Pamela Schwartz - Academia.edu (original) (raw)
Papers by Pamela Schwartz
Preventive Medicine Reports
NAM Perspectives
The authors would like to recognize and thank those who contributed greatly to the dose concept a... more The authors would like to recognize and thank those who contributed greatly to the dose concept and publication of this report, including Nicole Lezin of Cole Communications for her contributions to writing and editing as well as our community and evaluation partners and Kaiser Permanente colleagues who provided invaluable feedback as we built the concept and attempted to operationalize it.
ABSTRACT Creative ways must be found to engage both community residents and political leaders aro... more ABSTRACT Creative ways must be found to engage both community residents and political leaders around policy and environmental solutions to public health issues. Photovoice is a community-based, participatory approach to documentary photography that provides people with training on photography, ethics, critical discussion, and policy advocacy. Photovoice projects have been implemented across the nation as part of Kaiser Permanente's Community Health Initiative-a community-based obesity prevention effort. This article focuses on the first Photovoice project implemented in three communities in Colorado. Photovoice themes related to healthy eating and active living include a lack of access to healthy food choices in stores and schools, unsafe street crossings and sidewalks, and the need to redevelop certain areas to encourage safe recreation. The involvement of policy leaders in the project combined with several dissemination activities has contributed to healthier food offerings in schools and neighborhoods and city planning efforts that emphasize walkability and access to healthy food, and park revitalization.
National Civic Review, 2014
Journal of Nutrition Education and Behavior, 2012
Objective: To compare knowledge gains and knowledge retention of healthful eating and active livi... more Objective: To compare knowledge gains and knowledge retention of healthful eating and active living behaviors in elementary school children participating in Educational Theatre Programs (ETP). Methods: The study sample included 47 schools (2,915 third-or fourth-grade students) in 8 Kaiser Permanente regions. Children's knowledge of 4 healthful behaviors was measured using a brief survey before and immediately after performances, followed by a post-delay survey 3 weeks later. Results: Statistically significant increases in knowledge pre/post for individual topics (P < .01). The percentage of children who answered all 4 questions correctly increased from 17% to 63% immediately after ETP performances (P < .01). Knowledge was retained over the short term; the proportion of students who correctly identified recommended healthful eating/active living practices had declined only slightly 3 weeks later. Conclusions and Implications: The ETP significantly improved participating students' knowledge of healthful eating and active living concepts. Theater programs should be considered for inclusion in elementary school health curricula.
The Journal of Early Adolescence, 2001
Considerable progress has been made in prevention science, and since reaching a high in the late ... more Considerable progress has been made in prevention science, and since reaching a high in the late 1970s and early 1980s, overall substance use has declined in the United States. However, for some populations and substances, smaller declines or even increased use has been observed. Notably, the traditional gender gap in substance use has decreased substantially, and it has disappeared completely for some substances, especially among younger cohorts. This article was written to integrate existing evidence on the relevance of gender for substance use prevention research and to move the field forward by suggesting theoretical models that might inform future prevention research with girls. This article reviews the following: (a) trends in substance use, (b) gender differences in risk factors, and (c) theoretical models deemed relevant to substance use prevention among girls. Finally, recommendations regarding needed research and prevention strategies that take gender, race, and ethnicity ...
Journal of Nutrition …, 2011
OBJECTIVE: To compare knowledge gains and knowledge retention of healthful eating and active livi... more OBJECTIVE: To compare knowledge gains and knowledge retention of healthful eating and active living behaviors in elementary school children participating in Educational Theatre Programs (ETP). METHODS: The study sample included 47 schools (2,915 third-or fourth-...
Health Promotion Practice, 2010
Creative ways must be found to engage both community residents and political leaders around polic... more Creative ways must be found to engage both community residents and political leaders around policy and environmental solutions to public health issues. Photovoice is a community-based, participatory approach to documentary photography that provides people with training on photography, ethics, critical discussion, and policy advocacy. Photovoice projects have been implemented across the nation as part of Kaiser Permanente’s Community Health Initiative—a community-based obesity prevention effort. This article focuses on the first Photovoice project implemented in three communities in Colorado. Photovoice themes related to healthy eating and active living include a lack of access to healthy food choices in stores and schools, unsafe street crossings and sidewalks, and the need to redevelop certain areas to encourage safe recreation. The involvement of policy leaders in the project combined with several dissemination activities has contributed to healthier food offerings in schools and ...
