Results from a lay health advisor intervention to prevent lead poisoning among rural Native American children

Effectiveness of the lay health advisor program on oral function and quality of life in aboriginal older adults: A randomized controlled trial

BACKGROUND

Aboriginal older adults residing in remote areas have poor oral function due to inadequate access to healthcare services. Lay health advisor (LHA) strategies can fill capacity shortages of healthcare professionals in rural communities and increase population acceptance of health care or healthy behaviours.

OBJECTIVE(S)

To evaluate the effectiveness the LHA program on oral function and oral health-related quality of life (OHRQoL) among older adults in aboriginal community.

METHODS

Participants were randomly assigned to an experimental group (EG; n = 122) and a control group (CG; n = 118). All participants performed oral exercises, and the EG received additional one-on-one 30-min lessons by an LHA over 4 weeks. Data were collected through face-to-face interview and oral examination. The generalized estimating equation model was used to analyse changes in outcomes over time.

RESULTS

The EG exhibited significantly greater improvement in swallowing (β = .63) at the 6-month follow-up and in masticatory performance (β = .52) and pronunciation of the syllable/pa/ (β = 2.65) at the 2-week follow-up than the CG did. The EG had a significantly lower plaque control record (β = -.14) and plaque index (β = -.30) at the 3-month follow-up than the CG did. Moreover, the OHRQoL was significantly increased at 6-months follow-up in the EG (p = .010).

CONCLUSION

The LHA program had positive effects on chewing, swallowing and plaque control in aboriginal older adults. LHA group also experienced positive long-term effect on OHRQoL after intervention.

Community Health Workers in Schools: A Systematic Review

BACKGROUND

Community health workers (CHWs) are trusted community members who provide health education and care. However, no consensus exists regarding whether community health worker-based interventions are effective within the school setting.

OBJECTIVE

To determine outcomes and best practices of school-based community health worker interventions.

DATA SOURCES

PubMed, CINAHL, and SCOPUS databases.

STUDY ELIGIBILITY CRITERIA

This systematic literature review examined articles that described an intervention led by community health workers, targeted children and/or parents, and took place primarily within a Kindergarten-12th grade school setting. Articles were excluded if they described an intervention outside the United States.

PARTICIPANTS

Community health workers, children, and/or their parents INTERVENTIONS: School-based community health worker programs RESULTS: Of 1875 articles identified, 13 met inclusion criteria and were included in the final analysis. Of these, 5 described a statistically significant primary outcome. Seven articles provided details regarding community health worker recruitment, training, and roles that would enable reproduction of the intervention.

LIMITATIONS

This review focused on interventions in the United States. Bias of individual studies had a wide range of scores (9-21). Heterogeneity of studies also precluded a meta-analysis of primary outcomes.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

The utilization of Community health workers in school-based interventions for children and/or parents is promising. This review identified a lack of detail and uniformity in program presentation, specifically with Community health worker recruitment, training, and roles. A standardized reporting mechanism for Community health worker interventions in schools would better allow for reproducibility and scalability of existing studies.

Family-centred interventions for Indigenous early childhood well-being by primary healthcare services

BACKGROUND

Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches.

OBJECTIVES

To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes.

MAIN RESULTS

We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes.

AUTHORS' CONCLUSIONS

There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years.

Insights into the Slow Uptake of Residential Lead Paint Remediation Funds: A Lancaster, Pennsylvania, Case Study

Lead poisoning is a preventable condition that continues to affect thousands of children each year. Given that local governments and municipalities are eligible to apply for federal funds to perform lead remediation in low-income family homes, we sought to understand how lead poisoning knowledge levels may affect the uptake of these funds. We recruited and conducted 28 in-depth, semi-structured interviews with community members from Lancaster County in the state of Pennsylvania in the USA. We audio-recorded and transcribed each interview, and analyzed each transcript for salient themes. The interviewed participants displayed a varying degree of knowledge about lead and lead poisoning. Most of the participants were unaware of the lead paint remediation funds. Participants learned about lead from various sources, such as social media, and personal experiences with lead poisoning appeared to enhance knowledge. Some participants assumed lead poisoning prevention would be addressed by other stakeholders if necessary, including healthcare professionals and landlords. The results of this study suggest that in order to increase the timely uptake of the remediation funds, community-based organizations should design interventions that aim to increase awareness and knowledge about lead poisoning and lead poisoning prevention. These interventions should be tailored for different audiences including community members, healthcare professionals, and landlords.

