Can communities and academia work together on public health research? Evaluation results from a community-based participatory research partnership in Detroit

This article reports the results of a formative evaluation of the first 4 years of the Detroit Community-Academic Urban Research Center (URC), a community-based participatory research partnership that was founded in 1995 with core funding from the Centers for Disease Control and Prevention (CDC). Several organizations are members of this partnership, including a university, six community-based organizations, a city health department, a health care system, and CDC. The Detroit URC is a strong partnership that has accomplished many of its goals, including the receipt of over $11 million in funding for 12 community-based participatory research projects during its initial 4 years. Detroit URC Board members identified a number of facilitating factors for their growth and achievements, such as (1) developing a sound infrastructure and set of processes for making decisions and working together, (2) building trust among partners, (3) garnering committed and active leadership from community partners, and (4) receiving support from CDC. Board members also identified a number of ongoing challenges, including organizational constraints, time pressures, and balancing community interests in interventions and academic research needs. Overall, the Detroit URC represents a partnership approach to identifying community health concerns and implementing potential solutions.

Conspiracy Theories: Evolved Functions and Psychological Mechanisms

Belief in conspiracy theories—such as that the 9/11 terrorist attacks were an inside job or that the pharmaceutical industry deliberately spreads diseases—is a widespread and culturally universal phenomenon. Why do so many people around the globe believe conspiracy theories, and why are they so influential? Previous research focused on the proximate mechanisms underlying conspiracy beliefs but ignored the distal, evolutionary origins and functions. We review evidence pertaining to two competing evolutionary hypotheses: (a) conspiracy beliefs are a by-product of a suite of psychological mechanisms (e.g., pattern recognition, agency detection, threat management, alliance detection) that evolved for different reasons, or (b) conspiracy beliefs are part of an evolved psychological mechanism specifically aimed at detecting dangerous coalitions. This latter perspective assumes that conspiracy theories are activated after specific coalition cues, which produce functional counterstrategies to cope with suspected conspiracies. Insights from social, cultural and evolutionary psychology provide tentative support for six propositions that follow from the adaptation hypothesis. We propose that people possess a functionally integrated mental system to detect conspiracies that in all likelihood has been shaped in an ancestral human environment in which hostile coalitions—that is, conspiracies that truly existed—were a frequent cause of misery, death, and reproductive loss.

Why are there so many explanations for primate brain evolution?

The question as to why primates have evolved unusually large brains has received much attention, with many alternative proposals all supported by evidence. We review the main hypotheses, the assumptions they make and the evidence for and against them. Taking as our starting point the fact that every hypothesis has sound empirical evidence to support it, we argue that the hypotheses are best interpreted in terms of a framework of evolutionary causes (selection factors), consequences (evolutionary windows of opportunity) and constraints (usually physiological limitations requiring resolution if large brains are to evolve). Explanations for brain evolution in birds and mammals generally, and primates in particular, have to be seen against the backdrop of the challenges involved with the evolution of coordinated, cohesive, bonded social groups that require novel social behaviours for their resolution, together with the specialized cognition and neural substrates that underpin this. A crucial, but frequently overlooked, issue is that fact that the evolution of large brains required energetic, physiological and time budget constraints to be overcome. In some cases, this was reflected in the evolution of 'smart foraging' and technical intelligence, but in many cases required the evolution of behavioural competences (such as coalition formation) that required novel cognitive skills. These may all have been supported by a domain-general form of cognition that can be used in many different contexts.This article is part of the themed issue 'Physiological determinants of social behaviour in animals'.

