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Evaluations help to maintain participation if they include shorter-term indicators of progress symptoms you have diabetes buy generic olanzapine 7.5mg online. Evaluations of implementation ("monitoring") and of outcomes provide coalitions with a basis for improvements medicine 0636 generic 2.5mg olanzapine free shipping, better training or supervision medications in mothers milk generic olanzapine 7.5mg online, as well as the ability to press for additional changes in interventions or environments or for the enforcement of agreed-upon policies medicine kit purchase olanzapine without a prescription. Such presentations, however, are not sufficient by themselves; at a minimum, people need to know their options for action and they often require some guidance about how to implement those options. These requirements provide opportunities to work with other sectors on improving the positive impact and minimizing the negative impact on health of their proposed interventions. Yet, again, it is unclear how much community partnerships actually use such tools. Chapters 7 and 8 include these and other tools and strategies that may increase their use, such as community-based participatory research and policy mandates. Two surveys of health departments found an impressively high level of use: 100 percent of community health departments in Kansas reported using community assessments to identify health priorities (Curtis, 2002) while 73 percent of community assessments conducted by local health departments in Washington state were used this way (Spice and Snyder, 2009). Community assessments also facilitated better communication among community groups, helped with the development of new Improving the Usefulness of Obesity Evaluation Information to Potential Users 47 Copyright © National Academy of Sciences. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress partnerships, and facilitated understanding of problems (Curtis, 2002; Solet et al. In Kansas, 72 percent of the communities completing community assessments reported starting efforts to address the identified health priorities (Curtis, 2002). In Washington, community assessments were used to develop health programs, strategies, or services (42 percent); develop or modify health policies (21 percent); influence budget decisions (23 percent); and establish or modify agency strategy (26 percent) (Spice and Snyder, 2009). Yet, in New York State, researchers piloting and field-testing an evaluation instrument had difficulty identifying community stakeholders outside of health departments who were knowledgeable about community assessments (Myers and Stoto, 2006; Stoto et al. Coalitions for community substance abuse control have been found to make little use of other technical assistance tools, resources, or consultation, even when offered without cost (Hallfors et al. There are certainly opportunities to increase their utility among community groups. Community decision makers include mayors, city planners and managers, city councils, health departments, parks and recreation directors, transportation directors, school administrators, and school boards and other policy bodies. Administrators at this level may directly manage activities related to obesity prevention. They may lead or be part of formal community coalitions, or they may not, but they are often the drivers for change. Community and state governments sometimes serve as laboratories that may innovate, implement, evaluate, and pave the way for federal policies. Learning communities and practitioner networks are beginning to emerge as policy makers innovate and share information about how to institute and implement relevant policies. Following on principles from Diffusion of Innovations (Rogers, 2003), several of the examples in this chapter relate to early adopters, often opinion leaders, who are taking actions to address obesity and often provide lessons to others. In many cases, community actions are taking place in light of limited research-tested evidence on what works to prevent obesity, thus highlighting the need for strong evaluation resulting in so-called practice-based evidence (Green and Glasgow, 2006). Media attention to community or regional evaluations of innovations can accelerate their adoption and spread. This dynamic has important implications for innovations that need testing (Leviton et al. For all these reasons, community and state policy agendas are quite advanced compared to the federal agendas on obesity prevention: examples include instituting incentives and disincentives for healthful eating; reconstructing built environments; and encouraging child care, health care, worksite, and school policies. As in the case of tobacco, bold innovations in policy and environmental change appear to be coming first from community and state levels. As in the case of tobacco, lobbying by forces opposed to these policies may be less effec- 48 Evaluating Obesity Prevention Efforts Copyright © National Academy of Sciences. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress tive at state and community levels than at the national level because the multiplicity of community initiatives can outrun the lobbyists who are organized primarily to work with state and federal lawmakers. Yet, the data necessary to do so are often unavailable at the community level or not available in a timely or accessible manner. Community body mass index data in particular are often not available, although they are valued by the public and by school administrators (Haboush et al.

