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Inconclusive evidence for how food environments affect health may result from an emphasis on residential neighborhood-based measures of exposure. We used an activity space approach to examine whether 1) measures of food access and 2) associations with diet and BMI differ between residential and activity space food environments among low-income African American women in Atlanta, Georgia (n = 199). Although residential and activity space environments differed across all dimensions of food access, being located farther away from 'unhealthy' outlets was associated with lower BMI in both environments. Future research should move beyond asking whether residential and activity space environments differ, toward examining if, how, and under what conditions these differences impact the estimation of health effects., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Estimate Healthy Homes/Healthy Families (HHHF) intervention efficacy for improving dietary quality., Methods: Low-income overweight and obese women (n = 349) recruited from rural community health centers were randomized to receive HHHF, a 16-week home environment-focused coaching intervention or health education materials by mail. Healthy Eating Index-2010 scores were calculated from 2 24-hour dietary recalls collected at baseline and 6- and 12-month follow-up., Results: HHHF participants reported greater improvements in Healthy Eating Index-2010 total scores at 6-month follow-up (+3.41 ± 13.43 intervention vs +2.02 ± 12.26 control; P =.009). Subcomponent analysis indicated greater consumption of total vegetables (P = .02) and greens and beans (P = .001), whole grains (P = .02) and reduced consumption of empty calories (P = .03). Standardized intervention effect sizes were 0.16 at 6 months and 0.13 at 12 months of follow-up., Conclusions and Implications: The HHHF resulted in short-term improvements in dietary quality, although more research is needed to interpret the clinical significance of effect sizes of this magnitude., (Copyright © 2018 Society for Nutrition Education and Behavior. All rights reserved.)

Exposure to secondhand smoke occurs primarily in the home due to passage of smoke-free legislation. Creation of a total household smoking ban can reduce associated health conditions such as asthma, lung cancer, heart disease and stroke. This paper describes the results of a randomized control trial of a minimal intervention to create smoke-free homes. 2-1-1 callers were invited to participate in the trial and were randomized to an intervention (mailings and a coaching call) or a control group (no intervention). We assessed reach, dose, fidelity, and receptivity to the intervention through program records and a 3-month follow-up survey with intervention participants. For the intervention materials, materials were mailed to 244 participants (99.2%) and 227 participants (92.3%) received the coaching call intervention. 92.3% received all intervention components. Participants who had full household bans at 3 months were more likely to conduct behaviors leading to a smoke-free home (i.e., making a list of reasons, having a family talk, posting a pledge) than were those with no/partial ban. The intervention materials also were rated higher in relevance and usefulness by non-smokers than smokers. Results demonstrate that this minimal intervention had high fidelity to the delivery of components and relatively high receptivity., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: To use qualitative methods to explore how clinicians approach weight counseling, including who they counsel, how they bring up weight, what advice they provide, and what treatment referral resources they use., Methods: Thirty primary care physicians, physician assistants, and nurse practitioners from four multi-clinic community health center systems (CHCs) in the state of Georgia (U.S.) completed one-on-one semi-structured interviews. Interviews were digitally recorded, transcribed verbatim, and coded., Results: Clinicians report addressing weight with those who have weight-related chronic conditions, are established patients, or have a change in weight since the previous visit. Most clinicians address weight in the context of managing or preventing chronic conditions. Clinicians report providing detailed dietary advice to patients, including advice about adding or avoiding foods. Many clinicians base advice on their own experiences with weight. Most report no community-based resources to offer patients for weight loss. In the absence of resources, clinicians develop or use existing brochures, refer to in-house weight programs, or use online resources., Conclusion: Clinicians use a variety of approaches for addressing weight, many of which are not evidence-based. Linkages with weight loss resources in the health care system or community are not widely reported., Implications for Practice: Clinicians and others from the primary care team should continue to offer weight-related counseling to patients with obesity, however, evidence-based treatment approaches for weight loss may need to be adapted or expanded for the CHC practice environment., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: To describe home food environments and examine which aspects are associated with fruit and vegetable intake and percent calories from fat among overweight and obese women., Design: Baseline data from a weight gain prevention trial collected through telephone interviews., Setting: Participants were recruited from 3 federally qualified health centers in rural Georgia., Participants: Overweight and obese patients (n = 319) were referred by their providers if they had a body mass index (BMI) > 25 and lived with at least 1 other person. Participants were primarily African American (83.7%), with a mean BMI of 38.4., Main Outcome Measures: Fruit and vegetable intake and percent calories from fat., Analysis: Descriptive statistics and multiple regression., Results: Participants reported a large variety of both fruits and vegetables and unhealthy foods in their homes, and an average of 2.6 family meals from non-home sources per week. Eating family meals with the television on was common. Availability of fruits and vegetables in the home (P < .001) and frequency of fruit shopping (P = .01) were associated with fruit and vegetable intake. The number of unhealthy foods in the home (P = .01) and food preparation methods (P = .01) were associated with percent calories from fat., Conclusions and Implications: Home food environments may be effective intervention targets for nutrition programs designed for overweight and obese women., (Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

