Papers by Rachael Dombrowski
Community Development Journal, 2015
ABSTRACT Many low-income and minority communities have reduced access to healthy foods, which may... more ABSTRACT Many low-income and minority communities have reduced access to healthy foods, which may contribute to unhealthy eating. This has led to interventions in existing small, neighbourhood stores (corner stores) to bring healthier foods to those communities. In 2011–2012, the Cook County Department of Public Health partnered with eight suburban community organizations in predominantly low-income, minority communities to increase healthy food availability in local corner stores. The project goal was to increase the capacity of partnering community organizations to ensure effective implementation and promote sustainability in a geopolitically complex region. This approach is unlike most corner store interventions, usually conducted within a single city or by a single organization. To evaluate the impact on community organizational capacity, interviews were conducted with key project staff from partnering community organizations in April 2012. Interviews were recorded and transcribed, and qualitative analysis was conducted. Findings included that the training and materials provided by the project increased staff confidence in carrying out and sustaining the intervention. Individualized project support was particularly meaningful. Other aspects of capacity, such as leadership support and staff time, were limitations to project success. These findings will inform other efforts, especially those in large, complex jurisdictions, in implementing collaborative community interventions.
International Journal of Environmental Research and Public Health
Improving healthy food access in low-income communities continues to be a public health challenge... more Improving healthy food access in low-income communities continues to be a public health challenge. One strategy for improving healthy food access has been to introduce community food stores, with the mission of increasing healthy food access; however, no study has explored the experiences of different initiatives and models in opening and sustaining healthy food stores. This study used a case study approach to understand the experiences of healthy food stores in low-income communities. The purpose of this paper is to describe the methodology used and protocol followed. A case study approach was used to describe seven healthy food stores across urban settings in the U.S. Each site individually coded their cases, and meetings were held to discuss emerging and cross-cutting themes. A cross-case analysis approach was used to produce a series of papers detailing the results of each theme. Most case studies were on for-profit, full-service grocery stores, with store sizes ranging from 900...
One of the most important public health issues of the new century is food justice, which is a spe... more One of the most important public health issues of the new century is food justice, which is a special case of environmental justice, food access and health equity. Food justice encompasses a range of issues from assuring the production and distribution of healthy food in ways that promote local consumption and protect natural resources and human labor. Further, it also is concerned with community self-determination in food access and honors cultural sensitivity and cultural renewal in terms of how food is made available, and which food products are offered. Food justice goes beyond food security to address health equity in that available foods meet current dietary guidelines and foster healthy eating over the life span. Given the persistence of health inequities and the national and global obesity epidemic, this concept has emerged as highly salient for community health improvement, particularly in underserved, minority communities. This chapter will review the science and practice ...
The Journal of School Nursing
Data on school health policy implementation are limited due to the absence of a validated measure... more Data on school health policy implementation are limited due to the absence of a validated measurement tool. The purpose of this study was to create and pilot a school health policy implementation survey. A modified, four-round Delphi process was used to achieve consensus on content and format of the survey. The final 76-item survey was piloted in 655 schools with a return rate of 57.1% (n  =  378). Seven schools participated in environmental audits. Based on the audits, survey responses represented an accurate description of school practices for 84.2% (n  =  64) of questions. The remaining 15.8% (n  =  12) of survey items were eliminated or revised. This measurement tool begins to fill the research gap between the evaluation of written school health policy and implementation. Further, this tool may be used by school nurses in alignment with the Framework for 21st Century School Nursing Practice.
International public health journal, 2013
IntroductionObesity has reached epidemic proportions in the United States. In 2007-2008, 34% of U... more IntroductionObesity has reached epidemic proportions in the United States. In 2007-2008, 34% of US adults and 18.1% of adolescents 12 to 19 years old were obese (1, 2). Nationally, obesity has hit a plateau with no significant increase for adults since 2003-2004 and among children from 2008-2010. In 2011, 27.7% of Illinois adults and 20.7% of Illinois children between the ages of 10 and 17 were obese (3,4). Obesity disproportionally affects minority and low-income individuals; including 39.5% of African Americans, 31.5% of Latinos and 33.8% of adults with an annual household income less than $15,000 in Illinois (3). While national obesity rates are stabilizing, Illinois continues to experience increases in the prevalence of obesity among adults and children with a disproportionate burden falling on minority populations and those living in poverty.Obesity is associated with chronic diseases and conditions such as cardiovascular disease, diabetes mellitus II, arthritis, depression, ce...
