Whole-of-Community Cancer Prevention for Children and Families

Welcome

The Dzewaltowski lab focuses on community systems and their practices, how communities  create the conditions in which children grow, learn, and play that determine health promoting behaviors, and methods to facilitate the diffusion of evidence-based  practices  into community systems for population health improvement and the prevention of cancer and other chronic conditions.  We link measures of community population  cancer prevention behaviors (such as child physical activity) with measures of directly observed group practices in community  places (such as clinics, child care centers, schools, after school programs, clubs, and youth sport) and study the impact of new evidence-based ideas on implemented practices and health behaviors. 

Laboratory Services

For the  scientist community, we offer technical support for direct audio, video and in-person observation of implemented practices  (including methods and data processing), social ecological system theory-based hypothesis generation, implementation science research design, and analysis and reporting methods (e.g,, mixed model analysis, RE-AIM Framework).

For communities and organizations,  we offer technical assistance through workshops and coaching on  methods to create community health coalitions and social networks (we call a community hub), community data systems, and community action based on evidence-based practices to improve community conditions for children and families to promote healthy behavior, which leads  to improve population health and cancer prevention. 

The Community Wellness Landscape - Where Children and Families Live, Learn, Work, and Play Matters for Health and Development

The Dzewaltowski Lab coined the term "community wellness landscape," which is a mosaic of diverse places across a community providing the conditions for children and family development, health behavior, and the prevention of cancer and other chronic diseases.  His laboratory studies contribute to generalizable knowledge on  methods to promote the integration of research evidence across the whole-of-communities to implement practices that improve population health .
Communities across the U.S. and internationally are working to improve population health to increase child health and development and to decrease health care costs.  There is evidence that where children and families live influence their health and development. Eight percent of 2 to 4 year olds living in low income families in Utah are obese while 20 percent living in Virginia are obese.  In Nebraska, where our laboratory is located, 16.9 percent of low-income family young children are obese.
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Dr. Dzewaltowski's laboratory is working to identify why where people live matters for preventive health behaviors, such as physical activity and nutrition, and how to help communities design locally led innovations for community population health improvement for all children and families.  An omnibus challenge to achieve population health and wellness improvement, therefore, is to facilitate change in conditions across in the numerous places where people live, learn, work, and play in a geographic area.  

Population Science

Population science is about describing, predicting, and developing strategies to influence the outcomes of populations.  A population approach can be contrasted with individual approach.  Where an individual approach target individual characteristics that determine  individual outcomes, our population approach targets community conditions that impact the outcomes of community populations.  Community population health is driven by the social determinants of health, which the World Health Organization defines as the conditions under which people are born, grow, live, work and age.  Our lab focuses on population health behavior outcomes important for child and family development and prevention of cancer and other chronic diseases in Great Plains rural communities and beyond, and the intent is for this work to generalizable knowledge for all. 

Join our Lab or For More Information

My team is seeking Ph.D. and  MPH students  and undergraduate interns and research assistants interested in careers as research scientists or research associates studying processes that impact community population health for children and families. Please contact Dr. David Dzewaltowski directly (David.Dzewaltowski@unmc.edu).

Contributions to Science

Community Social Systems characterized by context characteristics and individual characteristics emerge to drive population health behavior.

Our  recent work has focused on identifying the organizational and individual practices of settings that are related to improved population health behavior using observation of physical and social environments and measurement of health behavior objectively, such as physical activity with accelerometers. With this information, our work will contribute to refining interventions that train leaders of settings  to implement practices that create social systems that promote healthful behavior.  Our studies have demonstrated that the contextual factors promoting physical activity (e.g., social, solitary) interact with individual differences, which suggests that interventions can be tailored with precision for larger health behavior outcome effects
Schlechter CR, Rosenkranz RR, Milliken GA, Dzewaltowski DA. Physical activity levels during youth sport practice: does coach training or experience have an influence? J Sports Sci. 2017 Jan;35(1):22-28. PubMed PMID: 26930302.

Schenkelberg MA, Rosenkranz RR, Milliken GA, Dzewaltowski DA. Social Environmental Influences on physical activity of children with Autism Spectrum Disorders. J Phys Act Health. 2015 May;12(5):636-41. PubMed PMID: 25109324.

Schenkelberg, M. A., Rosenkranz, R. R., Milliken, G. A., Menear, K., & Dzewaltowski, D. A. (2017). Implications of Social Groups on Sedentary Behavior of Children with Autism: A Pilot Study. Journal of autism and developmental disorders, 47(4), 1223-1230.
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Schlechter, C. R., Rosenkranz, R. R., Fees, B. S., & Dzewaltowski, D. A. (2017). Preschool daily patterns of physical driven by location and social context. Journal of School Health, 87(3), 194-19

Adult and youth setting leaders capacity can be developed to modify their implemented practices.