Origins of music in credible signaling

Music comprises a diverse category of cognitive phenomena that likely represent both the effects of psychological adaptations that are specific to music (e.g., rhythmic entrainment) and the effects of adaptations for non-musical functions (e.g., auditory scene analysis). How did music evolve? Here, we show that prevailing views on the evolution of music - that music is a byproduct of other evolved faculties, evolved for social bonding, or evolved to signal mate quality - are incomplete or wrong. We argue instead that music evolved as a credible signal in at least two contexts: coalitional interactions and infant care. Specifically, we propose that (1) the production and reception of coordinated, entrained rhythmic displays is a co-evolved system for credibly signaling coalition strength, size, and coordination ability; and (2) the production and reception of infant-directed song is a co-evolved system for credibly signaling parental attention to secondarily altricial infants. These proposals, supported by interdisciplinary evidence, suggest that basic features of music, such as melody and rhythm, result from adaptations in the proper domain of human music. The adaptations provide a foundation for the cultural evolution of music in its actual domain, yielding the diversity of musical forms and musical behaviors found worldwide.

Patterns of interventions and the effect of coalitions and sociality on male fitness

In group living animals, especially among primates, there is consistent evidence that high-ranking males gain a higher reproductive output than low-ranking males. Primate studies have shown that male coalitions and sociality can impact male fitness; however, it remains unclear whether males could potentially increase their fitness by preferentially supporting and socializing with females. Here we investigate patterns of male interventions and the effect of coalitions and sociality on male fitness in rhesus macaques (Macaca mulatta) with particular focus on male-female interactions. We combined behavioural observations collected on Cayo Santiago with genetic data analysed for male reproductive output and relatedness. Our results revealed that the ten top-ranking males provided the majority of all male support observed. In contrast to other primates, male rhesus macaques mainly formed all-down coalitions suggesting that coalitions are less likely used to enhance male dominance. Males supporting females during and before their likely conception were not more likely to fertilize those females. We also found no evidence that males preferably support their offspring or other close kin. Interestingly, the most important predictor of male support was sociality, since opponents sharing a higher sociality index with a given male were more likely to be supported. Furthermore, a high sociality index of a given male-female dyad resulted in a higher probability of paternity. Overall, our results strengthen the evidence that sociality affects fitness in male primates, but also suggest that in species in which males queue for dominance, it is less likely that males derive fitness benefits from coalitions.

The multiple functions of male song within the humpback whale (Megaptera novaeangliae) mating system: review, evaluation, and synthesis

Humpback whales (Megaptera novaeangliae) are seasonal breeders, annually migrating from high-latitude summer feeding grounds to low-latitude winter breeding grounds. The social matrix on the winter grounds is a loose network of interacting individuals and groups and notably includes lone males that produce long bouts of complex song that collectively yield an asynchronous chorus. Occasionally, a male will sing while accompanying other whales. Despite a wealth of knowledge about the social matrix, the full characterization of the mating system remains unresolved, without any firm consensus, as does the function of song within that system. Here, I consider and critically analyse three proposed functions of song that have received the most attention in the literature: female attraction to individual singers, determining or facilitating male-male interactions, and attracting females to a male aggregation within the context of a lekking system. Female attraction suggests that humpback song is an advertisement and invitation to females, but field observations and song playback studies reveal that female visits to individual singers are virtually absent. Other observations suggest instead that females might convey their presence to singers (or to other males) through the percussive sounds of flipper or tail slapping or possibly through vocalizations. There is some evidence for male-male interactions, both dominance and affiliative: visits to singers are almost always other lone males not singing at that time. The joiner may be seeking a coalition with the singer to engage cooperatively in attempts to obtain females, or may be seeking to disrupt the song or to affirm his dominance. Some observations support one or the other intent. However, other observations, in part based on the brevity of most pairings, suggest that the joiner is prospecting, seeking to determine whether the singer is accompanying a female, and if not soon departs. In the lekking hypothesis, the aggregation of vocalizing males on a winter ground and the visits there by non-maternal females apparently for mating meet the fundamental definition of a lekking system and its role though communal display in attracting females to the aggregation, although not to an individual singer. Communal singing is viewed as a form of by-product mutualism in which individuals benefit one another as incidental consequences of their own selfish actions. Possibly, communal singing may also act to stimulate female receptivity. Thus, there are both limitations and merit in all three proposals. Full consideration of song as serving multiple functions is therefore necessary to understand its role in the mating system and the forces acting on the evolution of song. I suggest that song may be the prime vector recruiting colonists to new winter grounds pioneered by vagrant males as population pressures increase or as former winter grounds become unavailable or undesirable, with such instances documented relatively recently. Speculatively, song may have evolved historically as an aggregating call during the dynamic ocean conditions and resulting habitat uncertainties in the late Miocene-early Pliocene epochs when Megaptera began to proliferate. Early song may have been comprised of simpler precursor sounds that through natural selection and ritualization evolved into complex song.