This is the level that includes a strong evidence base and is associated with evidence of cause and effect medications 8 rights discount generic olanzapine uk. Paradoxically treatment plan for ptsd buy discount olanzapine 7.5mg, it is the level least likely to be effective in creating and sustaining change in a complex system cancer treatment 60 minutes generic 10 mg olanzapine. Table 9-1 describes the intervention levels and associates them with objectives for evaluation 6 medications that deplete your nutrients buy genuine olanzapine online. A clear example of interventions implemented at multiple levels of a system is the tobacco experience over the past several decades. The interrelated set of activities that eventually connected several levels of interventions represents an evolution toward a systems approach to address tobacco use in the United States. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress munity, population, system, and public education levels all contributed to overall tobacco use reductions in the country. Simple rules and system levels can be used to identify opportunities to take action and may be regarded as a fundamentally different way of thinking about how to approach complex problems, such as obesity. This report builds from this knowledge base by applying a systems approach to evaluation design and implementation. The Committee built on three reports that present applicable discussion of system approaches to obesity prevention; they are briefly presented in Table 9-2 below. Systems and Evaluation: Placing a Systems Approach in Context 263 Copyright © National Academy of Sciences. This framework can help evaluators to maximize opportunities to generate evidence from policy and practice, and it can help other end users-such as public health practitioners-collect, analyze, and present information. This report developed a framework for assessing the value of community-based nonclinical prevention policies and wellness strategies. It discussed the value of a systems approach to coalition formation, research design, and analytical descriptions and evaluations. The tools range from sophisticated computer models, such as systems dynamics modeling (Homer and Hirsch, 2006; Sterman, 2006), dynamic microsimulation modeling (Mitton et al. Simulated Virtual worlds: A Quantitative Model Simulated virtual worlds, an example of a quantitative method that is based on formal models, are widely used to advance hypotheses about how a system behaves over time. The ReThink Health dynamics simulation model was designed to help planners to test different quantitatively estimated effects of scenarios by tracking changes in health status, utilization, costs, and equity following different intervention options (ReThink Health, 2012). To varying degrees, the proposed interventions address risk, care, capacity, cost, funding, and/or economic and health care trends. These simulated scenarios are also useful for evaluators because they shed light on what types of impacts can be expected under different conditions in the short- and long-term. As a result, they point to where in the system evaluators should monitor and measure change, and at what intervals of time. This iterative approach, conducted over several meetings, fosters collaboration and stakeholder involvement, and it can help to address issues of transparency by articulating underlying assumptions. It may be especially valuable when working with marginalized communities (Hovmand et al. Systems and Evaluation: Placing a Systems Approach in Context 265 Copyright © National Academy of Sciences. Some tools or methods can be applied to multiple sections or the entire framework at once, whereas others may be applied to a single step in the model. For example, a systems map can encompass sources of input, activities in the evaluation efforts, identified outputs and intended outcomes, and anticipated impacts. Examples of systems approaches to obesity prevention evaluation that may be applied to the framework are provided in Figure 9-3. The examples are presented as part of each step of the model as well as in the context of the entire model. The "Inputs" box dialogue sessions may be one example of collecting insights that follow a systems approach methodology. The "Impacts" box the need to collect School Health Policies and Practices Study and School Nutrition Dietary Assessment Study­like data on child care settings on a national and periodic basis represents another opportunity for cross-agency collaboration. In addition the ability to identify sociocultural and socioeconomic determinants, timing of exposure, and living and working conditions across populations illustrates another important multi-level relationship that follows a systems approach methodology (further described in Chapter 5 and applied in Chapters 6, 7, and 8).

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Methods for community-based participatory policy work to improve food environments in New York City symptoms low potassium discount 5 mg olanzapine with amex. Considerations for incorporating health equity into project designs: A guide for community-oriented maternal medicine 1800s order 5 mg olanzapine, neonatal medications on a plane generic 7.5 mg olanzapine visa, and child health projects treatment 8mm kidney stone olanzapine 10 mg. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress Work Group for Community Health and Development and University of Kansas. A multilevel approach to estimating small area childhood obesity prevalence at the census block-group level. Community Obesity Assessment and Surveillance 221 Copyright © National Academy of Sciences. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress 8 Monitoring and Summative Evaluation of Community Interventions1 Why: Why develop a Community-Level Obesity Intervention Monitoring and Summative Evaluation Plan? Monitoring and summative evaluation of local interventions is critically important both to guide community action and to inform national choices about the most effective and cost-effective interventions for funding, dissemination, and uptake by other communities. What: What is a Community-Level Obesity Intervention Monitoring and Summative Evaluation Plan? Complementary to the Community Obesity Assessment and Surveillance Plan (in Chapter 7), a Monitoring and Summative Evaluation Plan for community-level obesity interventions is a template to help communities to monitor implementation of the intervention and evaluate the long-term outcomes and population impacts such as behavior change, reduced prevalence of obesity, and improved health. How: How should a Community-Level Obesity Intervention Monitoring and Summative Evaluation Plan be implemented? A template for customizing plans for monitoring and summative evaluation identifies priorities to accommodate local differences in terms of opportunities for change, context, resources available for evaluating strategies recommended in the Accelerating Progress in Obesity Prevention report, and stakeholder input. Because innovations in obesity prevention often receive their initial test at the community level, rigorous and practical methods are desirable to build national knowledge. Combining knowledge from both experimental studies and practice experience can inform national evaluation by casting light on the prevalence of strategies, their feasibility, and their ease of implementation. A portion of this chapter content was drawn from commissioned work for the Committee by Allen Cheadle, Ph. