4. HOPE Works 2004-2009 Health, Opportunities, Partnerships and Empowerment

5. UNC Center for Health Promotion and Disease Prevention Alice Ammerman, DrPH, RD, Director Marci K. Campbell, PhD, MPH, RD (PI) Marci K. Campbell, PhD, MPH, RD (PI) Salli Benedict, MPH, Project Director Salli Benedict, MPH, Project Director Katie Barnes Katie Barnes Peggy Bentley, PhD Peggy Bentley, PhD Brenda DeVellis, PhD Brenda DeVellis, PhD Andrea Meier, PhD Andrea Meier, PhD Kristine Kelsey, PhD Kristine Kelsey, PhD Chantelle Fisher-Borne, MPH Chantelle Fisher-Borne, MPH Beth Hooten, PhD Beth Hooten, PhD

6. The evolution of the Health Works projects from participation to empowerment Health Works for Women (HWW) 1993-1998 Work-site health promotion project focusing on individual risk factors (diet and exercise) and strengthening social support networks Worksites included nine textile, apparel, and light manufacturing companies in Eastern North CarolinaWorksites included nine textile, apparel, and light manufacturing companies in Eastern North Carolina Project employed traditional research methods, as well as formative research methodsProject employed traditional research methods, as well as formative research methods

7. The evolution of Health Works: From participation to empowerment Health Works for Women/Health Works in the Community (HWW/HWC) 1998-2003 Health Works for Women/Health Works in the Community (HWW/HWC) 1998-2003 Scope of the project expanded to address organizational and community factors that impact health and well-beingScope of the project expanded to address organizational and community factors that impact health and well-being Community Advisory Committee (CAC), consisting of workplace representatives, local agencies, advocacy groups, established to provide guidance and feedbackCommunity Advisory Committee (CAC), consisting of workplace representatives, local agencies, advocacy groups, established to provide guidance and feedback Plant closings and lay-offs occurred in the course of project implementationPlant closings and lay-offs occurred in the course of project implementation

8. The evolution of the Health Works projects: From participation to empowerment Health Works After the Flood (HWATF) 2000- 2003 Health Works After the Flood (HWATF) 2000- 2003 In the wake of devastation wrought by Hurricane Floyd in 1999, CAC members and UNC initiated a project with CDC support to address stress and IPV in the months following the floodingIn the wake of devastation wrought by Hurricane Floyd in 1999, CAC members and UNC initiated a project with CDC support to address stress and IPV in the months following the flooding Composition of the CAC changes to include more community members, domestic violence and mental health agencies, more leadership rather than adviceComposition of the CAC changes to include more community members, domestic violence and mental health agencies, more leadership rather than advice

9. Community Advisory Committee October 2006 Priscilla Allen Priscilla Allen Katie Barnes, Chair Katie Barnes, Chair Sharon Brown Sharon Brown Tabatha Brewer Tabatha Brewer Consuela Combs Consuela Combs Darlene Leysath Dixon Darlene Leysath Dixon Anne Doolen Anne Doolen Pamela Gonzalez Pamela Gonzalez Addie Hall Addie Hall Barbara Harris Barbara Harris Katherine Hernandez Katherine Hernandez Judy Johnson-Truitt Judy Johnson-Truitt Donna Kelly Donna Kelly Mary Bea Kolbe Mary Bea Kolbe Elizabeth Maynor Elizabeth Maynor Pastor Patricia Peterson (Co-chair) Pastor Patricia Peterson (Co-chair) Imani Rivera Imani Rivera Delphine Smith Delphine Smith

10. Women’s Empowerment Days Community Advisory Committee Project 2003 In response to community concerns about the economic downturn and the need for grassroots development and empowerment efforts Planned and implemented by the Community Advisory Committee Planned and implemented by the Community Advisory Committee Address health and economic needs of blue collar women Address health and economic needs of blue collar women Community-wide events Community-wide events New linkages among agencies New linkages among agencies

12. Community Partner: MBA (Multicultural Business Association)

15. “ Poverty is hazardous to women’s health”: The link between health and poverty Considerable micro-level research suggests a strong relationship between individual health and income (i.e. poverty leads to lower health status) Considerable micro-level research suggests a strong relationship between individual health and income (i.e. poverty leads to lower health status) Important findings include: Important findings include: Income level is a more important predictor of health status than income changeIncome level is a more important predictor of health status than income change Income level has a greater impact on the health status of poor than high-income individualsIncome level has a greater impact on the health status of poor than high-income individuals Extended periods of time in poverty have a greater and more negative impact on health than occasional episodes of povertyExtended periods of time in poverty have a greater and more negative impact on health than occasional episodes of poverty Phipps, S.

