Peer Reviewed: The Role of State Health Departments in Supporting Community-based Obesity Prevention

Chronic Disease and Injury Section, North Carolina Division of Public Health, 1915 Mail Service Center, Raleigh, NC 27699-1915, USA.
Preventing chronic disease (Impact Factor: 2.12). 07/2011; 8(4):A87.
Source: PubMed
ABSTRACT
Recent national attention to obesity prevention has highlighted the importance of community-based initiatives. State health departments are in a unique position to offer resources and support for local obesity prevention efforts.
In North Carolina, one-third of children are overweight or obese. North Carolina's Division of Public Health supports community-based obesity prevention by awarding annual grants to local health departments, providing ongoing training and technical assistance, and engaging state-level partners and resources to support local efforts.
The North Carolina Division of Public Health administered grants to 5 counties to implement the Childhood Obesity Prevention Demonstration Project; counties simultaneously carried out interventions in the community, health care organizations, worksites, schools, child care centers, and faith communities.
The North Carolina Division of Public Health worked with 5 local health departments to implement community-wide policy and environmental changes that support healthful eating and physical activity. The state health department supported this effort by working with state partners to provide technical assistance, additional funding, and evaluation.
State health departments are well positioned to coordinate technical assistance and leverage additional support to increase the strength of community-based obesity prevention efforts.

Full-text

Available from: Cathy Thomas, Jun 24, 2014
VOLUME 8: NO. 4, A87 JULY 2011
The Role of State Health Departments in
Supporting Community-Based Obesity
Prevention
COMMUNITY CASE STUDY
Suggested citation for this article: Cousins JM, Langer
SM, Rhew LK, Thomas C. The role of state health depart-
ments in supporting community-based obesity prevention.
Prev Chronic Dis 2011;8(4):A87. http://www.cdc.gov/pcd/
issues/2011/jul/10_0181.htm. Accessed [date].
PEER REVIEWED
Abstract
Background
Recent national attention to obesity prevention has high-
lighted the importance of community-based initiatives.
State health departments are in a unique position to offer
resources and support for local obesity prevention efforts.
Community Context
In North Carolina, one-third of children are overweight
or obese. North Carolina’s Division of Public Health
supports community-based obesity prevention by award-
ing annual grants to local health departments, providing
ongoing training and technical assistance, and engaging
state-level partners and resources to support local efforts.
Methods
The North Carolina Division of Public Health administered
grants to 5 counties to implement the Childhood Obesity
Prevention Demonstration Project; counties simultane-
ously carried out interventions in the community, health
care organizations, worksites, schools, child care centers,
and faith communities.
Outcome
The North Carolina Division of Public Health worked with
5 local health departments to implement community-wide
policy and environmental changes that support healthful
eating and physical activity. The state health department
supported this effort by working with state partners to
provide technical assistance, additional funding, and
evaluation.
Interpretation
State health departments are well positioned to coordinate
technical assistance and leverage additional support to
increase the strength of community-based obesity preven-
tion efforts.
Background
More than two-thirds of North Carolina’s adults and one-
third of the state’s children are overweight or obese (1,2). To
reverse the growing obesity epidemic, the North Carolina
Division of Public Health (NCDPH) supports community-
based obesity prevention efforts through funding, training,
and technical assistance. Strong partnerships at the state
and local levels are necessary for these efforts. Community
partners include community coalitions, recreation centers,
religious organizations, physician’s offices, child care pro-
viders, and schools.
Recent federal initiatives provide support for commu-
nity-based interventions. In 2009, the Centers for Disease
Control and Prevention (CDC) released the Recommended
Community Strategies and Measurements to Prevent
Obesity in the United States (3). In 2010, CDC granted
federal stimulus funding to states, territories, tribal enti-
ties, and community initiatives for evidence-based obesity
prevention strategies through the Communities Putting
Prevention to Work initiative. For the community initia-
tives, CDC directly funded health districts serving more
Jamie M. Cousins, MPA; Sarah M. Langer, MPH; Lori K. Rhew, MA, CHES, PAPHS; Cathy Thomas, MAEd
www.cdc.gov/pcd/issues/2011/jul/10_0181.htm • Centers for Disease Control and Prevention 1
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
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2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2011/jul/10_0181.htm
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position
of the Centers for Disease Control and Prevention.
than 500,000 people; districts serving less than 500,000
could only apply through their state health department.
