Ripple Effects of the Communities Preventing Childhood Obesity Project.

This research examines the practice of community coaching within coalitions in the Communities Preventing Childhood Obesity project. A quasi-experimental design was used in seven Midwestern states. Each state selected two rural, low-income communities with functioning health coalitions. Coalitions were randomly assigned to be intervention or comparison communities. After 4 years of the coaching intervention, ripple effect mapping served as one method for examining the coalitions' work that may affect children's weight status. A research team from each state conducted ripple effect mapping with their two coalitions, resulting in 14 ripple maps. Community capitals framework and the social-ecological model were used for coding the items identified within the ripple maps. A quantitative scoring analysis determined if differences existed between the intervention and comparison coalitions in terms of the activities, programs, funding, and partnerships for social-ecological model score (e.g., individual, community, policy levels), community capitals score, and ripples score (e.g., number of branches formed within the maps). All scores were higher in intervention communities; however, the differences were not statistically significant (p > .05). Assessing community assets, such as availability of a community coach, is necessary in order to decide whether to deploy certain resources when designing health promotion strategies.

Perfil clínico y Psicosocial de los Adolescentes de 15 a 18 años Intentadores de Suicidio Hospitalizados en la Clínica Psiquiátrica de la Universidad de Chile (CPU) 2009-2011 / Clinical and Psychosocial Profile of 15 to 18-year-old Adolescents with Suicide Attempts Hospitalized in the Universidad de Chile Psychiatric Clinic (CPU) 2009-2011

El fenómeno suicida ha aumentado en la población general y esto cobra especial relevancia en los adolescentes de nuestro país. Si bien se conocen factores de riesgo asociados, existen aún escasos estudios locales respecto a las características de los adolescentes intentadores de suicidio en población consultante. Métodos: Se consideró población estudio a los adolescentes entre 15 y 18 años hospitalizados en la CPU entre 2009 y 2011, se dividieron intentadores (IS) y no intentadores de suicidio (NIS), registrando características clínicas y sociodemográficas, analizadas luego con el software STATA. Resultados: En el grupo de intentadores de suicidio el 68,13% presentaban historia de intento suicida previo, siendo más frecuente en mujeres. Otra característica distintiva de este grupo es la asociación a conducta suicida de familiar de primer grado y el antecedente de abuso sexual infantil. Palabras Clave: comportamiento suicida, intento suicida, adolescentes, perfil psicosocial, abuso sexual.

The suicidal phenomenon has increased in the general population and this is especially relevant in our country's adolescents. Although there are known risk factors for suicide, there are still few local studies regarding the characteristics of adolescents attempting suicide in our consulting population. Methods: The study population was considered to be 15 to 18-year-old adolescents hospitalized in the CPU between 2009 and 2011, they were divided into suicide attempters (SA) and non suicide attempters (NSA); clinical and sociodemographic characteristics were recorded and later analyzed with the software STATA. Results: In the group of suicide attempters 68.13% presented a history of previous suicide attempts, more frequently in women. Another distinctive feature of this group is the association of suicide attempts to suicidal behavior of a first-degree relative and a history of child sexual abuse.Key words: suicidal behaviour, suicidal attempt, adolescent, psychosocial profile, sexual abuse.

Communities Partnering With Researchers: An Evaluation of Coalition Function in a Community-Engaged Research Approach.

BACKGROUND: Community coalitions are frequently used as partners for community-engaged research. However, limited research shows how these partnerships affect the coalitions. OBJECTIVE: To evaluate the effects of researcher-coalition collaboration on coalition function in the pilot year of a 4-year intervention program targeting childhood obesity in rural, low-income communities. METHODS: A quasi-experimental study using a quantitative survey (Coalition Self-Assessment Survey [CSAS]) evaluated factors related to coalition function and efficacy. Twelve community coalitions from seven states completed survey evaluations at baseline (n = 133), and at the 1-year follow-up (n = 113). Pearson's χ2 and Mann-Whitney U tests were computed; significance was set at p < .05. RESULTS: Survey results revealed significant changes for coalitions engaged in research partnership. Institutional engagement with community health coalitions in the first year of partnership was related to enhanced coalition function. CONCLUSIONS: Coalitions with a greater degree of researcher collaboration may be more successful in addressing community health problems.

A quasi-experimental study to mobilize rural low-income communities to assess and improve the ecological environment to prevent childhood obesity.

BACKGROUND: The Ecological Model of Childhood Overweight focuses on characteristics that could affect a child's weight status in relation to the multiple environments surrounding that child. A community coaching approach allows community groups to identify their own strengths, priorities and identity. Little to no research currently exists related to community-based efforts inclusive of community coaching in creating environmental change to prevent childhood obesity particularly in rural communities. METHODS: A quasi-experimental study will be conducted with low-income, rural communities (n = 14) in the North Central region of the United States to mobilize capacity in communities to create and sustain an environment of healthy eating and physical activity to prevent childhood obesity. Two rural communities within seven Midwestern states (IN, KS, MI, OH, ND, SD, WI) will be randomly assigned to serve as an intervention or comparison community. Coalitions will complete assessments of their communities, choose from evidence-based approaches, and implement nutrition and physical activity interventions each year to prevent childhood obesity with emphasis on policy, system or environmental changes over four years. Only intervention coalitions will receive community coaching from a trained coach. Outcomes will be assessed at baseline, annually and project end using previously validated instruments and include coalition self-assessments, parental perceptions regarding the built environment, community, neighborhood, and early childhood environments, self-reflections from coaches and project staff, ripple effect mapping with coalitions and, final interviews of key stakeholders and coaches. A mixed-methods analysis approach will be used to evaluate if Community Coaching enhances community capacity to create and sustain an environment to support healthy eating and physical activity for young children. ANOVA or corresponding non-parametric tests will be used to analyze quantitative data relating to environmental change with significance set at P < .05. Dominant emergent themes from the qualitative data will be weaved together with quantitative data to develop a theoretical model representing how communities were impacted by the project. DISCUSSION: This project will yield data and best practices that could become a model for community development based approaches to preventing childhood obesity in rural communities.

