Using frameworks to diagram value in complex policy and environmental interventions to prevent childhood obesity.

BACKGROUND: To date, few tools assist policy makers and practitioners in understanding and conveying the implementation costs, potential impacts, and value of policy and environmental changes to address healthy eating, active living, and childhood obesity. For the Evaluation of Healthy Kids, Healthy Communities (HKHC), evaluators considered inputs (resources and investments) that generate costs and savings as well as benefits and harms related to social, economic, environmental, and health-related outcomes in their assessment of 49 HKHC community partnerships funded from 2009 to 2014. METHODS: Using data collected through individual and group interviews and an online performance monitoring system, evaluators created a socioecological framework to assess investments, resources, costs, savings, benefits, and harms at the individual, organizational, community, and societal levels. Evaluators customized frameworks for 6 focal strategies: active transportation, parks and play spaces, child care physical activity standards, corner stores, farmers' markets, and child care nutrition standards. RESULTS: To illustrate the Value Frameworks, this brief highlights the 38 HKHC communities implementing at least 1 active transportation strategy. Evaluators populated this conceptual Value Framework with themes from the strategy-specific inputs and outputs. The range of factors corresponding to the implementation and impact of the HKHC community partnerships are highlighted along with the inputs and outputs. CONCLUSIONS: The Value Frameworks helped evaluators identify gaps in current analysis models (ie, benefit-cost analysis, cost-effectiveness analysis) as well as paint a more complete picture of value for potential obesity prevention strategies. These frameworks provide a comprehensive understanding of investments needed, proposed costs and savings, and potential benefits and harms associated with economic, social, environmental, and health outcomes. This framing also allowed evaluators to demonstrate the interdependence of each socioecological level on the others in these multicomponent interventions. This model can be used by practitioners and community leaders to assess realistic and sustainable strategies to combat childhood obesity.

Evaluating the implementation and impact of policy, practice, and environmental changes to prevent childhood obesity in 49 diverse communities.

BACKGROUND: The purpose of this article is to assess and understand the intervention reach, dose, and impact of policy, practice, and environmental changes implemented by the 49 Healthy Kids, Healthy Communities (HKHC) community partnerships across the United States and in Puerto Rico. These partnerships planned and implemented healthy eating and active living policy, system, and environmental interventions to support healthier communities for children and families, with special emphasis on reaching children at highest risk for obesity. METHODS: Using a mixed-methods, participatory evaluation design, investigators analyzed multiple qualitative and quantitative data sources collected during the HKHC initiative from 2009 to 2014. Evaluators used an inductive approach to develop indicators to assess intervention reach, dose, and impact for 6 cross-site strategies, including corner stores, farmers' markets, child care nutrition standards, child care physical activity standards, active transportation, and parks and play spaces. RESULTS: Across HKHC community partnerships, 4261 policy, practice, or environmental changes occurred in 1536 intervention settings. Several trends emerged from the data related to how different levels of intervention (ie, community-level, setting-level, and within-setting), the size and access to intervention settings, the stage of implementation, and the sociodemographic composition of the intervention settings play important roles in the way policy, practice, and environmental changes "count" toward intervention reach, dose, and impact. CONCLUSIONS: This exploratory analysis provided a method and typology for increasing understanding in the field related to the reach, dose, and impact of policy, practice, and environmental changes promoting healthy eating and active living in order to reduce childhood overweight and obesity.

Applying a mixed-methods evaluation to Healthy Kids, Healthy Communities.

