The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

Abstract

Policy, systems, and environmental (PSE) change interventions to improve local food and physical activity environments play an important role in addressing the ongoing obesity crisis, especially in conjunction with nutrition, physical activity, and food resource management education. These interventions are particularly important tools to address health equity because education alone is insufficient to reduce racial disparities in obesity rates,1Mackey ER Burton ET Cadieux A et al.Addressing structural racism is critical for ameliorating the childhood obesity epidemic in Black youth.Child Obes. 2022; 18: 75-83Crossref PubMed Scopus (11) Google Scholar,2Kumanyika SK. A framework for increasing equity impact in obesity prevention.Am J Public Health. 2019; 109: 1350-1357Crossref PubMed Scopus (98) Google Scholar and maybe insensitive in the face of structural barriers to healthful eating and physical activity.3Kolavalli C. Whiteness and food charity: experiences of food insecure African-American Kansas City residents navigating nutrition education programs.Hum Organ. 2019; 78: 99-109Crossref Scopus (8) Google Scholar Federally funded nutrition education programs, including Supplemental Nutrition Assistance Program-Education (SNAP-Ed) and the Expanded Food and Nutrition Education Program (EFNEP), are encouraged by their funders to make PSE changes,4Galdamez I. NIFA-19-018 EFNEP integration of policy, systems, and environmental change efforts. https://nifa.usda.gov/nifa-19-018-efnep-integration-policy-systems-environmental-change-efforts. Accessed November 15, 2022.Google Scholar,5Burke MP Gleason S Singh A Wilkin MK. Policy, systems, and environmental change strategies in the Supplemental Nutrition Assistance Program-Education (SNAP-Ed).J Nutr Educ Behav. 2022; 54 (Published online 2022): 320-326Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar but funders do not specify whether PSE interventions should be designed by implementers or by the community implementers serve. For example, SNAP-Ed guidance does not provide instruction regarding the decision-making process for selecting PSE change strategies.6US Department of Agriculture, Food and Nutrition Service. FY 2023 Supplemental Nutrition Assistance Program Education (SNAP-ED) Plan Guidance: Nutrition Education and Obesity Prevention Program. US Department of Agriculture, Supplemental Nutrition Assistance Program; 2023.https://snaped.fns.usda.gov/sites/default/files/documents/FY2023_SNAPEd_PlanGuidance_FV.pdf. Accessed June 20, 2022.Google Scholar In addition, training on PSE change strategies for SNAP-Ed implementers generally focuses on federal guidelines, defining PSE change strategies, and providing examples of successful implementation.7Pope HC Draper C Younginer N Whitt O Paget C. Use of decision cases for building SNAP-Ed implementers’ capacities to realize policy, systems, and environmental strategies.J Nutr Educ Behav. 2020; 52: 512-521Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar Similarly, EFNEP guidance does not instruct implementers on how to decide on the PSE change strategies.8Galdamez I. Expanded food and nutrition Education Program (EFNEP) integrating policy, systems, and environmental change efforts. https://connect.extension.org/g/efnep/resource/efnep-pse-guidance. Accessed November 15, 2022.Google Scholar Furthermore, EFNEP PSE training states that PSEs should be implemented through coordination with community partners, although those partners should not decide on PSEs.9Bishop-Smith C, Feighner A, Galdamez I. EFNEP PSE guidance and planning in the 5-year plan. https://efneppse.org/wp-content/uploads/2020/06/March-Webinar-Part-1-EFNEP-PSE-Guidance-and-Planning-in-the-5-Year-Plan.pdf. Accessed November 15, 2022.Google Scholar Including participants in the design and delivery of health-focused interventions may improve the recruitment and retention of participants, the appropriateness of the intervention for the target audience, and intervention sustainability.10Harris J Cook T Gibbs L et al.Searching for the impact of participation in health and health research: challenges and methods.BioMed Res Int. 2018; 20189427452Crossref PubMed Scopus (25) Google Scholar, 11Rifkin SB. Examining the links between community participation and health outcomes: a review of the literature.Health Policy Plan. 2014; 29: ii98-ii106Crossref PubMed Scopus (195) Google Scholar, 12Cargo M Mercer SL. The value and challenges of participatory research: strengthening its practice.Annu Rev Public Health. 2008; 29: 325-350Crossref PubMed Scopus (680) Google Scholar Community involvement in PSE change interventions is particularly vital to address structural racism, a contributor to increased obesity, food insecurity, and physical inactivity rates in marginalized communities that have been of increasing interest to public health professionals.1Mackey ER Burton ET Cadieux A et al.Addressing structural racism is critical for ameliorating the childhood obesity epidemic in Black youth.Child Obes. 2022; 18: 75-83Crossref PubMed Scopus (11) Google Scholar,13Singleton CR Uy WF Landry MJ. Strengthening cross-sector collaborations in hunger-relief efforts to address structural racism.J Nutr Educ Behav. 