Clinical Medicine & Research, 2012
Background/Aims: The majority of patients with mental health concerns turn to their primary care ... more Background/Aims: The majority of patients with mental health concerns turn to their primary care physician (PCP). We investigate whether periodic health exams (PHEs) may be a good opportunity for these patients to receive mental health services. We examine the impact of patients' need for mental health care, competing demands from biomedical issues, and the availability of behavioral health providers on the probability of discussing mental health. Methods: The study uses audio recordings of 308 unique patients' PHEs with 59 PCPs. Visits took place in 22 clinics of an integrated delivery system in metropolitan Detroit between 2007-2009. Administrative data and electronic medical records spanning 12-months before the PHE are also used. Patients are aged 50 to 80; all were deemed to be potentially in need of mental health services because of their Personal Health Questionnaire (PHQ2) score, prior diagnosis of mental illnesses, use of behavioral health services, or psychotropic medication use. We coded the audio to capture visit contents and time spent on each "topic" (defined as an issue that had at least two complete exchanges between patient and physician). We examined the probability of a mental health discussion using a logit generalized estimating equation (GEE) regression. Results: The median length of patient-physician interaction was 26 minutes. The median number of "topics" was 19. Biomedical discussions were present in all visits; 38% (118 of 308) of the visits included a mental health discussion. The median length of a mental health discussion was 47 seconds. Logit results suggest the likelihood of mental health discussion increased if the patient had a PHQ2 =3 (odds ratio [OR]=5.30, p<0.01), was on psychotropic medication (OR=2.47, p<0.05), had a mental health diagnosis in prior year (OR=2.52, p<0.05), and was female (OR=1.88, p<0.05). The likelihood decreased if the clinic has co-located behavioral health (OR=0.47, p<0.05). Percent time spent on biomedical issues did not significantly impact the probability of a mental health discussion. Conclusions: Many discussions occurred during PHEs with patients potentially needing mental health care. Only 38% (118 of 308) of all visits contained mental health discussions, and in those that did more than half lasted less than a minute.
American Journal of Health Promotion, 2012
Purpose. To describe the evaluation findings and lessons learned from the Kaiser Permanente Healt... more Purpose. To describe the evaluation findings and lessons learned from the Kaiser Permanente Healthy Eating Active Living-Community Health Initiative. Design. Mixed methods design: qualitative case studies combined with pre/post population-level food and physical activity measures, using matched comparison schools for youth surveys. Setting. Three low-income communities in Northern California (combined population 129,260). Subjects. All residents of the three communities. Intervention. Five-year grants of $1.5 million awarded to each community to support the implementation of community-and organizational-level policy and environmental changes. Sectors targeted included schools, health care settings, worksites, and neighborhoods. Measures. Reach (percentage exposed) and strength (effect size) of the interventions combined with population-level measures of physical activity (e.g., minutes of physical activity) and nutrition (e.g., fruit and vegetable servings). Analysis. Pre/post analysis of population level measures, comparing changes in intervention to comparison for youth survey measures. Results. The population-level results were inconclusive overall, but showed positive and significant findings for four out of nine comparisons where ''high-dose'' (i.e., greater than 20% of the population reached and high strength) strategies were implemented, primarily physical activity interventions targeting school-age youth. Conclusion. The positive and significant changes for the high-dose strategies suggest that if environmental interventions are of sufficient reach and strength they may be able to favorably impact obesity-related behaviors.
Health Promotion Practice, 2013
Photovoice is a community-based participatory research method that provides participants who trad... more Photovoice is a community-based participatory research method that provides participants who traditionally have little voice in community policy decisions, with training in photography, ethics, critical dialogue, photo captioning, and policy advocacy. Photovoice has been used primarily as a needs assessment and advocacy tool and only rarely as a pre-/postintervention evaluation method. This article describes the use of Photovoice as a participatory evaluation method in the Community Health Initiative, a 6-year, multisite community-based obesity prevention initiative, sponsored by Kaiser Permanente. Fifty community participants (including six youth) from six Community Health Initiative communities used photos and captions to identify, from their perspective, the most significant accomplishments from the initiative at both baseline and follow-up. Accomplishments identified included increased access to fresh/healthy food in local neighborhoods; policy changes supporting a “healthy eati...
