Issues: Black youth experience racism at multiple levels that can manifest as racial trauma – the stressful impact or emotional pain that comes from experiencing racism. Racial trauma is associated with depression, anxiety, general psychological distress, and suicidal ideation as well as increases in increases allostatic load that can lead to physical health problems.

Description: There is a need for culturally responsive approaches to address racial trauma that recognize and address the multiple levels of racism Black youth experience. Through youth participatory action research (YPAR) we have partnered with Black youth exposed to racial trauma to co-construct healing approaches centered on developing critical consciousness, deconstructing power hierarchies, and engaging in community building.

Lessons Learned: Through our photovoice and iterative intervention development studies we have co-developed two healing approaches for racial trauma that we will present in partnership with our youth leaders: promoting Black History Knowledge and integrating cultural healing practices into evidence-based traumatic stress interventions. Through our process we have learned key factors that support engaging Black youth as equitable partners including: 1) consistent communication and relationship building; 2) offering multiple ways to engage and contribute; and 3) building trust and long-term commitment through consistently showing up and leveraging resources to respond to identified needs.

Recommendations: Next steps include continuing our YPAR focused on evaluating our co-constructed healing approaches to address racial trauma among Black youth. We recommend engaging Black youth as equitable partners to build from their expertise and strengths in developing comprehensive solutions to address racial trauma.

Issue: Gun violence has increased exponentially over the past 4 decades. School shootings are on the rise and create mental, social, and emotional trauma for all youth. The Flint Public Health Youth Academy (FPHYA) has been providing youth led discussions and programming focused on public health, health equity and social justice since 2018. More recently, FPHYA has launched a virtual health messaging campaign against gun violence designed to increase dialogue, create policy recommendations, and elevate youth voice.

Description: A series of youth-focused health communications on Gun Violence and Prevention launched in Flint/Genesee County, MI, Spring of 2023. Virtual billboards, strategic messaging, hybrid-educational learning (in-person and virtual) and collaborative projects were created and launched on social media platforms. Our “Youth Perspective” talk show is facilitated by youth and a large following of supporters was garnered. On average the talk show receives 3K-6K in views.

Lessons Learned: Providing platforms for youth to discover their own voice, empowering them to be creators and facilitators of effective programs and interventions is key. FPYHA engaged over 500 youth in hybrid learning, social media engagements and collaborative efforts. Community-based participatory approaches were effective to introduce youth to careers in public health. FPHYA youth interns, collaborated with various youth-serving organizations locally and nationally sharing participatory approaches to engage youth in public health.

Recommendation: Utilize Community-Engaged Research (CEnR) approaches as a framework for youth to: 1) develop campaign content (messaging, imagery and hashtags), 2) identify effective media platforms for dissemination, and 3) engage the intended audience.

Issue: Childhood obesity rates have risen across the United States since 2000 with significant disparities in health outcomes for Hispanic children. These trends are evident in Tucson, Arizona where nearly 45% of the population identifies as Hispanic/Latino. Using the Catalyzing Communities Stakeholder-driven Community Diffusion framework, Activate Tucson formed a community-based coalition to identify the drivers of childhood obesity. Lack of resources for health promotion within schools was identified as a driver of obesity risk in children in our community. Tax policy was presented as an intervention point for addressing low resourced schools, intervening on childhood obesity, and improving child health.

Description: Activate Tucson has begun a pilot program in collaboration with a private, local accounting firm to educate income tax preparers and their clients on tax credit donations to direct funding to support school-based health programming. Our focus is on an underserved school district within a majority Hispanic, lower socioeconomic population.

Lessons Learned: Stakeholder engagement and planning has resulted in the identification of specific inputs/resources, activities, outputs and outcomes outlined in a program Logic model Program evaluation will include mixed methods including focus groups, semi-structured interviews, surveys for preparers and school personnel as well as, marketing data for campaigns.

Recommendations: The final deliverable for all stakeholders will be a tax credit donation implementation guide founded in the Practical Implementation Sustainability Model (PRISM) for public/private partnerships seeking to address multilevel contextual factors relevant to addressing childhood obesity.

Issue

The goal of the Cancer Health Awareness through screeNinG and Education (CHANGE) project is to address racial disparities and inequities in cancer care. CHANGE’s sustainable community partnership seeks to understand challenges and support our partners, by challenging racial inequities, poor access to cancer screening and care, alongside opportunities to impact modifiable behavioral risk factors.

