workteam18_GRANT

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Abstract
The Ann Arbor YMCA seeks to foster youth development, healthy living, and social
responsibility through inclusive, community-oriented programs and services. The broad variety
of programs offered range from disease prevention to management across the lifespan (Ann
Arbor YMCA, 2011). Due to its continually diversifying membership, the Y regularly explores
how to meet members’ varied needs. One way the Y highlights their inclusionary mission is
through a rebranding strategy to identify as the “Y” instead of the “YMCA” (B. Richards,
personal communication, April 20, 2015). This is how the agency will hereafter be referred to
throughout this proposal. In addition to programming within the facility, the Y strives to reach
communities that face disparate challenges in accessing health promoting services, namely the
neighboring city of Ypsilanti. Residents of Ypsilanti experience a number of health disparities,
many of which put them at greater risk of cardiovascular disease (CVD). These disparities are
due to health behaviors that are influenced by a number of factors. For the purposes of this
proposal, physical activity and sodium consumption will be addressed as they relate to a
determinant of CVD, hypertension. Ypsilanti children are more sedentary, and consume more
fast food and soda than their Ann Arbor counterparts (Jackson et al. 2009; Washtenaw County
Public Health, 2014b). Because Ypsilanti residents in general have limited access to recreational
facilities, the Y has successfully implemented many programs in the area since 2009
(Washtenaw County Public Health Department, 2014b). The Y also identifies youth as an age
group for which they would like to develop more programming (D. Carr, personal
communication, January 29, 2015). The Y plans to open an Ypsilanti facility, though this will
not be completed until 2017. Therefore, they continue to cultivate partnerships with Ypsilanti
agencies to host their programs. The proposed program, entitled YMCA HEART (Healthy,
Empowered, Active, Resilient Teens), will seek to prevent and reduce hypertension in sixth-
grade students that attend Ypsilanti Community Middle School. Over the course of each school
year, six six-week sessions will occur for up to 75 students per session. Participants will receive
education about hypertension and two contributing factors, physical activity and sodium
consumption. Major objectives include: 90% of participants will understand what their blood
pressure is and what their personal blood pressure score means by the end of each six-week
session; 80% of participants will exhibit a 10% increase in knowledge about sodium intake and
physical activity by the end of each session; and students with prehypertension and hypertension
will reduce their systolic blood pressure by 80% within a year of completing the program. 10
high school students, two college interns, and a program manager will be assist the program
director in the delivery of the intervention. A major outcome objective of this program is to reach
66% of Ypsilanti Community Middle school sixth-graders annually, therefore reaching most of
the school by the end of the third year. In order to administer this program to its full potential, we
request $90,619.02 for three years of implementation.

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Program Narrative
Health Issue: Hypertension
The major health issue selected for this grant proposal is hypertension, a condition where the
arteries have persistently high pressure, which creates tremendous stress on the heart (Wang et
al., 2006). The main reason for focusing on hypertension is that it is a significant risk factor that
strongly predisposes individuals to cardiovascular disease (CVD), the number one cause of
mortality in both men and women in the United States. In fact, CVD leads to one in four deaths
in the U.S. (Centers for Disease Control and Prevention, 2014a). Hypertension is defined by a
systolic blood pressure greater than or equal to 140 mm Hg and a diastolic blood pressure greater
than or equal to 90 mm Hg (Wang et al., 2006). A study conducted by Hayman et al., found that
each additional one to two mm Hg in systolic blood pressure within children was associated with
a 10% greater risk of developing hypertension in adulthood after accounting for inherent blood
pressure variability (Hayman et al, 2007). Many studies, including the 2005 national Youth Risk
Behavior Surveillance (YRBS) results, indicated that CVD risk factors such as hypertension are
initiated during adolescence (Eaton et al, 2006). Hypertension causes damage to the heart and
arteries over several years, often times going unnoticed and undiagnosed. This has earned it the
nickname “silent killer.”
Many contributing determinants of hypertension are modifiable through primary prevention
initiatives early in childhood and adolescence (Hayman et al., 2007). Because of this, it is
important that these initiatives be available to adolescents. This type of prevention strategy will
also help prevent adult hypertension longitudinally (Lauer & Clarke, 1989). The main risk
factors of hypertension include genetics, physical activity level, sodium intake, tobacco use,
obesity and BMI, alcohol consumption, and diabetes (Blackburn, 1986; Hayman et al., 2007;
Johnson et al., 2014). For this proposal, the focus is on two of the most modifiable determinants
of hypertension: sodium intake and physical activity (see Appendix A for a hypertension risk
factors chart).
High sodium intake. The 2005 national YRBS survey found that a total of 79.9% of high
school students failed to consume the recommended daily serving of fruits and vegetables (Eaton
et al., 2006; Hayman et al., 2007). The recommended maximum sodium intake from the
American Heart Association is 1,500mg per day; however, children are on average consuming
3,387mg of sodium per day (Stamler, 1991). Increased sodium intake is positively associated
with increases in systolic blood pressure and a risk for pre-hypertension and hypertension among
U.S. adolescents. This association is strongest in children with obesity or sodium sensitivity
(Stamler, 1991; Yang et al., 2012).
Contributing factors. One direct contributing factor of high sodium intake is an unhealthy
diet. The Center for Disease Control reports that nine in 10 U.S. children between the ages of six
and 18 years old consume high levels of sodium, most of which comes from highly processed
and fast food items. These foods are highly accessible in school settings, which often promote a
fast food culture (Schaub & Marian, 2011). They can also be found in grocery stores,
convenience stores, and restaurants (Centers for Disease Control and Prevention, 2014b). In
addition, older adolescents, ages 12 to 18, are found to consume greater amounts of nutrient-poor
foods and sweetened beverages, and a higher percentage of total calories from unhealthy foods
(Hayman et al., 2007).
Areas with more limited access to fresh food often have higher rates of diet-related diseases
(Gallagher, 2007), making food access an indirect contributing factor of unhealthy diets. Stress
and prolonged screen time, too, can impact diet choices; higher levels of each are associated with

