Community & Behavioral Health Promotion

The Community and Behavioral Health Promotion (CBHP) faculty include: Young Cho, Paul Florsheim, Amy Harley, Emmanuel Ngui, Renee Walker, Lance Weinhardt, and Fang (Alice) Yan. Learn more about featured research projects by the CBHP faculty:


Community action and community capacity building for type 2 diabetes (T2D) prevention
Alice Fang Yan, Patricia MacManus
Diabetes is the seventh-leading cause of death in the United States (US). African American women are disproportionally affected by T2D. It is estimated that African American women over the age of 20 make up 15% of the total cases of T2D in the US. They also have the highest rates of being overweight or obese (80%) compared to other groups in the US,3 which further increases their risks of developing T2D. The overall goal of this pilot study is to test the feasibility to translate the evidence-based diabetes prevention strategies to reduce risks for T2D among overweight or obese African American women, using Community-Based Participatory Research (CBPR) approach.

Developing a men's wellness network to improve community health outcomes
Amy Harley, David Frazer, Jessie Tobin, Maanaan Sabir, Sharon Adams, Shanee Jenkins
The Lindsay Heights Neighborhood, home to the Lindsay Heights Neighborhood Health Alliance, is abundant with talents and assets, but also faces numerous socio-economic and health challenges. African American men, in particular, bear the burden of stunning disparities in social determinants of health (high rates of unemployment, incarceration, and racism) and health outcomes, including the highest mortality rates in the country. The Health Alliance has identified a need to strengthen the African American male leadership in this neighborhood’s community-wide health promotion and disease prevention efforts.

Evaluation of the Fondy Food Center Youth Chef Academy
Amy Harley, Young Kim, Lisa Kingery, Lora Jorgensen
The Fondy Food Center Youth Chef Academy aims to impart skills and knowledge that connect young people to healthy foods, empowering them with culinary skills to prepare healthy, tasty plant based meals and the context to appreciate their role in the local food system that produces and delivers food to them. The Fondy Food Center was interested in working with an academic partner to test the feasibility of conducting the Youth Chef Academy in a classroom setting, and to design an evaluation of its effectiveness in achieving its goals. The evaluation plan includes parent surveys, pre- and post- student surveys, observations of students’ willingness to try new foods and cooking skills, and a brief parent phone interview at completion of the curriculum. Data will be analyzed by observing changes in scores from pre- and post-surveys and qualitatively based on observations made by project staff.

E-Z Access to Health Project
Sharlen Moore, Paul Florsheim
Sexual health is a core component of individual and community health. African American youth in Milwaukee experience higher rates of teen pregnancy, sexually transmitted infections (STIs) and HIV infection than other youth. The purpose of this small demonstration study is to develop and test a social networking model of sexual health promotion intended to encourage African American youth to practice safe sex. Once the program is developed, youth leaders (ages 16-24) will be trained to inform other youth about a free evening sexual health clinic on Milwaukee’s Northwest side with the goal of increasing access and utilization. We are interested in measuring changes in the youth leaders’ communication skills (important to social networking) and tracking how youth leadership activities predict fluctuation in clinic attendance over time.

Fast food restaurant and convenience store density in relation to neighborhood sociodemographics
Renee E. Walker, Jason Block, Ichiro Kawachi
Differences in the local food environment are hypothesized to contribute to neighborhood disparities in obesity prevalence. The density of and proximity to fast food restaurants and convenience stores according to levels of neighborhood median incomes will be explored. The distribution of food stores in relation to city schools will also be explored using Geographic Information System technology. Close proximity of fast food restaurants and convenience stores expose children to unhealthy food options that may contribute to unhealthy eating and obesity, especially in economically disadvantaged neighborhoods.

