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Introduction: A growing number of health systems are leading health promotion efforts in their wider communities. What impact are these efforts having on health behaviors and ultimately health status? This paper presents evaluation results from the place-based Kaiser Permanente Healthy Eating Active Living Zones obesity prevention initiative, implemented in 2011-2015 in 12 low-income communities in Kaiser Permanente's Northern and Southern California Regions.Methods: The Healthy Eating Active Living Zones design targeted places and people through policy, environmental, and programmatic strategies. Each Healthy Eating Active Living Zone is a small, low-income community of 10,000 to 20,000 residents with high obesity rates and other health disparities. Community coalitions planned and implemented strategies in each community. A population-dose approach and pre and post surveys were used to assess impact of policy, program, and environmental change strategies; the analysis was conducted in 2016. Population dose is the product of reach (number of people affected by a strategy divided by target population size) and strength (the effect size or relative change in behavior for each person exposed to the strategy).Results: More than 230 community change strategies were implemented over 3 years, encompassing policy, environmental, and programmatic changes as well as efforts to build community capacity to sustain strategies and make changes in the future. Positive population-level results were seen for higher-dose strategies, particularly those targeting youth physical activity. Higher-dose strategies were more likely to be found in communities with the longest duration of investment.Conclusions: These results demonstrate that strong (high-dose), community-based obesity prevention strategies can lead to improved health behaviors, particularly among youth in school settings.Supplement Information: This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. [ABSTRACT FROM AUTHOR]

Objective: To compare knowledge gains and knowledge retention of healthful eating and active living behaviors in elementary school children participating in Educational Theatre Programs (ETP). Methods: The study sample included 47 schools (2,915 third- or fourth-grade students) in 8 Kaiser Permanente regions. Children's knowledge of 4 healthful behaviors was measured using a brief survey before and immediately after performances, followed by a post-delay survey 3 weeks later. Results: Statistically significant increases in knowledge pre/post for individual topics (P < .01). The percentage of children who answered all 4 questions correctly increased from 17% to 63% immediately after ETP performances (P < .01). Knowledge was retained over the short term; the proportion of students who correctly identified recommended healthful eating/active living practices had declined only slightly 3 weeks later. Conclusions and Implications: The ETP significantly improved participating students' knowledge of healthful eating and active living concepts. Theater programs should be considered for inclusion in elementary school health curricula. [ABSTRACT FROM AUTHOR]

Increasing rates of childhood overweight have been linked to the rising energy density of the diet. We sought to provide temporal profiles of dietary energy density (DED) in a nationally representative sample of U.S. children and adolescents < or = 19 y old and to describe associations between DED and predictors of overweight. We used a subset of data from the 1994-1996, 1998 Continuing Survey of Food Intake for Individuals (CSFII) and a multivariate regression model to determine independent associations between DED and socioeconomic and demographic variables after controlling for covariates. In this cross-sectional data set, DED was positively associated with total energy intakes and varied with both age and gender. DED increased from birth, peaked at 7-8 y of age, and then declined. Boys consumed more energy-dense diets than girls. Among children < or = 4 y old, higher DED was associated in the regression model with lower household incomes and with enrollment in the food stamp program. Among adolescents 12-19 y old, higher DED was associated with being African-American. In contrast, lower DED among children < or = 11 y old was associated with being Asian or Hispanic and with total daily consumption of fluid milk. The quality of the diet for young children, as indexed by high DED, may be adversely affected by limited household economic resources. Although food insecurity and WIC enrollment were not associated with DED in this study sample, milk consumption in children < or = 4 y old was associated with lower DED. [ABSTRACT FROM AUTHOR]

: BackgroundRegular exercise is associated with many health benefits. Community-based exercise programs may increase exercise participation, but little is known about cost implications.: MethodsA retrospective, matched cohort study was conducted to determine if changes in healthcare costs for Medicare-eligible adults who choose to participate in a community-based exercise program were different from similar individuals who did not participate. Exercise program participants included 1114 adults aged ≥65 years, who were continuously enrolled in Group Health Cooperative of Puget Sound (GHC) between October 1, 1997 and December 31, 2000 and who participated in the Lifetime Fitness (exercise) Program© (LFP) at least once; three GHC enrollees who never attended LFP were randomly selected as controls for each participant by matching on age and gender. Cost and utilization estimates from GHC administrative data for the time from LFP enrollment to December 31, 2000 were compared using multivariable regression models.: ResultsThe average increase in annual total healthcare costs was less in participants compared to controls (+$642 vs +$1175; p=0.05). After adjusting for differences in age, gender, enrollment date, comorbidity index, and pre-exposure cost and utilization levels, total healthcare costs for participants were 94.1% (95% confidence interval [CI], 85.6%–103.5%) of control costs. However, for participants who attended the exercise program at an average rate of ≥1 visit weekly, total adjusted follow-up costs were 79.3% (95% CI, 71.3%–88.2%) of controls.: ConclusionsIncluding a community exercise program as a health insurance benefit shows promise as a strategy for helping some Medicare-eligible adults to improve their health through exercise. [Copyright &y& Elsevier]

Successful community-level health initiatives require implementing an effective portfolio of strategies and understanding their impact on population health. These factors are complicated by the heterogeneity of overlapping multicomponent strategies and availability of population-level data that align with the initiatives. To address these complexities, the population dose methodology was developed for planning and evaluating multicomponent community initiatives. Building on the population dose methodology previously developed, this paper operationalizes dose estimates of one initiative targeting youth physical activity as part of the Kaiser Permanente Community Health Initiative, a multicomponent community-level obesity prevention initiative. The technical details needed to operationalize the population dose method are explained, and the use of population dose as an interim proxy for population-level survey data is introduced. The alignment of the estimated impact from strategy-level data analysis using the dose methodology and the data from the population-level survey suggest that dose is useful for conducting real-time evaluation of multiple heterogeneous strategies, and as a viable proxy for existing population-level surveys when robust strategy-level evaluation data are collected.Supplement Information: This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. [ABSTRACT FROM AUTHOR]