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increased fatty food intake and decreased fresh food intake (Cartwright et al., 2003; Lowry,
Wechsler, Galuska, Fulton, & Kann, 2002).
A second direct contributing factor of high sodium intake is a lack of nutritional literacy.
People in the U.S. often struggle with basic nutritional knowledge (Physicians Committee for
Responsible Medicine, 2012). Those who struggle to understand nutritional information have
greater difficulty making healthy food choices (Grimes, Riddell, & Nowson, 2009), which causes
them to consume more sodium rich foods.
Indirect contributing factors that impact health literacy include sociocultural factors, such as
traditional dishes that are high in salt, and language barriers for non-native English speakers.
Furthermore, low socioeconomic status (SES) is an indirect contributing factor of high sodium
intake since healthy food is often more expensive. In addition, there could be limited access to
healthy food in low SES areas (Gallagher, 2007), unhealthy school lunches, high screen time that
encourages snacking, high stress, or a lack of nutrition education (Appendix A).
Low physical activity. The 2005 national YRBS survey found that 67% of adolescents failed
to attend physical education classes, and 13.1% were overweight (Eaton et al., 2006; Hayman et
al., 2007). With regards to physical activity, the percentage of high school students who are
active (60 mins of activity every day) was 27.1% in 2013 (Johnson et al., 2014). The American
Heart Association recommends that individuals be active for 30 minutes at least five days each
week (American Heart Association, 2014). A sedentary or inactive lifestyle is directly linked to
an increase in CVD and hypertension in both children and adults, and physical activity is a
protective measure against hypertension (Blackburn, 1986; American Heart Association, 2014).
Contributing factors. Direct contributing factors of physical activity include a lack of
community resources, inadequate accessibility of community resources, an inactive individual
lifestyle, and a sociocultural environment that does not support physical activity (See appendix A
for a visual representation). It is believed that inadequate funding, low SES, and a poor built
environment (i.e. lack of recreation space) influence the availability of resources since a
community can either promote or deter lifelong physical activity through policies, built
environments, and programs (Wendel-Vos, Droomers, Kremers, Brug, & van Lenthe, 2007;
Humpel, Owen, & Leslie, 2002; Centers for Disease Control and Prevention, 1997). When those
community resources are available, it is important that they are accessible to those who need
them. It is more difficult, particularly for those with a lower SES, to control physical activity in
inaccessible environments. (Wendel-Vos, Droomers, Kremers, Brug, & van Lenthe, 2007;
Estabrooks, Lee, & Gyurcsik, 2003; Humpel, Owen, & Leslie, 2002). This often relates to
insufficient transportation options, safety concerns, or ineffective marketing of available
resources.
It is also the case that individuals living in an environment of inactive lifestyles are less likely
to seek out physical activity (Owen, Leslie, Salmon, & Fotheringham, 2000). An inactive
lifestyle is thought to be due to indirect contributing factors such as high screen time, inactive
parents or peers, peer preference for social activities over physical activities, and limited physical
activity in school curricula. Finally, one’s sociocultural environment may not encourage physical
activity (Wendel-Vos, Droomers, Kremers, Brug, & van Lenthe, 2007). For example, different
cultural and religious norms or beliefs may make someone uncomfortable being active in a
variety of contexts. Or they may have limited access to much-needed social support to be more
active. Perceived community danger could also be an indirect contributing factor if the
sociocultural context keeps someone from engaging in physical activity.

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Population served. The specific population being supported in this proposal’s programming
is sixth-grade adolescents in Ypsilanti Community Middle School. The Ypsilanti and nearby
Willow Run school districts recently consolidated, combining their school districts at the middle
school and high school level. The total population in Ypsilanti in 2013 was estimated to be
19,809, with just under 3,000 people under the age of 18. This number does not include the
student population from Willow Run in Ypsilanti Charter Township. Of those living in the City
of Ypsilanti, as seen in Figure 1, 61.5% are white, 29.2% are African American, 3.4% are Asian,
and 3.9% are Hispanic/Latino (United States Census Bureau, 2015). As many as 9.5% of
Ypsilanti residents speak a language other than English at home (United States Census Bureau,
2015). Important historical, social, political, and economic factors influence the incidence of
hypertension in this population, including income, culture, education, and public policy.
Figure 1
According to the U.S. Census Bureau, the 2013 per capita household income in Ypsilanti was
$21,350 compared to $34,247 in Ann Arbor, its neighboring city. As seen in Figure 2, the
median household income was $33,406 in Ypsilanti compared to $55,003 in Ann Arbor (United
States Census Bureau, 2015). Approximately 30.2% of Ypsilanti residents live below the poverty
line compared to 22.1% in Ann Arbor. Low-income areas are associated with the risk factors that
contribute to hypertension, such as inactivity and unhealthy diets (Jackson, 2009).

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Figure 2
Low education levels can influence knowledge about resources, help-seeking behaviors, and
even how to obtain medical attention (Nilsson, 2009). In Washtenaw County during 2013, 61%
of African Americans graduated from a four-year high school compared to their white
counterparts with a rate of 86% completion. Only 65% of all economically disadvantaged
students graduated in 2013 (Waller, 2014).
According to Diane Carr from the Y, current legislation aims to make physical education
optional rather than required for graduation, which could further reduce the physical activity that
adolescents obtain (D. Carr, personal communication, January 29, 2015)(See Appendix B for list
of staff interviews). Compared to Ann Arbor students, as seen in Figure 3, Ypsilanti students
participated less in school-based physical activity, such as sports teams (34.6% vs. 62.8%) and
physical education classes (58.6% vs. 89.7%). Ypsilanti children were also more sedentary
(Jackson et al., 2009).
Figure 3

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In Washtenaw County, just 39.8% of middle school children and 34.7% of high school
juniors eat five servings of fruits and vegetables per day (Michigan Department of Education,
2014). Compared to Ann Arbor middle school students, Ypsilanti students consume more fried
meats (7.5% vs. 3.2%), French fries (14.3% vs. 7.9%), and soda (18% vs. 7.9%) (Jackson et al.,
2009). In Ypsilanti, over 50% of residents have limited food access and 56% eat fast food once
or more per week, compared to 42% in Ann Arbor and 29% on the west side of the county
(Washtenaw County Public Health, 2014b).
In Washtenaw County, 20.5% of middle school aged children are obese, as are 23.7% of high
school juniors (Michigan Department of Education, 2014), and more Ypsilanti middle school
children are obese (22.2%) compared to Ann Arbor children (12.6%) (Jackson et al., 2009). This
prevalence of obesity, as seen in Figure 4, is why the Y has identified obesity as an area for
improvement (B. Richards, personal communication, January 29, 2015).
Figure 4
Community. Ypsilanti is located just east of the Huron River, six miles east of Ann Arbor
and 29 miles west of Detroit, Michigan (City of Ypsilanti, 2015). In total, the city of Ypsilanti is
approximately 4.33 square miles with 4,490 individuals per square mile (United States Census
Bureau, 2015). This area is separated into several neighborhood associations that center around
the downtown area. Most of the housing is rented property for Eastern Michigan University
(EMU) students (United States Census Bureau, 2015; Ypsilanti, 2015). The city includes a
historic district (Depot Town), and a small commercial district with restaurants, bars, shops, and
other businesses. The majority of built structures are originals from the late 1800’s (City of
Ypsilanti, 2015). EMU is a cornerstone of Ypsilanti’s downtown, attracting both undergraduates
and graduates to the area. The whole community is of mixed demographics with high school
students, young professionals, working singles, and families with small children.
Ypsilanti is struggling to balance its budget and debt. By 2017, “the city’s annual debt
service payments will be around $1.7 million annually, all of which will come out of the general
fund” (Elliott, 2014). The closure of both the former GM Willow Run Plant and the former
Visteon Plant cost thousands of jobs, and the city is trying to shift from an industrial town to a
college town (City of Ypsilanti, 2015; Elliott, 2014). Several businesses and shops in the area are
vacant or for sale, and redevelopment is widespread.
The area of Ypsilanti that is located near the Huron River has trails and parks for residents to
enjoy. On average, a high level of individuals walk, bike, or use public transportation to reach

