Scholar Enlists Youth to Promote Health in a Disadvantaged Community

    • August 9, 2013

A fighting spirit. Talking to Flavia Perea, it becomes obvious pretty quickly that she’s not the kind of scholar who enjoys hiding behind piles of books and statistics. She loves to be out in the field, alongside the people she’s studying, and she loves the give and take of working collaboratively in communities. It also becomes obvious pretty quickly that she’s not afraid to push the envelope and challenge people in their comfort zones to work for what she believes is necessary and just—even if, she says, “My way is not necessarily falling in line with the rest of the band.”

What might sound like defiance is more about determination. Perea is fiercely committed to improving the lives of minority children and youth, particularly Latinos, who so often are faced by seemingly insurmountable challenges of poverty and bad health.

A personal commitment. The memory of a little boy she met years ago in New York City’s South Bronx sticks with Perea to this day. She was running the child-care program at a homeless shelter, and the boy had severe asthma—not surprising in a borough known to have some of the worst air quality in the world.

Perea remembers how pleased she was when the boy’s mother found an apartment. She also remembers how disappointed she was when she learned the apartment was in Hunts Point, one of the Bronx’s toughest neighborhoods with notoriously poor air quality.

Perea knew there was little chance the boy’s asthma would improve in Hunts Point. She also knew that chronic asthma wouldn’t help him cope with all the other challenges he’d face growing up there. His mother knew that, too, but there wasn’t anything she could do about it. She couldn’t afford anything better.

Perea’s indignation at the unfairness of it all lies very close to the surface. “It’s one thing to read about these kids in an article or see them on the news,” she says, “but it’s a different story when you interact with them directly. You see how profound those early disadvantages are—how inequitable and wrong and preventable they are.” She pauses, and her voice becomes more emphatic. “It shouldn’t be that way. There’s no reason for it to be that way. My take-away message from working in the Bronx was that every kid has a sparkle and every kid has potential. Unfortunately, in far too many cases it’s either taken away or extinguished before it can be realized.”

It wasn’t long after meeting that little boy that Perea decided she would become an advocate for positive change on his behalf—and on behalf of countless other children like him.

An accidental academic. The path Perea ended up following surprised her—she calls herself an “accidental academic.” Before she took the homeless shelter job, she’d already earned a master’s degree in education and taught at several New York City public and private schools. She’d grown up in Manhattan, where her father and mother, immigrants from Argentina and Italy, respectively, worked for the United Nations. She left teaching because “You see how grossly inadequate learning environments are ... How they just don’t put kids on positive pathways a lot of the time.”

A scholarship from the Heller School for Social Policy and Management at Brandeis University in Waltham, Mass., led to a PhD in social policy. She published her dissertation as a book, Language, Gender, and Academic Performance: A Study of the Children of Dominican Immigrants, in 2011 (LFB Scholarly Publishing). While earning her doctorate, she received competitive fellowships from Columbia University, Teachers College, and through the Spencer Foundation program at Brandeis University. She also did research for the United Nations and U.S. Congressman Charles Rangel.

While completing her post-doctorate with funding from the National Institute of Child Health and Human Development she was teaching classes at Tufts University outside Boston in Medford, Mass., and wondering how she got there—as she’d assumed that after earning her doctorate she’d work in program management or design. Then she heard about two national programs sponsored by the Robert Wood Johnson Foundation (RWJF), Active Living Research and New Connections, and her astonishing career took another surprising turn.

The RWJF connection. In retrospect the two programs seem tailor-made for someone with Perea’s background, interests, and credentials. Active Living Research supports research on environmental and policy strategies that promote daily physical activity for children and families across the United States. The program focuses on children of color and lower-income children, two groups at especially high risk for obesity. (For more information, read the Program Results Report.)

New Connections promotes the careers of early- to mid-career scholars who represent “historically underrepresented research communities,” aiming to develop diverse leadership in health care research and policy. Part of the reason RWJF started New Connections was to expose its own leaders to diverse voices and perspectives. The program’s full title—New Connections: Increasing Diversity of RWJF Programming—reflects that goal. (For more, read a Progress Report on the program.)

As an emerging scholar from an Argentine/Italian background, Perea fit the New Connections criteria to a T, and she had a project in mind that fit the Active Living Research agenda equally well. The two programs joined forces to fund it with $75,000 (Grant ID# 67308), an accomplishment that helped Perea land a full-time assistant professorship at Tufts.

Improving parks, empowering kids. The project, based in Lawrence, Mass., was a collaboration between three partners: Tufts, a local nonprofit called Groundwork Lawrence, and the city’s community development department. The project was called “Improving our Opportunities for Recreation and Physical Activity: Engaging Youth in Research and Local Policy Advocacy” (“Mejorando Nuestros Oportunidades para Recreación y Actividad Física”).

Perea and her partners recruited five local students, aged 17 to 21, to serve as their research team. From February 2010 through August 2011 they systematically studied the conditions of Lawrence’s parks. They also collected data on the number and variety of people using the parks, how often, and for what kinds of activities. And they scrutinized the city’s policies on managing and maintaining parks and playgrounds.

The goal was to provide information and insight that would lead to improvements in Lawrence’s park system, which in turn would encourage physical activity in the community and reduce obesity. A second key goal was to give local youth an opportunity to work for positive change in their community.

The students regularly published their findings in a bilingual newsletter, along with a regular “Park of the Week” feature. The team published a summary report on its findings, which was disseminated throughout Lawrence in print and online, and went on to present their summary findings to the Mayor’s Health Task Force, and at the Museum of Science in Cambridge, Mass.

