Eat Well El Paso!: Lessons Learned From a Community-Level Restaurant Initiative to Increase Availability of Healthy Options While Celebrating Local Cuisine

PURPOSE

Restaurants have the potential to improve nutrition and positively shape social norms. We describe lessons learned and recommended strategies from Eat Well El Paso! (EWEP), a local restaurant initiative.

DESIGN

Descriptive case study.

SETTING

EWEP partnered with local restaurants from 2012-2017 in El Paso, Texas, along the US/Mexico border.

SAMPLE

Our sampling frame included EWEP staff and managers/owners at participating restaurants, of which the majority participated (80% and 85%, respectively).

INTERVENTION

EWEP was a local restaurant initiative led by the city public health department. EWEP contracted registered dietitians to assist locally-owned restaurants to increase availability of healthy menu options.

MEASURES

Observation, key informant interviews, and document review assessed participation, barriers, and facilitators to restaurant participation and program sustainability.

ANALYSIS

Thematic and descriptive analyses.

RESULTS

57% of restaurants completed the full on-boarding process, but long-term retention was low (24% of completers). Restaurant managers/owners perceived value in marketing, nutritional analysis, and menu design. Barriers included scheduling, complexity of restaurant culture, fear of food inspections, restaurant turnover, competing responsibilities, and lack of dedicated funding.

CONCLUSION

Although local context and sample size may limit generalizability, lessons learned and recommended strategies are relevant and informative for communities working to increase restaurants' healthy menu options.

A Chronic Care Management Framework Bridging Clinic, Home, and Community Care in a Mexican American Population

Despite evidence that chronic care management improves outcomes, a framework designed for low income, uninsured populations is still needed to improve health disparities and guide further replication. We describe the Innovative Care for Chronic Conditions framework implemented by a coalition of clinics and agencies to address chronic care management for Mexican Americans with Type 2 diabetes mellitus who have low income and primarily uninsured. The core elements of the framework are described by clinic, home and community settings with community health workers playing an essential role in the delivery of community-based services that address the social determinants of health. Promising results are described. This framework expands the understanding of chronic care management approaches and contributes to further replication of the framework in diverse settings.

Changing the Game: College Dance Training for Well-Being and Resilience Amidst the COVID-19 Crisis

The COVID-19 pandemic has disrupted all aspects of life, from health to financial to social. College students in particular have faced difficulties adjusting to an entirely virtual atmosphere, compounding the normal stressors that come with full class loads and transitioning into more independent adult lives. In response to the onset of the COVID-19 crisis, a faculty member at the University of South Florida's College of Public Health designed impromptu, free dance lessons offered through a virtual video platform to the college and broader community. The lessons were offered with the intent of providing a healthy and engaging environment to help students and others in the community cope with lockdown stress, depression, and anxiety throughout spring and summer 2020. This article summarizes the structure of the intervention, lessons learned throughout implementation, and the broader practice potential during the COVID-19 pandemic and beyond.

Cardiovascular Risk Factor Knowledge among Monolingual Hispanics

Hispanics in the United States have worse cardiovascular disease (CVD) risk factor profiles than non-Hispanic Whites. Cardiovascular health literacy is important for health promotion but is not well characterized among monolingual Spanish-speaking Hispanics outside of health care settings. We recruited Hispanic participants (N=235) from a community-based health fair in Denver, Colorado. A total of 182 participants (77%) completed a subsequent language-congruent telephone survey to assess CVD risk-factor knowledge. Of these, 174 self-identified as monolingual Spanish-speaking, and constituted the analysis cohort. Cardiovascular disease risk knowledge score was defined as the number of established risk factors an individual participant could name (out of 10 pre-specified), and multivariable regression analyses were conducted to determine factors independently associated with knowledge. The mean knowledge score for the cohort was 2.2 ± 1.1 out of 10. This suggests an unmet need for tailored educational interventions beyond simple screening events.

