Search

Community health initiatives typically involve time-limited funding from foundation or government grants to support their initial activities. But if there are to be lasting improvements in health outcomes, initiative activities must be sustained over a relatively long period of time. Despite the importance of sustaining work begun under health initiatives, there have been few attempts to track sustainability after the period of funding has ended. This article provides a framework for evaluating the legacy of community health initiatives and illustrates its use with the legacy evaluation from The California Wellness Foundations Health Improvement Initiative (HII). The HII was largely successful in sustaining its core elements of collaborative partnerships, community-level systems changes, direct services, and population health measurement. The authors discuss differences in evaluation design and data collection between the funded-period and legacy evaluations; these differences may justify a distinct methodological approach.

Describes pilot test of survey of grocery store product displays to measure the amount of health education information provided and the proportion of the display devoted to "healthier" products. Finds that inter-rate reliability ranged between 0.73 and 0.78 for the healthiness indices and between 0.30 and 0.67 for the health education measures. Test reliability ranged from 0.44 to 1.0. (FMW)

The article discusses initiatives to prevent obesity in communities across the U.S., focusing on changes to the environment and policy on food and physical activity. Some changes include levying taxes on sugar-sweetened beverages, removal of unhealthy foods from vending machines in schools, and increasing the availability of healthy food/beverage options at public venues. Other topics of the article include the sponsoring of initiatives by foundations such as the W.K. Kellogg Foundation, the Robert Wood Johnson Foundation, and Kaiser Permanente, the impact of public health initiatives, and strategies to improve initiatives such as focusing on youths, using multiple strategies on one population, and using sustainable strategies.

Nutrition policy advocates have identified many evidence-based strategies that could improve the nutritional health of populations, but progress toward policy enactment is limited. Cross-sector collaboration is a time-tested way to advance the policy process. A group of advocates, practitioners, and researchers examined policy interests across nutrition, agriculture, and environmental sectors. The group then examined how these factors played out in the Local Farms–Healthy Kids legislation in Washington State. Cross-sector advocacy based on shared values regarding healthy food access and mutual interests in production, sales, and consumption of healthy local food strengthened the policy development process. [ABSTRACT FROM PUBLISHER]

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]

Purpose. To evaluate the effect of the Health Improvement Initiative (HII), a 5-year grantmaking initiative funded by The California Wellness Foundation designed to identify the critical factors needed to bring about population health improvements through community-level systems change. Design. The evaluation of the HII used a case-study, logic-model approach to make inferences about the effect of each community coalition (Health Partnership) on its target community. The primary outcome measure was the creation of significant and sustainable community-level systems change. Setting. The HII included nine communities in California that received funding to create broad-based Health Partnerships. Subjects. Primary data were collected from a variety of Initiative stakeholders by key informant interviews, closed-ended surveys, and participant observation. Intervention. The HII provided funding over 5 years to nine Health Partnerships that were intended to be a driving force in implementing community-level systems change. The ultimate objective of the systems change process was to improve ‘population health,’ broadly defined to include social, economic, and cultural determinants of health, in addition to traditional health status indicators. Measures. Both qualitative and quantitative techniques were used to assess the effect of the HII on key community systems. The primary outcomes were qualitative descriptions of community-level changes. Results. At the end of the 5 years of HII funding, six of the nine Partnerships had played a critical role in implementing sustainable systems changes that would likely have a significant effect in their target communities. Conclusion. The HII was successful in promoting community-level systems change in the majority of funded communities, although the evidence was mixed regarding the role of the Partnerships in bringing about these changes. [ABSTRACT FROM AUTHOR]

Research indicates that health disparities may be reduced by increasing the number of ethnic minorities working in health occupations. Establishing health career pathway programs for immigrant and ethnic minority students is one way to address this problem. One such program, Cross-Cultural Education in Public Health (CCEPH), was developed, implemented, and evaluated to determine whether participants expressed greater interest in pursuing health care careers after program completion. A sample of 72 immigrant students in two high schools participated in the program, which was based on Bandura's theory of self-efficacy. Data were gathered using pre- and postprogram surveys that measured academic self-efficacy and career consideration. Results for academic efficacy were not statistically significant, but Interest level in health care careers rose substantially. Although further research needs to be conducted to determine whether such programs increase self-efficacy, programs such as CCEPH can increase the consideration of health careers among immigrant and ethnic minority students. [ABSTRACT FROM AUTHOR]

Between 1995 and 2001, the California Center for Health Improvement (CCHI) initiated eight large-scale surveys of public opinion and performed policy analyses on issues and alternatives related to population health. A nonpartisan organization, CCHI aimed to advance the understanding of social factors and behavior as determinants of health and promote this understanding as a factor in policy making. Opinions of persons knowledgeable about policy making in California were obtained. Data included ninety brief interviews and twenty-four in-depth interviews with key informants who were capable of judging the impact of CCHI's activity. The entry of CCHI into the Sacramento policy community constitutes a natural experiment on the deliberate use of polls and policy analysis to influence policy. Key informants indicated that both polls and policy analysis affect the actions of policy makers. More than 48 percent believed that opinion polls "moderately" affected and 42.2 percent believed that opinion polls "strongly" affected the actions of policy makers. More than 58 percent indicated that policy analysis "moderately" affected and 33.7 percent believed that policy analysis "strongly" affected policy decisions. Effects of polling and policy analysis appeared to vary according to several contextual factors, such as the substantive policy issue, point in the legislative cycle, and perceived neutrality of the poll or analysis. Study findings provide evidence that polls and policy analyses affect policy by helping establish visibility and framing issues rather than determining outcomes. Hypotheses under a contingency model of factors in policy decision making are suggested. [ABSTRACT FROM AUTHOR]

Rigorous evaluation of community-based programs can be costly, particularly when a representative sample of all members of the community are surveyed in order to assess the impact of a program on individual health behavior. Community-level indicators (CLIs), which are based on observations of aspects of the community other than those associated with individuals, may serve to supplement individual-level measures in the evaluation of community-based programs or in some cases provide a lower-cost alternative to individual-level measures. Because they are often based on observations of the community environment, CLIs also provide a way of measuring environmental changes--often an intermediate goal of community-based programs. The Centers for Disease Control and Prevention convened a panel of experts knowledgeable about community-based program evaluation and cardiovascular disease (CVD) prevention to develop a list of CLIs, and rate their feasibility, reliability and validity. The indicators developed by the panel covered tobacco use, physical activity, diet and a fourth group that were considered `cross-cutting' because they related to all three behaviors. The indicators were subdivided into policy and regulation, information, environmental change, and behavioral outcome. For example, policy and regulation indicators included laws and ordinances on tobacco use, policies on physical education, and guidelines for menu and food preparation. These indicators provide a good starting point for communities interested in tracking CVD-related outcomes at the community level. [ABSTRACT FROM AUTHOR]

Green criminologists have argued that exposure to environmental pollution constitutes a serious form of green victimization of the general public and public health. This claim has not been widely assessed empirically. The present study employs data from the National Health and Nutrition Examination Survey (NHANES) over time to examine trends in exposure to environmental toxins among the U.S. population. NHANES data allow such an assessment through the collection of biological sampling used to determine exposure to environmental toxins. We examined trends for NHANES exposure estimates for biological indicators of pollutant exposure over time for 64 chemicals that have multiple measures. We divide the exposure trends into declining, stable, increasing, and unclear trajectory patterns and discuss the health consequences associated with exposure to measured chemical exposures. Discussion of the implications of this analysis and the need for future studies is provided. [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]

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]