Grantee Research Project Results
Final Report: Williamsburg Brooklyn Asthma and Environment Consortium
EPA Grant Number: R828595Title: Williamsburg Brooklyn Asthma and Environment Consortium
Investigators: Acosta, Luis Garden
Institution: El Puente , Woodhull Medical and Mental Health Center , New York University School of Medicine
Current Institution: El Puente , New York University School of Medicine , Woodhull Medical and Mental Health Center
EPA Project Officer: Hahn, Intaek
Project Period: January 1, 2001 through December 31, 2005
Project Amount: $1,040,000
RFA: Environmental Justice: Partnerships for Communication (1999) RFA Text | Recipients Lists
Research Category: Environmental Justice , Human Health
Objective:
The U.S. Environmental Protection Agency (EPA) awarded El Puente a grant to research the environmental health concerns of the Latino residents in North Brooklyn who are disproportionately affected (as compared to other urban populations) by asthma, and are overrepresented in high asthma risk, low paying, industrial sectors and are also exposed to asthma triggers at home, work and within their communities on a daily basis.
The overall objectives of the research project were to: (1) initiate a research program that promotes a partnership between members of an environmentally stressed community, academia, and health practitioners; (2) develop culturally appropriate education and communication activities;(3) design and implement preventative environmental interventions to reduce exposure to key asthma precipitating agents, and interventions to improve quality of asthma care; (4) evaluate the process, the partnership, selected health outcomes and interventions; and (5) disseminate the successful outcomes of the program throughout the North Brooklyn community and health care communities.
Summary/Accomplishments (Outputs/Outcomes):
Summary of Findings
1. - Initiate a Partnership
El Puente led the effort to create the North Brooklyn Asthma and Environment Consortium (the Consortium or the NBAEC). The Consortium consisted of a partnership between El Puente, a community-based organization; Woodhull Medical and Mental Health Center; and the NYU School of Medicine, Department of Environmental Medicine. The overarching goal of the Consortium was to create the partnership necessary to develop a family health promotion model in which residents have access to easily understood, scientifically accurate, community specific information about their health, their environment, and the relationship between the two, enabling them to take targeted action to reduce the impact of environmental factors on their asthma. This model was applied to assist the residents with their asthma-related concerns. The model was to be developed to train El Puente’s members, who would then proceed to teach other community residents. Such was the case, initially, with the support of the NYC Department of Health. Two community health workers (Promotoras de Salud) were trained and worked with both El Puente and other community members to not only understand the model but also to engage in community research.
High school students (El Puente members) became a key factor in developing a community driven research approach.
The NBAEC conducted community-based environmental health research on asthma in Williamsburg, Brooklyn’s predominantly Latino “Southside” neighborhood. The NBAEC gathered their resources to conduct community assessments on asthma severity, environmental conditions and health care needs.
It became clear at the onset of the partnership that we had to establish relationships across three entities that, literally, spoke different languages and saw their work from very different perspectives. Woodhull Medical and Mental Health Center clearly understood and welcomed community leadership in the development of the partnership. It was more difficult for trained researchers from the NYU School of Medicine to understand both the language of community and the efficacy of the community’s role in research. Over many weeks of meetings and with the leadership of Dr. George Friedman-Jiménez, we were able to build a comfort zone for all partners.
Ultimately, through regular communication between the partners, including bi-monthly meetings and accessible information system terminals at El Puente’s Community Health and Environment Institute (CHE) and Woodhull Medical Center, the Consortium established and maintained a strong and open relationship. This allowed the NBAEC to discuss recent trends in asthma care/incidence, cultural competency in health care provision, and other issues facing asthmatics in the Williamsburg Community and other parts of North Brooklyn.
The establishment of a strong relationship between El Puente, Woodhull and NYU provided an opportunity for referrals among the partners, where Woodhull patients were referred to El Puente’s health promotion program, and community residents who required specialized clinical services were referred to Woodhull. It also allowed for a method of participatory research to be integrated into the study, which provided the Consortium with recognizable research themes. The NBAEC combined and complimented each partner’s relative expertise in health promotion, community organizing, environmental and occupational medicine research, risk communication, and primary medical care to create a holistic response to the environmental precipitants of asthma in Williamsburg. The partnership provided the driving force in support of Woodhull’s initiative in creating a community asthma coalition with its focus on the mastery of asthma.
2. Culturally Appropriate Education
Cultural competency was a primary focus of the partners involved in the NBAEC. Since this project was proposed as a community-based research study, a culturally relevant and appropriate framework was inherent in the project’s scope. Promoting an effective and culturally sensitive asthma education occurred naturally, as El Puente had been in the “Southside” community for approximately 20 years at the time of the study.
Woodhull Medical Center also participated in the cultural effort as they developed a “Prep for Asthma” card that helped patients extract vital information from their providers. It was observed that there was a communication gap between providers and patients and families of color and languages other than English. The card addressed this gap by listing six principle questions to be answered by the medical provider during any visit, to ensure that a culturally appropriate interpretation of information was taking place.
El Puente created the Community Advisory Committee (CAC), which consisted of local community leaders from organizations such as churches, neighborhood civic associations and other neighborhood entities, to ensure that the input of the community was properly included in the asthma study. El Puente also worked with Woodhull and the NYU School of Medicine to create scientifically accurate questionnaires and asthma assessment tools for use by North Brooklyn community residents.
The above tactics were implemented to provide the community with a more active role in managing their asthma-related concerns. The NBAEC tailored the research study to properly represent the populations that are disproportionately affected by asthma, such as Latina Domestic Workers. This allowed the NBAEC to put asthma-specific preventative measures in place where they were most needed.
