Planning for the North Carolina healthy homes initiative

Substandard housing conditions have been linked to widespread childhood environmental health ailments, including two of the leading causes of childhood morbidity: lead poisoning and asthma. In 2009, the United States Surgeon General called for action around healthy homes. Improving home health environments can alleviate the cycle of childhood morbidity and mortality. The North Carolina (NC) Department of Environment and Natural Resources Children's Environmental Health Branch is working to build capacity at the State level to expand the childhood lead poisoning prevention program to respond to additional in-home environmental health issues. To achieve this objective, North Carolina must consider recommendations for assessment, management, and evaluation. This paper will situate healthy homes on the national public health agenda; discuss ways that healthy homes programs address children's environmental health disparities; introduce the NC Healthy Homes Initiative; explore current healthy housing efforts in North Carolina through an examination of the Guilford County Healthy Homes Initiative; and provide recommendations for the NC Healthy Homes Initiative to address children's environmental health disparities.     

A sustainability assessment of a health equity fund initiative in Cambodia

All but one of the health equity funds (HEFs) currently operating in Cambodia, introduced to address the adverse effects of low user fee exemption rates, rely heavily on external funding and have high administrative overheads. This article reports on a study of one type of HEF, based in Kirivong Operational Health District (KOD) and operated through local pagoda structures, which demonstrates minimal reliance on external funding and low administrative overheads. We utilize an adapted sustainability assessment framework to assess the ability of pagoda structures to enable financial access for the poorest to public sector health services. We further analyse the strengths and limitations of the pagoda-managed equity fund initiative, with a view to assessing not only its sustainability but its potential for replication in other settings.Our study shows that, against key sustainability indicators (health service utilization and health outcomes; management capacity and financial viability; community mobilization and government support), the pagoda-managed equity fund initiative scores well. However, it is evident that some external financial support is needed to allow the HEFs to function effectively. We conclude with recommendations for replicating the initiative, which include working innovatively with indigenous grassroots organizations to enhance community HEF ownership and to keep administrative overheads low.     

The healthy Hawaii initiative: A social ecological approach promoting healthy communities

PURPOSE: The tobacco settlement has provided the opportunity for the state of Hawaii to implement the Healthy Hawaii Initiative (HHI), targeting smoking, poor nutrition and physical inactivity. The purpose of this paper is to describe and document preliminary findings. METHODS: The social ecological model is translated into practice through school and community grants to create systems, environmental and policy changes, teacher training on health and physical education standards, continuing education for the medical community in behavioral health, and a public education campaign. A comprehensive evaluation provides ongoingfeedback for program improvement and progress on the effects of psychosocial mediators, behaviors, and long-term chronic diseases. RESULTS AND DISCUSSION: Preliminary process results presented here are promising. The components are thought to interact synergistically to bring about behavior changes statewide. The HHI is one example of how to implement a multilevel initiative to target the three major behavioral determinants of chronic disease (tobacco use, physical inactivity, and poor nutrition) and build healthier communities.     

A green and healthy future: the settings approach to building health,equity and sustainability

As we move further into the twenty-first century, there is growing realization that the relationship between humans and the wider environment is crucially important, and a recognition that unfettered globalization linked to an increasingly dominant consumer culture has wrought devastating impacts. Within this context, and catalyzed particularly by concerns about climate change, there has also been increased appreciation that public health and the health of the planet are closely interrelated. This article focuses on the opportunities and potential value of encouraging joined-up thinking and integrated action in the settings where people live their lives. Having set the broad context regarding health, equity and sustainability, we scope current activity in relation to ‘greening’ settings before honing in on two concerns: that few such initiatives reflect the holistic and ecological perspective that underpins a settings approach to health promotion, and that work on sustainability and work on health have largely been developed in parallel rather than in an integrated manner. Having discussed these concerns, we propose six principles for progressive practice as a means of grounding a healthy and sustainable settings approach, before concluding by looking to the future and highlighting the likely need and benefits of daring to make more radical changes to our individual, community and working lives.     