Community health workers involvement in preventative care in primary healthcare: a systematic scoping review

OBJECTIVES

To review effective models of community health worker (CHW) involvement in preventive care for disadvantaged culturally and linguistically diverse (CALD) patients in primary healthcare (PHC) that may be applicable to the Australian context.

DESIGN

Systematic scoping review.

DATA SOURCES

The studies were gathered through searching Medline, EMBASE, EMCARE, PsycINFO, CINAHL and online portals of relevant organisations.

ELIGIBILITY CRITERIA

All selected studies were original research studies which essentially evaluated preventive intervention undertake by CHWs in PHC. The intervened population were adults with or without diagnosed chronic health disease, culturally and linguistically diverse, or vulnerable due to geographic, economic and/or cultural characteristics that impede or compromise their access to healthcare.

DATA EXTRACTION AND SYNTHESIS

Data extraction was undertaken systematically in an excel spreadsheet while the findings were synthesised in a narrative manner. The quality appraisal of the selected studies was performed using effective public health practice project quality assessment tool.

RESULTS

A total of 1066 articles were identified during the initial search of six bibliographic databases. After screening the title, abstract and full text, 37 articles met the selection and methodological criteria and underwent data extraction. A high-quality evidence-base supporting the positive impact of CHWs supporting patients' access to healthcare and influencing positive behaviour change was found. Positive impacts of CHW interventions included improvements in clinical disease indicators, screening rates and behavioural change. Education-focused interventions were more effective in improving patient behaviour, whereas navigation interventions were most effective in improving access to services. Implementation was enhanced by cultural and linguistic congruence and specific training of CHWs in the intervention but reduced by short duration interventions, dropouts and poor adherence of patients.

CONCLUSION

The evidence generated from this systematic scoping review demonstrates the contribution of CHWs to improving access to preventive care for patients from CALD and disadvantaged backgrounds by providing both education and navigational interventions. More research is needed on CHW training and the incorporation of CHWs into primary health care (PHC) teams.

Exploring the role of community engagement in improving the health of disadvantaged populations: a systematic review

BACKGROUND

Although community engagement (CE) is widely used in health promotion, components of CE models associated with improved health are poorly understood. This study aimed to examine the magnitude of the impact of CE on health and health inequalities among disadvantaged populations, which methodological approaches maximise the effectiveness of CE, and components of CE that are acceptable, feasible, and effective when used among disadvantaged populations.

DESIGN

The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We carried out methodological assessments of the included studies using rating scales. The analysis focussed on model synthesis to identify the key CE components linked to positive study outcomes and comparative analysis between positive study outcomes, processes, and quality indicators of CE.

RESULTS

Out of 24 studies that met our inclusion criteria, 21 (87.5%) had positively impacted health behaviours, public health planning, health service access, health literacy, and a range of health outcomes. More than half of the studies (58%) were of good quality, whereas 71% and 42% of studies showed good community involvement in research and achieved high levels of CE, respectively. Key CE components that affected health outcomes included real power-sharing, collaborative partnerships, bidirectional learning, incorporating the voice and agency of beneficiary communities in research protocol, and using bicultural health workers for intervention delivery.

CONCLUSIONS

The findings suggest that CE models can lead to improved health and health behaviours among disadvantaged populations if designed properly and implemented through effective community consultation and participation. We also found several gaps in the current measurement of CE in health intervention studies, which suggests the importance of developing innovative approaches to measure CE impact on health outcomes in a more rigorous way.

Increasing hand washing compliance with a simple visual cue

We tested the efficacy of a simple, visual cue to increase hand washing with soap and water. Automated towel dispensers in 8 public bathrooms were set to present a towel either with or without activation by users. We set the 2 modes to operate alternately for 10 weeks. Wireless sensors were used to record entry into bathrooms. Towel and soap consumption rates were checked weekly. There were 97,351 hand-washing opportunities across all restrooms. Towel use was 22.6% higher (P=.05) and soap use was 13.3% higher (P=.003) when the dispenser presented the towel without user activation than when activation was required. Results showed that a visual cue can increase hand-washing compliance in public facilities.

