Youth Photovoice Project: “Creating Safe Neighborhoods” Manchester, NH A partnership between the City of Manchester, UNH

1. Youth Photovoice Project:“Creating Safe Neighborhoods”Manchester, NHA partnership between the City of Manchester, UNH, and Dartmouth

2. Background • Marginalization from decision-making processes mirrors the health disparities observed worldwide with respect to infrastructure investments, exposure to violence and environmental hazards, and rates of chronic disease • Participatory Action Research (PAR) methods, such as Photovoice, can facilitate the co-creation of culturally relevant strategies to address complex health issues • e.g., intersection of violence prevention and chronic disease prevention

3. Context: Institutional Policy Changes in Manchester, NH Manchester implemented institutional policy changes to build cross-sector collaboration around issues of violence prevention and healthy neighborhood environments: • Crime Prevention Through  Environmental Design (CPTED) • Community Policing • Neighborhood Revitalization Projects • Safe Routes to School • Safe Havens • ‘One Touch’ Healthy Homes program

4. Objectives As part of a Community-Based Participatory Research study, we conducted a Photovoiceproject in Manchester, NH to: 1) Explore youthperceptions of relationships between safety, active living, and healthy eating in the context of their daily lives 2) Understand barriers/enablers of health in their neighborhoods

5. Methods • Fourteen adolescents (ages 13-19) were recruited to participate in a Photovoice project for six weeks • n=12 were from refugee resettlement families from various countries (including Sudan, Somalia, Tanzania, and Rwanda); one was White and one African American.

6. Photovoice: Facilitated Dialogue Discussion of photos was facilitated using the “SHOWeD” method: • What do you See here? • What’s really Happening? • How does this relate to Our lives? • Whydoes this problem/strength exist? • What can we Do about this?) Field notes and audio recordings were collected to capture dialogue. Sources: Strack RW, Magill C, McDonagh K. Engaging Youth Through Photovoice. Health Promotion Practice. 2004; 5(1):49-58; Wang C, Burris MA. Photovoice: Concept, Methodology, and Use for Participatory Needs Assessment. Health Education & Behavior. 1997; 24(3):369-387

7. Photovoice: Guiding Questions • What things in your neighborhood make you feel healthy? Unhealthy? • What do you see when you go outside to play?

8. “I took this picture of cigarette signs on a gas station next to Pulaski Park. Smoking is bad for you, yet the advertising is big and eye-catching. It’s weird that these ads are so close to a place that is healthy and good. “ −S.R, 16

9. “This is a picture of an alleyway by Union and Central. This shows the laziness by people. We need to work together to fix this. “ –W.P., age 15 (Manchester police reviewed this photo, and marked this scene as an arson hazard to be addressed).

10. Trash in alleys where kids play –W.P., 15

11. “This is the back of my house by my neighbor’s apartment.  This is how it looks but it’s not how my family wants our house to look like.  What really makes my family angry is that we told our landlord and he didn’t do anything about it.” -     C.I., girl, 16, West Side

12. “This is sidewalk in my neighborhood. It’s not safe, someone could cause a crash if they were riding a bike and got off to avoid a crack. It makes me feel people don’t care about our place.” − S.R., 16

13. “Why can’t this vacant lot be used for a community garden or a sports field?” − S.R., 16

14. “This picture is of a mural in my school that was never finished.  I took this picture because I feel it makes our school look unprofessional because, why start something and never finish?  I don’t think it sends a good message to the students. ” - T.L., girl, 15, West Side

15. Residents of this home built their own ramp for a handicapped resident, after repeated requests to the landlord and months of carrying the person up the stairs in order to go inside the house--(Caption by RM, Research Assistant and Manchester resident)

16. The hole in the ceiling of this rental home started out small, but after kids picking at it for a month it became this big. Residents of this household moved out to protect their health, after repeated requests to the landlord to fix the ceiling... .-(Caption by RM, Research Assistant and Manchester resident. Many older buildings contain lead paint.)

17. The ceiling at this household was peeling and no effort was made by the landlord to get it fixed. It was fixed the day before the home inspector arrived. .. -(Caption by --RM, Research Assistant and Manchester resident)

18. “I love this picture because I think it is beautiful.  It shows the beauty of the West side of Manchester.  It shows that some people’s thoughts about the West side are wrong. If you are looking for the good in something, you will find it. But if you are focused on the bad, you will only see the negative”.    T.L., girl, 15, West Side

19. “This is Pulaski Park and the basketball court. It’s a place that keeps me active. I wish there could be more parks, more ball courts, and that they’d keep them fixed up.” – N.M.,17

20. “This is a torn basketball hoop at our park. We fixed it with duct tape.” -S.R., boy, East Side

21. ‘The Bishop’ -- I like hanging out there with friends, just talking about our days, and having fun. – W.G.,14

22. This school (West side) allows my family to use the outdoor athletic fields…I go there to work out.

23. “I took this picture of the B.R.I.N.G. I .T! Nursing program at Hillside Middle School.  This picture is special to me because it shows that there are good programs that can help keep kids off the streets and doing something productive with their time.” -     T.L., girl, 15, West Side (BRING IT= Bringing Refugees, Immigrants and Neighbors Gently Into Tomorrow)

24. “This is an African dish that my family makes, using fresh ingredients we get at the Farmer’s market” -Girl, age 15, East Side

25. Key Findings(1) • Photovoice greatly enhanced our understanding of immigrant/refugee teens’ perceptions of neighborhood safety, health, and active living, especially with respect to juxtapositions of perceived barriers and enablers of health that often coexisted in close geographical proximity. • Youth recognized that they were targets of advertising for beer and cigarettes near parks and neighborhood corner stores.

