Facilitators and Barriers to Implementation of Community-Based Socio-Ecological Approaches to Obesity Prevention Among Cooperative Extension Agents

Perceptions, knowledge, and attitudes of Cooperative Extension Service (CES) Family and Consumer Science (FCS) agents related to the planning and implementation of community-based multi-level ecological obesity prevention strategies were identified through qualitative, exploratory research. Focus group discussions (FGD) were conducted in the five regions of the Louisiana State University CES (LSU AgCenter). Participants included CES FCS Extension agents (n = 35; 97% of agents). Participants were female and responsible for conducting programming in parishes (counties). Thematic analysis of data found principal factors that influenced FCS Extension agents’ perceived ability to plan and implement community-based multi-level obesity prevention approaches to include knowledge of the socio-ecological model, beliefs about roles of CES, funding, human resources, community connectedness, community buy-in, guidance, and internal support. Assessing what FCS agents perceived as barriers and facilitators to implementing community-based obesity prevention approaches provided valuable direction to the state FCS office. Understanding gaps in knowledge, professional development needs, and existing strengths will help make the transition to community-based obesity prevention initiatives more effective. These findings may be beneficial to other CES and public health agencies implementing multi-level, community-based obesity prevention programs in partnership with community coalitions

Adapting Ripple Effect Mapping to a Virtual Survey Format

Community development projects continue despite the COVID-19 pandemic. Participatory evaluation of these projects is crucial. Ripple effect mapping (REM) is a participatory approach to evaluation that captures coalition and community member perspectives on program outcomes and impacts. In response to COVID-19, the Louisiana State University AgCenter Healthy Communities Initiative adapted REM for online delivery. The REM evaluation was found to be an effective way for community coalitions to reflect on outcomes and impacts and to motivate continued engagement

Implementing Policy, Systems, and Environmental Change Through Community Coalitions and Extension Partnerships to Address Obesity in Rural Louisiana

Community coalitions and agents funded by the Louisiana State University Agricultural Center\u27s Healthy Communities program implemented multilevel obesity prevention interventions in 3 rural parishes (ie, counties) with an obesity prevalence of 40% or higher. The Healthy Communities coalitions appraised local health concerns through needs assessments and community forums. On the basis of local needs and the evidence base, the coalitions identified and implemented policy, systems, and environmental (PSE) strategies and supporting education to promote healthy behavior change among residents, overcoming barriers in the process. Interventions varied by parish but included Complete Streets implementation plans, healthy retail initiatives, play space improvements, downtown beautification projects, and Smarter Lunchrooms

Active Transportation, Context, and Community Participation: Engaged Citizens and Destination-Based Walking and Biking

Active transportation is associated with many benefits, including improved health outcomes, higher commuting satisfaction, lower pollution, reduced traffic, and social capital. One understudied area of research on active transportation and social capital is the relationship between active transportation and community participation. Although prior work has established a connection, little is known about the contexts in which this relationship may occur, or about how active transportation may affect the relationship between a context and community participation. The purpose of Chapter 3 is to examine how active transportation may mediate the relationship between perceptions of place and community participation. Significant work has examined subjective neighborhood perceptions and aspects of social capital; however, scant work has considered active transportation as a mediator in these relationships. Using representative data from the Survey of the Health of Wisconsin (n = 1758), path analysis within a structural equation modeling framework assessed mediation, including direct, indirect, and total effects. Results suggest perceptions of place (well-maintained, interesting places with walkable destinations) has a relationship to community participation; however, when assessed for mediation through active transportation, only an indirect effect remained significant, indicating the relationship between perception of place and community participation occurs through active transportation. Chapter 4 examines the relationship between active transportation and community participation in six low- and middle-income countries. The vast majority of active transportation research examines North America, Europe, and Australia, with no known studies investigating active transportation and community participation in low- or middle-income national contexts. This chapter used data from the World Health Organization’s Study on Global Ageing and Adult Health (SAGE), which includes representative data from China, Ghana, India, Mexico, Russia, and South Africa (n = 35,064) for adults aged 50 and older. Results find a relationship between active transportation and community participation in Ghana, Russia, and South Africa but not in China, India, or Mexico. This dissertation\u27s findings indicate both context and active transportation matter for community participation. Biking and walking for transportation inherently occurs in public spaces. Public contexts are important, but how contexts are used (i.e., for active transport) makes a difference for how they impact community participation

Macro-level modifiable variables affecting breastfeeding rates.

