A Little about Community Population Health and Wellness for Children and Families
Where Children and Families Live Matters for Health and Development
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, the rate of low income obese of young children is 16.9 percent.
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. This a multilevel whole-of-community population health and wellness dynamic system problem.
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, the rate of low income obese of young children is 16.9 percent.
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. This a multilevel whole-of-community population health and wellness dynamic system problem.
Creating a Landscape of Community Population Health and Wellness Contexts for Children
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 his 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 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.
Dr. David Dzewaltowski his 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 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.
Dr. David Dzewaltowski
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Community Population Health
Social Scientist Professor and Endowed Community Chair for Activity, Nutrition, and Obesity Prevention College of Public Health, University of Nebraska Medical Center Buffett Early Childhood Institute, University of Nebraska Emeritus Professor, Kansas State University Fellow, National Academy of Kinesiology |
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The Community Population Health and Wellness for Children Research Projects
While the project name is new, our team has been collaborating with communities and organizations in integrated research and practice efforts building healthy places (www.healthyplaces.org) where "children live, learn, work and play" (Dzewaltowski et al., 2002, p. 2010)" to promote population health outcomes in children, youth and families targeting physical activity, nutrition and other health behaviors since 1999.
Scientists studying implementation science for population health outcomes can access a set of resources and talks on grant writing for "Translating Effective Interventions into Practice: An Interactive, Pragmatic Workshop for T3-T4 Research as part of the Great Plains Idea - Clinical & Translational Research Forum.
- Evaluate the impact of a whole-of-community development platform on community population health for children.
- Go here to see our emerging community wellness platform (www.wellscapes.org, www.healthyplaces.org).
- Go here to see our partnership on development of a school wellness platform (https://www.iowaswitch.org).
- Determine the innovation and implementation social system drivers of community population health for children.
- Develop and disseminate research and community observation tools to investigate community population health social systems organizational structure and reproduced social practices.
- Go here to see our Wel-Map observation tool and Wel-Map reports.
- Go here to see our Child Leadership Observation for Understanding Developmental Episodes and Engagement tool.
- Go here to demo our partner Greg Welk's Youth Activity Profile tool.
- Go here to access our online physical activity leader training.
- Contribution to the development of generalizable principles to guide practices, programs, and policies through the development of a ecological systems theory that addresses inequity of opportunity.
While the project name is new, our team has been collaborating with communities and organizations in integrated research and practice efforts building healthy places (www.healthyplaces.org) where "children live, learn, work and play" (Dzewaltowski et al., 2002, p. 2010)" to promote population health outcomes in children, youth and families targeting physical activity, nutrition and other health behaviors since 1999.
Scientists studying implementation science for population health outcomes can access a set of resources and talks on grant writing for "Translating Effective Interventions into Practice: An Interactive, Pragmatic Workshop for T3-T4 Research as part of the Great Plains Idea - Clinical & Translational Research Forum.
- See Dr. Dzewaltowski's implementation science grant writing workshop talk titled "The scientific premise for implementation science: What generalizes?".
Contributions to Science
Individual perceptions of self-efficacy determine physical activity
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Lack of physical activity is a major public health problem. Dzewaltowski’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 physical activity 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. Dzewaltowski DA. Toward a model of exercise motivation. . 1989; 11(3):251-269. |
Adult and youth setting leaders capacity can be developed to modify their practices to improve children's health behavior.
.Evolving from his earlier health behavior work that was strongly influenced by an individual level approach to health behavior theory, he adopted and 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.
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.
Systems characterized by context characteristics and individual characteristics emerging to drive population health behavior.
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With an understanding that leaders of child development settings can be trained to modify organizational practices to improve the social and physical environments of youth to promote health behavior, one line of his recent work has focused on further identifying the implementation of organizational practices of these settings that are related to increased physical activity using observation of physical and social environments and measurement of physical activity with accelerometers. With this information, his work will contribute to refining interventions that train youth leaders to promote healthful behavior. These 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
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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. 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 |
Ecological validity is essential to implementation success
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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.
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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. |
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Key Concepts
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Community Success Stories
Coming Soon |
Presentations, Publications, and Courses
Coming Soon |
Community Population Health and Wellness Projects
Iowa SWITCH
Healthy Ones
Healthy Options for Physical Activity and Nutrition (HOP'N) After School
Scouting Activity and Nutrition Program (SNAP)
El Paso CATCH
Healthy Youth Places
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| Healthy Places: The system, process, and study |
Dzewaltowski, D.A. (2005). Healthy Places: The system, process and study. Kansas State University Research and Extension, Manhattan, KS.
Dzewaltowski, D. A., Estabrooks, P. A., & Johnston, J. A. (2002). Healthy youth places promoting nutrition and physical activity. Health Education Research, 17(5), 541-551.
Dzewaltowski, D. A., Estabrooks, P.A., Johnston, J.A., & Gyurscik, N. (2002). Promoting physical activity through community development. In J. L. Van Raalte & B. W. Brewer (Eds.), Exploring Sport and Exercise Psychology 2nd Edition, Washington, DC: American Psychological Association.
Dzewaltowski, D. A., Estabrooks, P. A., Welk, G., Hill, J., Milliken, G., Karteroliotis, K., & Johnston, J. A. (2009). 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 Education & Behavior, 36(3), 583-600.
* Winner of the Lawrence W. Green Paper of the Year Award.
Dzewaltowski, D. A., Estabrooks, P. A., & Johnston, J. A. (2002). Healthy youth places promoting nutrition and physical activity. Health Education Research, 17(5), 541-551.
Dzewaltowski, D. A., Estabrooks, P.A., Johnston, J.A., & Gyurscik, N. (2002). Promoting physical activity through community development. In J. L. Van Raalte & B. W. Brewer (Eds.), Exploring Sport and Exercise Psychology 2nd Edition, Washington, DC: American Psychological Association.
Dzewaltowski, D. A., Estabrooks, P. A., Welk, G., Hill, J., Milliken, G., Karteroliotis, K., & Johnston, J. A. (2009). 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 Education & Behavior, 36(3), 583-600.
* Winner of the Lawrence W. Green Paper of the Year Award.
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Health Opportunities for Physical Activity and Nutrition (HOP'N) After School
We have had several successful projects demonstrating that communities can improve population health outcomes in children. Left is a news story from several years ago reviewing our HOP'N After School Project (Dzewaltowski, et al 2010). This was one of the first school randomized trials to demonstrate improved physical activity outcomes in children by increasing the capacity of the community and after school program leaders.
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