1. Applying community engagement principles to a neighborhood-based survey of adult chronic disease risks: Baseline findings from Community Interventions for Health, New Haven
Amy Carroll-Scott, PhD, MPH
Jeannette Ickovics, PhD
Alycia Santilli, MSW
APHA Annual Meeting, November 8, 2009
Amy Carroll Scott, Dissertation prospectus

2. Presenter Disclosures Amy Carroll-Scott
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
No relationships to disclose

3. New Haven Challenges Wealth disparity Health disparity
CT is one of the wealthiest states in the US
New Haven is one of poorest US cities. 21% of residents live in poverty.
Health disparity
From birth to death, New Haven residents face risk of illness and disability 1.5 to 7 times higher than others in the state
New Haven is majority minority (39% black, 23% Hispanic), increasing disparities
Amy Carroll Scott, Dissertation prospectus

4. Why Focus on Chronic Disease?
It’s costly: 75% of the nation’s $2.5 trillion health care expenditures
It’s prevalent and growing:
133 million have a chronic condition
50% have more than 1 condition
1/3 of people who die before age 65, die from chronic disease
Causes 70% of all deaths
It’s preventable: targeting 3 risk behaviors can help to prevent most chronic diseases…
Diet
Exercise
Tobacco use
Amy Carroll Scott, Dissertation prospectus

5. Why CBPR?
There is a history of mistrust between Yale and the New Haven community
Residents see Yale researchers as “looking for guinea pigs”
Even if research was well-intentioned, usually the researcher disappears before sharing results
In the current economic climate, announcement of large grants shows community Yale has resources it doesn’t share
The only valid data of community experience is data that is collected in partnership with the community

6. Community Interventions for Health

7. Focus on Six Low-Resource Neighborhoods
Dixwell
Fair Haven
Hill North
Newhallville
West River/Dwight
West Rock
City wide = 6 neighborhoods for our purposes

8. Research Questions
What are the current chronic disease rates among adults in these 6 neighborhoods in New Haven?
What are New Haven residents’ eating, exercise, and tobacco use behaviors?
What are the environmental facilitators and inhibitors of diet, exercise, and tobacco use in New Haven?
Amy Carroll Scott, Dissertation prospectus

9. Accelerated Timeline 2009-2010
Aug:
Asset Map
Sept:
Hire/Train Community Members
Oct/Nov:
Surveys
Dec:
Preliminary Results
Feb-Apr:
Reports & Community Dialogues
Research can be slow

10. Neighborhood Health Surveys

11. Methods Randomized household survey
20 community interviewers from New Haven were hired, trained, and supported
Interviews knocked 3 times, offered to reschedule, conduct elsewhere, conduct in Spanish
Data collected via PDA
Items focused on general health, health care access, diet, exercise, tobacco use, neighborhood perceptions, and safety
Sample: 1205 residents, approximately 200 in each neighborhood, response rate of 73%
85% of people approached participated
Rapidly providing results!

12. Demographic Characteristics of Sample

13. Health Insurance
Amy Carroll Scott, Dissertation prospectus

14. Self-Rated Health
Amy Carroll Scott, Dissertation prospectus

15. Chronic Disease Rates
Amy Carroll Scott, Dissertation prospectus

16. Diet
48% report eating vegetables 7 days a week. On the days they eat vegetables, 73% report eating just 1 or 2 servings
38% report eating fruits 7 days a week; 65% of report just 1 or 2 servings per day
In contrast, 53% report drinking sugar-sweetened beverages 7 days per week, with 76% drinking 2 or more per day
Many report difficulty finding affordable, healthy foods. Since survey, the only major grocery store in New Haven has closed.
85% of people approached participated
Rapidly providing results!

17. Food Insecurity
Amy Carroll Scott, Dissertation prospectus

18. Exercise
58% report no regular exercise, which is worse than national average of 51%
Walking is the most frequent form of exercise with 47% reporting walking for for at least 10 minutes every day in the past 7 days
The most common reasons given for not exercising included no time (36%), no energy (30%), poor health (27%), no self- discipline or willpower (28%), no equipment or space (20%), and no one with whom to exercise (20%)
85% of people approached participated
Rapidly providing results!

19. Smoking Rate
Amy Carroll Scott, Dissertation prospectus

20. Stress and Safety
65% “strongly” or “somewhat agree” that it is unsafe to go for walks in their neighborhood at night
High rates of mental stress:
56% report feeling some level of tension, stress, or pressure during the past month
20% reported feeling more stress than is usual for people in general
4% reported that “life is almost unbearable”
28% report they have been bothered by feeling down, depressed or hopeless
24% report they have been bothered by little interest or pleasure in doing things
85% of people approached participated
Rapidly providing results!

21. Conclusions
Residents of these 6 low-income New Haven neighborhoods experience:
Lower self-rated health and insurance
More chronic conditions
More health damaging behaviors
More stress
More food insecurity
CARE’s next steps:
Developing interventions on the city, neighborhood, school, worksite, and clinic levels
Collecting identical data in 2 years
Amy Carroll Scott, Dissertation prospectus

22. Additional Benefits of Community Interviewers
Anecdotal evidence that residents answered the door only because they knew the interviewer or field captain
Interviewers debriefed at the end of each day, discussed experience, and brainstormed new ways to communicate benefits of project and encourage folks to take the survey
Interviewers found out there was a lot of food insecurity and need for resources, and so connected respondents to food pantries and developed a local resource list
Planning and mobilizing residents for CIH interventions
Several interviewers conducted outreach and dissemination of results
Amy Carroll Scott, Dissertation prospectus

23. Additional Benefits to Community Interviewers
Training and data collection increased interviewers’ research capacity
Several got jobs with the Census and other research projects
One is spear-heading another data collection project in one of the neighborhoods around increasing access to healthy foods
One leveraged this experience to apply to graduate school
Increased their ability to explain research, health disparities, and social determinants of health to their friends, family and neighbors
Amy Carroll Scott, Dissertation prospectus

24. Implications for Engaging Communities in Academic Research
See CBPR as an employment opportunity. See research as an industry.
Streamline university hiring and HR processes. CARE’s next step: working with Yale HR.
Create a trajectory for community members to earn certificates or degrees. CARE’s next step: RA program through local community college.
Develop a research capacity building program that “demystifies” research for volunteer leaders and youth. CARE’s next step: seeking funding to expand Democracy School.
Develop a more rigorous capacity building program for CBOs. CARE’s next step: seeking funding.
Amy Carroll Scott, Dissertation prospectus

25. Acknowledgements
Lauren Kelley, Our 20 wonderful community interviewers, Our many community partners, Yale Center for Clinical Investigation

26. Contact Info
Amy Carroll-Scott
Amy Carroll Scott, Dissertation prospectus