A qualitative evaluation of the Avon Foundation Community Education and Outreach Initiative Patient Navigation Program

This study presents a qualitative evaluation of the Avon Foundation Community Education and Outreach Initiative (CEOI) Patient Navigation Program. Qualitative in-depth interviews were conducted with breast cancer patients (N = 18) of the CEOI Patient Navigation Program. Primary strengths of the program include the nature of the relationship between the patient and navigator, the availability of navigators to attend appointments, and the fact that navigators were breast cancer survivors. The process of enrolling patients into the program was a weakness. Participants described positive experiences with this program. They also identified areas of improvement that are relevant to other patient navigation programs in the US.

Community- and family-level factors influence care-giver choice to screen blood lead levels of children in a mining community

CONTEXT

Bunker Hill, in Kellogg, Idaho, formerly a lead mine (1884-1981) and smelter (1917-1981), is now a Superfund site listed on the Environmental Protection Agency's (EPA) National Priorities List. Lead contamination from the site is widespread due to past smelter discharges to land, water, and air, placing children at risk for both exposure to lead and resultant health effects of lead. Since 1983, the EPA has used child blood lead levels to inform the clean-up standards for the Bunker Hill Superfund site. This study was undertaken to examine factors that have contributed to the significant fall-off in the rates and numbers of children being screened for blood lead in Kellogg (number screened decreased from 195 to 8 from 2002 to 2007). The goal of this research project was to define community- and family-level factors which influence care-giver choice to screen blood lead levels of their children in this environment.

METHODS

This formative research study used mixed methods and was comprised of three research components: (1) preliminary interviews using community-based participatory research methods to define key research questions of relevance to community members, government and NGOs working in relation to the Bunker Hill clean-up; (2) a quantitative analysis of a cross-sectional household survey conducted with adult care-givers about child blood lead screening in Kellogg; and (3) ethnographic community rapid assessment methods formed the in-depth interview process and qualitative analysis.

RESULTS

The survey showed the likelihood of blood lead screening that for children under the age of 18 years increases 34% with each one-year increase in current age of the child (95% CI, 1.08-1.67, p-value=0.009), and decreases 45% with annual household income greater than $10,000 (95% CI, 0.35-0.88, p-value=0.013). Sibling birth order increased the likelihood of blood lead screening by 61% (95% CI, 1.04-2.48, p-value=0.032) for each successive child. Female children were rated by their care-givers as 3.7 times less agitated or easily angered than male children (95% CI, 1.5-8.8, p-value=0.005). Across all levels of interviews, regulators, residents, and non-governmental organization representatives reported that Kellogg's long history as a mining town has continued to influence attitudes and actions of care-givers to access blood lead screening for their children. The mining context has been described as instilling stigmas, parental blame and a sense of shame about lead exposure and resultant health effects.

DISCUSSION

Children under 6 years of age are currently the least likely to have been screened for lead in Kellogg and screening rates decreased in the 2000s. According to most indicators, socio-economic status did not influence the likelihood of a care-giver to screen children's blood lead levels. However, children in homes with an annual income below $10,000 were more likely to have been screened than the rest of the population. Former concerted screening efforts, including outreach, support, follow-up, and financial incentives in the 1980s-1990s to screen children, may have influenced low-income residents. Programmatic outreach for children under 6 years of age in Kellogg should focus on increasing female child and first child blood lead screening, rather than targeting only low-income families, by improving approaches to promotion, implementation and environmental follow-up for child lead screening. Some families have resided in Kellogg for five to six generations, and the long-term mining context influences community values and perceptions of lead exposure and screening for children through a conflicted combination of pride in the mining history, attachment to the past economy that supported the community in juxtaposition to the personalized blame, shame, guilt, and stigma associated with children having high blood lead levels. Health communication and other programs should prioritize methods of reducing parental feelings of blame, shame and guilt, and stigmas associated with the health effects of lead in a way that respects the pride of former mine workers, their families, and the history of the town.

Using network analysis to assess the evolution of organizational collaboration in response to a major environmental health threat

Effective inter-organizational collaboration is essential to a community's ability to leverage social and material resources for community problem solving, particularly in the face of complex public health problems. This study used network analysis to document the evolution of collaboration among 21 organizations in the Tar Creek Superfund site in northeastern Oklahoma from 1997 to 2005. The Tar Creek Superfund site was part of a major lead and zinc mining operation and suffers from widespread heavy metal contamination. An organizational network of 21 organizations and a subset of eight tribes were assessed through interviews at three points in time for density and centrality. In addition to collaboration on any topic, we examined information exchange and joint planning related to lead. Density scores were consistently higher in 2005 than in 1997 for both the full and tribal networks. Centralization indices for information exchange showed a marked reduction in the hierarchical structure of information exchange over time. Of particular note is that tribal linkages with local, state and federal agencies increased over time, as did inter-tribal linkages to address the lead issue.