The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend 6 months of exclusive breastfeeding followed by at least six additional months of complementary feedings. Current rates in the United States are well below recommended levels. This thesis reviews the literature surrounding modifiable macro-level variables affecting breastfeeding rates, using the Ecological Model of Health Promotion as a theoretical framework. Major recommendations include initiating paid maternity leave at the national level, restricting formula marketing practices, and making hospital breastfeeding rates publicly available.M.P.H

Perceptions of the Food Environment and Access among Predominantly Black Low-Income Residents of Rural Louisiana Communities

Food insecurity in rural settings is complex and not fully understood, especially from the perspective of low-income and Black residents. The goal of this study was to use qualitative methods to better understand experiences with food access and perceptions of the food environment among low-income, predominately Black rural Louisiana residents in the United States. Data were collected from focus group discussions (FGD) and focus group intake forms. Study participants were all rural residents eligible to receive at least one nutrition assistance program. FGD questions focused on perceptions of the food environment, with an emphasis on food access. Participants (n = 44) were predominately Black and female. Over half (n = 25) reported running out of food before the end of the month. Major themes included: store choice, outshopping, methods of acquiring foods other than the grocery store, and food insecurity. Concerns around price, quality, and transportation emerged as factors negatively impacting food security. Understanding residents’ perceptions and experiences is necessary to inform contextually appropriate and feasible policy and practice interventions that address the physical environment and social conditions that shape the broader physical food environment in order to achieve equitable food access and food security

Perceptions of the Food Environment and Access among Predominantly Black Low-Income Residents of Rural Louisiana Communities

Food insecurity in rural settings is complex and not fully understood, especially from the perspective of low-income and Black residents. The goal of this study was to use qualitative methods to better understand experiences with food access and perceptions of the food environment among low-income, predominately Black rural Louisiana residents in the United States. Data were collected from focus group discussions (FGD) and focus group intake forms. Study participants were all rural residents eligible to receive at least one nutrition assistance program. FGD questions focused on perceptions of the food environment, with an emphasis on food access. Participants (n = 44) were predominately Black and female. Over half (n = 25) reported running out of food before the end of the month. Major themes included: store choice, outshopping, methods of acquiring foods other than the grocery store, and food insecurity. Concerns around price, quality, and transportation emerged as factors negatively impacting food security. Understanding residents’ perceptions and experiences is necessary to inform contextually appropriate and feasible policy and practice interventions that address the physical environment and social conditions that shape the broader physical food environment in order to achieve equitable food access and food security

Empty Houses, Loose Dogs, and Engaged Citizens: Lessons Learned From Community Participatory Data Collection in Rural Areas

Rural surveys tend to oversample easy to reach populations, which can misrepresent community health needs. To achieve baseline data reflective of the communities served by the high obesity program (HOP), an innovative evaluation plan was created to prioritize equity and reflect the whole community. Principles of Community-Based Participatory Research (CBPR) were used to guide instrument development, research protocols, and data collection. A random sample of addresses created with United States Postal Service records provided a representative list of addresses in three HOP counties in Louisiana. Local data collectors were recruited to go door to door at the selected addresses to collect in-person surveys (N = 682; response rate of 84%). Over a quarter of participants reported using the charitable food system and walking for transportation at least weekly. Collecting door to door data in rural communities presents unique challenges, including abandoned properties, inaccurate address records, loose dogs, and at times, racial tensions and houses far removed from public roads. Lessons learned include the importance of local knowledge, adapting protocols to fit local conditions, and community awareness of the survey. Health practitioners need confidence when they are making data-based decisions about interventions, and one way to provide this confidence is to collect data from a true cross-section of the community. With a plan and in partnership with community members, a probability sample is feasible to collect in rural communities