American Journal of Evaluation, 2013
ABSTRACT When planning and evaluating community-level initiatives focused on policy and environme... more ABSTRACT When planning and evaluating community-level initiatives focused on policy and environment change, it is useful to have estimates of the impact on behavioral outcomes of particular strategies (e.g., building a new walking trail to promote physical activity). We have created a measure of estimated strategy-level impact—“population dose”—based on our work in evaluating obesity prevention initiatives that uses elements of the RE-AIM method of combining reach and effectiveness to estimate the impact of a strategy on risk behaviors within a target population. We provide a definition and examples of measuring population dose, discuss measurement options in the face of uncertainty about key parameters, review ways of increasing population dose, and illustrate how the concept of population dose has been used in the Kaiser Permanente Community Health Initiative.
American Journal of Public Health, 2010
Despite growing support amongpublichealthresearchers and practitioners for environmental approach... more Despite growing support amongpublichealthresearchers and practitioners for environmental approaches to obesity prevention, there is a lack of empirical evidence from intervention studies showing a favorable impact of either increased healthy food availability on healthy eating or changes in the built environment on physical activity. It is therefore critical that we carefully evaluate initiatives targeting the community environment to expand the evidence base for environmental interventions. We describe the approaches used to measure the extent and impact of environmental change in 3 community-level obesityprevention initiatives in California. We focus on measuring changes in the community environment and assessing the impact of those changes on residents most directly exposed to the interventions.
American Journal of Public Health, 2010
The Kaiser Permanente (KP) Community Health Initiative (CHI) is a program-wide strategy for impro... more The Kaiser Permanente (KP) Community Health Initiative (CHI) is a program-wide strategy for improving the health of communities served by KP. The thematic focus is on "Healthy Eating, Active Living" (HEAL) - promoting improvements in nutrition and physical activity and reductions in overweight/obesity. The CHI intervention approach is to use environmental and policy changes to promote population-level improvements in levels of physical activity and proportions of the population eating a healthy diet. Thirty communities in five KP regions are currently implementing CHI. A comprehensive, cross-site evaluation is being conducted covering the five years of CHI implementation (2006-2011). Evaluation methods include baseline and follow-up population-level surveys of youth and adults, and documentation of community programmatic and environmental changes taking place as a result of CHI. This presentation will provide an overview of the design for the CHI cross-site evaluation, des...
Preventive Medicine Reports
NAM Perspectives
The authors would like to recognize and thank those who contributed greatly to the dose concept a... more The authors would like to recognize and thank those who contributed greatly to the dose concept and publication of this report, including Nicole Lezin of Cole Communications for her contributions to writing and editing as well as our community and evaluation partners and Kaiser Permanente colleagues who provided invaluable feedback as we built the concept and attempted to operationalize it.
ABSTRACT Creative ways must be found to engage both community residents and political leaders aro... more ABSTRACT Creative ways must be found to engage both community residents and political leaders around policy and environmental solutions to public health issues. Photovoice is a community-based, participatory approach to documentary photography that provides people with training on photography, ethics, critical discussion, and policy advocacy. Photovoice projects have been implemented across the nation as part of Kaiser Permanente's Community Health Initiative-a community-based obesity prevention effort. This article focuses on the first Photovoice project implemented in three communities in Colorado. Photovoice themes related to healthy eating and active living include a lack of access to healthy food choices in stores and schools, unsafe street crossings and sidewalks, and the need to redevelop certain areas to encourage safe recreation. The involvement of policy leaders in the project combined with several dissemination activities has contributed to healthier food offerings in schools and neighborhoods and city planning efforts that emphasize walkability and access to healthy food, and park revitalization.
National Civic Review, 2014
Journal of Nutrition Education and Behavior, 2012
Objective: To compare knowledge gains and knowledge retention of healthful eating and active livi... more Objective: To compare knowledge gains and knowledge retention of healthful eating and active living behaviors in elementary school children participating in Educational Theatre Programs (ETP). Methods: The study sample included 47 schools (2,915 third-or fourth-grade students) in 8 Kaiser Permanente regions. Children's knowledge of 4 healthful behaviors was measured using a brief survey before and immediately after performances, followed by a post-delay survey 3 weeks later. Results: Statistically significant increases in knowledge pre/post for individual topics (P < .01). The percentage of children who answered all 4 questions correctly increased from 17% to 63% immediately after ETP performances (P < .01). Knowledge was retained over the short term; the proportion of students who correctly identified recommended healthful eating/active living practices had declined only slightly 3 weeks later. Conclusions and Implications: The ETP significantly improved participating students' knowledge of healthful eating and active living concepts. Theater programs should be considered for inclusion in elementary school health curricula.
