Article

Improving Health Services for Residents Through Community-Based Participatory Research: A Public Housing Leadership Perspective

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Background: In response to feedback from a health forum, resident leaders of public housing in Washington, DC, were inspired to create a health survey for and by the residents. Objective: The survey was designed to document residents' concerns about health, health care, and environmental threats. It also explored tobacco use and support for smoke-free housing. Methods: A newly created Health Planning Committee of the Citywide Advisory Board, including residents, academics, and representatives of health and housing organizations, facilitated the creation of a health needs assessment. Questionnaires were initially mailed, then hand-delivered to every public housing household. More than 1,000 completed questionnaires have now been returned. Lessons learned: This project highlights a model that places resident leaders in charge of health issues, including leading advocacy efforts for policies to reduce health disparities in public housing. It identifies research challenges and ways to overcome them and empowers the community for continued research.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Previous studies have documented significantly higher levels of environmental health risks for residents of public housing projects. 23,24 This study can be extended to examine whether the disproportionate presence of public housing in neighborhoods proximate to RMP facilities has resulted in greater exposure to extremely hazardous substances for disabled residents. Finally, future research would also focus on identifying other processes and events that have caused disabled populations to reside near RMP facilities. ...
Article
Background: While numerous studies have found socially disadvantaged groups such as minorities and low-income individuals to be disproportionately distributed with respect to various health hazards and pollution sources, previous research has not examined if people with disabilities reside near facilities where accidental releases of extremely hazardous substances are likely to occur. Objective: Using data from the 2011–2015 American Community Survey estimates and facilities submitting Risk Management Plans (RMPs) to the Environmental Protection Agency (EPA), the distribution of proximity to RMP facilities is compared to the disability characteristics of the civilian noninstitutionalized population in Harris County, Texas. The goal is to determine whether neighborhoods containing a higher proportion of disabled individuals are located near RMP facilities, after controlling for relevant socio-demographic factors. Methods: Proximity to RMP facilities is calculated at the census tract level using a spatial enumeration methodology developed by the EPA. Statistical analyses are based on descriptive comparisons, bivariate correlations, and multivariate generalized estimating equations--a modeling technique appropriate for clustered data. Results: RMP facility proximity increases significantly as the percentage of overall disability, as well as the percentages for specific types of disability increase, after accounting for population density, racial/ethnic composition, and socioeconomic status of neighborhoods. Disabled individuals with hearing and cognitive difficulties are particularly more likely to reside near RMP facilities. Conclusions: These findings emphasize the growing need to consider individuals with physical and mental disabilities in future research on environmental justice and health risk disparities, as well as evacuation planning for chemical accidents.
... One group working with public housing residents in the District of Columbia to improve a variety of health services noted the importance of a community-based participatory approach, empowering residents to take charge of planning and advocacy efforts designed to address their health needs. 49 Without such an inclusive approach, residents feel that they have no voice, 49 making them less likely to participate in policy implementation and evaluation efforts. ...
Article
Multiunit housing (MUH) residents are susceptible to secondhand smoke (SHS) exposure, which can transfer between living units. This review summarises existing scientific literature relevant to smoke-free MUH, discusses knowledge gaps and provides recommendations for future research to inform public health action. We conducted a systematic search of peer-reviewed articles using three databases: EBSCOhost CINAHL, PubMed and Web of Science. Article titles, abstracts and text were reviewed to ascertain three inclusion criteria: (1) English language; (2) conducted in the USA; (3) reported on baseline data, development, implementation or evaluation of smoke-free MUH. We used a multistep process to identify eligible articles: (1) two reviewers separately evaluated article titles; (2) two reviewers separately evaluated abstracts and (3) one reviewer read each article and determined inclusion eligibility. We identified and included 35 articles published during 2001-2014, grouped based on broad themes: MUH resident (n=16); MUH operator (n=6); environmental monitoring and biomarkers (n=9); economic (n=2); legal (n=3); and implementation process and policy impact (n=8). Studies with multiple themes were included in all relevant groups. Existing literature has focused on self-reported, cross-sectional studies of MUH residents and operators; some studies of environmental markers, biomarkers and economic indicators have also been conducted. Future research on smoke-free MUH policy compliance and enforcement, and on the impact of these policies on smoking behaviours and health outcomes, could further inform public health planning, policy and practice. Despite these gaps, the current literature provides sufficient evidence for action to eliminate SHS exposure in MUH. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
... In contrast to traditional investigator-driven research, CBPR begins with an issue selected by the community, and involves community stakeholders throughout the research process (Wallerstein & Duran, 2006). Prior studies have used a CBPR approach to drive improvements in health services for residents of subsidized housing environments (Council et al., 2013;Henwood et al., 2013). The present study describes an effort to conduct research in the context of a community driven evaluation of a local permanent supportive housing provider, Urban Housing Solutions (UHS) in Nashville, TN. ...
