Journal of Community Engagement and Scholarship

Volume 8 | Issue 2 Article 6

August 2015 Hear Our Voices: Case Study Connecting Under- Represented Communities to Research Legislators on Safe Routes to School and Active Transportation Huda Ahmed University of Minnesota

Khalid Adam University of Minnesota

Karen Clark Women's Environmental Institute

Felicia Wesaw University of Minnesota

Sarah Gollust University of Minnesota

See next page for additional authors

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Recommended Citation Ahmed, Huda; Adam, Khalid; Clark, Karen; Wesaw, Felicia; Gollust, Sarah; and Nanney, Marilyn S. (2015) "Hear Our Voices: Case Study Connecting Under-Represented Communities to Research Legislators on Safe Routes to School and Active Transportation," Journal of Community Engagement and Scholarship: Vol. 8 : Iss. 2 , Article 6. Available at: https://digitalcommons.northgeorgia.edu/jces/vol8/iss2/6

This Article is brought to you for free and open access by Nighthawks Open Institutional Repository. It has been accepted for inclusion in Journal of Community Engagement and Scholarship by an authorized editor of Nighthawks Open Institutional Repository. Hear Our Voices: Case Study Connecting Under-Represented Communities to Research Legislators on Safe Routes to School and Active Transportation

Authors Huda Ahmed, Khalid Adam, Karen Clark, Felicia Wesaw, Sarah Gollust, and Marilyn S. Nanney

This article is available in Journal of Community Engagement and Scholarship: https://digitalcommons.northgeorgia.edu/jces/vol8/ iss2/6 Ahmed et al.: Hear Our Voices: Case Study Connecting Under-Represented Communit Hear Our Voices: Case Study Connecting Under-Represented Communities to Research and Legislators on Safe Routes to School and Active Transportation

Huda Ahmed, Khalid Adam, Karen Clark, Felicia Wesaw, Sarah Gollust, and Marilyn S. Nanney

Abstract Although research indicates the built environment influences the walkability of a geographic region among a general population, less is known about the built-environment influences among communities that face health and socio-economic disparities. Built-environment initiatives like Safe Routes to School and Active Transportation that do not take into account the unique assets/barriers of these communities can inadvertently widen disparities. With a health equity lens, this project focused on bridging information gaps that exist between underserved communities, research, and health policy-making. Community listening sessions focusing on Safe Routes to School/Active Transportation were held in the spring of 2014. Over 180 participants from some of Minnesota’s communities of color (Native American, Somali/Oromo, and LGTBQ Two-Spirit) generated recommendations for policy and program decision- makers. These recommendations illustrated that in addition to the built-environment Safe Routes to School/Active Transportation address, public safety concerns needed to be addressed for successful implementation of Safe Routes to School and Active Transportation in their communities.

Introduction Despite health disparities nationally being high- Minnesota is repeatedly ranked as one of lighted as an issue decades ago (Nickens, 1986), the healthiest states in the country (http://www. they continue to persist. According to the 2014 health.state.mn.us/ommh/publications/legislati- Advancing Health Equity Report by the Minneso- verpt2013.pdf). This ranking, however, does not ta’s Commissioner of Health; they persist because tell the whole story. Despite being healthy on av- of structural policies and programs that routinely erage, Minnesota ranks among the states with the advantage one mainstream population (Cauca- worst health disparities. This means that the op- sian) and disadvantage others (minorities). These portunity to be healthy is not enjoyed equally by policies and programs reinforce the disparities by all Minnesotans. According to a recently released taking a one size fits all approach that does not take from the Minnesota Department of Health, exam- into account the unique needs, assets, and culture ples that highlight such disparities include: of other communities, these same communities that are afflicted with higher morbidity and mor- African American and American Indi- tality rates. This calls for an upstream approach an babies die in the first year of life at that engages disadvantaged communities as poli- twice the rate of white babies. While in- cies and program are being planned and developed fant mortality rates for all groups have so that resulting health policies and programs ad- declined, the disparity in rates has exist- dress their specific needs in a way that is appropri- ed for over 20 years. American Indian, ate to them. Hispanic/Latino, and African American Currently in Minnesota, there are many youth have the highest rates of obesity. health policy projects underway that communities Gay, lesbian and bisexual university stu- affected by health disparities, if equipped with rel- dents are more likely than their hetero- evant research best practices, can help shape and sexual peers to have struggles with their influence. These include; mental health (http://www.health.state. 1. Statewide Health Improvement Pro- mn.us/divs/chs/healthequity/ahe_leg_re- gram (SHIP). SHIP is a state initiative that works port_020414.pdf). on policy, systems, and environmental factors that need to be in place for a healthier community. Ac- tivities include: Farm to School to promote healthy