Additionally, First Lady Michelle Obama launched the
Let’s Move campaign in 2010, calling for comprehensive,
collaborative, and community-oriented solutions to the
childhood obesity epidemic (4). These national initiatives
promote community-based projects that address obesity
in several settings and facilitate change on the personal,
interpersonal, organizational, policy, and environmental
levels (3,4). Shape Up Somerville: Eat Smart, Play Hard
exemplified this multilevel, multisetting, community-
based approach in Massachusetts (5) and was the inspira-
tion for the Childhood Obesity Prevention Demonstration
Project (COPDP).
As communities across the nation strive to reduce and pre-
vent childhood obesity, state health departments can offer
vital resources to enhance their efforts. In 2008-2009, the
North Carolina General Assembly funded an innovative
community-based project to reduce and prevent childhood
obesity. Administered by NCDPH, COPDP offers valuable
insight for state health departments supporting multi-
level, multisetting, community-based obesity prevention.
COPDP, which was supported with substantial state fund-
ing and state health department resources, resulted in
positive change in 5 North Carolina counties. We discuss
the role of NCDPH in this community-based childhood
obesity prevention project. The purpose of this case study
is to examine the role that state health departments play
in supporting community-based efforts.
Community Context
In 2010, North Carolina ranked 11th in the nation for
childhood obesity among children aged 10 to 17 years (6).
According to the 2007 National Survey of Children, 18.6%
of North Carolina youth aged 10 to 17 years were obese
(7), compared with 16.4% nationally (8). According to
North Carolina’s Child Health Assessment and Monitoring
Program, one-third of children in North Carolina aged 10
to 17 years were overweight or obese in 2009 (2).
NCDPH support for community-based obesity prevention
NCDPH dedicates resources to build the capacity of local
health departments and local partnerships to address var-
ious health issues. Specific to healthful eating and physi-
cal activity, the NCDPH Physical Activity and Nutrition
(PAN) Branch uses federal Preventive Health and Health
Services Block Grant funds for the Statewide Health
Promotion Program. This program supports policy and
environmental change in 98 of North Carolina’s 100 coun-
ties by building local capacity through funding, training,
and technical assistance. In addition, local health depart-
ments, in collaboration with their partners, compete for
grants of up to $20,000 annually to encourage physical
activity and healthful eating in their communities by
changing policies and environments.
The PAN Branch also uses CDC grant funding to cultivate
and sustain state-level partnerships. Strong communica-
tion among state-level partners creates a more supportive
statewide context for community-based initiatives. The
most notable partnership is the Eat Smart, Move More
North Carolina (ESMM-NC) leadership team, a multidis-
ciplinary group of more than 60 statewide partner orga-
nizations. The PAN Branch provides staff support to the
ESMM-NC leadership team, which guides the ESMM-NC
movement (9) to increase opportunities for healthful eat-
ing and physical activity wherever people live, learn, earn,
play, and pray.
In 2008, the PAN Branch, with support from North
Carolina’s state health director and chronic disease direc-
tor, worked with ESMM-NC partners to advocate for state-
supported, community-based projects to address childhood
obesity. Partners used data such as the correlation between
physical inactivity and academic performance and obesity-
related health care costs to make a case for state funding
to explore best practices in preventing childhood obesity.
These partners created the COPDP plan based on the
socioecological model, a multilevel, multisetting approach
similar to the Shape Up Somerville project.
Funding
In state fiscal year 2008-2009, the North Carolina General
Assembly awarded $1.9 million to NCDPH for COPDP.
The funding was originally in the budget as recurring
but was ultimately designated as nonrecurring. The
North Carolina General Assembly directed NCDPH to
allocate the entire $1.9 million directly to local health
departments to implement COPDP; however, the North
Carolina General Assembly did not allocate funding for
the state to provide administration and technical assis-
tance. Consequently, NCDPH identified other resources
to fund a state coordinator for the project and an external
evaluation.