An Ecological Approach to Exploring Rural Food Access and Active Living for Families With Preschoolers.

OBJECTIVE: To identify factors using the Ecological Model of Childhood Overweight related to accessing nutritious foods and physical activity opportunities from the perspectives of rural parents of preschoolers. METHODS: A mixed-methods study using a quantitative survey (Active Where?) and qualitative interviews. Analyzed interview themes provided context to the survey results. The setting was Head Start centers, county human service offices, and Women, Infants, and Children Program sites in rural counties in the Midwest. Rural parents (n = 377) of preschoolers took part in the survey in 7 Midwestern states; 15 similar participants were interviewed from 1 of the states. Transcribed interviews were coded. Frequencies and chi-square tests were computed; significance was set at P < .05. RESULTS: The Active Where? survey and interviews revealed that close proximity to recreation spaces and traffic safety issues influenced physical activity. For food access, close proximity to full service grocery stores did not influence access to healthy foods because respondents traveled to urban communities to purchase healthy foods. CONCLUSIONS AND IMPLICATIONS: Public transportation solutions and enhanced neighborhood safety are potential community-wide obesity prevention strategies in rural communities. However, interventions should be tailored to the community's stage of readiness. Strong social networks should be considered an asset for community change in these regions.

Evaluation of Nutrition and Physical Activity Policies and Practices in Child Care Centers within Rural Communities.

BACKGROUND: Although some researchers have examined nutrition and physical activity policies within urban child care centers, little is known about the potentially unique needs of rural communities. METHODS: Child care centers serving preschool children located within low-income rural communities (n = 29) from seven states (Indiana, Kansas, Michigan, North Dakota, Ohio, South Dakota, and Wisconsin) were assessed to determine current nutrition and physical activity (PA) practices and policies. As part of a large-scale childhood obesity prevention project, the Community Healthy Living Index's previously validated Early Childhood Program Assessment Tool was used to collect data. Descriptive statistical analysis was conducted to identify high-priority areas. Healthy People 2020 and the Academy of Nutrition and Dietetics' recommendations for nutrition and PA policies in child care centers were used as benchmarks. RESULTS: Reports of not fully implementing (<80% of the time) recommended nutrition-related policies or practices within rural early child care centers were identified. Centers not consistently serving a variety of fruits (48%), vegetables (45%), whole grains (41%), limiting saturated fat intake (31%), implementing healthy celebration guidelines (41%), involving children in mealtime (62%), and referring families to nutrition assistance programs (24%) were identified. More than one third of centers also had limited structured PA opportunities. Although eligible, only 48% of the centers participated in the Child and Adult Care Food Program. CONCLUSIONS: Overall, centers lacked parental outreach, staff training, and funding/resources to support nutrition and PA. These results provide insight into where child care centers within low-income, rural communities may need assistance to help prevent childhood obesity.

Decisional balance for health and weight is associated with whole-fruit intake in low-income young adults.

Bone health, decreased risk of certain cancers, heart disease, and stroke has been associated with the consumption of fruits. These and other health benefits, such as feeling better and weight loss, have been identified as intrinsic motivators for consumers to increase their consumption of fruits. Thus, if individuals believe more could be gained than lost (decisional balance) by increasing their fruit intake, it is likely that they will consume more. However, despite fruits' positive effect on health, young adults and individuals with low incomes, limited education, or low self-efficacy consume insufficient amounts. To determine variables associated with increased fruit consumption, we hypothesized that decisional balance pros for health and weight would be associated with increased fruit consumption in young adults with low incomes. We surveyed 235 respondents between the ages of 18 and 24 years, with an annual income less than $25,000. Multiple regression analysis measured the impact of the independent variables' (i.e., age, weight satisfaction, income, education, self-efficacy, and pros and cons decisional balance) association with fruit consumption. The decisional balance pros was significantly (F = 2.189, P = .036) associated with overall fruit consumption. Respondents consumed 1.94 +/- 1.64 cups of fruit daily, with fruit juices consumed in greater amounts than any other form of fruit. Decisional balance questions relating to health (P < .05) and weight (P < .01) were significantly related to increased whole fruit intake. Results of this study suggest that decisional balance pros for health and weight can be used to predict whole-fruit consumption in low-income young adults.

The National Weight Control Registry: a critique.

This article is a critique of the claim that the National Weight Control Registry provides data showing that a significant number of adults in the United States have achieved permanent weight loss. We believe that promoting calorie-restricted dieting for the purpose of weight loss is misleading and futile. We advocate the adoption of a health-at-every-size (HAES) approach to weight management, focusing on the achievement and maintenance of lifestyle changes that improve metabolic indicators of health.