From 2008 to 2014, the Healthy Kids, Healthy Communities (HKHC) national program funded 49 communities across the United States and Puerto Rico to implement healthy eating and active living policy, system, and environmental changes to support healthier communities for children and families, with special emphasis on reaching children at highest risk for obesity on the basis of race, ethnicity, income, or geographic location. Evaluators designed a mixed-methods evaluation to capture the complexity of the HKHC projects, understand implementation, and document perceived and actual impacts of these efforts. Eight complementary evaluation methods addressed 4 primary aims seeking to (1) coordinate data collection for the evaluation through the web-based project management system (HKHC Community Dashboard) and provide training and technical assistance for use of this system; (2) guide data collection and analysis through use of the Assessment and Evaluation Toolkit; (3) conduct a quantitative cross-site impact evaluation among a subset of community partnership sites; and (4) conduct a qualitative cross-site process and impact evaluation among all 49 community partnership sites. Evaluators identified successes and challenges in relation to the following methods: an online performance-monitoring HKHC Community Dashboard system, environmental audits, direct observations, individual and group interviews, partnership and community capacity surveys, group model building, photographs and videos, and secondary data sources (surveillance data and record review). Several themes emerged, including the value of systems approaches, the need for capacity building for evaluation, the value of focusing on upstream and downstream outcomes, and the importance of practical approaches for dissemination. The mixed-methods evaluation of HKHC advances evaluation science related to community-based efforts for addressing childhood obesity in complex community settings. The findings are likely to provide practice-relevant evidence for public health.

Partnership and community capacity characteristics in 49 sites implementing healthy eating and active living interventions.

BACKGROUND: One component of the Evaluation of Healthy Kids, Healthy Communities, funded by the Robert Wood Johnson Foundation, was to assess partnership and community capacity characteristics of 49 cross-sector, multidisciplinary community demonstration projects to increase healthy eating and active living as well as to prevent and reduce childhood obesity. METHODS: From December 2012 to December 2013, an 82-item partnership and community capacity survey instrument assessed perspectives of community partnership members and community representatives from 48 of the 49 communities on the structure and function of their partnerships and the capacity of the community to create change. Through factor analysis and descriptive statistics, the evaluators described common characteristics of the partnerships, their leadership, and their relationships to the broader communities. RESULTS: A total of 603 individuals responded from 48 of the 49 partnerships. Evaluators identified 15 components, or factors that were broken into a themes, including leadership, partnership structure, relationship with partners, partnership capacity, political influence of partnership, and perceptions of partnership's involvement with the community and community members. CONCLUSIONS: Survey respondents perceived the Healthy Kids, Healthy Communities partnerships to have the capacity to ensure the partnerships' effectiveness in forming and growing their structures and functions, collaborating to implement policy and environmental change, and planning for sustainability.

Systems thinking in 49 communities related to healthy eating, active living, and childhood obesity.

BACKGROUND: Community partnerships to promote healthy eating and active living in order to prevent childhood obesity face a number of challenges. Systems science tools combined with group model-building techniques offer promising methods that use transdisciplinary team-based approaches to improve understanding of the complexity of the obesity epidemic. This article presents evaluation methods and findings from 49 Healthy Kids, Healthy Communities sites funded to implement policy, system, and environmental changes from 2008 to 2014. METHODS: Through half-day group model-building sessions conducted as part of evaluation site visits to each community between 2010 and 2013, a total of 50 causal loop diagrams were produced for 49 communities (1 community had 2 causal loop diagrams representing different geographic regions). The analysis focused on the following evaluation questions: (1) What were the most prominent variables in the causal loop diagrams across communities? (2) What were the major feedback structures across communities? (3) What implications from the synthesized causal loop diagram can be translated to policy makers, practitioners, evaluators, funders, and other community representatives? RESULTS: A total of 590 individuals participated with an average of 12 participants per session. Participants' causal loop diagrams included a total of 227 unique variables in the following major subsystems: healthy eating policies and environments, active living policies and environments, health and health behaviors, partnership and community capacity, and social determinants. In a synthesized causal loop diagram representing variables identified by at least 20% of the communities, many feedback structures emerged and several themes are highlighted with respect to implications for policy and practice as well as assessment and evaluation. CONCLUSIONS: The application of systems thinking tools combined with group model-building techniques creates opportunities to define and characterize complex systems in a manner that draws on the authentic voice of residents and community partners.

