Laurie Carpenter

An introduction to the Food & Fitness community partnerships and this special issue

This special issue of Community Development introduces the Food and Fitness community partnerships and their work to increase access to healthy, locally grown food, and opportunities for physical activity, in vulnerable communities across the country. Established in 2007 and funded by the WK Kellogg Foundation, the partnerships are increasing the capacity of communities to participate in policy and systems change to positively affect their health and well-being. These articles together provide an illustration of how funders, grantees, and partners can work together to create sustainable change at the neighborhood level to ensure that all children and families are able to thrive.

Food & Community: the cross-site evaluation of the W.K. Kellogg Food & Fitness community partnerships

This article describes the collaborative development of the cross-site evaluation of the Food & Fitness initiative. Evaluators and community partners together created a multi-site evaluation to document similarities and unique aspects across the work in the nine participating communities. The evaluation includes measures of partner engagement, resources, processes, and outcomes of achieving systems and policy change, and impact of the work in vulnerable communities. Inherent in and critical to the evaluation is a process for providing feedback to communities and stakeholders. Pioneering ways to assess the process of achieving systems and policy change and the impact of this work on children and families, the Food & Fitness cross-site evaluation is creating a picture of the collective accomplishments of these community partnerships, which are doing innovative work related to equity around food access and the built environment.

Sustaining School‐Based Asthma Interventions Through Policy and Practice Change

BACKGROUND Schools are an ideal setting for implementation of asthma interventions for children; however, sustaining school-based programs can be challenging. This study illustrates policy and practice changes brought about through the Childhood Asthma Linkages in Missouri (CALM) program to sustain such programs. METHODS Researchers analyzed caregiver-reported quantitative data regarding asthma-related outcomes in preintervention and postintervention surveys and qualitative data regarding sustainability efforts in schools reported by CALM grantees. A grounded theory approach was used to identify key concepts and themes that emerged. RESULTS In 330 children, significant improvements were seen in asthma symptoms, rescue inhaler use, health care utilization, school absenteeism, and activity limitations. Overall, 27 school-based policy and practice changes supporting program sustainability were reported, with policy changes most often concerning the assessment and/or monitoring of children with asthma in the school setting, and practice changes most often regarding institution of regular asthma education programs for students and school personnel. CONCLUSIONS Sustaining school-based asthma programs is challenging, but can be realized through the participation of diverse partners in enacting policy and practice changes that support the institutionalization of programs into the day-to-day processes of the schools.

Moving toward and beyond equity: the Food & Fitness approach to increasing opportunities for health in communities

Through creating avenues for authentic civic engagement of individuals living in vulnerable communities, the Food & Fitness community partnerships have actualized innovative ways to change the trajectory of health outcomes in neighborhoods across the United States. Working to increase the availability of healthy, locally grown food and opportunities for physical activity in communities that have suffered from years of disinvestment, the partnerships have moved toward and beyond merely bridging the equity gap.

The impact of patient autonomy on older adults with asthma

BACKGROUND Understanding patient preferences and desire for involvement in making medical decisions is important when managing chronic conditions. Previous studies have used the Autonomy Preference Index (API) in younger patients with asthma to evaluate these preferences. OBJECTIVE To identify factors associated with autonomy and to determine whether autonomy is related to asthma outcomes among older adults. METHODS A total of 189 older adults (>55 years old) with persistent asthma were included. Preferences for autonomy were assessed using the API, with a higher score indicating higher desire for autonomy. Scores were separated into 2 domains of information-seeking and decision-making preferences. The separated scores were correlated with asthma outcomes and demographic variables. To control for confounding factors, a linear regression analysis was performed. RESULTS Higher decision-making preference scores correlated with female sex (P = .007), higher educational level (P = .01), and lower depression scores (P = .04). Regarding outcomes, decision-making scores positively correlated with Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) scores (P = .01). On linear regression analysis, the Mini-AQLQ score remained significantly associated with decision-making preference scores (P = .03). There was no association with asthma control test scores, spirometry values, and health care use. Information-seeking preference scores correlated with educational level (P = .03), but there was no correlation with asthma outcomes. CONCLUSION Older adults with asthma and a greater desire for involvement in decision making have better asthma-related quality of life. Future studies with the intention to increase patient autonomy may help establish a causal relationship.

Risk factors and clinical outcomes associated with fixed airflow obstruction in older adults with asthma

BACKGROUND Asthma in older adults is associated with increased morbidity and mortality compared with asthma in younger patients. Fixed airflow obstruction (FAO) is associated with decreased survival in younger patients, but its significance remains unclear in older adults with asthma. OBJECTIVE To identify risk factors and outcomes related to FAO in older adults with asthma. METHODS Subjects older than 55 years with a physician diagnosis of persistent asthma were evaluated. Collected data included participant demographic information, medications, asthma exacerbations, Asthma Control Test (ACT) score, Asthma Quality of Life (AQLQ) score, comorbidities, spirometry, atopic status, and fractional exhaled nitric oxide. Clinical characteristics and outcomes associated with FAO (defined as post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity ≤70%) were assessed. RESULTS A total of 186 participants were analyzed (48 men and 138 women, mean age 66 years). FAO was demonstrated in 30% of participants. Using regression analysis, predictors of FAO included advanced age, African American race, male sex, and longer duration of asthma. In outcomes analysis, FAO was associated with worsened ACT and AQLQ scores; however, after controlling for confounding factors, logistic regression showed no association. No significant association was found between FAO and exacerbations, fractional exhaled nitric oxide, atopy, rhinitis, education level, depression, smoking, or body mass index. CONCLUSION Risk factors associated with FAO in older adults with asthma include advanced age, African American race, increased asthma duration, and male sex. Unlike younger patients, FAO is not independently associated with worsened asthma control, quality of life, or exacerbations in older patients with asthma. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01979055.