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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position
of the Centers for Disease Control and Prevention.
Objective of COPDP
The objective of COPDP was to implement a set of
multilevel, multisetting interventions for preventing and
reducing obesity among children in a community. For the
demonstration project, the state’s objective was to learn
lessons in community-based obesity prevention, how to
support obesity-prevention efforts, and how to apply les-
sons learned in counties across the state.
Methods
The demonstration project framework
COPDP included 8 required and 4 optional community
interventions (Table 1). Before the implementation of
COPDP, each of the interventions had been implemented
in some North Carolina communities, but no community
had implemented all of them. The interventions targeted
children and their adult role models in 6 settings: the
community at-large, health care organizations, worksites,
schools, child care centers, and religious organizations.
COPDP incorporated 4 recommended strategies for physi-
cal activity, nutrition, and obesity prevention from the
Guide to Community Preventive Services: 1) community-
wide campaigns (10), 2) community-scale urban design
and land-use policies (11), 3) worksite programs combin-
ing nutrition and physical activity (12), and 4) enhanced
physical education classes in schools (13).
COPDP required simultaneous implementation of the
interventions in 5 selected counties. A community-wide
media campaign united each of the separate COPDP
interventions under a single brand and ensured consistent
obesity prevention messages. The counties used existing
resources from the ESMM-NC statewide movement to
raise awareness of the interventions and create a support-
ive environment for physical activity and healthful eating.
County selection
NCDPH used a 2-step, competitive application process
to select counties to implement COPDP, beginning with
a request for applications in July 2008. Twenty-nine
counties submitted brief proposals describing their local
partnerships, experiences collaborating on community-
based projects, and plans to coordinate COPDP. Of these,
11 were invited to submit full applications with a detailed
plan for implementing each of the interventions. The
applications also included descriptions of the capacity of
each county’s project coordinator and key staff. NCDPH
awarded grants of $380,000 to each of 5 selected counties
beginning on October 1, 2008. In accordance with the state
fiscal year, the grant period ended May 31, 2009, giving
the counties 8 months to implement the program. The
counties ranged in population from 34,296 to 172,223 (14)
and were geographically distributed across the state.
State administration and technical assistance
NCDPH administered and provided technical assistance
for COPDP. Preventive Health and Health Services Block
Grant funds supported a full-time state coordinator at
NCDPH. The state coordinator facilitated the involvement
of state-level partners, developed a system for providing
technical assistance, maintained constant contact with
the county coordinators, and fostered sharing among the
counties. These efforts ensured the efficient engagement
of state-level expertise and resources, ongoing quality
improvement, and problem solving to support the counties
throughout COPDP. The state coordinator also monitored
the counties progress through site visits, monthly tele-
phone calls, and reviews of written monthly summary
reports.
Statewide partners assisted with COPDP by providing
additional funding, technical assistance, and training
(Table 2). For example, the North Carolina State Board of
Education provided an additional $250,000 to school dis-
tricts in the 5 counties to further support obesity preven-
tion through coordinated school health programs as part of
COPDP. In addition, COPDP counties were the first coun-
ties to participate in a new initiative to enhance physical
education in schools across the state. Through this initia-
tive, counties received technical assistance and training in
an evidence-based physical education curriculum and in
fitness-testing software. NCDPH developed a centralized
technical assistance infrastructure (Figure) to support the
counties with the COPDP interventions and to streamline
this support as much as possible.
County implementation
COPDP grants went to local health departments in each
county, which collaborated with county partnerships to
implement the project. County-level implementation was
directed by a county coordinator who worked closely with
the state coordinator to ensure the fulfillment of all grant
requirements.
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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position
of the Centers for Disease Control and Prevention.
The county partnerships were well estab-
lished before COPDP. Once funded, each
partnership assessed its membership and
added members as needed to include rep-
resentation from all intervention settings.
The number of agencies represented in
each partnership ranged from 9 to 16.
The partnerships garnered resources (eg,
volunteer time, space for classes, access
to organizations and individuals, support
from local leaders and boards) through
their existing connections and relation-
ships.
