavioral Economics  Working with Dan Ariely and Janet Schwartz, Duke University  Qualitative Interviews with all Circle Leaders What are some of the negative effects of saving? How can encouraging someone to save inadvertently have negative outcomes? Example: Deciding to stop going to the gym in order to save. 17

Project Timeline September 2009: September June 2010: Summer 2010: Fall 2010 – Spring 2011: Spring & Summer 2011: 18 Awarded ARRA Challenge Grant Planning Stage, development of materials, coordinator training Circle Leader trainings and participant recruitment Circle sessions and savings period (six months) Evaluation, data analysis, writing up results for dissemination

Challenges Patriot Act requires that each individual opens an account with a social security number Not AFI = Means that anyone who saves over a certain amount of money may jeopardize govt benefits Short savings period (6 months) 19

HOPE Accounts for Women “It is possible to eliminate poverty from our world because it is not natural to human beings—it is artificially imposed on them.” - Muhammad Yunus 20

Thank you! Questions? Please contact us! Andrea Taylor (Presenter) Salli Benedict (Project Director)