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work or activities (Ypsilanti, 2015). The public transit of choice is The Ride through the Ann
Arbor Transportation Authority, which provides fixed bus routes around the Ann Arbor and
Ypsilanti cities with more limited access in Ypsilanti. However, those living in the townships do
not have access to buses, making it difficult to access public recreation areas. There is also
incomplete access to sidewalks and bike paths in the county. An additional barrier to increased
physical activity in Washtenaw County is weather, since the winter months limit outdoor
recreation (D. Carr, personal communication, January 29, 2015).
Ypsilanti residents have less access to recreational facilities overall, and about 56.2% of
adults in the county are overweight or obese (Washtenaw County Public Health Department,
2014b). Decreasing this proportion is a priority for the county health department, and for the Y
(D. Carr, personal communication, January 29, 2015). African Americans have higher obesity
rates (67%) than the county average (56.2%) (Washtenaw County Public Health Department,
2014b).
Community resources. Growing Hope is located in Ypsilanti and organizes two Ypsilanti
farmer’s markets, one in downtown Ypsilanti and a second in Depot Town. These markets accept
tokens from the Supplemental Nutrition Assistance Program (SNAP) as well as Double Up Food
Bucks (Growing Hope, 2015). Fair Food Network organizes the Double Up Food Bucks
program, which helps people in SNAP to double their benefits when buying fresh produce
(Washtenaw County Health Department, 2014c). The Farm at St. Joseph Mercy Hospital also
offers a farmers’ market in the hospital lobby. Ypsilanti residents can purchase food at several
well-established grocery stores, such as Meijer’s and Kroger, as well as several small markets
(Ypsilanti, 2015).
Ypsilanti’s Growing Hope also has nutrition education and garden clubs available on site,
and more in-depth summer camps. The Y has a partnership project with Growing Hope to
engage youth in social responsibility. The youth help plant seeds, harvest produce, and sell food
at farmers markets (Ann Arbor YMCA, 2011). Food Gatherers organizes a Go, Slow, Whoa
program intended to educate visitors about making healthy food choices. (Washtenaw County
Health Department, 2014c). However, most adolescents do not pick up their family’s food.
The Corner Health Center’s Preconception Health Education program counsels adolescents
with high Body Mass Indexes on nutrition and physical activity. Patients receive workout gear
and cooking supplies (Washtenaw County Health Department, 2014c). Michigan Model for
Health is a K-12 health education curriculum for the classroom and administered by public
school teachers. It is designed to help adolescents adopt healthy attitudes and behaviors
(Washtenaw County Health Department, 2014c). Data was not available on which educators are
incorporating this curriculum into their lesson plans, so it is not clear how well this resource is
utilized by Ypsilanti schools.
The University of Michigan Health System runs the Michigan Pediatric Outpatient Weight
Evaluation and Reduction Program (MPOWER). This program is a six-month, intensive weight-
loss program for children ages 12-18 with a BMI at or above the 95th percentile (Washtenaw
County Health Department, 2014c).
Girls on the Run of Southeastern Michigan offers youth development for young girls
through health education, physical activity, and mentoring. Programs are offered through the
eighth-grade level (Washtenaw County Health Department, 2014c).
The Ypsilanti Township Community Center (Rec Center) used to provide year round
programs and services to the greater Ypsilanti community. There were programs for youth to
become engaged in sports, health and fitness, dance, arts and crafts, camps, and special events

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(Ypsilanti, 2015). The Rec Center includes a recreation department, gymnasium, three
racquetball/wallyball courts, arts and crafts rooms, dance and aerobic studios (City of Ypsilanti,
2015; Ypsilanti, 2015). Unfortunately, the Rec Center stopped receiving public funding for
recreational programs following large tax base losses. Because of the unavailability of this space,
Y programs are hosted at schools and apartment complexes (D. Carr, personal communication,
January 29, 2015).
Ypsilanti’s neighboring townships are underserved by the aforementioned programs, and
have high childhood obesity rates. These programs address childhood obesity, but do not focus
specifically on hypertension. In addition, these programs tend to focus on nutrition education or
increased physical activity, but rarely both. There are also still service gaps for engaging
adolescents, who are challenging to recruit even when resources are available. There are no
mentorship-based activity programs linking the younger age groups with the older age groups,
which could make activities more attractive to teenagers who want to develop marketable life
skills.
Agency Experience and Capability
The Y was originally established in 1858 by students from the University of Michigan. Since
its founding, it has moved locations twice, finally settling in its current home at 400 West
Washington in downtown Ann Arbor. Its purpose is to foster youth development, healthy living,
and social responsibility through inclusive, community-oriented programs and services (Ann
Arbor YMCA, 2011). The Y’s mission is “to provide quality services responsive to member and
community needs, which support a continuum of growth opportunities for families, youth and
adults in Washtenaw County. These affordable and diverse services are meant to foster spiritual,
physical and social development over a life-span in a safe and secure environment” (Young
Men’s Christian Association, 1990).
The Y relies on partnerships, shared resources, grants, and fundraising to deliver its many
programs and services. Chronic disease management programs are heavily funded through
grants. Its youth and adolescent programs are largely supported by fundraising efforts, such as
the Y’s Strong Kids Campaign. Small local grants (i.e. PNC Bank) may also be used to fund
youth programs (D. Carr, personal communication, January 29, 2015).
In order to run the facility and its programs effectively, the Y has approximately 30 full-time
staff, which includes administrative and programming positions. There are 16 directors who
oversee different program departments (i.e. aquatics) and are responsible for defining staff roles
and budgeting. Directors administer programs and manage part-time staff with help from full-
time coordinators. Regular director and coordinator meetings are held to discuss Y operations (C.
Wood, personal communication, January 27, 2015). Part-time staff and volunteers are
responsible for assisting members and implementing programs. They are the most immediately
accessible employees to the members and community. Year-round, part-time staff total
approximately 220-230 individuals, not including 100 summer/seasonal staff for summer
programs, such as camps. Additionally, the Y benefits from the support of approximately 115
volunteers annually.
The Y has a continually diversifying membership base, and recognizes the need to ensure
inclusivity in its program offerings and marketing strategies. One way this has been addressed is
through recent rebranding strategies, including the shift to identifying as the “Y” instead of the
“YMCA” (B. Richards, personal communication, April 20, 2015). Today, the Y serves
approximately 25,000 people each year with 5,000 to 6,000 family memberships and 12,000 to