Healthy neighborhoods, healthy eating study
Renee E. Walker, Christopher Keane, James Butler, Craig Fryer, Andrea Kriska, Jessica G. Burke
An extensive body of literature has been generated focusing on the importance of consuming fresh fruits and vegetables. In neighborhoods that lack a supermarket, maintaining a healthy diet can be difficult. Studies focusing on these neighborhoods, referred to as “food deserts”, are becoming more common in the U.S. However, many of these studies fail to understand the various factors that are involved in where people purchase food, when people purchase food and the types of food purchased. This study seeks to explore perceptions of factors influencing food buying practices among low-income residents of an urban food desert and low-income residents of a food oasis. A second aim is to understand how residents’ perceptions of factors influencing food buying practices differ by food security status. Results of this study have major implications for intervention and policy development aimed at increasing access to affordable and healthy foods.

mHealth text messaging for physical activity promotion in college youth: A participatory approach for content development
Alice Fang Yan, Cheryl Holt, Patricia Stevens, Tiffany Feller, Hui Xie
Moreover, critical health habits, such as a sedentary lifestyle established in emerging adulthood continue into later adulthood, thereby affecting life-long health. Thus, it is important to design an effective youth adult-centered intervention in order to undertake targeted exercise promotion efforts at such an important development stage. Mobile Health (mHealth) has emerged as a promising means of delivering healthcare services and promoting health-behavior changes by providing the right prompt, education, and/or feedback in “real-time”. Text messaging (otherwise referred to as Short Message Service, or SMS) has become the preferred channel of communication medium used by youths when compared to other commonly used forms of communication forms such as Facebook, email, or talking over the mobile phone. The overall objective of this project implemented an innovative participatory approach (1) to develop the physical activity promotion text messages contents guided by the transtheoretical model and social cognitive theory; (2) to understand what specific features in the text messages are favored or not favored by users; and (3) to assess the feasibility and acceptability of using text messages to promote physical activity in a sample of college students.

Neighborhood effects on the substance abuse treatment outcomes
Young Cho, Michael Fendrich, Timothy Johnson, Lillian Pickup
This study examines the effects of neighborhood environments of both patients' residences and treatment facilities simultaneously, as well as the interplay between the two, on substance abuse treatment outcomes. The primary objective is to document ecological disparities in treatment effectiveness by identifying neighborhood environments that hinder or contribute to successful treatment and to estimate the proportion of variance accounted for by individual client and treatment facility characteristics. This approach delves into fundamental questions regarding the degree to which the location of treatment facilities does in fact matter, accounting for both patient and organizational components. Assessing such disparities in treatment effectiveness will also help us identify areas with poor expected treatment outcomes. Some of the preliminary findings are reported in the Journal of Drug Issues.

Pathways linking poverty, food security, and HIV in rural Malawi
Lance Weinhardt, Loren Galvao, Winford Masanjala, Patricia Stevens
Poverty and lack of predictable, stable source of food are two fundamental determinants of ill health, including HIV/AIDS. Conversely, episodes of poor health from HIV can disrupt the ability to maintain economic stability in affected households. Research examining how improvements in peoples’ economic status and food security translate into change in HIV vulnerability is lacking. This is particularly germane in the Republic of Malawi, a largely agrarian society, facing severe health vulnerabilities due to poverty, food shortages and high levels of HIV infection. The Pathways project aims to answer the question: “What role does economic change have on HIV-related risk and prevention behaviors and their distribution in a population?” The American College Health Association (2008) found that 57.2% of college students did not meet the minimum requirement for healthy levels of exercise during the previous week (at least 20 minutes of vigorous or 30 minutes of moderate exercise on at least three of the seven previous days).

Predictors of hospital readmission among low-income patients with diabetes
Renee E. Walker, Melanie Gordon, Lorraine Halinka Malcoe, Xuexia (Helen) Wang
Hospital Readmissions are often preventable and pose great concerns among health providers treating patients with diabetes. Readmissions are associated with decreased quality of life, increased mortality and unnecessary costs. Identifying predictors of readmissions is salient for addressing difficulties in clinical management of diabetes, eliminating disparities in diabetes treatment, and improving survival. In this exploratory study, we will identify which biomarker or combinations of biomarkers are the best predictors of readmissions 30, 60, and 90 days after a diabetes-related event among patients with Type 2 diabetes. Additionally, we will examine if predictors of readmissions differ by race/ethnicity or sex. Results of this study will allows us to better identify patients at increased risk for readmissions, identify upstream approaches for reducing the likelihood of diabetes-related readmissions and emergency department utilization, improve diabetes self-management, and reduce the economic burden associated with diabetes-related readmissions.