26. Key Findings(2) • Photos revealed vacant lots, empty storefronts, and unused spaces in the city, which teens described as giving a poor impression of their neighborhoods. • Youth consistently voicedtheir frustrations with landlords who did not take better care of apartment buildings (e.g., broken doors and windows, heat that didn’t work, inaccessible entrances, litter and debris in yards and alleyways). • Youth viewed these issues as essential to healthy living, and since many of their parents had limited English skills, teens were often responsible for negotiating with landlords.

27. Key Findings (3) • Compared to boys, girls’ perceptions of vulnerability constrained their geographies in ways that limited their ability to engage in physical activity • As Photovoice sessions progressed, participants began to discuss ways that they could initiate change. • Boys voiced higher comfort levels in reporting crime and disorder to police. • Girls began speaking about reaching out to resettlement mentors, guidance counselors, teachers, and the student council to offer recommendations. An Art Exhibit and a community-wide Photovoice training session was held at the end of the study to enable to community members to conduct future Photovoice projects themselves.

28. Creating Safe Neighborhoods for Active Living A research study conducted in Manchester 2011-2012 Partners: The University of New Hampshire, The Prevention Research Center at Dartmouth, City of Manchester Health Department, Manchester Police Department, Manchester Weed & Seed • The City of Manchester, in partnership with researchers at the University of New Hampshire and The Prevention Research Center at Dartmouth, was awarded a grant from the Robert Wood Johnson Foundation to learn about how families in Manchester feel about the safety and health of their neighborhoods, especially for youth. With rates of childhood obesity increasing, national attention has focused on strategies that simultaneously increase physical activity, promote healthy lifestyles, and reduce violence. Manchester’s public health initiatives combined with evidence-based criminal justice programs, such as Weed & Seed, were recognized as being innovative models for bringing citizens, law enforcement, public health, and other partners together to create safer, healthier neighborhoods. • This study was conducted from January 2011- January 2012, in two specific neighborhood areas: Wilson St. and Rimmon Heights. Children in these neighborhoods have been shown to be at greater risk of obesity compared to the city as a whole. To gain a better understanding of how to make neighborhoods healthier places to live, work, and play, the project included a teen “Photovoice” project for youth living in these neighborhoods. Several City departments expressed interest in giving youth more opportunities to share their concerns about issues they faced in their daily lives so that collaborative solutions could be developed. • Photovoice is a research process that gives cameras to teens (ages 13-18) and asks them to take photos that tell a story of their neighborhood and things that are important in their lives. Approximately 15 youth participated in the project. The teens followed a structured curriculum for approximately 6 weeks, and created a photo exhibit to showcase their images. They selected 4-8 photos each week for group discussions using the “SHOWeD” method: • What do you See here? • What’s really Happening? • How does this relate to Our lives? • Why does this problem/strength exist? • What can we Do about this? The youth’s photos and narratives revealed a holistic interpretation of “health” (e.g., physical, mental, environmental). They identified many community assets, such as the Boys and Girls’ Club, the YMCA, Salvation Army, several parks, churches, Farmer’s Markets, and programs such as “Teen Night”, “BRING IT”, community policing, and the Manchester Police Athletic League (MPAL), which they described as being important to their health. They emphasized the importance of outdoor and indoor facilities for play, but indicated that these spaces were not always safe, clean, accessible, or affordable. Housing issues, access to healthy foods, bullying in schools, exposure to advertising for unhealthy products in public spaces, and cultural sensitivity were concerns that emerged from the youth’s photos and discussions. We are grateful to the City of Manchester, and the representatives from City departments, residents, and youth who generously worked with us on this project in hopes of creating strong partnerships to make Manchester a safe and healthy place to live. We share their commitment to “Believe in a Healthy Community” (http://www.manchesternh.gov/website/ LinkClick.aspx?fileticket=omDcfgsVQ4k%3D&tabid=700), and hope that these youth’s images will spark a conversation to achieve that vision. We are also indebted to the artistic talent of Ross Bachelder, manager of the frame shop and Franklin Gallery at Ben Franklin Crafts in Rochester, New Hampshire for creating the display of the youths’ photos and captions. If you have comments you’d like to share, please write them in the journal next to the exhibit. Thank you, Dr. Semra Aytur, PhD (University of New Hampshire) Dr. Karen Schifferdecker, PhD, MPH (Prevention Research Center at Dartmouth) Rebecca Butcher, PT, MS, MPH ‘12 (UNH-M and Center for Program Design and Evaluation at Dartmouth) Support for this research was provided in part by a grant from the Robert Wood Johnson Foundation through its national program, Active Living Research RWJF I.D. 68495. The Prevention Research Center at Dartmouth is a member of the Prevention Research Centers Program, supported by the Centers for Disease Control and Prevention cooperative agreement 1U48DP001935-01.