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13,000 individual memberships. On a given day, the gym itself draws approximately 2,500
people (Ann Arbor YMCA, 2011; C. Wood, personal communication, January 27, 2015). The
Y’s facility hours are 5:30am to 10:00 p.m. on weekdays and 7:00 a.m. to 7:00 p.m. on weekends
(Ann Arbor YMCA, 2011). During these hours, members can access the fitness floor,
gymnasium, indoor track, pool, studios, and locker rooms. Additionally, when using the facility,
parents can leave children in a child-watch center, which is included as a part of their family
membership.
A number of programs are delivered within the Y building, usually for a small, additional
fee. Most group fitness classes take place in the facility’s studios, and range from tai chi to studio
cycling to judo. Personal training, private yoga, and private pilates lessons are also available.
Adults and children are able to participate in sports leagues, such as basketball, pickleball, and
volleyball. Many chronic disease programs are also conducted in the Y building, including
Pedaling for Parkinsons, the LiveStrong program for cancer survivors, the Diabetes Prevention
Program, and the Blood Pressure Management Program (Ann Arbor YMCA, 2011). These
programs are all evidence-based and have shown huge success since their implementation (D.
Carr, personal communication, January 29, 2015).
In addition to its child-watch center, the Y has a child daycare center available to members
and nonmembers. Children in the daycare program are able to enjoy the facility as well by using
the Y’s playground and swim lessons. Classrooms are also utilized for youth lessons on language
and art. Youth programming also includes athletic programs, such as youth sports leagues,
gymnastics, and martial arts classes. However, these programs are primarily available to youth
under the age of 12. Opportunities for ages 13 to 17 are largely focused on professional
development, not physical activity. For example, group fitness classes are not typically open to
adolescent members, and even if they are, they cater more to the adult participants (B. Richards,
personal communication, January 29, 2015). Opportunities for youth ages 13-17 include the
Youth Volunteer Corps, where youth come together to serve people in the Washtenaw County
area, and the Teen After School Program. They take place in the Y’s teen center, which was
designed by teens but is underutilized outside of these programs (B. Richards, personal
communication, January 29, 2015).
To align with its mission to support youth development, healthy living, and social
responsibility, the Y also offers off-site programs in different community spaces. Some of these
programs are athletic leagues, such as baseball, which take place in various parks. Some
programming takes place within schools. The Y’s day and overnight camps are also hugely
successful, and they operate outside of the Ann Arbor area.
The neighboring community of Ypsilanti also benefits from the Y’s commitment to off-site
programming. Since 2009, they have offered youth and adult programs for members and non-
members with much success. Schools and senior centers have been important partners in
Ypsilanti as they provide space for these programs to occur. Enhance Fitness classes take place
not only in the downtown location, but also at Riverside Arts Center in Ypsilanti. Many summer
day camps take place at Ypsilanti schools (Ann Arbor YMCA, 2011). In another example,
SPLASH is a free learn-to-swim program during the summer for elementary school children.
This program partners with Ypsilanti apartment complexes to reach children and families where
it is most convenient for them. The Y is exploring the possibility of opening an Ypsilanti site in
2017, but hopes to continue their current programming until then despite the resource challenges
they experience (D. Carr, personal communication, January 29, 2015).

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As illustrated, the Y provides a variety of fitness and nutrition programs to the Ann Arbor
and Ypsilanti communities that address a range of health concerns, from prevention to chronic
disease management (Ann Arbor YMCA, 2011). Additionally, the Y emphasizes healthy
development throughout the lifespan, providing evidence-based programs for all ages (D. Carr,
personal communication, January 29, 2015). While there are many programs that address youth
physical activity and nutrition habits, they fail to adequately cultivate healthy lifestyle habits and
chronic disease prevention. For example, though there is a blood pressure management program,
it is tailored to adult audiences (Ann Arbor YMCA, 2011). Due to the absence of a Y building in
Ypsilanti, the Y acknowledges the need to continue and increase partnerships with supporting
agencies in order to implement effective programming.
Goals and Objectives
YMCA HEART (Healthy, Empowered, Active, Resilient Teens)
Program goals. The goal of this intervention program is to prevent and reduce hypertension
in sixth-grade students that attend Ypsilanti Community Middle School.
Process objectives. The objectives for the intervention’s delivery and target service offerings
include the following:
● By the beginning of each semester, the Y will recruit and train 10 junior and seniors from
Ypsilanti Community High School (hereafter referred to as student mentors) to facilitate
the weekly program sessions. For winter sessions, recruitment and training will be
complete by January 2016, 2017 and 2018. For fall sessions, recruitment and training will
be complete by September 2016 and 2017.
● By the beginning of each semester, the Y will recruit 75 sixth-grade participants from
Ypsilanti Community Middle School for each six-week HEART intervention session.
● Each semester, weekly meetings between the student mentors and the Program Director
will occur at Ypsilanti Community High School to prepare for weekly activities and
lessons.
● Throughout the six-week sessions, sixth-grade participants at Ypsilanti Community
Middle School will partake in weekly activities facilitated by student mentors and college
students.
Outcome objectives. The objectives for the intervention’s target short-term changes include:
● By the end of each academic year, 66% of Ypsilanti Community Middle School sixth-
grade students will have participated in the HEART program.
● By the end of each six-week session, 80% of sixth-grade participants will exhibit a 10%
change in knowledge about sodium intake and physical activity from baseline as
measured through surveys at the beginning and end of sessions.
● In the school year(s) following program participation (September 2016 and 2017), 60%
of program participants will exhibit retention of knowledge about sodium intake and
physical activity from baseline as measured through surveys.
● Within a year of completing the program, 80% of students with prehypertension and
hypertension will show a reduction of 2-4 mm Hg in systolic blood pressure.

