and interventions should also be able to show how changes in short-term or intermediate outcomes relate to changes in long-term outcomes.
Interventions with evaluation components that target underserved populations and that also increase the level of engagement of these populations in communitywide approaches are urgently needed to effectively address childhood obesity in these diverse groups. Successful engagement will require the identification of the distributional equity and the differential effects of programs on underserved ethnically diverse groups and groups of various SES in order to inform “midcourse corrections” or the next generation of interventions. The capacity to reduce the obesity risk or disparities among certain subpopulations may be adopted as a selection criterion for intervention actions.
Behavioral interventions and evaluation approaches should be expanded into a variety of multicultural and resource-limited settings. The magnitude of the influence of any health promotion intervention will depend on the combination of its effectiveness, the extent and quality of its implementation, and its sustainability (Rogers, 2003). The active promulgation and the use of a variety of evidence-based programs and policies are needed to foster the societal uptake and institutionalization of obesity prevention interventions. Certain types of behavioral outcomes (e.g., tobacco use and immunization status) are easier to evaluate than other outcomes (e.g., cultural competency, social cohesion, civic engagement, and collective efficacy) (Anderson et al., 2003b, 2005).
Furthermore, it is challenging to accurately assess the intermediate outcomes of community interventions aimed at broad social determinants of health, such as community advocacy and economic and educational opportunities, that effect change across multiple intermediate and long-term outcomes because of the limitations in establishing links between upstream health promotion interventions and health outcomes (Anderson et al., 2005) (Chapter 6). The approaches taken must balance the trade-offs between initial selectivity, which improves retention and homogeneity (internal validity), and broader inclusiveness, which preserves relevance to the targeted population (external validity).
Important considerations for the design, implementation, monitoring, and evaluation of culturally competent obesity prevention interventions in diverse populations include the following:
Build on cultural assets (e.g., the salience of dance as a common form of physical activity among African Americans and Hispanics/ Latinos) (Beech et al., 2003; Boon and Clydesdale, 2005; Day, 2006; Robinson et al., 2003; Yancey et al., 2006c), recognize the role of cultural influence on health, and integrate culturally competent ap-