Farmers Market Food Navigator Program: Key Stakeholder Perceptions and Program Outcomes

The Farmers Market (FM) Food Navigator program was designed over 3 years and follows a social ecological framework to increase vulnerable populations' access to local foods and build confidence to shop in a FM supporting local food systems while promoting fruit and vegetable consumption. Food Navigators followed a program Playbook, though unlike many similar programs, the program did not offer incentives to subsidize FM purchases. To inform program design and understand outcomes, data were collected from Food Navigators, shoppers, FM managers, and FM vendors. Food Navigators supported five to seven FMs each season (May through October), spending 590 days in FMs over three seasons. Due to their interaction with Food Navigators, shoppers in Season 3 (n = 689) indicated that they would: shop more at the FM (80%); eat more vegetables (52%); and purchase more vegetables (50%). Of shoppers who interacted with Food Navigators more than once (n = 55), 26% reported a higher frequency of vegetable consumption on their last survey compared with their first. In Season 3, at least half of FM managers (n = 4, 50%) and vendors (n = 68, 57%) agreed that food navigators helped increase overall market fruit and vegetables sales. Findings indicated the program did influence multiple levels of a social ecological framework as intended. FM nutrition programs can have success at increasing market sales and improving health-related behaviors without offering incentives. As a result, programs could operate with smaller budgets and be more likely to have increased shopper fruit and vegetable consumption sustainably beyond the direct subsidy of purchases.

Waiora: Connecting People, Well-Being, and Environment Through Waka Ama in Aotearoa New Zealand

Waka ama is unique as a sport because, as well as the physical benefits for paddlers, it also creates opportunities for participants to experience and connect with the natural environment. This research draws on interviews with waka ama paddlers in Aotearoa New Zealand to illustrate how the well-being of the environment connects to the spiritual, cultural, and physical health of people. Results highlight the multifaceted benefits of participating in waka ama. As well as the physical benefits for paddlers, waka ama also has a strong tikanga, which encourages language revitalization with the use of te reo Māori through karakia, waiata, and the general terms used associated with waka. It also creates opportunities for participants to experience and connect with the natural environment and improve their health. The knowledge gained from participants provide evidence of effective ways to improve health and well-being within communities with a particular focus on waiora, the spiritual connection between hauora and the environment.

Prevention Is Possible: A Brief History of the Origin and Dissemination of the Icelandic Prevention Model

In two decades, the Icelandic prevention model (IPM) has been employed to dramatically reduce rates of adolescent substance use in Iceland. Briefly, the IPM is a multisectoral, community-based, collaborative system where researchers, policy makers, administrative leaders, and practitioners join forces to reduce the odds of adolescent substance use over time. Comparatively, Iceland now ranks among the lowest in adolescent substance use in all of Europe. Since 2005, the IPM has garnered considerable international attention, and several countries or municipalities within them have adapted, or are presently adapting, the model to their needs. In this commentary, we first briefly review the history and formation of the IPM in Iceland from a school-based survey to a fully integrated prevention system. In the second part, we present a short overview of the national consensus building and institutional collaboration that led to the implementation of the model in Chile in Latin America, as a demonstrative example. In this volume of Health Promotion Practice, we also present a series of two practice-based articles that introduce the IPM. The first article, titled "Development and Guiding Principles of the Icelandic Model for Preventing Adolescent Substance Use," introduces the theoretical origins of the model, five guiding principles, and evidence of effectiveness to date. In the second article, titled "Implementing the Icelandic Model for Preventing Adolescent Substance Use," we outline 10 practice-based steps to guide model implementation in other countries. Both articles are available via open access, and both are also available online in Spanish.

Bridging the GAP: Leveraging Partnerships to Bring Quality Nutrition Education to the Gardening Apprenticeship Program

In the United States, about 12% of households are food-insecure, which can have negative health outcomes for children, including delayed development and early onset of obesity. Although many programs prioritize children, few evidence-based interventions exist for adolescents that address nutrition education. One promising intervention is teaching adolescents how to cook healthy meals. The Los Angeles Trust for Children's Health partnered with The Los Angeles Neighborhood Land Trust to integrate nutrition education and hands-on cooking demonstrations into an after-school program called the Gardening Apprenticeship Program at a local high school. Designed as a yearlong intervention, the Gardening Apprenticeship Program involves garden-based activities teaching food and environmental justice. Cultivating partnerships with other community-based organizations can help build capacity to pilot and replicate similar programs in other communities in food deserts.

Outcomes of a Community-Wide Health Intervention in a Low-Income, Primarily Hispanic Community: The Go! Austin/Vamos! Austin (GAVA) Initiative

OBJECTIVES

To describe outcomes of a 4-year physical activity (PA) and nutrition intervention (2013-2017) in Dove Springs, a low-income urban community in Texas.