17. Loss of traditional industries in eastern NC The manufacturing industry in the United States has experienced extensive economic restructuring in the past 30 years, primarily affecting rural areas in the Southeast. The manufacturing industry in the United States has experienced extensive economic restructuring in the past 30 years, primarily affecting rural areas in the Southeast. Between 1997 and 2002, North Carolina lost 100,000 jobs in the textile industry and 70,000 jobs in the apparel industry. Between 1997 and 2002, North Carolina lost 100,000 jobs in the textile industry and 70,000 jobs in the apparel industry. Hossfeld L, Legerton M, Keuster G. Kalishman J, Stogner S, Ramey J.

18. HOPE Works Builds on HWW-1 and HWW-2/HWC Builds on HWW-1 and HWW-2/HWC Community-based participatory research project, active participation of Community Advisory Committee Community-based participatory research project, active participation of Community Advisory Committee Addresses high prevalence of obesity… Addresses high prevalence of obesity… …and addresses social determinants of health (education, employment, living situations) …and addresses social determinants of health (education, employment, living situations) Modeled on loan circles/microenterprise Modeled on loan circles/microenterprise

19. Health Determinants Community factors Employment Housing Economic systems Education Culture and history Environment factors Built environment Rurality Flood damage and recovery Individual factors Socioeconomic Language Culture Education Family Health status Intermediate Outcomes Health and Social Change Outcomes Community level Neighborhood resources Opportunities for learning and developing capacity Community development and employment opportunity Community involvement,collective efficacy, social capital Health and obesity prevention resources Partnerships/linkages Individual level Goal achievement Self-efficacy Knowledge/awareness Skills and capacity building Social support Health behavior changes Obesity prevention Health promotion Empowerment HOPE HOPE Works Conceptual Model HOPE Works Intervention

20. HOPE Works Intervention expands to larger community, not just workplaces Intervention expands to larger community, not just workplaces Retain women’s health focus Retain women’s health focus Address link between health, poverty, and hope Address link between health, poverty, and hope Goal setting Goal setting Uses third world community development principles and models Uses third world community development principles and models

21. Planning for HOPE Works (2003-2004) CAC women trained to lead focus groups (8 focus groups conducted) CAC women trained to lead focus groups (8 focus groups conducted) CBPR Process/Committees formed: CBPR Process/Committees formed: Facilitator trainingFacilitator training MarketingMarketing KickoffKickoff Evaluation (baseline and community surveys)Evaluation (baseline and community surveys)

22. HOPE Works Intervention HOPE Circles Low income, overweight women, multi- ethnic (African American, white, Latina, Coharie Tribe) Low income, overweight women, multi- ethnic (African American, white, Latina, Coharie Tribe) Circles led by trained leaders from the community Circles led by trained leaders from the community Experiential learning (fitness activities, ice breakers, healthy food) Experiential learning (fitness activities, ice breakers, healthy food) Provide social support, information, strategies for health behavior change Provide social support, information, strategies for health behavior change Goal-setting in health and hope domains (e.g. getting education, jobs, housing, etc) Goal-setting in health and hope domains (e.g. getting education, jobs, housing, etc)

23. Circle Leader Training Friday evening, all day Saturday Friday evening, all day Saturday Experiential: ice breakers, fitness activities (music), healthy food Experiential: ice breakers, fitness activities (music), healthy food Presentations on weight management, healthy eating, fitness, stress, economic empowerment Presentations on weight management, healthy eating, fitness, stress, economic empowerment Goal setting: didactic and practice Goal setting: didactic and practice Monthly meetings Monthly meetings

27. HOPE Works Intervention Tailored newsletters (6) that address both health and hope-related issues and goals Tailored newsletters (6) that address both health and hope-related issues and goals Community-wide events and interventions; new focus on advocacy

31. Evaluation --250 women in HOPE circles vs. 250 comparison women Individual change in weight, diet, PA, hope, self-efficacy, social support, community involvement, social capital, psychological and economic well-beingIndividual change in weight, diet, PA, hope, self-efficacy, social support, community involvement, social capital, psychological and economic well-being --Comparison of HOPE Works counties with neighboring counties via random surveys (via mail) Health behaviors, awareness, community involvement, social capital, hopeHealth behaviors, awareness, community involvement, social capital, hope

32. Qualitative Evaluation of Circle Leaders Personal life and health-related changes in Leaders Personal life and health-related changes in Leaders Interviews, photo voice Interviews, photo voice Formative: intervention adaptations Formative: intervention adaptations