Published by NighthawksVol. 8, No. Open 2 ­—JOURNALInstitutional Repository, OF COMMUNITY 2015 ENGAGEMENT AND SCHOLARSHIP—Page 59 1 Journal of Community Engagement and Scholarship, Vol. 8, Iss. 2 [2015], Art. 6 eating; Safe Routes to School to have more kids Our community-academic partnership imple- walking to school to increase their physical activi- mented a robust community engagement process ty; Physical activity in schools that are working to connecting policy-relevant obesity research find- increase physical activity within the instructional ings with disadvantaged communities to mobilize setting; and Tobacco Free Campuses. SHIP was be- them toward impacting policy decisions, specif- hind the University of Minnesota’s going tobacco ically the legislative 2014 target of Safe Routes to free this year. School. 2. Community Transformation Grant All partners recognized they have unique (CTG). This is a federally funded initiative from expertise that when combined moves the needle the Center for Disease Control that in Minnesota, toward health equity for all. Researchers affiliated works to expand efforts in tobacco-free living, ac- with University of Minnesota Program in Health tive living and healthy eating, and quality clinical Disparities Research (PHDR), have been involved and other preventive services, all toward a goal of in a study funded by the National Institutes of addressing health disparities, helping control health Health on use of research evidence in policy mak- care spending, and creating a healthier future. ing decisions. This project, while including policy- Unfortunately, many of the communities that makers, advocates, and state agency staff, did not are affected by health inequities are not engaged include any underserved communities, an import- at these policy shaping discussions for the reasons ant oversight that this project corrects. The com- discussed earlier. So, as certain communities be- munity partners were key in bringing the two to- come healthier by benefiting from the above pol- gether due to their strong relationship with PHDR icies and programs, others are at the wrong end of and their communities. A community dialogue se- a widening health equity gap because they are not ries platform brought all three together; research, part of the conversation. community, and the 2014 policy initiative of Safe Routes to School. This project was “shovel ready” “Bridging the Gap” Project Overview for implementation and could serve as a model for Current research (Gollust, Kite, Benning, Cal- engaging disadvantaged communities in achieving lanan, Weisman, & Nanney, 2014) examining ways health equity initiatives. The University of Minne- in which childhood obesity research evidence is sota IRB determined the project to be exempt. used in the policymaking process highlighted sev- eral gaps, including engaging communities to have The Policy: Safe Routes to School influence on policy decisions. Since legislators are With the growing rates of childhood obesity accountable to community demands, commu- around the country (Ogden, Carroll, Kit, & Flegal, nities that are engaged and knowledgeable about 2012), the American Heart Association in 2015 rec- policy-relevant research findings can have an in- ommended that kids get about an hour of physical fluential role in helping to advocate for policies to activity a day (http://www.heart.org/HEARTORG/ improve health. There needs to be a connection be- GettingHealthy/HealthierKids/ActivitiesforKids/ tween research and policy and, even more impor- The-AHAs-Recommendations-for-Physical-Ac- tantly, to eliminate health inequity disadvantaged tivity-in-Children_UCM_304053_Article.jsp). communities must be a part of this connection Increasing children’s physical activity has been from the beginning. Often when policy-shaping shown to decrease obesity. An 850-article literature discussions are happening and when important review on the topic (Strong, Malina, Blimkie, Dan- research findings are being disseminated, they are iels, Dishman, Gutin, Hergenroeder, Must, Nixon, done in a way that leaves out communities that are Pivarnik, J.M., Rowland, Trost, & Trudeau, 2005) not connected for many reasons. This continues to concluded that 60 minutes or more of moderate reinforce health inequities because it produces an to vigorous physical activity that was developmen- information gap that leaves these communities lag- tally appropriate was recommended for school age ging. This project offered the opportunity for com- youth. Most U.S. children did not meet the rec- munities to provide input to real time state and ommended one hour minimum of daily moder- local policy making. By engaging these communi- ate-to-vigorous activity (Troiano, Berrigan, Dodd, ties at the beginning and tailoring the engagement Mâsse, Tilert, & McDowell, 2008). process to their needs, our approach ensured they Recent research has shown that Active Com- were part of health impacting conversations from munity to School and Safe Routes to School can the start. provide a frequent opportunity for children to reg-

