T H E
S
C I E N CE
O F
L I F E S T Y L E
C H A N
Commentary
Model Communities: A Vital Strategy to Implementing Policy and Environmental Change for Active Living and Addressing Health Equity in Suburban Cook County, Illinois Gina L. Massuda Barnett, MPH; Rachael D. Dombrowski, MPH; Christina R. Welter, DrPH, MPH; Maryann Mason, PhD; Melody V. Geraci, MA; Kelsey A. Gilmet, RN, MN; Michael C. Fagen, PhD; Devangna A. Kapadia, MS, MPH INTRODUCTION Active Living Research awarded the sixth annual Translating Research to Policy Award to the Model Conimtmities Initiative of Suburban Cook County, Illinois (SCC). Model Commvmities is a local strategy designed and implemented to address obesity in SCC. The purpose of the award is to recognize innovative teams or individtials representing research, policy, or advocacy who have had success in catalyzing policy or environmental change of relevance to youth physical activity, sedentary behavior, and obesity prevention. The goal is to celebrate achievements, understand how success occurs, and share these stories so others will be inspired to improve the use of research in policymaking. The commentary that follows describes the work that is recognized by the award. Active Living Research Cina. L. Massuda Barnett, MPH, is at the Cook County Department of Public Health, Chronic Disease Prevention ¿f Health Promotion Unit, Oak Forest Health Center, Oak Forest, Illinois. Rachael D. Dornbroxuski, MPH, previously with Suburban Cook County Communities Putting Prevention to Work, is at Chicago Public Schools, Chicago, Illinois. Christina R. Welter, DrPH, MPH, previously with the Cook County Department of Public Health, Prevention Services Unit, is at the University of Illinois at Chicago, School of Public Health, Chicago, Illinois. Maryann Mason, PhD, is at the Consortium to Loxuer Obesity in Chicago Children, Smith Child Health Research Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Melody V. Geraci, MA, is with Active Transportation Alliance, Chicago, Illinois. Kelsey A. Gilmet, RN, MN; Michael C. Fagen, PhD; and Devangna A. Kapadia, MS, MPH, are at MidAmerica Center for Public Health Practice, University of Illinois at Chicago, School of Public Health, Chicago, IIIÍ710ÍS. Send reprints to Gina L. Massuda Barnett, MPH, Cook County Department of Public Health, Chronic Disease Prevention & Health Promotion Unit, Oak Forest Health Center, 1.5900 Cicero Ave, Bldg E, Oak Forest, IL 60452; gmbarnett®cookcotuilyhhs.or'g. Copyright © 2014 by Aviericcm journat of Heatth Promotion, Inc. ()Kl)tl71/14/$5.00+0 Dot 10.42 78/ajhp. 28.3s. S122
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commends the awardees on their sticcessftil participation in the policy process, and we recommend their approach as a model to others. THE PROBLEM Chronic diseases are the major cause of morbidity and mortality in SCC with striking disparities among racial and ethnic minorities and people living in poverty.' Contributing to this health btirden is the prevalence of obesity, poor nutrition, and physical inactivity among SCC residents. Nearly two-thirds of adtilts are currently overweight or obese." The rate among yotith is Jttst as alarming, with more than 25% of high-school sttidents being overweight or obese.^ Moreover, 42% of sixth graders and 33% of kindergarteners are overweight, and 23.8% and 17.9%, respectively, are obese. This is not surprising, as data indicate that both adtilts and youth have unhealthy diets and do not meet recommended standards for physical activity.^'^ Demographic shifts have led to increasing poverty rates predominantly in SCC communities with poor, minority populations that have historically suffered from lower income levels, educational achievement gaps, and limited access to healthier options and resources. '"^ These conditions in which people live, work, and play increase their likelihood of chronic diseases and continue to contribtite to health inequities. In regard to physical activity, community design plays a key role in promoting sedentary lifestyles and atitomobile dependency —especially in municipalities with multiple challenges (e.g., lack of Jobs and sidewalks; violence). Despite variotis efforts and services to meet the growing need, lack of infrastructure and coordination, coupled with uneven local capacity and disparate resources,*^ makes it difficult to effectively address the health disparities in SCC. Given resources, needs, and challenges in SCC, the Cook County Department of Public Health (CCDPH) with several community leaders developed a bold vision to facilitate and sustain a culture shift towards healthy living and health equity. Advancement was then made possible when CCDPH in collaboration with the Public Health Institute of
