LaVonna Lewis

Improving the nutritional resource environment for healthy living through community-based participatory research.

OBJECTIVES: To build health promotion capacity among community residents through a community-based participatory model, and to apply this model to study the nutritional environment of an urban area to better understand the role of such resources in residents’ efforts to live a healthy life.DESIGN: A multiphase collaborative study that inventoried selected markets in targeted areas of high African-American concentration in comparison with markets in a contrasting wealthier area with fewer African Americans.SETTING: A community study set in the Los Angeles metropolitan area.PARTICIPANTS: African-American community organizations and community residents in the target areas.INTERVENTIONS: Two surveys of market inventories were conducted. The first was a single-sheet form profiling store conditions and the availability of a small selection of healthy foods. The second provided detailed information on whether the store offered fruit, vegetables, low-fat dairy products, dried goods and other items necessary for residents to consume a nutritious diet.RESULTS: The targeted areas were significantly less likely to have important items for living a healthier life. The variety and quality of fresh fruit and vegetable produce was significantly lower in the target areas. Such products as 1% milk, skim milk, low-fat and nonfat cheese, soy milk, tofu, whole grain pasta and breads, and low-fat meat and poultry items were significantly less available.CONCLUSIONS: Healthy food products were significantly less available in the target areas. The authors conclude from these results that the health disparities experienced by African-American communities have origins that extend beyond the health delivery system and individual behaviors inasmuch as adherence to the healthy lifestyle associated with low chronic disease risk is more difficult in resource-poor neighborhoods than in resource-rich ones.

Putting Promotion Into Practice: The African Americans Building a Legacy of Health Organizational Wellness Program

A Los Angeles REACH demonstration project led by Community Health Councils, Inc. adapted and implemented an organizational wellness intervention originally developed by the local health department, providing training in incorporating physical activity and healthy food choices into the routine “conduct of business” in 35 predominantly public and private, nonprofit-sector agencies. A total of 700 staff, members, or clients completed the 12-week or subsequently retooled 6-week curriculum. Attendance and retention rates between baseline and postintervention assessments were improved substantially in the shortened offering. Feelings of sadness or depression decreased significantly (p = .00), fruit and vegetable intake increased significantly (+0.5 servings/day, p = .00), and body mass index decreased marginally (-0.5 kg/m2, p = .08) among 12-week participants. The numbers of days in which individuals participated in vigorous physical activity increased significantly among 6-week participants (+0.3, p = .00). This model holds promise for extending the reach of environmentally focused work-site wellness programming to organizations and at-risk populations not traditionally engaged by such efforts.

Trust in a Cross-Sectoral Interorganizational Network: An Empirical Investigation of Antecedents

This study explores the antecedents to trust among the participants in a cross-sectoral interorganizational network. We offer hypotheses for nine potential antecedents of trust divided into three categories: attributes of the trustor, of the trustee, and of their relationship. We analyzed dyadic data collected from a network of community-based organizations collaborating to promote change in a south Los Angeles community. The results of our analysis reveal that trust building is not a simple process but results from a combination of attributes of trustors, trustees, and their relationships. Trustors’ general tendency to trust other participants in the network, trustees’ reputation in the network, whether a trustee is from the same sector as the trustor, whether a trustee is important to the trustor, and the multiplexity of interactions between a trustor and trustee significantly influenced the level of trust. Some suggestions for developing trust among participants in such networks are offered.

Transforming the urban food desert from the grassroots up: a model for community change.

Confronted by continuing health disparities in vulnerable communities, Community Health Councils (CHC), a nonprofit community-based organization in South Los Angeles, worked with the African Americans Building a Legacy of Health Coalition and research partners to develop a community change model to address the root causes of health disparities within the communitys African American population. This article discusses how the CHC Models development and application led to public policy interventions in a “food desert.” The CHC Model provided a systematic approach to engaging impacted communities in support of societal level reforms, with the goal to influence health outcomes.

Developing networks for community change: exploring the utility of network analysis

This article demonstrates how network analysis can be used to develop a better understanding of a community-based network and steps that might be taken to facilitate network development. The focal network in this study was organized by a local non-profit organization as part of their effort to effect community-level change. The activities of this network were guided by three steering committees, 23 members of which provided data regarding numerous aspects of their relationships with a set of 39 organizations. We first provide descriptive information regarding patterns of relationships among network participants at both the committee and whole-network level. We then summarize results of hierarchical linear modeling and analysis of variance analyses that clarify how data generated through network analysis can be incorporated into these traditional analytic procedures to yield additional insights regarding network properties. The article concludes with a discussion of the implications of these findings for the continued development of this community-based network, as well as implications for others interested in using network analysis to facilitate change in their own communities.