Implications of network structure on public health collaboratives

Interorganizational collaboration is an essential function of public health agencies. These partnerships form social networks that involve diverse types of partners and varying levels of interaction. Such collaborations are widely accepted and encouraged, yet very little comparative research exists on how public health partnerships develop and evolve, specifically in terms of how subsequent network structures are linked to outcomes. A systems science approach, that is, one that considers the interdependencies and nested features of networks, provides the appropriate methods to examine the complex nature of these networks. Applying Mays and Scutchfields's categorization of "structural signatures" (breadth, density, and centralization), this research examines how network structure influences the outcomes of public health collaboratives. Secondary data from the Program to Analyze, Record, and Track Networks to Enhance Relationships (www.partnertool.net) data set are analyzed. This data set consists of dyadic (N = 12,355), organizational (N = 2,486), and whole network (N = 99) data from public health collaborations around the United States. Network data are used to calculate structural signatures and weighted least squares regression is used to examine how network structures can predict selected intermediary outcomes (resource contributions, overall value and trust rankings, and outcomes) in public health collaboratives. Our findings suggest that network structure may have an influence on collaborative-related outcomes. The structural signature that had the most significant relationship to outcomes was density, with higher density indicating more positive outcomes. Also significant was the finding that more breadth creates new challenges such as difficulty in reaching consensus and creating ties with other members. However, assumptions that these structural components lead to improved outcomes for public health collaboratives may be slightly premature. Implications of these findings for research and practice are discussed.

Triadic social interactions operate across time: a field experiment with wild chimpanzees

Social animals cooperate with bonding partners to outcompete others. Predicting a competitor's supporter is likely to be beneficial, regardless of whether the supporting relationship is stable or transient, or whether the support happens immediately or later. Although humans make such predictions frequently, it is unclear to what extent animals have the cognitive abilities to recognize others' transient bond partners and to predict others' coalitions that extend beyond the immediate present. We conducted playback experiments with wild chimpanzees to test this. About 2 h after fighting, subjects heard recordings of aggressive barks of a bystander, who was or was not a bond partner of the former opponent. Subjects looked longer and moved away more often from barks of the former opponents' bond partners than non-bond partners. In an additional experiment, subjects moved away more from barks than socially benign calls of the same bond partner. These effects were present despite differences in genetic relatedness and considerable time delays between the two events. Chimpanzees, it appears, integrate memories of social interactions from different sources to make inferences about current interactions. This ability is crucial for connecting triadic social interactions across time, a requirement for predicting aggressive support even after a time delay.

The evolutionary significance of Red Sox nation: sport fandom as a by-product of coalitional psychology

Sport fandom has received considerable attention from social scientists, yet few have considered it from an evolutionary perspective. To redress this gap, we develop the hypothesis that team sports exhibit characteristics that activate mechanisms which evolved to facilitate the development of coalitions in the context of small-scale warfare. Based on this by-product hypothesis, we predicted a correlation between fandom and binding (i.e. group-relevant) concerns, especially loyalty. To test this prediction, we administered the Sport Spectator Identification Scale (SSI) and the Moral Foundations Questionnaire (MFQ) to 495 undergraduates. The MFQ measures three binding concerns, including loyalty, and two individualizing ones, harm and fairness. As predicted, fandom correlated significantly with loyalty (r = .27) and, within men, the two other binding concerns, authority (r =.22) and purity (r = .24). By contrast, fandom did not significantly correlate with harm or fairness. In addition, we predicted and found that men reported significantly higher levels of fandom (Cohen's d =.45) and loyalty (d = .27) than did women. In conclusion, this study presents data supporting the coalitional by-product hypothesis of fandom and should spur further research using fandom as a window into our evolved psychology.