ABSTRACT Introduction In suburban Cook County, IL communities with high proportions of low-income... more ABSTRACT Introduction In suburban Cook County, IL communities with high proportions of low-income households, have higher obesity prevalence. These same communities often have limited access to healthy foods - especially fresh produce. Small, independent corner stores are the primary source of groceries in many of these communities, especially for residents without automobiles. These existing stores may be resources for bringing healthier options to residents in need. Approach In 2010, the suburban Cook County Communities Putting Prevention to Work initiative engaged 21 store owners in eight low income communities in Healthy Hotspot (HH), a pilot corner store project that aimed to increase healthy food access for low-income residents. Collaborating local organizations provided store owners training on healthy food pricing/placement and free marketing/promotional events to increase the stock and sale of healthy foods. A 2012, project evaluation was conducted to determine impact on store owners' knowledge, attitudes and motivation to continue the sale of healthy foods. Results Interviews with store owners found positive attitudes towards healthier food sales, increased knowledge of the impact of healthier eating on the community, and a sense of commitment among store owners around obesity prevention - including a commitment to provide health education to customers. Store owner motivation to continue the project was not always tied to increased sales of healthy foods, especially in Latino communities. Discussion Understanding small retail owners' perspectives is important to inform strategies for increasing healthy food access for low-income residents. Engaging local store owners can provide for sustainable and effective food access interventions.
This study identifies and describes the locally relevant understanding of healthy corner stores a... more This study identifies and describes the locally relevant understanding of healthy corner stores as community-based enterprises (CBEs) within eight suburban communities. In this study, CBEs are defined as a community-lead or community-oriented small businesses with a common goal to improve population health (Peredo and Chrisman, 2006). The 21 corner store owners assessed in this study were participants of the suburban Cook County Healthy HotSpot (HH) corner store pilot project. In collaboration with eight local community-based organizations (CBOs), owners facilitated increasing healthy food access within low-income communities. The aims of this study are: 1) to explicate the locally relevant understanding of corner stores as CBEs and health promoting agents, and 2) to theorize about the role of store owners’ CBE identities in the institutionalization of health promoting activities, to foster healthy eating over the long-term. In order to determine store owner alignment with a CBE ide...
International Journal of Environmental Research and Public Health
The Best Food Forward (BFF) project aims to provide multiple nutrition supports and interventions... more The Best Food Forward (BFF) project aims to provide multiple nutrition supports and interventions to improve family food security (FS) and health outcomes associated with FS within two metropolitan school districts. A quasi-experimental time-series design guided a multilevel evaluation for BFF through surveys, biometric screenings, focus groups, and observations among a random sample of caregiver–child dyads. FS, utilization of school meal programs, and nutrition behaviors were observed and analyzed at three time points: preintervention, postintervention pre-COVID-19, and postintervention post-COVID-19. Participants included 122 parents and 162 youth. Families reported (1) an income less than $35,000 annually (48.8%) and (2) a COVID-19-related job loss (36.9%). Parents used Supplemental Nutrition Assistance Programs or Women, Infants, Children benefits prior to (51.1%) and following COVID-19 (50.0%). No significant differences in FS were found. RM-ANOVA indicated an increase in brea...