https://digitalcommons.northgeorgia.edu/jces/vol8/iss2/6Vol. 8, No. 2­—JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 60 2 Ahmed et al.: Hear Our Voices: Case Study Connecting Under-Represented Communit ularly obtain their moderate to vigorous activity ing bodies. After receiving the grant, partners con- (Mendoza, Watson, Nguyen, Cerin, Baranowski, vened for a kick-off meeting that was focused on & Nicklas, 2011). As a result of these research rec- communicating mutual understanding of the ob- ommendations, there are national and state level jectives of the grant mechanism and on the deliv- initiatives to address environmental barriers to erables outlined in the grant application. Follow-up school age kids being able to walk or bike to school. meetings were then scheduled with each partner Most of these efforts, including those in Minneso- to finalize a project work plan, establish a mutually ta, include infrastructure improvement; filling in agreed upon memorandum of understanding that side walk cracks; installing traffic control devices highlighted how each of the partners and academ- such as stop signs; and education campaigns. In ic team would work together for a co-learning and 2014, when this project was being implemented, co-empowering process, and to address anticipated the Minnesota legislature was looking at whether logistical and technical needs. to continue funding Safe Routes to School and at what level. Phase 2 All four community partners agreed to host in The Community Partners their respective communities with a goal of reach- Our partnership focused specifically on en- ing 50 people each. It was also during this planning gaging communities that are often not part of the phase that community partners worked closely with conversation on health policy change due to how, the academic coordinator to augment their under- when and where these conversations are conduct- standing of evidence based research focused on ed. The community partners that were part of increasing physical activity. The academic partner, this project have roots with these communities. PHDR, agreed to provide a condensed summary of Along with the academic partner, PHDR, the other research that highlighted the benefits of SRTS (ma- partners were: Women’s Environmental Institute terials available upon request from authors). The (WEI), Positive Images, Health Equity Working summary was co-developed with the community Group (HEWG), and Brian Coyle Community coordinators so that it was in a format that was use- Center. The communities engaged and represent- ful and understandable to respective communities. ed by these partners are Native American, Soma- li, Hmong, African American, and LGBTQ com- Phase 3 munities of color. These are communities (among Three out of the four partners were able to others) that suffer from poorer health and are less organize and facilitate convenings in their com- connected than others due to a lack of access to munities that reached their recruitment goals. The information and resources. Together, we aimed to PHDR team made up of the project coordinator, bridge the information gap that exists and enforc- the project manager and academic faculty whom es the health inequalities for these communities. were present at all convenings to transcribe the Our engagement processes included staff with the conversations that were taking place, to contex- same cultural backgrounds and speak the native tualize the objectives of the grant and to answer language of the impacted community members, any questions community members had of the dialogue events located in the community, and in- research. While all the community partners were formation presented in a way that is understood able to adapt the questions for the dialogue as they by all. Lastly, the community’s voice is combined saw fit for their communities, there was a set of with the research to meet the project objective of general frame work questions that all the partners bridging the information gaps that exist between agreed upon: underserved communities, research, and health policy-making. 1. What is happening in your community now (Safe Routes to School, Active Trans- Methods portation)? Phase 1 2. What are the main challenges to address- The community and academic partnership ing these in your community? What do submitted a grant application to the Blue Cross Blue you want to tell policymakers/imple- Shield of Minnesota Center for Prevention and menters about Safe Routes/Active Trans- proposed to bridge persistent information gaps be- portation and how it relates to your com- tween researchers, communities, and policy-mak- munity?