33. Preliminary data: random community surveys* What do you believe is the single biggest issue facing your community today? Jobs and the economy Jobs and the economy Drugs/alcohol Drugs/alcohol Social change/social capital Social change/social capital Poverty Poverty Hispanic immigration Hispanic immigration Cost of health care, prescriptions Cost of health care, prescriptions Environment (hog, poultry farms, landfill) Environment (hog, poultry farms, landfill) *511 surveys: over 80% completed this question *511 surveys: over 80% completed this question

34. “No jobs. Most of the factories are closing—send the work overseas. If they keep this up no one will be able to buy their products when it comes back to America because no one will have jobs. The gas prices have increased faster than the cost of living increases in wages. Depression is hitting everyone because they cannot afford what they’ve been having. No jobs, no pay increase, but everything keeps going up. Yes everything was better years ago. So obesity and health problems are on the rise. This problem will continue to increase as long as there is no jobs and depression from losing everything grows.” “No jobs. Most of the factories are closing—send the work overseas. If they keep this up no one will be able to buy their products when it comes back to America because no one will have jobs. The gas prices have increased faster than the cost of living increases in wages. Depression is hitting everyone because they cannot afford what they’ve been having. No jobs, no pay increase, but everything keeps going up. Yes everything was better years ago. So obesity and health problems are on the rise. This problem will continue to increase as long as there is no jobs and depression from losing everything grows.”

35. “In my community we don’t have anywhere for the children to go like a recreation center and its hardly any stores or restaurants where I live it’s a very small town. Something about me I am 31 years old, single mother with asthma. I have 3 children ages 10, 7 and 5. I would really like to lose weight for my health and to do more things with my children. I weigh about 300 pounds right now. And its hard for me to try and exercise because of my asthma and then my breasts are real big.”

36. Preliminary analysis of random community surveys : Hope Preliminary analysis of random community surveys : Hope Hope is significantly higher among women with more education and income, higher self-reported health, more healthy days/month (BRFSS), more positive perceptions of their community’s economic and social capital. Hope is significantly higher among women with more education and income, higher self-reported health, more healthy days/month (BRFSS), more positive perceptions of their community’s economic and social capital. Hope higher among employed women Hope higher among employed women

37. Preliminary random survey analysis: Hope Level of hope was not different by age or race Level of hope was not different by age or race Level of hope and body mass index: there was significantly lower hope among more obese (controlling for age, race, and education) Level of hope and body mass index: there was significantly lower hope among more obese (controlling for age, race, and education)

38. HOPE Works…? Will the HOPE Works intervention that links health promotion/obesity prevention with social support and economic education/empowerment result in positive health and hope outcomes for women?

41. Seeds of HOPE Goal: to create a sustainable model Born of growing interest in the importance of economic empowerment to women’s health and community development Born of growing interest in the importance of economic empowerment to women’s health and community development Opportunities, training, education, resources for enhancing economic empowerment and community wealth Opportunities, training, education, resources for enhancing economic empowerment and community wealth Community-led partnership w/UNC, CDC, business and entrepreneurial organizations: one-year participatory strategic planning process Community-led partnership w/UNC, CDC, business and entrepreneurial organizations: one-year participatory strategic planning process

42. Seeds of HOPE Partners UNC (Jim Johnson, Anita Brown Graham, Jesse White) UNC (Jim Johnson, Anita Brown Graham, Jesse White) Community (community colleges, economic development agencies) Community (community colleges, economic development agencies) Good Work Good Work NC Rural Center NC Rural Center NCSU College of Design and Textile School NCSU College of Design and Textile School

43. Seeds of HOPE Strategic Plan Goals Start a business that will serve as an example of an exemplary worker- owned business Start a business that will serve as an example of an exemplary worker- owned business Increase financial education across all HOPE Works activities Increase financial education across all HOPE Works activities Increase networking with organizations that support entrepreneurial activities Increase networking with organizations that support entrepreneurial activities

44. Threads of HOPE: Creation of a Woman-owned Business The Seeds of HOPE strategic plan: to create Threads of HOPE Build on skills of unemployed textile/apparel workers Unique design or product to reflect HOPE Works values, place and culture Collaboration with NCSU College of Design (and Penelope Bags?)

45. Threads of HOPE Goals Training for low income women in every aspect of running a business Training for low income women in every aspect of running a business Worker owned Worker owned Living wage Living wage Health benefits Health benefits Health promoting business/HOPE Circles Health promoting business/HOPE Circles Leadership development Leadership development Opportunity to pursue educational goals Opportunity to pursue educational goals

46. Threads of HOPE Activities Collaboration with NCSU School of Textile and College of Design Collaboration with NCSU School of Textile and College of Design Student contest: unique Threads of HOPE design Student contest: unique Threads of HOPE design Meetings with community women Meetings with community women Ms. Tuggle’s Draperies Ms. Tuggle’s Draperies Contract with PRC Annual meeting Contract with PRC Annual meeting