2021; 53: 93-94Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,14Odoms-Young A Bruce MA. Examining the impact of structural racism on food insecurity: implications for addressing racial/ethnic disparities.Fam Community Health. 2018; 41: S3-S6Crossref PubMed Scopus (170) Google Scholar Interventions that aim to improve health equity and address health disparities should combine PSE changes and education and be implemented with participation and feedback from intended beneficiaries. However, recent reviews of nutrition interventions designed to address structural racism among African Americans, and interventions that obtained input from African American participants, indicate a lack of participatory interventions to address structural barriers to healthful eating.15Greene M Houghtaling B Sadeghzadeh C et al.Nutrition interventions addressing structural racism: a scoping review.Nutr Res Rev. 2022; : 1-53Google Scholar,16Greene M Houghtaling B Sadeghzadeh C et al.African Americans’ perceptions of nutrition interventions: a scoping review.Nutr Res Rev. 2022; : 1-20Google Scholar To our knowledge, no similar reviews have been found to assess nutrition or physical activity interventions to address structural racism in Hispanic and Native American populations. Given the benefits of community-driven PSE change interventions and the need for those approaches to promote health equity, implementers of health-focused Cooperative Extension programs may consider obtaining community buy-in and feedback when designing and implementing PSE change interventions rather than using a predetermined menu of strategies. However, putting the choice of PSE change strategy in the hands of community residents requires time and resources to engage and build trust with community members. The Louisiana State University Agriculture Center (LSU AgCenter) Healthy Communities Initiative was designed as a standardized process to engage underserved and historically marginalized communities despite different community needs and characteristics. Program materials are outlined in Table 1 and are publicly available online at: https://forms.office.com/r/R0zDrH9Diw. Materials include a timeline and plan for a community needs assessment, forum, coalition building, forum script, communication materials, coalition member job descriptions, PSE action plans, training materials, and evaluation materials.Table 1Components of the LSU AgCenter Healthy Communities Initiative MaterialsaAvailable online at: https://forms.office.com/r/R0zDrH9DiwComponentPurposeLSU AgCenter Healthy Communities Initiative program manual and timelineProvides implementers with all materials needed to solicit community input support for the implementation of PSE change interventionsHealthy Communities forum guidebIncluded in the LSU AgCenter Healthy Communities Initiative program manual.A script for implementers to lead a community focus group to determine which PSE change interventions to implementHealthy Communities coalition overview and coalition member job description templatesbIncluded in the LSU AgCenter Healthy Communities Initiative program manual.Provides coalition members an example of their role and purpose when participating in Healthy Communities coalitionsHealthy Communities coalition action plan templatebIncluded in the LSU AgCenter Healthy Communities Initiative program manual.Provides a method of keeping coalition members accountable to planned work when implementing PSE changesThe follow-up community forum and ripple effect mapping scriptA script for a second-time community forum to discuss work that has been completed, gather community input on future work and produce a ripple effect map to evaluate work that has been completedPSE change quick reference guideA short tool that shows implementers of nutrition education programs how to link their work to PSE change interventionsHealthy Communities talking pointsDescribes the LSU AgCenter Healthy Communities Initiative to potential partner organizations and PSE change sites to encourage participationFood system PSE change and collaborative decision-making toolHelps Healthy Communities Initiative implementers identify opportunities for PSE changes in their local food systemsLSU AgCenter indicates Louisiana State University Agriculture Center; PSE, policy, systems, and environmental.a Available online at: https://forms.office.com/r/R0zDrH9Diwb Included in the LSU AgCenter Healthy Communities Initiative program manual. Open table in a new tab LSU AgCenter indicates Louisiana State University Agriculture Center; PSE, policy, systems, and environmental. Cooperative Extension's 2014 National Framework for Health and Wellness outlined the need for PSE change interventions and education to address factors influencing behavior change according to the social ecological model.17Braun B, Bruns K, Cronk L, et al. Cooperative Extension's National Framework for Health and Wellness. www.aplu.org/wp-content/uploads/national-framework-for-health-and-wellness.pdf. Accessed November 15, 2022.Google Scholar This model describes influences on behavior beyond individual knowledge, such as interpersonal influences, societal and social norms, and environmental factors.18Langille JLD Rodgers WM. Exploring the influence of a social ecological model on school-based physical activity.Health Educ Behav. 