The Journal of Early Adolescence, 2001
Considerable progress has been made in prevention science, and since reaching a high in the late ... more Considerable progress has been made in prevention science, and since reaching a high in the late 1970s and early 1980s, overall substance use has declined in the United States. However, for some populations and substances, smaller declines or even increased use has been observed. Notably, the traditional gender gap in substance use has decreased substantially, and it has disappeared completely for some substances, especially among younger cohorts. This article was written to integrate existing evidence on the relevance of gender for substance use prevention research and to move the field forward by suggesting theoretical models that might inform future prevention research with girls. This article reviews the following: (a) trends in substance use, (b) gender differences in risk factors, and (c) theoretical models deemed relevant to substance use prevention among girls. Finally, recommendations regarding needed research and prevention strategies that take gender, race, and ethnicity ...
Journal of Nutrition …, 2011
OBJECTIVE: To compare knowledge gains and knowledge retention of healthful eating and active livi... more OBJECTIVE: To compare knowledge gains and knowledge retention of healthful eating and active living behaviors in elementary school children participating in Educational Theatre Programs (ETP). METHODS: The study sample included 47 schools (2,915 third-or fourth-...
Health Promotion Practice, 2010
Creative ways must be found to engage both community residents and political leaders around polic... more Creative ways must be found to engage both community residents and political leaders around policy and environmental solutions to public health issues. Photovoice is a community-based, participatory approach to documentary photography that provides people with training on photography, ethics, critical discussion, and policy advocacy. Photovoice projects have been implemented across the nation as part of Kaiser Permanente’s Community Health Initiative—a community-based obesity prevention effort. This article focuses on the first Photovoice project implemented in three communities in Colorado. Photovoice themes related to healthy eating and active living include a lack of access to healthy food choices in stores and schools, unsafe street crossings and sidewalks, and the need to redevelop certain areas to encourage safe recreation. The involvement of policy leaders in the project combined with several dissemination activities has contributed to healthier food offerings in schools and ...
Clinical Medicine & Research, 2012
Background/Aims: The majority of patients with mental health concerns turn to their primary care ... more Background/Aims: The majority of patients with mental health concerns turn to their primary care physician (PCP). We investigate whether periodic health exams (PHEs) may be a good opportunity for these patients to receive mental health services. We examine the impact of patients' need for mental health care, competing demands from biomedical issues, and the availability of behavioral health providers on the probability of discussing mental health. Methods: The study uses audio recordings of 308 unique patients' PHEs with 59 PCPs. Visits took place in 22 clinics of an integrated delivery system in metropolitan Detroit between 2007-2009. Administrative data and electronic medical records spanning 12-months before the PHE are also used. Patients are aged 50 to 80; all were deemed to be potentially in need of mental health services because of their Personal Health Questionnaire (PHQ2) score, prior diagnosis of mental illnesses, use of behavioral health services, or psychotropic medication use. We coded the audio to capture visit contents and time spent on each "topic" (defined as an issue that had at least two complete exchanges between patient and physician). We examined the probability of a mental health discussion using a logit generalized estimating equation (GEE) regression. Results: The median length of patient-physician interaction was 26 minutes. The median number of "topics" was 19. Biomedical discussions were present in all visits; 38% (118 of 308) of the visits included a mental health discussion. The median length of a mental health discussion was 47 seconds. Logit results suggest the likelihood of mental health discussion increased if the patient had a PHQ2 =3 (odds ratio [OR]=5.30, p<0.01), was on psychotropic medication (OR=2.47, p<0.05), had a mental health diagnosis in prior year (OR=2.52, p<0.05), and was female (OR=1.88, p<0.05). The likelihood decreased if the clinic has co-located behavioral health (OR=0.47, p<0.05). Percent time spent on biomedical issues did not significantly impact the probability of a mental health discussion. Conclusions: Many discussions occurred during PHEs with patients potentially needing mental health care. Only 38% (118 of 308) of all visits contained mental health discussions, and in those that did more than half lasted less than a minute.