HKHC Community Dashboard: design, development, and function of a Web-based performance monitoring system.

BACKGROUND: As part of Robert Wood Johnson Foundation's Healthy Kids, Healthy Communities (HKHC) national grant program, a technical assistance team designed the HKHC Community Dashboard, an online progress documentation and networking system. The Dashboard was central to HKHC's multimethod program evaluation and became a communication interface for grantees and technical assistance providers. METHODS: The Dashboard was designed through an iterative process of identifying needs and priorities; designing the user experience, technical development, and usability testing; and applying visual design. The system was created with an open-source content management system and support for building an online community of users. The site developer trained technical assistance providers at the national program office and evaluators, who subsequently trained all 49 grantees. Evaluators provided support for Dashboard users and populated the site with the bulk of its uploaded tools and resource documents. The system tracked progress through an interactive work plan template, regular documentation by local staff and partners, and data coding and analysis by the evaluation team. Other features included the ability to broadcast information to Dashboard users via e-mail, event calendars, discussion forums, private messaging, a resource clearinghouse, a technical assistance diary, and real-time progress reports. RESULTS: The average number of Dashboard posts was 694 per grantee during the grant period. Technical assistance providers and grantees uploaded a total of 1304 resource documents. The Dashboard functions with the highest grantee satisfaction were its interfaces for sharing and progress documentation. A majority of Dashboard users (69%) indicated a preference for continued access to the Dashboard's uploaded resource documents. CONCLUSIONS: The Dashboard was a useful and innovative tool for participatory evaluation of a large national grant program. While progress documentation added some burden to local project staff, the system proved to be a useful resource-sharing technology.

Behavior-over-time graphs: assessing perceived trends in healthy eating and active living environments and behaviors across 49 communities.

CONTEXT: In the evaluation of the Healthy Kids, Healthy Communities initiative, investigators implemented Group Model Building (GMB) to promote systems thinking at the community level. As part of the GMB sessions held in each community partnership, participants created behavior-over-time graphs (BOTGs) to characterize their perceptions of changes over time related to policies, environments, collaborations, and social determinants in their community related to healthy eating, active living, and childhood obesity. OBJECTIVE: To describe the process of coding BOTGs and their trends. DESIGN: Descriptive study of trends among BOTGs from 11 domains (eg, active living environments, social determinants of health, funding) and relevant categories and subcategories based on the graphed variables. In addition, BOTGs were distinguished by whether the variables were positively (eg, access to healthy foods) or negatively (eg, screen time) associated with health. SETTING: The GMB sessions were held in 49 community partnerships across the United States. PARTICIPANTS: Participants in the GMB sessions (n = 590; n = 5-21 per session) included key individuals engaged in or impacted by the policy, system, or environmental changes occurring in the community. MAIN OUTCOME MEASURES: Thirty codes were developed to describe the direction (increasing, decreasing, stable) and shape (linear, reinforcing, balancing, or oscillating) of trends from 1660 graphs. RESULTS: The patterns of trends varied by domain. For example, among variables positively associated with health, the prevalence of reinforcing increasing trends was highest for active living and healthy eating environments (37.4% and 29.3%, respectively), partnership and community capacity (38.8%), and policies (30.2%). Examination of trends of specific variables suggested both convergence (eg, for cost of healthy foods) and divergence (eg, for farmers' markets) of trends across partnerships. CONCLUSIONS: Behavior-over-time graphs provide a unique data source for understanding community-level trends and, when combined with causal maps and computer modeling, can yield insights about prevention strategies to address childhood obesity.

Collaborating to support Healthy Kids, Healthy Communities partnerships.

