I. INTRODUCTION

The vision of the University of Chicago Urban Health Initiative (UHI), a top institutional priority, is that Chicago’s South Side will become a paradigm of urban health by 2025. Chicago’s South Side, with the University of Chicago and its world class medical school at its epicenter, is a region disproportionately affected by poor health and poverty. The South Side Health and Vitality Studies (SSHVS) forms the research and evaluation arm of the Urban Health Initiative to produce actionable knowledge that informs health behavior, policy and investments in the region.  The South Side Health and Vitality Studies employ an asset-based, community-engaged (Figure 1) research strategy whereby community and university members work as equal partners to 1) identify community priorities, 2) track community assets, 3) leverage community assets, 4) conduct research, and 5) generate new knowledge that is then used to reset priorities.  SSHVS strives for “science in service to community, conducted in partnership with the community.”  This philosophy is articulated in a recent paper published in Preventive Medicine (attached) by university and community collaborators for the Studies and provides the framework of our urban health teaching activities. The South Side of Chicago, a 95 square mile region including 34 of the city’s 77 community areas, is one of the largest contiguous African American urban communities in the US (70% of 803,000 people). Of Chicago’s 10 poorest communities, 9 are on the South Side, and the health of individuals living on in this area lags far behind that of the rest of the city and the nation. Despite a high prevalence of poverty and poor health, the South Side of Chicago is uniquely vital in its strong community organizations, robust social networks, rich cultural and faith traditions, and resilient small businesses.

See the Model of Community and University Engagement for the SSHVS at http://www.sshvs.org/pdfs/Community-Health-Model.pdf.

Guided by principles jointly developed by our community and university team members (below), we are committed to “creating learning opportunities by involving students, trainees, and community members” and “jointly learn and discover – together and from each other” in our research activities.  Our training program in community-engaged urban health research includes two predominant kinds of activities: 1) experiential learning in a mentored community-university team research setting, and 2) classroom, workshop and community-university summits.  The syllabus is integrated vertically across courses in the medical and postdoctoral curricula and is designed for relevance and adaptability to both university and community audiences using adult learning strategies. Training is available to individuals with varying levels of knowledge and experience, including community members, university faculty and staff, and undergraduate, graduate, and medical students. A community-based literacy consultant works closely with our team to advise on translation of our syllabus for various community audiences.  The length and content of training experiences is tailored to study priorities and audience objectives.

Guiding Principles:

Community and University Collaboration, Mutual Respect, and Shared Benefit

• Involve diverse community members in key decisions throughout the project
• Build mutual respect and trust between the researchers and community members
• Address issues that are most important to the health and vitality of the community across socio-economic boundaries
• Maximize participation of and leadership by people living in our target communities on the South Side
• Collect data that can quickly benefit community organizations by providing data and enhancing skills
• Jointly learn and discover – together and from each other – the value of research for improving and sustaining health and vitality
• Engage a multi-disciplinary team of researchers from across the institution
• Create learning opportunities by involving students, trainees, and community members
• Enhance sustainability of the Studies by focusing on the strengths of the research team and by developing external funding

Study Design

• Focus on understanding the social and environmental determinants of health and vitality
• Employ a life-course approach to understanding health and vitality, collecting data across the age span
• Use minimally-invasive techniques for biological and other data collection
• Collect data that are comparable with existing national, regional, and local datasets
• Gather and share data with efficiency and transparency
• Focus on modifiable problems for which the research can inform testable interventions and policy changes
• Build-in potential for replicability in other communities, including international settings

II. PURPOSE

To introduce individuals with an interest in health science to the principles, tools, and ethics of community-engaged population-based urban health research with the primary goal of developing competent leaders and partners to help fulfill the vision that the South Side of Chicago will become a paradigm of urban health by 2025.

III. OBJECTIVES

The objectives of our training program are for trainees to:

1. Understand strategies for conducting urban health research, including dominant principles and models for conducting community- or population-based health research.

2. Apply the Asset-Based Community-Engaged Research Model to design and implementation of health research activities that advance urban health in our region and elsewhere.

3. Demonstrate skill in performing minimally invasive biological and physical measures for use in population-based urban health research, including an understanding of the rationale and ethics.

4. Develop competency, especially via experiential learning and mentorship, in interacting with a broad diversity of community and university collaborators to optimize each individual’s contribution and the productivity of the overall team in reaching urban health goals.  Following participation in our training program, all individuals will be able to:

1. Describe the vision of the Urban Health Initiative and the role of the South Side Health and Vitality Studies in achieving this vision.
2. Describe the asset-based, community-engaged research strategy, its origin, and the rationale for its use in urban health research.
3. Ethically practice urban health research in harmony with the guiding principles of the South Side Health and Vitality Studies, and understand the process for and value of a principle-based approach to community-engaged health research.
4. Communicate, to a variety of audiences, the rationale for and risks/benefits of biological and physical measurement in population-based health research.