Description

Residents of Augusta Housing Authority (AHA) communities experience community-wide environmental initiatives that support healthy behaviors, evidence-based cancer education, and navigation to cancer screening through trained facilitators. The Augusta Locally Grown produce stand and community garden, as well as fitness classes, walking groups (Fleet Feet Augusta, Salvation Army Kroc Center), neighborhood story walks (Golden Blocks Legends Comics, AU Literacy Center), and upgraded crosswalks have all been implemented by CHANGE's Community Advisory Board, which is made up of AHA residents representing five communities. Access to the neighborhood park and disc golf course have been secured (City of Augusta Traffic Engineering Division, Augusta Disc Golf Association).

Lessons

The evidence-based program has encouraged participants to use healthcare services, with 17 referrals made for cancer screening or tobacco cessation, and self-reported increases in physical activity and fruit and vegetable consumption.

Recommendation

CHANGE and AHA members are shaping Cancer Health Awareness by identifying the needs and challenges that must be addressed to support cancer risk reducing behaviors through a health equity approach. Future directions seek to further improve access to cancer screening and health education through at home screening and expansion of the environmental change projects to other communities.

Issue: Participatory research partnerships require considerable discussion and planning to meet the needs of every party involved. The shared foundation of a CBPR definition, shared knowledge, power, effective communication, resource sharing, capacity, and long-term implications surrounding a research project are often seen through differing lens by researchers and partnering community organizations.

Description: The Arizona Prevention Research Center has been conducting CBPR projects for over 20 years. The Community Action Board that guides research is comprised of various community partners, and together they developed two infographics to address key discussion topics that should occur when researchers approach new community partners. One infographic addresses key questions for community organizations when they are approached by a researcher, while the second is designed for researcher to increase their sensitivity to the burdens of research. Each infographics identifies key topics of discussion that should take place when forming a CBPR partnership. The researcher’s infographic, as well as the community partner’s are accompanied by an extended guide, further explaining the key principles of a successful partnership.

Lessons-learned: When exploring the possibility of engaging in a CBPR partnership both researchers and community partners encounter confusion, miscommunication and a sense of self-interest that could deter or pose barriers in the development of CBPR partnerships. Often both parties overlook uncomfortable topics of time, resource, and capacity, in an effort to work together on an identified shared issue. Empowering communities with the right information can improve the CBPR process and foster trust between researchers and future project proposals.

Issues: Community health centers (CHCs) increasingly play an important role in research aimed at engaging underrepresented patient populations and health equity. However, traditional research partnerships can be challenging to develop and maintain due to limited resources and competing priorities. Active engagement of CHCs as partners is paramount.

Description: Caring Health Center, a Federally Qualified Health Center (FQHC) in Springfield, MA is collaborating with long-standing academic partners to conduct its first randomized clinical trial (RCT) with waitlist control on medication adherence among patients with hypertension. Addressing social and ethical considerations of engaging underrepresented minoritized patients in research while mitigating workforce and implementation challenges is iterative and requires clearly defined roles and responsibilities within the community-academic research partnership.

Lessons Learned: Critical questions about RCT implementation in a real-world CHC setting are addressed. They include obtaining buy-in from a 51% patient-led board of directors, iterative study design adaptation that is responsive to ongoing practice advancements, prioritizing patient care while maintaining scientific rigor, ensuring rapid translation to practice improvements, and hiring amidst pandemic-related staffing shortages. By striking a mission-aligned balance between clinical innovation and CHC operations the study offers critical insight into the FQHC role as a research partner rather than a study site.

Recommendations: CHCs may prioritize building community-academic research partnerships and engaging minoritized patients in research. They may also seek funding for research initiatives that prioritize health equity for minoritized patient populations with complex social and medical needs. Addressing pragmatic and ethical considerations related to FQHC engagement in research is crucial.

Background:

Person-centered analyses such as Latent Class Analysis (LCA) are used to study Community Violence Exposures (CVE), but modeling is exclusively performed by researchers. We hypothesize that all stages of LCA model development and reporting can be accessible and empowering to community members while also improving modeling.

Methodology:

Participatory Action Researchers (PAR) performed street-identified snowball sampling recruitment for nine semi-structured focus groups (N = 48) of Black American adult men and women living in the city of Wilmington, DE who experienced CVE, exploring beliefs and attitudes about health and violence. Preliminary LCA modeling of locally conducted PAR Health Survey 2017 data comparing CVE with health-related distal outcomes were presented. Thematic analysis of audio transcripts was performed.