2010; 37: 879-894Crossref PubMed Scopus (101) Google Scholar The leadership of nutrition and health education programs implemented through Cooperative Extension recommended that implementers use PSE change approaches to address food insecurity and obesity.4Galdamez I. NIFA-19-018 EFNEP integration of policy, systems, and environmental change efforts. https://nifa.usda.gov/nifa-19-018-efnep-integration-policy-systems-environmental-change-efforts. Accessed November 15, 2022.Google Scholar,19US Department of Agriculture Food & Nutrition Service. Supplemental Nutrition Assistance Program Education Guidance: Nutrition Education and Obesity Prevention Grant Program. US Department of Agriculture; 2015. https://snaped.fns.usda.gov/library/materials/fy-2016-snap-education-plan-guidance. Accessed August 12, 2022.Google Scholar In response, the LSU AgCenter's Family and Consumer Sciences (FCS) Program launched the LSU AgCenter Healthy Communities Initiative.20Holston D Stroope J Cater M Kendall M Broyles S. Implementing policy, systems, and environmental change through community coalitions and extension partnerships to address obesity in rural Louisiana.Prev Chronic Dis. 2020; 17: E18Crossref PubMed Scopus (15) Google Scholar In this initiative, LSU AgCenter FCS agents were encouraged to form coalitions to secure community input, foster partnerships, and guide the implementation of PSE change efforts. These staff previously worked to provide research-based nutrition education to the public and did not engage in formal community development or PSE change work. From 2014 to 2020, program policies and tools were developed and refined to arrive at the current version of the Healthy Communities Initiative materials, which guide implementers through the process of holding a community forum, determining which PSE change strategies to implement, recruiting coalition members, holding coalition meetings, and building action plans to address PSE change strategies. Beginning in 2018, all FCS agents hired by the LSU AgCenter were required to implement the Healthy Communities Initiative within their first year of employment, beginning with an informal needs assessment. In this assessment, FCS agents collect information on resources and needs of their communities and locate any underserved and historically marginalized areas according to census-tract level poverty data and information from local key informants such as mayors, city council members, community and religious leaders, neighborhood associations, health workers, and others. After identifying communities on the basis of these assessments, FCS staff hold community forums in which residents identify and prioritize strategies for PSE changes according to a standard set of questions provided in the LSU AgCenter Healthy Communities Initiative materials. Although there are no minimum or maximum attendance restrictions, if there are > 12 attendees, the group is split into 2 smaller groups to discuss community needs and develop separate PSE change strategies before reassembling as a larger group to vote on and prioritize the suggested PSE strategies. Forums typically occur in-person, but adaptations to a virtual format were necessary during the coronavirus disease 2019 pandemic.21Greene MD Stroope J Holston D. Adapting ripple effect mapping to a virtual survey format.J Ext. 2022; 60 (Article 9)Google Scholar Forums guide community members toward generating a list of priority health concerns that may or may not include nutrition and physical activity. If the community does not address nutrition and physical activity, follow-up questions will specifically ask about those areas. If only nutrition or physical activity concerns are mentioned, the forum facilitator encourages attendees to think outside those topics and consider other aspects influencing the community's health. Forum attendees then create a list of possible strategies to improve the health of their community. The concept of PSE change is not discussed, but community members are encouraged to think of strategies that will result in a long-term change to their community, and the facilitator may guide suggested strategies toward PSE interventions. Residents then vote on which strategies would be most important to implement and which strategies would be easiest to implement. Strategies typically include some nutrition and physical activity-focused strategies, but not all strategies need to be directly related to those aspects of health. Community forums also serve as a way to recruit residents to participate in community coalitions. Following the initial forum and recruitment for the community coalition, the coalition members pool local resources and/or recruit outside organizations to address identified needs. These resources typically include volunteer support, donations from local businesses, and in-kind support such as land for parks or gardens or space to implement environmental changes. Recruiting outside funding