IV. SYLLABUS COMPONENTS

1. SAMPLE READING MATERIAL

Academic medicine and community partnerships

• Ahmed, S.M., Palermo, A.G., 2010. Community engagement in research: frameworks for education and peer review. Am J Public Health. 100, 1380-7.
• Hill LD, Madara JL. Role of the urban academic medical center in US health care. Jama – Journal of the American Medical Association. 2005;294(17):2219-2220.
• Israel, B.A., et al., 2001. The Detroit Community-Academic Urban Research Center: development, implementation, and evaluation. J Public Health Manag Pract. 7, 1-19.
• Israel, B.A., et al., 1998. Review of Community-Based Research: Assessing Partnership Approaches to Improve Public Health. Annual Review of Public Health. 19, 173-202.
• Jones L, Wells K. Strategies for academic and clinician engagement in community-participatory partnered research. Jama. Jan 24 2007;297(4):407-410.
• Lantz PM, Viruell-Fuentes E, Israel BA, Softley D, Guzman R. Can communities and academia work together on public health research? Evaluation results from a community-based participatory research partnership in Detroit. Journal of Urban Health-Bulletin of the New York Academy of Medicine. 2001;78(3):495-507.
• Norris, K.C., et al., 2007. Partnering with community-based organizations: an academic institution’s evolving perspective. Ethn Dis. 17, S27-32.

Asset-based Approaches

• Aronson, R.E., et al., 2007. Neighborhood mapping and evaluation: a methodology for participatory community health initiatives. Matern Child Health J. 11, 373-83.
• Kretzmann JP, McKnight JL. Building Communities from the Inside Out: A Path Toward Finding and Mobilizing a Community’s Assets. Evanston, IL: ACTA Publications; 1997.
• Lindau ST, Makelarski JA, Chin MH, Desautels S, Johnson D, Johnson WE Jr, Miller D, Peters S, Robinson C, Schneider J, Thicklin F, Watson NP, Wolfe M, Whitaker EE. Building community-engaged health research and discovery infrastructure on the South Side of Chicago: Science in service to community priorities. Preventive Medicine. 2011;52(3-4):200-207. (Attached)
• Mathie, A., Cunningham, G., 2003. From Clients to Citizens: Asset-Based Community Development as a Strategy for Community-Driven Development. Development in Practice. 13, 474 – 486.
• Minkler, M., Hancock, T., 2003.Community-Driven Asset Identification and Issue Selection, in: Minkler, M., Wallerstein, N. (Eds.), Community-Based Participatory Research for Health.  Jossey-Bass Publishers, San Francisco, pp. 135-154.

Ethics

• Bastida, E., et al., 2010. Ethics and community-based participatory research: perspectives from the field. Health Promot Pract. 11, 16-20.
• Ross, L.F., et al., 2010a. Human subjects protections in community-engaged research: a research ethics framework. J Empir Res Hum Res Ethics. 5, 5-17.
• Ross, L.F., et al., 2010b. Nine key functions for a human subjects protection program for community-engaged research: points to consider. J Empir Res Hum Res Ethics. 5, 33-47.

Population-based Biosocial Research

• Woolf, S.H., 2008. The meaning of translational research and why it matters. JAMA. 299, 211-3.
• Berkman LE. Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?  Annual Review of Public Health. 2009;30:27-41.
• Berkman L, Kawachi I (Eds). Social Epidemiology. New York: Oxford University Press; 2000.
• Institute of Medicine. For the Public’s Health: The Role of Measurement in Action and Accountability.  Washington, DC: The National Academies Press; 2011 [pre-publication].
• Sánchez-Jankowski, M., 2008. Cracks in the pavement: social change and resilience in poor neighborhoods. University of California Press, Berkeley, CA.
• Shah AMea. A Participatory Approach to Designing a Community Health Survey: A Report on the Survey Development Process 2003.
• Wells, K., Jones, L., 2009. “Research” in community-partnered, participatory research. JAMA. 302, 320-1.
• Whitman S, Shah A, Benjamins M. Urban Health: Combating Disparities with Local Data. New York, NY: Oxford University Press Inc; 2010.

2. SAMPLE LECTURES: Our community-engaged curriculum is not taught via a single course; rather, the syllabus is integrated vertically across medical and post-doctoral courses and classroom, workshop, and community summit activities.

Examples of Urban Health and Related Lectures in the Medical and Post-Doctoral Curricula

Course Name/Lecture Title

Health Care Disparities in America/Doctors’ Role in Caring for Underserved

Chicago Academic Medicine Program for Minority Undergraduate Premedical Students/Sexuality and Urban Adolescence

Scholarship and Discover:  Epidemiology and Research Design/Qualitative Research in Biomedicine

Dept of Ob/Gyn Resident Research Training Curriculum/Navigating the IRB:  Ethics and Human Subjects in Women’s Health Research

MacLean Center on Clinical Medical Ethics Fellows Curriculum/South Side Health and Vitality Studies and Urban Health

MacLean Center on Clinical Medical Ethics Fellows Health Disparities Seminar/Science in Service to Community:  The South Side Health and Vitality Studies

Pritzker Scholar in Translational Aging Research Training Course/ Biogerontology using Integrated Data to Advance Knowledge of Aging

Fundamentals of Health Services Research/Theory, Methods, Applications for Integrating Health Research:  Harnessing Biological and Social Data

3. EXAMPLE TRAINING OPPORTUNITIES Our training program in community-engaged urban health research includes two predominant kinds of activities: 1) experiential learning in a mentored community-university team research setting, and 2) classroom, workshop and community-university summits.  In addition, we have a robust communication infrastructure that uses monthly newsletters, social media, and widely publicized community-based events to provide broad dissemination of knowledge, information about training opportunities, and to share trainees’ reflections on their training experiences.