Bonds of bros and brothers: Kinship and social bonding in postdispersal male macaques

Group-living animals often maintain a few very close affiliative relationships-social bonds-that can buffer them against many of the inevitable costs of gregariousness. Kinship plays a central role in the development of such social bonds. The bulk of research on kin biases in sociality has focused on philopatric females, who typically live in deeply kin-structured systems, with matrilineal dominance rank inheritance and life-long familiarity between kin. Closely related males, in contrast, are usually not close in rank or familiar, which offers the opportunity to test the importance of kinship per se in the formation of social bonds. So far, however, kin biases in male social bonding have only been tested in philopatric males, where familiarity remains a confounding factor. Here, we studied bonds between male Assamese macaques, a species in which males disperse from their natal groups and in which male bonds are known to affect fitness. Combining extensive behavioural data on 43 adult males over a 10-year period with DNA microsatellite relatedness analyses, we find that postdispersal males form stronger relationships with the few close kin available in the group than with the average nonkin. However, males form the majority of their bonds with nonkin and may choose nonkin over available close kin to bond with. Our results show that kinship facilitates bond formation, but is not a prerequisite for it, which suggests that strong bonds are not restricted to kin in male mammals and that animals cooperate for both direct and indirect fitness benefits.

The Benefits of Youth Engagement in HIV-Preventive Structural Change Interventions

Youth are infrequently included in planning the health promotion projects designed to benefit them as many of the factors infringing upon youth's health and well-being also limit their engagement in community-based public health promotion projects. This article explores youth engagement in 13 coalitions implementing structural changes meant to reduce HIV transmission among adolescents. There was wide variation of youth membership and involvement across coalitions. Using analytic induction, the authors show that youth engagement was associated with the successful completion of structural change efforts. The authors also describe how youth engagement indirectly facilitated coalitions' success. The authors suggest that youth engagement in planning and conducting structural interventions is itself a valuable structural change.

Dressed to kill? Visible markers of coalitional affiliation enhance conceptualized formidability

Displaying markers of coalitional affiliation is a common feature of contemporary life. In situations in which interaction with members of rival coalitions is likely, signaling coalitional affiliation may simultaneously constitute an implicit challenge to opponents and an objective commitment device, binding signalers to their coalitions. Individuals who invite conflict, and who cannot readily back out of conflict, constitute a greater threat than those who avoid conflict and preserve the option of feigning neutrality. As a consequence, the former should be viewed as more formidable than the latter. Recent research indicates that relative formidability is summarized using the envisioned physical size and strength of a potential antagonist. Thus, individuals who display markers of coalitional affiliation should be conceptualized as more physically imposing than those who do not. We tested this prediction in two experiments. In Study 1, conducted with U.S. university students, participants inspected images of sports fans' faces. In Study 2, conducted with U.S. Mechanical Turk workers, participants read vignettes depicting political partisans. In both studies, participants estimated the physical formidability of the target individuals and reported their own ability to defend themselves; in Study 2, participants estimated the target's aggressiveness. Consonant with predictions, targets depicted as signaling coalitional affiliation in situations of potential conflict were envisioned to be more physically formidable and more aggressive than were those not depicted as signaling thusly. Underscoring that the calculations at issue concern the possibility of violent conflict, participants' estimates of the protagonist's features were inversely correlated with their ability to defend themselves.

Rank acquisition in rhesus macaque yearlings following permanent maternal separation: The importance of the social and physical environment

Rank acquisition is a developmental milestone for young primates, but the processes by which primate yearlings attain social rank in the absence of the mother remain unclear. We studied 18 maternally reared yearling rhesus macaques (Macaca mulatta) that differed in their social and physical rearing environments. We found that early social experience and maternal rank, but not individual traits (weight, sex, age), predicted dominance acquisition in the new peer-only social group. Yearlings also used coalitions to reinforce the hierarchy, and social affiliation (play and grooming) was likely a product, rather than a determinant, of rank acquisition. Following relocation to a familiar environment, significant rank changes occurred indicating that familiarity with a physical environment was salient in rank acquisition. Our results add to the growing body of literature emphasizing the role of the social and physical environment on behavioral development, namely social asymmetries among peers.