Article
The aim of this study was to determine an association between resident characteristics at time of entry to permanent supportive housing and exit status. A community-based participatory research (CBPR) approach was the guiding framework for the design, implementation and evaluation of this project. This retrospective observational study used an administrative data source from a local permanent supportive housing provider to compare resident characteristics among those who left housing voluntarily or involuntarily. The population based sample (n=407) was comprised of 51% males and 47% African-Americans with a mean age of 40 years (SD=11.8). Involuntary exits (IEs) occurred in 40% of the sample (n=166). IE was less likely with receipt of mainstream benefits, compared to employment income (O.R.=.546, p=.032). IE was more likely for residents self-identifying as African-American (O.R.=1.56, p=.037) and when children resided in the household (O.R.=2.03, p=.013). Despite limitations of community-derived data, findings suggest that supportive housing providers consider income source and family status when designing interventions to decrease IEs. A CBPR approach is a promising framework to guide evaluation efforts for supportive housing programs. Copyright © 2014 Elsevier Ltd. All rights reserved.
... In contrast to traditional investigator-driven research, CBPR begins with an issue selected by the community, and involves community stakeholders throughout the research process (Wallerstein & Duran, 2006). Prior studies have used a CBPR approach to drive improvements in health services for residents of subsidized housing environments (Council et al., 2013;Henwood et al., 2013). The present study describes an effort to conduct research in the context of a community driven evaluation of a local permanent supportive housing provider, Urban Housing Solutions (UHS) in Nashville, TN. ...
Conference Paper
SBIRT Across the Lifespan: Meeting the Goals of Healthy People 2020 Screening, Brief Intervention, Referral to Treatment (SBIRT) is gaining momentum and showing positive outcomes in reducing negative outcomes of alcohol and other drug consumption across the lifespan. A recent study (Knight et al, 2012) using a 5 minute computer screening followed by discussing the results with a pediatrician, reduced the risk of drinking almost 50% for three months, and by close to 25% by years end. Pediatricians were provided with talking points following the screening. Healthy People 2020s objectives includes several objectives related to substance abuse, including 2 notable teen objectives (SA1 and SA2) calling for reducing the proportion of adolescents who report that they rode with someone who had been drinking (by 10%) and increasing the number of teens who have never used substances (by 10%). The National Institute on Alcohol Abuse and Alcoholisms (NIAAA) new screening guidelines in 2011 focus on SBIRT in youth ages 9-18, with screening questions for elementary, middle and high school students to evaluate risk (lower, moderate and highest risk). Step by step algorithms then guide the patient who does not drink and assess risk for those who do drink alcohol. Brief interventions are provided for low risk, moderate risk and highest risk patients and follow up guidelines. Implementing the new youth SBIRT guidelines in primary practice sites is the next step after trauma centers and college campuses which has been well documented. The adult SBIRT guidelines have been available on the NIAAA website www.NIAAA.gov. Nurse Practitioner faculty should routinely prepare graduates to implement the guidelines in order to promote accomplishment of the Healthy People 2020 Objectives related to Substance Abuse. This presentation will review the evidence supporting SBIRT and prepare faculty to gain competency using SBIRT tools for primary care and specialty practices, with a special focus on using the new NIAAA tool for youth. Nurse Practitioners who implement the guidelines across the lifespan with patients will promote the goals of Healthy People 2020 to reduce the impact of alcohol and other drugs in youth, and across the lifespan.
Article
Full-text available
We conducted a review of the peer-reviewed literature focused on conducting community health needs assessments and highlighted the necessary steps to conduct a community health needs assessment in a rural community. From the literature review, we identified three steps necessary— establishing partnerships, using a mixed methods approach, and disseminating results—to successfully conduct a needs assessment that fitted the definition of the Affordable Care Act. These three steps have been used as a guide for developing a protocol for conducting a community health needs assessment in Meadville, PA. We detail our preliminary project protocol here.