The Robert Wood Johnson Foundation (RWJF) (http://www.rwjf.org/en.html) launched Healthy Kids, Healthy Communities (HKHC) in 2008, with a $33.4 million commitment to help reverse the childhood obesity epidemic by 2015. With grant funding and technical assistance, HKHC supported 50 diverse community partnerships focusing on populations at greatest risk for obesity. Active Living By Design served as the national program office, and St. Louis-based Transtria conducted the evaluation. Collaboration fundamentally shaped HKHC's national program design and strategy, the grantee selection process, technical assistance, the HKHC learning network, and evaluation. This article describes the ways in which the concept of collaboration was defined and practiced among the Robert Wood Johnson Foundation, Active Living By Design, Transtria, and other national partners, and how it shaped the evolving vision for and expectations from HKHC grantees. Collaboration contributed to HKHC grantees' success, helped build the healthy communities movement, and influenced philanthropic practices.

Increasing community capacity for participatory evaluation of healthy eating and active living strategies through direct observations and environmental audits.

BACKGROUND: Local partnerships from the Healthy Kids, Healthy Communities initiative elected to participate in enhanced evaluation trainings to collect data through environmental audits and direct observations as well as to build their evaluation capacity. METHODS: Environmental audit and direct observation tools and protocols were adapted for the relevant healthy eating and active living policy and environmental change approaches being conducted by the Healthy Kids, Healthy Communities partnerships. Customized trainings were conducted by the evaluation team to increase capacity and understanding for evaluation activities. RESULTS: A total of 87 trainings were conducted by the evaluation team in 31 Healthy Kids, Healthy Communities community partnerships. Data were collected for a total of 41 environmental audits and 17 direct observations. Community case examples illustrate how these trainings developed evaluation capacity. For instance, youth from one community presented environmental audit findings to local elected officials. CONCLUSIONS: The 31 partnerships participating in the community-based evaluation efforts resulted in 164 individuals trained in collecting context-specific data to assess the impact of healthy eating and active living policy and environmental strategies designed to create community change.

Childhood obesity policy research and practice: evidence for policy and environmental strategies.

Investigators developed a review system to evaluate the growing literature on policy and environmental strategies to prevent childhood obesity. More than 2000 documents published between January 2000 and May 2009 in the scientific and grey literature were identified (2008-2009) and systematically analyzed (2009-2012). These focused on policy or environmental strategies to reduce obesity/overweight, increase physical activity, and/or improve nutrition/diet among youth (aged 3-18 years). Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, investigators abstracted studies of 24 intervention strategies and assessed evidence for their effectiveness (i.e., study design, intervention duration, and outcomes) and population impact (i.e., effectiveness and reach--participation or exposure, and representativeness) in 142 evaluation study groupings and 254 associational study groupings (n=396 groupings of 600 peer-reviewed studies). The 24 strategies yielded 25 classifications (school wellness policies yielded nutrition and physical activity classifications): 1st-tier effective (n=5); 2nd-tier effective (n=6); "promising" (n=5); or "emerging" (n=9). Evidence for intervention effectiveness was reported in 56% of the evaluation, and 77% of the associational, study groupings. Among the evaluation study groupings, only 49% reported sufficient data for population impact ratings, and only 22% qualified for a rating of high population impact. Effectiveness and impact ratings were summarized in graphic evidence maps, displaying effects/associations with behavioral and obesity/overweight outcomes. This paper describes the results and products of the review, with recommendations for policy research and practice.

Lessons from a mixed-methods approach to evaluating Active Living by Design.