and resources is important for organizations with limited funds or restrictions on using those funds. Strategies to make PSE changes are different for each community. Examples include healthy retail programs, produce distribution programs, school and community gardens, and the stenciling of vacant lots and playgrounds at community centers and schools with images promoting activity (eg, hopscotch and instructions for bodyweight exercises). The implementation of these strategies differs in each community, and assistance from state FCS leadership is provided to individual FCS staff to guide implementation. Therefore, program materials focus heavily on the community forum, coalition building, and evaluating progress toward PSE change and the outcomes of PSE change interventions. A mixed-methods evaluation led by the program evaluator was used to assess the LSU AgCenter's progress toward PSE changes and the impact of those changes. Mixed-methods evaluation designs are essential tools to uplift participants’ voices and advance equity through evaluation.22Mertens DM. Transformative paradigm: mixed methods and social justice.Journal of Mixed Methods Research. 2007; 1: 212-225Crossref Scopus (347) Google Scholar Although FCS staff from all funding sources use the same evaluation, the evaluation was conducted according to the SNAP-Ed evaluation framework.23Naja-Riese A Keller KJM Bruno P et al.The SNAP-Ed Evaluation Framework: demonstrating the impact of a national framework for obesity prevention in low-income populations.Transl Behav Med. 2019; 9: 970-979Crossref PubMed Scopus (19) Google Scholar The framework suggests staff collect and report the number, type, and strength of partnerships, coalitions, PSE changes made to improve nutrition and physical activity environments, PSE changes accompanied by education or training, and outside resources supporting those PSE changes. These indicators are described in greater detail in Table 2. The evaluation was deemed exempt from review by the LSU AgCenter Institutional Review Board under blanket approval for program evaluation.Table 2Quantitative Outcomes of the LSU AgCenter Healthy Communities InitiativeSelected SNAP-Ed Evaluation Framework IndicatoraMore information on the SNAP-Ed evaluation framework indicators is available at (https://snapedtoolkit.org/framework/index/). The letters indicate the duration of the expected change (ST, MT, LT), and each category has several indicators, represented by the numbers following the letters. The table presents relevant indicators selected to evaluate the LSU AgCenter Healthy Communities Initiative, but other indicators are listed on the SNAP-Ed websiteFY2020FY2021FY2022TotalST7a. Partnerships establishedbPartner organizations that regularly meet, exchange information, and identify and implement mutually reinforcing activities that will contribute to the adoption of ≥ 1 PSE change intervention5026988312,031ST7b. Partnership strength NetworkcDefined as sending and receiving information related to the LSU AgCenter Healthy Communities Initiative547488216 CooperatordDefined as working with LSU AgCenter to deliver nutrition or physical activity education programs142195245582 CoordinationeDefined as working with LSU AgCenter to implement PSE changes at 1 location78177128383 CoalitionfDefined as membership in an LSU AgCenter Healthy Communities coalition working to implement PSE changes at multiple locations112133158403 CollaborationgDefined as working with LSU AgCenter to jointly lead planning and implementation of educational or PSE change activities.116177212505ST8. Coalitions established4652146244MT5a Nutrition-focused PSE changes532880161 MT5b. Policy changes70916 MT5c. Systems changes33161968 MT5d. Environmental changes331852103MT6a. Physical activity-focused PSE changes324069141 MT6b. Policy changes70310 MT6c. Systems changes1015732 MT6d. Environmental changes283859125LT5a. PSE changes that included education or staff training103922LT9. Leveraged resources LT9b. Funding (total dollars spent)$4,379,863$111,700$4,827$4,496,390 LT9c. In-kind support (volunteer hours)2,6091,8381,2065,653 LT9c. In-kind support (value of volunteer hours at $25.43/h)$66,347$46,740$30,667$143,754FY indicates fiscal year; LSU AgCenter, Louisiana State University Agriculture Center; LT, long term; MT, medium term; PSE, policy, systems, or environmental; SNAP-Ed, Supplemental Nutrition Assistance Program-Education; ST, Short term.a More information on the SNAP-Ed evaluation framework indicators is available at (https://snapedtoolkit.org/framework/index/). The letters indicate the duration of the expected change (ST, MT, LT), and each category has several indicators, represented by the numbers following the letters. The table presents relevant indicators selected to evaluate the LSU AgCenter Healthy Communities Initiative, but other indicators are listed on the SNAP-Ed websiteb Partner organizations that regularly meet, exchange information, and identify and implement mutually reinforcing activities that will contribute to the adoption of ≥ 1 PSE change interventionc Defined as sending and receiving information related to the LSU AgCenter Healthy Communities Initiatived Defined