Measuring Dimensions of Coalition Functioning for Effective and Participatory Community Practice

Social Work has a long history of community practice, but community practice models have been understudied. An important first step in conducting such studies is the establishment of psychometrically sound measures relevant for evaluations of community practice. In this paper, data are used from a community-randomized trial of Communities That Care (CTC), a coalition-based model of community practice shown to be effective at transforming communities and changing rates of youth problem behavior. Coalition functioning is reported by coalition members in 12 communities across intervention implementation phases. A four-dimensional model of coalition functioning (goal-directedness, efficiency, opportunities for participation, and cohesion) was confirmed using factor analysis and the dimensions were found to be invariant across time. One test of validity of these dimensions is conducted by correlating coalition members' ratings of coalition functioning with those of external observers.

Conflict transformation, stigma, and HIV-preventive structural change

Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.

Learning From Coalitions' Efforts to Promote Equity and Justice

Coalitions and collaboratives are working to address many of the most pressing contemporary health and social issues. The articles in this special issue provide numerous insights into these complex collaborative processes across different contexts and focal issues. All emphasize and scrutinize the strategies that groups are using in their work. These strategies seek to navigate not only conventional notions of effectiveness but also the challenges of pursuing greater equity and justice. In this concluding article, we distill some of the key insights from these articles as a collective. This special issue on collaborating for equity and justice can serve as a launching point for new efforts by coalitions and researchers pursuing policy, systems, and structural changes, particularly those intent on addressing root causes of health and social disparities.

Coalitional capacities and environmental strategies to prevent underage drinking

Coalitions are the most common platform for implementing community-level environmental strategies (ES), such as media, policy, or enforcement for substance use prevention. The current study examines the associations between two types of coalition capacity (general and innovation-specific) and ES implementation efforts and outputs within 14 intervention communities over a three-year period. Efforts refer to the amount of energy exerted to implement an ES while outputs refer to the materials produced through these efforts. Quantitative measures of capacity were provided by coalition key informants and expert-raters. Additionally, Training and Technical Assistance (TTA) provided proactively to improve the implementation of ES was also examined. Greater general capacity, as rated by a coalition informant, was associated with more ES policy effort. Both expert-rated general and innovation-specific capacity, however, were associated with greater ES outputs. Study results also found that community coalitions that endorsed weaker mobilization, structure and task leadership, (measures of general capacity), utilized more TTA compared to those who perceived their coalition as having greater capacity. Moreover, communities that utilized more TTA resources reported a greater number of successful policy changes. The study supports the need to consider both general and innovation-specific capacity for ES implementation and offers promising preliminary findings regarding the role of TTA for improving coalitions' capacity to facilitate policy change.

Perspectives of community partners and researchers about factors impacting coalition functioning over time

This study explored organizational and contextual factors impacting coalition functioning across 15 community-researcher coalitions that were formed to lower rates of HIV among youth. Mixed-methods (qualitative and quantitative) longitudinal data were collected from both community partners and researchers across three time points, and were analyzed to assess factors associated with initial coalition development and functioning. Specific facilitators of coalition functioning over time included developing group trust and cohesion, creating diverse coalition membership, developing a shared vision, and ensuring clarity of coalition purpose and goals. Specific barriers to coalition functioning over time included experiencing a lack of clarity over member roles and responsibilities, balancing power/resource dynamics between researchers and community partners, balancing coalition building and coalition pace, and experiencing HIV/AIDS-related stigma. Recommendations are offered for how to develop and sustain successful community-researcher coalitions over time in order to address relevant social issues.

