Policy implementation and outcome evaluation: establishing a framework and expanding capacity for advocacy organizations to assess the impact of their work in public policy.

Advocacy organizations can play a crucial role in evaluating whether legislation or regulation has had its intended effect by supporting robust public policy implementation and outcome evaluation. The American Heart Association, working with expert advisors, has developed a framework for effective evaluation that can be used by advocacy organizations, in partnership with researchers, public health agencies, funders, and policy makers to assess the health and equity impact of legislation and regulation over time. Advocacy organizations can use parts of this framework to evaluate the impact of policies relevant to their own advocacy and public policy efforts and inform policy development and guide their organizational resource allocation. Ultimately, working in partnership, advocacy organizations can help bring capacity, commitment and funding to this important implementation and outcome evaluation work that informs impactful public policy for equitable population health and well-being.

The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Neighborhood Health Action Center.

Place-based approaches have been promoted as one way to reduce health inequities by addressing community-level factors that shape health, such as housing quality, healthcare systems, the built environment, and social capital. In 2016-2017, the NYC Health Department's Center for Health Equity launched three Neighborhood Health Action Centers (Action Centers), which use a place-based approach to improve health in neighborhoods with disproportionate burdens of premature mortality. We describe this approach and the genesis of the Action Centers. We then describe the East Harlem Action Center, which was the first to open, and share findings from qualitative interviews with the East Harlem Action Center's Governance Council, a group comprised of Action Center staff and co-located partners and programs which supports Action Center coordination. Interviewees felt that collaboration, being responsive to community needs, and being community based were essential elements of the Action Center. Interviewees recognized the complex dynamic of a large city agency serving as the host for the Action Center while simultaneously aiming to establish more equitable relationships with partners. Governance Council members' expectations and hopes for the East Harlem Action Center were consistent with the overall vision and model for the Action Centers, which may facilitate implementation.

Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population.

PURPOSE: Women of color in the United States, particularly in high-poverty neighborhoods, experience high rates of poor birth outcomes, including cesarean section, preterm birth, low birthweight, and infant mortality. Doula care has been linked to improvements in many perinatal outcomes, but women of color and low-income women often face barriers in accessing doula support. DESCRIPTION: To address this issue, the New York City Department of Health and Mental Hygiene's Healthy Start Brooklyn introduced the By My Side Birth Support Program in 2010. The goal was to complement other maternal home-visiting programs by providing doula support during labor and birth, along with prenatal and postpartum visits. Between 2010 and 2015, 489 infants were born to women enrolled in the program. ASSESSMENT: Data indicate that By My Side is a promising model of support for Healthy Start projects nationwide. Compared to the project area, program participants had lower rates of preterm birth (6.3 vs. 12.4%, p < 0.001) and low birthweight (6.5 vs. 11.1%, p = 0.001); however, rates of cesarean birth did not differ significantly (33.5 vs. 36.9%, p = 0.122). Further research is needed to explore possible reasons for this finding, and to examine the influence of doula support on birth outcomes among populations with high rates of chronic disease and stressors such as poverty, racism, and exposure to violence. However, feedback from participants indicates that doula support is highly valued and helps give women a voice in consequential childbirth decisions. CONCLUSION: Available evidence suggests that doula services may be an important component of an effort to address birth inequities.

Community Vision and Interagency Alignment: A Community Planning Process to Promote Active Transportation.

In 2010, the Brooklyn Active Transportation Community Planning Initiative launched in 2 New York City neighborhoods. Over a 2-year planning period, residents participated in surveys, school and community forums, neighborhood street assessments, and activation events-activities that highlighted the need for safer streets locally. Consensus among residents and key multisectoral stakeholders, including city agencies and community-based organizations, was garnered in support of a planned expansion of bicycling infrastructure. The process of building on community assets and applying a collective impact approach yielded changes in the built environment, attracted new partners and resources, and helped to restore a sense of power among residents.