Published by NighthawksVol. 8, No. Open 2 ­—JOURNALInstitutional Repository, OF COMMUNITY 2015 ENGAGEMENT AND SCHOLARSHIP—Page 61 3 Journal of Community Engagement and Scholarship, Vol. 8, Iss. 2 [2015], Art. 6 3. What needs to be improved/addressed/ of age. The second convening at Native American acknowledged before these can be reali- Community Development Institute (NACDI) also ty/improved in your community? What reflected the surrounding communities’ racial and would you like to see happen? ethnic makeup. Thirty community members di- verse in age and gender were part of the participant The partners were free to frame these questions pool during this second convening. as they saw fit. One out of the three partners chose to Brian Coyle/Cedar Riverside Community. focus on Active Transportation and not Safe Routes. These convenings were held for residents of the Cedar Riverside Plaza. Two convenings were con- Phase 4 ducted one with youth (n=~10) and one with par- Partners then reviewed transcripts generated ents and grandparents (n=~55). Residents mainly from the convenings and worked closely with a comprised of Somalis who lived in the Cedar Riv- graphic designer to transform the data into engag- erside Plaza apartments. ing one page handouts geared for decision-makers Health Equity Working Committee/Two that articulated the distinct needs (challenges, rec- Spirit. This convening was held for LGB (Lesbi- ommendations) of their communities as it related an, Gay, Bisexual), Transgender/Gender non-con- to active living and Safe Routes active issues. forming/Two-spirit Native Americans/people The partnership then reconvened community of color. The convening attracted more than 55 members for another dialogue to present the one participants who represented a wide variety of page hand outs and ask, Here is what you said as age groups, sexual orientations, gender identities, far as challenges and solutions, is that correct? and expressions. This convening was not restricted What should we do next? to individuals residing in a specific geographic location and attracted individuals from as far Project Measures as Shakopee. Measures of success were determined by the Expectations. Three of the four partners and following guidelines the PHDR team met the expectations outlined 1. REACH: Convenings within each com- in our respective work plans. Major timelines munity that reached 50 people respectively. and due dates were observed and the PHDR 2. REPRESENTATION: Convenings that team ensured the compilation of relevant policy reflected the identities of the intended audiences. research and the transcription of data from the 3. EXPECTATIONS: Meeting the objectives convenings was completed in a timely manner and of communication to policy makers and timelines sent back to the community partners. Currently, of the collaboratively developed work plans. all three community organizations that were able Reach: Three community organizations met to mobilize a convening have been able to work and exceeded their recruitment goals for their con- with a communications consultant to translate venings. Collectively, they exceeded their goals by their findings into engaging one page handouts for approximately 22%. (On a goal of 150 people, we policy makers. Two of the three organizations have collectively reached approximately 184 people). presented their findings to policy makers. Representation: All three communities reached their intended demographics. Detailed Project Findings breakdowns are listed below by community. While there were some uniqueness to each WEI/Little-Earth/Phillips Neighborhood: These of the communities’ needs and assets, there were convenings were held for the residents Little Earth and similarities in their recommendations for what the Phillips neighborhoods. Approximately 34 com- SRTS and Active Transportation should look munity members from the neighborhood gathered like in their communities. Generally, these needs for the first convening. The average participant age showed that in addition to the built environment was 38–40 years of age. Participants in this conven- infrastructure challenges that SRTS and Active ing comprised mainly of women (~75%) who iden- Transportation address, there were other needs tified as American Indian/Native American (~92%). that needed to be taken into account before these Approximately 40% of the participants were parents community members would send their kids walking with 38% of the parent participants having more than or biking or to school or the LGBTQ communities one child. Parent participants overwhelmingly had of color would ride the bus or walk. These concerns children who were between 7 months and 20 years focused largely on crime safety concerns.

