Building Support for Place-Based Solutions to Childhood Obesity: Findings From Missouri.

BACKGROUND: Place-based efforts offer promise in reducing childhood obesity. Yet, lack of public demand and support may hinder implementation. AIMS: This study aimed to assess whether the emphasis on place-based solutions, community-wide strategies, and multisector engagement in the Healthy Schools Healthy Communities (HSHC) initiative would shift public views on obesity including the need for greater public involvement and an increase in awareness and support for strategies. METHOD: As part of the evaluation, two surveys were conducted-in 2014 and 2016-to examine the relationship between HSHC strategies and changes in public perception, support, and awareness of obesity. Both surveys were cross-sectional and conducted with a randomized sample of households. RESULTS: Most respondents indicated that parents/family (84.3% in 2014; 87.8% in 2016) and children (70.9% in 2014; 74.8% in 2016) had a large/very large responsibility for addressing childhood obesity. A higher percentage of 2016 respondents indicated willingness to work with others to increase availability of healthy foods (71.3% vs. 64.2%, respectively; p = .0280) and increase the number of places to be physically active in their community (71.1% vs. 60.7%, respectively; p = .0015). DISCUSSION: Findings suggest awareness and support of place-based efforts and willingness to engage may help garner ongoing support. However, individuals and families are still perceived as primarily responsible for addressing childhood obesity. Countering this mindset remains an ongoing challenge. CONCLUSION: Streamlined messaging regarding the issue and associated solutions, enhanced skills and capacity to implement these efforts, and citizen engagement to garner support for place-based initiatives are important.

Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities initiative.

BACKGROUND: Although successful, assessment of multi-component initiatives (MCIs) prove to be very challenging. Further, rigorous evaluations may not be viable, especially when assessing the impact of MCIs on long-term population-level behavior change (e.g., physical activity (PA) and health outcomes (e.g., childhood obesity). The purpose of this study was to use intensity scoring, to assess whether higher intensity MCIs implemented as part of Healthy Schools Healthy Communities (HSHC) were associated with improved physical activity and reduced sedentary behaviors among youth (dependent variables). METHODS: PA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative; 2) duration; and 3) reach. A MCI intensity score of all strategies was calculated for each school district and its respective community. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and student enrollment size. RESULTS: Strategy intensity scores ranged from 0.3 to 3.0 with 20% considered "higher-scoring" (score > 2.1) and 47% considered "lower-scoring" (< 1.2). Average MCI intensity scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average MCI intensity score, the number of days per week that students reported PA for at least 60 min increased by 0.010 days (p < 0.01), and the number of hours per weekday that students reported engaging in screen time strategies decreased by 0.006 h (p < 0.05). An increase of 50 points in MCI intensity score was associated with an average 0.5 day increase in number of weekdays physically active and an increase of 55 points was associated with an average decrease of 20 min of sedentary time per weekday. CONCLUSIONS: We found a correlation between intensity and PA and sedentary time; increased PA and reduced sedentary time was found with higher-intensity MCIs. While additional research is warranted, practitioners implementing MCIs, especially with limited resources (and access to population-level behavior data), may consider intensity scoring as a realistic and cost effective way to assess their initiatives. At a minimum, the use of intensity scoring as an evaluation method can provide justification for, or against, the inclusion of an individual strategy into an MCI, as well as ways to increase the likelihood of the MCI impacting population-health outcomes.

Overcoming Challenges Resulting From COVID-19: New York State's Creating Healthy Schools and Communities Initiative.

"Upstream" interventions that increase access or reduce barriers to healthy foods and opportunities for physical activity - referred to as policy, systems, or environmental strategies - are central to encouraging and supporting healthy behaviors that prevent chronic disease at a population level. However, they are complex and challenging to execute, especially during coronavirus disease 2019 (COVID-19), and efforts to build practitioner capacity are warranted. In this commentary, we describe a user or human-centered design (HCD) capacity-building approach to support practitioners in accomplishing the goals of the New York State Creating Healthy Schools and Communities (CHSC) initiative. This approach has been especially helpful during COVID-19, as it enables support to be responsive to practitioners' constantly changing needs. Given that CHSC is a project specific to New York State and that the efforts of the Obesity Prevention Center for Excellence were tailored to obesity prevention, more research and evaluations should be conducted to better understand how the use of HCD could support practitioners addressing other complex public health issues in the United States.

Food Access and Its Relationship to Perceived Walkability, Safety, and Social Cohesion.

Understanding social inequalities in terms of neighborhood characteristics and the context to which individuals belong is important for reducing disparities. This article describes how perceptions of food access are related to three physical and social environmental factors: perceived neighborhood walkability, safety, and social cohesion. A cross-sectional survey was conducted with a random sample of 1,500 households in Springfield, Missouri. The main outcome measures were ease of purchase; availability of a large selection and quality; and affordability of fresh fruits and vegetables (FVs) and low-fat products (LFPs). Overall, 63% of respondents reported consuming <5 servings of FVs daily in the past month. Most agreed it was easy to purchase FVs (70%) and LFPs (76%) in their neighborhood and felt there was a large selection available (70% and 71%, respectively). High walkability (odds ratio [OR]: 1.8), low crime (OR: 1.6), and high social cohesion (OR: 1.7) were significantly associated with having greater selection of FVs. High walkability (OR: 1.6) and low crime (OR: 1.6) were associated with greater access to FVs. Given that healthy food access is an important component to improving health outcomes, understanding how to alter environmental features that influence behaviors like eating is important.