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress T his chapter presents guidance to develop plans for monitoring and evaluating2 community-level obesity prevention interventions. Monitoring and evaluating community-level efforts to prevent obesity is critical for accelerating national progress in obesity prevention and for providing evidence to inform a national plan for evaluation. Community-level evaluation encompasses the issues of learning not only "what works," but also the relative feasibility to implement interventions in different situations and the comparative effectiveness of various strategies-the extent to which they work. In line with "what works," monitoring of the implementation of interventions also informs local implementers on how to improve and manage interventions. Finally, it encompasses translating effective interventions for implementation on a broader scale and determining the contexts in which they are and are not effective. This learning will allow greater return on national investments in obesity prevention. Communities vary widely with respect to population size, diversity, context, and impact of obesity. Community capacities for monitoring and summative evaluation are also highly variable, with a wide range of expertise and resources for collecting and using data to evaluate the implementation and effectiveness of interventions. Community intervention monitoring and summative evaluation can be focused on programs, systems, policies, or environmental changes, or any combination of these in multi-faceted initiatives. In the past, local efforts focused mostly on counseling, education, and behavior-change programs delivered directly to individuals as well as some broader school-based and community-based programs. Evaluation is the effort to detect changes in output, outcomes, and impacts associated with interventions and to attribute those changes to the interventions. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress munity organizations). This chapter covers some important considerations for monitoring and summative evaluation that exist across obesity prevention programs and community-level initiatives. The chapter emphasizes the particular challenges and opportunities of community-level evaluation, for which evaluation methods are less well established and evolving. This makes the monitoring of implementation essential and the use of rigorous evaluation methods more challenging (Hawkins et al. Any evaluation must weigh trade-offs between internal and external validity, feasibility, and ethics versus experimental control, and intrusiveness versus free choice among participants. These decisions become more difficult for initiatives that arise from community decision making (Mercer et al.

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Neighborhood design and rates of walking and biking to elementary school in 34 California communities medicine ketorolac purchase olanzapine 7.5 mg with amex. Reliability and validity of the healthy home survey: A tool to measure factors within homes hypothesized to relate to overweight in children medications safe while breastfeeding order olanzapine 10mg with mastercard. Neighborhood playgrounds medications similar buspar olanzapine 10 mg low cost, fast food restaurants symptoms 3 days after conception discount 7.5mg olanzapine, and crime: Relationships to overweight in low-income preschool children. Parental report of outdoor playtime as a measure of physical activity in preschool-aged children. Measuring cues for healthy choices on restaurant menus: Development and testing of a measurement instrument. Environmental and policy factors associated with overweight among adults in Missouri. Fast-food outlets and walkability in school neighbourhoods predict fatness in boys and height in girls: A Taiwanese population study. Texas school food policy changes related to middle school a la carte/snack bar foods: Potential savings in kilocalories. The impact of the Texas public school nutrition policy on student food selection and sales in Texas. Food expenditures and food purchasing among low-income, urban, African-American youth. Community food environment, home food environment, and fruit and vegetable intake of children and adolescents. Mapping access to food in a deprived area: the development of price and availability indices. Active community environments and health: the relationship of walkable and safe communities to individual health. School-based behavioral assessment tools are reliable and valid for measurement of fruit and vegetable intake, physical activity, and television viewing in young children. Ecological and socioeconomic correlates of fruit, juice, and vegetable consumption among African-American boys. Reducing sedentary behavior: the relationship between park area and the physical activity of youth. Test-retest reliability of a questionnaire to assess physical environmental factors pertaining to physical activity. Test-retest reliability of a questionnaire on physical activity and its correlates among women from diverse racial and ethnic groups. Obesity relationships with community design, physical activity, and time spent in cars. Validation of a survey instrument to assess home environments for physical activity and healthy eating in overweight children. Inequality in the built environment underlies key health disparities in physical activity and obesity. Environmental resources moderate the relationship between social support and school sports participation among adolescents: A cross-sectional analysis. Observations of marketing on food packaging targeted to youth in retail food stores. The quality of school wellness policies and energy-balance behaviors of adolescent mothers. Environmental influences on dietary behavior among children: Availability and accessibility of fruits and vegetables enable consumption. Fruit and vegetable access in four lower income food deserts communities in Minnesota. Using observational methods to evaluate public open spaces and physical activity in Brazil. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress Horodynski, M. Mealtime television viewing and dietary quality in low-income African American and caucasian mother-toddler dyads. Barriers to buying healthy foods for people with diabetes: Evidence of environmental disparities.

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