1. 1413 THE HEALTHY ENVIRONMENTS PARTNERSHIP 1 Amy J. Schulz*, Srimathi Kannan +, J. Timothy Dvonch +, Alison Benjamin ×, Zachary Rowe ‡, Sheryl Weir* on behalf of the Healthy Environments Partnership 1 *Department of Health Behavior and Health Education, +Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI 48109-2029, USA × Southwest Detroit Environmental Vision, Detroit, MI ‡ Friends of Parkside, Detroit, MI Introduction Methods Progress/ Accomplishments Figure 2. Sampling Equipment at SW Detroit Air Quality Monitoring Site. Figure 1. Location of Detroit Communities Major Objectives for 2002-2003 1. The Healthy Environments Partnership includes: Brightmoor Community Center, Butzel Family Center, the Detroit Health Department, Friends of Parkside, Henry Ford Health System, Southwest Counseling and Development Services, Southwest Detroit Environmental Vision, University of Detroit Mercy, and the University of Michigan School of Public Health, School of Nursing, and the Institute for Social Research. The work of the Healthy Environments Partnership is supported by NIEHS Grant #5-R01-ES10936-03. The Healthy Environments Partnership is a community-based participatory research project designed to examine and address aspects of the social and physical environments that contribute to disparities in risk of cardiovascular disease in Detroit. It is funded as part of the National Institute of Environmental Health Science “Health Disparities Initiative.” The specific aims of the project are to:  Estimate the relationship between racial and ethnic group status, socioeconomic status, and mental and physical health status;  Investigate independent and cumulative effects of exposure to psychosocial stressors on biological risk markers for cardiovascular disease (e.g., systolic and diastolic lipid profile);  Document the strength of the association between airborne particulate matter (PM10 and PM2.5) and selected proximate risk and protective factors (e.g., dietary intake, social support) for cardiovascular disease;  Investigate potential mediating and moderating effects of behavioral and psychosocial responses to stressors;  Create a Community Outreach and Education Program to disseminate and translate knowledge gained from the study to inform intervention and policy efforts in Detroit. Ann Arbor Detroit E Detroit 5 km SW Detroit Face-to-face survey conducted with a stratified, multi-stage probability sample (n=1000) of an adult population in Detroit. Survey components include: physical health status, mental health indicators, socioeconomic status, assessment of psychosocial stressors, coping responses, nutritional assessment, and health related behaviors. Biomarker data collection with a subset (n=200- 400) of the survey sample. Biomarker data consists of sample of salivary cortisol collected over two consecutive days, and a blood sample. Filter-based measurements of PM 2.5 and PM 10. 24-hour sample durations, collected over a three year period. Healthy Environments Partnership NW Detroit A Survey Subcommittee made up of representatives from community organizations and academic researchers from diverse disciplines designed, pretested and revised a community survey instrument to assess aspects of the social environment (e.g., perceived stressors), socioeconomic status (e.g., income, occupation, wealth), health related behaviors (e.g., smoking), indoor air exposures (e.g., self-reported occupational exposures), health status indicators (e.g., physical functioning, blood pressure), and dietary intake (e.g., food frequency). At the completion of each survey, community residents are invited to participate in a Biomarker Component of the study, following a protocol designed by the Biomarker Subcommittee. To date, 163 of 228 (71%) survey respondents have consented to participate in the biomarker component of the study which involves collection of salivary cortisol over a two day period, and a blood draw. As of June 30, 2002; 75 (46%) had completed the biomarker component; others will complete this component throughout the summer Each participant in the biomarker component of the study is mailed a feedback from based on analysis of their blood samples. The feedback form includes information about risk and protective factors related to CVD, as well as information about actions they can take to reduce the risk of CVD. Survey implementation began in April of 2002 and is expected to continue through September 2002. Surveys are being administered in three areas of the city : Southwest, East Side and Northwest Detroit. Figure 3. Goal and Number of Survey Respondents as of 6/30/02, by Area of Detroit Each survey respondent is mailed a Nutrition Feedback Form developed using their responses to the nutrition questions included in the survey. The tailored feedback form, created using HEP customized nutrition analysis, includes information about dietary protective and risk factors related to CVD, and suggests foods that can increase their protective factors or reduce their risk factors. Figure 4: Excerpt from Nutrition Feedback Form Community-Based Participatory Research The Healthy Environments Partnership uses a Community-Based Participatory Research Process (Israel et al 1998) in which Partners are actively involved in each step of the research process, including decisions about study design, implementation, methodology, interpretation and translation of results in interventions at the individual, community or policy levels. All members of the Healthy Environments Partnership have been actively involved in designing this study through participation in one or more of the following subcommittees: Survey Subcommittee, Biomarker Subcommittee, Air Quality Monitoring Subcommittee. In addition, members of the Partnership have worked in small, less formal, groups on the sampling design and the design of the Nutrition Feedback Form (described below). Preliminary Data  Create database which integrates all components of the study  Begin analysis of data toward study objectives  Complete all data collection  Develop and begin implementation of Community Outreach and Education Program (COEP)  Subcommittees that involve representatives from diverse academic disciplines and from community organizations are an effective mechanism for designing a complex project  Involvement of community partners has been key for:  identifying mechanisms for community awareness about the HEP Partnership  recruitment of interviewers and participants for study components  defining data collection instruments and methods that have contextual validity  designing meaningful feedback strategies  Effective coordination of Partners takes time, energy, organization and commitment on the part of all involved  Having an effective and organized Project Manager is essential! Lessons Learned The following are Protective Nutrients Your Actual Nutrient Intake.Recommende d Nutrient Intake Your Top Three Nutrient Sources 1 Good Sources of this Nutrient Fiber (grams) 2325 Broccoli, bread, cereal Whole-grain breads and cereals Vitamin A ( Retinol Equivalent) 11001000 Carrots, liver, grains Sweet potato, spinach, mango Vitamin E ( Internat’l Units ) 2330 Green salad, fruits Sunflower seeds, almonds, wheat germ Figures 5 and 6 demonstrate that a large fraction of the PM2.5 and PM10 across Detroit comes from regional sources. However, the first year of data collected also suggest that there are small yet detectable differences across the three community sampling sites in both PM2.5 and PM10, as levels increase from NW Detroit to Eastside Detroit to SW Detroit. Though this is likely due to differences among communities in proximity to local sources (power plants, incinerators, automobile traffic), additional years of data collection are necessary to determine the statistical significance. Figure 5. PM2.5 in Detroit (Annual Mean: Year 2000) Figure 6. PM10 in Detroit (Annual Mean: Year 2000)