METHOD

Go! Austin/Vamos! Austin is a place-based intervention targeting the built and social environments of PA and nutrition. Baseline and follow-up measures related to PA and nutrition were obtained from 357 parent-child dyads (final n = 236) in the intervention community and a control community. A three-level dose of exposure measure was created to indicate the amount of exposure to intervention activities across the 4 years. Pre-post changes in key outcomes by level of exposure and contrasts across "high exposure" and "no exposure" categories were obtained using repeated-measures regression, adjusting for important confounders.

RESULTS

"High exposure" adult participants showed consistently more favorable changes than "no exposure" participants across a variety of indicators, including positive perceptions and utilization of community PA resources, amount of moderate PA, utilization of retail outlets offering fresh produce, and measures of healthy eating. Few improvements were seen in child-level outcomes.

CONCLUSIONS

Community interventions can successfully improve health-promoting behaviors provided they ensure sufficient dose of exposure.

Implementing Play Streets in Low-Income Rural Communities in the United States

Play streets involve the temporary closure of streets that for a specified time create a safe place for active play. Play streets have been implemented primarily in cities; it is unknown if they could be adapted and implemented in rural areas. To learn about implementation, core components of play streets and inform adaptation, we conducted systematic peer-reviewed and grey literature searches and interviews with a purposive sample of key informants. Data were analyzed by theme and used to inform implementation of play streets by four community organizations in low-income rural areas of Maryland, North Carolina, Oklahoma, and Texas from June to September 2017. Core elements of play streets in urban areas were present in rural settings-the content (e.g., activities offered), delivery of the intervention in partnership with community members and local organizations, and reoccurrence of play streets at a single location. There were three key adaptations relating to delivery and context to consider uniquely when implementing play streets in rural areas (1) using locations other than streets, (2) varying locations to account for geographic dispersion, and (3) maximizing participation and resources by coupling play streets with community events. Play streets can be successfully implemented in rural settings with these modifications, which support feasibility, reach, and access. Play streets in rural areas should include activities for active play that are age-appropriate and fun, without necessarily tailoring content for rural areas.

Impact of a Healthy Retail Intervention on Fruits and Vegetables and Total Sales in Tribally Owned Convenience Stores: Findings From the THRIVE Study

BACKGROUND

Healthy retail interventions are a recommended intervention strategy to address diet-related diseases, such as obesity and diabetes; however, retail managers are concerned about their bottom line. This study's aim was to assess the impact of a healthy retail intervention on fruits and vegetables (FV) sales, as well as total sales, in tribally owned convenience stores where grocery stores are scarce.

METHOD

We analyzed weekly sales data over the first 6 months of a healthy retail intervention. We assessed the proportion of sales from two FV baskets. The FV basket included all fresh, canned, and dried FV sold at stores; while the fruits, vegetables, and salads (FVS) basket included all FV items as well as all salads sold. We compared mean weekly sales rates in intervention and control stores over the 6-month period using generalized estimating equations models to account for repeated measures.

RESULTS

Mean weekly FV basket sales rates were higher in intervention stores than control stores in both Nations. Mean weekly FVS baskets sales were significantly higher in intervention stores than control stores in one Nation and were higher, but not statistically significant, in intervention stores in the other Nation. Total sales remained steady throughout the intervention period.

CONCLUSIONS

The THRIVE (Tribal Health and Resilience in Vulnerable Environments) intervention increased FV sales without negatively affecting total sales. Policy and Practice Implications. Healthy retail interventions in tribal convenience stores, where many Native Americans living in rural areas shop due to scarcity of grocery stores, could improve diet-related disparities without reducing total sales.