Public-will building to reduce obesity in the Latino community of Milwaukee
Raisa Koltun, Ana Paula Sores, Stephanie Calloway, Amy Harley, Loren Galvão, Samuel Dennis, Suzanne Galoucher
Proyecto Salud recognizes that the problem of obesity in the Latino community is equally as detrimental as the lack of engagement in the social change process. With the ultimate goal of reducing obesity in the Milwaukee Latino community, Proyecto Salud proposes taking a public-will building approach to address this issue. Public-will building is grounded in the philosophy of connecting a community to an issue through its existing values, essentially building public support for social change by understanding existing values and recognizing the context in which we live, work and play.

School Community Partnership for Mental Health (SCPMH)
Sheri Johnson, Paul Florsheim
The School Community Partnership for Mental Health (SCPMH) is a pilot project between the Milwaukee Public School (MPS) system, the Planning Council and several community-based mental health agencies. The goal of this collaborative effort focused on increasing access to mental health care services for MPS students by complementing ongoing mental health promotion activities in the schools and increasing parent/caregiver engagement. Data from the pilot indicates that access to non- MPS mental health services increased from approximately 5% of children who were referred for services to 55% of children referred. The project is now in the process of further development and expansion. Dr. Johnson and Dr. Florsheim are collaborating in the design and assessment of this public-private partnership to promote youth mental health.

A social ecological assessment of physical activity among urban adolescents
Alice Fang Yan, Carolyn C. Voorhees, Kenneth H. Beck, PhD, Min Qi Wang
Healthy People 2020 encourages using a multidisciplinary approach to increase the physical activity levels and improve health in the United States. As a result, a burgeoning area of research related to active living has emerged. Active living is a broader concept that promotes the incorporation of all domains of physical activity including recreation, transportation, occupation and household activities into daily routines. Using the social-ecological framework, the purpose of the current study was threefold : (1) to examine physical activity domains; (2) to investigate the extent to which the frequency of physical activities occurs within these physical (where), social (with whom) and temporal (when) contexts; and (3) to examine how these associations vary by sex, in a sample of predominately urban African-American adolescents.

Strong families healthy homes
Alice Fang Yan, Kristina Finnel, Mollie Yocum, Karissa Vogel
While the racial disparity in infant mortality rates in the United States is high at 2.5 to 1, the situation in Milwaukee is more striking as the black infant mortality rate (15.7) is nearly three times higher than the white rate (6.4). For the period 2005–2008 in Milwaukee, of the 807 infant deaths and stillbirths, 686 or 85% were infants of color. Researchers working within the lifecourse theory have created a growing body of evidence that the deleterious effects of maternal stress — accumulated over a lifetime — may be causing the unusually high rate of negative birth outcomes among African Americans. Addressing the mental health of the parents, decreasing stress levels and providing a support system will hopefully increase healthy birth outcomes and decrease infant mortality in Milwaukee’s African American community. Depression in pregnancy has been implicated as a risk factor for many problems, such as poor weight gain, late or delayed prenatal care, self-neglect poor birth outcomes and postpartum depression. Women who are depressed have a higher prevalence of comorbid poor health habits, such as cigarette smoking, and drug and alcohol use. It is clear that the need for prenatal and infancy home visit intervention is great. This proposed study will pilot test the feasibility and effectiveness of translating and adapting the evidence-based “Strong Families Healthy Homes” (SFHH) and “Healthy Families America” programs as a combined comprehensive prenatal and infancy home visit preventive model to address mental health and stress among pregnant African American women who live with a mental illness or substance abuse disorder.

The Young Parenthood Project: A father engagement strategy for healthy families
Janice Litza, Paul Florsheim
The rate of childbirth to unwed parents has risen dramatically over the past several decades particularly among young, economically disadvantaged couples. While some unmarried co-parenting couples are able navigate a successful transition to parenthood, many experience high levels of stress and intense relationship problems, putting them at risk for intimate partner violence, negative parenting and paternal disengagement. Until relatively recently, young, unmarried fathers were considered irrelevant to maternal-child health because they were seen as peripherally involved in prenatal care and child rearing or having a negative influence on young mothers. There is recent evidence that many young men want to remain positively involved as co-parents, but often lack the skills or support to make that happen. This project tests the Young Parenthood Program, an innovative co-parenting counseling program designed to facilitate the development of relationship skills and decrease negative co-parenting outcomes among young, at-risk expectant couples.