Search

When planning and evaluating community-level initiatives focused on policy and environment change, it is useful to have estimates of the impact on behavioral outcomes of particular strategies (e.g., building a new walking trail to promote physical activity). We have created a measure of estimated strategy-level impact—“population dose”—based on our work in evaluating obesity prevention initiatives that uses elements of the RE-AIM method of combining reach and effectiveness to estimate the impact of a strategy on risk behaviors within a target population. We provide a definition and examples of measuring population dose, discuss measurement options in the face of uncertainty about key parameters, review ways of increasing population dose, and illustrate how the concept of population dose has been used in the Kaiser Permanente Community Health Initiative. [ABSTRACT FROM PUBLISHER]

Creative ways must be found to engage both community residents and political leaders around policy and environmental solutions to public health issues. Photovoice is a community-based, participatory approach to documentary photography that provides people with training on photography, ethics, critical discussion, and policy advocacy. Photovoice projects have been implemented across the nation as part of Kaiser Permanente's Community Health Initiative--a community-based obesity prevention effort. This article focuses on the first Photovoice project implemented in three communities in Colorado. Photovoice themes related to healthy eating and active living include a lack of access to healthy food choices in stores and schools, unsafe street crossings and sidewalks, and the need to re develop certain areas to encourage safe recreation. The involvement of policy leaders in the project combined with several dissemination activities has contributed to healthier food offerings in schools and neighborhoods and city planning efforts that emphasize walkability and access to healthy food, and park revitalization. [ABSTRACT FROM AUTHOR]

This article describes a community organizing approach to promoting physical activity among underserved older adults in southeast Seattle: the Southeast Senior Physical Activity Network (SESPAN). The organizing strategy involves networking with a variety of community-based organizations, with two broad objectives: (a) program objective--to make connections between two (or more) community-based organizations to create senior physical activity programs where none existed before; and (b) coalition objective--to build a broader network or coalition of groups and organizations to assist in making larger scale environmental and policy changes. Networking among organizations led to the creation of a number of potentially sustainable walking and exercise programs that are reaching previously underserved communities within Southeast Seattle. In addition, a major community event led to the establishment of a health coalition that has the potential to continue to generate new broad-based programs and larger scale environmental changes. [ABSTRACT FROM AUTHOR]

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: Social support may be associated with improved diet and physical activity—determinants of overweight and obesity. Wellness programs increasingly target worksites. The aim was to evaluate the relationship between worksite social support and dietary behaviors, physical activity, and body mass index (BMI). Method: Baseline data were obtained on 2878 employees from 2005 to 2007 from 34 worksites through Promoting Activity and Changes in Eating, a group-randomized weight reduction intervention in Greater Seattle. Worksite social support, diet, physical activity, and BMI were assessed via self-reported questionnaire. Principal component analysis was applied to workgroup questions. To adjust for design effects, random effects models were employed. Results: No associations were found with worksite social support and BMI, or with many obesogenic behaviors. However, individuals with higher worksite social support had 14.3% higher (95% CI: 5.6%–23.7%) mean physical activity score and 4% higher (95% CI: 1%–7%) mean fruit and vegetable intake compared to individuals with one-unit lower support. Conclusion: Our findings do not support a conclusive relationship between higher worksite social support and obesogenic behaviors, with the exception of physical activity and fruit and vegetable intake. Future studies are needed to confirm these relationships and evaluate how worksite social support impacts trial outcomes. [Copyright &y& Elsevier]

Purpose. This study established a framework to audit environments supporting walking in neighborhoods. Design. Cross-sectional analysis using a telephone survey and 200 objective environmental variables. Setting. Urbanized King County, WA. Subjects. 608 randomly sampled adults. Measures. Walking measures constructed from survey questions; objective environmental measures taken from parcel-level databases in Geographic Information Systems. Analysis. Multinomial models estimated the odds of people engaging in moderate walking (<149 min/wk) and in walking sufficiently to meet recommendations for health (150 + min/ wk), relative to not walking; and in walking sufficiently, relative to walking moderately. A base model consisted of survey variables, and final models incorporated both survey and environmental variables. Results. Survey variables strongly associated with walking sufficiently to enhance health included household income, not having difficulty walking, using transit, perceiving social support for walking, walking outside of the neighborhood, and having a dog (p < .01). The models isolated 14 environmental variables associated with walking sufficiently (pseudo R2 up to 0.46). Measures of distance to neighborhood destinations dominated the results: shorter distances to grocery stores/markets, restaurants, and retail stores, but longer distances to offices or mixed-use buildings (p < .01 or .05). The density of the respondent's parcel was also strongly associated with walking sufficiently (p < .01). Conclusions. The study offered valid environmental measures of neighborhood walkability. [ABSTRACT FROM AUTHOR]

Purpose. To examine the association between worksite social support and changes in diet, physical activity, and body mass index (BMI). Design. Cohort analysis of an underlying randomized, controlled, weight gain prevention worksite trial: Promoting Activity and Changes in Eating. Setting. The trial occurred in the greater Seattle area. Subjects. Baseline and follow-up data xoere obtained on a nested cohort of employees (n = 958-1078) from 33 small- to medium-sized worksites. Measures. Worksite social support, diet, physical activity, and BMI measures were assessed using a self-reported questionnaire. Analysis. To adjust for multilevel data and multiple time points, we used generalized estimating equations and logistic mixed models. Results. Higher baseline worksite social support was associated with greater changes in fruit and vegetable intake (p = .001; summary food-frequency questions). Conclusion. This study does not support a conclusive relationship between worksite social support and health behavior change. [ABSTRACT FROM AUTHOR]

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]