Community Health Through Engagement and Environmental Renewal (CHEER)

Community Health from Engagement and Environmental Renewal (CHEER) will leverage previous Centers for Disease Control and Prevention (CDC) community engagement projects to reach and intervene on a high need population. Disadvantage and poverty have long-term and transgenerational adverse impacts on social interaction and cohesion and residents' emotional and physical health. Mothers living and raising children in these conditions face multiple stressors without the community support previous generations relied on. Decades of research on American cities have connected the social, economic, and physical characteristics of neighborhoods with a lack of social cohesion, inability to maintain shared norms of acceptable behavior,and increases in health disparities and risky behaviors. Social cohesion and collective efficacy inversely associate with depression among youth. In a parallel manner, improved parenting practices and youth behavior directly associate with neighborhood social interactions and social cohesion. While these associations are suggestive, CHEER will directly test causal hypotheses at the neighborhood and family levels in a randomized control trial, that can significantly advance the evidence base for public health interventions: Family Youth Intervention (FYI) and an Environment: Social and Physical Intervention (ESPI) to increase social interaction, social cohesion, and collective efficacy and influence wellbeing of mothers and their youth.

Study Overview

• Status: Completed
• Conditions: Family Relations; Blight
• Intervention / Treatment: Behavioral: Community Health through Engagement and Environmental Renewal (CHEER)

Detailed Description

Aim 1 Family System: To test the effect of FYI on primary outcomes of youth psychosocial behaviors and sexual risk compared to a Wait List Control.

1a. FYI will significantly improve our primary outcomes of externalizing (e.g. impulsivity, violence, theft) and internalizing (e.g. depression, withdrawal, anxiety, loneliness) behaviors and early and risky sex (i.e. sexual initiation at less than 16 years of age and sexual intercourse without a condom) (Effectiveness).

1. b. FYI will significantly lower parental stress, improve maternal emotional health, enhance parenting skills and improve youth Social and Emotional Competence (SEC) to change primary outcomes (Mediation).

   Aim 2 Community System: To test the effect of ESPI on neighborhood environment compared to Wait List Control.

2. a. ESPI significantly will increase our primary outcomes of social interaction, social cohesion, collective efficacy, and shared norms compared to wait list control (Effectiveness).

2b. Engaging residents in community-designed and -led projects to develop common spaces will significantly improve neighborhood perceptions (e.g. attractiveness, safety) and provide opportunities for residents to interact to change primary outcomes (Mediation).

Aim 3 Community and Family Systems: To test the effects of combining FYI and ESPI on the same youth and neighborhood environmental outcomes as in Aims 1 and 2 compared to FYI alone, ESPI alone, and a Wait List Control.

3a. ESPI and FYI will significantly reduce primary youth and neighborhood environmental outcomes (Effectiveness).

3b. ESPI and FYI will change neighborhood environmental and family processes to change primary outcomes of adolescent SEC, external and internal behaviors, and early and risky sex (Mediation).

• Study Type: Interventional
• Enrollment (Actual): 915
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Alabama
    • Birmingham, Alabama, United States, 35233
      • UAB Center for the Study of Community Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 11 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• For FYI, parents who reside in the FYI intervention neighborhood (North Titusville, South Titusville, Rising -West Princeton, and Belview Heights) and have a child age 11-16 years.
• For ESPI, residents who live in the ESPI intervention neighborhoods (North Titusville, South Titusville, Druid Hills, and Fountain Heights).