Leaders of child development settings can be trained to modify organizational and individual practices to improve the social and physical environments of youth to promote health behavior. Evolving from Dzewaltowski's lab earlier health behavior work that was strongly influenced by an individual level approach to health behavior theory, we have  adopted an ecologically informed social cognitive approach and later an ecological social systems approach to setting intervention. These setting intervention studies were designed to test the effectiveness of a community participatory approach to training adult and youth leaders to adopt evidence-based practices to modify the social and physical environment (context) to promote health behavior in children and youth. The findings demonstrated that the capacity of leaders of youth settings can be developed to modify organizational practices to impact health behavior. Communities have adopted the intervention programs resulting from these studies for implementation. For example, the National Cancer Institute has listed the Scouting Nutrition and Activity Program as a "research-tested intervention program."
Dzewaltowski DA, Rosenkranz RR, Geller KS, Coleman KJ, Welk GJ, Hastmann TJ, Milliken GA. HOP'N after-school project: an obesity prevention randomized controlled trial. Int J Behav Nutr Phys Act. 2010 Dec 13;7:90. 

Rosenkranz RR, Behrens TK, Dzewaltowski DA. A group-randomized controlled trial for health promotion in Girl Scouts: healthier troops in a SNAP (Scouting Nutrition and Activity Program). BMC Public Health. 2010 Feb 19;10:81. 

Dzewaltowski DA, Estabrooks PA, Welk G, Hill J, Milliken G, Karteroliotis K, Johnston JA. Healthy youth places: a randomized controlled trial to determine the effectiveness of facilitating adult and youth leaders to promote physical activity and fruit and vegetable consumption in middle schools. Health Educ Behav. 2009 Jun;36(3):583-600. 

Coleman KJ, Tiller CL, Sanchez J, Heath EM, Sy O, Milliken G, Dzewaltowski DA. Prevention of the epidemic increase in child risk of overweight in low-income schools: The El Paso coordinated approach to child health. Arch Pediatr Adolesc Med. 2005 Mar;159(3):217-24. 

Individual perceptions of self-efficacy determine health behavior

Lack of physical activity is a major public health problem. Dzewaltowski Lab’s early work could arguably be considered to be one of the first lines of research to take on the challenge of identifying the determinants of physical activity from a theoretical perspective. His work compared several psychology discipline theoretical models and in 1989 identified self-efficacy as a central social cognitive process mediating health behavior change. These findings were widely cited and became central to Albert Bandura's books and papers addressing self-efficacy and other social cognitive processes and health behavior theory.
"Some researchers have tested whether factors included in alternative conceptions of health behavior add incremental prediction over about a subset of sociocognitive determinants. In several of these studies, the sociocognitive determinants included efficacy beliefs, and satisfaction or dissatisfaction with the changes in achieved heath habits (Dzewaltowski, 1989; Dzewaltowski et al, 1990). Both efficacy beliefs and affective self-reaction to personal progress contributed to adherence to healthful behaviors. Attitude and perceived social pressure similarly accounted for healthful behavior, but they did not improve prediction when added to the subset of sociocognitive determinants. Such findings suggest redundancy of determinants under different names rather than dissimilar determinants. (p., 286, Bandura, 1997)." The work supported adopting a social cognitive approach to health behavior change and later helped direct the field toward addressing intervention development targeting psychosocial causal processes within a theory-driven mediation/moderation framework.
Bauman AE, Sallis JF, Dzewaltowski DA, Owen N. Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders. Am J Prev Med. 2002 Aug;23(2 Suppl):5-14.

Dzewaltowski DA. Physical activity determinants: a social cognitive approach. Med Sci Sports Exerc. 1994 Nov;26(11):1395-9. 

Dzewaltowski DA, Noble JM, Shaw JM. Physical activity participation: Social cognitive theory versus the theories of reasoned action and planned behavior.. 1990; 12(4):388-405.
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Dzewaltowski DA. Toward a model of exercise motivation. . 1989; 11(3):251-269.

Ecological validity is essential to implementation success

Dr. Dzewaltowski was also a founding member of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) work group, whose goal has been to encourage program planners, evaluators, readers of journal articles, funders, and policy-makers to pay more attention to essential program elements that can improve the sustainable adoption and implementation of effective, evidence-based health promotion programs. The RE-AIM framework is rooted in implementation and dissemination science and has spread over the last 15 years. In a recent network analysis of the RE-AIM Framework publications, Dzewaltowski was identified as the 7th highest author in centrality to the spread across the international network of implementation science researchers.
Dzewaltowski DA, Estabrooks PA, Glasgow RE. The future of physical activity behavior change research: what is needed to improve translation of research into health promotion practice? Exerc Sport Sci Rev. 2004 Apr;32(2):57-63. 

Dzewaltowski DA, Estabrooks PA, Klesges LM, Bull S, Glasgow RE. Behavior change intervention research in community settings: how generalizable are the results?. Health Promot Int. 2004 Jun;19(2):235-45. 

Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM. Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Educ Res. 2006 Oct;21(5):688-94.

Schlechter CR, Rosenkranz RR, Guagliano JM, Dzewaltowski DA. A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework. Preventive Medicine, 2016; 91:233-243.  

Funders 

The organizations below support our laboratory.  The views expressed on this website are those of Dr. Dzewaltowski.