The current study examines how community context affected collaborative planning and implementation in eight sites participating in a healthy cities and communities initiative in California. Data are from 23 focus groups conducted with coalition members, and 76 semi-structured interviews with local coordinators and community leaders. Multiple case study methods were used to identify major themes related to how five contextual domains influenced collaborative planning and implementation. Results showed that history of collaboration can influence resources and interpersonal and organizational connections available for planning and implementation, as well as priorities selected for action. Community politics and history can affect which segments of the community participate in a planning process and what issues are prioritized, as well as the pool of partners willing to aid in implementation. Some community norms and values bring people together and others appear to limit involvement from certain groups. Community demographics and economic conditions may shape outreach strategies for planning and implementation, and may also shape priorities. Geography can play a role in assessment methods, priority selection, partners available to aid in implementation, and participation in activities and events. Results suggest that community context plays a substantive role in shaping how community-based health promotion projects unfold., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Purpose: To describe a positive youth development program that was successfully designed and implemented in partnership with a Vietnamese American community and to provide insight into the types of outcomes that can result from such programs in similar communities., Methods: In-depth interviews were conducted with Vietnamese community leaders (n = 8) and youth (n = 10) who were involved in a positive youth development program in Oklahoma City. Interviews were tape recorded, transcribed verbatim, and coded by two independent analysts. Data matrices were used to help identify major themes., Results: Participants felt they had strengthened numerous assets as a result of involvement in the youth development program, including communication with parents or another adult, leadership skills, constructive use of free time, and positive peer influences. Some of the participants also reported establishment of a relationship with a nonparent adult, inclusion of community service in their aspirations for the future, and avoidance of high-risk behaviors owing to their involvement in the program. Both adults and youth felt that the Vietnamese community had changed its perception of youth as a result of increased involvement of young people in community service and cultural activities., Conclusion: Positive youth development is a promising prevention strategy that can be adapted to Vietnamese communities in the United States.

Purpose: To describe coalition membership, examine associations between coalition processes and short-term coalition outcomes, and assess the relative contribution of key coalition processes to perceived accomplishments in teen pregnancy prevention coalitions., Methods: A self-administered survey was distributed to active members of 21 teen pregnancy prevention coalitions in 13 communities. The overall response rate was 67%, with 471 surveys returned. Process measures included staff competence, member influence in decision making, and coalition functioning. Short-term outcome measures included perceived accomplishments, member satisfaction, member participation, and coalition viability., Results: About 50% of coalition members represented health or teen pregnancy prevention or youth development service organizations, with 13% participating primarily as residents or youth. None of the process measures were associated with coalition viability (defined as active 2 years post-survey). Many bivariate associations between coalition processes and other short-term outcomes were significant at the individual and coalition levels of analysis. In a multivariate random coefficients model, coalition functioning (p <.001) and member influence in decision making (p = .019) were significantly associated with perceived coalition accomplishments., Conclusion: Consistent with research on coalitions that have addressed other health issues, good coalition processes were associated with short-term indicators of effectiveness in these teen pregnancy prevention coalitions. Coalition processes were not associated with coalition viability 2 years post-survey, however, suggesting that other factors influence coalition survival.

Purpose: To examine the relationship among individual youth assets and adolescent sexual risk behaviors., Methods: Cross-sectional, in-home interview data from randomly selected inner-city neighborhood teenagers (N = 1253) and their parents (N = 1253) were analyzed. Demographic information (e.g., age, parental income, family structure) was statistically controlled for while investigating the relationships among youth asset and sexual activity outcomes using logistic regression analyses. Potential interactions between the demographic variables and the assets were also examined. The five sexual risk behaviors included "never had sexual intercourse," current sexual activity, number of lifetime sexual partners, current use of birth control, and age at first intercourse., Results: Youth mean age was 15.4 (+/- 1.7) years; 52% were female; 49% were Non-Hispanic Caucasian, 23% Non-Hispanic African-American, 19% Hispanic and 10% Non-Hispanic Native American. Sixty-three percent reported never having had sexual intercourse. Multiple logistic regression analyses indicated that, after controlling for the demographic variables and the other significant assets, Non-Parental Adult Role Models, Peer Role Models, Use of Time (Religion), and Future Aspirations were independently significantly related (p <.05) to whether or not youth had ever participated in sexual intercourse. Individual multiple logistic regression analyses indicated that, after controlling for the demographic variables, Peer Role Model and Family Communication assets were each significantly associated with birth control use by sexually active youth (p <.05)., Conclusions: Specific youth assets may have a protective effect from certain sexual risk behaviors.

Typical computer programs for patient education are didactic and fail to tailor information to an individual's specific needs. New technology greatly enhances the potential of computers in patient education. Computer-assisted instruction programs can now elicit information from users before leading them through problem-solving exercises. New authoring systems enable health professionals to develop their own programs. The capacity to elicit and report back information about factors that influence patients' health behaviors give the newest computer programs one of the strengths of face-to-face patient counseling: the ability to tailor an educational message for an individual patient. These programs are not intended to replace but rather to enhance personal interaction between providers and patients. This article describes the advantages of using computers for individualizing patient education and assessing trends across groups of patients. Innovative programs and features to look for in programs and equipment selection are also described.