"Their help is not helping": Policing as a Tool of Structural Violence against Black Communities.

Objective: To illustrate Black youth's perceptions of police violence in West Louisville, Kentucky, how they make sense of it, and their responses to it. Method: The study used qualitative interviews with youth ages 10 to 24 residing in West Louisville. The interviews did not specifically inquire about experiences with police, but the theme emerged so strongly from the overall analysis that the current study was warranted. The research team employed a constructivist analytic approach. Results: The analysis yielded two overarching themes, each with several subthemes. The first theme was Black youth experience profiling and harassment by police, with subthemes focused on youth feeling targeted, youth recognizing policing as a tactic to remove them from their community, and youth being acutely aware of police-involved violence. The second theme was Black youth's experiences with the police cultivates mistrust and unsafety, with subthemes including police seen as more likely to harm than help, police not resolving injustices against Black people, and police presence escalating conflict in Black communities. Conclusions: Youth's narratives regarding their experiences with police highlight the physical and psychological violence enacted by police who come into their community, supported by the law enforcement and criminal justice systems. Youth recognize systemic racism in these systems and how it affects officers' perceptions of them. The long-term implications of persistent structural violence these youth endure has implications on their physical and mental health and wellbeing. Solutions must focus on transforming structures and systems.

Public Health's Next Step in Advancing Equity: Re-evaluating Epistemological Assumptions to Move Social Determinants From Theory to Practice.

The field of public health has increasingly promoted a social ecological approach to health, shifting from an individual, biomedical paradigm to a recognition of social and structural determinants of health and health equity. Yet despite this shift, public health research and practice continue to privilege individual- and interpersonal-level measurements and interventions. Rather than adapting public health practice to social ecological theory, the field has layered new concepts ("root causes," "social determinants") onto a biomedical paradigm-attempting to answer questions presented by the social ecological schema with practices developed in response to biomedicine. This stymies health equity work before it begins-limiting the field's ability to broaden conceptions of well-being, redress histories of inequitable knowledge valuation, and advance systems-level change. To respond effectively to our knowledge of social determinants, public health must resolve the ongoing disconnect between social ecological theory and biomedically-driven practice. To that end, this article issues a clarion call to complete the shift from a biomedical to a social ecological paradigm, and provides a basis for moving theory into practice. It examines biomedicine's foundations and limitations, glosses existing critiques of the paradigm, and describes health equity challenges presented by over-reliance on conventional practices. It then offers theoretical and epistemological direction for developing innovative social ecological strategies that advance health equity.

Critical Reflexivity of Communities on Their Experience to Improve Population Health.

Although community capacity has been prominent in the public health literature for nearly 20 years, the field has only operationalized a few dimensions. An intriguing dimension of capacity is a community's ability to critically reflect. On the basis of previous research as well as theoretical and practical insights from management and organizational learning literature, we offer a process framework for critical reflexivity practice in community. The framework draws on ideas regarding cognition and agency, praxis, as well as the transformative learning model to conceptualize how reflexivity happens as an emergent community process. The implication is that reflexivity is a community-level process of making meaning of experiences that drive a common narrative. Inclusivity and establishing consensus are paramount, and can be difficult in light of power dynamics and consideration of dissenting voices and different experiences; enlightened self-interest and creating conducive spaces for dialogue are key in this process. Strengthening communities' ability to gain and employ collective wisdom from their experience will also build their overall capacity for population health improvement.

Stand-Biased Versus Seated Classrooms and Childhood Obesity: A Randomized Experiment in Texas.

OBJECTIVES: To measure changes in body mass index (BMI) percentiles among third- and fourth-grade students in stand-biased classrooms and traditional seated classrooms in 3 Texas elementary schools. METHODS: Research staff recorded the height and weight of 380 students in 24 classrooms across the 3 schools at the beginning (2011-2012) and end (2012-2013) of the 2-year study. RESULTS: After adjustment for grade, race/ethnicity, and gender, there was a statistically significant decrease in BMI percentile in the group that used stand-biased desks for 2 consecutive years relative to the group that used standard desks during both years. Mean BMI increased by 0.1 and 0.4 kilograms per meter squared in the treatment and control groups, respectively. The between-group difference in BMI percentile change was 5.24 (SE = 2.50; P = .037). No other covariates had a statistically significant impact on BMI percentile changes. CONCLUSIONS: Changing a classroom to a stand-biased environment had a significant effect on students' BMI percentile, indicating the need to redesign traditional classroom environments.

Predicting violent behavior in clinical settings: a case-control study of a mental health inpatient unit.