Health Education & Behavior
Reports of small business owner motivations for participation in health promotion interventions a... more Reports of small business owner motivations for participation in health promotion interventions are rarely reported in the literature, particularly in relation to healthy eating interventions. This study explicates and defines the development of healthy corner stores as community-based enterprises (CBEs) within eight low-income, suburban communities. CBEs are defined as community-oriented small businesses with a common goal to improve population health. The corner stores assessed in this study were participants in Healthy HotSpot (HH), a corner store initiative of the Cook County Department of Public Health. To determine store alignment with the CBE construct, a case study design was used for qualitative inquiry. Participant narratives from store owners ( n = 21), community-based organizations (CBOs; n = 8) and consumer focus groups ( n = 51) were analyzed using an iterative process to determine how store owners aligned with the CBE construct, and how this influenced continuation of...
Journal of Planning Education and Research
To characterize participants of a statewide healthy food incentive program in terms of shopping b... more To characterize participants of a statewide healthy food incentive program in terms of shopping behaviors, surveys were collected at farmers markets (N = 436) and grocery stores (N = 131). Farmers market and grocery store respondents were mostly forty-five to fifty-four years old (21 percent to 24 percent) and female (72 to 82 percent). Grocery store respondents were more diverse. Farmers market participants were more likely to be female ( p = .011), not have children ( p = .006), and traveled further compared to grocery store participants. As healthy food incentive programs expand, participant characteristics should inform tailored outreach to expand to diverse populations to have a greater public health impact.
ABSTRACT Introduction: Overweight or obesity prevalence among kindergarten, 6th and 9th graders i... more ABSTRACT Introduction: Overweight or obesity prevalence among kindergarten, 6th and 9th graders in Chicago Public Schools (CPS) was 43.3% in 2010, with higher rates among African-American and Hispanic students. CPS Office of Student Health and Wellness (CPS-OSHW) adopted strengthened school wellness and physical education policies in school year 2012-13, which encourage healthy school environments to improve healthy weight, nutrition and physical activity of 400,000 students. Simultaneously, CPS-OSHW received a CDC-funded Community Transformation Grant to enhance policy implementation (Healthy CPS), which is currently being evaluated. Methodology: Healthy CPS impact is assessed using student survey data, with multilevel models to account for student and school characteristics, including school climate and degree of policy implementation. Stakeholder interviews will inform interpretation of the results. Baseline data from Fall 2013 represent 1,898 4th and 7th graders in a total of 16 intervention and control schools; post-program data will be collected in Spring 2014. Results: Baseline survey respondents included 30% African-American and 65% Hispanic students. African-American students reported higher rates of teachers rewarding students with junk food (68% vs. 50%), withholding recess (60% vs. 38%) and availability of junk food and soda/sport drinks compared to Hispanic students. Similarly, African-American students reported lower water consumption (5 vs. 5.6 days) and higher soda intake (4 vs. 3.4 days) compared to Hispanic students. Discussion: The impact analysis will determine whether Healthy CPS improved nutrition and physical activity outcomes and reduced outcome disparities, especially those related to policies implemented at participating schools, including whether differences are influenced by school culture.
Local health departments (LHD) rely heavily on grants to fund core public health initiatives and,... more Local health departments (LHD) rely heavily on grants to fund core public health initiatives and, in some cases, build organizational infrastructure. Many pitfalls exist with this funding approach, including but not limited to, ever-changing and unrealistic deliverables, unreliable and inconsistent funding sources, and fast turn around times. The impact is a loss in productivity as too much time is spent on trying to organize the work. In addition, grant implementation tends to focus on operational issues instead of strategic ones, reducing the capacity to impact improvement in public health outcomes. As LHDs continue to remain dependent on grant funding, implementation strategies are needed to help organize the work in an effective and efficient manner that allows for both a focus on strategy and operations. The Cook County Department of Public Health (CCDPH) in collaboration with the Public Health Institute of Metropolitan Chicago was awarded nearly $16 million from a 2-year feder...