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● By the end of their six-week session, 90% of participants will know what their blood
pressure is and what a blood pressure score means as measured through surveys and
Program Manager observation.
Impact objectives. The objectives for the intervention’s target long-term or quality of life
changes include the following:
● 50% of intervention participants will have reduced rates of hypertension into adulthood.
Program Approach and Methods
HEART conceptual framework. The two primary conceptual frameworks from which we
are basing our intervention strategy are Montano and Kasprzyk’s Integrated Behavioral Model
(IBM) and Bandura’s Social Cognitive Theory (SCT). The underlying concepts driving our
intervention are student intentions to change behavior and student knowledge and skills. Student
intentions are constructs from the IBM, and student knowledge and skills are constructs in the
Social Cognitive Theory. The two behavior changes being addressed by this intervention are
increasing physical activity and minimizing the sodium in student diets.
Integrated Behavioral Model. As the IBM posits, successfully enabling individual behavior
change is determined by that individual’s attitudes, perceived norms (injunctive and descriptive),
and personal agency toward the behavior. Varying levels of these three determinants impact
one’s intention to perform a given behavior. Whether or not students intend to perform the
desired behaviors is therefore dependent on their emotional reaction and their belief that these
behaviors will result in favorable outcomes, namely preventing and reducing hypertension to
decrease longitudinal CVD risk. The intervention strategy and activities were developed to frame
physical activity and healthy eating habits as valuable, favorable behaviors. This will be
accomplished by having fun and relevant activities for the students around physical activity and
nutrition.
While parents can influence their children’s behaviors in the home environment, middle
school students are often swayed by social pressures from peers. Middle school students, and
even their high school mentors, will often choose whether or not to perform a behavior based on
normative influences. The perceived norms construct from IBM addresses peer influence and
highlights the importance of shaping students’ social environment to promote a given behavior.
The injunctive norms being addressed are changing students’ perceptions of whether having a
normal blood pressure, eating healthier, and being physically active are expected behaviors.
Descriptive norms are addressed by peers who exhibit these health behaviors. This intervention
seeks to create a positive perceived norm toward physical activity and healthy eating by
connecting these behaviors to mentors who already perform these health behaviors.
The IBM differs from its predecessors because it accounts for behavioral constructs in
addition to intention. The most notable of these are salience of the behavior and the knowledge
and skills to perform the behavior. These constructs are incredibly important for this audience
because hypertension and its long-term effects are not often salient to adolescents (Viner, 2005).
For middle and high school students to believe that physical activity and reduced sodium intake
are worth pursuing, they must understand the risks of having hypertension as well as what
hypertension predicts for their health and future quality of life. Furthermore, students may not
know what a reduced sodium diet entails, or have the skills to pursue physical activities that suit
their needs. This intervention seeks to provide the knowledge and skills a student would need to
manage their own blood pressure.

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Social Cognitive Theory. The intervention strategies used to address changing attitudes,
perceived norms, and knowledge or skills of a behavior are drawn from the SCT. This
conceptual framework is influenced by social aspects that either inhibit or facilitate behavior
change, and is well suited to generate positive peer influence, attitudes, and group learning. This
intervention is reliant upon activities that provide observational learning, capacity building, goal
setting, and self-efficacy. Students should acquire more favorable attitudes, perceived norms,
knowledge, and skills about healthy behaviors by observing the actions and outcomes of student
mentors and sixth-grade peers. Increasing student knowledge of blood pressure measurements,
healthy food choices, and physical activity behaviors will enhance capacity building. Similarly,
designing an intervention that incorporates SCT’s self-control construct allows for goal-directed
behavior that works well in group and team settings. Students who are provided opportunities to
set goals and earn rewards or reinforcements may react more positively to the target behaviors.
The development of self-efficacy over time is also heavily influenced by SCT, and influences
intervention curricula so that small steps occur over the course of the six-week sessions.
HEART intervention strategy. Our intervention employs a health promotion approach that
targets sixth-grade students with pre-hypertension and hypertension, and will be available to all
sixth-grade students regardless of hypertension status. Students enrolled in the intervention will
obtain knowledge and skills related to hypertension prevention and reduction. However, by
focusing on increasing physical activity and decreasing sodium consumption, intervention
activities will encourage students to consider their health habits more broadly. In general,
adolescence is a critical time for creating health habits that will continue into adult life (Viner,
2005). We want students to leave the program with a higher health literacy level, specifically
regarding hypertension risk factors and preventative health behaviors. An increase in health
literacy will hopefully foster enhanced critical thinking about health behaviors and health
outcomes (Chinn, 2011). Health promotion strategies are appropriate for our intervention, and
they align well with the Y’s general activities (D. Carr, personal communication, January 29,
2015).
Level of prevention. Our intervention strategy, as indicated in our overall program goal,
seeks to both prevent and reduce hypertension. Foremost, we seek to prevent hypertension in
adolescents at the Ypsilanti Community Middle School. This employs primary prevention
strategies such as educating participants about what hypertension is, what the risk factors are,
and what health choices will help prevent the development of hypertension. Primary prevention
strategies seek to remove causative risk factors, thereby complementing or reflecting health
promotion (University of Ottawa, 2015). Because the community receiving the intervention may
include students with hypertension or prehypertension, the same intervention strategies will be
used as a means to address secondary prevention. By educating all students about hypertension
and prevention, we may be able to help those with hypertension to reduce and manage their
blood pressure. It is possible students who require tertiary prevention will participate in the
program, and the education and activities included in the intervention will be useful for them
more broadly. However, they may require more individual medicalized attention than our
intervention can provide. To address this we will prepare the Program Director to provide
resources and/or referrals to the student.
Some students may be unaware of their hypertension status. Since this program will measure
the blood pressure of as many students as possible regardless of program participation, this
intervention may be an illuminating process for students, their families, the school, the Y, and
the greater Ypsilanti community. Once the initial sessions of the intervention are in process,