Pedagogic Tailoring of a Human Research Ethics Training for Community-Engaged Research With Latinos

Because of the increase in community-engaged research, several human research ethics trainings for laypeople have been developed. We aim to (1) describe the pedagogical tailoring of a research ethics training for laypeople for a research study where promotores-community health workers-delivered an intervention to increase health care access and promote healthy behaviors among Latinos and (2) present results of the application of the training after 4 months in the field. We tailored a previously developed training to Latino community members implementing a research study. Key modifications included (1) translation (2) use of pedagogical tools, such as cooperative learning, role-plays, and inclusion of cultural preferences. One novel addition was to use dialogues that the trainees enacted and then discussed. We evaluated the training with a posttraining survey with eight community liaisons and 13 promotores implementing the intervention, and a focus group with eight promotores, 4 months after working in the field. Trainees said they felt confident obtaining informed consent, felt the dialogues were realistic and helped them remember what they learned, and wanted more feedback from trainers on their performance. Promotores demonstrated the application of ethical principles beyond the training by discussing the possibility of advertising broadly in social media (justice), the risks and benefits of providing community resources to participants (beneficence), and the university's role in legitimizing their position as promotores (respect). We conclude that a pedagogically tailored ethics research training for laypeople can be successful and that dialogues to be enacted need to be explored further.

Evaluation of the rural response system intervention to prevent violence against women: findings from a community-randomised controlled trial in the Central Region of Ghana

Background: Intimate partner violence (IPV) affects one in three women globally and undermines women’s human rights, social and economic development, and health, hence the need for integrated interventions involving communities in its prevention.

Objective: This community-randomised controlled trial evaluated the Rural Response System (RRS) intervention, which uses Community Based Action Teams to prevent IPV by raising awareness and supporting survivors, compared to no intervention.

Methods: Two districts of the Central Region of Ghana were randomly allocated to each arm. Data were collected by repeated, randomly sampled, household surveys, conducted at baseline (2000 women, 2126 men) and 24 months later (2198 women, 2328 men). The analysis used a difference in difference (DID) approach, adjusted for age and exposure to violence in childhood.

Results: In intervention communities, women’s past year experience of sexual IPV reduced from 17.1% to 7.7% versus 9.3% to 8.0% in the control communities (DID = −9.3(95%CI; −17.5,−1.0), p = 0.030). The prevalence of past-year physical IPV among women in the intervention communities reduced from 16.5% to 8.3% versus 14.6% to 10.9% in the controls (DID = −4.2(−12,3.6), p = 0.289). The prevalence of severe IPV experienced by women reduced from 21.2% to 11.6% in intervention versus 17.3% to 11.4% in controls (DID = −3.7(−12.5,5.1), p = 0.408). The direction of impact of the intervention on violence perpetrated by men was more towards a reduction but changes were not statistically significant. Emotional IPV perpetration was significantly lower (DID = −15.0(−28.5, −1.7), p = 0.031). Women’s depression scores and reports of male partner controlling behaviour significantly also reduced in the intervention arm compared to those in the control arm (DID = −4.8(−8.0,−1.5), p = 0.005; DID = −2.7(−3.3,−1.0), p = 0.002, respectively).

Conclusion: Our findings indicate that the RRS intervention reduced women’s experiences of IPV, depression, and partner controlling behaviour and some evidence of men’s reported reductions in the perpetration of IPV. The RRS intervention warrants careful scale-up in Ghana and further research.

Evaluation of a culturally sensitive social and emotional well-being program for Aboriginal and Torres Strait Islanders

OBJECTIVE

To evaluate Deadly Thinking, a social and emotional well-being promotion program targeted to remote and rural Aboriginal and Torres Strait Islander communities. Deadly Thinking aims to improve emotional health literacy, psychological well-being and attitudes towards associated help-seeking.

DESIGN

Participants completed pre/post-test evaluations via a brief self-report survey immediately before and after the Deadly Thinking workshop.

SETTING

Aboriginal and Torres Strait Islander communities in rural and regional Australia.

PARTICIPANTS

Data were obtained from 413 participants (69.8% female, mean age 41.6 years), of whom 70.4% identified as Aboriginal or Torres Strait Islanders.

INTERVENTION

Deadly Thinking workshops involve participant's engaging with a series of videos and facilitated group discussions with other participants related to social and emotional well-being topics relevant to individuals and communities.

MAIN OUTCOME MEASURES

Participants completed measures of psychological distress, suicidal ideation, substance use, changes in attitudes towards help-seeking and help-seeking intentions and satisfaction with the workshop. Additionally, participants in a train-the-trainer workshop rated their perceived confidence to deliver the program post-workshop.

RESULT

Participants reported positive perceptions of community safety and well-being and low rates of marked distress, with no significant difference between train-the-trainer and community workshop participants. Results indicated significant improvement in help-seeking intentions post-workshop and high rates of satisfaction with workshop components.