as working with LSU AgCenter to deliver nutrition or physical activity education programse Defined as working with LSU AgCenter to implement PSE changes at 1 locationf Defined as membership in an LSU AgCenter Healthy Communities coalition working to implement PSE changes at multiple locationsg Defined as working with LSU AgCenter to jointly lead planning and implementation of educational or PSE change activities. Open table in a new tab FY indicates fiscal year; LSU AgCenter, Louisiana State University Agriculture Center; LT, long term; MT, medium term; PSE, policy, systems, or environmental; SNAP-Ed, Supplemental Nutrition Assistance Program-Education; ST, Short term. Quantitative data collection occurred through FCS staff recording progress toward these indicators, such as the number and attendance of coalition meetings, partnerships, and PSE changes. The FCS staff reported these data using an application called Dynamics, developed by the LSU AgCenter information technology staff according to specifications provided by the LSU AgCenter SNAP-Ed Principal Investigator, program manager, and evaluator. The application served as a database for this information and was linked to a data visualization platform called Power BI. This allowed the evaluator to track PSE changes, coalitions, and partnerships and determine which changes most commonly occurred, what resources supported them, and where they occurred. A qualitative, participatory evaluation was then conducted to obtain an indepth understanding of the impact of these projects. This evaluation occurred through ripple effect mapping (REM), a collaborative session during which residents and partner organizations share program successes grouped into categories according to the community capitals framework (CCF) and displayed on a graphic visualization or map of all reported impacts from the coalition's work. The CCF describes different aspects of a community that may be affected by an intervention, such as human capital (knowledge and skills of residents) and built capital (physical changes to a community).24Chazdon S Emery M Hansen D Higgins L Sero R A Field Guide to Ripple Effects Mapping. University of Minnesota Libraries Publishing, 2017Google Scholar,25Emery M Flora C. Spiraling-up: mapping community transformation with community capitals framework.Community Dev. 2006; 37: 19-35Crossref Google Scholar This participatory evaluation method empowers residents and partner organizations to engage in decisions about the evaluation process, ensuring that it serves the needs of residents and partner organizations.26Minkler M Wallerstein N. Community-Based Participatory Research for Health: From Process to Outcomes. John Wiley & Sons, 2011Google Scholar These methods are an essential component of any program evaluation that aims to promote social justice,27Mertens DM. Transformative Research and Evaluation. Guilford Press, 2008Google Scholar and critical for community-based programs that seek to make lasting change and address community needs. Once Healthy Communities coalitions made ≥ 1 PSE change addressing the original needs identified at the community forum, the program evaluator held a REM session according to a fixed set of questions publicly available with program materials. Discussion responses were coded by the evaluator in a deductive process according to the CCF.25Emery M Flora C. Spiraling-up: mapping community transformation with community capitals framework.Community Dev. 2006; 37: 19-35Crossref Google Scholar,28Saldaña J. The Coding Manual for Qualitative Researchers. Sage, 2015Google Scholar In some cases, REM sessions occurred virtually or through surveys followed by a focus group discussion, methods that have been described elsewhere.29Greene MD Stroope J Holston D. Adapting ripple effect mapping to a virtual survey format.J Ext. 2022; 60: 9Google Scholar Since 2020, LSU AgCenter FCS agents have reported building 2,031 partnerships, 244 Healthy Communities coalitions, and implementing 302 PSE (Table 2). Most nutrition-focused PSE changes were environmental changes (eg, promoting healthy retail options or systems, including encouraging farmer's markets to accept SNAP benefits). Most PSE changes focused on physical activity were environmental, such as adding walking trails. Qualitative results from REM sessions held in 5 communities demonstrated that participants in all sessions identified program impacts in each of the constructs of the CCF. The most frequently cited impacts across all 5 sessions were impacts on human capital, such as increased knowledge of accessible gardening techniques after the establishment of an accessible teaching garden. The least frequently cited capital was natural capital, such as reducing erosion and collecting rainwater after a coalition received a grant for rain barrels. Additional examples of outcomes identified through REM are available online alongside program materials. Common outcomes across all coalitions included improving access to and attractiveness of areas for physical activity, raising awareness of the needs of marginalized communities, and enhancing the ability to advocate for communities. Through REM, community members and