1. HOPE Works The University of North Carolina at Chapel Hill Center for Health Promotion and Disease Prevention Funded by the Centers for Disease Control and Prevention

3. HOPE Works Team (UNC) Marci K. Campbell, PhD, MPH, RD (PI) Salli Benedict, MPH, Project Coordinator Margaret Bentley, PhD Brenda DeVellis, PhD Kristine Kelsey, PhD Chantelle Fisher-Borne, MPH

4. Community Advisory Committee and Community Staff (*) Priscilla Allen David Barnes *Katie Barnes, Chair Annie Blue *Tabatha Brewer Sharon Brown Consuela Combs Darlene Leysath Dixon *Anne Doolen Pamela Gonzalez Addie Hall *Barbara Harris Katherine Hernandez Judy Johnson-Truitt Donna Kelly Elizabeth Maynor *Pastor Patricia Peterson, Co-Chair *Lily Pool *Imani Rivera Delphine Smith

7. The evolution of the Health Works projects: from participation to empowerment Health Works for Women (HWW) 1993-1998 Work-site health promotion project focusing on individual risk factors such as diet and exercise as well as strengthening of social support networks Works sites included nine textile, apparel, and light manufacturing companies in Eastern North Carolina Project employed traditional research methods, as well as formative research methods

10. The evolution of the Health Works projects: from participation to empowerment Health Works for Women/Health Works in the Community (HWW/HWC) 1998-2003 Scope of the project expanded to address organizational and community factors that impact health and well-being Community Advisory Committee (CAC), consisting of workplace representatives, local agencies, advocacy groups, established to provide guidance and feedback Plant closings and lay-offs occurred in the course of project implementation

11. The evolution of the Health Works projects: from participation to empowerment Health Works After the Flood (HWATF) 2000-2003 In the wake of devastation wrought by Hurricane Floyd in 1999, CAC members and UNC initiated a project with CDC support to address stress and IPV in the months following the flooding Composition of the CAC changes to include more community members, domestic violence and mental health agencies, more leadership rather than advice

12. The evolution of the Health Works: from participation to empowerment Women’s Empowerment Days (2002) Events planned and implemented by CAC members in response to community concerns about the economic downturn and the need for grassroots development and empowerment efforts First formal linkage between health and economic issues Process evaluation: women want education and jobs

14. HOPE Works 2004-2009 Health: obesity prevention, healthy eating, physical activity, stress management; mental health Opportunities: education, work, economic improvement Partnerships: community resources, community colleges, support from other women Empowerment: to make healthy life choices

15. “ Poverty is hazardous to women’s health” The link between health and poverty Considerable micro-level research suggests a strong relationship between individual health and income (i.e. poverty leads to lower health status) Important findings include: –Income level is a more important predictor of health status than income change –Income level has a greater impact on the health status of poor than high-income individuals –Extended periods of time in poverty have a greater and more negative impact on health than occasional episodes of poverty Phipps, S.

16. Loss of traditional industries in eastern NC The manufacturing industry in the United States has experienced extensive economic restructuring in the past 30 years, primarily affecting rural areas in the Southeast. Between 1997 and 2002, North Carolina lost 100,000 jobs in the textile industry and 70,000 jobs in the apparel industry. Hossfeld L, Legerton M, Keuster G. Kalishman J, Stogner S, Ramey J.

17. HOPE Works Builds on previous 10 years of experience and community relationships CBPR project, active participation of CAC in all phases of planning Addresses high prevalence of obesity and community concern about this issue …and addresses social determinants of health, including education, employment, and income

18. HOPE Works Expands to larger community, not just workplaces Retain women’s health focus Address link between health and hope Goal setting and empowerment focus Uses principles and models from developing countries: micro-enterprise and loan circles

19. HOPE Works Intervention HOPE Circles: Low income, overweight women, multi- ethnic: African American, Latina, American Indian (Coharie) and Anglo Circles led by trained facilitators from the community Provide social support, information, strategies for health behavior change Goal-setting in health and hope domains (e.g. getting education, jobs, housing, etc)

20. HOPE Works Intervention Tailored newsletters (6) that address both health and hope-related issues and goals Planning and participating in community- wide events (kickoffs, health fairs, advocacy)

22. Evaluation --Randomized trial of 250 women in HOPE circles vs. 250 comparison women Individual change in weight, diet, PA, hope, self-efficacy, social support, community involvement, social capital, psychological and economic well-being --Comparison of HOPE Works counties with neighboring counties via RDD surveys Health behaviors, awareness, community involvement, social capital, hope --Cortisol sub-study on stress and weight

23. Seeds of HOPE Spin-off of HOPE Works Specifically addresses economic development/empowerment CDC provided funds for developing a strategic plan 2-day Seeds of HOPE Conference in Sampson and Duplin Counties July 2005

24. Seeds of HOPE Goal: to create a sustainable model Born of growing interest in the importance of economic empowerment to women’s health and community development Opportunities, training, education, resources for enhancing economic empowerment and community wealth Community-led partnership w/UNC, CDC, business and entrepreneurial organizations: one-year participatory strategic planning process

25. Seeds of HOPE Partners UNC (Jim Johnson, Anita Brown Graham, Jesse White) Community (community colleges, economic development agencies) Good Work NC Rural Center

26. Seeds of HOPE Strategic Plan Goals Start a business that will serve as an example of an exemplary worker-owned business Increase financial education across all HOPE Works activities Increase networking with organizations that support entrepreneurial activities

27. Threads of HOPE: Creation of a Woman-owned Business The Seeds of HOPE strategic plan: to create Threads of HOPE Build on skills of unemployed textile/apparel workers Unique design or product to reflect HOPE Works values, place and culture Collaboration with NCSU College of Design and Penelope Bags

28. Threads of HOPE Goals Training for low income women in every aspect of running a business Worker owned Living wage Health benefits Health promoting business/HOPE Circles Leadership development Opportunity to pursue educational goals

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30. Threads of HOPE Activities Consultant: Lori Eichel Site visits to NCSU School of Textile and College of Design Student fashion show “Secret Shopper” marketing trip Meeting with Duplin County sewing business owner

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32. Next steps Develop a business plan (Good Work) School of Design student competition Community meetings with design student

33. Mohamed Yunus, Grameen Bank Founcer 2006 Nobel Peace Prize Lecture “A human being is born into this world fully equipped not only to take care of him or herself, but also to contribute to enlarging the well being of the world as a whole. Some get the chance to explore their potential to some degree, but many others never get any opportunity, during their lifetime, to unwrap the wonderful gift they were born with.” Threads of HOPE may provide that opportunity.