CONCLUSION

Initial evaluation indicates good acceptability and feasibility of delivering the Deadly Thinking program in rural and remote Indigenous communities; however, more robust evaluation of the program is warranted using controlled conditions to measure effectiveness, particularly for changing in help-seeking behaviour.

Capacity assessment in public health community interventions: a systematic review

The importance of building capacity in community interventions is well recognized. There is general agreement about the determinants of capacity and a range of existing capacity frameworks, however there is limited evidence or consistency in practice around assessing capacity in community interventions. The aim of this review was to describe how capacity is assessed in community interventions. A systematic review of the literature across four databases (MEDLINE, CINAHL, PsycINFO and Sociological Abstracts) was performed. Studies in English from 2000 to 2017, that explicitly described how capacity building processes were assessed in community interventions in healthy populations, were included. All types of empirical study designs were eligible. From 2596 records, after exclusion criteria were applied, 19 studies were included describing 12 different capacity assessment frameworks or tools. Seventeen studies assessed capacity processes by measuring individual capacity domains in community interventions. The most common capacity domains used to assess capacity were leadership, resources, partnerships and intelligence. The majority (n = 15) of studies used qualitative or mixed methods designs to measure capacity. Nine studies assessed capacity prospectively over time; three before/after and six multiple times during the intervention. Five studies assessed capacity retrospectively. The findings suggest that capacity assessment may need to remain context specific and flexible in order to capture the ever-changing nature of capacity building over time. Future research should explore the utility of theoretical adaptive capacity assessment guidelines that direct researchers and practitioners when describing capacity assessment in community interventions.

Promotoras Voice Their Challenges in Fulfilling Their Role as Community Health Workers

Promotoras de salud (Spanish for female community health workers) are integral to efforts to enhance the health and well-being of Latinx individuals, families, and communities. The purpose of this study was to describe the challenges that promotoras face and the proposed solutions from the perspective of the promotoras themselves. Five promotoras who worked for a year as volunteers in a community-based participatory research study, Lazos Hispanos, participated in two group interviews. Eight challenges emerged-balancing their new work with their family commitments, handling their perceived imbalance of power with men, managing the emotional impact of hearing participants' problems, facing and handling the barriers imposed by having limited English language skills, feeling discouraged by the perception of ethnocentric beliefs and discrimination from some providers, feeling disheartened by the cultural beliefs of some Latinx participants, handling the lack of transportation for themselves and for the participants, and managing the burden of data collection for the research aspect of the program. The explanation of these challenges and the practical solutions they proposed are embedded in their intersecting identities. The solutions are a valuable addition to the practice of health promotion and community-based participatory research, particularly within Latinx communities.

Formative Research and Cultural Tailoring of a Substance Abuse Prevention Program for American Indian Youth: Findings From the Intertribal Talking Circle Intervention

Background. Substance use among American Indians (AIs) is a critical health issue and accounts for many health problems such as chronic liver disease, cirrhosis, behavioral health conditions, homicide, suicide, and motor vehicle accidents. In 2013, the highest rates of substance use and dependence were seen among AIs when compared to all other population groups, although these rates vary across different tribes. Among AI adolescents, high rates of substance use have been associated with environmental and historical factors, including poverty, historical trauma, bicultural stress, and changing tribal/familial roles. Our project, the Intertribal Talking Circle intervention, involved adapting, tailoring, implementing, and evaluating an existing intervention for AI youth of three tribal communities in the United States. Formative Results. Community partnership committees (CPCs) identified alcohol, marijuana, and prescription medications as high priority substances. CPC concerns focused on the increasing substance use in their communities and the corresponding negative impacts on families, stating a lack of coping skills, positive role models, and hope for the future as concerns for youth. Cultural Tailoring Process Results. Each site formed a CPC that culturally tailored the intervention for their tribal community. This included translating Keetoowah-Cherokee language, cultural practices, and symbolism into the local tribal customs for relevance. The CPCs were essential for incorporating local context and perceived concerns around AI adolescent substance use. These results may be helpful to other tribal communities developing/implementing substance use prevention interventions for AI youth. It is critical that Indigenous cultures and local context be factored into such programs.

