Implementing Policy, Systems, and Environmental Change Through Community Coalitions and Extension Partnerships to Address Obesity in Rural Louisiana

Holston, Denise; Stroope, Jessica; Cater, Melissa; Kendall, Michaela; Broyles, Stephanie T.

doi:10.5888/pcd17.190284

Cited by 26 publications

(28 citation statements)

References 10 publications

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“…Direct education and PSE change are more effective when implemented together ( 10 ). Enhanced approaches leveraging FCS direct education and public health strategies enable impacts at multiple social ecological model levels, including social networks, living and working conditions, and political factors determining individual health behaviors and community health outcomes ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Exploring Extension Agent Capacity and Readiness to Adopt Policy, Systems and Environmental Change Approaches

Washburn

Norman-Burgdolf

Jones

et al. 2022

Front. Public Health

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IntroductionEnhanced Extension outreach strategies combine traditional direct education programs with public health approaches like policy, systems, and environmental (PSE) change. However, the Cooperative Extension system and county-based Family and Consumer Sciences (FCS) Extension agents have historically prioritized direct education programming and diffusion of enhanced outreach strategies has varied. Extension personnel may lack capacity and readiness for successful PSE change implementation. This study explored perceived acceptability, capacity, and readiness for PSE change work among FCS Extension agents in two states.MethodA survey was developed framed by selected domains from the Consolidated Framework for Implementation Research: Intervention Characteristics, Inner Setting, Characteristics of Individuals, and Process. All questions utilized a 5-point Likert scale, except for an item examining respondents' stage of change regarding PSE change strategies. Descriptive statistics and response frequencies for all variables were calculated.ResultsSurvey responses (n = 116) indicated PSE change work was perceived as valuable. Potential barriers included perceived complexity, organizational readiness issues (e.g., reporting and evaluation structures; performance incentives), and worries about stakeholder responses in shifting away from direct education. Responses indicated self-efficacy for skills important in implementing PSE change. Most respondents (53%) indicated being at the pre-contemplation or contemplation stage of change in pursuing PSE change work.DiscussionCombining PSE change strategies and direct education programming allows Extension to do what it does best – provide effective programs to improve and sustain health and wellbeing of individuals and families. Findings are informative for others aiming to build capacity within community educators, Extension and public health professionals to implement PSE change.

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Section: Introductionmentioning

confidence: 99%

Exploring Extension Agent Capacity and Readiness to Adopt Policy, Systems and Environmental Change Approaches

Washburn

Norman-Burgdolf

Jones

et al. 2022

Front. Public Health

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“…, 4. , 5. We chose in-hospital mortality, a more robust critical illness marker than intensive care or IMV, to evaluate the impact of obesity on outcome during a hospitalization for COVID-19.…”

Section: Introductionmentioning

confidence: 99%

“…Obesity is highly prevalent in Louisiana, 5 and patients hospitalized for COVID-19 at University Medical Center (UMC) in New Orleans have a wide range of body mass index (BMI, kg/m 2 ) that enables evaluation of COVID-19 outcome in evenly distributed BMI strata. We aimed to study the impact of obesity (BMI >30 kg/m 2 ), severe obesity (BMI ≥35–<40 kg/m 2 ), morbid obesity (BMI >40 kg/m 2 ) and obesity related conditions on in-hospital mortality.…”

Section: Introductionmentioning

confidence: 99%

COVID 19 in-hospital mortality, body mass index and obesity related conditions

Sidhu

Samson

Nedunchezian

et al. 2021

Journal of Diabetes and its Complications

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Objective Obese patients with respiratory failure need more intensive care and invasive mechanical ventilation than their non-obese counterparts. We aimed to evaluate the impact of body mass index and obesity related conditions on fatal outcome during a hospitalization for COVID-19. Methods From March 1 to April 30, 2020, 425 consecutive patients with severe acute respiratory syndrome coronavirus 2 were hospitalized at University Medical Center, in New Orleans. Clinical variables, comorbidities, and hospital course were extracted from electronic medical records. Special attention was given to obesity related conditions like hypertension, type 2 diabetes, and dyslipidemia. Severe obesity was defined as a body mass index ≥35–<40 kg/m 2 and morbid obesity as body mass index ≥40 kg/m 2 . Risk of mortality was determined by applying multivariate binary logistic regression modeling to risk factor variables (age, sex, race, and Charlson comorbid score). Results Patients were mostly African American (77.9%) and 51.0% were women. Age and Charlson comorbidity index scores averaged 60 (50–71 years) and 3.0 (1.25–5), respectively. In-hospital mortality was greater in morbidly obese than non-morbidly obese patients. Of the 64 severely obese patients, 16 had no obesity related conditions, and 48 had at least one obesity related condition: hypertension (60%), type 2 diabetes mellitus (28%), and dyslipidemia (20%). In-hospital mortality was greater in severely obese patients with than without at least one obesity related condition. Conclusion During a hospitalization for COVID-19, severely obese patients with at least one obesity related condition and morbidly obese patients have a high mortality.

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“…Assessment of MCIs prove to be very challenging [18,23], and rigorous evaluations (e.g., randomized control trial, quasi-experiment) may not be viable especially when assessing the long-term effectiveness of MCIs. Moreover, while funders and other stakeholders want to see population-level health improvements (e.g., reduced obesity), these changes may not be detectable in the short-term [24,25]. Efforts to assess strategies and their likely positive impact in the long-term are warranted, and have been increasingly explored [15,[26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Implementing Policy, Systems, and Environmental Change Through Community Coalitions and Extension Partnerships to Address Obesity in Rural Louisiana

Cited by 26 publications

References 10 publications

Exploring Extension Agent Capacity and Readiness to Adopt Policy, Systems and Environmental Change Approaches

Exploring Extension Agent Capacity and Readiness to Adopt Policy, Systems and Environmental Change Approaches

COVID 19 in-hospital mortality, body mass index and obesity related conditions

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

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