Laurel Jacobs

Predictors and a Framework for Fostering Community Advocacy as a Community Health Worker Core Function to Eliminate Health Disparities

OBJECTIVES Using a mixed-method, participatory research approach, we investigated factors related to community health worker (CHW) community advocacy that affect social determinants of health. METHODS We used cross-sectional survey data for 371 CHWs to assess demographics, training, work environment, and leadership qualities on civic, political, and organizational advocacy. We present advocacy stories to further articulate CHW activities. The data reported are from the recently completed National Community Health Workers Advocacy Study. RESULTS CHWs are involved in advocacy that is community-focused, although advocacy differs by intrinsic leadership, experience, training, and work environment. We propose a framework to conceptualize, support, and evaluate CHW advocacy and the iterative processes they engage in. These processes create opportunities for community voice and action to affect social and structural conditions that are known to have wide-ranging health effects on communities. CONCLUSIONS The framework presented may have utility for CHWs, their training programs, and their employers as well as funders and policymakers aiming to promote health equity.

Need for Specific Sugar-Sweetened Beverage Lessons for Fourth- and Fifth-Graders

OBJECTIVE Consumption of sugar-sweetened beverages (SSB) is linked to obesity. The authors hypothesized that school-based nutrition education would decrease SSB consumption. DESIGN Self-selected interventional cohort with random selection for pre and post measurements. SETTING Arizona Supplemental Nutrition Assistance Program-Education Program-eligible schools. PARTICIPANTS Randomly selected (9%) fourth- and fifth-grade classroom students. INTERVENTION The University of Arizona Nutrition Network provided general nutrition education training and materials to teachers, to be delivered to their students. The University of Arizona Nutrition Network administered behavioral questionnaires to students in both fall and spring. MAIN OUTCOME MEASURE(S) Change in SSB consumption. ANALYSES Descriptive statistics were computed for student demographics and beverage consumption on the day before testing. Paired t tests evaluated change in classroom averages. Linear regression assessed potential correlates of SSB consumption. RESULTS Fall mean SSB consumption was 1.1 (± 0.2) times; mean milk and water intake were 1.6 (± 0.2) and 5.2 (± 0.7) times, respectively. Beverage consumption increased (3.2%) in springtime, with increased SSBs (14.4%) accounting for the majority (P = .006). Change in SSB consumption was negatively associated with baseline SSB and water consumption but positively associated with baseline milk fat (P ≤ .05). CONCLUSIONS AND IMPLICATIONS The results suggest the need for beverage-specific education to encourage children to consume more healthful beverages in warmer weather.