Advocacy coalitions involved in California's menu labeling policy debate: Exploring coalition structure, policy beliefs, resources, and strategies

Advocacy coalitions often play an important role in the state health policymaking process, yet little is known about their structure, composition, and behavior. In 2008, California became the first state to enact a menu labeling law. Using the advocacy coalition framework, we examine different facets of the coalitions involved in California’s menu labeling policy debate. We use a qualitative research approach to identify coalition members and explore their expressed beliefs and policy arguments, resources, and strategies by analyzing legislative documents (n=87) and newspaper articles (n=78) produced between 1999 and 2009. Between 2003 and 2008, six menu labeling bills were introduced in the state’s legislature. We found the issue received increasing media attention during this period. We identified two advocacy coalitions involved in the debate—a public health (PH) coalition and an industry coalition. State organizations acted as coalition leaders and participated for a longer duration than elected officials. The structure and composition of each coalition varied. PH coalition leadership and membership notably increased compared to the industry coalition. The PH coalition, led by nonprofit PH and health organizations, promoted a clear and consistent message around informed decision making. The industry coalition, led by a state restaurant association, responded with cost and implementation arguments. Each coalition used various resources and strategies to advance desired outcomes. PH coalition leaders were particularly effective at using resources and employing advocacy strategies, which included engaging state legislators as coalition members, using public opinion polls and information, and leveraging media resources to garner support. Policy precedence and a local policy push emerged as important policymaking strategies. Areas for future research on the state health policymaking process are discussed.

Catalyzing Implementation of Evidence-Based Interventions in Safety Net Settings: A Clinical–Community Partnership in South Los Angeles

This study is a process evaluation of a clinical–community partnership that implemented evidence-based interventions in clinical safety net settings. Adoption and implementation of evidence-based interventions in these settings can help reduce health disparities by improving the quality of clinical preventive services in health care settings with underserved populations. A clinical–community partnership model is a possible avenue to catalyze adoption and implementation of interventions amid organizational barriers to change. Three Federally Qualified Health Centers in South Los Angeles participated in a partnership led by a local community-based organization (CBO) to implement hypertension interventions. Qualitative research methods were used to evaluate intervention selection and implementation processes between January 2014 and June 2015. Data collection tools included a key participant interview guide, health care provider interview guide, and protocol for taking meeting minutes. This case study demonstrates how a CBO acted as an external facilitator and employed a collaborative partnership model to catalyze implementation of evidence-based interventions in safety net settings. The study phases observed included initiation, planning, and implementation. Three emergent categories of organizational facilitators and barriers were identified (personnel capacity, professional development capacity, and technological capacity). Key participants and health care providers expressed a high level of satisfaction with the collaborative and the interventions, respectively. The CBO’s role as a facilitator and catalyst is a replicable model to promote intervention adoption and implementation in safety net settings. Key lessons learned are provided for researchers and practitioners interested in partnering with Federally Qualified Health Centers to implement health promotion interventions.

Perceived Barriers and Facilitators to Healthy Eating and School Lunch Meals among Adolescents: A Qualitative Study

OBJECTIVES We explored how perceived barriers and facilitators influence healthy eating and investigated the acceptability of changes to school lunch meals among adolescents after implementation of the Healthy, Hunger-Free Kids Act of 2010. METHODS We conducted 8 focus groups with adolescents (N = 64) at 3 South Los Angeles high schools. Data collection instruments included a semi-structured guide and questionnaire. Two researchers independently coded transcripts. RESULTS Most participants believed fruits and vegetables were available in their community and reported high relative cost, poor quality, and lack of motivation as barriers to consumption. Many said school meals were an important source of healthy food and were aware of recent changes to the school lunch program. A primary facilitator to eating school lunches was access to fresh food items (eg, a salad bar). Perceived barriers included long cafeteria lines, time constraints, lack of variety, and limited quantities of preferred items. Adolescents viewed off-campus food establishments near the school as competition to school meals. CONCLUSIONS Our findings suggest the need to measure perceived and actual barriers to healthy eating among adolescents and to examine the effect of these barriers on dietary behavior. We provide programmatic and policy recommendations.

Ending Cervical Cancer Screening in Low-Risk Women After Age 65: Understanding Barriers to Adherence With Evidence-Based Guidelines Among Primary Care Providers

Background: Current evidence-based cervical cancer testing guidelines recommend that screening of low-risk women ceases after age 65. Despite this, research suggests that continued testing by primary care providers remains common and represents unnecessary patient discomfort, cost, and consumption of valuable primary care resources. Objective: To understand why primary care providers might knowingly ignore consensus evidence-based screening guidelines for cervical cancer in low-risk women of this age-group and to identify barriers to adherence with best practice recommendations. Methods: A survey tool to identify barriers to adherence with current guidelines for cervical cancer screening in low-risk women older than age 65 was mailed to 4929 randomly selected primary care providers throughout California. Providers were asked to indicate the predominant reason(s) they might knowingly continue cervical cancer screening in women older than 65 years, despite evidence-based recommendations to the contrary. Results: Qualified surveys were received from 1259 (25.5%) of those surveyed, representing primary care providers of all types, practicing in areas of vastly different demographics. Despite published reassurance to the contrary, many providers retain fear that discontinuation of testing in low-risk women after age 65 may result in missed invasive cervical cancer. Even among health-care providers who agree that cessation of screening is safe, other circumstances prompt their recommendation to continue cervical screening. Conclusion: Although the data from this study suggest areas of policy intervention to lessen unnecessary cervical cancer screening, the broader implication is that advancement of evidence-based medicine will be of little value in improving the quality and cost of health care if barriers to guideline adherence are poorly understood and addressed.