Monica L. Wendel

The Impact of Stand-Biased Desks in Classrooms on Calorie Expenditure in Children

Childhood obesity is a public health concern with significant health and economic impacts. We conducted a prospective experimental study in 4 classrooms in central Texas to determine the effect of desks that encourage standing rather than sitting on caloric expenditure in children. Students were monitored with calorie expenditure-measuring arm-bands worn for 10 days in the fall and spring. The treatment group experienced significant increases in calorie expenditure over the control group, a finding that has implications for policy and practice.

The Evaluation of the Impact of a Stand-Biased Desk on Energy Expenditure and Physical Activity for Elementary School Students

Due to the increasing prevalence of childhood obesity, the association between classroom furniture and energy expenditure as well as physical activity was examined using a standing-desk intervention in three central-Texas elementary schools. Of the 480 students in the 24 classrooms randomly assigned to either a seated or stand-biased desk equipped classroom, 374 agreed to participate in a week-long data collection during the fall and spring semesters. Each participant’s data was collected using Sensewear® armbands and was comprised of measures of energy expenditure (EE) and step count. A hierarchical linear mixed effects model showed that children in seated desk classrooms had significantly lower (EE) and fewer steps during the standardized lecture time than children in stand-biased classrooms after adjusting for grade, race, and gender. The use of a standing desk showed a significant higher mean energy expenditure by 0.16 kcal/min (p < 0.0001) in the fall semester, and a higher EE by 0.08 kcal/min (p = 0.0092) in the spring semester.

Using stand/sit workstations in classrooms: lessons learned from a pilot study in Texas.

Childhood obesity has grown into a national epidemic since the 1980s. Many school-based intervention efforts that target childhood obesity involve curriculum and programming that demands instructional time, which disincentivizes school participation. Stand-biased classrooms are an environmental intervention that promotes standing rather than sitting by utilizing standing height desks that allow students to stand during normal classroom activities. The quasi-experimental pilot study was conducted in 5 first-grade classrooms in a Texas elementary school, with 2 control classrooms, 2 treatment classrooms, and 1 classroom that was a control in the fall and treatment in the spring (to allow for within-group comparisons). This intervention has been shown effective in significantly increasing caloric expenditure. In addition, the present study reveals potential behavioral effects from standing. This article presents lessons learned from the pilot study that may prove useful for others implementing similar interventions and calls for additional research on the academic benefits of standing for students.

The effect of stand-biased desks on academic engagement: an exploratory study

Schools have been suggested as a viable avenue to combat childhood obesity. School administrators are sometimes faced with the conflicting demands of improving the health of their students and maintaining academic performance. Dynamic furniture such as stand-biased desks may be one way to address both academic and health demands placed on schools to prevent childhood obesity. Classrooms with stand-biased desks were compared with classrooms using traditional seated desks in 2nd, 3rd, and 4th grades. The academic engagement of 282 participants was observed in the fall and spring during one academic year. The engagement of the treatment classrooms was compared with the engagement of the control classrooms. Both groups showed general increases in their academic engagement over time. Stand-biased desks do not seem to result in adverse effects on academic engagement when used in elementary classrooms. The data suggest promising results for the use of stand-biased desks in elementary school classrooms. The results suggest that stand-biased desks can be introduced in the classroom to combat childhood obesity through increasing energy expenditure without affecting academic engagement.

Community-Based Participatory Research and Community Health Development

Community-based participatory research (CBPR) has become a primary focus for public health practice and research in the past decade and is included as a core competency in public health (Calhoun et al. 2008; Minkler and Wallerstein 2008). CBPR emphasizes inclusion of ‘‘research participants’’ and communities in the process of identifying and defining problems, determining what questions to ask, how to ask the questions (methodology), interpretation of the results, the development and implementation of interventions to address public health problems, program evaluation, and dissemination of results. Thus, CBPR offers the potential for addressing power differentials between researchers and communities and appeals to a broad range of professionals interested in population health improvement (Minkler and Wallerstein 2008). In a CBPR-oriented initiative communities are engaged in the research and intervention process, and the expectation is that skills related to problem definition, assessment, research, intervention development and implementation, and evaluation skills will be transferred from researchers to community members and community capacity will be strengthened (Goodman et al. 1998; Israel et al. 2008). Related to CBPR is a strategy of community health development (CHD), which has been widely practiced in international development work but also used in the United States (Steuart 1985, 1993; Wendel et al. 2007). Community health development emphasizes the dual outcomes of improving health status of the population and building community capacity to address factors influencing health status. Rather than focusing on a single issue or need, CHD focuses on strengthening and developing community infrastructure as the vehicle and context for activities to improve the health of communities. Moreover, as described below, the underlying theoretical frame for CHD is drawn from the broad literature on community and locality development, as well as relying on the broad framework of CBPR. CHD is based on an application of multiple theories of planned social change broadly categorized as rationale-empirical, normative-re-educative, and power-coercive (Chin and Benne 1976). In a community health development strategy, planned social change is implemented through the ‘‘mixing and phasing’’ of strategies (Rothman 2001). Rothman characterized three different approaches to working with communities: locality development, social planning, and social action. These models are differentiated from each other on the J. N. Burdine (&) K. McLeroy C. Blakely M. L. Wendel Center for Community Health Development, School of Rural Public Health, Texas A&M Health Science Center, 1266 TAMU, College Station, TX 77843-1266, USA e-mail: jnburdine@srph.tamhsc.edu