January/February 2014, Vol. 28, No. 3 Supplement
Metropolitan Chicago (PHIMC) was awarded nearly $16 million in March 2010 to address obesity as part of Communities Ptitting Prevention to Work (CPPW) administered by the Centers for Disease Control and Prevention. This federal initiative was grounded in policy, systems, and environmental (PSE) changes that made healthy living easier.' In SCC, a comprehensive, multilevel approach was used, integrating systems thinking and commimity-organizing principles, to advance PSE changes across multiple sectors that were far-reaching and sustainable. THE CONTEXT SCC covers a total of 700 square miles; encompasses about 130 municipalities with nearly 2.5 million people; and is home to numerous stakeholders (e.g., 140-f school districts). To meet the tmique needs of SCC; assure linkage with county, state, and national initiatives; and stistain efforts, the Model Communities (MC) Program was designed and implemented by CCDPH, PHIMC, and technical expert organizations (TA partners) as a key health promotion strategy within the overall SCC CPPW approach. The program aimed to transform localities with an emphasis on cultivating partnerships and reducing health inequities to maximize and sustain impact. Through this program, local governments, school districts, and cominunity-based institutions serving SCC communities were provided with resources and tools to advance PSE changes supporting healthy eating and active living. Up to $4 million was awarded to 38 entities, many of whom promoted active living by creating convenient, safe places to be active and increasing opportunities for physical activity before, during, and after school. Grounded in the literature, the MC program's theoretical underpinning encompassed the following three elements descriljed in more detail elsewhere"*: (1) building constituency support and alliances through grassroots coalitions and participation in a county-wide chronic disease prevention collaborative (Alliance for Healthy and Active Communities [AHAC] ) to help augment connectivity, build legitimacy, and leverage and optimize resources'^ (2) enhancing organizational and community capacity via MC-wide trainings
and one-on-one technical assistance provided by SCC CPPW staff and TA partners ; and (3) using communication stratèges to influence ptiblic opinion and garner support for miijor policies.'^ The program's success required intensive coordination and communication between CCDPH, PHIMC, SCC CPPW staff, TA partners, and evaluators, and was also hinged upon the grant recipients' ability to take necessai"y steps, including mobilizing local leaders and stakeholders within their respective settings, to instill PSE change that sotight to turn the tide on obesity. WORKING TOWARD SOLUTIONS The combination of the three elements described earlier was expected to increase organizational and community capacity by providing key individuals the knowledge, skills, and resources needed to effectively advance PSE change. Additionally, the menu of MC interventions leading to PSE
American Journal of Health Promotion
changes were thought to promote positive poptilation behaviors that wotild eventually impact health outcomes, particularly in underresotirced communities and schools, which made up 71% of MC grantees. Evaluation results helped in aspects of the change process. Grantees were required to participate in the Change Institute, including three in-person and two Web-based trainings. Data collected on grantees' level of collaboration and competencies, aligned with PSE change for the evaluation, were used to tailor the trainings at the Change Institute and AHAC quarterly meetings, and the technical assistance provided by SCC CPPW staff and TA partners. The program evaluation found that most MC grantees (89%) experienced an increase in organizational capacity for PSE change over the project period, with statistically significant increases in their abilities to identify PSE change targets, build support for PSE change, and use data to engage in PSE change. Similarly, .59% of MC grantees increased organizational alliances for PSE change, although these changes were not statistically significant. Overall, MC grantees increased their collaboration in healthy lifestyle coalitions and shared work in legislation and policy development, data analysis, and cohosting events. The MC grant program led to 150 PSE changes in 127 schools and 73 communities, with active living PSE initiatives having the greatest reach and potential impact. For example, active transportation plans and policies that were enacted (e.g., transit chapters of a comprehensive plan; Complete Streets; Safe Park Zones; zoning