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

HIGH AND RISING PREVALENCE OF OBESITY AND TYPE 2 DIABETES, ESPECIALLY LOW INCOME AND MINORITY WOMEN 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 n EXCESSIVE PREGNANCY WEIGHT GAIN AND POSTPARTUM WEIGHT RETENTION n 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%

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 Key Aim: Community participation in planning program and policy interventions

PROMOTING HEALTHY LIFESTYLES AMONG WOMEN COLLABORATION MODEL

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 0Inadequate public facilities/lack of safe, clean parks and recreation centers 0Inadequate sidewalks 0Heavy traffic (especially Southwest Detroit 0Cracked sidewalks 0Air pollution (especially Southwest Detroit) 0Men, prostitutes on streets 0Crime 0Weather (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

POLICY/PROGRAM LEADERS’ STRATEGIES FOR REDUCING ENVIRONMENTAL BARRIERS