Background Socioeconomic disparities are abundant among the nearly 400,000 CPS student population... more Background Socioeconomic disparities are abundant among the nearly 400,000 CPS student population, as 87% are from low-income families and nearly 50% are overweight or obese. Chicago Public Schools (CPS) Office of Student Health and Wellness is working to address these disparities through implementation of a comprehensive, coordinated health education (HE) strategy that is aligned with Illinois Common Core, supports current efforts around nutrition and sexual health, and reflects national standards. In January, CPS became the first school in the nation to adopt a physical education policy, which allocates 60 minutes per week (out of 150) of instructional time to HE. Improving students’ knowledge of HE through a coordinated strategy can improve health outcomes and is integral to education reform and academic achievement, as there is currently no established national model for school districts to implement. Methods The strategy includes implementation of a strategic plan, a pilot proj...
Introduction: Overweight or obesity prevalence among kindergarten, 6th and 9th graders in Chicago... more Introduction: Overweight or obesity prevalence among kindergarten, 6th and 9th graders in Chicago Public Schools (CPS) was 43.3% in 2010, with higher rates among African-American and Hispanic students. CPS Office of Student Health and Wellness (CPS-OSHW) adopted strengthened school wellness and physical education policies in school year 2012-13, which encourage healthy school environments to improve healthy weight, nutrition and physical activity of 400,000 students. Simultaneously, CPS-OSHW received a CDC-funded Community Transformation Grant to enhance policy implementation (Healthy CPS), which is currently being evaluated. Methodology: Healthy CPS impact is assessed using student survey data, with multilevel models to account for student and school characteristics, including school climate and degree of policy implementation. Stakeholder interviews will inform interpretation of the results. Baseline data from Fall 2013 represent 1,898 4th and 7th graders in a total of 16 interven...
The Cook County Department of Public Health (CCDPH) which serves a geopolitically complex jurisdi... more The Cook County Department of Public Health (CCDPH) which serves a geopolitically complex jurisdiction, comprised of nearly 2.3 million people residing in 125 communities, has traditionally addressed increasing rates of chronic disease through service oriented work. A demographic shift from urban centers to suburban communities among impoverished and minority populations coupled with decreased resources, initiated an agency shift from traditional public health towards policy and environmental change strategies in order to ensure greatest impact. In March 2010, a Communities Putting Prevention to Work (CPPW) grant administered by the Centers for Disease Control and Prevention was awarded to CCDPH and the Public Health Institute of Metropolitan Chicago. This expansive obesity prevention initiative provided CCDPH the fiscal and human resources required to expand a policy and environmental change agenda. Given the complexities of working within a large, multi-faceted jurisdiction with n...
PHIMC has expertise in working with and convening community-based coalitions who often serve as s... more PHIMC has expertise in working with and convening community-based coalitions who often serve as safety net public health providers for many low-income racial and ethnic minority communities throughout Chicago. These coalitions have faced common economic challenges that threatened their sustainability. As a result, the life cycle of many coalitions we've worked with is disappointingly short or preoccupied with a search for financial support, with few coalitions surviving beyond initial formation. To address these issues among our community health partners, PHIMC developed the Community Centered Health Network (The Network). The purpose of the Network is to assist health-related partnerships and coalitions to achieve sustainability. Challenges, barriers and potential solutions to coalition sustainability are being explored with stakeholders and community leaders through a series of interactive forums, workshops, interviews, surveys and targeted capacity-building projects. Based on...
Introduction: Many Chicago Public School (CPS) students have access to foods and beverages sold b... more Introduction: Many Chicago Public School (CPS) students have access to foods and beverages sold by mobile vendors before and after school yet assessments documenting the types of products available has not been widely recorded. As a partner for Healthy CPS, a CDC-funded initiative of the CPS Office of Student Health and Wellness, the Consortium to Lower Obesity in Chicago Children (CLOCC) sought to describe mobile vendors’ contribution to the food environment and identify opportunities for intervention to improve the healthfulness of items offered. Methods: We conducted 221 menu audits at a convenience sample of 15 schools using a menu audit tool tailored for mobile vendors. Audits were conducted around school dismissal on three days in a calendar week at each school to account for variation in vendor attendance. We categorized products offered by type (e.g., fruit, chips, frozen desserts), combined them into healthy and unhealthy categories, and ran descriptive statistics. Results:...
Uploads
Papers by Rachael Dombrowski