regulations to stipport Transit Oriented Development; bicycle plans and signage installation) affected a total of 54 municipalities encompassing nearly 1.5 million residents. It was further estimated that if all planning recommendations were implemented, 236 miles of new pedestrian facilities (e.g., sidewalks, trails, and other multiuse paths) and 550 miles of new bike facilities (e.g., bike lanes, marked shared lanes, recommended bike routes, btiffered bike lanes, and multitise paths) would be created; and 1.2 million residents would live within 1 V2 miles of a bike route. Additionally, 19 school districts incltiding 115 schools with a total student poptilation of 86,936 advanced one or more policy changes that increased opporttmities for students and staff to be physically active before, during, and after school (e.g., improved physical education standards, physical activity integrated into school ctnrictiltim, physical activity requirements in after-school programs, and adoption of school travel plans). LESSONS LEARNED The evaluation of the MC program proved to be uselttl in modifying MC-wide trainings and resources for the grantees, identifying facilitators and barriers to the PSE change process (via case studies), determining future adjustments to the program's theoretical underpinning and future implementation, and validating the potential value for this strategy. Despite these benefits, evaltiating PSE change work proved to be challenging because strategies for achieving
January/February 2014, Vol. 28, No. 3 Supplement
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these changes are built incrementally and initiated in response to many contextual factors. Further, becattse the impact of change efforts often goes beyond the adoption of a PSE, there can be multiple outcomes to assess. In recognition of the many ways in which achievement can be characterized in PSE change work, CCDPH, SCC CPPW staff, and the evaltiators collaboratively developed a theory of change, identified performance measures and an evaluation plan that applied mixed methods. Many lessons were learned, including the following: (1) A need for data earlier and more freqtiently to stipport change processes, allowing for more effective tailoring of individualized technical assistance activities or collaboration opportunities that met organizations and communities' readiness; (2) Being clear on how capacity building is defined, implemented, and evaluated. We learned that grantees engaged more in events and activities that provided them with knowledge and skills than those that offered collaboration opportunities. Increased capacities and competencies reflected in the data can be misleading owing to limitations in consistency of who participated in the evaluation from each MC organization, and the fact that MCs with less capacity and infrastructure straggled, regardless of all capacity-building opportunities; (3) Progress and successes need to be shared more effectively across SCC to continue to garner cross-sector buy-in; and (4) Long-term follow-up is required to track capacity as it relates to the impact of PSE changes on health behaviors and tiltimately, health outcomes. The MC program is a long-term development strategy that aims to address health issues in a complex region marked by fragmented government, diverse populations with varying needs and growing health disparities. The program provided opportunities for collaborating across boundaries while also ctistomizing support for organizations and commtmities. Other complex regions may benefit from this accotmt, both in identifying strategy components and in shaping outcome expectations. Acknowledgments Tîie sïtccess of the Model Communities Program- supported try the federal Communities Putting Prevention to Work initiative xuould not have been possibte without the commitment of CPPW program ."¡taff and the fottowing technical assistance and evaluation partners: Active Transportation Alliance; American Heart Association, Midwest Affiliate; AgeOptions; Alliance for a Healthier t~kneratiûn; The Center for Faith and Community Health Transformation; Chicago Metropolitan Agency for Planning; Consortium to Lower Obesity in Chicago Children; Delta Institute; Health Connect One; Illinois Chapter American Academy of Pediatrics; MidAmerica Center for Public Health Practice; and Seven Cenerations Ahead. The opinions expressed try authors contributing to tins (mnmenlmy do not necessarily reflect the opinions of the US Department of Heat th and
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American Journal of Healfh Promofion
Human Services, the Centers for Disease Control and Prevention, or the authors ' affitiated institutions.