Exclusion Criteria:

• For FYI, does not met the above requirements and did not consent to participate.
• For ESPI, not residing in one of the above neighborhoods and did not consent to participate.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Family Youth Intervention (FYI); The primary objective of FYI is to evaluate the effectiveness of a theory-based, peer-supported family strengthening intervention on the primary outcomes in a sample of 120 parent-child pairs living in resource-poor urban neighborhoods in Birmingham. For FYI, we will utilize community health advisors (CHAs) to implement the intervention. CHAs will be recruited from each FYI neighborhood and will be trained in research ethics. CHAs will assist and support FYI participants in mastering the sequential skills of the 12 modules designed to improve maternal, youth, and family functioning. Additionally, CHAs will provide emotional social support that is helpful, hopeful, and trustful.	Behavioral: Community Health through Engagement and Environmental Renewal (CHEER); FYI and ESPI intervention activities will be implemented in the overall study, CHEER. It will also allow us to examine possible synergistic effects of both interventions when implemented in the same neighborhoods. Separate sets of participants will be selected for the FYI comparisons and for the ESPI comparisons. Because the FYI intervention focuses on mothers and their children, participants for the FYI comparisons will be selected by Respondent Driven Sampling of eligible families from the neighborhoods in all four cells. The ESPI intervention targets the whole neighborhood, and thus a random sample of neighborhood residents will be enrolled in each of the four cells. Because the primary outcomes for FYI and ESPI are connected but differ from each other, the FYI samples will be assessed for the FYI outcomes in all four cells and the ESPI samples will be assessed for the ESPI outcomes in all four cells.; Other Names: Family-Youth Intervention (FYI); ESPI Environment: Social and Physical Intervention (ESPI)
Active Comparator: ESPI Environment: Social and Physical Intervention (ESPI); ESPI will enroll 500 community members to examine the effect of blight elimination through lot recovery on primary outcomes of improved social interaction, social cohesion around common neighborhood norms, and collective efficacy to effect change in the neighborhoods . Neighborhood residents will select a cluster of lots (2-3) for lot recovery that are highly visible in the neighborhood (e.g. on a main thoroughfare). The community residents will lead the neighborhood projects. In some cases, neighborhood residents will personally undertake all or part of the greening projects.	Behavioral: Community Health through Engagement and Environmental Renewal (CHEER); FYI and ESPI intervention activities will be implemented in the overall study, CHEER. It will also allow us to examine possible synergistic effects of both interventions when implemented in the same neighborhoods. Separate sets of participants will be selected for the FYI comparisons and for the ESPI comparisons. Because the FYI intervention focuses on mothers and their children, participants for the FYI comparisons will be selected by Respondent Driven Sampling of eligible families from the neighborhoods in all four cells. The ESPI intervention targets the whole neighborhood, and thus a random sample of neighborhood residents will be enrolled in each of the four cells. Because the primary outcomes for FYI and ESPI are connected but differ from each other, the FYI samples will be assessed for the FYI outcomes in all four cells and the ESPI samples will be assessed for the ESPI outcomes in all four cells.; Other Names: Family-Youth Intervention (FYI); ESPI Environment: Social and Physical Intervention (ESPI)
Other: Wait-List Control; The two communities will get ESPI, upon completion of the study.	Behavioral: Community Health through Engagement and Environmental Renewal (CHEER); FYI and ESPI intervention activities will be implemented in the overall study, CHEER. It will also allow us to examine possible synergistic effects of both interventions when implemented in the same neighborhoods. Separate sets of participants will be selected for the FYI comparisons and for the ESPI comparisons. Because the FYI intervention focuses on mothers and their children, participants for the FYI comparisons will be selected by Respondent Driven Sampling of eligible families from the neighborhoods in all four cells. The ESPI intervention targets the whole neighborhood, and thus a random sample of neighborhood residents will be enrolled in each of the four cells. Because the primary outcomes for FYI and ESPI are connected but differ from each other, the FYI samples will be assessed for the FYI outcomes in all four cells and the ESPI samples will be assessed for the ESPI outcomes in all four cells.; Other Names: Family-Youth Intervention (FYI); ESPI Environment: Social and Physical Intervention (ESPI)
Active Comparator: FYI and ESPI; Two of the eight neighborhoods will receive both FYI and ESPI intervention.	Behavioral: Community Health through Engagement and Environmental Renewal (CHEER); FYI and ESPI intervention activities will be implemented in the overall study, CHEER. It will also allow us to examine possible synergistic effects of both interventions when implemented in the same neighborhoods. Separate sets of participants will be selected for the FYI comparisons and for the ESPI comparisons. Because the FYI intervention focuses on mothers and their children, participants for the FYI comparisons will be selected by Respondent Driven Sampling of eligible families from the neighborhoods in all four cells. The ESPI intervention targets the whole neighborhood, and thus a random sample of neighborhood residents will be enrolled in each of the four cells. Because the primary outcomes for FYI and ESPI are connected but differ from each other, the FYI samples will be assessed for the FYI outcomes in all four cells and the ESPI samples will be assessed for the ESPI outcomes in all four cells.; Other Names: Family-Youth Intervention (FYI); ESPI Environment: Social and Physical Intervention (ESPI)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Problem Behaviors in Children Ages 11 to 16 Years.	Three items asked have the child ever been suspended from school and within the past 12 months prior to the baseline survey have they smoked cigarettes or drunk alcohol. Participants choose 1 for yes and 0 for no. The range is form 0 to 3, where 3 describes a higher problematic behavior. Three questions were asked at 1-week and 6 month follow-up: have they been suspended from school, smoked cigarettes or drunk alcohol since baseline.	Baseline, 1-week and 6-month Follow-up
Age of Sexual Initiation	Year of age at sex. Two variables were used to measure sexual initiation. Answer choices ranged continuously from 1 (10 years old) to 9 (18 years or older).	Baseline
Number of Participants Who Participates in Risky Sex	Follow-up questions for individuals endorsing sexual initiation to assess risky sex behavior. The count was assessed on how often did the participant had sex without a condom.	Baseline
Project on Human Development in Chicago Neighborhoods: Community Survey- Cohesion Index Subscale	Project on Human Development in Chicago Neighborhoods: Community Survey assesses city-level variables relating to neighborhood structure. This scale consisted of 7 items that were measured on a scale of 1 to 6. The range of scores are from 7 to 35. The mean score was analyzed where the higher the score the community interaction was the worst.	Baseline, 12-month Follow up 1 and 18-month Follow up 2
Number of Participants Who Like Living in Their Neighborhood	Survey item on whether they like or dislike living their neighborhood.	Baseline
Project on Human Development in Chicago Neighborhoods: Community Survey- Neighborhood Perception	Project on Human Development in Chicago Neighborhoods: Community Survey assesses city-level variables relating to neighborhood structure. Three items on a scale of 1 to 6, were used to measure how participants perceive their neighborhood. The range of the scores were from 3 to 12. The mean score was analyzed where the higher the score is a better overall perception of their neighborhood.	Baseline, 12-month Follow up and 18-month Follow-up
Social Contacts and Resources Scale	Social Contacts and Resources Scale, a 5-item measure of social activities with their neighbors. Responses ranged from 1 (never) to 4 (often). a total mean score were derived where higher scores indicating greater social contact. The scores range from 5 to 20.	Baseline, 12- month Follow up 1, and 18-month Follow up 2

