Conceptualizing the Problem: The Social, Educational and Environmental Risks Factors Placing Youth at-Risk in Homewood

Background/Purpose: This paper highlights the challenges faced by children and youth with asthma in one of Pittsburgh’s least livable communities and the role of youth engagement in a community-based participatory research (CBPR) process. Asthma is increasingly being recognized among health professionals as the result of the complex interplay of contextual and psychosocial factors. Strengthening the existing University-Community partnership between the University of Pittsburgh School of Social Work and the Homewood Children’s Village, a child-centered community organization, the Health Living, Healthy Learning, Healthy Lives (HL3) project seeks to better understand the causes of race disparities in asthma and the social, educational and environmental risks attributed to the context in which children and youth live, learn and play.

The conceptual framework includes three general domains: fundamental factors (i.e. poverty, segregation), intermediate factors (i.e. neighborhood infrastructure, social environment, the physical environment, the educational environment), and proximate factors (i.e. exposure to violence, stressors). We highlight these factors within the context of Homewood, with a focus on the intermediate and proximate factors that were measured in a recent neighborhood assessment, key informant interviews from personnel working with youth, and administrative data collected from local schools.

This framework guides our efforts to understand pediatric asthma and its risks as well as provide a rationale for a youth-led intervention. The HL3 project mobilized six youth to address the asthma challenge facing their community. Their participation was a vital component of CBPR research in the urban context.

Methods: To better understand the social, educational and environmental risk factors related to asthma in Homewood, the HL3 study team used a community-based participatory research approach and multiple sources of data (e.g., census data, participatory concept mapping with residents, 50 surveys of caregivers of children with asthma and administrative data from schools) to conceptualize the social determinants associated with asthma in Homewood. These data were gathered by the University-Community partnership and informed our research and conceptual framework with youth. 

Results: The use of this a revealed two of Homewood’s “fundamental” or macro-level asthma risk factors: residential segregation (95% African American) and economic inequality (40% of Homewood’s adults live in poverty and 50% are unemployed). We also explored the associated educational factors, namely achievement (8% at achievement level for literature and 3% for algebra 1) in demonstrating a critical need to involve youth in research. 

Conclusions/Implications: Taken together, we find the social, educational and environmental risks in which our children and youth live, learn, and play, impedes on their healthy development. While the qualitative and quantitative data available suggests factors tied to living in the neighborhood as well as living in poverty are closely related; how best to intervene warranted additional input from the youth. Recognizing the vital need for youth voices, we collaborated with University of Pittsburgh Medical Center (UPMC), establishing the Homewood Pitt-Bridge project, providing six youth led an opportunity to improve their science and research skills while collaborating with researcher to understand the causes and consequences of asthma in Homewood.