14
program staff will have a clearer picture of the school’s needs and may adjust the program
accordingly.
Level of intervention. The level of intervention will be individual, interpersonal, and
community oriented. By working with individual students to cultivate knowledge and skills, we
will be impacting their individual ability to understand hypertension. This will also impact their
attitudes, beliefs, and perceived behavioral control about healthy lifestyle choices. Our
intervention will support the construction of interpersonal relationships to increase social support
for healthy choices through the inclusion of student mentors in program delivery (Viner, 2005).
Furthermore, intervening at school and providing a participatory group program will foster
behaviors and descriptive norms in the sixth-grade community. By focusing on sixth-graders for
each of the three years of the program, we will build a school culture around similar health
beliefs and habits; this culture may trickle into the high school and larger community through the
student mentors. It is our hope that sixth-grade participants will share their knowledge and skills
with family members via an educational binder given to all participants. Overall, there is
evidence that intervening at multiple levels during adolescence is important for reiterating health
promotion messages (Viner, 2005).
Activities. Our program will help prevent or reduce hypertension in adolescents by holding a
one-and-a-half-hour after school program in six-week increments for sixth-grade students at
Ypsilanti Community Middle School. This program will consist of six, six-week sessions
throughout the school year, with approximately 75 participants in each session, amounting to
66% of the sixth-grade Ypsilanti Middle School population. The program sessions will educate
the participants on proper nutrition and physical activity to reduce hypertension and improve
their long-term health. The sessions will include nutrition education, specifically related to
sodium intake and how it impacts blood pressure and hypertension. The school sessions will also
have a physical activity component wherein participants will learn ways to be active in both
group and individual settings. Lastly, the sessions will teach the participants how to take their
blood pressure and how to interpret the measurement, thereby improving their health literacy.
The following is an example of a weekly session: 20 minutes of discussing and eating a
healthy snack; 40 minutes of physical activities (half of the sessions (3) will be activities that
promote teamwork and the other half (3) will be activities that promote individual activity); 20
minutes with a guest lecturer, such as Growing Hope’s Executive Director, a dietician from the
Corner Health Center, or Diana Carr from the Y; and 10 minutes of blood pressure
measurements. To maintain a high retention rate, all participants will be eligible for scholarships
to attend Y summer camps if they attend all six sessions.
Moreover, we will recruit and train 10 current juniors and seniors from the high school to
become student mentors for the six-week program. This role will involve the student mentors
helping to plan and lead sessions for sixth-graders throughout the semester. Before the semester
begins, the selected student mentors will attend a weekend retreat to learn more about program
content and their responsibilities. The retreat will also focus on skill and team building exercises
with their fellow mentors, encouraging collaboration among peers and encouraging the group to
become a closer community. The student mentors will receive support from two college-aged
interns in addition to the Program Director.
Lastly, to encourage sixth-grade participants to practice health behaviors outside of
intervention sessions, a social media contest will be offered (i.e. show a picture of yourself being
physically active or a healthy meal/snack that was made). To incentivize participation in these
contests, there will be prizes for the winners such as fitbits.

16
Project management. This intervention will employ a Program Director. This person will be
responsible for developing curriculum, training college interns and student mentors to facilitate
activities, overseeing weekly meetings, linking participants to additional services, coordinating
with partners, and working with a Program Manager to evaluate progress and effectiveness. One
Program Manager will be hired to help with data collection and analysis of the data. Please
reference the budget section below for more details about personnel. Two college interns will be
hired from EMU or Washtenaw Community College and will preferably be enrolled in nutrition,
kinesiology, public health, or a related degree program. The college students will be trained by
the Program Director to help develop program curriculum, assist student mentors, and supervise
the Ypsilanti Community Middle School activities. These leadership intermediaries will be a
topical and organizational resource to the younger student mentors, and will give the Program
Director more time for high-level programmatic needs. The 10 Ypsilanti Community High
School student mentors will be required to apply for their positions for each semester. They will
also be required to attend weekly meetings with the Program Director and college interns for the
purpose of creating lesson plans and gaining valuable practice in facilitating session activities.
Each student mentor will be responsible for a group of five to 10 sixth-grade participants during
the after-school intervention sessions. Refer to the diagram below for a detailed program
hierarchy description.
Delivery coordination. The Y will be working with the Ypsilanti Community High School
to recruit student mentors and hold weekly planning meetings. Ypsilanti Community Middle
School will host the proposed after-school intervention for the sixth-grade participants. To
develop a working partnership with the schools, the Y will present a letter of intent along with a
proposal detailing the intervention strategy, activities, and desired outcomes. The letter will
specifically address how the program would strengthen the health of the school’s students and
impact the larger community as a whole, as well as detail the exact accommodations required of
the school. These would include the continued use of the school itself, which is already utilized
for some Y programs but would be the primary host site for the intervention. Furthermore, the

17
HEART Program Director and college interns may work to identify local organizations that
would be willing to be guest lecturers, as mentioned previously. As an incentive for area
organizations to become involved in intervention activities their organization would be displayed
in all marketing materials for the intervention program.
Monitoring and Evaluation
Both qualitative and quantitative data measures will be collected and analyzed to address the
effectiveness of the HEART program at preventing and reducing blood pressure through
increased physical activity and reduced sodium intake. Monitoring and evaluation will help
inform the success of this intervention model for accessing this particular age group and whether
it can be replicated at a school-wide level in other districts.
The Program Manager and the Program Director will be responsible for monitoring and
evaluating the intervention components. It is the responsibility of the Program Manager to
collect, analyze, and interpret intervention data, which will inform the Program Director’s
improvements of program components. The Program Manager will also use this information to
determine the feasibility of implementing and sustaining this intervention over time.
We will be measuring the success of the intervention through a number of evaluation
strategies. Process evaluation methods will be used to investigate the quality of the program’s
delivery. A survey will be developed by the Program Manager that addresses subjective
experiences of participants enrolled in each six-week session. The questions on the survey will
focus on how satisfied program participants were with the intervention activities and their
delivery, along with how the student mentors and college interns impacted the experience and
their level of program engagement. The survey will also contain questions that allow for
outcomes and overall program impact to be evaluated. These survey questions will address the
following: improvements in participants’ knowledge about hypertension and its determinants;
participant confidence in ability to control his/her blood pressure through lifestyle modifications;
participant confidence in his/her ability to measure and understand a blood pressure
measurement; participants’ plans to engage in healthy lifestyle choices that relate to intervention
content; and lastly, whether or not the school climate around healthy eating and physical activity
has changed since implementation of the program.
For each six-week intervention session, program participants will have their blood pressure
measurements taken at the beginning, middle, and end the session. In addition, non-participant
sixth-grade students will have their blood pressure measured and recorded in gym class at the
beginning, middle, and end of the academic school year. Blood pressure measurements will be
collected by program staff before being analyzed and interpreted by the Program Manager. The
qualitative survey will also be distributed to all sixth-grade students during gym class at the
beginning of the year to establish baseline knowledge about hypertension, diet habits, and
physical activity level. Program participants will receive a qualitative survey at the beginning
and end of their six-week intervention session to measure knowledge and activity level. The end-
of-session survey will also collect student feedback about the intervention’s strengths and
weaknesses. Additionally, a survey will be distributed at the end of the academic school year to
collect data on participants’ behavior change with regards to diet and physical activity. The
measurements of program participants juxtaposed against non-participants will help to determine
if there is an association between program participation and blood pressure reduction as well as
blood pressure management over time.
Methods for data collection will incorporate primary and secondary data. Primary data