References 1. Cook County Department of Public Health. wePLAN 2015: Suburban Cook County Community Health Assessment and Plan. Available at: hltp://www.cookcountypubUchealth.org/files/pdf/ weplan-201.5.pdf. Published 2011. Accessed August 30, 2012. 2. Cook Cotinty Department of Public Health. 2010 Suburban Cook County Behavioral Risk Factor Surveillance System. Available at: http://www.cookcountypublichealth.org/data-reports#RiskFactors. Accessed August 29, 2013. 3. Cook County Departrnent of Public Health. 2010 Suburban Cook County Youth Risk Behavior Survey. Available at: http:// cookcotuitypublichealth.org/files/data-and-reports/risk-factors/ 2010%20SCC%20YRBS/20]0CUAH%20Summary%20Tables.pdf. Accessed August 29, 20f3. 4. Cook County Department of Public Health and ConsotUum to Lower Obesity in Chicago Children. 2010-2012 Overweight and obesity prevalence among school-aged children in Subttrban Cook County, Illinois. Available at: http://www.cookcountypublichealth. org/data-reports. Published September 2013. Accessed September 30, 2013. 5. US Census Bureau. State and County QuickFacts: Cook County, Illinois. Available at: http://quickfacts.census.gov/qfd/states/17/ 1703I.html. Accessed Match 6, 2013. 6. Berube A, Ktieebone E. Tiuo Steps Back: City and Suhurhan Poverty Trends 1999-2005. Washington, DC: Brookings Instittttion: 2006. 7. American Pttblic Health Association. The hidden health costs of transportation. Available at: http://www.apha.org/NR/rdonlyres/ F84640FD-13CF-47EA-8267-F767A1099239/0/ HiddetiHealthCosLsofTransportationShortFinal.pdf Ptiblished Februaty 2010. Accessed August 30, 2012. 8. Hendrick R, Mossberger K. Uneven Capacity and Delivery of Human Services in Chicago Suburbs: The Role of Toxonships and Municipalities. Chicago, 111: University of Illinois Chicago: 2009. 9. Bunnell R, O'Neil D, Soler R, et al. Fifty cotiimunities putting prevention to work: accelerating chronic disease prevention throttgh policy, .system.s and environmental change. / Community Health. 2012;37(5):1081-1090. 10. Dombrowski R, Mason M, Welch S, et al. Model communities as a strategy for achievitig policy, systeiris and environmental change for obesity control and reduction. In Caron R, Merrick J, eds. Building Community Capacity: Case Examples From Around the World. Jerusalem, Israel: Nova: 2013:1-18. 11. National Cancer Institute. Greater Than the Sum: Systems Thinking in Tobacco Control. Tobacco Control Monograph No. 18. Bethesda, Md: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute: 2007. NIH publication 066085. 12. Glanz K, Ritner B, Lewis F, eds. Health Behavior and Health Education: Theory, Research and Practice. San Francisco, Calif: fossey-Bass; 2002. 13. Maibach EW, Van Dttyn MAS, Bloodgood B. A marketing perspeclive on dissetninating e\'idence-based approaches to disease ptevention and health promotion. Prev Chronic Dis. 2006;3(3):A97. Available at: http://www.cdc.gov/pcd/issues/2006/jul/05_0154. htm. Accessed November 30, 2009.
January/February 2014, Vol. 28, No. 3 Supplemenf
Copyright of American Journal of Health Promotion is the property of American Journal of Health Promotion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
S
C I E N CE
O F
L I F E S T Y L E
C H A N
Commentary
Model Communities: A Vital Strategy to Implementing Policy and Environmental Change for Active Living and Addressing Health Equity in Suburban Cook County, Illinois Gina L. Massuda Barnett, MPH; Rachael D. Dombrowski, MPH; Christina R. Welter, DrPH, MPH; Maryann Mason, PhD; Melody V. Geraci, MA; Kelsey A. Gilmet, RN, MN; Michael C. Fagen, PhD; Devangna A. Kapadia, MS, MPH INTRODUCTION Active Living Research awarded the sixth annual Translating Research to Policy Award to the Model Conimtmities Initiative of Suburban Cook County, Illinois (SCC). Model Commvmities is a local strategy designed and implemented to address obesity in SCC. The purpose of the award is to recognize innovative teams or individtials representing research, policy, or advocacy who have had success in catalyzing policy or environmental change of relevance to youth physical activity, sedentary behavior, and obesity prevention. The goal is to celebrate achievements, understand how success occurs, and share these stories so others will be inspired to improve the use of research in policymaking. The commentary that follows describes the work that is recognized by the award. Active Living Research Cina. L. Massuda Barnett, MPH, is at the Cook County Department of Public Health, Chronic Disease Prevention ¿f Health Promotion Unit, Oak Forest Health Center, Oak Forest, Illinois. Rachael D. Dornbroxuski, MPH, previously with Suburban Cook County Communities Putting Prevention to Work, is at Chicago Public Schools, Chicago, Illinois. Christina R. Welter, DrPH, MPH, previously with the Cook County Department of Public Health, Prevention Services Unit, is at the University of Illinois at Chicago, School of Public Health, Chicago, Illinois. Maryann Mason, PhD, is at the Consortium to Loxuer Obesity in Chicago Children, Smith Child Health Research Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Melody V. Geraci, MA, is with Active Transportation Alliance, Chicago, Illinois. Kelsey A. Gilmet, RN, MN; Michael C. Fagen, PhD; and Devangna A. Kapadia, MS, MPH, are at MidAmerica Center for Public Health Practice, University of Illinois at Chicago, School of Public Health, Chicago, IIIÍ710ÍS. Send reprints to Gina L. Massuda Barnett, MPH, Cook County Department of Public Health, Chronic Disease Prevention & Health Promotion Unit, Oak Forest Health Center, 1.5900 Cicero Ave, Bldg E, Oak Forest, IL 60452; gmbarnett®cookcotuilyhhs.or'g. Copyright © 2014 by Aviericcm journat of Heatth Promotion, Inc. ()Kl)tl71/14/$5.00+0 Dot 10.42 78/ajhp. 28.3s. S122