BACKGROUND: Beginning in 2003, Active Living by Design (ALbD) established innovative approaches across 25 communities to increase physical activity through community design, public policies, programming, and communication strategies. PURPOSE: The complexity of the ALbD projects called for a mixed-methods evaluation to understand implementation as well as perceived and actual impacts of these efforts. METHODS: Six primary evaluation methods addressed three primary aims: (1) to assess impacts of physical projects and policy changes on community environments; (2) to document intervention strategies implemented, as well as intended and unintended consequences; and (3) to identify strengths and challenges in planning, developing, and implementing interventions. The ALbD evaluation included cross-site comparisons and more in-depth case studies. This article describes the methods used to address the three aims. RESULTS: Analysis of the strengths and challenges associated with the different methods, including partnership capacity surveys, Concept Mapping, an online progress reporting system, key informant interviews, focus groups, and photos and videos. Additional methods, including environmental audits and direct observation, were explored to specifically assess environmental changes. Several important challenges included the lack of baseline data, difficulty in evaluating natural experiments, the need for ongoing policy surveillance, and the need to capture longer-term endpoints. CONCLUSIONS: The mixed-methods evaluation of ALbD advances implementation and evaluation science related to community-based efforts for promoting active living through identification of methods and measures to capture multicomponent and complex interventions as well as translation of a range of approaches to create community change across a variety of populations and settings.

Identifying the role of community partnerships in creating change to support active living.

BACKGROUND: Active Living by Design (ALbD) partnerships were established to change environments and policies as well as support complementary programs and promotions to increase physical activity in 25 communities across the U.S. PURPOSE: This paper summarizes the structural and functional aspects of partnerships identified as having a substantial influence on these initiatives. METHODS: A mixed-methods evaluation included qualitative (e.g., key informant interviews, focus groups) and quantitative (e.g., survey, web-based tracking) methods. Data were collected from 2003 to 2008, systematically analyzed to identify influential factors, and triangulated for model development. RESULTS: The partnerships identified a number of structural and functional factors that were important to their success, including multisectoral partners, flexible governance structures, leadership, group management, action planning, and assessment/evaluation. Three types of partnership models-utilitarian, lead agency, and collaboration-emerged across the community partnerships. Most partnerships reported challenges with engaging community members and ensuring equitable distribution of resources at the local level. CONCLUSIONS: The ALbD community partnerships utilized several structural and functional factors to enhance the success of their multisector collaborations. Yet, the varied types of lead agencies, partners, and partnership structures suggest that there is no one best way to bring partners together.

Assessment for active living: harnessing the power of data-driven planning and action.

BACKGROUND: Robert Wood Johnson Foundation's Active Living by Design (ALbD) grant program funded 25 communities across the U.S. The ALbD National Program Office (NPO) supported grantee community partnerships with technical assistance for assessment, planning, and implementation activities intended to increase population levels of physical activity. PURPOSE: This paper analyzes and summarizes the range of assessments conducted to identify local barriers and opportunities for active living as important elements of a thorough intervention planning process. METHODS: Evaluation of the partnerships focused on documenting community changes and strategies used to produce those changes. With support from NPO staff and external evaluators, partnerships tracked and summarized their community assessment approaches as well as strengths and challenges in conducting assessments. RESULTS: The partnerships documented a range of assessment strategies and methods. Partnerships used several qualitative methods, including focus groups, individual and group interviews, and public meetings. Quantitative methods included surveys, audits, observations, and analysis of existing data, among others. The environmental audit was the most common assessment method used by the partnerships. Assessment processes and findings were used for not only intervention planning but also community engagement and direct advocacy. Assessment data collectors varied from professional staff to community volunteers. CONCLUSIONS: Assessments were essential to the identification of local barriers and assets related to active living, which in turn helped ALbD partnerships prioritize and refine their action strategies. Assessment processes were also valuable in building relationships with new partners, community members, and local officials.

Evaluation of physical projects and policies from the Active Living by Design partnerships.

