New Core Research Project- 2010-2014 

Improving Public Housing Residents' Access to Primary Care and Prevention
Principal Investigator: Tracy Battaglia, MD
Health Topics: Cardiovascular health | Community health | Diabetes | Nutrition & physical activity for adults | Oral Health | Tobacco prevention & control

Residents of public housing in Boston have low incomes and insufficient health insurance, which decreases the likelihood that they receive regular medical care. Residents may lack knowledge about risk factors for and symptoms of chronic disease. Promoting residents' use of preventive care requires new strategies.

Researchers train Resident Health Advocates (RHA) to motivate fellow residents to seek recommended medical care and to enroll in health promoting programs. Participants, 540 mostly Hispanic and African-American residents, are screened for diabetes, high cholesterol, hypertension, and dental disease. All participants with positive screening results receive printed materials about where to get a diagnosis and treatment, and how to enroll in citywide prevention programs. Then some participants are assigned to an intervention group in which an RHA helps them navigate the health system. RHAs also help residents enroll in well-established citywide prevention services such as the state-sponsored Smoker's Quitline, Strategic Alliance for Health, or the Family Weight Management program. The other participants are assigned to delayed intervention groups.

RHAs are also working with community clinics, hospitals, and dental clinics to make appointments for residents. RHAs attend follow-up appointments with residents in the intervention group and work to remove logistical barriers to primary care appointments. At 4 and 6 months after screening, researchers ask RHA-assisted residents if they kept appointments for treatment prevention programs. Results for the intervention group are compared with those of residents who received only the printed materials. Health care centers may benefit from increased understanding of referral and communication processes for reaching underserved clients.

Ongoing Research Project

Use of a Telephone Survey to Assess the Health of Boston Public Housing Residents
In collaboration with the Boston Public Health Commission, the Boston Housing Authority, and the Community Committee, the center is creating a database of health status indicators of Boston public housing residents. Information for the database is drawn from an augmented Boston Behavioral Risk Factor Surveillance Survey (BRFSS) of public housing residents. The BPHC added a question to identify public housing residents (PHRs) to it's biennial telephone health survey in 2001 and 2003. This approach represents a useful and cost-effective method for surveillance among an important and potentially vulnerable, population. This project has been submitted to the APHA for publication and is in press.

Past Core Research Projects

RHAM: Resident Health Advocates on the Move Community intervention strategies are needed to increase the number of individuals who receive preventive services and reduce the morbidity and mortality associated with racial and ethnic health disparities. A trial will be conducted to augment health screenings, through a mobile van, for hypertension, diabetes, and dental disease. This project will:

• demonstrate the effectiveness of Resident Health Advocates (RHAs) and peer leaders in increasing the participation of public housing residents in health screening for diabetes, hypertension and dental disease by increased utilization of “Healthy Connection” , Boston’s Public Health Mobile Van, and

• demonstrate the effectiveness of Resident Health Advocates in increasing the clinical follow-up of housing residents screened for diabetes, hypertension and dental disease who are referred for such follow-up.

The primary evaluation will be a comparison of the proportion of persons (all residents 18 years and above) screened in the two intervention sites versus the two control sites.

A Pilot Smoking Cessation Program for Public Housing Residents: The PHH-PRC, principal investigators, the West Broadway Housing Development Task Force, South Boston, MA and residents participated in a smoking cessation program using a Tobacco Treatment Specialist to provide on-site cessation counseling and two bilingual (English/Spanish) residents trained as Tobacco Treatment Advocates to provide motivational interventions, raise awareness of health risks and availability of treatment services and referrals to more intensive services.  Random door-to-door surveys were conducted prior to providing services.

GirlStars: Working for healthier futures
Being proactive in striving for healthier adults of tomorrow means working with the youth of today. PHH-PRC’s The GirlStars Program was one example of community-based public health work in action. The comprehensive program emphasized organized physical activity with health education for young girls, ages 10 through 13, living in various Boston Housing Authority public housing developments. GirlStars participants enjoyed activities such as aerobics, ballet, kick boxing, rowing, swimming, tennis, health education sessions that included discussions on goal setting, conflict resolution, nutrition, and body-image.

Waging Peace
The Waging Peace pilot project tested the feasibility of training public housing residents to serve as information resources for identifying and preventing domestic violence. This project took place at the Maverick Gardens development in East Boston, between 2001 and 2003. The tenant task force identified domestic violence as an important health and safety issue, and the pilot project explored the capacity of public housing residents to design, implement, and assist in evaluating effective intervention and prevention programs for individuals at risk for domestic violence.

Twelve women from five housing developments completed training to become Family Health Ambassadors for Waging Peace, a health, wellness and safety program developed as a pilot project of the PHH-PRC.  Eight of the women were from one housing development where the pilot project was conducted.  Family Health Ambassadors (FHAs) received 12 hours of training in family violence and violence prevention.  FHA at one development became members of the Waging Peace Project Advisory Board, which focuses its energies on planning for future projects that are resident-defined in the community and in other public housing developments.   Two of the eight women from the pilot project found full time jobs after the Program training and four are continuing with advocate training at a collaborating community agency. 

Family Health Ambassadors:

• Act as trusted neighbors and health leaders in their communities 

• Serve as a resource to other housing residents about health issues

• Assist residents with health care concerns

• Learn skills that will be helpful in the job market