Background and Purpose
The built environment and neighborhood characteristics of a community are associated with the physical activity (PA) levels of its residents (Saelens, Sallis, Frank, 2003). For example, perceived neighborhood safety, aesthetics, traffic, and other factors, can facilitate or discourage physical activity among community residents (Kerr et al., 2010). Sallis and colleagues found that neighborhood income disparities are associated with perceived attributes of the built environment, and can discourage or facilitate physical activity (Sallis et al., 2011). In Texas border communities, frequent barriers to physical activity include: unleashed dogs, weather, heat, traffic, no streetlights, and no place like a park to exercise (Umstattd Meyer, Sharley, Patterson, Dean, 2013). Several programs have successfully utilized promotoras (Spanish-speaking community health workers) to promote healthy behaviors, provide access to community resources, and lead physical activity and nutrition sessions (Balcazar et al., 2006; McCloskey, 2009; Staten, Scheu, Bronson, Peña, & Elenes, 2005). A pilot study in San Diego found that promotoras and youth community members could successfully collaborate and advocate for resources to improve their neighborhood and a nearby park (Arredondo et al. 2013). Similarly, others have engaged promotoras as co-researchers and advocates for policy change in a project to promote environmental justice in a Latino community (Minkler, Garcia, Williams, LoPresti, & Lilly, 2010).

Objectives
The objectives of this study are to increase physical activity opportunities by: 1) identifying determinants of successful advocacy programs that aim to improve the built environment; and 2) outlining the steps and strategies necessary in empowering promotoras to lead health promotion activities and built environment improvement projects in their local communities.

Methods
Sixteen churches were recruited and randomized to either the intervention (PA) or attention control (cancer prevention) for the larger parent study between January 2011 and March 2013. Selection criteria for promotoras included involvement in church and community, bilingual (English/Spanish), and readiness for training. In each church, two to three women were recruited, hired, and trained to be promotoras.. The promotoras in the intervention (PA) churches were trained to lead multiple group exercise classes and walking groups at their for the two-year intervention period. After six months, WalkSanDiego conducted two 4-hour Advocacy Training Workshops to empower promotoras and members of each intervention church by providing tools to create local change on a grass-roots level and to advocate for improvement in their churches and surrounding neighborhoods. The first workshop reviewed the basics of advocacy, defined walkability, led participants in a walk audit of the church neighborhood, and detailed steps for creating an action plan. The second workshop taught participants how to create a fact sheet, provided tips on contacting local officials, assisted participants in identifying and prioritizing targets for change, and addressed sustainability. Promotoras then applied their learned advocacy skills during meetings with church members, where they identified targets for built environment change to promote physical activity. and prioritized one church-based and one community-based project. Once targets were identified, promotoras and church members partnered with WalkSanDiego, Fe en Acción staff, community organizations, and their churches to advocate for built environment changes.

Results
Promotoras in all 8 intervention churches completed Advocacy Training Workshops with WalkSanDiego. Additionally, targets for change were identified at both the church and community levels. In most cases, church projects were more difficult to complete than community projects. Church readiness for change was a major factor in the success of the church-based projects. The priest’s readiness for change and the cohesion of church members and their interest in the project determined, in large part, the success of built environment changes. Success of community-based built environment improvements varied by site, which can be attributed to community characteristics (i.e. urban vs. rural, high-income vs. low-income, etc.), personal characteristics of the promotoras themselves, and the presence or lack of other groups already working on built environment improvements. Case studies will be presented on four different communities to illustrate factors that facilitated environmental changes.

Conclusions
Future programs should take into account a promotora’s availability and willingness to attend and present at large community and church meetings. Also, programs should aim to identify realistic targets for change, given the program’s timeline. In addition, relationships with key leaders, both at the church and community levels, should be developed from the beginning of the program and communication maintained throughout. Finally, future programs should consider partnering with other community programs and initiatives already working to improve community health and build on their success.

Implications for Practice and Policy
The environmental advocacy component of the Fe en Acción study found that churches are an untapped resource of organizing and advocacy power. Choosing the right leaders, in this case promotoras, makes all the difference. Finally, we found that the setting also matters in that heavy resistance from leaders, both at the church and communities levels, yields few positive results.

References

1. Arredondo, E., Mueller, K., Mejia, E., Rovira-Oswalder, T., Richardson, D., & Hoos, T. (2013). Health Promotion Practice, 14(5): 759-766.
2. Balcazar, H., Alvarado, M., Hollen, M. L., Gonzalez-Cruz, Y., Hughes, O., Vazquez, E., & Lykens, K. (2006). Salud para su Corazon-NCLR: A comprehensive promotora outreach program to promote heart-healthy behaviors among Hispanics. Health Promotion Practice, 7(1): 68-77.
3. Kerr, J., Norman, G. J., Adams, M. A., Ryan, S., Frank, L., Sallis, J. F., Calfas, K. J., & Patrick, K. (2010). Do neighborhood environments moderate the effect of physical activity lifestyle interventions in adults? Health & Place, 16(5): 903-908.
4. McCloskey, J. (2009) Promotores as partners in a community-based diabetes intervention program targeting Hispanics. Family & Community Health, 31(1): 48-57.
5. Minkler, M., Garcia, A. P., Williams, J., LoPresti, T., & Lilly, J. (2010). Si se puede: Using participatory research to promote environmental justice in a Latino community in San Diego. Journal of Urban Health, 87(5) 796-812.
6. Saelens, B. E., Sallis, J. F., & Frank, L. D. (2003). Environmental correlate of walking and cycling: Findings from the transportation, urban design, and planning literatures. Annals of Behavioral Medicine, 25(2): 80-91.
7. Sallis, J. F., Slymen, D. J., Conway, T. L., Frank, L. D., Saelens, B. E., Cain, K., & Chapman, J. E. (2011). Income disparities in perceived neighborhood built and social environment attributes. Health & Place, 17(6): 1274-1283.
8. Staten, L. K., Scheu, L. L., Bronson, D., Peña, V., & Elenes, J. (2005). Pasos adelante: The effectiveness of a community-based chronic disease prevention program. Preventing Chronic Disease, 2(1): A18.
9. Umstattd Meyer, M. R., Sharkey, J. R., Patterson, M. S., & Dean, W. R. (2013). Understanding contextual barriers, supports, and opportunities for physical activity among Mexican-origin children in Texas border colonias: A descriptive study. BMC Public Health, 13:14.

Support / Funding Source
NCI 1R01CA138894