Primary prevention of lead poisoning in rural Native American children: behavioral outcomes from a community-based intervention in a former mining region

The current study examined the effectiveness of a community-based lay health advisor intervention, combined with youth engagement, in improving lead poisoning prevention behaviors and associated beliefs in a rural Native American population located in and near a Superfund site containing mining waste. Three sequential (1997, 2000, and 2004) cross-sectional assessments involving in-person interviews with Native American and White caregivers of young children were conducted. Results showed significant improvements over time for Native American, but not for White, for children washing their hands before meals and snacks, and for annual blood lead testing of both Native American and White children. Findings lend support to the value of community-based education for primary prevention of lead poisoning in Native American and rural communities.

The Relationships Between Feelings of Satisfaction and Burden With Respect to Activity and Social Support Among Health Promotion Volunteers in Japan

Health promotion volunteers (HPVs) working to promote community health in Japan feel both satisfaction and burden with their community engagement activities. This study examined the relationship between their satisfaction and burden toward their activities and social support. A mail-in self-check questionnaire survey was distributed to 604 HPVs in Japan in September 2005. Multiple regression analysis showed that high “activity attachment” was associated with more support from family, colleagues, and public health nurses; high “personal benefit” was associated with more support from colleagues and public health nurses. It was also found that low “burden on everyday life” was associated with more support from family and colleagues and that low “psychological burden” was associated with more support from colleagues and community members. It became clear that social support from various sources was positively related to HPVs’ satisfaction and negatively related to HPVs’ burden with their activities. To encourage HPV activities, it is important to consider what kinds of social support would be most useful to increase the satisfaction and reduce the burden felt by HPVs.

Potential health impacts of heavy-metal exposure at the Tar Creek Superfund site, Ottawa County, Oklahoma

The potential impact of exposure to heavy metals and health problems was evaluated at the Tar Creek Superfund site, Ottawa County, Oklahoma, USA. Observed versus expected mortality was calculated for selected conditions in the County and exposed cities. Excess mortality was found for stroke and heart disease when comparing the exposed County to the state but not when comparing the exposed cities to the nonexposed rest of the County. However, sample sizes in the exposed area were small, population emigration has been ongoing, and geographic coding of mortality data was incomplete. In an exposed community, 62.5% of children under the age of 6 years had blood lead levels exceeding 10 microg/dl. The relationships between heavy-metal exposure and children's health and chronic disease in adults are suggestive that a more thorough investigation might be warranted. A number of possible environmental and health studies are suggested, including those focusing on possible central nervous system impacts. Unfortunately, the exposed population is dispersing. One lesson learned at this site is that health studies need to be conducted as soon as possible after an environmental problem is identified to both study the impact of the most acute exposures and to maximize study sample size-including those exposed to higher doses-and minimize the loss of individuals to follow-up.

Adaptation of a lay health advisor model as a recruitment and retention strategy in a clinical trial of college student smokers

This study describes and provides results from a process evaluation of a lay health advisor (LHA) model to enhance participation in a clinical trial of the effectiveness of motivational interviewing on smoking cessation in college fraternity and sorority members. The implementation of the model had two phases: (a) the selection and training of LHAs as liaisons between research staff and participants and (b) LHAs' roles in recruitment and retention. Perceptions of the LHA model were explored using survey questionnaires. Trial participants (N = 118) and LHAs (N = 8) were generally satisfied with the model and identified LHAs as helpful to participation. Seventy-four percent of chapter members were screened and 73% of participants received three of the four motivational interviewing sessions. These results indicate the LHA model was well received and met the needs of the research project.

Community-based participatory research: a vehicle to promote public engagement for environmental health in China

BACKGROUND

In the past 25 years, China has experienced remarkable economic growth and rapid agricultural-to-industrial and rural-to-urban transitions. As a consequence, China now faces many daunting environmental challenges that are significantly affecting human health and quality of life, including indoor and outdoor air pollution, water pollution, deforestation, loss of agricultural land, and sustainability. Chinese government leaders have recently emphasized the need for better environmental protection practices along with interventions involving strong public participation.

