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Week of June 24, 2013

Windshield Tours promote understanding of the roots of infant mortality

An improvement in Genesee County, Michigan’s African American infant mortality rate can be attributed in part to a program that opened the eyes of many in the community to the challenges faced by African-American mothers, according to research led by a faculty member in the School of Public Health.

African American infant mortality declined to an historic level in 2005 and has remained lower, following a series of tours designed to increase understanding of obstacles for expectant mothers in some of the most impoverished areas of economically depressed Flint, Mich.

The Genesee County Racial and Ethnic Approaches to Community Health (REACH) program’s Windshield tours exposed some 1,000 physicians, hospital administrators and staff, faculty members, medical center residents, community partners and residents to the conditions that have contributed to poor maternal care.

“Local hospital staff members, especially medical residents, are from all over the world. They work long hours and commute to work by freeway, so they do not experience the same community conditions as many of their patients,” said Daniel Kruger, research assistant professor, School of Public Health.

Kruger and REACH partners conducted pre- and post-tour surveys to measure participants’ understanding of the issues mothers face and the conditions within the community, and to measure any changes that resulted from their increased knowledge. The results are featured in an article published in the Journal of Primary Prevention.

The tours took place in the areas where infant mortality was the highest, and participants noted such disparities as the lack of grocery stores, the number of abandoned and dilapidated buildings, a number of unsafe areas, the absence of police facilities, and unreliable transportation options.

Other research from the REACH project has shown that a deteriorated built environment predicts adverse birth outcomes, especially for African Americans, independent of traditional socio-demographic factors.

“We encourage everyone to have a healthy diet, but that is not easy when all that is in the neighborhood is fast food restaurants and convenience food at liquor stores,” Kruger said. After hearing about such difficulties, transportation officials created a new bus stop at a full-service grocery store at the city’s edge.

Upon learning the barriers faced by expectant mothers in some of the most impoverished areas of the community, many of the participants reported adjustments in their health care practices, and several led advocacy efforts to encourage more change.

The result: health care professionals became more understanding about appointment tardiness and less hasty about canceling, local stores began to stock more produce and fresh food options, tobacco advertising was reduced due to advocacy efforts, and buses were rerouted and schedules became more reliable.

The project received funding from the Centers for Disease Control and Prevention REACH 2010 and REACH US grants.

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