Evaluation
NCDPH funded the evaluation of COPDP
through the Prevention Research Center
at the University of North Carolina-
Chapel Hill. A full-time COPDP evaluator
worked with the state and county coordi-
nators to 1) collect output data describing
implementation, 2) measure intermediate
outcomes describing changes in the com-
munities, 3) examine the role of county
partnerships in facilitating the success of the project, and
4) identify potential long-term outcome measures. The
COPDP evaluator also conducted interviews and focus
groups, provided data analyses, and summarized findings.
NCDPH engaged statewide partners in discussion of the
evaluation results to share successes and opportunities
for further collaboration. The institutional review board of
the University of North Carolina at Chapel Hill approved
the evaluation.
Outcome
Changes
The existence of COPDP resulted in immediate policy and
environmental changes in the community, health care
organizations, worksites, schools, child care centers, and
religious organizations (Table 3). In the 5 counties, 42
child care providers made changes that affected more than
2,400 children. Policy changes to support physical activ-
ity and healthful eating in hospital and school worksites
affected more than 13,800 employees. Sixty-six children at
risk for type 2 diabetes completed a 36-session prevention
program; of the 25 children who began the program with
high triglycerides, 22 reduced their triglycerides and 14
achieved a normal range. Additionally, more than 6 miles
of greenways and sidewalks were constructed or designed.
In some cases, the effect of these changes reached beyond
county and even state lines. For instance, a child care
center’s request for skim and 1% milk led to new food
purchasing and distribution policies, which provided more
healthful milk options for affiliated child care centers
across the nation.
The media campaign blanketed communities with con-
sistent messages that tied interventions together. One
woman claimed that seeing and hearing the same ESMM-
NC messages in multiple places — both in the community
and in her workplace made her feel connected to a
larger effort. NCDPH and the counties documented suc-
cess stories like these to illustrate the personal effect on
community members. These stories were used to educate
policy makers and stakeholders.
Lessons learned
The short time line, high visibility, and the large scale
of COPDP presented challenges. Once the funding was
awarded, NCDPH quickly leveraged support from state
Figure. Technical Assistance (TA) Workflow for the Childhood Obesity Prevention Demonstration
Project (COPDP). Abbreviations: NC, North Carolina; NCAAHPERD, North Carolina Alliance for
Athletics, Health, Physical Education, Recreation, and Dance; CDC, Centers for Disease Control and
Prevention.
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of the Centers for Disease Control and Prevention.
partners for the 5 counties in the form of additional
funding, training, and technical assistance for COPDP.
NCDPH’s long-standing relationships and collaboration
with state partners made this possible.
The 8-month time line for the COPDP presented several
challenges. Incorporating grant activities, such as staff
training and a new physical education curriculum for kin-
dergarten through 8th grade, was challenging for schools
because lesson plans and teacher professional develop-
ment days had already been set for the year. Seasonal
effects also limited progress; for example, farmers’ mar-
kets closed for winter just as COPDP began.
NCDPH worked with counties to balance the need for fidel-
ity in implementation with the need for flexibility to adapt
interventions to the local context. County health depart-
ments were asked to adhere to specific grant require-
ments, even if they adapted activities. In some cases,
counties were simply not able to implement the interven-
tions as specified because of time and other constraints.
For example, several counties adapted the enrollment cri-
teria for 1 intervention because they could not otherwise
recruit enough participants in the given time frame.
A community-based health initiative’s duration affects
its sustainability, and several years of implementation
are needed to institutionalize the desired change (15).
Although COPDP was designed for 5 years of funding,
only 1 year of funding was initially awarded. NCDPH and
the counties knew that continued funding was tentative;
when a state fiscal crisis ensued in 2009, funding was not
allocated for COPDP. Counties developed sustainabil-
ity plans, but without additional resources, not all of the
interventions could be continued. Likewise, funding was
not available to evaluate the outcomes of COPDP beyond
the 8-month time frame. Further evaluation of this project
is needed to track the counties’ continued efforts and mea-
sure long-term effects. Additional results, lessons learned,
and success stories are available on the ESMM-NC
website (www.EatSmartMoveMoreNC.com/ObesityDemo/
ObesityDemo.html).