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Parent-Adolescent Communication	This is a 20-item scale where response choices range from 1= Strongly Disagree to 5= Strongly Agree. Items are summed to arrive at a total communication score (range 20-100), with higher scores suggesting better overall communication quality.	Baseline, 1-week and 6-month follow up
Parental Nurturance	Measured using using a single item, " I get the emotional help and support I need from my family." The responses to the item is on a 7-point likert scale ranging from Very Strongly Agree to Very Strongly Disagree where Very Strongly Disagree describes a less nurturing parent and Very Strongly Agree describes more nurturance the parent displays. Scores ranged from 1 to 7.	Baseline, 1-week and 6-month follow up
Family Functioning	American Strength Inventory was uses six categories to measure the strength of a family. Participants responded with Not true (1), Sometimes true (2) and Often true (3). The items were added for a total family strength score where a mean score was analyzed. The subscale Global Measure was used to measure family functioning. The scores range from 4 to 12, where the higher the score the higher the family functioning.	Baseline, 1-week and 6-month follow up
Coping	Measured using the Managing Stress and Crisis Effectively subscale of the American Family Strength Inventory assess family functioning and qualities that makes a family strong. Participants responded with Not true (1), Sometimes true (2) and Often true (3). The scores ranged from 6 to 24. The items were added for a total family strength score where a mean score was analyzed. Higher mean scores means higher coping with stress skills.	Baseline, 1-week and 6-month follow up
Perceived Depression	The Patient Health Questionnaire Scale (PHQ-9) is a abbreviated scale that measures self-report depressive symptoms. Respondents report on a 4-point likert scale where 0 is Not at All and 3 is Nearly Everyday. Items were added to determine the presence and severity of depressive symptoms. The range of the scores are 0 to 27. Score interpretations are 1-4 Minimal depression, 5-9 Mild depression, 10-14 Moderate depression,15-19 Moderately severe depression, and 20-27 Severe depression. A mean score was analyzed.	Baseline, 1-week and 6-month follow up
Social Support	Measured using items from the World Health Organization's Quality of Life Questionnaire to measure satisfaction with the level of social support they receive. The responses were on a 5-point likert scale ranging from very dissatisfied (1) to very satisfied (5). The higher the score the more scarification with their social support.	Baseline, 1-week and 6-month follow up
The World Health Organization Quality of Life Brief Scale	The World Health Organization Quality of Life Brief Scale measures four domains of quality of life: physical health, psychological, social relations and environment. The scores are transformed on a scale from 0 to 100 where higher score mean higher quality of life.	Baseline, 1-week and 6-month follow up
Punitive Discipline Scale	Punitive discipline is assessed using four items that indicate the frequency of spanking/hitting, scolding, and threatening to spank/hit or threatening to punish. Response categories included 1 = never in past 12 months; 2 = a few times; 3 = once a month or more; 4 = once a week or more; and, 5 = almost everyday. After totaling the score, the higher the score the more the parent uses punitive discipline. Scores range from 4 to 20 where the higher the score the more often the parent used punitive discipline. A mean score was analyzed.	Baseline, 1-week and 6-month follow up
Parental Monitoring Scale	Adolescents reported how often their parents knew where they were and what they were doing after school, on weeknights, and on weekends. All items used a 4-point scale ranging from 1 (almost never), to 2 (sometimes), to 3 (usually), to 4 (almost always). Scores ranging from 1 (low levels of parental monitoring) to 4 (high levels of parental monitoring). The range of the scores are 7-28. After totaling the score, the higher the score the higher levels of parental monitoring were present. A mean score was analyzed.	Baseline, 1-week and 6-month follow up

