Abstract
A Framework for Evaluating Health in All Policies Initiatives in the United States
Lauren Gase, PhD, MPH1, Taylor Schooley, MPH1, Meredith Lee, MPH2, Sierra Rotakhina, MPH3, John Vick, PhD4 and Julia Caplan, MPP, MPH5
(1)Los Angeles County Department of Public Health, Los Angeles, CA, (2)California Department of Public Health, Sacramento, CA, (3)Washington State Board of Health, Tumwater, WA, (4)Metro Nashville Public Health Department, Nashville, TN, (5)Public Health Institute, California Department of Public Health, Sacramento, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Health is determined by multiple factors outside of the direct control of the health care and public health system, including access to educational, economic, and job opportunities; transportation and housing options; and neighborhood quality and safety. In recent years, an increasing number of public health agencies have adopted a Health in All Policies (HiAP) approach to help address the social determinants of health by fostering sustained collaboration among governmental agencies, advancing health-promoting policies, and integrating health criteria into decision-making in “non-health” sectors. Despite the growth in HiAP practice, relatively little has been done to assess the process and impact of implementing HiAP initiatives.
This presentation will introduce a framework that can help inform the design and evaluation of HiAP initiatives. The framework was developed between June 2015 and January 2016 through an iterative process involving literature review and expert consultation (n=25). This presentation will familiarize audiences with the evaluation framework - a starting place to help researchers and practitioners identify the inputs, activities, outputs and outcomes of HiAP initiatives and define potential indicators that can be used to conduct process and impact evaluations. Examples from California, Washington, and Nashville will be highlighted in order to illustrate the framework's application and utility. The evaluation framework can serve as a flexible tool to help address some of the challenges associated with implementing and evaluating HiAP initiatives in the United States.
Conduct evaluation related to programs, research, and other areas of practice Program planning Public health or related public policy
Abstract
Preventing Sexual Bullying among Georgia's Youth:Evaluating Step Up. Step In. Campaign
Chinwe Ejikeme, DrPH, Jean O'Connor, JD, DrPH, Kia Powell-Threets, MS, Mosi Bayo, M.Ed. and Kia Toddle, BS
Georgia Department of Public Health, Atlanta, GA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: In the US, sexual bullying is prevalent and harmful particularly because of its implications regarding perpetration and victimization in both early and late adolescence. In 2013, 41% and nearly 20% of Georgia middle and high school students, respectively, reported being bullied on school property. Furthermore, more than 18% and nearly 14% of middle and high school students, respectively, reported being bullied electronically.
Methods: With funding from CDC in 2015, Georgia Department of Public Health implemented Step Up. Step In., an awareness campaign designed to stop sexual bullying in Georgia. In the pilot program, 7 middle and 15 high schools implemented Step Up. Step In. Led by student advisory boards, students, creatively, implemented awareness and pledge campaigns and schools addressed sexual bullying by highlighting policies or recommending system changes for policy. To assess the impact, pre post surveys were administered to convenient samples of students from each participating school, to determine the effectiveness of the campaign in creating awareness and its impact among students.
Results: All data will be collected and analyzed by February, 2016. Based on preliminary reports, 88% of students accepted the campaign message and 72% of them believed that the campaign will help to reduce sexual bullying in the school. Also, 60% of students demonstrated their willingness to change norms around sexual bullying.
Conclusion: Participating schools have utilized students' creativity to bring to light the issue of sexual bullying, suggesting possible success in reducing adolescent sexual bullying in Georgia, with great potential for implementation statewide and replication in other states.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs
Abstract
Evaluation of an out-of-class time program to promote youth healthy relationships
Deinera Exner-Cortens, PhD, MPH1, David Wolfe, PhD2, Debbie Chiodo, MA, MEd2, Ray Hughes2 and Claire Crooks, PhD, CPsych2
(1)University of Calgary, Calgary, AB, Canada, (2)Western University, London, ON, Canada
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background. Building healthy relationships among youth is increasingly recognized as key to preventing interpersonal violence and promoting adolescent well-being. However, despite the theoretical promise of such an approach, rigorous evaluation of youth healthy relationships programs is limited to date. Thus, the present study evaluated an out-of-class time, small groups program for adolescents designed to promote healthy relationships and youth mental health, called the Fourth R: Healthy Relationships Plus Program (HRPP). Methods. The program was implemented in July 2014, and evaluated using a randomized controlled trial design. Data were collected at five occasions (pre-test, post-test, 4-, 8-, 12-month follow-up) from 211 adolescents aged 14-16 in Southwestern Ontario (67.0% female, 76.7% White). Retention over the study year was 90.6%. Key outcomes at 12-month follow-up included bullying and positive mental health. Data were analyzed using bivariate statistics. Results. At 12 month follow-up, treatment individuals were significantly less likely than control individuals to report physical bullying victimization: at pre-test, 27% of treatment individuals and 21% of control individuals reported physical bullying (p=NS), compared to 11% of treatment individuals and 23% of control individuals one year after the program (p=.02). This finding may be the result of greater help-seeking and better emotion regulation reported by the treatment group over the course of the study year. There was also a borderline impact on positive mental health at 12 month follow-up. Conclusions. Based on the results of this evaluation, the HRPP represents a promising way to promote adolescent well-being. Implications of this study for program implementation and dissemination will be discussed.