Abstract: This disaggregate cross-sectional study uses primary data on the cycling behavior of 608 randomly sampled respondents in urbanized King County, Washington, and objective parcel-level GIS measures of land use and infrastructure conditions. Binary logit model findings provide new insights on who bicycles, and on perceived and actual built environmental conditions associated with the likelihood of cycling in neighborhoods, controlling for socio-demographic variables. A high 21% of the respondents report cycling at least once a week in their neighborhood, more often for recreation or exercise than for transportation. Cycling is more popular among male, younger adults, transit users, and those who are physically active and in good health. Both perceived and objective environmental conditions contribute to the likelihood of cycling. Proximity to trails and the presence of agglomerations of offices, clinics/hospitals, and fast food restaurants, measured objectively, are significant environmental variables. Previously researched correlates of cycling, such as the presence of bicycle lanes, traffic speed and volume, slope, block size, and the presence of parks, are found insignificant when objectively measured. A non-linear relationship is found between the odds of cycling and the perception of traffic problems and automobile-oriented facilities. Overall, cycling is only moderately associated with the neighborhood environment. It appears to be an individual choice that is independent from environmental support. This finding likely reflects the limited bicycle infrastructure in the sample frame—an unfortunate condition found in most US metropolitan regions. Policy and intervention programs could increase cycling by improving both actual and perceived environmental conditions. [Copyright &y& Elsevier]

Introduction: From 2011 to 2014, small stores in three communities participated in a community-wide obesity prevention initiative. The study aimed to determine how participation in the initiative influenced store environments and consumer purchases.Study Design: Pre- and post-intervention without control. Structured observations of the store environments and intercept surveys of adult shoppers at all stores, and of children at two stores, conducted at baseline and follow-up. Manager/owner interviews regarding perceived impacts of the intervention conducted at follow-up.Setting/participants: Shoppers at nine small stores in three diverse, low-income communities in Northern California.Intervention: The store interventions were determined locally with combinations of strategies such as product displays, healthier options, marketing and promotion, store layout, and facility improvements that were implemented to varying degrees at each site.Main Outcome Measures: Changes in store environments and purchases of select foods and beverages.Results: Stores experienced consistent, but not always significant, declines in purchases of sweets and chips and increases in purchases of fruits and vegetables at select stores. Decreases in purchases of targeted sugar-sweetened beverages were offset by increases in purchases of other sugar-sweetened beverages. Changes in store environments and promotional activities varied widely from store to store and corresponded to variations in changes in purchasing. The owners/managers perceived benefits to their bottom line and community/customer relations, but challenges were identified that may account for the varied degree of implementation.Conclusions: Substantive improvements in fruit and vegetable availability and promotion were needed to achieve a measurable impact on purchases but reducing purchases of unhealthy foods, like sweets and chips, required a less consistent intensive effort. These findings suggest it may be challenging to achieve the consistent and targeted implementation of changes and ongoing promotional efforts at a large enough proportion of stores where residents shop that would be required to get measurable impacts at the community level.Supplement Information: This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. [ABSTRACT FROM AUTHOR]

A major challenge in community-based health promotion is implementing strategies that could realistically improve health at the population level. Population dose methodology was developed to help understand the combined impact of multiple strategies on population-level health behaviors. This paper describes one potential use of dose: as a tool for working collaboratively with communities to increase impact when planning and implementing community-level initiatives. Findings are presented from interviews conducted with 11 coordinators who used dose for planning and implementing local efforts with community coalitions. During early-stage planning, dose was used as a tool for strategic planning, and as a framework to build consensus among coalition partners. During implementation, a dose lens was used to revise strategies to increase their reach (the number of people exposed to the intervention) or strength (the relative change in behavior for each exposed person) to create population-level impact. A case study is presented, illustrating how some community coalitions and evaluators currently integrate dose into the planning and implementation of place-based healthy eating and active living strategies. Finally, a planning checklist was developed for program coordinators and evaluators.Supplement Information: This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. [ABSTRACT FROM AUTHOR]

Objective: in an academic family practice clinic, we performed a controlled trial of a multifaceted intervention versus usual care for managing diabetes. Providers received didactic training and computerized compliance feedback to support staged diabetes management, an evidenced-based approach to diabetes care. Research design and methods: one firm of the clinic practice received the intervention, the other served as the control group during a 14-month baseline period and a 14-month study period. HbA1c was the principal outcome measure. Results: there was a significant 0.71% difference in change in HbA1c values between the intervention and control firms (P=0.02). The subgroup with the greatest improvement in HbA1c was those subjects who started the intervention with a HbA1c above 8%. The overall improvement in glycemic control could not be explained by differences in visit frequency or the aggressiveness of drug therapy. There were no changes in healthcare utilization or costs between the two firms. Conclusion: in an academic family practice clinic, a multifaceted intervention in support of diabetes treatment guidelines modestly improved glycemic control without incurring additional costs. The improvement was mostly due to mitigation of the natural deterioration in control usually seen. Further efforts are required to involve all patients in co-managing their diabetes. [Copyright &y& Elsevier]

Analyzes whether responses to standard dietary assessment instruments could be affected by a brief dietary intervention. Methodology used; Number of participants in the study; Details on the dietary assessment instruments; What the results indicated.