Reimagining the Role of Health Departments and Their Partners in Addressing Climate Change: Revising the Building Resilience against Climate Effects (BRACE) Framework.

Public health departments have important roles to play in addressing the local health impacts of climate change, yet are often not well prepared to do so. The Climate and Health Program (CHP) at the Centers for Disease Control and Prevention (CDC) created the Building Resilience Against Climate Effects (BRACE) framework in 2012 as a five-step planning framework to support public health departments and their partners to respond to the health impacts of climate change. CHP has initiated a process to revise the framework to address learnings from a decade of experience with BRACE and advances in the science and practice of addressing climate and health. The aim of this manuscript is to describe the methodology for revising the BRACE framework and the expected outputs of this process. Development of the revised framework and associated guidance and tools will be guided by a multi-sector expert panel, and finalization will be informed by usability testing. Planned revisions to BRACE will (1) be consistent with the vision of Public Health 3.0 and position health departments as "chief health strategists" in their communities, who are responsible for facilitating the establishment and maintenance of cross-sector collaborations with community organizations, other partners, and other government agencies to address local climate impacts and prevent further harm to historically underserved communities; (2) place health equity as a central, guiding tenet; (3) incorporate greenhouse gas mitigation strategies, in addition to its previous focus on climate adaptation; and (4) feature a new set of tools to support BRACE implementation among a diverse set of users. The revised BRACE framework and the associated tools will support public health departments and their partners as they strive to prevent and reduce the negative health impacts of climate change for everyone, while focusing on improving health equity.

Physical Activity-Related Policy and Environmental Strategies to Prevent Obesity in Rural Communities: A Systematic Review of the Literature, 2002-2013.

INTRODUCTION: Health disparities exist between rural and urban residents; in particular, rural residents have higher rates of chronic diseases and obesity. Evidence supports the effectiveness of policy and environmental strategies to prevent obesity and promote health equity. In 2009, the Centers for Disease Control and Prevention recommended 24 policy and environmental strategies for use by local communities: the Common Community Measures for Obesity Prevention (COCOMO); 12 strategies focus on physical activity. This review was conducted to synthesize evidence on the implementation, relevance, and effectiveness of physical activity-related policy and environmental strategies for obesity prevention in rural communities. METHODS: A literature search was conducted in PubMed, PsycINFO, Web of Science, CINHAL, and PAIS databases for articles published from 2002 through May 2013 that reported findings from physical activity-related policy or environmental interventions conducted in the United States or Canada. Each article was extracted independently by 2 researchers. RESULTS: Of 2,002 articles, 30 articles representing 26 distinct studies met inclusion criteria. Schools were the most common setting (n = 18 studies). COCOMO strategies were applied in rural communities in 22 studies; the 2 most common COCOMO strategies were "enhance infrastructure supporting walking" (n = 11) and "increase opportunities for extracurricular physical activity" (n = 9). Most studies (n = 21) applied at least one of 8 non-COCOMO strategies; the most common was increasing physical activity opportunities at school outside of physical education (n = 8). Only 14 studies measured or reported physical activity outcomes (10 studies solely used self-report); 10 reported positive changes. CONCLUSION: Seven of the 12 COCOMO physical activity-related strategies were successfully implemented in 2 or more studies, suggesting that these 7 strategies are relevant in rural communities and the other 5 might be less applicable in rural communities. Further research using robust study designs and measurement is needed to better ascertain implementation success and effectiveness of COCOMO and non-COCOMO strategies in rural communities.

Local Health Department Engagement in Community Physical Activity Policy.

INTRODUCTION: This study assessed correlates of self-reported local health department (LHD) participation in community policy/advocacy activities that support physical activity. METHODS: In 2014, cross-sectional data from the nationally representative 2013 National Profile of Local Health Departments study administered by the National Association of County and City Health Officials were analyzed. Outcomes were participation in policy/advocacy activities related to urban design/land use, active transportation, and access to recreational facilities. Independent variables included structural characteristics, performance improvement efforts, and collaboration. Multivariate logistic regression models were computed. RESULTS: Representatives of 490 LHDs participated (79% response rate). Respondents reported similar participation in urban design/land use (25%); active transportation (16%); and recreational facility access (23%) policy/advocacy. LHDs with populations of ≥500,000 were more likely to report urban design/land use (p=0.004) as well as active transportation policy/advocacy participation (p=0.007) compared with those with populations of ≤50,000. LHDs with a community health improvement plan were more likely to participate in urban design/land use policy/advocacy (p=0.001). LHDs who regularly use the Community Guide were more likely to report policy/advocacy activity on active transportation (p=0.007) and expanding access to recreation facilities (p=0.009). LHDs engaged in a land use partnership were more likely to report urban design/land use (p<0.001) and active transportation (p=0.001) policy/advocacy participation. CONCLUSIONS: Participation in community physical activity policy/advocacy among LHDs was low in this study and varied by LHD characteristics. Intervention opportunities include assisting smaller LHDs and promoting performance improvement efforts and evidence-based practice resources.

Diabetes self-management: perspectives of Latino patients and their health care providers.

UNLABELLED: Lifestyle modification programs tailored to experience, culture, psychosocial characteristics, and world-view can improve knowledge, self-care behaviors, and glucose control among Latinos with diabetes. Few data exist, however, on improving diabetes self-management among Latinos. In addition, views and practices of practitioners caring for these patients have received little attention. OBJECTIVE: This study describes findings from qualitative research to inform the refinement of self-management interventions tailored to Latino patients with type 2 diabetes. METHODS: Two practitioner focus groups assessed perceptions of patients' knowledge, attitudes, and behaviors. Four patient focus groups examined knowledge, beliefs, practices, barriers, and facilitators. Data were transcribed and subjected to content analysis. RESULTS: Thirty-seven patients seeking care at a community clinic participated, along with 15 health care practitioners. Important knowledge gaps regarding diabetes causation and self-management were identified. Negative attitudes towards self-management were common among patients. Key facilitators included strong religious faith and support of medical practitioners. Families both facilitated and prevented adoption of self-management practices. CONCLUSION: This study provides unique insights into the knowledge, attitudes, practices, and perceived barriers facing Latino patients and their providers regarding diabetes self-management. PRACTICE IMPLICATIONS: Study findings underscore the need to develop tailored programs for this population and to train practitioners on their implementation.

Views and preferences of low-literate Hispanics regarding diabetes education: results of formative research.

Hispanics are twice as likely as non-Hispanic Whites to have diabetes and are also at higher risk for diabetes-related complications and poorer outcomes. The prevalence of diabetes is inversely related to educational status. Low literacy is common, especially among older Hispanics. Little literature exists on formative research to create diabetes education materials for this audience. Two focus groups assessed views and preferences for diabetes education of low-literate, low-income, non-English-speaking urban Caribbean and Central American Hispanics with diabetes, as well as utility of materials developed specifically for this population, as part of the preliminary work for a pilot study of a diabetes intervention. Implications for practitioners and researchers are discussed.