Airway and circulating levels of carotenoids in asthma and healthy controls

BACKGROUND: Elevated oxidative stress and impaired antioxidant defences are increasingly recognised features of asthma. Carotenoids are potent dietary antioxidants that may protect against asthma by reducing oxidative damage. OBJECTIVES: This study aimed firstly, to characterise circulating and airway levels of carotenoids in asthma compared to healthy controls, in relation to dietary intake. Secondly, the study aimed to test whether airway lycopene defences can be improved using oral supplements. METHODS: Induced sputum and peripheral blood samples were collected from subjects with asthma (n = 15) and healthy controls (n = 16). Dietary carotenoid intakes were estimated using the 24-hour recall method and analysed using a modified version of the Foodworks 210 Nutrient Calculation Software. Another group of healthy controls (n = 9) were supplemented with 20 mg/day lycopene for 4 weeks. Carotenoids (beta-carotene, lycopene, alpha-carotene, beta-cryptoxanthin, lutein/zeaxanthin) were measured by HPLC. RESULTS: Despite similar dietary intake, whole blood levels of total carotenoids, lycopene, lutein, beta-cryptoxanthin, alpha-carotene and beta-carotene were significantly lower in asthma than controls. However, there were no differences in plasma or sputum carotenoid levels. Induced sputum carotenoid levels were significantly lower than plasma and whole blood levels, but correlated strongly with plasma levels (r = 0.798, p < 0.001). Although there were no overall increases in either plasma or sputum lycopene levels following supplementation, changes in airway lycopene levels correlated with changes in plasma levels (r = 0.908, p < 0.002). CONCLUSIONS: Whole blood, but not plasma or sputum, carotenoid levels are deficient in asthma. Plasma carotenoid levels reflect airway carotenoid levels and when plasma levels are improved using oral supplements this is reflected in the airways.     

The short and long-term impact of the healthy kids initiative on depressed mood in youth living with obesity

PurposeThe purpose of this study is to determine the effect of a free, comprehensive program with social support on depressed mood in youth (aged 11–17 years) living with obesity in a prospective, longitudinal, community-based study.MethodsYouth living with obesity (BMI > 30), residing in three cities in Saskatchewan, Canada, were eligible to participate in a 12-week program designed to facilitate behavioural change with five physical activity sessions a week, one dietary session a week, and one group cognitive behavioural session per week offered by health care professionals. Baseline data were collected on depressed mood (Centre for Epidemiological Studies-Depression 12 or CES-D 12), health-related quality of life (SF-12), and self-esteem (NLSCY) at baseline, 12-weeks, and at 52-weeksResultsOverall, 2598 youth started and 2292 (88.2 %) completed the 12-week program with 1703 (74.3 %) of participants presenting for 52-week follow-up. Depressed mood improved significantly over the course of the program: 79.2 % of participants had depressed mood at the start of the program and this decreased to 64.7 % at the end of 12-weeks; which was an overall relative reduction of 18.4 % (Cohen’s d = 0.94). The mean CES-D 12 score at one-year was significantly lower than the mean baseline score (17.90 compared to 21.11, p < .001). By depressed mood severity, 58.7 % of participants had severe depressed mood at baseline, which reduced to 31.6 % at 12 weeks, and 27.9 % at 52 weeks. Age and maternal occupation were initially significantly associated with depressed mood at 52-week follow-up (unadjusted). However, after binary logistic regression was used to determine the independent risk factors for having depressed mood at 52-week follow up, only older age (OR 1.88, 95 % CI 1.52–2.34, p < .001) was significant.ConclusionThe Healthy Kids Initiative lends more evidence that healthy behavioural interventions can have a positive impact on depressed mood among youth living with obesity.     

Great expectations and hard times: developing community indicators in a healthy communities initiative in Canada

This paper reports on expectations for and community members' experience in the development of community indicators in a healthy communities initiative (HCI) in Alberta, Canada. The HCI process involved community visioning, the creation of action plans to further the vision by addressing key health priorities and/or community capacity building activities and the development of indicators to monitor and report on progress towards goals. Nineteen semi-structured interviews were conducted with community participants to discuss definitions of success in the HCI and participant experience in developing indicators. Three themes emerged: the formal indicators lacked relevance to community members; the community did not own the HCI indicators and participants instead drew upon measures of success which were largely experiential in nature. The study provides a critically reflective, candid account of on-the-ground work with communities. The findings reveal limitations in the process of developing community indicators in this HCI, which we attribute in part to skills and discontinuities on the staffing side of the health authority and in part to failure to recognize and fully appreciate 'different ways of knowing' between communities and agencies.     

Evaluation of a cardiovascular health program for participants with mental retardation and normal learners.

An evaluation was conducted to compare the impact of an 8-week cardiovascular disease risk reduction group teaching program for 92 individuals with mental retardation (MR; IQ less than 70) and 97 normal learners. The curriculum emphasized exercise, nutritional choices, and stress reduction. Body Mass Index (BMI; weight in kilograms, divided by height in meters, squared), knowledge of healthy eating choices, self-report of fruit and vegetable intake, and exercise were measured before and after the intervention. The mean BMI decreased by .89 for normal learners and not at all for the group with MR. However, BMI decreased by at least .75 units (or approximately 5 pounds) for 18.5% of individuals with MR and 44.3% of normal learners.