Development of measures to evaluate youth advocacy for obesity prevention.

BACKGROUND: Youth advocacy has been successfully used in substance use prevention but is a novel strategy in obesity prevention. As a precondition for building an evidence base for youth advocacy for obesity prevention, the present study aimed to develop and evaluate measures of youth advocacy mediator, process, and outcome variables. METHODS: The Youth Engagement and Action for Health (YEAH!) program (San Diego County, CA) engaged youth and adult group leaders in advocacy for school and neighborhood improvements to nutrition and physical activity environments. Based on a model of youth advocacy, scales were developed to assess mediators, intervention processes, and proximal outcomes of youth advocacy for obesity prevention. Youth (baseline n = 136) and adult group leaders (baseline n = 47) completed surveys before and after advocacy projects. With baseline data, we created youth advocacy and adult leadership subscales using confirmatory factor analysis (CFA) and described their psychometric properties. RESULTS: Youth came from 21 groups, were ages 9-22, and most were female. Most youth were non-White, and the largest ethnic group was Hispanic/Latino (35.6%). The proposed factor structure held for most (14/20 youth and 1/2 adult) subscales. Modifications were necessary for 6 of the originally proposed 20 youth and 1 of the 2 adult multi-item subscales, which involved splitting larger subscales into two components and dropping low-performing items. CONCLUSIONS: Internally consistent scales to assess mediators, intervention processes, and proximal outcomes of youth advocacy for obesity prevention were developed. The resulting scales can be used in future studies to evaluate youth advocacy programs.

A pilot study evaluating the effects of a youth advocacy program on youth readiness to advocate for environment and policy changes for obesity prevention.

Youth advocacy for obesity prevention is a promising but under-evaluated intervention. The aims of this study are to evaluate a youth advocacy program's outcomes related to youth perceptions and behaviors, develop an index of youth advocacy readiness, and assess potential predictors of advocacy readiness. Youth ages 9-22 in an advocacy training program (n = 92 matched pairs) completed surveys before and after training. Youth outcomes and potential predictors of advocacy readiness were assessed with evaluated scales. All 20 groups who completed the evaluation study presented their advocacy projects to a decision maker. Two of six perception subscales increased following participation in the advocacy program: self-efficacy for advocacy behaviors (p < .001) and participation in advocacy (p < .01). Four of five knowledge and skills subscales increased: assertiveness (p < .01), health advocacy history (p < .001), knowledge of resources (p < .01), and social support for health behaviors (p < .001). Youth increased days of meeting physical activity recommendations (p < .05). In a mixed regression model, four subscales were associated with the advocacy readiness index: optimism for change (B = 1.46, 95 % CI = .49-2.44), sports and physical activity enjoyment (B = .55, 95 % CI = .05-1.05), roles and participation (B = 1.81, 95 % CI = .60-3.02), and advocacy activities (B = 1.49, 95 % CI = .64-2.32). The youth advocacy readiness index is a novel way to determine the effects of multiple correlates of advocacy readiness. Childhood obesity-related advocacy training appeared to improve youths' readiness for advocacy and physical activity.

Youth advocacy as a tool for environmental and policy changes that support physical activity and nutrition: an evaluation study in San Diego County.

BACKGROUND: As evidence grows about the benefits of policy and environmental changes to support active living and healthy eating, effective tools for implementing change must be developed. Youth advocacy, a successful strategy in the field of tobacco control, should be evaluated for its potential in the field of obesity prevention. COMMUNITY CONTEXT: San Diego State University collaborated with the San Diego County Childhood Obesity Initiative to evaluate Youth Engagement and Action for Health! (YEAH!), a youth advocacy project to engage youth and adult mentors in advocating for neighborhood improvements in physical activity and healthy eating opportunities. Study objectives included documenting group process and success of groups in engaging in community advocacy with decision makers. METHODS: In 2011 and 2012, YEAH! group leaders were recruited from the San Diego County Childhood Obesity Initiative's half-day train-the-trainer seminars for adult leaders. Evaluators collected baseline and postproject survey data from youth participants and adult group leaders and interviewed decision makers. OUTCOMES: Of the 21 groups formed, 20 completed the evaluation, conducted community assessments, and advocated with decision makers. Various types of decision makers were engaged, including school principals, food service personnel, city council members, and parks and recreation officials. Eleven groups reported change(s) implemented as a result of their advocacy, 4 groups reported changes pending, and 5 groups reported no change as a result of their efforts. INTERPRETATION: Even a brief training session, paired with a practical manual, technical assistance, and commitment of adult leaders and youth may successfully engage decision makers and, ultimately, bring about change.

The Active Living Research program: six years of grantmaking.

