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.

Increasing access to farmers markets for beneficiaries of nutrition assistance: evaluation of the farmers market access project.

INTRODUCTION: Increased acceptance of nutrition benefits at farmers markets could improve access to nutritious foods for low-income shoppers. The objective of this study was to evaluate a pilot project to increase participation by farmers markets and their vendors in the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: The intervention targeted 9 markets in lower-income regions of King County, Washington. Markets and vendors were offered subsidized electronic benefits transfer (EBT) terminals for processing SNAP, and vendors could apply to accept WIC cash value vouchers. WIC staff received information on using SNAP and vouchers at farmers markets. We used mixed methods post-implementation to measure participation, describe factors in acceptance of benefits, and assess information needs for WIC staff to conduct effective outreach. RESULTS: Of approximately 88 WIC-eligible vendors, 38 agreed to accept vouchers. Ten of 125 vendors installed an EBT terminal, and 6 markets installed a central market terminal. The number of market stalls accepting SNAP increased from 80 to 143, an increase of 79%. Participating vendors wanted to provide access to SNAP and WIC shoppers, although redemption rates were low. Some WIC staff members were unfamiliar with markets, which hindered outreach. CONCLUSION: Vendors and markets value low-income shoppers and, when offered support, will take on some inconvenience to serve them. To improve participation and sustainability, we recommend ongoing subsidies and streamlined procedures better suited to meet markets' capabilities. Low EBT redemption rates at farmers markets suggest a need for more outreach to low-income shoppers and relationship building with WIC staff.

Initiating policy, systems, and environmental changes for childhood obesity prevention by engaging six faith-based organizations.

Little is known about how to engage faith-organizations, especially churches, when using policy, systems, and environmental (PSE) change approaches for prevention. This article documents the PSE changes implemented by engaging 6 faith organizations, with an estimated reach of 3500 members, for 18 months. Timeline (n = 6), focus group (n = 6), report (n = 18), and observational meeting (n = 16) and event (n = 5) summaries were analyzed using content analysis. Early changes were usually environmental changes. Mid and later changes focused on policy and systems change. Churches structured for process and outcome accountability and person-centered accountability can accomplish PSE changes.

Effective community health assessments in King County, Washington.

BACKGROUND: Community health assessment (CHA) is widely practiced in public health, but its effectiveness has seldom been evaluated. METHOD: We present three examples of successful CHAs, carried out by Public Health-Seattle & King County, with diverse strategies: a quantitative assessment of asthma hospitalizations; Communities Count, a set of social and health indicators paired with qualitative data; and Growing Up Healthy, an assessment using qualitative methods to provide guidance for a statewide media campaign on youth sexual abstinence. FINDINGS: These assessments were successful in attracting new resources, forming and sustaining new partnerships, and/or providing guidance or resources for program and policy development. They also illustrate the difficulties of evaluating the effects of CHA in at least three ways: untangling its effects from other important community and political factors; documenting outcomes that are distant in time from and indirectly related to the assessment; and cultural or political restrictions on collecting sensitive evaluation data. We suggest common characteristics of an effective assessment, potential effectiveness indicators, and evaluation strategies. CONCLUSIONS: Despite barriers to documenting the relative contribution of a CHA, a set of rigorous evaluation methods needs to be developed and tested to document the benefits of a CHA in a competitive funding environment.