Collaborators and Investigators

• Sponsor: University of Alabama at Birmingham
• Collaborators: Centers for Disease Control and Prevention
• Investigators: Principal Investigator: Jeff T Walker, PhD, University of Alabama at Birmingham

Publications and helpful links

General Publications

• Collins WJ, Wanamaker MH. Up from slavery? Black intergenerational economic mobility since 1880.
• National Bureau of Economic Research Working Paper 23395 http://www.nber.org/papers/w23395 (accessed 2018 Jan 27).
• Shaw CR, McKay HD. Juvenile delinquency and urban areas. Chicago: University of Chicago Press; 1943.
• Aneshensel CS, Sucoff CA. The neighborhood context of adolescent mental health. J Health Soc Behav. 1996 Dec;37(4):293-310.
• Wilson, WJ. The truly disadvantaged. the inner city underclass and public policy. Chicago: University of Chicago Press; 1987.

Study record dates

Study Major Dates

• Study Start (Actual): May 21, 2021
• Primary Completion (Actual): August 10, 2024
• Study Completion (Actual): September 1, 2025

Study Registration Dates

• First Submitted: April 17, 2020
• First Submitted That Met QC Criteria: April 22, 2020
• First Posted (Actual): April 27, 2020

Study Record Updates

• Last Update Posted (Actual): March 13, 2026
• Last Update Submitted That Met QC Criteria: February 20, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: 300004617

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No