Interpretation
Communities are an essential forum for obesity preven-
tion, and state health departments are uniquely positioned
to support and enhance these efforts. States can leverage
support and help to build the local capacity needed to
implement comprehensive projects that effect change in
multiple community settings. NCDPH found that many
North Carolina counties have already united with part-
ners for obesity prevention and are well positioned to
increase the scale of their efforts. Examples of NCDPH’s
long-term commitment to strengthen the capacity of local
partnerships and public health departments include the
Statewide Health Promotion Program and the distribution
of community grants.
State health departments must think strategically about
investing in community-based health initiatives. States
funding large-scale, multilevel, and multisetting obesity
prevention projects should consider a community part-
nership’s previous experience in collaborating on similar
projects. Prior collaboration and existing relationships
equip local partnerships to work through the challenges of
these initiatives.
States should also consider the leadership capacity and
skills of local coordinators. Focus groups and in-depth
interviews with key informants in the COPDP counties
revealed that skilled county coordinators were instrumen-
tal to the success of the effort. From the community per-
spective, the coordinators were the leaders of local part-
nerships that provided opportunities to network, share
information, solve problems, and celebrate successes.
From the state perspective, the county coordinators were
necessary for troubleshooting, problem solving, engaging
state technical assistance, and facilitating data collection.
Given the state budget process, funding often comes with
short notice and duration. When offering grants for com-
munity-based projects, state health departments should
allow themselves enough time to develop clear expecta-
tions and allow grantees enough time to plan effectively
and secure partner commitments. More time before the
start of COPDP would have allowed NCDPH and partners
to better prepare materials, organize technical assistance,
and develop data collection tools. Additionally, securing
several years of funding and state resources to support
COPDP would have enhanced the degree of sustainable
change. To be effective, state health departments must
be prepared to work within the context of short timelines
and high expectations. As shown by COPDP, maintaining
strong partnerships can lead to quick mobilization and
additional resources when opportunities arise.
Finally, state health department staff time and resourc-
es are needed for community-based childhood obesity
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of the Centers for Disease Control and Prevention.
prevention programs. The state coordinator for COPDP
provided guidance on implementing evidence-based and
best practices, engaged state-level partners, and coordi-
nated technical assistance. Addressing obesity is complex,
requiring expertise in nutrition, physical activity, urban
planning, sustainable food systems, school health, and
other disciplines. Although some of this expertise exists
among the state health department staff, much of it
requires collaboration with external partners. State health
department staff are well positioned to work with partners
to coordinate technical assistance and leverage additional
support to increase the strength of community-based obe-
sity prevention efforts.
Acknowledgments
We thank the North Carolina General Assembly and the
North Carolina State Board of Education for recogniz-
ing the importance of obesity prevention and for funding
COPDP. Funding from the federal Preventive Health and
Health Services Block Grant supported administration
and evaluation of this project.
We thank the following local health departments, part-
nerships, and county coordinators for leading the way in
community-based childhood obesity prevention: Jennifer
Bryan Greene, Appalachian District Health Department a
nd the Watauga County Healthy Carolinians; Victoria
Manning, Cabarrus Health Alliance and Healthy
Cabarrus; Stephanie Bowers, Dare County Health Depart-
ment and the Dare County Childhood Obesity Prevention
Partnership; Terri Wallace, Henderson County Partnership
for Health; Linda Charping, Henderson County Department
of Public Health; and Roxanne Leopper, MooreHealth and
the Moore County Health Department.
We also thank the following state-level partners for pro-
viding support and technical assistance throughout this
project: the North Carolina State Board of Education;
North Carolina Healthy Schools Initiative (a collaboration
of the North Carolina Department of Public Instruction
and NCDPH); WakeMed Health and Hospitals; the
North Carolina Alliance for Athletics, Health, Physical
Education, Recreation, and Dance; Community Care of
North Carolina; North Carolina Partnership for Children;
the North Carolina Hospital Association; and the
University of North Carolina at Chapel Hill’s Prevention
Research Center. Several agencies within NCDPH also
contributed: North Carolina Office of Healthy Carolinians
and Health Education, North Carolina Diabetes Prevention
and Control Branch, North Carolina State Center for
Health Statistics, and the Women’s and Children’s Health
Section in NCDPH.