Retail Food Environment Intervention Planning: Interviews With Owners and Managers of Small- and Medium-Sized Rural Food Stores

Retail food environments are an important setting for promoting healthier diets and reducing the global burden of diet-related disease. The purpose of this 2-year community-university partnership was to develop a health promotion intervention for stores in a rural and remote region of British Columbia, Canada. This article reports on the qualitative interviews that were conducted with retail operators as part of an intervention planning process. Seven in-depth, semistructured interviews were conducted with store owners and managers of small- and medium-sized stores in a rural and remote region. Interviews were analyzed using thematic analysis to identify business operations and practices relevant to intervention planning and implementation. Relevant considerations for health promotion planners included the unique business models of rural stores; the prominence of regional travel and "outshopping" in rural and remote regions; challenges balancing between choice, value, and profitability; relationships with suppliers; and using local products to attract and retain customers. Involving retailers in settings-based approaches to improve population nutrition may help to mobilize existing practices and ensure that interventions are responsive to local context.

Facilitators and Barriers to Developing, Implementing, and Evaluating Healthy Vending Policies in Four Cities

Vending machines are a common source of low-nutrient, energy-dense snacks, and beverages. Many cities are beginning to adopt healthy vending policies in public areas, but evidence regarding best practices for developing, implementing, and evaluating these healthy vending polices is limited. This study used a mixed-methods, multiple case study design to examine healthy vending policies and initiatives in four cities. Data were collected between August 2017 and December 2017. Research staff worked with a designated contact person to coordinate site visits to each city where observations of the vending machines were conducted. Semistructured interviews were conducted with multiple stakeholders from each site and documents, including policies, vendor contracts, and nutrition standards, were reviewed. The following elements were identified as being essential to a healthy vending policy or initiative: having a champion and support from leadership, internal and external partnerships, and clear communication. Conducting regular compliance checks of the vending machines and the ability to obtain sales data, especially pre- and post-healthy vending policy sales data, continues to be a challenge. Stakeholders across all cities reported that concerns about profit-loss from the vendor and city revenue and procurement departments are barriers to adopting healthy vending policies. More research and evaluation are needed, as results are mixed regarding the impact on overall revenue/profits. This study yielded a variety of resources and "lessons learned" from those who have developed and implemented healthy vending policies and initiatives. This information should be used by others looking to influence healthier snacking behaviors through vending machines.

'It is important for us to see the mentors as persons' - participant experiences of a rehabilitation group

Purpose: The purpose of the study was to examine what was beneficial and what was challenging in a group intervention for young adults based on RENEW principles in a municipal employment centre. RENEW (Rehabilitation for Empowerment, Natural support, Education, and Work) is an education-oriented support model for young people. Method: The eight young adults who participated in the group and three mentors who led the group were interviewed about their experiences with the group, and a workshop was held for staff to validate the themes found in the study. Results: Three themes emerged, one denoted the importance of helpful personal relationships, both between the mentors and the young adults and among the young adults; another denoted how an authentic attitude from the mentors made group exercises inconspicuous as the group members experienced activities in the group as originating from spontaneous, genuine interest rather than the manual-based exercises they were. The last theme conveyed how the group process was challenged by the institutionally regulated compulsory attendance and the mentors' lack of teamwork resources. Conclusions: The study suggests that meeting young adults authentically and flexibly combining a certain element of self-disclosure with a manual-based group intervention such as RENEW can strengthen relatedness and convey hope, thereby supporting educational rehabilitation.

Translating systems thinking into practice for community action on childhood obesity

We report on the first 18 months of two communities' efforts using methods inspired by community-based participatory system dynamics for the development, implementation, and evaluation of whole of community efforts to improve the health of children. We apply Foster-Fishman's theoretical framework for characterizing systems change to describe the initiatives. Bounding the system began with defining leaders more broadly than standard health interventions to be those who had the ability to change environments to improve health, including food retailers, government, and business, and using high-quality childhood monitoring data to define the problem. Widespread access to junk food, barriers to physical activity, and efforts to promote health predominantly through programmatic approaches were identified as potential root causes. System interactions existed in the form of relationships between stakeholder groups and organizations. The approach described built new relationships and strengthened existing relationships. Willingness in taking risks, changing existing practice, and redesigning health promotion work to have a community development focus, were levers for change. This approach has resulted in hundreds of community-led actions focused on changing norms and environments. Insights from this approach may be useful to support other communities in translating systems theory into systems practice. Further empirical research is recommended to explore the observations in this paper.