Adaptation and Implementation of a Science-Based Prevention System in Colombia: Challenges and Achievements

During the last 2 years, the Colombian government and the Nuevos Rumbos Corporation have been implementing an adapted version of the Communities That Care (CTC) prevention system, called Comunidades Que se Cuidan (CQC) in Spanish, for use in Colombia. This brief report presents the process of implementing CQC and identifies some of the main challenges and achievements of implementing the system in eight communities in Colombia. Preliminary results of a pilot study of CQC implementation in Colombia show that prevention system development, including a focus on measuring community risk and protection, can be established successfully in Latin American communities despite a lack of rigorously tested prevention programs and strategies. Moreover, mobilizing community coalitions toward science-based prevention, with a focus on examining local risk and protective factor data, can spur development and evaluation of prevention efforts in Latin America.

Factors influencing perceived sustainability of Dutch community health programs

We assessed the perceived sustainability of community health programs organized by local intersectoral coalitions, as well as the factors that collaborating partners think might influence sustainability. Semi-structured interviews were conducted among 31 collaborating partners of 5 community health programs in deprived neighborhoods in the southern part of the Netherlands. The interview guide was based on a conceptual framework that includes factors related to the context, the leading organization, leadership, the coalition, collaborating partners, interventions and outcomes. Interviews were recorded, transcribed and content analyzed using NVivo 8.0. Participants in each of the programs varied in their perceptions of the sustainability of the program, but those people collaborating in pre-existing neighborhood structures expressed relatively high faith in their continuation. The participating citizens in particular believed that these structures would continue to address the health of the community in the future. We found factors from all categories of the conceptual framework that were perceived to influence sustainability. The program leaders appeared to be crucial to the programs, as they were frequently mentioned in close interaction with other factors. Program leaders should use a motivating and supportive leadership style and should act as 'program champions'.

Justice System Reform for Health Equity: A Mixed Methods Examination of Collaborating for Equity and Justice Principles in a Grassroots Organizing Coalition

Recent critiques of collective impact have provided a conceptual alternative that emphasizes the necessity of community organizing, and more explicit emphasis on advancing equitable systems and policy changes. This article reports results from a study of a citywide coalition in Chicago, IL that espoused many of these same principles. The coalition focused on justice system reform-systems and policy change that would dismantle punitive policies disproportionately affecting people of color-but also sought to connect these efforts with broader social determinants of health. The organizations that comprised the coalition were a pairing of those traditionally involved in restorative justice practice, and those traditionally involved in grassroots organizing. An action research partnership provided an opportunity to investigate processes and outcomes of a coalition created to advance equitable systems and policy changes. This analysis of the coalition's functioning employs a mixed methods approach. We utilize two waves of interorganizational social network data and qualitative data including participant observation, in-depth interviews, and archival document review to examine the coalition's successes and challenges related to each of the six core principles of Collaborating for Equity and Justice. This analysis provides practical insights into the benefits and challenges of implementing deeply participatory processes to address policy and systemic drivers of social determinants of health. Findings show that fully integrating all six principles is challenging, especially when a coalition represents broad constituencies across race, geography, and organizational philosophy. In such diverse settings, considerable time must be spent to build relationships and a strong foundation for sustainable processes.

Conceptual framework of the Controlling Asthma in American Cities Project

The Controlling Asthma in American Cities Project (CAACP) was designed to improve the control of asthma in inner-city populations of children with a disparate burden of symptoms and adverse outcomes. As with many chronic diseases, asthma is the manifestation of multiple biologic, environmental, and social determinants. In addition to appropriate medical management, individuals with asthma must have logistical, financial, and cultural access to environments that allow avoidance of asthma triggers and encourage good asthma management practices. In recognition of this complexity, the CAACP required the seven project sites to coordinate and synchronize multiple interventions (education, healthcare access, medical management, trigger reduction) at multiple levels (individual, home, school, community, and policy) through the collaboration of relevant groups, institutions, and individuals. This paper describes the "program theory" of the CAACP project-the assumptions about how the project worked, how the components were linked, and what outcomes were anticipated. It relates the subsequent papers in the supplement to the program theory and describes how the papers can inform and guide other community-based interventions, and advance the translation of scientific knowledge to effective interventions in communities of need.

