Jeri Brittin

Healthy eating design guidelines for school architecture.

We developed a new tool, Healthy Eating Design Guidelines for School Architecture, to provide practitioners in architecture and public health with a practical set of spatially organized and theory-based strategies for making school environments more conducive to learning about and practicing healthy eating by optimizing physical resources and learning spaces. The design guidelines, developed through multidisciplinary collaboration, cover 10 domains of the school food environment (eg, cafeteria, kitchen, garden) and 5 core healthy eating design principles. A school redesign project in Dillwyn, Virginia, used the tool to improve the schools’ ability to adopt a healthy nutrition curriculum and promote healthy eating. The new tool, now in a pilot version, is expected to evolve as its components are tested and evaluated through public health and design research.

SaludableOmaha: Development of a Youth Advocacy Initiative to Increase Community Readiness for Obesity Prevention, 2011–2012

Background Childhood obesity rates in minority populations continue to rise despite leveling national trends. Although interventions that address social and environmental factors exist, processes that create demand for policy and environmental change within communities have not been identified. Community Context We developed a pilot program in South Omaha, a Nebraska Latino community, based on the community readiness model (CRM), called SaludableOmaha. We used CRM to explore the potential of youth advocacy to shift individual and community norms regarding obesity prevention in South Omaha and to advocate for health-promoting community environments. Methods We used CRM to assess supply and demand for health programs, engage the community, determine the community’s baseline readiness to address childhood obesity, and guide youth advocacy program development. We conducted our project in 2 phases. In the first, we trained a cohort of youth. In the second, the youth cohort created and launched a Latino health movement, branded as SaludableOmaha. A third phase, which is currently under way, is directed at institutionalizing youth advocacy in communities. Outcome At baseline, the community studied was at a low stage of readiness for change. Our program generated infrastructure and materials to support the growth and institutionalization of youth advocacy as a means of increasing community readiness for addressing obesity prevention. Interpretation CRM is an important tool for addressing issues such as childhood obesity in underserved communities because it provides a framework for matching interventions to the community. Community partnerships such as SaludableOmaha can aid the adoption of obesity prevention programs.

SaludABLEOmaha: Improving Readiness to Address Obesity Through Healthy Lifestyle in a Midwestern Latino Community, 2011-2013

Background A community’s readiness for change is a precursor to the effective application of evidence-based practices for health promotion. Research is lacking regarding potential strategies to improve readiness to address obesity-related health issues in underserved communities. Community Context This case study describes SaludABLEOmaha, an initiative to increase readiness of residents in a Midwestern Latino community to address obesity and adopt healthy lifestyles. Methods SaludABLEOmaha emphasized 2 core approaches, youth activism and collaboration among public and private institutions, which we applied to planning and implementing tactics in support of 3 interconnected strategies: 1) social marketing and social media, 2) service learning in schools (ie, curricula that integrate hands-on community service with instruction and reflection), and 3) community and business engagement. Following the Community Readiness Model protocol (http://triethniccenter.colostate.edu/communityReadiness.htm), structured interviews were conducted with community leaders and analyzed before and 2.5 years after launch of the program. Outcome The community increased in readiness from stage 3 of the Community Readiness Model, “vague awareness,” at baseline to stage 5, “preparation,” at follow-up. Interpretation SaludABLEOmaha improved community readiness (eg, community knowledge, community climate), which probably contributed to the observed increase in readiness to address obesity through healthy lifestyle. Community mobilization approaches such as youth activism integrated with social marketing and social media tactics can improve community responsiveness to obesity prevention and diminish health disparities.

Physical Activity Design Guidelines for School Architecture

Increasing children’s physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students’ physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment’s impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.

A system dynamics model to simulate sustainable interventions on chronic disease outcomes in an urban community

Socio-demographics of urban US populations have been associated with poor health status and chronic disease. Patterns of rising chronic disease prevalence have persisted in populations with lower socio-economic status despite substantial and costly public health efforts to the contrary. In this paper, we used a system dynamics model to simulate chronic disease prevalence, along with potential interventions, for a low-income urban community in Chicago, Illinois. We hypothesized that the ‘triple bottom line’ of sustainability—addressing economic, social, and environmental issues—would be key to mitigation and reduction of chronic disease over time in such a community. The aim was to inform decision making about urban design and public health programme planning towards formulation of approaches—some beyond the traditional boundaries of health interventions—to improve community chronic disease outcomes over time. We found that single interventions on the constructs of Income and Employment, Neighbourhood Attractiveness, and Social Cohesion were most impactful in reducing or reversing the rise of chronic disease prevalence. Increasing Housing Capacity allowed the Neighbourhood Attractiveness intervention to have a greater impact. In addition, interventions in Neighbourhood Attractiveness and Chronic Disease Prevention produced a greater combined mitigating effect on chronic disease prevalence than the sum of the individual intervention effects. Findings suggest that socio-environmental conditions should be addressed, with consideration of population migration dynamics, in formulating viable and sustainable solutions to improve community-level health outcomes such as chronic disease prevalence.

