coalitions is in mobilizing the community to work for change, they are not generally designed to develop or manage specific community services or activities (Chavis, 2001).

Community collaborative efforts focused on health are of growing interest across the United States. Models are being refined on ways to link community organizations, community leaders and interested individuals, health-care professionals, local and state public health agencies, and universities and research organizations (Lasker et al., 2001; Lasker and Weiss, 2003). Community coalitions have played significant roles in efforts to prevent or stop tobacco use. The American Stop Smoking Intervention Study (ASSIST), which was funded by the National Cancer Institute and featured the capacity building of community coalitions, targeted tobacco control efforts at the state and local levels. States with ASSIST programs had greater decreases in adult smoking prevalence than non-ASSIST states (Stillman et al., 2003); factors identified as contributing to participation and satisfaction with the ASSIST coalitions included skilled members and effective communication strategies (Kegler et al., 1998). Coalition building and community involvement also have been effective in community fluoridation efforts (Brumley et al., 2001).

Health Disparities

Although this report focuses primarily on population-wide approaches that have the potential to improve nutrition and increase physical activity among all children and youth, the committee recognizes the additional need for specific preventive efforts. Children and youth in certain ethnic groups including African-American, Mexican-American, American-Indian, and Pacific Islander populations, as well as those whose parents are obese and those who live in low-income households or neighborhoods, are disproportionately affected by the obesity epidemic (Chapter 2). Many issues—including safety, social isolation, lack of healthy role models, limited access to food supplies and services, income differentials, and the relative unavailability of physical activity opportunities—may be barriers to healthier lifestyles for these and other high-risk populations. Moreover, as discussed in Chapter 3, perceptions about body image and healthy weight can vary between cultures and ethnic groups, and these groups can manifest differing levels of comfort with having an elevated weight. Furthermore, there may be a “communication gap” in making information about the health concerns of childhood obesity widely available.

As a result, culturally appropriate and targeted intervention strategies are needed to reach high-risk populations. There are examples of these types of strategies having positive results. For example, a 10-county study of churches participating in the North Carolina Black Churches United for



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