Instilling confidence in the youth of “Immigrant City”: Highlights of Research Findings and Recommendations

Lawrence is a community of 76,000 about 30 miles north of Boston. Nearly 70 percent of its population is Hispanic, which is why it’s been called Immigrant City. It’s also been called, in a 2012 article in Boston magazine, a “city of the damned.” According to that article, the unemployment rate in Lawrence was close to 18 percent, compared with a statewide rate of 7 percent. The median family income was just over $31,600—the lowest in the state. The article described rampant crime and drug use. In 2011 the state had taken charge of the Lawrence school system, calling it “chronically underperforming.” Three previous school superintendents had been fired, and the last had been indicted for embezzlement (he was later convicted).

Not surprisingly, the academic performance of the city’s students has suffered under these conditions, as has their health. At an Active Living Research conference in 2011, Perea reported that the high school graduation rate in Lawrence was 40 percent (see her presentation). She also reported that the city had the highest obesity rate in Massachusetts, notably among children and adolescents, and that Lawrence lagged behind the rest of the state on virtually all health indicators, including rates of coronary heart disease, hypertension, and diabetes. More than 90 percent of its students received free or reduced-price lunch.

A number of public and private organizations are trying to turn Lawrence’s fortunes around, and working closely with them was one reason Perea found the RWJF project very satisfying. She didn’t have much choice: having relatively limited resources meant she couldn’t afford to send graduate students from Tufts to handle the countless daily details of the project. “It was very, very hands on,” she says. “And it was successful because we worked with the community really closely. It was very synergistic with other things that were happening in the city, and we wouldn’t have accomplished everything we did if we’d done it any other way.”

At least as satisfying for Perea was seeing the self-confidence that this project instilled in her young researchers. “It was really powerful to see the growth and change in them,” she says, “and to see how much they got out of participating in the project—how much they learned from the relationships they built, the exposure they got, and also the way they think about their own education. Most of these kids don’t really think about college, and at the end they were all talking about college.” (After participating in the project, all the youth enrolled in or applied to college.)

Each of the students contributed a personal statement to the project’s final report. Reading them, it’s easy to see what Perea is talking about. Here, for example, is an excerpt from Juana Matias’ statement:

I am 18 years old and I have lived in Lawrence for 12 years now. I am currently attending Merrimack College. I am proud to say that I have done something successful for my community but also for myself. I feel like I have accomplished something good for myself because I know that I am capable of doing good things and setting a good example for future generations .... This project is valuable for the community because people have the opportunity to become more united by doing something for their community. Being a part of this program gave me the opportunity to learn skills that will be useful in my future career.

Staying flexible. A lesson Perea makes a point of teaching her students at Tufts is that researchers who work in communities have to be flexible, because the real world doesn’t stand still. The Lawrence project provided a perfect demonstration of that fact. Just as the project was about to launch, the city elected a new mayor. Suddenly, several of the key people (community gatekeepers) with whom Perea had established relationships were gone, requiring her to build a new set of relationships, quickly. “What you think will happen won’t happen, and you have to think on your feet and figure it out,” Perea says.

Perea reveals a similar flexibility when it comes to her own future. Despite her many successes as a scholar, she’s keeping her options open. One thing she feels sure of: she will continue advocating for disadvantaged minority children, whether she does so as a researcher or in some other capacity. Her commitment on that score has become, if anything, even more pronounced now that she has two young children of her own.

“I’m interested in what makes a community a healthy community, a health-promoting community, and how that’s different for different groups. How can we work to improve things for certain population groups? I take those questions wherever I go.”

RWJF Perspective. Launched in 2000, Active Living Research is a $31 million national program that supports research to examine how physical and built environments and policies influence the amount of physical activity Americans get as part of everyday life. Findings from the research are used to help inform policy, the design of the built environment and other factors necessary to re-engineer healthy levels of physical activity into everyday life for all Americans. Over the past few years, the program has focused on reversing the rise in childhood obesity, particularly in the lower-income and racial/ethnic minority communities in which childhood obesity levels are highest and rising fastest.

A recent analysis by Program Director James Sallis, PhD, documents dramatic growth in research to identify policy and environmental factors and interventions affecting physical activity at the population level and in high-risk populations following the program’s launch in 2001.

Active Living Research grantees are required to be transdisciplinary, involving investigators from multiple disciplines and backgrounds who work together across traditional disciplinary boundaries. The researchers represent more than 20 different disciplines (e.g., public health, urban planning, architecture, behavioral science, exercise science, transportation, sociology, and political science). “In addition to building an evidence base to guide physical activity policy and community design, Active Living Research is developing a vibrant, new transdisciplinary field and diverse network of accomplished researchers,” says C. Tracy Orleans, PhD, RWJF distinguished fellow and senior scientist.

Active Living Research actively seeks to translate actionable research findings into policy and practice change as rapidly as possible. Says Orleans: “For instance, if we find out that adding bike paths and sidewalks or walk-to-school programs significantly increases physical activity, we want to get this information out to key decision- and policy-makers as quickly and effectively as possible, so they can start using it.”

Orleans adds, “The Active Living Research program has sparked new awareness among policy-makers and community leaders in many sectors that our everyday physical activity levels depend on the presence or absence of environmental and policy supports for physical activity. In addition, a growing number of urban planners and transportation policy-makers recognize that community design is critical for health.”

Meanwhile the New Connections program provides support and professional development opportunities to a network of more than 1,200 scholars from under-represented communities. RWJF “recognizes the vital role diverse perspectives have in creating solutions and innovations to address today’s most pressing health and health care issues,” says Debra J. Perez, PhD, MPH, RWJF assistant vice president for research and evaluation.