The prevalence of community programmes and policies to prevent childhood obesity in a diverse sample of US communities: the Healthy Communities Study.

INTRODUCTION: This manuscript describes the prevalence and attributes of community programmes and policies (CPPs) to address childhood obesity documented as occurring in 130 diverse US communities. METHODS: Key informant interviews (N = 1420) and document abstraction were used to identify and characterize CPPs to promote physical activity and healthy nutrition occurring during a 10-year retrospective study period. Data were collected in 2013-2015 and analysed in 2016. RESULTS: Across all 130 communities, 9681 distinct CPPs were reported as occurring by key informants. Of these, 5574 (58%) focused on increasing physical activity, 2596 (27%) on improving nutrition and 1511 (16%) on both behaviours. The mean number of CPPs per community was 74.0, with a range of 25 to 295 across all communities. Most CPPs occurred more than once (63%) and on average lasted 6.1 years. The greatest number of reported CPPs occurred in school settings (44%). CONCLUSIONS: Communities showed a wide range of investment in the amount of CPPs occurring in settings that affect opportunities for children to engage in physical activity and healthy nutrition. The pattern of implementation of CPPs showed variation over time, with an increase in more recent years. This observational study provides new and valuable information about what US communities are doing to prevent childhood obesity.

Objectives of community policies and programs associated with more healthful dietary intakes among children: findings from the Healthy Communities Study.

BACKGROUND: Rational planning of community policies and programs (CPPs) to prevent obesity requires an understanding of CPP objectives associated with dietary behaviours. OBJECTIVE: The objective of the study is to identify objectives of CPPs associated with healthful dietary behaviours. METHODS: An observational study identified 4026 nutrition CPPs occurring in 130 communities in the prior 6 years. Dietary intakes of fruits and vegetables, added sugar and sugar-sweetened beverages, among others, were reported among 5138 children 4-15 years of age from the communities, using a Dietary Screener Questionnaire with children age 9 years and older (parent assisted) or parent proxies for younger children. CPPs were documented through key informant interviews and characterized by their intensity, count, and objectives including target dietary behaviour and food environment change strategy. Associations between dietary intakes and CPP objectives were assessed using hierarchical statistical models. RESULTS: CPPs with the highest intensity scores that targeted fast food or fat intake or provided smaller portions were associated with greater fruit and vegetable intake (0.21, 0.19, 0.23 cup equivalents/day respectively with p values <0.01, 0.04, 0.03). CPPs with the highest intensity scores that restricted the availability of less healthful foods were associated with lower child intakes of total added sugar (-1.08 tsp/day, p < 0.01) and sugar from sugar-sweetened beverages (-1.63 tsp/day, p = 0.04). Similar associations were observed between CPP count and dietary outcomes. No other significant associations were found between CPP target behaviours or environmental strategies and dietary intakes/behaviours. CONCLUSION: CPPs that targeted decreases in intakes of less healthful foods and/or aimed to modify the availability of less healthful foods and portions were associated with healthier child dietary behaviours.

Association between community characteristics and implementation of community programmes and policies addressing childhood obesity: the Healthy Communities Study.

BACKGROUND: Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity. OBJECTIVE: The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities. METHOD: Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4-15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy). CONCLUSION: Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics - urbanicity, region, being a large county and the per cent of African-Americans in a community - contributed to more (over 18% of the 25%) of the observed variability.

Measuring the intensity of community programs and policies for preventing childhood obesity in a diverse sample of US communities: the Healthy Communities Study.

INTRODUCTION: Efforts to address the critical public health problem of childhood obesity are occurring across the USA; however, little is known about how to characterize the intensity of these efforts. OBJECTIVES: The purposes of this study are to describe the intensity of community programs and policies (CPPs) to address childhood obesity in 130 US communities and to examine the extent to which observed CPPs targeted multiple behaviours and employed a comprehensive array of strategies. METHODS: To document CPPs occurring over a 10-year period, key informants were interviewed using a semi-structured interview protocol. Staff coded CPPs for key characteristics related to intensity, including reach, duration and strategy. Three types of CPP scores were calculated for intensity of CPPs, targeting of CPPs towards multiple behaviours and strategies used. RESULTS: Nine thousand six hundred eighty-one CPPs were identified. On average, communities had 74 different CPPs in place (standard deviation 30), with variation in documented CPPs (range 25-295). Most communities experienced a steady, modest increase in intensity scores over 10 years. CPP targeting scores suggested that communities expanded the focus of their efforts over time to include more behaviours and strategies. CONCLUSIONS: Findings of this large-scale study indicate that great variation exists across communities in the intensity and focus of community interventions being implemented to address childhood obesity.

The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the Healthy Communities Study.

