Mark Rivera

Obesity Prevention and Diabetes Screening at Local Health Departments

OBJECTIVES We assessed whether local health departments (LHDs) were conducting obesity prevention programs and diabetes screening programs, and we examined associations between LHD characteristics and whether they conducted these programs. METHODS We used the 2005 National Profile of Local Health Departments to conduct a cross-sectional analysis of 2300 LHDs nationwide. We used multivariate logistic regressions to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Approximately 56% of LHDs had obesity prevention programs, 51% had diabetes screening programs, and 34% had both. After controlling for other factors, we found that employing health educators was significantly associated with LHDs conducting obesity prevention programs (OR = 2.08; 95% CI = 1.54, 2.81) and diabetes screening programs (OR = 1.63; 95% CI = 1.23, 2.17). We also found that conducting chronic disease surveillance was significantly associated with LHDs conducting obesity prevention programs (OR = 1.66; 95% CI = 1.26, 2.20) and diabetes screening programs (OR = 2.44; 95% CI = 1.90, 3.15). LHDs with a higher burden of diabetes prevalence were more likely to conduct diabetes screening programs (OR = 1.20; 95% CI = 1.11, 1.31) but not obesity prevention programs. CONCLUSIONS The presence of obesity prevention and diabetes screening programs was significantly associated with LHD structural capacity and general performance. However, the effectiveness and cost-effectiveness of both types of programs remain unknown.

Racial and ethnic approaches to community health: reducing health disparities by addressing social determinants of health.

Poor people and people of color are more likely to live shorter and sicker lives and are less likely to survive a host of chronic illnesses. Policies and organizational practices that improve the environments in which people live, work, learn, and play can reduce these disparities. Using the World Health Organizations “Call to Action” principles as a discussion framework, we highlight the Centers for Disease Control and Preventions Racial and Ethnic Approaches to Community Health programs that have developed and applied such strategies to address chronic illnesses. Several, in turn, foster health equity.

Community Health Workers as an Integral Strategy in the REACH U.S. Program to Eliminate Health Inequities

Mounting evidence indicates that community health workers (CHWs) contribute to improved behavioral and health outcomes and reductions in health disparities. We provide an overview (based on grantee reports and community action plans) that describe CHW contributions to 22 Racial and Ethnic Approaches to Community Health (REACH) programs funded by the Centers for Disease Control and Prevention from 2007 to 2012, offering additional evidence of their contributions to the effectiveness of community public health programs. We then highlight how CHWs helped deliver REACH U.S. community interventions to meet differing needs across communities to bridge the gap between health care services and community members, build community and individual capacity to plan and implement interventions addressing multiple chronic health conditions, and meet community needs in a culturally appropriate manner. The experience, skills, and success gained by CHWs participating in the REACH U.S. program have fostered important individual community-level changes geared to increase health equity. Finally, we underscore the importance of CHWs being embedded within these communities and the flexibility they offer to intervention strategies, both of which are characteristics critical to meeting needs of communities experiencing health disparities. CHWs served a vital role in facilitating and leading changes and will continue to do so.

Health promotion practice and the road ahead: addressing enduring gaps and encouraging greater practice-to-research translation.

A decade ago, Lancaster and Roe described four critical gaps (i.e., communications, accessibility, credibility, and expectations) between research and practice in health education and health promotion that formed the framework for this department. Despite considerable attention and some progress, these gaps persist and are barriers to interaction and translation between health promotion and health education research and practice. Looking to the next several years as the new Associate Editors for this department, we renew the department’s commitment toward addressing these enduring gaps around which we frame new questions and invite continued dialogue.