Finally, we thank Jenni Albright, Sharon Nelson, Mary
Bea Kolbe, and Sheree Vodicka with the NCDPH and
also Phyllis Fleming, PhD, with the University of North
Carolina at Chapel Hill’s Prevention Research Center for
their contributions to COPDP and review of this manu-
script.
Author Information
Corresponding Author: Jamie M. Cousins, MPA, Chronic
Disease and Injury Section, North Carolina Division of
Public Health, 1915 Mail Service Center, Raleigh, NC
27699-1915. Telephone: 919-707-5241. E-mail: jamie.cous-
ins@dhhs.nc.gov.
Author Affiliations: Sarah M. Langer, North Carolina
State University, Raleigh, North Carolina; Cathy Thomas,
Lori K. Rhew, Eat Smart, Move More North Carolina,
Raleigh, North Carolina. At the time of this study,
Sarah Langer was affiliated with the University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina; dur-
ing the writing of this article, she was affiliated with the
North Carolina Division of Public Health, Raleigh, North
Carolina. At the time of this study, Lori Rhew was affili-
ated with the North Carolina Division of Public Health,
Raleigh, North Carolina.
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of the Centers for Disease Control and Prevention.
Tables
Table 1. Childhood Obesity Prevention Demonstration Project (COPDP) Interventions, North Carolina, 2008-2009
Setting
Required or
Optional Intervention Description
Community
Required Partnership development Assess partnership (eg, leadership’s effectiveness, member satisfaction),
offer member training, and engage members in strategic planning and
sustainability planning
Required Built environment Complete construction or design phases of an existing project in the
county’s master plan
Required Health communication and social
marketing
Implement a community-wide campaign by using Eat Smart, Move More
North Carolina messages and branding in conjunction with local partner-
ship branding and marketing of other COPDP interventions
Optional Farmers’ market/farm stands Create or enhance farmers’ markets or farm stands to improve access to
fresh produce
Health care
Required WakeMed ENERGIZE! Program Establish clinical referral process and conduct an intensive 12-week pro-
gram for children aged 10-18 years with or at risk for diabetes and other
metabolic diseases
Required Pediatric obesity clinical tools and
training
Provide resources and training for health care providers or practices in
assessment and treatment of pediatric obesity
Worksite
Required Hospital worksite wellness Support hospital wellness committees to change policies and environ-
ments and offer initiatives to improve employee health
Optional School worksite wellness Support school wellness committees to change policies and environments
and offer programs to improve staff health
School
Required NCAAHPERD’s In-School
Prevention of Obesity and Disease
Program
Train kindergarten through high school physical education teachers on
the SPARK curriculum and FITNESSGRAM assessments, including calcula-
tion of body mass index
Optional Other coordinated school health
interventions
Improve health education, nutrition services, and healthful school environ-
ments
Child care center
Required NAP SACC program Train staff and improve policies, practices, and environments to support
physical activity and healthful eating
Faith-based
organization
Optional Faith community intervention Support leadership and wellness committees in changing policies and
environments and offering programs to improve member health
Abbreviations: NCAAHPERD, North Carolina Alliance for Athletics, Health, Physical Education, Recreation, and Dance; SPARK, Sports, Play, and Active
Recreation for Kids; NAP SACC, Nutrition and Physical Activity Self-Assessment for Child Care.
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www.cdc.gov/pcd/issues/2011/jul/10_0181.htm • Centers for Disease Control and Prevention 9
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position
of the Centers for Disease Control and Prevention.