Children’s Discourse of Liked, Healthy, and Unhealthy Foods

BACKGROUND Food literacy and nutrition education from kindergarten to 12th grade is a recommended strategy to address obesity prevention. However, limited research has explored childrens understanding and conceptualization of food and healthy eating to inform the development of curricula and messaging strategies. OBJECTIVE To explore and identify patterns and themes regarding how children discuss and describe food and healthy eating. DESIGN Focus groups were conducted during which children were asked to identify and describe foods they liked and perceived as healthy and unhealthy. To triangulate findings, children also completed written worksheets on which they identified and described foods. Discourse analysis was used to code and interpret data by focusing on the language children used in relation to different types of food. PARTICIPANTS/SETTING Seven focus groups were held with children in grades 3 through 7 (n=38) from one rural community. RESULTS Analysis indicated four main themes. Children used a heuristic based on major food groups to determine healthfulness, did not strongly connect health values with liked foods and foods perceived as unhealthy, expressed that taste, texture, and visual appeal primarily shaped likeability, and associated liked foods with positive home and family experiences. CONCLUSIONS Childrens descriptions of liked and unhealthy foods were largely disconnected from health values and connected to taste and familiarity. Nutrition education should expand strategies beyond promotion of health benefits to include taste and sociocultural familiarity.

The Role of School Design in Shaping Healthy Eating-Related Attitudes, Practices, and Behaviors Among School Staff.

BACKGROUND Schools have increasing responsibility to address healthy eating, but physical barriers influence their ability to adopt and sustain recommended strategies. We took advantage of a natural experiment to investigate the role of the physical environment in shaping healthy eating attitudes and practices among school staff members. METHODS A school district consolidated its elementary schools and incorporated architectural features to support healthy eating into a building renovation. Surveys along with structured, in-depth interviews were administered prior to and at 12 months postoccupancy. Paired t-tests and McNemars tests were used to analyze changes in survey indices and interview data were coded for themes. RESULTS The school implemented new policies and programs, including staff wellness activities. There was a significant decrease in the percent of teachers with a high-fat diet (from 73.68% to 57.14%, p < .05). Many physical barriers were removed but new challenges emerged, and staff varied in their awareness and comfort with using the new healthy eating features. CONCLUSIONS We found promising evidence that school architecture can support a school to address healthy eating. To enhance influence of the physical environment, more research is merited to test complementary strategies such as improving ownership of space and increasing self-efficacy to manage space.

Community-Engaged Public Health Research to Inform Hospital Campus Planning in a Low Socioeconomic Status Urban Neighborhood

Objective: To compare sociodemographic and motivational factors for healthcare use and identify desirable health-promoting resources among groups in a low socioeconomic status (SES) community in Chicago, IL. Background: Disparities in health services and outcomes are well established in low SES urban neighborhoods in the United States and many factors beyond service availability and quality impact community health. Yet there is no clear process for engaging communities in building resources to improve population-level health in such locales. Methods: A hospital building project led to a partnership of public health researchers, architects, and planners who conducted community-engaged research. We collected resident data and compared factors for healthcare use and choice and likelihood of engaging new health-promoting services. Results: Neighborhood areas were strongly associated with ethnic groupings, and there were differences between groups in healthcare choice and service needs, such as, proximity to home was more important to Latinos than African Americans in choice of healthcare facility ( p adj = .001). Latinos expressed higher likelihood to use a fitness facility ( p adj = .001). Despite differences in vehicle ownership, >75% of all respondents indicated that nearby public transportation was important in choosing healthcare. Conclusion: Knowledge of community needs and heterogeneity is essential to decision makers of facility and community development plans. Partnerships between public health, urban planning, architecture, and local constituents should be cultivated toward focus on reducing health disparities. Further work to integrate community perspectives through the planning and design process and to evaluate the long-term impact of such efforts is needed.

Impacts of active school design on school-time sedentary behavior and physical activity: A pilot natural experiment

Background Children spend a significant portion of their days in sedentary behavior (SB) and on average fail to engage in adequate physical activity (PA). The school built environment may influence SB and PA, but research is limited. This natural experiment evaluated whether an elementary school designed to promote movement impacted students’ school-time SB and PA. Methods Accelerometers measured SB and PA at pre and post time-points in an intervention group who moved to the new school (n = 21) and in a comparison group experiencing no school environmental change (n = 20). Difference-in-difference (DD) analysis examined SB and PA outcomes in these groups. Measures were also collected post-intervention from an independent, grade-matched group of students in the new school (n = 21). Results As expected, maturational increases in SB were observed. However, DD analysis estimated that the intervention attenuated increase in SB by 81.2 ± 11.4 minutes/day (p<0.001), controlling for time in moderate to vigorous physical activity (MVPA). The intervention was also estimated to increase daily number of breaks from SB by 23.4 ± 2.6 (p < .001) and to increase light physical activity (LPA) by 67.7 ± 10.7 minutes/day (p<0.001). However, the intervention decreased MVPA by 10.3 ± 2.3 minutes/day (p<0.001). Results of grade-matched independent samples analysis were similar, with students in the new vs. old school spending 90.5 ± 16.1 fewer minutes/day in SB, taking 21.1 ± 2.7 more breaks from SB (p<0.001), and spending 64.5 ± 14.8 more minutes in LPA (p<0.001), controlling for time in MVPA. Students in the new school spent 13.1 ± 2.7 fewer minutes in MVPA (p<0.001) than their counterparts in the old school. Conclusions This pilot study found that active school design had beneficial effects on SB and LPA, but not on MVPA. Mixed results point to a need for active classroom design strategies to mitigate SB, and quick access from classrooms to areas permissive of high-intensity activities to promote MVPA. Integrating active design with programs/policies to promote PA may yield greatest impact on PA of all intensities.