From program to policy: expanding the role of community coalitions.

BACKGROUND: Diabetes mortality at the United States-Mexico border is twice the national average. Type 2 diabetes mellitus is increasingly diagnosed among children and adolescents. Fragmented services and scarce resources further restrict access to health care. Increased awareness of the incidence of disease and poor health outcomes became a catalyst for creating community-based coalitions and partnerships with the University of Arizona that focused on diabetes. CONTEXT: Five partnerships between the communities and the University of Arizona were formed to address these health issues. They began with health promotion as their goal and were challenged to add policy and environmental change to their objectives. Understanding the meaning of policy in the community context is the first step in the transition from program to policy. Policy participation brings different groups together, strengthening ties and building trust among community members and community organizations. METHODS: Data on progress and outcomes were collected from multiple sources. We used the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH) 2010 Community Change Model as the capacity-building and analytic framework for supporting and documenting the transition of coalitions from program to policy. CONSEQUENCES: Over 5 years, the coalitions made the transition, in varying degrees, from a programmatic focus to a policy planning and advocacy focus. The coalitions raised community awareness, built community capacity, encouraged a process of "change in change agents," and advocated for community environmental and policy shifts to improve health behaviors. INTERPRETATION: The five coalitions made environmental and policy impacts by engaging in policy advocacy. These outcomes indicate the successful, if not consistently sustained, transition from program to policy. Whether and how these "changes in change agents" are transferable to the larger community over the long term remains to be seen.

Need for specific sugar-sweetened beverage lessons for fourth- and fifth-graders.

OBJECTIVE: Consumption of sugar-sweetened beverages (SSB) is linked to obesity. The authors hypothesized that school-based nutrition education would decrease SSB consumption. DESIGN: Self-selected interventional cohort with random selection for pre and post measurements. SETTING: Arizona Supplemental Nutrition Assistance Program-Education Program-eligible schools. PARTICIPANTS: Randomly selected (9%) fourth- and fifth-grade classroom students. INTERVENTION: The University of Arizona Nutrition Network provided general nutrition education training and materials to teachers, to be delivered to their students. The University of Arizona Nutrition Network administered behavioral questionnaires to students in both fall and spring. MAIN OUTCOME MEASURE(S): Change in SSB consumption. ANALYSES: Descriptive statistics were computed for student demographics and beverage consumption on the day before testing. Paired t tests evaluated change in classroom averages. Linear regression assessed potential correlates of SSB consumption. RESULTS: Fall mean SSB consumption was 1.1 (± 0.2) times; mean milk and water intake were 1.6 (± 0.2) and 5.2 (± 0.7) times, respectively. Beverage consumption increased (3.2%) in springtime, with increased SSBs (14.4%) accounting for the majority (P = .006). Change in SSB consumption was negatively associated with baseline SSB and water consumption but positively associated with baseline milk fat (P ≤ .05). CONCLUSIONS AND IMPLICATIONS: The results suggest the need for beverage-specific education to encourage children to consume more healthful beverages in warmer weather.

Building a successful community coalition-university partnership at the Arizona-Sonora border.

PURPOSE: The purpose of the case study is to explore a successful community-university partnership through community-based participatory action and to examine the partnership's ability to make policy changes toward improving health behaviors. BACKGROUND: Diabetes mortality at the U.S.-Mexico Border is twice the national average. Poor health care access is also a concern. These factors prompted Douglas community members to form a community coalition and invite university participation. HISTORICAL OVERVIEW: Douglas coalition members and University of Arizona (UA) partners worked together to improve chronic disease prevention and control in Douglas, Arizona, by engaging programmatic and policy activities and working with the local schools and government. COALITION/PARTNERSHIP EFFECTIVENESS, STRENGTHS, AND WEAKNESSES: Data were collected from multiple sources, including key informant interviews, the Wilder Collaboration Factors Inventory, and annual evaluations to document effectiveness, strengths, and weaknesses. CONCLUSION: A successful community coalition-university partnership is the result of long-term collaboration, equal participation, and acknowledgement that policy work takes time. The Douglas partnership, through policy, has effected local health behavior changes.