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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.

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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

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EXCESSIVE PREGNANCY WEIGHT GAIN AND POSTPARTUM WEIGHT RETENTION

ALMOST UNIVERSAL AND FREQUENT CONTACT PRENATAL AND POSTPARTUM CARE

HIGH AND RISING PREVALENCE OF OBESITY AND TYPE 2 DIABETES, ESPECIALLY LOW INCOME AND MINORITY WOMENPREGNANCY AND POSTPARTUM PERIODS: UNDERESTIMATED OPPORTUNITY FOR EARLY INTERVENTION AND RISK REDUCTION

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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%

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PROJECT GOAL

Key Aim: Community participation in planning

program and policy interventions

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
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COMMUNITY-ACADEMIC RELATIONSHIPS

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
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
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 exercise10
ENVIRONMENTAL INFLUENCES ON EATING AND EXERCISE

BARRIERS TO REGULAR EXERCISE

  • Inadequate public facilities/lack of safe, clean parks and recreation centers
  • Inadequate sidewalks
  • Heavy traffic (especially Southwest Detroit
  • Cracked sidewalks
  • Air pollution (especially Southwest Detroit)
  • Men, prostitutes on streets
  • Crime
  • Weather (extreme heat, cold/ice)
interactions of physical and social environmental barriers
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)