In order to assist staff in recognizing patients prone to violence and guide their clinical decision-making, this study summarizes mental health inpatient unit incidents over a one-year period. Results describe demographic and clinical information for patients, and evaluate risk assessment tools currently used to predict risk. A retrospective analysis included data on patients involved in incidents and frequency matched controls. There were a total of 44 incidents, caused by 38 unique patients. A constructed model to estimate patient characteristics and risk of violent incidents included involuntary admittance (OR 2.07, 95% CI 1.05-6.11, p = 0.039), more than one admission at the facility (OR 4.18, 95% CI 1.71-10.22, p = 0.002) and Global Subjective Irritability on day one (OR 4.24, 95% CI 1.77-10.16, p = 0.001). Violent incidents on the mental inpatient unit threaten safety and disrupt the therapeutic environment. The findings may be useful in aiding clinicians to quickly recognize patients that are prone to violence.

A Qualitative Examination of Exergame Motivations in Geocaching.

INTRODUCTION: Exergames are an innovative type of physical activity that engages participants through interactive gameplay. One exergame growing in popularity is geocaching. Geocaching is a high-tech treasure hunt that uses GPS-enabled technology to locate hidden caches. Caches are hidden all over the world, and their coordinates are listed in an online forum ( Geocaching.com ). Exergames like geocaching are widely endorsed; however, there is a lot of information that still needs to be learned about why people participate in these activities. MATERIALS AND METHODS: Thirty-four current geocachers were recruited from a larger geocaching study to learn about their motivations for engaging in the game. Individuals were asked to respond to a 30-minute phone interview, and 12 both consented and participated the interviews. Interviews assessed how individuals became involved in geocaching, how frequently they participated, who they went geocaching with, and their motivations behind geocaching. Interviews were recorded and then thematically coded. RESULTS: The majority of participants had geocached for more than 5 years and had learned about the activity through media. All 12 participants geocached at least once a week. The primary motivations behind geocaching were being outdoors, social interaction, physical activity, and relaxation. Individuals described geocaching as being part of a community. They typically made friends while geocaching or when they were on Geocaching.com and felt connected to other geocachers through their mutual interest. CONCLUSIONS: Geocaching and other exergames that use game-like properties to engage users, specifically though technology, have the potential to impact individual health through nontraditional methods of activity and socialization.

Using Community-Based Participatory Research to Disseminate a Mass Media Campaign Into Rural Communities.

The authors present the results of a media documentary, Weight of the Nation, disseminated in rural communities in the Brazos Valley region of east central Texas. Researchers relied on a community-based participatory research strategy to assure community participation in the implementation and evaluation of the media documentary in rural communities. To measure the short-term effects of the documentary, the research team used a mixed-methods approach of quantitative panel data from a pre/post survey, qualitative meeting notes, and observations from facilitated discussion groups. Results showed short-term increases in behavioral intention, as well as an increase in self and collective efficacy of participants to make healthy changes at individual and community levels to reduce obesity. The findings suggest that Weight of the Nation is a catalyst for increasing awareness about obesity and initiating changes in intention and efficacy perceptions.

The evaluation of the impact of a stand-biased desk on energy expenditure and physical activity for elementary school students.

Due to the increasing prevalence of childhood obesity, the association between classroom furniture and energy expenditure as well as physical activity was examined using a standing-desk intervention in three central-Texas elementary schools. Of the 480 students in the 24 classrooms randomly assigned to either a seated or stand-biased desk equipped classroom, 374 agreed to participate in a week-long data collection during the fall and spring semesters. Each participant's data was collected using Sensewear® armbands and was comprised of measures of energy expenditure (EE) and step count. A hierarchical linear mixed effects model showed that children in seated desk classrooms had significantly lower (EE) and fewer steps during the standardized lecture time than children in stand-biased classrooms after adjusting for grade, race, and gender. The use of a standing desk showed a significant higher mean energy expenditure by 0.16 kcal/min (p < 0.0001) in the fall semester, and a higher EE by 0.08 kcal/min (p = 0.0092) in the spring semester.

Utilization of an interorganizational network analysis to evaluate the development of community capacity among a community-academic partnership.

BACKGROUND: Following a community health assessment the Brazos Valley Health Partnership (BVHP) organized to address fragmentation of services and local health needs. This regional partnership employs the fundamental principles of community-based participatory research, fostering an equitable partnership with the aim of building community capacity to address local health issues. OBJECTIVES: This article describes changes in relationships as a result of capacity building efforts in a community-academic partnership. Growth in network structure among organizations is hypothesized to be indicative of less fragmentation of services for residents and increased capacity of the BVHP to collectively address local health issues. METHODS: Each of the participant organizations responded to a series of questions regarding its relationships with other organizations. Each organization was asked about information sharing, joint planning, resource sharing, and formal agreements with other organizations. The network survey has been administered 3 times between 2004 and 2009. RESULTS: Network density increased for sharing information and jointly planning events. Growth in the complexity of relationships was reported for sharing tangible resources and formal agreements. The average number of ties between organizations as well as the strength of relationships increased. CONCLUSION: This study provides evidence that the community capacity building efforts within these communities have contributed to beneficial changes in interorganizational relationships. Results from this analysis are useful for understanding how a community partnership's efforts to address access to care can strengthen a community's capacity for future action. Increased collaboration also leads to new assets, resources, and the transfer of knowledge and skills.