Blight, Family Relations
Conditions
Brief summary
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.
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).
Interventions
BEHAVIORALCommunity 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.
Sponsors
University of Alabama at Birmingham
Centers for Disease Control and Prevention
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
PREVENTION
Masking
NONE
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.
Eligibility
Sex/Gender
ALL
Age
11 Years to No maximum
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Like Living in Their Neighborhood | Baseline | Survey item on whether they like or dislike living their neighborhood. |
| Problem Behaviors in Children Ages 11 to 16 Years. | Baseline, 1-week and 6-month Follow-up | Three items asked have the child ever been suspended from school and within the past 12 months prior to the baseline survey have they smoked cigarettes or drunk alcohol. Participants choose 1 for yes and 0 for no. The range is form 0 to 3, where 3 describes a higher problematic behavior. Three questions were asked at 1-week and 6 month follow-up: have they been suspended from school, smoked cigarettes or drunk alcohol since baseline. |
| Age of Sexual Initiation | Baseline | Year of age at sex. Two variables were used to measure sexual initiation. Answer choices ranged continuously from 1 (10 years old) to 9 (18 years or older). |
| Number of Participants Who Participates in Risky Sex | Baseline | Follow-up questions for individuals endorsing sexual initiation to assess risky sex behavior. The count was assessed on how often did the participant had sex without a condom. |
| Project on Human Development in Chicago Neighborhoods: Community Survey- Cohesion Index Subscale | Baseline, 12-month Follow up 1 and 18-month Follow up 2 | Project on Human Development in Chicago Neighborhoods: Community Survey assesses city-level variables relating to neighborhood structure. This scale consisted of 7 items that were measured on a scale of 1 to 6. The range of scores are from 7 to 35. The mean score was analyzed where the higher the score the community interaction was the worst. |
| Project on Human Development in Chicago Neighborhoods: Community Survey- Neighborhood Perception | Baseline, 12-month Follow up and 18-month Follow-up | Project on Human Development in Chicago Neighborhoods: Community Survey assesses city-level variables relating to neighborhood structure. Three items on a scale of 1 to 6, were used to measure how participants perceive their neighborhood. The range of the scores were from 3 to 12. The mean score was analyzed where the higher the score is a better overall perception of their neighborhood. |
| Social Contacts and Resources Scale | Baseline, 12- month Follow up 1, and 18-month Follow up 2 | Social Contacts and Resources Scale, a 5-item measure of social activities with their neighbors. Responses ranged from 1 (never) to 4 (often). a total mean score were derived where higher scores indicating greater social contact. The scores range from 5 to 20. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Parent-Adolescent Communication | Baseline, 1-week and 6-month follow up | This is a 20-item scale where response choices range from 1= Strongly Disagree to 5= Strongly Agree. Items are summed to arrive at a total communication score (range 20-100), with higher scores suggesting better overall communication quality. |
| Parental Nurturance | Baseline, 1-week and 6-month follow up | Measured using using a single item, " I get the emotional help and support I need from my family." The responses to the item is on a 7-point likert scale ranging from Very Strongly Agree to Very Strongly Disagree where Very Strongly Disagree describes a less nurturing parent and Very Strongly Agree describes more nurturance the parent displays. Scores ranged from 1 to 7. |
| Family Functioning | Baseline, 1-week and 6-month follow up | American Strength Inventory was uses six categories to measure the strength of a family. Participants responded with Not true (1), Sometimes true (2) and Often true (3). The items were added for a total family strength score where a mean score was analyzed. The subscale Global Measure was used to measure family functioning. The scores range from 4 to 12, where the higher the score the higher the family functioning. |
| Coping | Baseline, 1-week and 6-month follow up | Measured using the Managing Stress and Crisis Effectively subscale of the American Family Strength Inventory assess family functioning and qualities that makes a family strong. Participants responded with Not true (1), Sometimes true (2) and Often true (3). The scores ranged from 6 to 24. The items were added for a total family strength score where a mean score was analyzed. Higher mean scores means higher coping with stress skills. |
