Promoting Policy, Systems, and Environment Change to Prevent Chronic Disease: Lessons Learned From the King County Communities Putting Prevention to Work Initiative.

CONTEXT: Initiatives that convene community stakeholders to implement policy, systems, environment, and infrastructure (PSEI) change have become a standard approach for promoting community health. OBJECTIVE: To assess the PSEI changes brought about by the King County, Washington, Communities Putting Prevention to Work initiative and describe how initiative structures and processes contributed to making changes. DESIGN: The impact evaluation used a logic model design, linking PSEI changes to longer-term behavioral impacts in healthy eating active living and tobacco use and exposure. Qualitative methods, including stakeholder interviews and surveys, were used to identify initiative success factors. SETTING: Communities Putting Prevention to Work activities occurred throughout King County, with a focus on 7 low-income communities in South Seattle/King County. PARTICIPANTS: The focus communities had a combined population of 652 000, or 35% of the county total, with lower incomes and higher rates of physical inactivity, tobacco use, poor diet, and chronic disease. INTERVENTION: Twenty-four PSEI strategies were pursued by organizations in sectors including schools, local governments, and community organizations, supported by the public health department. There were 17 healthy eating active living strategies (eg, enhancements to school menus, city planning policies) and 7 tobacco strategies (eg, smoke-free policies in schools, housing, and hospitals). MAIN OUTCOME MEASURE: PSEI changes made and numbers of residents reached. RESULTS: Twenty-two of the 24 strategies achieved significant progress toward implementing PSEI changes. The most common success factor was a "dyad" consisting of a dedicated technical assistance provider-either an outside consultant or public health department staff-working closely with a champion from the participating organizations to bring about PSEI changes. CONCLUSIONS: An initiative structure that creates and supports external consultant/internal organizational champion dyads in key community sectors offers a promising approach that may be adopted by similar community health efforts in the future.

Listening to youth: reflections on the effect of a youth development program.

To identify key elements that contribute to the effectiveness of a youth development program, interviews were conducted with 35 former Chicago Youth Programs (CYP) participants who remained in the program until age 18 years and went on to attend college, and 25 participants who left the program (and are currently older than age 18). Of the college participants who remained in CYP until age 18, 97% reported that the program had helped them by providing tutoring, mentoring, and financial support. In comparison, only 56% of the CYP dropouts had completed some college, and nearly 50% reported being involved in illegal activities. Many of the CYP dropouts were drawn to illegal activities for financial reasons or because they felt there was inadequate adolescent programming. All reported benefiting from their CYP participation. Incorporating financial incentives or specific adolescent programming may lead to longer youth program participation and, perhaps, more positive outcomes.