Escaping the Prison of Mind: Meditation as Violence Prevention for the Incarcerated

People in prison are disproportionately affected by health problems, some of which lead to imprisonment and some of which are caused by imprisonment. Mental illness and substance use disorders fall into both of these categories, but they are not the only ailments affiliated with incarceration. Prior to their incarceration, many people in prison did not have safe housing or stable employment and job security, and institutional policies and/or budgetary concerns prevent many inmates from receiving adequate health care while in prison. Prison inmates in the United States are both victims and perpetrators of violence while incarcerated. In all cases, acts of violence have negative psychological consequences for the victim, including depression and shame. Mindfulness meditation training for prison inmates might be among the most effective of interventions, helping to prevent violence, improve quality of life, and reduce recidivism. Research and evaluation of data suggest that mindfulness-based nonviolence programs are transferable to other inmate populations, and the author recommends that both the private and public prison systems implement such programs nationwide, with the support of state and federal governments.

The Evaluation of IDEAL-REACH Program to Improve Nutrition among Asian American Community Members in the Philadelphia Metropolitan Area

Objective Asian Americans’ food purchasing, cooking, and eating patterns are not well understood. Greater insight into these behaviors is urgently needed to guide public health interventions of dietary behaviors in this population. The present study aims to examine the effects of a community-level intervention on food purchasing and preparation, nutrition knowledge, and health awareness in Asian Americans. Methods From 2015 to 2017, we conducted the Improving Diets with an Ecological Approach for Lifestyle (IDEAL-REACH) intervention to increase access to healthy food or beverage options for the Asian-American population in the Philadelphia metropolitan area. Participants (1110 at pre- and 1098 at post-assessment) were recruited from 31 community-based organizations (CBOs). We assessed Asian Americans’ dietary behaviors, nutrition knowledge, and awareness of heart health. Results The results of pre-post intervention comparisons showed that the IDEAL-REACH intervention was successful in promoting whole grains consumption, reducing sodium consumption, and raising knowledge and awareness related to nutrition and heart health. Conclusions To our knowledge, this is one of the first initiatives in the U.S. to engage CBOs to promote healthier dietary behaviors. The findings show that CBOs serve as a powerful platform for community-level interventions to improve healthy nutrition behaviors in Asian-American communities.

Enhancing Community-Based Participatory Research Through Human-Centered Design Strategies

Introduction. The purpose of this review is to compare and contrast the values, purpose, processes, and outcomes of human-centered design (HCD) and community-based participatory research (CBPR) approaches to address public health issues and to provide recommendations for how HCD can be incorporated into CBPR partnerships and projects. Review Process. By consulting published literature, source materials, and experts on both approaches, a team of researchers completed a three-phased process of synthesizing key similarities and differences between HCD and CBPR and generating recommendations for ways to integrate HCD strategies in CBPR projects. Results. There are five HCD strategies that can be readily incorporated into CBPR projects to improve outcomes: (1) form transdisciplinary teams, (2) center empathy, (3) recruit and work with "extreme users," (4) rapidly prototype, and (5) create tangible products or services. Conclusions. Integrating HCD in CBPR projects may lead to solutions that potentially have greater reach, are more readily adopted, are more effective, and add innovation to public health services, products, and policies.

Adjournment in Community HIV Prevention: Exploring Transitions in Community-Academic Partnerships

Barbershop-based interventions have been increasingly implemented as a means to support culturally relevant and community-accessible health promotion and disease prevention efforts. Specifically, in neighborhoods of Brooklyn, New York, with high HIV seroprevalence rates, barbers have volunteered to support an initiative to help reduce sexual risk behavior. After implementing the Barbershop Talk With Brothers program for 5 years, we explored how program participation has affected barbers' HIV prevention and counseling skills to promote their clients' health, and assessed their views of next stages of the community-academic partnership, once the specific project ended. Through employing rigorous qualitative research methods with personnel at participating barbershops, key results include that although barbers self-identify as community leaders and even as health educators, they want ongoing support in educating customers about other topics like nutrition and physical activity, including upstream social determinants of health, such as housing and employment. They are also concerned regarding how best to support continuity of efforts and maintenance of partnerships between projects. These findings provide insight toward adjourning community-based participatory research projects, which can inform other academic researchers, organizations, and businesses that partner with community members.