Exploring the Health and Spatial Equity Implications of the New York City Bike Share System.

INTRODUCTION: This paper examines spatial equity and estimates the health impact of Citi Bike, New York City's (NYC) bike share system. We discuss how further system expansion and utilization by residents in high-poverty communities of color could affect the potential benefit of the largest bicycle share system in the United States. METHODS: First, we compared the Citi Bike station distribution by census tract poverty during the system's 2013 launch and after the 2015 geographic expansion. Second, we applied the World Health Organization's Health Economic Assessment Tool (HEAT) to estimate the benefit of cycling associated with annual Citi Bike members for two 12-month time periods and analyzed change of the benefit over time. RESULTS: The results showed that the greatest proportion of Citi Bike stations were located in low-poverty (wealthier) NYC census tracts (41% per period), and there were no significant changes in station distribution during expansion. HEAT estimated an increase from two to three premature deaths prevented and an increased annual economic benefit from $18,800,000 to $28,300,000 associated with Citi Bike use. CONCLUSION: In conclusion, although Citi Bike stations are not equitably located, the estimated annual health benefits are substantial and have increased over time. Our findings underscore the potential for even greater benefits with increased spatial access in higher-poverty neighborhoods and communities of color. Our findings highlight the importance of the built environment in shaping health and the need for a health equity lens to consider the social and political processes that perpetuate inequities.

Cycling in the city: an in-depth examination of bicycle lane use in a low-income urban neighborhood.

BACKGROUND: Regular physical activity such as biking can help prevent obesity and chronic disease. Improvements in cycling infrastructure are associated with higher overall cycling rates, but less is known about bike lane utilization in low-income urban neighborhoods. METHODS: During the summer of 2009, 4 Central Brooklyn streets with bicycle lanes were studied using camcorders to record for a total of 40 hours. Video recordings were coded for behaviors and characteristics of cyclists and motorists. An intercept survey (N = 324, 42% participation rate) captured information on cyclist demographics, behaviors, and attitudes. RESULTS: 1282 cyclists were observed on study streets. Cyclists were primarily male (80.0%) and non-White (54.5%). 9.9% of motorists drove in the bike lane and parked vehicles blocked the bike lane for 9.6% of the observational period. Of cyclists surveyed, 69.4% lived locally, 61.3% were normal weight or underweight, and 64.8% met recommended levels of physical activity by cycling 30+ minutes/day on 5+ days of the past week. CONCLUSIONS: Bicycle lanes were used by local residents of a low-income urban neighborhood. Compared with neighborhood residents overall, cyclists reported better health and health behaviors. Enhancing infrastructure that supports active transportation may be effective in reducing health inequities in low-income urban communities.

Navigating the urban food environment: challenges and resilience of community-dwelling older adults.

OBJECTIVE: Identify factors involved in food shopping among older urban adults. DESIGN: A qualitative study of 30 in-depth interviews and 15 "tagalong" shopping trip observations were conducted. SETTING: Brooklyn, New York. PARTICIPANTS: Black, white, and Latino men and women aged 60-88 years. MAIN OUTCOME MEASURE: Transcripts were coded inductively to identify emergent themes. RESULTS: Older adults shopped at multiple stores to obtain the quality of foods preferred at prices that fit their food budgets. Participants often traveled outside their neighborhoods to accomplish this, and expressed dissatisfaction with the foods locally available. Adaptive food shopping behaviors included walking or the use of public transit to purchase food in small batches, as well as reliance on community resources and social network members. CONCLUSIONS AND IMPLICATIONS: Participants identified a number of multilayered factors and challenges involved in procuring food. These factors conform to elements of ecological behavioral models described as intrapersonal, social, and environmental level influences and have resulted in adaptive behaviors for this population. These findings provide evidence that can be used to develop more effective programs, as well as promote testable interventions aimed at keeping older adults independent and capable of acquiring food that meets their age-specific needs.