Conduct evaluation related to programs, research, and other areas of practice Social and behavioral sciences
Abstract
Evaluation of Registry-Driven Text Messaging Campaign To Increase HPV Vaccine Series Completion in Georgia
Nicolle Dally, MPH1, Tamira Moon, MPH, CHES2, Ben Sloat, MPH2, Kia Bryant, MPH2 and Jean O'Connor, JD, DrPH
(1)Georgia State University, Atlanta, GA, (2)Georgia Department of Public Health, Atlanta, GA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background
Human Papilloma Virus (HPV) vaccine uptake continues to lag other required adolescent vaccines such as Tdap and Meningococcal. HPV is the leading cause of cervical cancer and is linked to vulvar, anal, penile, and oropharyngeal cancers. The Georgia Comprehensive Cancer Control Program and Georgia Immunization Program collaborated to implement and evaluate a text messaging reminder campaign using the Georgia Immunization Registry (GRITS).
Objective
Assess the effectiveness of a registry-driven text messaging campaign to increase HPV vaccine series completion.
Setting
The 1996 Georgia Immunization Registry Law mandates reporting by any person who administers a vaccine. The registry is a decision support tool to ensure that all Georgians receive appropriate, timely immunizations.
Methods
Nonrandomized sample of adolescents aged 9-18 years who had received at least one dose of HPV vaccine with a parent phone number listed was drawn from the Georgia Immunization Registry in June 2015. 208,792 adolescents were included in the sample. Parents received a single text message reminder to complete the vaccine series.
Results
9,711 text messages were successfully sent to parents of adolescents 9 – 18 years. After 3 months, the 3-dose coverage rate was higher among those who received a text message reminder (16% vs 7%).
Conclusions
The registry-driven campaign improved 3-dose HPV vaccine coverage among adolescents in Georgia. This parent-centered strategy complements the Georgia Cancer Consortium's activities to increase coverage. Proposed solutions to the challenges with the immunization registry and text messaging reminder system should be implemented prior to scaling up the campaign.
Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Program planning Public health or related research
Abstract
Fidelity of Implementation of Texas Grow! Eat! Go!: A Coordinated School Health, Garden, Nutrition and Physical Activity Intervention
Debra Kellstedt, MPH1, Michael Lopez, MUP2, Ashley McKinley, MPH3, Nalini Ranjit, PhD4, Alexandra Evans, PhD, MPH5, Judith Warren, PhD6 and Marcia Ory, PhD, MPH7
(1)Texas A&M Health Science Center, College Station, TX, (2)Texas A&M AgriLife Extension, College Station, TX, (3)Texas A&M School of Public Health, College Station, TX, (4)The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, (5)University of Texas Health Science Center at Houston, School of Public Health, Austin Regional Campus. Dell Center for Healthy Living, Austin, TX, (6)Texas A&M AgriLife Extension Service, College Station, TX, (7)School of Public Health, Texas A&M University, College Station, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
background: Coordinated efforts between schools, communities, and families can provide successful childhood obesity prevention strategies. In 2012, sixteen low income schools in Texas implemented the Texas Grow! Eat! Go! (TGEG) project and assessed the independent and combined impact of garden, nutrition, and physical activity (PA) interventions. Outcome variables included healthy eating, PA behaviors, and weight status among students and parents. This presentation focuses on the development of tools used to evaluate fidelity of implementation of TGEG interventions and the examination of factors related to fidelity.
methods: 88 teachers at participating schools were trained to implement three interventions in a randomized group design—Coordinated Approach to Child Health (CATCH), Walk Across Texas (WAT), and Learn! Grow! Eat! Go! (LGEG). Teacher Activity Logs were created to assess treatment fidelity of the interventions. In order to obtain a quantitative measure of the difference in implementation fidelity, implementation scores were constructed for each school on a 1-3 scale (low, medium, high) using Teacher Logs and additional process data collected from school administrators and project specialists.
results: Implementation scores differed by school and treatment, varying from 1.2 to 3. Seventy teachers completed Teacher Logs. Process data indicated that specific school level factors (i.e., a school champion, administrative support, teacher buy-in) were associated with higher implementation.
conclusion: Program implementation was affected by a number of interacting programmatic and organizational factors. The examination of actual implementation informs our understanding of the effect of school programs on children's health and can be used as a model to improve similar implementation efforts.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs
Abstract
Using integrative health and health literacy to prevent and reduce chronic disease
Andrew Pleasant, PhD, Jennifer Cabe, MA, Chuck Palm, MPH, Ana Lucero-Liu, PhD and Caitlin Maish, B.S.