Table 2. Role of State Partners in Implementing the Childhood Obesity Prevention Demonstration Project (COPDP)
Agency Role Activities
North Carolina Division of Public Health
(NCDPH), Physical Activity and Nutrition
Branch
Funding, administration, technical
assistance
Provided funding for a full-time state coordinator and external evalua-
tion of COPDP. Administered grants, coordinated technical assistance
from NCDPH and partners, and supported evaluation of the project
NCDPH — North Carolina Office of Healthy
Carolinians and Health Education
Advocacy support Supported local partnerships in implementing the COPDP and high-
lighted the project at the annual Healthy Carolinians conference
NCDPH — North Carolina Diabetes
Prevention and Control Branch
Technical assistance Provided technical assistance in implementing the WakeMed
ENERGIZE! Program
NCDPH — North Carolina State Center for
Health Statistics
Technical assistance Provided technical assistance on developing and implementing survey
tools for evaluation of COPDP
North Carolina State Board of Education Funding, technical assistance Provided funding to school districts (total $250,000) in COPDP coun-
ties to support coordinated school health interventions as part of
COPDP; provided technical assistance on these interventions
North Carolina Healthy Schools
a
Technical assistance Provided technical assistance on COPDP interventions to support
coordinated school health programs
WakeMed Health and Hospitals Training, technical assistance Provided training to health care practitioners in screening program
participants and provided training and technical assistance to local
health departments and partners in implementing the WakeMed
ENERGIZE! Program
North Carolina Alliance for Athletics, Health,
Physical Education, Recreation, and Dance
Training, technical assistance Coordinated SPARK curriculum training for physical education teach-
ers; provided technical assistance in implementing the In-School
Prevention of Obesity and Disease program
Community Care of North Carolina Consultation Consulted with NCDPH and COPDP counties on implementing an
intervention to train health care practitioners on the use of pediatric
obesity clinical tools
North Carolina Partnership for Children Consultation, technical assistance Consulted with NCDPH and COPDP counties on implementing the NAP
SACC program; provided technical assistance to local Partnership for
Children agencies as requested
University of North Carolina at Chapel Hill’s
Prevention Research Center
Evaluation, technical assistance Developed and implemented an evaluation plan for COPDP; provided
technical assistance to the counties and NCDPH in data collection
and analysis
Abbreviations: SPARK, Sports, Play, and Active Recreation for Kids; NAP SACC, Nutrition and Physical Activity Self-Assessment for Child Care.
a
CDC-funded partnership between the North Carolina Department of Public Instruction and North Carolina Department of Health and Human Services to sup-
port coordinated school health programs.
Page 9
VOLUME 8: NO. 4
JULY 2011
10 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2011/jul/10_0181.htm
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position
of the Centers for Disease Control and Prevention.
Table 3. Childhood Obesity Prevention Demonstration Project (COPDP) Evaluation Highlights, North Carolina, 2008-2009
Setting Intervention Evaluation Highlights
Community
Partnership development Five county partnerships completed a pre- and post-partnership self-
assessment tool and conducted at least 2 trainings for partnership mem-
bers.
Built environment Four counties built a total of 4.14 miles of sidewalks and greenways
directly accessible to more than 7,300 residents in adjacent neighbor-
hoods; 1 county completed the design and engineering phase for 1.5
miles of greenway.
Health communication and social marketing 5.7% more residents were familiar with the ESMM-NC campaign at the
end of the project.
Farmers’ market/farm stands Four counties completed action plans with initiatives to increase access
to 14 farmers’ markets or farm stands.
Health care
WakeMed ENERGIZE! program Children (n = 66) completed at least 30 of 36 sessions over a 12-week
period.
Pediatric obesity clinical tools and training Clinicians (n = 133) were trained on the importance and use of the pedi-
atric obesity tools.
Worksite
Hospital worksite wellness Six hospital systems implemented policies, environmental changes, and
initiatives with the potential to affect 13,800 employees.
School worksite wellness Four school worksite wellness committees in 3 counties implemented pol-
icies, environmental changes, and initiatives with the potential to affect
more than 2,700 staff.
School
NCAAHPERD’s In-School Prevention of Obesity and
Disease program
More than 180 teachers were trained in the SPARK curriculum.
Other coordinated school health interventions Five counties implemented initiatives, including a pilot farm-to-school pro-
gram, menu labeling, new vending policies, and installation of steamers in
school cafeterias.
