Background:
Community Voice: Taking it to the People addresses racial disparities in infant mortality rates by teaching risk reduction strategies to community residents through a series of five classes. The program was first implemented in Lynchburg Virginia in 2000 and made possible by a grant from the March of Dimes. When the program began, African American infant mortality rates in Lynchburg were 29.4 (1999) and after three years of operation the city saw a dramatic decrease in the rates to 5.5 in 2003. When funding was no longer available and the program did not operate in Lynchburg, rates began to rise again and were 22.0 in 2004.

Objectives:
Increase community awareness of the high rates of black infant death, prematurity and low birth weight.
Encourage lifestyle changes that help to reduce the risk of premature birth, low birth weight, SIDS and infant death.
Reduce the disparity between African American infant death rates and other races.

Methods:
Train community residents to become "Lay Health Advisors" through a series of five classes that address SIDS, preterm labor, early and adequate prenatal care, the risks of substance abuse during pregnancy, common myths associated with pregnancy, infant safety, tobacco use during and after pregnancy and other topics. Quarterly newsletters are produced and distributed to all Lay Health Advisors. An annual Lay Health Conference is held to review the curriculum and motiviate participants. Lay Health Advisors take information from the program and are trained to share it with family, co-workers, friends, neighbors and other acquaintances.

Results:
Lay Health Advisors have made thousands of community contacts (an exchange of perinatal health information) in their communities. Pre and post test results indicate a substantial increase in knowledge. Lower infant mortality rates were seen in two cities where the program operated, Lynchburg and Danville, Virginia. Two cities in Tennessee are planning to replicate the program.

Conclusion and implications for practice:
Community Voice, combined with risk appropriate medical care, has the potential to impact a high risk population and reduce the risk of premature birth, low birth weight and infant death, and could be replicated nationally.