https://digitalcommons.northgeorgia.edu/jces/vol8/iss2/6Vol. 8, No. 2­—JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP—Page 62 4 Ahmed et al.: Hear Our Voices: Case Study Connecting Under-Represented Communit Concerns Table 1. Concerns by Community Collective Recommendations to Decision-Makers Community Concerns 1. Infrastructure Safety Cedar-Riverside Cracked sidewalks. Lack of lighting and lack of signage for proper crossing. Recommendations: General lack of understanding on how to read and follow signage. Inconsistent de-icing and plowing months. Mend cracked sidewalks Lack of green spaces in the neighborhood. and other hazards. Kids have to walk through cigarette smoke, triggering Asthma Install proper crossing and other health issue. signs. Little Earth/ Enforce existing no-smok- East Phillips No effective adult intervention controls enroute or at bus stops in ing codes on community the neighborhood. A lack of effective support from police and others in dealing with properties. these safety issues. Improve lighting. LGBTQ Two Gender- and sexuality-based hate crimes. Conduct audits to iden- Spirit Poorly lit roads, bike routes (such as Chicago Avenue), and enclosed bus shelters. tify bus routes and stops with the most use/need. to address these barriers. A lack of cultural competence noting incidents of homophobia and 2. Crime Safety Recommen- transphobia perpetrated by those in authority. dations: Increasing positive police presence and interactions. elders to ride the school bus with students Train police officers and bus drivers on cultural to help address the lack of safety on school competency; work to eliminate homophobia and buses. This was a big issue that kept coming transphobia. up in the dialogues. Create structured opportunities for groups to walk to school together. Partners were also asked to present project Allow adult parents or elders, hired and trained findings at the National Conference of State Leg- in appropriate intervention techniques as bus islatures – National Caucus of Native American monitors, to ride and participate in school bus State Legislators held in Minneapolis, Minnesota transport. (2014). 3. Education, and Socioeconomic Recommenda- tions: Conclusion Educate community members on how to read/ Our community-academic partnership mod- use crossing signs and identify safe routes. el successfully engaged communities, incorporat- Engage the community in designing solutions at ed research and stories, and resulted in ongoing the planning levels discussions with various decision-makers to in- Campaign to normalize presence of LGBTQ Two form current policy discussions. This communi- Spirit residents (e.g., bus stop posters) ty engagement project highlighted the fact that a one size fits all approach for health policies and Impact and Success programs likely only deepens existing health in- Each of the communities participating in this equities. This is especially important as substan- project has a story that shows success: tial funds are being dedicated to Safe Routes to School and Active Transportation initiatives both 1. Brian Coyle was able to secure a pilot grant to federally and at the state level. As public health re- address the tobacco issue in their neighbor- searchers and professionals, it is imperative to keep hood that was identified through this project. the macro view in perspective, engage in ethical 2. Health Equity Working Group and its part- non-hierarchical collaborations with communities ners were reached out to by the office of a city and that we understand there is no one solution; council member to present their finding from rather there are many solutions that have to be im- this project at the council members’ Trans Eq- plemented simultaneously so that all communities uity Summit in 2014. can be healthy and benefit from public health ini- 3. Phillips/Little Earth has already started a tiatives equally. process with the Minneapolis School Board to change a rule that does not allow parents/

Published by NighthawksVol. 8, No. Open 2 ­—JOURNALInstitutional Repository, OF COMMUNITY 2015 ENGAGEMENT AND SCHOLARSHIP—Page 63 5 Journal of Community Engagement and Scholarship, Vol. 8, Iss. 2 [2015], Art. 6 References Gollust, S.E., Kite, H.A., Benning, S.J., Calla- nan, R.A., Weisman, S.R., & Nanney, M.S.. (2014). Use of research evidence in state policymaking for childhood obesity prevention in Minnesota. Amer- ican Journal of Public Health, 104(10), 1,894–1,900. Mendoza, J.A., Watson, K., Nguyen, N., Cerin, E., Baranowski, T., & Nicklas, T.A. (2011). Active commuting to school and association with physi- cal activity and adiposity among US youth. Journal of Physical Activity & Health, 8(4), 488–495. Nickens, H. (1986). Report of the secretary’s Task Force on Black and Minority Health: A sum- mary and a presentation of health data with regard to blacks. Journal of the National Medical Associa- tion, 78(6), 577–580. Ogden, C.L., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2012). Prevalence of obesity and trends in body mass index among US children and adoles- cents, 1999-2010. JAMA, 307(5), 483–490. Strong, W.B., Malina, R.M., Blimkie, C.J., Dan- iels, S.R., Dishman, R.K., Gutin, B., Hergenroeder, A.C., Must, A., Nixon, P.A., Pivarnik, J.M., Row- land, T., Trost, S., & Trudeau F. (2005). Evidence based physical activity for school-age youth. The Journal of Pediatrics, 146(6), 732–737. Troiano, R.P., Berrigan, D., Dodd, K.W., Mâsse, L.C., Tilert, T., & McDowell, M. (2008). Physical activity in the United States measured by accelerometer. Medicine and Science in Sports and Exercise, 40(1), 181–188.

About the Authors Huda Ahmed is associate director of Policy & Community Programs Manager of the University of Minnesota Department of Family Medicine and Community Health Program in Health Disparities Research. Khalid Adam is community programs assistant in the University of Minnesota Depart- ment of Family Medicine and Community Health Program in Health Disparities Research. Karen Clark is the executive director of the Women’s En- vironmental Institute. Felicia Wesaw is community organizer of the University of Minnesota Division of Health Policy and Management in the School of Public Health Women’s Environmental Insti- tute. Sarah Gollust is an assistant professor and McKnight Land-Grant Professor in the Division of Health Policy and Management in the School of Public Health at the University of Minnesota. Marilyn S. Nanney is an associate professor in the Department of Family Medicine and Community Health at the University of Minnesota.

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