Community Health Development: A Strategy for Reinventing America’s Health Care System One Community at a Time

The purpose of this article is to propose a set of ideas for reinventing America’s health care system, one community at a time. Community health development is proposed as a strategy and approach to population health improvement, the ultimate goal of health care reform. The practice of community health development, particularly the partnership approach, provides guidance about how this approach might be employed as a national health care reform strategy. Examples of two communities successfully using the partnership approach illustrate the methods described. Six specific recommendations for policy makers and public administrators in the new administration resulting from our experience with community health development are presented. First, adopt and apply community health development (CHD) as the American approach for facilitating population health improvement and building community capacity. Second, the partnership approach should be promoted as a model for communities to use in implementing CHD. Third, make the community-level the focus for planning, implementing, evaluating, and sustaining a full continuum of health and human services. Fourth, formally recognize the social determinants of health as a key component of a new population/community health status model and as a public policy driver for health care reform, marketplace issues, and population health status improvement at all levels of society. Fifth is a call for a national strategy for the recruitment, training, education, and support of individuals to facilitate this community movement. Sixth, Congress and the Obama Administration adopt and apply CHD as a national strategy and utilize American community-based experiences to bring about a national plan.

The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

Assessing depression in rural communities.

OBJECTIVES Examined the severity of depressive symptoms and the rates of probable depression assessed by different instruments that were included in two separate surveys of residents in a predominately rural region of the United States. METHOD Surveys of the Brazos Valley region in south central Texas were conducted and responses to the short form of the Center for Epidemiological Studies-Depression scale (in the 2006 survey) and the Patient Health Questionnaire-9 (in the 2010 survey) were analyzed. RESULTS Regardless of instrument used, results indicate that women and African Americans are at greater risk for depression in this underserved region, but no unique effects were found for rural residency. IMPLICATIONS Implications for research, assessment, program planning, and policy are discussed.

Increasing Access to Care for Brazos Valley, Texas: A Rural Community of Solution

Compared with their urban counterparts, rural populations face substantial disparities in terms of health care and health outcomes, particularly with regard to access to health services. To address ongoing inequities, community perspectives are increasingly important in identifying health issues and developing local solutions that are effective and sustainable. This article has been developed by both academic and community representatives and presents a brief case study of the evolution of a regional community of solution (COS) servicing a 7-county region called the Brazos Valley, Texas. The regional COS gave rise to multiple, more localized COSs that implemented similar strategies designed to address access to care within rural communities. The regional COS, known as the Brazos Valley Health Partnership, was a result of a 2002 health status assessment that revealed that rural residents face poorer access to health services and their care is often fragmented. Their localized strategy, called a health resource center, was created as a “one-stop shop” where multiple health and social service providers could be housed to deliver services to rural residents. Initially piloted in Madison County, the resource center model was expanded into Burleson, Grimes, and Leon Counties because of community buy-in at each of these sites. The resource center concept allowed service providers, who previously were able to offer services only in more populous areas, to expand into the rural communities because of reduced overhead costs. The services provided at the health resource centers include transportation, information and referral, and case management along with others, depending on the location. To ensure successful ongoing operations and future planning of the resource centers, local oversight bodies known as health resource commissions were organized within each of the rural communities to represent local COSs. Through collaboration with local entities, these partnerships have been successful in continuing to expand services and initiating health improvements within their rural communities.

Use of technology to increase access to mental health services in a rural Texas community.

The Leon County Health Resource Commission sought to increase access to mental health services for their rural community. The commission formed a network of partners who collaborated to increase free transportation to mental health services outside the community and developed a telehealth-based counseling program through a counseling psychology training program. Learning opportunities emerged during the development and implementation of these activities for both the students and the community in how to successfully utilize and sustain this service. This article describes the telehealth counseling model, presents lessons learned in the process, and presents recommendations for others interested in utilizing similar strategies.