S122
American Journal of Health Promotion
commends the awardees on their sticcessftil participation in the policy process, and we recommend their approach as a model to others. THE PROBLEM Chronic diseases are the major cause of morbidity and mortality in SCC with striking disparities among racial and ethnic minorities and people living in poverty.' Contributing to this health btirden is the prevalence of obesity, poor nutrition, and physical inactivity among SCC residents. Nearly two-thirds of adtilts are currently overweight or obese." The rate among yotith is Jttst as alarming, with more than 25% of high-school sttidents being overweight or obese.^ Moreover, 42% of sixth graders and 33% of kindergarteners are overweight, and 23.8% and 17.9%, respectively, are obese. This is not surprising, as data indicate that both adtilts and youth have unhealthy diets and do not meet recommended standards for physical activity.^'^ Demographic shifts have led to increasing poverty rates predominantly in SCC communities with poor, minority populations that have historically suffered from lower income levels, educational achievement gaps, and limited access to healthier options and resources. '"^ These conditions in which people live, work, and play increase their likelihood of chronic diseases and continue to contribtite to health inequities. In regard to physical activity, community design plays a key role in promoting sedentary lifestyles and atitomobile dependency —especially in municipalities with multiple challenges (e.g., lack of Jobs and sidewalks; violence). Despite variotis efforts and services to meet the growing need, lack of infrastructure and coordination, coupled with uneven local capacity and disparate resources,*^ makes it difficult to effectively address the health disparities in SCC. Given resources, needs, and challenges in SCC, the Cook County Department of Public Health (CCDPH) with several community leaders developed a bold vision to facilitate and sustain a culture shift towards healthy living and health equity. Advancement was then made possible when CCDPH in collaboration with the Public Health Institute of
January/February 2014, Vol. 28, No. 3 Supplement
Metropolitan Chicago (PHIMC) was awarded nearly $16 million in March 2010 to address obesity as part of Communities Ptitting Prevention to Work (CPPW) administered by the Centers for Disease Control and Prevention. This federal initiative was grounded in policy, systems, and environmental (PSE) changes that made healthy living easier.' In SCC, a comprehensive, multilevel approach was used, integrating systems thinking and commimity-organizing principles, to advance PSE changes across multiple sectors that were far-reaching and sustainable. THE CONTEXT SCC covers a total of 700 square miles; encompasses about 130 municipalities with nearly 2.5 million people; and is home to numerous stakeholders (e.g., 140-f school districts). To meet the tmique needs of SCC; assure linkage with county, state, and national initiatives; and stistain efforts, the Model Communities (MC) Program was designed and implemented by CCDPH, PHIMC, and technical expert organizations (TA partners) as a key health promotion strategy within the overall SCC CPPW approach. The program aimed to transform localities with an emphasis on cultivating partnerships and reducing health inequities to maximize and sustain impact. Through this program, local governments, school districts, and cominunity-based institutions serving SCC communities were provided with resources and tools to advance PSE changes supporting healthy eating and active living. Up to $4 million was awarded to 38 entities, many of whom promoted active living by creating convenient, safe places to be active and increasing opportunities for physical activity before, during, and after school. Grounded in the literature, the MC program's theoretical underpinning encompassed the following three elements descriljed in more detail elsewhere"*: (1) building constituency support and alliances through grassroots coalitions and participation in a county-wide chronic disease prevention collaborative (Alliance for Healthy and Active Communities [AHAC] ) to help augment connectivity, build legitimacy, and leverage and optimize resources'^ (2) enhancing organizational and community capacity via MC-wide trainings
and one-on-one technical assistance provided by SCC CPPW staff and TA partners ; and (3) using communication stratèges to influence ptiblic opinion and garner support for miijor policies.'^ The program's success required intensive coordination and communication between CCDPH, PHIMC, SCC CPPW staff, TA partners, and evaluators, and was also hinged upon the grant recipients' ability to take necessai"y steps, including mobilizing local leaders and stakeholders within their respective settings, to instill PSE change that sotight to turn the tide on obesity. WORKING TOWARD SOLUTIONS The combination of the three elements described earlier was expected to increase organizational and community capacity by providing key individuals the knowledge, skills, and resources needed to effectively advance PSE change. Additionally, the menu of MC interventions leading to PSE
American Journal of Health Promotion