18
collection (qualitative, quantitative, and mixed-methods), will take place during the school year
with ongoing analysis, though largely interpreted in the summer months. Observational data will
be collected by the Program Manager, who will observe participants taking their own blood
pressure. Using a Likert Scale, observational data will be coded to provide quantitative data.
Secondary data (school and county demographic data) will be utilized by the Program Manager
to contextualize the Ypsilanti Community Middle School data and determine program
replicability.
Collected data will be stored on the Program Manager and Program Director’s shared Y
computer drive. It will need to be exported from the iPad device (which is being used to record
data), and transferred to a secure drive on YMCA program computers. The Program Manager
will use statistical software (SPSS) to look for trends in blood pressure reduction and
management, as well as the degree to which lifestyle modifications are adopted and maintained
by participants. A series of independent T-tests will be run to determine the level of significance
in measurement differences between the intervention target group and the control group (sixth-
grade non-participants).

19
Dissemination and Sustainability
Measured changes in blood pressure for program participants (compared to non-program
participants), in conjunction with survey data on knowledge and skill improvements, will speak
to the success of the program at reducing hypertension. This ongoing evaluation data will help
inform improvements for future iterations of the program. Data on the overall program impact
will be shared annually with all Y program directors, who can share the information with other
staff, and board members. In addition, this information will be shared on the Y website and in Y
promotional materials, such as the newsletter. Information about the progress from the previous
year will be compressed and summarized for presentation at each summer Ypsilanti Community
Schools Board of Education meeting.
Data will also be disseminated through marketing materials to recruit participants. The
Washtenaw County Public Health Department will receive program impact information to be
shared with county health leaders. This will hopefully help the Y to obtain additional funding in
the future and to create partnership opportunities. The program will also benefit immensely from
the YMCA Annual Campaign, which collects significant funds from Y supporters annually.
Eventually, HEART will be absorbed by the Ypsilanti YMCA, which is currently in the
development phase. The program will benefit from this new facility’s infrastructure and
resources.

20
Program Workplan
Workplan Activities
GOAL #1: The goal of this intervention program is to prevent and reduce hypertension in sixth-grade students that attend Ypsilanti Community
Middle School.
OBJECTIVES: ACTIVITIES: PERSON(S)
RESPONSIBLE:
TARGET DATE(S) FOR
COMPLETION:
Process Objective #1: By the
beginning of each semester, the Y will
recruit and train 10 junior and seniors
from Ypsilanti Community High
School (hereafter referred to as student
mentors) to facilitate the weekly
program sessions. For winter sessions,
recruitment and training will be
complete by January 2016, 2017 and
2018. For fall sessions, recruitment and
training will be complete by September
2016 and 2017.
1. Promote program to juniors
and seniors at Ypsilanti
Community High School
through homerooms, email,
and other student mentors
(snowball recruitment)
2. Interview and select student
mentor applicants
3. New student mentor retreat
will consist of three-day
training over a weekend prior
to the start of each semester
1. Program Director,
Program Manager
and college interns
2. Program Director
and college interns
3. Program Director
and college interns
1. September 2015, March
2016, September 2016,
March 2017, September
2017
2. November 2015, April
2016, November 2016,
April 2017, November
2017
3. January 2016, September
2016, January 2017,
September 2017, January
2018
Process Objective #2: By the
beginning of each semester, the Y will
recruit 75 sixth-grade participants from
Ypsilanti Community Middle School
for each six-week HEART intervention
session.
1. Program staff will prepare
promotional materials, such
as flyers and brochures.
2. Program staff will speak with
teachers and school
administrators about coming
to homerooms and gym
classes for recruitment.
3. Program staff will promote
program during gym class
when taking school blood
pressure measurements.
4. Session registration will be
offered in-person after
school via phone and email.
Program Manager
and college interns
Program Manager
and college interns
Program Manager
and college interns
Program Manager
and college interns
1. August 2015
2. September 2015
3. January 2016, June 2016,
2017, June 2017,
2018, June 2018
4. January 2016, June 2016,
2017, June 2017,
2018, June 2018

21
Process Objective #3: Each semester,
weekly meetings between the student
mentors and the Program Director will
occur at Ypsilanti Community High
School to prepare for weekly activities
and lessons.
1. Weekly lesson plan meeting:
program director and college
interns will create lesson
plan skeleton and use
feedback from student
mentors to complete
college interns and
student mentors
1. Weekly from January 2015
to June 2018 during
academic school year
months (September
through June)
Process Objective #4: Throughout the
six-week sessions, sixth-grade
participants at Ypsilanti Community
Middle School will partake in weekly
activities facilitated by student mentors
and college students.
1. Weekly lesson plan meeting
2. Weekly educational sessions
for program participants
a. Will include lessons
on healthy food
choices, specifically
related to sodium
intake and how it
impacts blood
pressure and
hypertension
b. Will also include a
physical activity
component wherein
participants will learn
ways to be active
c. Will include a health
snack and discussion
college interns and
student mentors
college interns and
student mentors
to June 2018 during
months (September
through June)
to June 2018 during
months (September
through June)