Results:

Community participants understood PAR generated labels for the 4-class results (victims, watchers, bystanders, and isolated) and self-identified with groups without prompting. Effective prompts for discussion were symbolic representations, heat maps, and use of relative comparisons between groups. No participants described negative concerns of class label choice. Community interpretation differed from researchers, especially related to gender and age. Participants wanted research data highlighting disparities to be presented to those in community leadership to enact change. At least 48% of participants had highest educational level of high school completion.

Conclusions:

LCA modeling of adult violence exposures can be understood and interpreted effectively by community members. Participant discussion exposed limitations to survey instruments and researcher interpretation, improving modeling. LCA in research can be made participatory and effective for feedback, model refinement, and dissemination to communities surveyed.

Ten years ago, a diverse group of concerned individuals were brought together by the question of how to effectively reduce justice system involvement for young people in Los Angeles County, home to the largest justice system in the nation. This group included community-based organizations, youth organizers, judges, lawyers, educators, policymakers, and public health researchers. To answer their question, the group employed a public health approach that led them to embark on a multi-year process of participatory systems change. This case study explores successes, challenges, and lessons learned from Los Angeles County’s youth justice transformation efforts. Methods include: 1) review of literature on systems change to identify characteristics of participatory approaches compared to traditional methods, 2) structured analysis of historical documents, and 3) qualitative analysis of semi-structured interviews with key participants (n=10). Document analysis will use a structured review tool to assess key themes from policy documents as well as collaborative reports and research findings from the study period. For qualitative analysis, members of the study team will review semi-structured interview transcripts using an inductive, exploratory approach to identify codes and themes directly from interview data and reconcile differences after independent coding. Findings will outline ways in which Los Angeles County’s youth justice transformation efforts align with characteristics of effective participatory systems change. Implications for public health professionals and partners in other jurisdictions will focus on specific steps that can be taken to improve health equity by strengthening participatory systems change based on lessons learned from Los Angeles County.

Issues: There is persistent inequality in participation in STEMM (Science, Technology, Engineering, Math, and Medicine) by women and underrepresented racial and ethnic groups. These groups disproportionately lack access to high quality, inclusive educational opportunities. Place-based education (PBE), rooted in the local community, relies on place as the foundation for teaching and learning. While all students realize benefits, research shows links between PBE and increased interest in STEMM by girls and underrepresented groups.

Description: Health in Our Hands (HiOH) connects the community to the science classroom. Students investigate critical public health concerns (diabetes and addiction) and use these real-world contexts to appreciate the importance of genetic and environmental factors in their risk for diseases. They conduct a culminating research project to improve community health and present their findings at a “Health Summit” to peers, family, and community. The co-developed HiOH project involves community/educational partners in every phase including curriculum design/enactment, Health Summits, dissemination, and grant writing.

Lessons Learned: Since 2018, 15 middle school teachers have enacted the curriculum with approximately 1800 students. Based on surveys and interviews of students, teachers, and community partners, we’ve studied and documented the transformative power of PBE developed in partnership with teachers and community. Students are highly engaged in science and their interest in STEMM increases. Benefits of PBE extend beyond students to teachers, partners, and community.

Recommendations: The HiOH partnership has documented processes, lessons learned, and plans for sustainability of this PBE. The next phase extends these lessons to other communities.

ISSUE

While conversations about mental health are becoming mainstream, the US still socially and ethically dismisses the disproportionate burden on BIPOC teens in regard to rates of mental health conditions, delayed diagnoses, and access to affordable, culturally relevant care. The youth mental health crisis is compounded by intergenerational traumas perpetuated by systemic racism.

DESCRIPTION

The Changemakers program fosters leadership development, community engagement and mental health & healing justice. Youth interns learn how to work with the communities they live in to identify strengths and gaps, and work in action teams to apply knowledge and advocate for community change alongside academic and community partners. Youth-driven action teams address immigration, education and (in)equity, and youth mental health and healing justice - with a focus on training youth to provide peer to peer mental health training opportunities. In Fall 2023, Changemakers will partner with UNC Chapel Hill students to facilitate parallel photovoice projects with youth and their guardians to raise awareness and advance intergenerational learning to support mental health and healing justice.

LESSONS LEARNED

Changemakers demonstrate that BIPOC teens offer powerful potential to lead intergenerational conversation and advocacy to change the landscape of community-based mental health supports. BIPOC teens and their guardians are deeply impacted and care about equity in mental health, and both are passionate about bringing about improvements.

RECOMMENDATIONS

Youth-led peer-to-peer community mental health trainings provide an opportunity for intergenerational community transformation and healing justice for BIPOC teens and should be explored as affordable, accessible, and culturally responsive alternatives to school-based services.