| Perceived Depression | Baseline, 1-week and 6-month follow up | The Patient Health Questionnaire Scale (PHQ-9) is a abbreviated scale that measures self-report depressive symptoms. Respondents report on a 4-point likert scale where 0 is Not at All and 3 is Nearly Everyday. Items were added to determine the presence and severity of depressive symptoms. The range of the scores are 0 to 27. Score interpretations are 1-4 Minimal depression, 5-9 Mild depression, 10-14 Moderate depression,15-19 Moderately severe depression, and 20-27 Severe depression. A mean score was analyzed. |
| Social Support | Baseline, 1-week and 6-month follow up | Measured using items from the World Health Organization's Quality of Life Questionnaire to measure satisfaction with the level of social support they receive. The responses were on a 5-point likert scale ranging from very dissatisfied (1) to very satisfied (5). The higher the score the more scarification with their social support. |
| The World Health Organization Quality of Life Brief Scale | Baseline, 1-week and 6-month follow up | The World Health Organization Quality of Life Brief Scale measures four domains of quality of life: physical health, psychological, social relations and environment. The scores are transformed on a scale from 0 to 100 where higher score mean higher quality of life. |
| Punitive Discipline Scale | Baseline, 1-week and 6-month follow up | Punitive discipline is assessed using four items that indicate the frequency of spanking/hitting, scolding, and threatening to spank/hit or threatening to punish. Response categories included 1 = never in past 12 months; 2 = a few times; 3 = once a month or more; 4 = once a week or more; and, 5 = almost everyday. After totaling the score, the higher the score the more the parent uses punitive discipline. Scores range from 4 to 20 where the higher the score the more often the parent used punitive discipline. A mean score was analyzed. |
| Parental Monitoring Scale | Baseline, 1-week and 6-month follow up | Adolescents reported how often their parents knew where they were and what they were doing after school, on weeknights, and on weekends. All items used a 4-point scale ranging from 1 (almost never), to 2 (sometimes), to 3 (usually), to 4 (almost always). Scores ranging from 1 (low levels of parental monitoring) to 4 (high levels of parental monitoring). The range of the scores are 7-28. After totaling the score, the higher the score the higher levels of parental monitoring were present. A mean score was analyzed. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJeff T Walker, PhD
University of Alabama at Birmingham
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 52 years STANDARD_DEVIATION 20 |
| Birmingham United Neighborhood (BUN) | 92 Participants |
| How long live in neighborhood 11 to 20 years | 63 Participants |
| How long live in neighborhood 1 to 5 years | 87 Participants |
| How long live in neighborhood 6 to 10 years | 45 Participants |
| How long live in neighborhood Less than a Year | 5 Participants |
| How long live in neighborhood Over 20 years | 41 Participants |
| How long live in neighborhood Unknown | 6 Participants |
| Neighborhood Belview Heights | 23 Participants |
| Neighborhood Druid Hills | 57 Participants |
| Neighborhood Fountain Heights | 6 Participants |
| Neighborhood North Titusville | 8 Participants |
| Neighborhood Other | 108 Participants |
| Neighborhood Riley Travellick | 50 Participants |
| Neighborhood Rising West Princeton | 43 Participants |
| Neighborhood South Titusville | 89 Participants |
| Neighborhood Unknown | 0 Participants |
| Neighborhood West Goldwire | 18 Participants |
| Plan to Move No | 133 Participants |
| Plan to Move Unknown | 1 Participants |
| Plan to Move Yes | 50 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 222 Participants |
| Race (NIH/OMB) More than one race | 10 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 6 Participants |
| Race (NIH/OMB) White | 8 Participants |
| Region of Enrollment United States | 237 participants |
| Sex: Female, Male Sex/Gender Female | 87 Participants |
| Sex: Female, Male Sex/Gender Male | 39 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 237 | 0 / 200 | 0 / 280 |
| other Total, other adverse events | 0 / 237 | 0 / 200 | 0 / 280 |
| serious Total, serious adverse events | 0 / 237 | 0 / 200 | 0 / 280 |
Outcome results
None listed