title: Promoting Policy, Systems, and Environment Change to Prevent Chronic Disease: Lessons Learned From the King County Communities Putting Prevention to Work Initiative.
abstract: Initiatives that convene community stakeholders to implement policy, systems, environment, and infrastructure (PSEI) change have become a standard approach for promoting community health.
  
  
  
  To assess the PSEI changes brought about by the King County, Washington, Communities Putting Prevention to Work initiative and describe how initiative structures and processes contributed to making changes.
  
  
  
  The impact evaluation used a logic model design, linking PSEI changes to longer-term behavioral impacts in healthy eating active living and tobacco use and exposure. Qualitative methods, including stakeholder interviews and surveys, were used to identify initiative success factors.
  
  
  
  Communities Putting Prevention to Work activities occurred throughout King County, with a focus on 7 low-income communities in South Seattle/King County.
  
  
  
  The focus communities had a combined population of 652 000, or 35% of the county total, with lower incomes and higher rates of physical inactivity, tobacco use, poor diet, and chronic disease.
  
  
  
  Twenty-four PSEI strategies were pursued by organizations in sectors including schools, local governments, and community organizations, supported by the public health department. There were 17 healthy eating active living strategies (eg, enhancements to school menus, city planning policies) and 7 tobacco strategies (eg, smoke-free policies in schools, housing, and hospitals).
  
  
  
  PSEI changes made and numbers of residents reached.
  
  
  
  Twenty-two of the 24 strategies achieved significant progress toward implementing PSEI changes. The most common success factor was a "dyad" consisting of a dedicated technical assistance provider-either an outside consultant or public health department staff-working closely with a champion from the participating organizations to bring about PSEI changes.
  
  
  
  An initiative structure that creates and supports external consultant/internal organizational champion dyads in key community sectors offers a promising approach that may be adopted by similar community health efforts in the future.
authors.affiliation: Center for Community Health and Evaluation, Group Health Research Institute, Seattle, Washington (Dr Cheadle and Ms Cromp); Action for Healthy Food, Seattle, Washington (Dr Krieger); Public Health-Seattle & King County, Seattle, Washington (Dr Chan, Ms Ross-Viles, and Mr Kellogg); and Sea Mar Community Health Centers, Seattle, Washington (Dr Rahimian). Dr McNees is retired from the position of Cultural Anthropologist with the Assessment, Policy Development and Evaluation unit at Public Health-Seattle & King County, where she performed qualitative evaluations and assessments. Dr MacDougall is a public health professional with expertise in nutrition and food policy. She was formerly the Healthy Eating and Active Living Policy and Program Manager at Public Health-Seattle & King County.
authors.forename: Allen
authors.initials: A
authors.lastname: Cheadle
authors.forename: DeAnn
authors.initials: D
authors.lastname: Cromp
authors.forename: James W
authors.initials: JW
authors.lastname: Krieger
authors.forename: Nadine
authors.initials: N
authors.lastname: Chan
authors.forename: Molly
authors.initials: M
authors.lastname: McNees
authors.forename: Sarah
authors.initials: S
authors.lastname: Ross-Viles
authors.forename: Ryan
authors.initials: R
authors.lastname: Kellogg
authors.forename: Afsaneh
authors.initials: A
authors.lastname: Rahimian
authors.forename: Erin
authors.initials: E
authors.lastname: MacDougall
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards; D005247:Feeding Behavior; D006291:Health Policy; D006293:Health Promotion / Q000379:methods; D006798:Housing / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D009111:Local Government; D011203:Poverty / Q000706:statistics & numerical data; D011322:Primary Prevention / Q000379:methods* / Q000592:standards; D016730:Program Development / Q000379:methods / Q000592:standards*; D036301:Qualitative Research; D012574:Schools / Q000592:standards / Q000706:statistics & numerical data; D014861:Washington