Article
Full-text available
HOPE VI has funded the demolition of public housing developments across the United States and created in their place mixed-income communities that are often inaccessible to the majority of former tenants. This recent uprooting of low-income, urban, and predominantly African American communities raises concern about the health impacts of the HOPE VI program for a population that already shoulders an enormous burden of excess morbidity and mortality. In this paper, we rely on existing literature about HOPE VI relocation to evaluate the program from the perspective of weathering-a biosocial process hypothesized by Geronimus to underlie early health deterioration and excess mortality observed among African Americans. Relying on the weathering framework, we consider the effects of HOPE VI relocation on the material context of urban poverty, autonomous institutions that are health protective, and on the broader discourse surrounding urban poverty. We conclude that relocated HOPE VI residents have experienced few improvements to the living conditions and economic realities that are likely sources of stress and illness among this population. Additionally, we find that relocated residents must contend with these material realities, without the health-protective, community-based social resources that they often rely on in public housing. Finally, we conclude that by disregarding the significance of health-protective autonomous institutions and by obscuring the structural context that gave rise to racially segregated public housing projects, the discourse surrounding HOPE VI is likely to reinforce health-demoting stereotypes of low-income urban African American communities. Given the potential for urban and housing policies to negatively affect the health of an already vulnerable population, we argue that a health-equity perspective is a critical component of future policy conversations.
Article
Full-text available
Research has shown that public housing residents have the worst health of any population in the USA. However, it is unclear what the cause of that poor health is among this population. The purpose of this paper is to investigate the association between public housing and health conditions: specifically, we ask if residents entered public housing already ill or if public housing may cause the poor health of its residents. The data used for this study come from the GSU Urban Health Initiative, which is a prospective, mixed-methods study of seven public housing communities earmarked for demolition and relocation (N = 385). We used the pre-relocation, baseline survey. We found that, while health was not the main reason residents gave for entering public housing, the majority of public housing residents entered public housing already ill. Substandard housing conditions, long tenure in public housing, and having had a worse living situation prior to public housing were not associated with an increased risk of a health condition diagnosed after entry into public housing. Our findings suggest that public housing may have provided a safety net for the very unhealthy poor.
Article
The purpose of this study is to provide new data on the relationship between housing quality and health status for people in five HOPE VI public housing developments around the country. HOPE VI is a federal program to replace or redevelop some of the poorest quality public housing in the country. A special survey of residents of these developments was conducted while they lived in HOPE VI housing before its redevelopment. Data for these individuals provides a profile of the quality of housing and the health status of people in HOPE VI housing before its renovation, of residents of publicly assisted housing across the nation, of other people living below the federal poverty level, and of non-poor people. Previously, the lack of data sets that included both housing quality and health status measures has prevented such an analysis. We examined two indicators of health status-perceived overall health status and medically diagnosed asthma. The health status of HOPE VI residents is decidedly worse than that of others in assisted housing and other poor people, despite their similarity in terms of economic deprivation. The difference in the level of asthma prevalence, a condition that has been tied to various measures of housing quality, is especially pronounced. Our analysis indicates that one major benefit of improving housing quality may be improved health status.
Article
We compared the health of public housing residents with other Boston residents through a random-digit-dial survey. We used data from the Boston Behavioral Risk Factor Surveillance System collected in 2001 and 2003 to make crude and demographically adjusted comparisons between public housing residents and other city residents on measures of health status, access and utilization, and health behaviors. Public housing residents were more likely to report fair or poor overall health status, ever-diagnosed hypertension, current asthma, ever-diagnosed diabetes, obesity, disability, loss of 6 or more teeth, and feelings of depression for 15 days or more in the past month. Public housing residents were slightly more likely than others to be without health insurance or report financial barriers to medical care. Public housing residents reported more smoking and physical inactivity, less past-month binge drinking and past-year marijuana use, and similar levels of lifetime drug use. Public housing residents reported substantially poorer health than did other city residents across a variety of conditions but similar levels of access to and utilization of health care. Public health departments may be able to use established surveys to measure health among public housing residents.