OBJECTIVES

Community-based participatory research (CBPR) is a collaborative approach to research that involves community members, organizational representatives, and researchers as equal participants in all phases of the research process. Over the past 15 years, CBPR has gained recognition and acceptance and is now valued as a means to effect change and provide scientific knowledge relevant to human health and the environment. In this article we highlight the success of CBPR in the United States and suggest that it could be a useful model for addressing environmental health problems in the People's Republic of China.

DISCUSSION

CBPR can reduce the tension between science and society by promoting genuine communication, by enabling scientists and administrators to listen and respond to the public, by allowing communities to help shape the research agenda, and by increasing accountability of researchers and governments to the public.

CONCLUSIONS

CBPR can potentially help improve environmental health in China, but it is likely to take a different form than it has in the West because the government will be leading the way.

A cervical cancer community-based participatory research project in a Native American community

The Messengers for Health on the Apsáalooke Reservation project uses a community-based participatory research (CBPR) approach and lay health advisors (LHAs) to generate knowledge and awareness about cervical cancer prevention among community members in a culturally competent manner. Northern Plains Native Americans, of whom Apsáalooke women are a part, continue to be disproportionately affected by cervical cancer. This article examines quantitative and qualitative changes that occurred in the community since the inception of the Messengers for Health program. Paired sample t tests are used to evaluate the one-group pretest and posttest interviews of 83 Apsáalooke women in knowledge, comfort, and cancer awareness levels. Results reveal cervical cancer knowledge gains, gains in participants' comfort discussing cancer issues, and gains in awareness of cervical cancer and the Messengers program. Field notes, meeting minutes, and community perceptions are used to qualitatively evaluate the effectiveness of the Messengers program. Practice implications are discussed.

Lay health advisor interventions among Hispanics/Latinos: a qualitative systematic review

BACKGROUND

With an expanding Hispanic/Latino community in the United States, practitioners and researchers working to promote health and prevent disease have relied on lay health advisor (LHA) models to address a variety of health issues. The primary goal of this systematic review was to explore how LHA approaches have been used and evaluated within Hispanic/Latino communities in the U.S.

METHODS

Ten literature databases were searched from their inception through July 2006, using keywords associated with LHA approaches. This review consisted of human studies that included adult Hispanics or Latinos of either gender, were conducted in the U.S., were published in English-language peer-reviewed journals, and contained enough abstractable information. Data abstraction was completed independently by three data abstractors using a standardized abstraction form that collected intervention characteristics and study results.

RESULTS

A total of 172 studies were identified and 37 met the inclusion criteria. Of these, 28 included female LHAs exclusively and five included a small number of male as well as female LHAs. Training for LHAs ranged from 6 to 160 hours. Primary roles of LHAs included: supporting participant recruitment and data collection, serving as health advisors and referral sources, distributing materials, being role models, and advocating on behalf of community members. Fourteen studies found evidence of effectiveness.

CONCLUSIONS

Given the long history of using LHAs as an approach to health promotion and disease prevention and the current emphasis of LHA approaches as a potential solution to health disparities in general, and among Hispanics/Latinos in particular, few rigorous studies have been published that document the effectiveness of LHAs on a variety of public health concerns. A stronger empirical evidence base is clearly needed.

Identification of contrastive and comparable school neighborhoods for childhood obesity and physical activity research

The neighborhood social and physical environments are considered significant factors contributing to children's inactive lifestyles, poor eating habits, and high levels of childhood obesity. Understanding of neighborhood environmental profiles is needed to facilitate community-based research and the development and implementation of community prevention and intervention programs. We sought to identify contrastive and comparable districts for childhood obesity and physical activity research studies.

We have applied GIS technology to manipulate multiple data sources to generate objective and quantitative measures of school neighborhood-level characteristics for school-based studies. GIS technology integrated data from multiple sources (land use, traffic, crime, and census tract) and available social and built environment indicators theorized to be associated with childhood obesity and physical activity. We used network analysis and geoprocessing tools within a GIS environment to integrate these data and to generate objective social and physical environment measures for school districts. We applied hierarchical cluster analysis to categorize school district groups according to their neighborhood characteristics. We tested the utility of the area characterizations by using them to select comparable and contrastive schools for two specific studies.