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Also, all communications were presented in both Spanish and English, allowing a greater population to be able to access questionnaires, flyers, fact sheets and any supplemental presentation materials. El Puente undertook a major project in training young high school students as community muralists. Using asthma and its relationship to the community as the theme of the mural, young people not only learned about the issue but, also, painted a large mural that was the first, such visible and culturally rooted, public art communicating the issue to the entire community (See Figure 1).
El Puente also disseminated information regarding findings in asthma and community driven research by participating in conferences such as the NYU Latino Health Conference. El Puente’s Luis Garden Acosta, who was the Principal Investigator on this grant, facilitated a workshop in 2002 entitled “Community Health in the 21st Century.” The workshop reviewed the more allopathic approach to health care delivery and contrasted it with the nature of a holistic, proactive approach to community health.
3. Design and Implement Preventative Interventions
The NBAEC’s project applied and extended existing etiological knowledge to help Williamsburg community residents deal with occupational asthma, as well as to identify and control environmental precipitants of asthma in the home.
One statistically interesting group was females over the age of 25. They had the highest prevalence of asthma, at 20%. After assessing the community studies, El Puente found that the reason for this anomaly was that a disproportionate number of Latina females over the age of 25 in the North Brooklyn community worked as domestic workers. For these Latina Domestic Workers, this meant that analyzing their cleaning products for any known asthma precipitating ingredients, and instructing them to no longer use that specific agent was a well-received and applicable preventative intervention. However, for the Domestic Workers this was not a perfect solution, as the choice of cleaning supplies is limited, especially when the purchase price range is restricted.
In 2004, El Puente held a large community-screening event at Junior High School 50, site of El Puente’s Beacon Program. El Puente worked with Woodhull Medical Center to draft an English/Spanish “Asthma Screening” questionnaire. The 13 questions were presented to approximately 85 community members to help El Puente determine the severity of community residents’ symptoms. The staff of El Puente performed follow-up with the participants of the study to help them reduce asthma precipitants in their homes. Based on the information gathered, El Puente was able to refer study participants to Woodhull if the answers warranted a more thorough exam.
Overall, the preventative interventions El Puente proposed to the community, and the community members’ participation, was satisfactory. The main difficulty in implementing preventative services was that some community residents objected to change. With gentle persistence the residents would adopt measures such as not smoking indoors, but we have reason to believe that some of the sample population did resume their asthma-inducing behaviors. One significant moment occurred when students of the El Puente Academy for Peace and Justice, El Puente’s public high school, reported to their predominantly Spanish-speaking parents on a survey that made the connection between smoking in the home and the incidence of respiratory problems in those homes. The parents were truly surprised and moved to learn that their behaviors directly correlated to their children’s asthma.
Conclusions:
El Puente’s participation in the NBAEC helped raise considerable awareness in the North Brooklyn Community of asthma and its precipitating agents. The partnership effected regular email communication and bi-weekly meetings, creating a productive and functioning collaboration. The community actively participated in the study at JHS 50 (as mentioned above), and in the high school student facilitated surveys as well as in the Asthma Self-Help Groups. Overall, the NBAEC has had a positive health impact on the North Brooklyn Community as the flyers, studies, press coverage and El Puente’s mural in Williamsburg have helped to enlighten the community and its perception of asthma. Additionally, the asthma work has expanded and continues today in the heightened and focused service provided by Woodhull Hospital.
The NBAEC exposed the difficulty in bridging the language and lens used in their approach to research and practice among the three partners. Only by building direct relationships and actually working together were we able to create a bridge of trust. Woodhull Hospital’s specialized, community driven focus on asthma care and mastery is a major legacy of the NBAEC. El Puente had hoped to continue its focus on community driven research, what at least one researcher has termed “Street Science” but the federal focus changed and we could no longer access the support needed. We took on a contract with the NYC Department of Health that helped support the continuation of some aspects of the NBAEC but that, too, was terminated.
It was a clear to us that without a commitment to support community organizations such as El Puente, these kinds of partnerships will never be equal and, therefore, fruitful in engaging the community in a most impactful way.
El Puente is very proud of the work that was accomplished in collaboration with Woodhull Hospital and the NYU School of Medicine. The NBAEC improved awareness of asthma and its precipitating effects, educated residents on understanding asthma, and helped change the tide of culture in the North Brooklyn community to become more health focused. El Puente wishes to thank the EPA for its support of the project.
Journal Articles on this Report : 2 Displayed | Download in RIS Format
| Other project views: | All 5 publications | 3 publications in selected types | All 2 journal articles |
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Cashman SB, Adeky S, Allen III AJ, Corburn J, Israel BA, Montano J, Raelito A, Rhodes SD, Swanston S, Wallerstein N, Eng E. The power and the promise: working with communities to analyze data, interpret findings, and get to outcomes. American Journal of Public Health 2008;98(8)1407-1417. |
R828595 (Final) |
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Corburn J. Reconnecting with our roots: American urban planning and public health in the twenty-first century. Urban Affairs Review 2007;42(5):688-713. |
R828595 (Final) |
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Supplemental Keywords:
Environmental justice, asthma, urban planning, public health, public-private partnerships, community-based participatory research, CBPR, health disparities, RFA, Scientific Discipline, ENVIRONMENTAL PROTECTION AGENCY, Economic, Social, & Behavioral Science Research Program, Health Risk Assessment, environmental justice, Social Science, Reinvention, education, intervention strategies, asthma, environmental toxicants, Hispanic, casa de salud, low income community, environmental equity models, community outreach, hazardous environmental exposures, environmental justice assessment, neighborhood home-based meetings (charlas), public health intervention, community based intervention, latino community, partnershipsRelevant Websites:
http://elpuente.us/
Progress and Final Reports:
Original AbstractThe perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Conclusions drawn by the principal investigators have not been reviewed by the Agency.