Child care center
NAP SACC program Forty-two child care centers implemented a total of 266 policy and envi-
ronmental changes to support healthful eating and physical activity.
Faith-based organization
Faith community intervention Nine faith communities implemented policies, environmental changes,
and initiatives reaching an estimated 758 members.
Abbreviations: ESMM-NC, Eat Smart, Move More North Carolina; NCAAHPERD, North Carolina Alliance for Athletics, Health, Physical Education, Recreation, and
Dance; SPARK, Sports, Play, and Active Recreation for Kids; NAP SACC, Nutrition and Physical Activity Self-Assessment for Child Care.
Page 10
  • Source
    • "These findings are similar to those from other obesity prevention infrastructure initiatives that demonstrated the effectiveness of partnerships in leveraging additional funding (9). Other program evaluations describe the critical role of state health departments in supporting and strengthening community-based obesity prevention by providing technical assistance, resources, and evaluation (10). "
    [Show abstract] [Hide abstract] ABSTRACT: Although various factors affect the sustainability of public health programs, funding levels can influence many aspects of program continuity. Program evaluation in public health typically does not assess the progress of initiatives after discontinuation of funding. The objective of this study was to describe the effect of funding loss following expiration of a 5-year federal grant awarded to state health departments for development of statewide obesity prevention partnerships. The study used qualitative methods involving semistructured key informant interviews with state health departments. Data were analyzed using thematic analysis for effect of funding loss on staffing, programs, partnerships, and implementation of state plans. Many of the programs that continued to run after the grant expired operated at reduced capacity, either reaching fewer people or conducting fewer program activities for the same population. Although many states were able to leverage funding from other sources, this shift in funding source often resulted in priorities changing to meet new funding requirements. Evaluation capacity suffered in all states. Nearly all states reported losing infrastructure and capacity to communicate widely with partners. All states reported a severe or complete loss of their ability to provide training and technical assistance to partners. Despite these reduced capacities, states reported several key resources that facilitated continued work on the state plan. Decisions regarding continuation of funding are often dependent on budget constraints, evidence of success, and perceived ability to succeed in the future. Evaluating public health funding decisions may help guide development of best practice strategies for supporting long-term program success.
    Preview · Article · Nov 2013 · Preventing chronic disease
  • Source
    • "Over the past decade, PCPs have been encouraged to build partnerships across disciplines to work collaboratively with public health departments and other colleagues, to identify and decrease barriers to the health and well-being of the children in their communities, and to coordinate and focus new and existing services for the benefit for all local children [34, 35]. In the articles we reviewed, health care providers participated in six multisector obesity prevention and treatment initiatives that achieved intermediate policy and systems goals [78–80]; changes in children's food and physical activity environments [80, 81]; and population-level health outcomes, including reduced BMI scores [82, 83] and changes in overweight and obesity prevalence trends [78, 79, 83]. "
    [Show abstract] [Hide abstract] ABSTRACT: Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.
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    [Show abstract] [Hide abstract] ABSTRACT: Background. In this pilot study, the authors aimed to examine the implementation of standing desks on classroom performance and behavior. They also examined how the standing desks affected in-class physical activity and body mass index. Methods. Eight sixth graders from Hope Lutheran elementary school participated in the study (age 11.3 ± 0.5 years). Baseline and 8-month postintervention measures were step counts using (W4L Classic pedometers), height, weight, and behavioral markers. Results. Data showed that there were no statistically significant changes in the participants’ body mass index (19.4 kg/m2 vs 19.3 kg/m2), step counts (1886 steps vs 2248 steps), and behavioral markers including classroom management, concentration, and discomfort. Height and weight changes were significant and are attributed to the normal growth rate associated with the age of the participants (146.8 cm vs 151.8 cm, P < .0001; 41.4 kg vs 44.5 kg, P > .0007). Conclusions. It is feasible to integrate standing desks into a classroom without negative effects. Although the authors observed over a 19% increase in pedometer activity, it was not statistically significant. This highlights the importance for larger experimental groups and the use of more advanced physical activity tracking and body composition technologies.
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