changes were thought to promote positive poptilation behaviors that wotild eventually impact health outcomes, particularly in underresotirced communities and schools, which made up 71% of MC grantees. Evaluation results helped in aspects of the change process. Grantees were required to participate in the Change Institute, including three in-person and two Web-based trainings. Data collected on grantees' level of collaboration and competencies, aligned with PSE change for the evaluation, were used to tailor the trainings at the Change Institute and AHAC quarterly meetings, and the technical assistance provided by SCC CPPW staff and TA partners. The program evaluation found that most MC grantees (89%) experienced an increase in organizational capacity for PSE change over the project period, with statistically significant increases in their abilities to identify PSE change targets, build support for PSE change, and use data to engage in PSE change. Similarly, .59% of MC grantees increased organizational alliances for PSE change, although these changes were not statistically significant. Overall, MC grantees increased their collaboration in healthy lifestyle coalitions and shared work in legislation and policy development, data analysis, and cohosting events. The MC grant program led to 150 PSE changes in 127 schools and 73 communities, with active living PSE initiatives having the greatest reach and potential impact. For example, active transportation plans and policies that were enacted (e.g., transit chapters of a comprehensive plan; Complete Streets; Safe Park Zones; zoning regulations to stipport Transit Oriented Development; bicycle plans and signage installation) affected a total of 54 municipalities encompassing nearly 1.5 million residents. It was further estimated that if all planning recommendations were implemented, 236 miles of new pedestrian facilities (e.g., sidewalks, trails, and other multiuse paths) and 550 miles of new bike facilities (e.g., bike lanes, marked shared lanes, recommended bike routes, btiffered bike lanes, and multitise paths) would be created; and 1.2 million residents would live within 1 V2 miles of a bike route. Additionally, 19 school districts incltiding 115 schools with a total student poptilation of 86,936 advanced one or more policy changes that increased opporttmities for students and staff to be physically active before, during, and after school (e.g., improved physical education standards, physical activity integrated into school ctnrictiltim, physical activity requirements in after-school programs, and adoption of school travel plans). LESSONS LEARNED The evaluation of the MC program proved to be uselttl in modifying MC-wide trainings and resources for the grantees, identifying facilitators and barriers to the PSE change process (via case studies), determining future adjustments to the program's theoretical underpinning and future implementation, and validating the potential value for this strategy. Despite these benefits, evaltiating PSE change work proved to be challenging because strategies for achieving
January/February 2014, Vol. 28, No. 3 Supplement
S123
these changes are built incrementally and initiated in response to many contextual factors. Further, becattse the impact of change efforts often goes beyond the adoption of a PSE, there can be multiple outcomes to assess. In recognition of the many ways in which achievement can be characterized in PSE change work, CCDPH, SCC CPPW staff, and the evaltiators collaboratively developed a theory of change, identified performance measures and an evaluation plan that applied mixed methods. Many lessons were learned, including the following: (1) A need for data earlier and more freqtiently to stipport change processes, allowing for more effective tailoring of individualized technical assistance activities or collaboration opportunities that met organizations and communities' readiness; (2) Being clear on how capacity building is defined, implemented, and evaluated. We learned that grantees engaged more in events and activities that provided them with knowledge and skills than those that offered collaboration opportunities. Increased capacities and competencies reflected in the data can be misleading owing to limitations in consistency of who participated in the evaluation from each MC organization, and the fact that MCs with less capacity and infrastructure straggled, regardless of all capacity-building opportunities; (3) Progress and successes need to be shared more effectively across SCC to continue to garner cross-sector buy-in; and (4) Long-term follow-up is required to track capacity as it relates to the impact of PSE changes on health behaviors and tiltimately, health outcomes. The MC program is a long-term development strategy that aims to address health issues in a complex region marked by fragmented government, diverse populations with varying needs and growing health disparities. The program provided opportunities for collaborating across boundaries while also ctistomizing support for organizations and commtmities. Other complex regions may benefit from this accotmt, both in identifying strategy components and in shaping outcome expectations. Acknowledgments Tîie sïtccess of the Model Communities Program- supported try the federal Communities Putting Prevention to Work initiative xuould not have been possibte without the commitment of CPPW program ."¡taff and the fottowing technical assistance and evaluation partners: Active Transportation Alliance; American Heart Association, Midwest Affiliate; AgeOptions; Alliance for a Healthier t~kneratiûn; The Center for Faith and Community Health Transformation; Chicago Metropolitan Agency for Planning; Consortium to Lower Obesity in Chicago Children; Delta Institute; Health Connect One; Illinois Chapter American Academy of Pediatrics; MidAmerica Center for Public Health Practice; and Seven Cenerations Ahead. The opinions expressed try authors contributing to tins (mnmenlmy do not necessarily reflect the opinions of the US Department of Heat th and
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American Journal of Healfh Promofion
Human Services, the Centers for Disease Control and Prevention, or the authors ' affitiated institutions.