Changes in policies and built environments are advocated as part of efforts to increase physical activity, but in 2001 the knowledge base to inform these changes was limited. The Robert Wood Johnson Foundation addressed this deficit by initiating Active Living Research (ALR). The mission of ALR was to stimulate and support research that could guide the improvement of environments, policies, and practices to promote active living. The program's goals were to (1) build the evidence base about environmental and policy factors related to physical activity, (2) build the capacity of researchers in multiple fields to collaborate, and (3) inform and facilitate policy change. To build the evidence base, 121 grants were supported with $12.5 million. Efforts were made to support new investigators, fund investigators from numerous disciplines, and increase the demographic diversity of researchers. Activities to build capacity to conduct collaborative research included annual conferences, journal supplements, seminars for multiple disciplines, and the posting of environmental measures. Coordination with Active Living Leadership was a primary means of communicating research to policymakers. Other activities to facilitate the application of research included research summaries written for nonresearchers, collaborations with Active Living by Design, several components of the website (www.activelivingresearch.org), and using policy relevance as a funding criterion. Two independent evaluations were accomplished, and they concluded that ALR made progress on all three goals. ALR has been renewed through 2012. The new mission is to use a $15.4 million research budget to contribute to reversing the childhood obesity epidemic, especially among youth in the highest-risk groups.

Schools as a community resource for physical activity: legal considerations for decision makers.

Public schools may offer community residents access to gymnasiums, playfields, etc. When school facilities are available and/or opened up for public use in this manner, what are the legal obligations and liability concerns that arise for the schools and the users? Joint- and shared-use facilities and lands have some legal protections, which this paper introduces and reviews. Legal cases (and precedent) are shared with readers. Within this context, a model depicting factors influencing decisions to allow public use of school facilities for recreation and physical activity is introduced.

The public health roots of zoning: in search of active living's legal genealogy.

BACKGROUND: Improvements in the built environment and changes in land-use policy are promising approaches to increasing physical activity among a largely sedentary population. Opportunities for walking and cycling as part of daily life are important to increasing physical activity and improving health. Yet, local zoning codes and related land-use regulations have made it difficult to create vibrant, mixed-use neighborhoods with well-connected streets and more compact development-the infrastructure necessary to support healthier rates of walking and cycling for transportation. METHODS: To better understand the dynamic nature of land-use law and policy, and how policymakers might accomplish zoning reform to encourage more physically active environments, this paper traces the public health roots of zoning through a family tree of land-use legal doctrines. RESULTS: Zoning and public health laws evolved from the same legal ancestors-the common law of public nuisance and the expansion of state police powers, both premised on protection of the public's health. When the U.S. Supreme Court approved zoning in the 1926 case of Ambler Realty v. Village of Euclid, it nominally recognized the health basis of zoning. But it went on to craft a new legal rationale focused more on protection of property rights and residential neighborhoods. Since Euclid, court decisions have given little consideration to the public health roots of zoning. Given an emerging body of research demonstrating the importance of walking-friendly environments and the deference shown by the courts to the passage of zoning laws, the courts are likely to support policymakers as they move to change zoning systems conceived long ago. CONCLUSIONS: Legal, historical, and policy rationales support the modernization of zoning and land use policies that allow sensible mixes of land uses. Mixed land uses make walking an attractive alternative to driving and support a more physically active and healthy citizenry.

Comparing telephone and written surveys to assess local adolescent immunization coverage rates.

To identify adolescent hepatitis B coverage levels, a survey was conducted of seventh grade parents in San Diego County, California, using a random digit-dial telephone survey. A written survey was fielded also that was distributed at selected schools. Results were validated using data from a mandated report from all schools. Both survey methods overestimated the proportion completing the hepatitis B series by about 10%. Parents accurately reported immunization shot dates from the child's parent-held immunization shot record on the telephone and written surveys. The written survey, in addition to having a somewhat lower cost, may be useful when focusing on a localized area, whereas the telephone survey permits a more representative sample of a larger county-wide population.

Implementing a seventh grade vaccination law: school factors associated with completion of required immunizations.

OBJECTIVES: We investigated school factors associated with successful implementation of a seventh grade vaccination requirement. METHODS: The proportion of students vaccinated with hepatitis B vaccine and measles containing vaccine was determined from records of schools in San Diego County, California. A school survey identified compliance strategies. Analysis identified factors associated with coverage. RESULTS: In October 1999, 67.2% of 38,875 students had received the required vaccine doses. Of 315 schools, coverage was less than 40% in 60 schools and exceeded 80% in 111 schools. Factors associated with high coverage included private schools, early and frequent notice to parents, and, for public schools, higher overall socioeconomic status of students. CONCLUSIONS: In preparation for a middle school vaccination requirement, early and frequent notification of parents improves coverage. Schools with a high percentage of low socioeconomic status students may require extra resources to support implementation.