BACKGROUND: Between 2003 and 2008, a total of 25 partnerships funded through the Active Living by Design (ALbD) program worked to change built environments and policies in communities to help citizens be active in their daily routines. PURPOSE: This paper systematically summarized the scope of ALbD physical projects and policy changes, described resources generated by the partnerships, and highlighted supports and barriers to the process. METHODS: Using a mixed-methods approach, multiple data sources, including key informant interviews, focus groups, and a web-based tracking system, were used to collect data during project implementation. Qualitative results were analyzed using systematic coding procedures to identify themes, ideas, and concepts derived from the data. Data analysis occurred in 2008-2010. RESULTS: Most of the 25 partnerships documented physical projects and policy changes in each of the following sectors: urban planning (n=16); active transportation (n=23); trails/parks/recreation/open space (n=22); communities (n=22); and schools (n=18). ALbD community partnerships were successful at generating ≈ $256 million in resources beyond their initial grant, mostly through policy changes. Challenges included creating and sustaining political will and community support as well as securing technical expertise and resources. Planning and relationship building were critical to success in changing policy and implementing projects. CONCLUSIONS: Although there is more to understand about how these change processes affect physical activity and health across populations and settings, as well as how social, cultural, and psychosocial factors influence community responses to the policy changes and physical projects, findings from this initiative provide a foundation for subsequent research and practice.

Programs and promotions: approaches by 25 Active Living by Design partnerships.

BACKGROUND: From 2003 to 2008, a total of 25 community partnerships funded through Active Living by Design (ALbD) implemented physical activity programs and promotions as part of integrated approaches complementing policy and environment changes. PURPOSE: This paper reviews the partnerships' efforts with respect to promotions and programs, the breadth and depth of these types of approaches, challenges, successes, and lessons learned. METHODS: Through a mixed-methods approach, including interviews, focus groups, and web-based tracking, multiple sources of data were collected and analyzed from 2006 to 2010. Evaluators summarized quantitative data by counts or means and qualitative results using systematic coding procedures to identify themes, ideas, and concepts. RESULTS: All 25 community partnerships were engaged in programs and promotions of varying degrees throughout the initiative. Programs were categorized as community walking and biking programs, school programs, afterschool programs, and worksite programs, among others. Promotional strategies were categorized as social marketing campaigns, media, events, and communications. The most common programs included Safe Routes to School, walking clubs, and Bike/Walk to School Day. Media efforts were undertaken by all 25 partnerships, totaling 2659 TV, newspaper, and radio hits. CONCLUSIONS: Programs and promotions can be resource-intensive and have limited population impact when offered in isolation; however, these strategies help connect people to their environments (e.g., increase awareness of facilities, provide social support for use of facilities) in order to improve physical activity behaviors.

Active living by design sustainability strategies.

BACKGROUND: Despite substantial increases in improving the translation of health promotion research into practice, community initiatives still struggle with maintaining changes once grant funding has ended. Researchers, funders, and community practitioners are interested in practices that maintain and sustain their efforts. PURPOSE: This qualitative study conducted a content analysis of evaluation findings from Active Living by Design (ALbD) to identify activities that community coalitions implemented to maintain their initiative and secure ongoing influence in communities. METHODS: Investigators analyzed data from interviews, focus groups, and the Progress Reporting System to identify sustainability approaches clustering into five areas: partnership expansion, sustainable funding, permanent advisory committees, policy change, and institution/organization change. RESULTS: Partnership expansion occurred across sectors and disciplines and into broader geographic areas. Additional funding extended beyond grants to earned income streams and dedicated tax revenues. Permanent advisory committees were established to inform decision makers about a range of active living impacts. Policy changes in zoning and comprehensive plans ensured maintenance of health-promoting built environments. Sustainability through institution/organization changes led to allocation of dedicated staff and incorporation of active living values into agency missions. CONCLUSIONS: Active Living by Design partnerships defined and messaged their projects to align with policymakers' interests and broad partnership audiences. They found innovative supporters and adapted their original vision to include quality of life, nonmotorized transport, and other complementary efforts that expanded their reach and influence. These sustainability strategies altered awareness within communities, changed community decision-making processes, and created policy changes that have the potential to maintain environments that promote physical activity for years to come.

Evaluation of Active Living by Design: implementation patterns across communities.