Community Prevention Coalition Context and Capacity Assessment: Comparing the United States and Mexico

Effective planning for community health partnerships requires understanding how initial readiness-that is, contextual factors and capacity-influences implementation of activities and programs. This study compares the context and capacity of drug and violence prevention coalitions in Mexico to those in the United States. Measures of coalition context include community problems, community leadership style, and sense of community. Measures of coalition capacity include the existence of collaborative partnerships and coalition champions. The assessment was completed by 195 members of 9 coalitions in Mexico and 139 members of 7 coalitions in the United States. Psychometric analyses indicate the measures have moderate to strong internal consistency, along with good convergent and discriminant validity in both settings. Results indicate that members of Mexican coalitions perceive substantially more serious community problems, especially with respect to education, law enforcement, and access to alcohol and drugs. Compared to respondents in the United States, Mexican respondents perceive sense of community to be weaker and that prevention efforts are not as valued by the population where the coalitions are located. The Mexican coalitions appear to be operating in a substantially more challenging environment for the prevention of violence and substance use. Their ability to manage these challenges will likely play a large role in determining whether they are successful in their prevention efforts. The context and capacity assessment is a valuable tool that coalitions can use in order to identify and address initial barriers to success.

State Fall Prevention Coalitions as Systems Change Agents: An Emphasis on Policy

BACKGROUND

Falls among older adults are an escalating public health issue, which requires a multidisciplinary and multilevel approach to affect systems change to effectively address this problem. The National Council on Aging established the Falls Free® Initiative, enfolding and facilitating statewide Fall Prevention Coalitions. Fall Free® activities included developing the State Policy Toolkit for Advancing Falls Prevention to promote sustainable change by supporting the dissemination and adoption of evidence-based strategies.

PURPOSE

To (1) determine if the policies being implemented were recommended and supported by the Toolkit, (2) identify the perceived barriers and facilitators to implementing policies, and (3) identify Coalitions' current and future fall prevention policy activities.

METHODS

A 63-item online survey was distributed to State Coalition Leads. Descriptive statistics (frequencies and counts) were used to describe Coalition characteristics and activities.

RESULTS

Coalitions had several similarities, and varied greatly in their number of member organizations and members as well as meeting frequencies. Key activities included building partnerships, disseminating programs, and pursuing at least one of the eight National Council on Aging-recommended policy goals. The most commonly reported facilitator was active support from the Coalition Leads, whereas the lack of funding was the most cited barrier.

CONCLUSION

This study serves as the first national census of empirical evidence regarding Falls Coalitions' composition, goals, and activities. Results indicate that Coalitions are actively pursuing evidence-based policies but could benefit from additional technical assistance and resources. Findings support the value of Toolkit recommendations by documenting what is feasible and being implemented. Knowledge about facilitators and barriers will inform future efforts to foster sustainable systems change in states with active Coalitions and encourage Coalitions in other states.

Language, Culture, and Collectivism: Uniting Coalition Partners and Promoting Holistic Health in the Menominee Nation

Recent perspectives on Indigenous health have recognized language, culture, and values as central to well-being and recovery from historical trauma. Health coalitions, which identify community health concerns and mobilize members to implement strategies for change, have begun to shift their focus from programs to policy, systems, and environmental change but have been slower to recognize the possibilities of centering Indigenous ways of being in their work. This article details a case study of the Menominee Wellness Initiative, an Indigenous health coalition that has increasingly made language, culture, and collective values the focus of their health promotion work, and often due to the participation and influence of community organizers in the coalition. The study is presented as a collaborative writing effort between coalition members and academic partners. Qualitative data were gathered through observations of coalition meetings; in-depth, semistructured interviews with coalition members; and interactive data analysis discussions within the collaborative writing team. In the results, we describe how the shift in the coalition's framework came to be and the influence this shift has had on the coalition, its activities, and its community impacts. These findings illustrate and extend understanding of several principles of Collaborating for Equity and Justice and supports literature and practice related to health promotion through the centering of Indigenous ways.