Community-based efforts to change the environment are proving to be an effective way of encouraging more physical activity and nutrition among school-age children, according to findings announced from Kaiser Permanente. Researchers examined a series of Kaiser Permanente community-based obesity prevention interventions in adults and children and found that the more effective obesity prevention interventions were those that were “high dose” – reaching large populations with greater strength – and those that focused specifically on changing child behaviors within the school environment.
Kaiser Permanente has been tracking the success of obesity prevention efforts as part of its Community Health Initiatives to improve population health. The recent findings confirm that the high-dose interventions in and around school settings can make positive, measurable impacts on health behaviors.
“Kaiser Permanente and our partners have been at this work for a long time and it is exciting to see that we are having an impact,” said Pamela Schwartz, MPH, Community Benefit director of program evaluation at Kaiser Permanente. “The concept of dose, in particular, has really galvanized our organization and served to clarify what we must do to have even greater impacts moving forward.”
Behavior Changes for Healthy Eating and Active Living
Researchers from the Center for Community Health Evaluation in Seattle looked at the results from three comprehensive community-based collaboratives in Northern California and funded by five-year grants from Kaiser Permanente. The results, recently published in the American Journal of Health Promotion, showed children’s physical activity behaviors could be improved as a result of such health interventions as increasing active minutes during school physical education classes, increasing minutes of activity in after-school programs, and increasing walking and biking to school. Physical activity in children is shown to improve bone health, heart health, mental health, and to support healthy weight.
Further findings from community initiatives in Colorado, not yet published, showed that changes made in the school cafeteria lunch menu to offer more fresh produce resulted in improvements in kids’ perception of healthy lunches and in kids eating more fruits and vegetables.
Researchers also tracked and evaluated the number of people reached by community interventions with the strength of those interventions. They found that the more people reached and the stronger the impact on each person reached, the more likely there was to be an observable difference in behavior at the population level.
Population dose provides a standard for comparing diverse community health projects and a way to measure interventions in aggregate. An article about the population dose findings was recently published in the American Journal of Evaluation.
“Community change is hard to do and even harder to measure,” explains Allen Cheadle, director of the Center for Community Health and Evaluation. “Our thinking around dose can enable public health leaders to better capture the impact that community health initiatives are having on community environments and individual behaviors.”
Kaiser Permanente’s Community Health Initiatives aim to increase healthy eating and active living in communities with Kaiser Permanente facilities. Active in over 40 communities, including 13 in California and 25 in Colorado, the program focuses on environmental and policy change, including work in neighborhoods, schools, workplaces, and the health sector.
With school-based health interventions showing promising results in improving community health, Kaiser Permanente is making plans to expand its school health efforts in the coming months.
Authors on the American Journal of Health Promotion paper on evaluation findings and lessons learned in Northern California communities include: Allen Cheadle, PhD, Group Health Research Institute; Suzanne Rauzon, MPH, RD and Rebecca Spring, MPH, University of California, Berkeley; Pamela M. Schwartz, MPH, Scott Gee, MD, Jodi Ravel, MPH, and Dana Williamson, MPH, Kaiser Permanente; Esmeralda Gonzalez, BS, Stanislaus County Health Services Agency; Coire Reilly, BA, West County HEAL; Anthony Taylor, BA, Department of Health Services, County of Sonoma.
Authors on the American Journal of Evaluation paper on the dose evaluation methods include: Allen Cheadle, PhD, Emily Bourcier, MPH, MHA, and Sandra Senter MN, MPH, Group Health Research Institute; Pamela M. Schwartz, MPH, Kaiser Permanente; Suzanne Rauzon, MPH, RD and Rebecca Spring, MPH, University of California, Berkeley.