Canyon Ranch Institute, Tucson, AZ
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The Canyon Ranch Institute Life Enhancement Program (CRI LEP) is an evidence-based, multi-disciplinary, integrative health program that targets health literacy while preventing, diagnosing, and addressing chronic diseases.
The CRI LEP is a model of integrative health in action, unifying the skills and passions of a team of health professionals to collectively address the whole person and the complex and interconnected determinants of health. The program consists of 40 + hours of contact time with participants, including hands-on cooking demonstrations, grocery store tours, and interactive sessions focused on behavioral health, sense of purpose, nutrition, exercise, and integrative health. Through rigorous formative research, the CRI LEP is tailored to each community and culture.
Evaluation measures reflect the integrative nature of the CRI LEP and include measures of change in knowledge, behaviors, attitudes, health literacy, and physiological changes in body size and chemistry.
We report on the analysis of the baseline, process, post-program, and three-month post program data. To date, over 600 people have participated in the program at multiple sites across the United States. Outcomes include a decrease of 7 unhealthy days per or 80 healthier days each year. Participants report a 28.6% increase in exercise each month and an 85.7% increase in strenuous exercise. Soda consumption declined by 52% and water consumption increased by 21%. PHQ-9 depression scores dropped by 38.2% and health literacy increased by 10.3%. Participants reported a host of other healthy, and statistically significant, changes in knowledge, attitudes, beliefs, and behaviors that we will detail in this session.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related research Social and behavioral sciences
Abstract
Development and Validation of the Stroke Literacy and Action Measure (S.L.A.M.) for Preadolescent Children
Alexandra DeSorbo, MPH1, John Allegrante, PhD2 and Olajide Williams, MD MS3
(1)Pilot Light, Chicago, IL, (2)Teachers College, Columbia University, New York, NY, (3)Columbia University College of Physicians and Surgeons, New York, NY
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Educating children, who are often bystanders to ischemic stroke events to recognize stroke signs and symptoms and call “911” to activate the emergency medical service, may reduce pre-hospital delays and improve outcomes in the treatment of stroke. However, there are no valid and reliable instruments to measure stroke literacy among children.
Objective: The objective of this study was to develop a valid and reliable Stroke Literacy and Action Measure (S.L.A.M.) for use among preadolescent children.
Method: The study was conducted in two phases. Drawing on a review of existing stroke literacy instruments for adults, Phase I entailed generating potential items for inclusion in the instrument. A panel of experts then reviewed the items to establish content validity and a focus group conducted with preadolescent children representative of the population for which the instrument was being designed was then used to establish validity of response. Phase II used factor analysis, item-to-total correlation, and test-retest administration to assess dimensionality, internal consistency, and reliability.
Results: Three sub-constructs comprise the S.L.A.M.: a) Stroke knowledge, b) Behavioral intention to call “911”, and c) Self-efficacy to take action. Cronbach's Alpha for stroke knowledge was 0.73; for behavioral intention to call “911”, 0.7; and for self-efficacy, 0.89. Based on their clinical significance, 39 of the original items were retained for inclusion in the final S.L.A.M. instrument.
Conclusions: The S.L.A.M. is a valid and reliable instrument that can be used to measure stroke literacy among preadolescent populations and may also be appropriate for use among low-literacy adults.
Administer health education strategies, interventions and programs Chronic disease management and prevention Conduct evaluation related to programs, research, and other areas of practice Planning of health education strategies, interventions, and programs Program planning Public health or related education
Abstract
Evaluation of the “Heart Smart” church-based intervention for cardiovascular disease risk reduction in rural, southernmost Illinois
Kristine Zimmermann, MPH1, Leslie Carnahan, MPH1, Apurba Chakraborty, MBBS, MPH1, Manorama Khare, PhD2, Cindy Veldhuis, PhD1, Yamile Molina, MS, MPH, PhD3 and Stacie E. Geller, PhD1
(1)University of Illinois at Chicago, Chicago, IL, (2)University of Illinois at Chicago College of Medicine at Rockford, Rockford, IL, (3)UIC School of Public Health, Chicago, IL
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Compared to Illinois residents overall, those living in Illinois' rural, southernmost seven counties face disproportionately high rates of cardiovascular disease and related risk factors. The Southern Seven Coalition for Women's Health developed, implemented, and evaluated a church-based health promotion model to address these risk factors and foster sustained improvements in health behaviors in a multi-ethnic sample.