References 1. Cook County Department of Public Health. wePLAN 2015: Suburban Cook County Community Health Assessment and Plan. Available at: hltp://www.cookcountypubUchealth.org/files/pdf/ weplan-201.5.pdf. Published 2011. Accessed August 30, 2012. 2. Cook Cotinty Department of Public Health. 2010 Suburban Cook County Behavioral Risk Factor Surveillance System. Available at: http://www.cookcountypublichealth.org/data-reports#RiskFactors. Accessed August 29, 2013. 3. Cook County Departrnent of Public Health. 2010 Suburban Cook County Youth Risk Behavior Survey. Available at: http:// cookcotuitypublichealth.org/files/data-and-reports/risk-factors/ 2010%20SCC%20YRBS/20]0CUAH%20Summary%20Tables.pdf. Accessed August 29, 20f3. 4. Cook County Department of Public Health and ConsotUum to Lower Obesity in Chicago Children. 2010-2012 Overweight and obesity prevalence among school-aged children in Subttrban Cook County, Illinois. Available at: http://www.cookcountypublichealth. org/data-reports. Published September 2013. Accessed September 30, 2013. 5. US Census Bureau. State and County QuickFacts: Cook County, Illinois. Available at: http://quickfacts.census.gov/qfd/states/17/ 1703I.html. Accessed Match 6, 2013. 6. Berube A, Ktieebone E. Tiuo Steps Back: City and Suhurhan Poverty Trends 1999-2005. Washington, DC: Brookings Instittttion: 2006. 7. American Pttblic Health Association. The hidden health costs of transportation. Available at: http://www.apha.org/NR/rdonlyres/ F84640FD-13CF-47EA-8267-F767A1099239/0/ HiddetiHealthCosLsofTransportationShortFinal.pdf Ptiblished Februaty 2010. Accessed August 30, 2012. 8. Hendrick R, Mossberger K. Uneven Capacity and Delivery of Human Services in Chicago Suburbs: The Role of Toxonships and Municipalities. Chicago, 111: University of Illinois Chicago: 2009. 9. Bunnell R, O'Neil D, Soler R, et al. Fifty cotiimunities putting prevention to work: accelerating chronic disease prevention throttgh policy, .system.s and environmental change. / Community Health. 2012;37(5):1081-1090. 10. Dombrowski R, Mason M, Welch S, et al. Model communities as a strategy for achievitig policy, systeiris and environmental change for obesity control and reduction. In Caron R, Merrick J, eds. Building Community Capacity: Case Examples From Around the World. Jerusalem, Israel: Nova: 2013:1-18. 11. National Cancer Institute. Greater Than the Sum: Systems Thinking in Tobacco Control. Tobacco Control Monograph No. 18. Bethesda, Md: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute: 2007. NIH publication 066085. 12. Glanz K, Ritner B, Lewis F, eds. Health Behavior and Health Education: Theory, Research and Practice. San Francisco, Calif: fossey-Bass; 2002. 13. Maibach EW, Van Dttyn MAS, Bloodgood B. A marketing perspeclive on dissetninating e\'idence-based approaches to disease ptevention and health promotion. Prev Chronic Dis. 2006;3(3):A97. Available at: http://www.cdc.gov/pcd/issues/2006/jul/05_0154. htm. Accessed November 30, 2009.
January/February 2014, Vol. 28, No. 3 Supplemenf
Copyright of American Journal of Health Promotion is the property of American Journal of Health Promotion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
