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Purpose

Community Health from Engagement and Environmental Renewal (CHEER) will leverage previous Centers for Disease Control and Prevention (CDC) community engagement projects to reach and intervene on a high need population. Disadvantage and poverty have long-term and transgenerational adverse impacts on social interaction and cohesion and residents' emotional and physical health. Mothers living and raising children in these conditions face multiple stressors without the community support previous generations relied on. Decades of research on American cities have connected the social, economic, and physical characteristics of neighborhoods with a lack of social cohesion, inability to maintain shared norms of acceptable behavior,and increases in health disparities and risky behaviors. Social cohesion and collective efficacy inversely associate with depression among youth. In a parallel manner, improved parenting practices and youth behavior directly associate with neighborhood social interactions and social cohesion. While these associations are suggestive, CHEER will directly test causal hypotheses at the neighborhood and family levels in a randomized control trial, that can significantly advance the evidence base for public health interventions: Family Youth Intervention (FYI) and an Environment: Social and Physical Intervention (ESPI) to increase social interaction, social cohesion, and collective efficacy and influence wellbeing of mothers and their youth.

Conditions

Eligibility

Eligible Ages
Over 11 Years
Eligible Genders
All
Accepts Healthy Volunteers
Yes

Inclusion Criteria

  • For FYI, parents who reside in the FYI intervention neighborhood (North Titusville, South Titusville, Rising -West Princeton, and Belview Heights) and have a child age 11-16 years. - For ESPI, residents who live in the ESPI intervention neighborhoods (North Titusville, South Titusville, Druid Hills, and Fountain Heights).

Exclusion Criteria

  • For FYI, does not met the above requirements and did not consent to participate. - For ESPI, not residing in one of the above neighborhoods and did not consent to participate.

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Factorial Assignment
Intervention Model Description
Hypotheses will be tested in a 2 X 2 design that includes the independent and combined effects of two interventions targeting the individual, family, and community level. Participating neighborhoods will be assigned into one of four cells: FYI alone, ESPI alone, FYI and ESPI combined, and Wait List Control.
Primary Purpose
Prevention
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Family Youth Intervention (FYI) 		The primary objective of FYI is to evaluate the effectiveness of a theory-based, peer-supported family strengthening intervention on the primary outcomes in a sample of 120 parent-child pairs living in resource-poor urban neighborhoods in Birmingham. For FYI, we will utilize community health advisors (CHAs) to implement the intervention. CHAs will be recruited from each FYI neighborhood and will be trained in research ethics. CHAs will assist and support FYI participants in mastering the sequential skills of the 12 modules designed to improve maternal, youth, and family functioning. Additionally, CHAs will provide emotional social support that is helpful, hopeful, and trustful.
  • Behavioral: Community Health through Engagement and Environmental Renewal (CHEER)
    FYI and ESPI intervention activities will be implemented in the overall study, CHEER. It will also allow us to examine possible synergistic effects of both interventions when implemented in the same neighborhoods. Separate sets of participants will be selected for the FYI comparisons and for the ESPI comparisons. Because the FYI intervention focuses on mothers and their children, participants for the FYI comparisons will be selected by Respondent Driven Sampling of eligible families from the neighborhoods in all four cells. The ESPI intervention targets the whole neighborhood, and thus a random sample of neighborhood residents will be enrolled in each of the four cells. Because the primary outcomes for FYI and ESPI are connected but differ from each other, the FYI samples will be assessed for the FYI outcomes in all four cells and the ESPI samples will be assessed for the ESPI outcomes in all four cells.
    Other names:
    • Family-Youth Intervention (FYI)
    • ESPI Environment: Social and Physical Intervention (ESPI)
Active Comparator
ESPI Environment: Social and Physical Intervention (ESPI) 		ESPI will enroll 500 community members to examine the effect of blight elimination through lot recovery on primary outcomes of improved social interaction, social cohesion around common neighborhood norms, and collective efficacy to effect change in the neighborhoods . Neighborhood residents will select a cluster of lots (2-3) for lot recovery that are highly visible in the neighborhood (e.g. on a main thoroughfare). The community residents will lead the neighborhood projects. In some cases, neighborhood residents will personally undertake all or part of the greening projects.
  • Behavioral: Community Health through Engagement and Environmental Renewal (CHEER)
    FYI and ESPI intervention activities will be implemented in the overall study, CHEER. It will also allow us to examine possible synergistic effects of both interventions when implemented in the same neighborhoods. Separate sets of participants will be selected for the FYI comparisons and for the ESPI comparisons. Because the FYI intervention focuses on mothers and their children, participants for the FYI comparisons will be selected by Respondent Driven Sampling of eligible families from the neighborhoods in all four cells. The ESPI intervention targets the whole neighborhood, and thus a random sample of neighborhood residents will be enrolled in each of the four cells. Because the primary outcomes for FYI and ESPI are connected but differ from each other, the FYI samples will be assessed for the FYI outcomes in all four cells and the ESPI samples will be assessed for the ESPI outcomes in all four cells.
    Other names:
    • Family-Youth Intervention (FYI)
    • ESPI Environment: Social and Physical Intervention (ESPI)
Other
Wait-List Control 		The two communities will get ESPI, upon completion of the study.
  • Behavioral: Community Health through Engagement and Environmental Renewal (CHEER)
    FYI and ESPI intervention activities will be implemented in the overall study, CHEER. It will also allow us to examine possible synergistic effects of both interventions when implemented in the same neighborhoods. Separate sets of participants will be selected for the FYI comparisons and for the ESPI comparisons. Because the FYI intervention focuses on mothers and their children, participants for the FYI comparisons will be selected by Respondent Driven Sampling of eligible families from the neighborhoods in all four cells. The ESPI intervention targets the whole neighborhood, and thus a random sample of neighborhood residents will be enrolled in each of the four cells. Because the primary outcomes for FYI and ESPI are connected but differ from each other, the FYI samples will be assessed for the FYI outcomes in all four cells and the ESPI samples will be assessed for the ESPI outcomes in all four cells.
    Other names:
    • Family-Youth Intervention (FYI)
    • ESPI Environment: Social and Physical Intervention (ESPI)
Active Comparator
FYI and ESPI 		Two of the eight neighborhoods will receive both FYI and ESPI intervention.
  • Behavioral: Community Health through Engagement and Environmental Renewal (CHEER)
    FYI and ESPI intervention activities will be implemented in the overall study, CHEER. It will also allow us to examine possible synergistic effects of both interventions when implemented in the same neighborhoods. Separate sets of participants will be selected for the FYI comparisons and for the ESPI comparisons. Because the FYI intervention focuses on mothers and their children, participants for the FYI comparisons will be selected by Respondent Driven Sampling of eligible families from the neighborhoods in all four cells. The ESPI intervention targets the whole neighborhood, and thus a random sample of neighborhood residents will be enrolled in each of the four cells. Because the primary outcomes for FYI and ESPI are connected but differ from each other, the FYI samples will be assessed for the FYI outcomes in all four cells and the ESPI samples will be assessed for the ESPI outcomes in all four cells.
    Other names:
    • Family-Youth Intervention (FYI)
    • ESPI Environment: Social and Physical Intervention (ESPI)