BACKGROUND: Although a national epidemic of childhood obesity is apparent, how community-based programmes and policies (CPPs) affect this outcome is not well understood. OBJECTIVES: This study examined the longitudinal relationship between the intensity of CPPs in 130 communities over 10 years and body mass index (BMI) of resident children. We also examined whether these relationships differ by key family or community characteristics. METHODS: Five thousand one hundred thirty-eight children in grades K-8 were recruited through 436 schools located within 130 diverse US communities. Measures of height, weight, nutrition, physical activity and behavioural and demographic family characteristics were obtained during in-home visits. A subsample of families consented to medical record review; these weight and height measures were used to calculate BMI over time for 3227 children. A total of 9681 CPPs were reported during structured interviews of 1421 community key informants, and used to calculate a time series of CPP intensity scores within each community over the previous decade. Linear mixed effect models were used to assess longitudinal relationships between childhood BMI and CPP intensity. RESULTS: An average BMI difference of 1.4 kg/m2 (p-value < 0.01) was observed between communities with the highest and lowest observed CPP intensity scores, after adjusting for community and child level covariates. BMI/CPP relationships differed significantly by child grade, race/ethnicity, family income and parental education; as well as community-level race/ethnicity. CONCLUSIONS: These results indicate that, over time, more intense CPP interventions are related to lower childhood BMI, and that there are disparities in this association by sociodemographic characteristics of families and communities.

A model memorandum of collaboration: a proposal.

The authors propose a model memorandum of collaboration for use by state and community partnerships, support organizations, and grantmakers in working together to build healthier communities. Described as an idealized social contract, the model memorandum lays out interrelated responsibilities for the key parties.

The Community Tool Box: a Web-based resource for building healthier communities.

Building healthier cities and communities requires an array of community-building skills that are not always taught in formal education. The Community Tool Box (http://ctb.ukans.edu) is an Internet-based resource for practical, comprehensive, accessible, and user-friendly information on community-building, which both professionals and ordinary citizens can use in everyday practice. It connects people, ideas, and resources, offering more than 200 how-to sections and more than 5,000 pages of text.

Developing capacities of youth as lay health advisors: a case study with high school students.

Youth lay health advising, a form of support or helping, is an important potential resource for preventive intervention. This article describes a case study of a youth lay health advising program designed to provide high school students with support and guidance to handle challenges and concerns related to their health and quality of life. First, the planning, program development, and implementation of the approach are described. Second, a rapid formative evaluation presents quantitative and qualitative information on adolescent issues faced, the types and content of interactions, and peer helper satisfaction with the program. Third, the strengths and challenges of the peer helping program and the role of youth as lay health advisors are discussed. The article concludes with a discussion of the implications for practitioners on this approach to building the capacity of adolescents as lay advisors for community health.

Evaluating community coalitions for prevention of substance abuse: the case of Project Freedom.

In the United States alone, there are more than 2,000 community coalitions to address local concerns about abuse of alcohol, tobacco, and other drugs. This article describes an evaluation system used to examine the process, outcome, and impact of coalitions for the prevention of substance abuse. The evaluation addresses five key questions: (a) Was the community mobilized to address substance abuse (Process)? (b) What changes in the community resulted from the coalition (Outcome)? (c) Is there a change in reported use of alcohol and other substances by youths (Outcome)? (d) Does the coalition have a community-level impact on substance abuse (Impact)? and (e) Is community-level impact related to changes facilitated by the coalition (Impact)? To address these and other questions, using eight core measurement instruments, the evaluation system collects 15 distinct measures. This evaluation system is illustrated with a multiyear study of Project Freedom, a substance abuse coalition in a large midwestern city.

Some values guiding community research and action.

The dual purposes of applied research-contributing to understanding and improvement-are only partially served by method systems that encourage studying (with increasing precision) a narrow range of questions of modest societal importance. To optimize contributions to challenging societal problems, a field's cherished standards should be adapted to support more adventuresome forms of community research and action. This paper outlines 10 values for community research and action, based on insights from the fields of behavioral and community psychology. These values-reflect the goals and challenges of establishing collaborative relationships with research participants, determining research goals and methods, designing and disseminating interventions, communicating research findings, and advocating for community change. Critical challenges are outlined, and implications for the field and its clients are discussed.

Courteous service: Its assessment and modification in a human service organization.

We evaluated strategies to increase behaviors associated with courteous provision of service by 3 staff members of a human service agency. Training included written instructions, practice, and performance feedback. A lottery procedure was introduced to maintain courteous service after training. The results of a multiple baseline design across the 3 participants showed marked increases in courteous behaviors following training. These effects were maintained at 3-, 5-, and 8-month follow-ups. Consumers' satisfaction with service also increased. These findings suggest that simple training and reinforcement procedures can enhance courtesy afforded those who receive service from public and nonprofit organizations.

Consequence analysis: Its effects on verbal statements about an environmental project.

Typically, citizens lack relevant information concerning possible consequences of proposed environmental projects. Despite federal requirements for citizen participation in decisions about proposed roadway projects, no systematic procedures exist for educating citizens as to the possible consequences of such projects. The effects of a consequence analysis procedure on community residents' verbal statements about the favorability of a proposed roadway project were assessed. The consequence analysis procedure involved asking residents to rate the desirability and magnitude of each of 48 possible consequences of the proposed roadway project. Following the intervention, overall ratings of favorability of the project changed for nine of ten residents. Community residents' ratings of the quality of participants' justifications of their position on the roadway issue provided evidence of generalization to this collateral behavior.