American Journal of Health Promotion, 2012
Purpose. To describe the evaluation findings and lessons learned from the Kaiser Permanente Healt... more Purpose. To describe the evaluation findings and lessons learned from the Kaiser Permanente Healthy Eating Active Living-Community Health Initiative. Design. Mixed methods design: qualitative case studies combined with pre/post population-level food and physical activity measures, using matched comparison schools for youth surveys. Setting. Three low-income communities in Northern California (combined population 129,260). Subjects. All residents of the three communities. Intervention. Five-year grants of $1.5 million awarded to each community to support the implementation of community-and organizational-level policy and environmental changes. Sectors targeted included schools, health care settings, worksites, and neighborhoods. Measures. Reach (percentage exposed) and strength (effect size) of the interventions combined with population-level measures of physical activity (e.g., minutes of physical activity) and nutrition (e.g., fruit and vegetable servings). Analysis. Pre/post analysis of population level measures, comparing changes in intervention to comparison for youth survey measures. Results. The population-level results were inconclusive overall, but showed positive and significant findings for four out of nine comparisons where ''high-dose'' (i.e., greater than 20% of the population reached and high strength) strategies were implemented, primarily physical activity interventions targeting school-age youth. Conclusion. The positive and significant changes for the high-dose strategies suggest that if environmental interventions are of sufficient reach and strength they may be able to favorably impact obesity-related behaviors.
Health Promotion Practice, 2013
Photovoice is a community-based participatory research method that provides participants who trad... more Photovoice is a community-based participatory research method that provides participants who traditionally have little voice in community policy decisions, with training in photography, ethics, critical dialogue, photo captioning, and policy advocacy. Photovoice has been used primarily as a needs assessment and advocacy tool and only rarely as a pre-/postintervention evaluation method. This article describes the use of Photovoice as a participatory evaluation method in the Community Health Initiative, a 6-year, multisite community-based obesity prevention initiative, sponsored by Kaiser Permanente. Fifty community participants (including six youth) from six Community Health Initiative communities used photos and captions to identify, from their perspective, the most significant accomplishments from the initiative at both baseline and follow-up. Accomplishments identified included increased access to fresh/healthy food in local neighborhoods; policy changes supporting a “healthy eati...
American Journal of Evaluation, 2013
ABSTRACT When planning and evaluating community-level initiatives focused on policy and environme... more ABSTRACT When planning and evaluating community-level initiatives focused on policy and environment change, it is useful to have estimates of the impact on behavioral outcomes of particular strategies (e.g., building a new walking trail to promote physical activity). We have created a measure of estimated strategy-level impact—“population dose”—based on our work in evaluating obesity prevention initiatives that uses elements of the RE-AIM method of combining reach and effectiveness to estimate the impact of a strategy on risk behaviors within a target population. We provide a definition and examples of measuring population dose, discuss measurement options in the face of uncertainty about key parameters, review ways of increasing population dose, and illustrate how the concept of population dose has been used in the Kaiser Permanente Community Health Initiative.
American Journal of Public Health, 2010
Despite growing support amongpublichealthresearchers and practitioners for environmental approach... more Despite growing support amongpublichealthresearchers and practitioners for environmental approaches to obesity prevention, there is a lack of empirical evidence from intervention studies showing a favorable impact of either increased healthy food availability on healthy eating or changes in the built environment on physical activity. It is therefore critical that we carefully evaluate initiatives targeting the community environment to expand the evidence base for environmental interventions. We describe the approaches used to measure the extent and impact of environmental change in 3 community-level obesityprevention initiatives in California. We focus on measuring changes in the community environment and assessing the impact of those changes on residents most directly exposed to the interventions.
American Journal of Public Health, 2010
The Kaiser Permanente (KP) Community Health Initiative (CHI) is a program-wide strategy for impro... more The Kaiser Permanente (KP) Community Health Initiative (CHI) is a program-wide strategy for improving the health of communities served by KP. The thematic focus is on "Healthy Eating, Active Living" (HEAL) - promoting improvements in nutrition and physical activity and reductions in overweight/obesity. The CHI intervention approach is to use environmental and policy changes to promote population-level improvements in levels of physical activity and proportions of the population eating a healthy diet. Thirty communities in five KP regions are currently implementing CHI. A comprehensive, cross-site evaluation is being conducted covering the five years of CHI implementation (2006-2011). Evaluation methods include baseline and follow-up population-level surveys of youth and adults, and documentation of community programmatic and environmental changes taking place as a result of CHI. This presentation will provide an overview of the design for the CHI cross-site evaluation, des...