Methods: The “Heart Smart” intervention was conducted over 27 months, and included a 12-week evidence-based program (enhanced intervention) for adult women, and a two-year monthly booster program (minimal intervention) open to all community adults. We monitored participants' diet and physical activity over two years, and compared post-intervention behavior change and maintenance of healthy behaviors within and between groups.
Results: We recruited 206 participants from 12 churches (mean age: 58.5+15.3; 90% female). In the enhanced intervention group, we detected favorable outcomes in several behaviors, with significant short-term improvements in meeting physical activity guidelines (p=0.007). Our comparison between groups also provides evidence of effectiveness of the enhanced intervention. Specifically, while vegetable intake among enhanced intervention participants remained stable over two years, in the minimal intervention group, vegetable intake decreased, with statistically significant changes across groups (p=0.01). Similarly, fat consumption in the enhanced intervention group decreased marginally while fat consumption in the minimal intervention group increased, leading to statistically significant changes across groups (p=0.04).
Conclusion: While an enhanced intervention with monthly boosters may not contribute to significant changes in all behaviors, it may slow the deterioration of health over time via maintenance of established healthy behaviors.
Chronic disease management and prevention Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Public health or related research
Abstract
Impact of a Multi-component Childhood Obesity Prevention Intervention on Children and Implementation Sites in 5 Nebraska Counties
Leah Carpenter, MPH1, Courtney Pinard, PhD1, Arli Boustead2 and Kelly Nielsen, MPH, MS, CPH3
(1)Gretchen Swanson Center for Nutrition, Omaha, NE, (2)Live Well Omaha Kids, Omaha, NE, (3)CHI Health, Omaha, NE
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Childhood obesity prevalence in Nebraska has steadily increased over the last decade currently reaching 32%, demanding the need for a multi-pronged prevention strategy. The purpose of this study is to evaluate the impact of an intervention that educates children and their families about five daily obesity prevention recommendations and has been implemented in schools, out-of-school organizations, and medical clinics in five counties in Nebraska.
Enrollment was tracked to ensure recruitment goals were being met in each county. Pre- and post-intervention surveys were conducted with children to determine their awareness and knowledge of the 5 recommendations, as well as behavior change. Post-intervention interviews were conducted with a contact from a sample of enrolled sites to gain feedback about program implementation.
84 sites were enrolled and over 700 child surveys were collected. Survey responses indicated that awareness and knowledge of the recommendations had increased, as well as demonstrating a positive change in health behaviors. Interviews (n=36) with site contacts indicated a high level of satisfaction with the program, that program materials (e.g. toolkits) of this kind have not been available previously, and that there was an intention to expand the program to additional sites.
Each county met their participation goals and the intervention materials were well received among implementation sites. This effort was demonstrated as a feasible and effective strategy to increase knowledge, awareness and positive behavior change related to obesity prevention among children. Lessons learned from this two-year intervention will guide future program expansion.
Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Public health or related research
Abstract
Healthy Parenting Workshops: A novel approach to nutrition and parenting education in Los Angeles County
Kelly A. Dumke, MS1, Lauren Walter, MPH, CHES1, Zoe Phillips, MS, MPH, CHES2, Wendy Slusser, MD, MS, FAAP3, Linda Aragon, MPH1 and Paul Simon, MD, MPH1
(1)Los Angeles County Department of Public Health, Los Angeles, CA, (2)Los Angeles County Department of Public Health, Alhambra, CA, (3)University of California, Los Angeles, Los Angeles, CA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: In Los Angeles County (LAC), approximately 19% of 3 and 4 year olds enrolled in the WIC Program are obese or overweight. A 2011 IOM report highlighted evidence-based recommendations for early childhood obesity prevention that focus on parenting skills development, yet traditional nutrition education programs often rely on didactic models. This highlights a critical need for actionable parenting education approaches to early childhood obesity prevention.
Approach: In 2013, the LAC Department of Public Health collaborated with parenting and nutrition experts at the University of California, Los Angeles to scale-up an evidence-based nutrition and parent skills-building curriculum. In expanding the curriculum to the serve the diverse population of LAC, the six-week Healthy Parenting Workshop (HPW) series was developed, combining nutrition education with parenting skills. Based on the Social Learning Theory, the HPW series incorporates group reflection, behavioral rehearsal, and modeling to facilitate transference from workshop to home.
Results: The HPW series is currently implemented by 20 agencies throughout LAC and supported by a comprehensive evaluation model. This presentation will highlight evaluation results and impact on knowledge and behavioral intention changes among the nearly 2,000 parents participating in the HPW series. Comparisons to the original randomized-controlled pilot study will also be discussed.
Conclusions: Novel approaches that look beyond didactic nutrition education not only teach healthful eating habits, but also build parenting skills through a social learning environment. From a health equity perspective, there is a critical need for accessible interventions among high-risk populations, especially when it comes to improving lifestyle habits during impressionable early childhood years.
Administer health education strategies, interventions and programs Chronic disease management and prevention Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related education