Academic

Addressing health disparities requires both community engagement and an understanding of the social determinants of health. Although elements of the built environment can influence behavior change in public health interventions, such determinants have not been explicitly teased out via participatory mapping. An opportunity exists to integrate community voice in the development of such metrics. To fill this gap and inform the deployment of public health interventions in the Flint (USA) Center for Health Equity Solutions (FCHES), we created a means of assessing spatially-varying community needs and assets in a geographic information system (GIS), what we refer to as a healthfulness index.

We engaged community and academic partners in their expert opinions on features of Flint's built environment that may promote or inhibit healthy behaviors via a multiple-criteria decision analysis framework. Experts selected from and ranked 29 variables in 6 categories (including amenities, environment, greenspace, housing, infrastructure, and social issues) using the analytic hierarchy process. The resulting matrices of expert opinions were aggregated and appended as weights for each variable's corresponding map layer. When combined through map algebra, composite scores yield spatially-varying healthfulness indices which signal any neighborhood's relative health promoting qualities (along a 0–100 scale).

Results varied substantially across Flint, with the middle belt scoring highest and older neighborhoods in the northeast and north center of the city scoring lowest. Scores were
aggregated to 38 Flint neighborhoods; for each of two project-specific indices, these ranged from lows of 38.7 (Hilborn Park) and 41.8 (Columbia Heights) to highs of 52.9 (College Cultural) and 58.0 (University Ave Corridor). We hypothesize that—even when controlling for individual-level factors—we will measure better and more sustained behavior change among participants living in neighborhoods with high healthfulness scores. Future work will examine this hypothesis and determine the importance of such indices in other similar communities.

In 2011, nearly 20% of Flint residents participating in a community-wide survey on health reported that they or a family member were a drug user or addicted to drugs in the past 2 years.​ Prevention and treatment work, but little is known about how to effectively implement evidence-based programs in communities such as Flint.

Strengthening Flint Families (SFF) is substance use prevention initiative in Flint that combines three coordinated evidence-based interventions​:​

Peer recovery coaching (PRC): Certified Peer Recovery Coaches (PRCs) are peers to their clients, have been successful in the recovery process for more than two years, and have completed specialized training and supervision. PRCs assist individuals with challenges related to their recovery and enroll clients’ families into the Strengthening Families Program. ​
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Strengthening Families Program: Strengthening Families Program: For Parents and Youth 7 - 17 (SFP 7 - 17) is an evidence-based program for families with children between the ages of 7 – 17. It consists of 10 interactive sessions that focus on strengthening protective factors and reducing risk factors for families.​

​Multi-media campaign: The campaign will deliver messages about the effectiveness and availability of family programs and substance use treatment and prevention in the community. Driven by the powerful message of growth and recovery from the affected populations, the campaign will be executed on social media platforms as well as print media and radio.

Chronic disease carries high morbidity and mortality in the United States, with large racial and ethnic disparities observed in chronic disease. Physical activity and healthy food are vital for chronic disease prevention yet challenging to access in economically distressed areas. Public health prevention efforts have become particularly prominent within faith-based organizations over the last three decades. This manuscript describes the protocol of the Church Challenge, a multilevel cluster-randomized controlled nutrition and physical activity trial across 24 churches to reduce blood pressure by 6 mmHg among 576 residents in Flint, MI. The Church Challenge was developed using community-based participatory approaches and is rooted in a church-based program developed by and for primarily African-American Flint church congregations. This three-level intervention addresses health at the community (level 3), church (level 2), and individual (level 1) to reduce blood pressure, reduce chronic disease risk, and promote health equity and wellbeing in Flint. Churches are randomized in a 1:1 ratio to a 16-week physical activity and nutrition program or a 4-session health and wellness workshop. Flint is not a unique community but has a history of traumatic community wide events; even now, the public health infrastructure continues to be a challenge and distract residents from focusing on their health. This trial is highly significant and innovative because it uses a combination of evidence-based practices simultaneously supporting health behavior change for individuals and their faith organizations, and evaluates multilevel efforts to sustain long-term health promotion activities in vulnerable communities like Flint.