A Community-Level Initiative to Prevent Obesity: Results From Kaiser Permanente's Healthy Eating Active Living Zones Initiative in California.

INTRODUCTION: A growing number of health systems are leading health promotion efforts in their wider communities. What impact are these efforts having on health behaviors and ultimately health status? This paper presents evaluation results from the place-based Kaiser Permanente Healthy Eating Active Living Zones obesity prevention initiative, implemented in 2011-2015 in 12 low-income communities in Kaiser Permanente's Northern and Southern California Regions. METHODS: The Healthy Eating Active Living Zones design targeted places and people through policy, environmental, and programmatic strategies. Each Healthy Eating Active Living Zone is a small, low-income community of 10,000 to 20,000 residents with high obesity rates and other health disparities. Community coalitions planned and implemented strategies in each community. A population-dose approach and pre and post surveys were used to assess impact of policy, program, and environmental change strategies; the analysis was conducted in 2016. Population dose is the product of reach (number of people affected by a strategy divided by target population size) and strength (the effect size or relative change in behavior for each person exposed to the strategy). RESULTS: More than 230 community change strategies were implemented over 3 years, encompassing policy, environmental, and programmatic changes as well as efforts to build community capacity to sustain strategies and make changes in the future. Positive population-level results were seen for higher-dose strategies, particularly those targeting youth physical activity. Higher-dose strategies were more likely to be found in communities with the longest duration of investment. CONCLUSIONS: These results demonstrate that strong (high-dose), community-based obesity prevention strategies can lead to improved health behaviors, particularly among youth in school settings. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.

Food access, availability, and affordability in 3 Los Angeles communities, Project CAFE, 2004-2006.

INTRODUCTION: Racial/ethnic minority communities are at increasingly high risk for chronic diseases related to obesity. Access to stores that sell affordable, nutritious food is a prerequisite for adopting a healthful diet. The objective of this study was to evaluate food access, availability, and affordability in 3 nonoverlapping but similar low-income communities in urban Los Angeles, California. METHODS: Using a community-based participatory research approach, we trained community members to conduct a food assessment to 1) map the number and type of retail food outlets in a defined area and 2) survey a sample of stores to determine whether they sold selected healthful foods and how much those foods cost. We used descriptive statistics to summarize findings. RESULTS: Of the 1,273 food establishments mapped in the 3 neighborhoods, 1,023 met the criteria of "retail food outlet." The most common types of retail food outlets were fast-food restaurants (30%) and convenience/liquor/corner stores (22%). Supermarkets made up less than 2% of the total. Convenience/liquor/corner stores offered fewer than half of the selected healthful foods and sold healthful foods at higher prices than did supermarkets. CONCLUSION: Access to stores that sell affordable healthful food is a problem in urban Los Angeles communities. Healthful food strategies should focus on changing food environments to improve overall community health.