Recruiting Locations

UAB Center for the Study of Community Health
Birmingham, Alabama 35233
Contact:
Jeff Walker, PhD
205-975-5701
jeffw@uab.edu

More Details

Status
Recruiting
Sponsor
University of Alabama at Birmingham

Study Contact

Jeff T Walker, PhD
205-975-5448
jeffw@uab.edu

Detailed Description

Aim 1 Family System: To test the effect of FYI on primary outcomes of youth psychosocial behaviors and sexual risk compared to a Wait List Control. 1a. FYI will significantly improve our primary outcomes of externalizing (e.g. impulsivity, violence, theft) and internalizing (e.g. depression, withdrawal, anxiety, loneliness) behaviors and early and risky sex (i.e. sexual initiation at less than 16 years of age and sexual intercourse without a condom) (Effectiveness). 1. b. FYI will significantly lower parental stress, improve maternal emotional health, enhance parenting skills and improve youth Social and Emotional Competence (SEC) to change primary outcomes (Mediation). Aim 2 Community System: To test the effect of ESPI on neighborhood environment compared to Wait List Control. 2. a. ESPI significantly will increase our primary outcomes of social interaction, social cohesion, collective efficacy, and shared norms compared to wait list control (Effectiveness). 2b. Engaging residents in community-designed and -led projects to develop common spaces will significantly improve neighborhood perceptions (e.g. attractiveness, safety) and provide opportunities for residents to interact to change primary outcomes (Mediation). Aim 3 Community and Family Systems: To test the effects of combining FYI and ESPI on the same youth and neighborhood environmental outcomes as in Aims 1 and 2 compared to FYI alone, ESPI alone, and a Wait List Control. 3a. ESPI and FYI will significantly reduce primary youth and neighborhood environmental outcomes (Effectiveness). 3b. ESPI and FYI will change neighborhood environmental and family processes to change primary outcomes of adolescent SEC, external and internal behaviors, and early and risky sex (Mediation).

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.