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Creating a Landscape of Community Population Health and Wellness Contexts for Children

Dr. Brandon Grimm, Dr. Athena Ramos, Chelsey Schlechter, & Dr. David Dzewaltowski

Dr. Brandon Grimm, Dr. Athena Ramos, Chelsey Schlechter, & Dr. David Dzewaltowski

Spotlight on Research at COPH – Preventive health behaviors, such as physical activity and healthful eating, are brief events that accumulate throughout the day.  Previous research and health professional practice have typically viewed sustained health behavior as an individual’s decision made frequently and habitually over time.  Strategies to promote healthy behavior have focused on developing knowledge and skills within individuals.  But, evidence has emerged that individual choices are made in relation to the characteristics of places and people that they interact with on a daily basis.  Solving population health behavior problems, therefore, is largely about designing more effective systems to foster health promoting community social contexts in settings where individuals live, learn, work and play.

Dr. David Dzewaltowski, Chelsey Schlechter, and their collaborators have conducted a series of investigations of community child development settings, such as childcare, schools, after school programs, scouting, and youth sport.  Utilizing a novel video observation method paired with the use of accelerometers to measure physical activity, they have demonstrated that these settings provide diverse social contexts that elicit highly variable levels of physical activity. The adult leaders of these settings define the routine social contexts that occur, and these routines ultimately drive the physical activity that children accrue.

Their paper, for example, recently published in BMC Public Health (https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5108-3) documented that in a childhood development setting (recreational sport flag football practice) only one-third of practice time was spent in moderate-to-vigorous physical activity.  Consistent with their previous work in other developmental settings, when coaches created as part of their practice routine free-play social contexts the time spent in moderate-to-vigorous physical activity was 20% greater than when coaches created sport skill or strategy instruction contexts.  These findings illustrate that, rather than children’s choices, physical activity is largely driven by the social contexts of community child development settings. And, adults may unintentionally create community social contexts that decrease population health behaviors of children.

Dr. Dzewaltowski’s team has developed a process for locally owned whole-of-community population health change through facilitating a network of organizations and leaders and developing their capacity to modify their child development setting daily routine social contexts.  Dr. Dzewaltowski’s team at UNMC, in partnership with scientists at Iowa State University and Kansas State University, have been funded by the National Cancer Institute of the National Institutes of Health to evaluate the impact of their whole-of-community process.  The process builds a community wellness landscape of health promoting social contexts. Physical activity and obesity have been linked to the prevention of many cancers and developing communities with social contexts that promote high frequency preventive health behaviors are key to cancer prevention and population health. Building on local health department partnerships, four volunteer rural communities (each having nested school, after-school, scouting/4-H club, youth sport organizations) will participate in this 5-year study funded for $2.8 million.

The UNMC Team members include Dr. David Dzewaltowski, Dr. Brandon Grimm, Dr. Athena Ramos, Chelsey Schlechter, Marisa Rosen, and Dr. Aramado De Alba.  Investigators from Iowa State and Kansas State include Cornelia Flora, Richard Rosenkranz, and Greg Welk.

This article was written by David A. Dzewaltowski, Ph.D., Community Chair for Physical Activity, Nutrition and Obesity and Professor, College of Public Health, University of Nebraska Medical Center and Buffett Early Childhood Institute

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