BACKGROUND: Twenty-five cross-sector, multidisciplinary community partnerships received funding through the Active Living by Design (ALbD) national program to design, plan, and implement innovative initiatives to support active living. PURPOSE: This paper examines implementation patterns across ALbD community partnerships related to community characteristics; preparation efforts; and policy, environmental, programmatic, and promotional strategies. METHODS: Investigators used a mixed-methods, participatory evaluation design, triangulating multiple qualitative and quantitative data sources collected from 2007 to 2009. Configural frequency analysis facilitated detection of variables as well as configurations of variables occurring more (types) or less (anti-types) frequently than patterns expected by chance alone. RESULTS: Overall, community partnerships with more preparation activities (assessment, sustainability) implemented a larger number of active living promotions, programs, policy influences, and physical projects, cumulatively (type). Yet, community partnerships working in communities with >40% of the population from a non-Caucasian racial and ethnic background and >40% of the population in poverty implemented fewer active living promotions, programs, policy influences, and physical projects, cumulatively (type). CONCLUSIONS: The resulting types and anti-types provide insight into patterns across communities that may be ascribed to varying configurations of community contexts, resources, and strategies implemented. Rigorous, systematic examination of the underlying causal structures related to the configurations of community characteristics, preparation efforts, and implementation strategies is needed.

Concept mapping: priority community strategies to create changes to support active living.

BACKGROUND: From 2003 to 2008, a total of 25 cross-sector, multidisciplinary community partnerships funded through the Active Living by Design (ALbD) national program designed, planned, and implemented policy and environmental changes, with complementary programs and promotions. PURPOSE: This paper describes the use of concept mapping methods to gain insights into promising active living intervention strategies based on the collective experience of community representatives implementing ALbD initiatives. METHODS: Using Concept Systems software, community representatives (n=43) anonymously generated actions and changes in their communities to support active living (183 original statements, 79 condensed statements). Next, respondents (n=26, from 23 partnerships) sorted the 79 statements into self-created categories, or active living intervention approaches. Respondents then rated statements based on their perceptions of the most important strategies for creating community changes (n=25, from 22 partnerships) and increasing community rates of physical activity (n=23, from 20 partnerships). Cluster analysis and multidimensional scaling were used to describe data patterns. RESULTS: ALbD community partnerships identified three active living intervention approaches with the greatest perceived importance to create community change and increase population levels of physical activity: changes to the built and natural environment, partnership and collaboration efforts, and land-use and transportation policies. The relative importance of intervention approaches varied according to subgroups of partnerships working with different populations. CONCLUSIONS: Decision makers, practitioners, and community residents can incorporate what has been learned from the 25 community partnerships to prioritize active living policy, physical project, promotional, and programmatic strategies for work in different populations and settings.

Strategies proposed by Healthy Kids, Healthy Communities partnerships to prevent childhood obesity.

INTRODUCTION: Healthy Kids, Healthy Communities (HKHC) is an initiative of the Robert Wood Johnson Foundation to prevent obesity among high-risk children by changing local policies, systems, and environments. In 2009, 105 community partnerships applied for funding from HKHC. Later that year, the Centers for Disease Control and Prevention (CDC) released recommended community strategies to prevent obesity by changing environments and policies. The objective of this analysis was to describe the strategies proposed by the 41 HKHC partnerships that received funding and compare them to the CDC recommendations. METHODS: We analyzed the funded proposals to assess the types and prevalence of the strategies proposed and mapped them onto the CDC recommendations. RESULTS: The most prevalent strategies proposed by HKHC-funded partnerships were providing incentives to retailers to locate and serve healthier foods in underserved areas, improving mechanisms for purchasing food from farms, enhancing infrastructure that supports walking and cycling, and improving access to outdoor recreational facilities. CONCLUSION: The strategies proposed by HKHC partnerships were well aligned with the CDC recommendations. The popular strategies proposed by HKHC partnerships were those for which there were existing examples of successful implementation. Our analysis provides an example of how information from communities, obtained through grant-writing efforts, can be used to assess the status of the field, guide future research, and provide direction for future investments.