PSE implementation partners also noted benefits such as bringing together politically divided communities for a common cause, improving awareness of the needs of underserved communities, and reducing politicians’ negative perceptions of a majority African American area of a community. The initiative and program materials have been adapted for use by Cooperative Extension Service staff in 2 states. As of July 2022, the LSU AgCenter Healthy Communities Initiative materials have been downloaded 26 times since it was made publicly available in March 2022. The LSU AgCenter Healthy Communities Initiative is a community-participatory model that aims to foster physical activity- and nutrition-focused PSE changes that serve the needs of historically marginalized populations. Qualitative results indicated that most impacts were seen in human capital, which was expected, given that the intervention is implemented by FCS agents who focus on providing nutrition and physical activity education. However, obesity prevention programs that go beyond nutrition- and physical activity-focused PSE and educational interventions may be better suited to addressing health equity.15Greene M Houghtaling B Sadeghzadeh C et al.Nutrition interventions addressing structural racism: a scoping review.Nutr Res Rev. 2022; : 1-53Google Scholar,30Hummer R Hamilton E. Population Health in America. University of California Press, 2019Google Scholar,31Link BG Phelan J. Social conditions as fundamental causes of disease.J Health Soc Behav. 1995; Spec: 80-94Crossref Scopus (3771) Google Scholar For example, Kumanyika's Getting to Equity framework for obesity prevention outlines the need to improve the social and economic resources of marginalized communities.2Kumanyika SK. A framework for increasing equity impact in obesity prevention.Am J Public Health. 2019; 109: 1350-1357Crossref PubMed Scopus (98) Google Scholar Differences in financial resources have been proposed to be a fundamental cause of health disparities,31Link BG Phelan J. Social conditions as fundamental causes of disease.J Health Soc Behav. 1995; Spec: 80-94Crossref Scopus (3771) Google Scholar and a method through which structural racism results in racial disparities in obesity and food insecurity.32Aaron DG Stanford FC. Is obesity a manifestation of systemic racism? A ten-point strategy for study and intervention.J Intern Med. 2021; 290: 416-420Crossref PubMed Scopus (26) Google Scholar,33Harrell CJP Burford TI Cage BN et al.Multiple pathways linking racism to health outcomes.Du Bois Rev. 2011; 8: 143-157Crossref PubMed Scopus (158) Google Scholar Participants in REM sessions identified benefits to areas not typically serviced by FCS agents, such as providing computers to low-income students and establishing an addiction rehabilitation center. These impacts may play a role in targeting fundamental causes of obesity by improving economic prospects and social cohesion of communities, and the LSU AgCenter Healthy Communities Initiative may provide an opportunity for nutrition educators to undertake such an approach while encouraging physical activity and nutrition PSE changes. Furthermore, innovations that build social capital in ways described at REM sessions (coming together across political and racial divides) have greater potential to improve health equity than interventions that do not bring together people from different political and racial groups.34Mason C Barraket J Friel S O'Rourke K Stenta CP Social innovation for the promotion of health equity.Health Promot Int. 2015; 30: ii116-ii125Crossref PubMed Scopus (51) Google Scholar Future work will need to assess program impacts when implemented in diverse settings and/or with members of historically marginalized communities, such as African Americans and Native Americans. It is important to provide specific interventions addressing the needs of those communities to alleviate disparities in obesity rates and food insecurity because race-neutral approaches tend to perpetuate existing inequalities.1Mackey ER Burton ET Cadieux A et al.Addressing structural racism is critical for ameliorating the childhood obesity epidemic in Black youth.Child Obes. 2022; 18: 75-83Crossref PubMed Scopus (11) Google Scholar,35Bonilla-Silva E Racism Without Racists: Color-Blind Racism and the Persistence of Racial Inequality in the United States. Rowman & Littlefield Publishers, 2006Google Scholar,36Delaney SW Essien UR Navathe A. Disparate impact: how colorblind policies exacerbate Black–White health inequities.Ann Intern Med. 2021; 174: 1450-1451Crossref PubMed Scopus (7) Google Scholar Finally, future work is needed to assess the sustainability and long-term impact of PSE changes implemented through the LSU AgCenter Healthy Communities Initiative. This investigation was deemed exempt from review by the Louisiana State University Agriculture Center Institutional Review Board under blanket approval for program evaluation. Program materials related to this intervention are available at: https://forms.office.com/r/9VUxvGNuF8. This study was funded by the US Department of Agriculture Supplemental Nutrition Assistance Program-Education and Louisiana State University Extension.