23
Budget and Budget Justification
Total Costs of Program

24
Senior/Key Personnel
Program Director. The Program Director will devote 36 months at an average of 80% effort
throughout the duration of the program. This individual will continue to be responsible for other
programs at the Y at 20% effort, and salary and benefits for that effort will be covered by the Y
general fund. Most of their time on this project will be during the school year (September
through June), but additional work will be done during the summer months. The Program
Director will take a pivotal role in the design and delivery of all aspects of the program. They
should have a Master of Public Health with a focus in health education. They will be responsible
for hiring, training, and managing the Program Manager, two college interns, 10 high school
student mentors, and 75 sixth-grade participants for each six-week session. They will plan and
attend weekly meetings to review each week’s lesson plans with college interns and student
mentors, as well as weekly program sessions to assist the college interns and student mentors in
the facilitation of the weekly sessions. In addition, they will set up program registration
opportunities throughout the year and plan the end-of-year party. Lastly, they will assist the
Program Manager in evaluation efforts as needed.
Project Manager. The Program Manager will devote 36 months at 50% effort on average
throughout the duration of this program. Most of their time will be during the summer months
(July-August), but additional work will be done during the school year. The Program Manager
should have extensive experience and expertise in qualitative research methods and process
evaluation. They should have a Master of Public Health with a focus in epidemiology or
biostatistics. The Program Manager should be able to analyze data and present research findings
in the form of reports, tables, charts, spreadsheets, and manuscripts. The Program Manager will
help to form the surveys to collect data on students’ sense of self-efficacy to take their own blood
pressure, what it is, and what their score means. The Program Manager will be responsible for
inputting data from blood pressure measurements and survey responses in a statistical software
program (SPSS) and running analysis of the changes in blood pressure throughout the school-
year.
Fringe Benefits
The Y’s current fringe benefit rate is 30% for full-time employees and for faculty academic
year salaries, and 0.0765% for part-time staff.
Direct Costs
Program SessionSupplies. This program supply budget includes the cost of supplies such
as paper, pencils, pens, and binders that are specifically required to create materials for the
program. The following details the requests for the program related supplies: Year 1 = $142.00,
Year 2 = $200.00, and Year 3 = $200.00. Year one supplies will only be needed for a single
semester, whereas the second and third years will cover two full school semesters. We expect to
recover at least one third of the supplies purchased each year for reuse the following year.
Photocopying. This photocopying budget includes the cost of printing and copying the
training materials for the peer leader and participant binders, as well as promotional materials. In
addition, photocopying will be used at the end of each year for the evaluation reports. We will
spend $550 per session on photocopying-related supplies. The following details the requests for
photocopying-related supplies: Year 1 = $1,650, Year 2 = $3,300, and Year 3 = $3,300.
Tablet. Funds are requested for the purchase of a tablet for program staff for use throughout
the three-year program. A tablet will enable the Project Director and Project Manager to record

25
blood pressure data quickly in the gym classes three times each year for non-participants, as well
as at the end of each session for participants. A total of $150 is requested to purchase one
DigiLand 10.1-inch, 16 GB tablet. The tablet should last the full three years of the program.
Software. The purchase of an annual license for SPSS statistical software for data analysis and
program evaluation will be required. Purchase of this software is in accordance with copyright laws
concerning software. It will be purchased for one of the Y’s desktop computers for the Program
Manager’s use. We request $240 ($80 for three years) to cover the purchase of the SPSS statistical
software.
Blood pressure monitors. Blood pressure monitors will be used to measure program participants’
blood pressure over the course of the intervention. In addition, the monitors will be used on all sixth-
graders not enrolled in the intervention to provide baseline blood pressure measurements for the sixth-
grader cohort, as well as serve as a control group for evaluation purposes. Two blood pressure
monitors will be purchased once at the start of the three year intervention. We request $50 per
monitor; $100 total for the duration of the three years.
Snacks. Participants will receive a snack at each weekly program session. There are approximately
90 people at each session (75 sixth-grade participants, 10 student mentors, two college interns, the
Program Director and the Program Manager). We have rounded up to 90 total people to account for
potential guests. We have estimated that the cost of snacks will be $0.50 per person. This totals $810
per semester.We are requesting $4,050 total for program session snacks. The following details the
requests for snacks by year: Year 1 = $810, Year 2 = $1,620, and Year 3 = $1,620.
Retreat. We would like to provide student mentors and program staff with lunch and dinner
throughout the weekend retreat. For 15 people (10 student mentors, two college interns, Program
Director, Program Manager, and potential guests) at $5 per person per meal (dinner on Friday, lunch
and dinner on Saturday and lunch on Sunday) for a total meal cost of $300 per retreat. There will be
five retreats total, beginning January 2016. Therefore, we request $1,500 total for retreat meals. The
following details the requests for the retreats: Year 1 = $300, Year 2 = $600, and Year 3 = $600.
Fitbit. One Fitbit prize per year will be awarded to the winner of a social media contest as an
incentive to encourage participation in middle school students. These devices can be purchased at local
electronics or media stores for $91 each. Therefore, we request $273 for all three Fitbits. The
following details the requests for the Fitbits: Year 1 = $91, Year 2 = $91, and Year 3 = $91.
Travel. Local travel funds are requested for the Program Director and Program Manager to
travel between the Y, Ypsilanti Community Middle School, and Ypsilanti Community High
School. Once a week during the school year, these staff members will use one personal vehicle to
travel to the Ypsilanti Community High School for intervention activities. This weekly round trip
is estimated to be 13.6 miles and will be needed for 40 weeks throughout the school year, taking
into account holidays and school breaks. College interns will be required to arrange their own
transportation. This cost totals $312.80 each year ($0.575 per mile).
The Program Director and Program Manager will also travel to Ypsilanti Community High
School to transport student mentors to and from the Ypsilanti Community Middle School for
intervention activities. For these sessions, they will use the Y vans, so reimbursement from
program funds will be paid to the Y instead of staff members. This round trip has been estimated
at 22.7 miles and will be needed for 40 weeks throughout the school year, taking into account
holidays and school breaks. This cost totals to $522.10 each year ($0.575 per mile). The total
funds requested for travel is $2,504.70 for all three years of the program ($834.90 per year).

26
Other Expenses
Undergraduate college interns. Each semester of the program, we will hire two
undergraduate interns to help the Program Director and the Program Manager in their
responsibilities. Undergraduate candidates must apply for the position and should have some
prior work or educational background in public health, psychology, nutrition, kinesiology,
education, or some related field. Interns should be able to provide their own transportation to the
program meetings. Each intern will receive an honorarium of $250 at the end of each semester.
We will spend $2,500 on honorariums for interns for all three years of the program. The
following details the honorarium budget request: Year 1 = $500 ($250 for two interns), Year 2 =
$1,000 ($250 for four interns), and Year 3 = $1,000 ($250 for four interns).
Indirect Costs
Some infrastructural costs for this new Y program will be covered by existing general
funding resources from the Y, including facility and administrative costs, as well as some
materials to facilitate intervention activities.

27
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31
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32
Appendix A
Hypertension Risk Factors and Contributing Factors

33
Appendix B
YMCA Interviews
Our team interviewed Chad Wood, Technical Services Director, via telephone on January 27 at
9:00AM. Mr. Wood oversees the Human Resources Committee and the Michigan Regional
Technology Network. He reports to Chief Financial Officer Pam Horiszny.
Our team next interviewed Diane Carr, Vice President of Programs and Community
Development, during an in-person site visit to the Ann Arbor facility on January 29 at 10:00AM.
Diane serves in a number of roles both within the YMCA organization and in the community.
Her position at YMCA oversees the Aquatics Director, the Prevention Coordinator, and the
Dance Coordinator. She is also the primary contact with partner organizations and collaborators,
including University groups.
Our team interviewed Ben Richards, Health and Wellness Director, in person on January 29 at
2:00PM. Mr. Richards reports to Vice President of Operations Mike Fitzsimmons. He oversees
the personal training coordination, as well as the Livestrong program.

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