Training public-speaking behavior: an experimental analysis and social validation.

The effect of an instructional package on public-speaking behaviors was analyzed in two experiments. The instructional package was designed to teach public-speaking trainees to look at the audience, make gestures, and perform a number of speaking behaviors. The results of Experiment I, with a university student serving as the trainee, showed that the percentage of each category of public-speaking target behavior increased only after the instructional package was introduced for that category. The results of Experiment 2, with three low-income paraprofessional staff members of a neighborhood service center serving as trainees, showed that the percentage of target behaviors increased after the instructional package was introduced for the respective trainee. Audience ratings of public-speaking performance were correlated with direct observations of target responses. All trainees showed marked improvements in audience ratings from pretraining to posttraining. This study demonstrated an effective procedure for training public-speaking behaviors.

Evaluating municipal policy: an analysis of a refuse packaging program.

The effect of a municipal enforcement program to improve residents' packaging of refuse was analyzed in a multiple-baseline design across two areas of a city. The enforcement program involved instruction concerning refuse-packaging regulations, collection only of appropriately packaged refuse, and feedback notices to residents concerning the reasons for noncollection of their inadequately packaged refuse. Both the number of violations and the percentage of residences violating each day were markedly reduced during the enforcement program. Furthermore, sanitation workers considered that the packaging of refuse and the safety and efficiency of refuse collection had improved. This study served as a pilot evaluation of a policy change in the city sanitation department, and was functional in determining the direction of that policy.

Community applications of instructional technology: teaching writers of instructional packages.

A community education program, to develop a variety of performance competencies in large numbers of neighborhood residents, requires a technology for preparing learning units administerable by community members themselves. The effects of a writing manual, designed to teach nonprofessionals to prepare such instructional packages, were analyzed in two experiments. Experiment I employed a multiple-baseline design across three university student trainees. The results showed that appropriate program writing increased by 75% after completion of the manual. The results of Experiment II, with two low-income neighborhood residents serving as trainees, showed that packages produced by trained writers resulted in a greater increase in skill activities than sets of training stimuli produced by untrained writers.

Community applications of instructional technology: training low-income proctors.

A community education system might be most effectively implemented in low-income communities if it were deliverable by neighborhood residents. A proctor training manual, designed to teach neighborhood residents how to administer standardized learning units to their peers, was analyzed in two experiments. The results of Experiment I showed that the percentage of occurrence of proctor behaviors increased after completion of the manual. Supplementary data suggest that specified proctor behaviors generalize to actual instructional situations. The results of Experiment II showed that the percentage of occurrence of trainee behaviors was higher when instructional packages were administered by trained proctors than when administered by untrained proctors. This study demonstrates an effective procedure for training low-income community residents to serve as proctors for a community education system.

Effects of environmental design and police enforcement on violations of a handicapped parking ordinance.

This study presents two experiments that evaluate strategies to reduce violations of a handicapped parking ordinance. The first experiment compared effects of upright versus ground handicapped parking signs on percentage of intervals in which cars were parked illegally. Introducing upright signs produced an immediate reduction in the percentage of intervals of inappropriate use of parking spaces. The second experiment examined effects of a police enforcement program on percentage of intervals of inappropriate use of parking spaces and frequency of inappropriately parked cars. Results showed consistent reductions in percentage of intervals of inappropriate use and number of inappropriately parked cars compared with a control site where no enforcement program was introduced. Implications of the research data for law enforcement and public policy are discussed.

Some promising dimensions for behavioral community technology.

In recent years, the search for effective and replicable approaches to planned change in communities has escalated. Applied behavior analysts have participated in these efforts to remedy existing community problems and to increase the capacities of community residents to meet their goals. Examples of behavioral technologies for community settings are described and their advantages are noted. Criteria for more contextually appropriate community technologies are suggested and strategies for developing behavioral methods according to these criteria are described. This paper outlines some promising dimensions for behavioral community technology and discusses several possible limitations to a behavioral approach to addressing societal problems.

Training counseling skills: an experimental analysis and social validation.

A community development perspective suggests the value of using local resources to solve local problems. Two low-income staff of a community service center served as nonprofessional counselors after receiving a training program consisting of written instructions, practice, and performance feedback. The effects of the 40-hour training program were positive for both counseling and problem-solving skills. There was also evidence of generalization of counseling performance across clients, problems, and time. In addition, expert judges' ratings of performance were obtained as a measure of social validity. These findings suggest that the training procedures are effective in enhancing the counseling and problem-solving skills of low-income nonprofessionals.

Reducing risk of pressure sores: effects of watch prompts and alarm avoidance on wheelchair push-ups.

People who use wheelchairs are at risk for developing pressure sores. Regular pressure relief, in the form of a wheelchair push-up, is one way to reduce the likelihood of pressure sores. We examined the effects of antecedent (i.e., instructions, audible prompts) and consequent (i.e., alarm avoidance) events on wheelchair push-ups, using a multiple baseline analysis with 2 participants with spina bifida. Results suggest that the combined procedure was more effective than either antecedent or consequent events alone, and there is some evidence suggesting maintenance of effects over time.