Purpose: Climate change, obesity and malnutrition has been identified by the EatLancet commission as serious challenges that needs to be addressed through a profound food systems transformation. Building on insights from the SoL community project a framework was developed for the neighborhood of Southern Harbor, Copenhagen. Vision is to foster better physical and mental health through participatory and multifaceted local food systems transformation. Short term goal is to demonstrate an increased uptake of plant foods among citizens by building on the resources and commitment of a broad range of community stakeholders. Intervention is informed by insights from the concepts of Alternative Food Networks (AFN), Community Supported Agriculture (CSA) and Nature-based solutions (NBS). 

Purpose of paper is to summarize the insights from the formative research that is the foundation for the development of the specific components of the program.

Methods:
The study was founded on the principles of Action Research (AR) that aims at co-creating solutions to problems in a partnership between researchers and local stakeholders as well as providing data for an empirical study. Using the AR approach co-creation is staged around Living Labs and are required to meet following criteria: Should be building on resources already present in community. Should be complaiant with scientific evidence. Should by co-constructed by researchers and community stakeholders. Data for the formative research was collected through in depth interviews, document analysis and participant observation from stakeholder consultations. Informants were representatives from local government, local housing providers, kindergartens schools, local growers, food retailers, food suppliers in the peri-urban area, informal community leaders and citizens.

Results
Develope components can be grouped under 5 headings: Coordinated local growing strategies. Shorter food supply chain design. Enhanced digital connectivity between food and citizens. Participatory food systems governance. Enhanced learning about food through innovation labs.

Conclusion
There is a broad interest in local food systems transformation from a broad range of stakeholders. The co-creative design process has revealed operational blueprints that can be used in the implementation. Next step is to draw up the evaluation protocol for the impact assessment.

Purpose: With Native American communities suffering the highest rates of food insecurity and diet-related chronic disease in North America, culturally appropriate and effective solutions are desperately needed.  Indigenous Food Sovereignty (IFS) represents a potential approach to address these problems based on four main principles: sacred food knowledge, community participation, self-determination, and policies to reconcile traditional food practices with mainstream economic activities. Despite the promise inherent in this approach, few intervention trials have incorporated these principles; nor have they been aligned clearly with community based participatory research approaches.

Methods:  For the OPREVENT2 trial, we implemented a multicomponent obesity reduction intervention targeting adults in collaboration with six Native American communities, using a community engaged approach that respected indigenous food sovereignty principles. The program worked with worksites, food stores, schools (grade 2-6), through social media and mailings, and with a local community action committee (CAC).  We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Standards were set to assess how well program components met implementation targets.

Results: A series of community meetings were conducted, and selected intervention strategies and materials from existing possibilities, generating new initiatives and policies that valued traditional foods, and leading to a system of interacting and mutually reinforcing intervention strategies. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time.  The school program had only moderate reach and dose delivered, as did the social media component.  The CAC achieved high reach and dose delivered.

Conclusions: Designing interventions for Native communities by combining CBPR and food sovereignty principles is a promising strategy for building community engagement support for complex multicomponent food systems interventions, and may lead to improved implementation and impacts.

Purpose: Examine whether the effectiveness of the multilevel Children’s Healthy Living (CHL) intervention was achieved through modification of specific levels of the food system by examining CHL food related intervention activities which focused on decreasing sugar sweetened beverages and increasing water, fruit and vegetable intake.

Methods: The two year CHL community randomized intervention trial was designed and implemented with 9 intervention and 9 control predominantly indigenous communities in 5 jurisdictions of the US Affiliated Pacific (Alaska, American Samoa, Commonwealth of the Northern Mariana Islands, Hawaii).  Of 19 intervention activities, 11 were food related and included each of the five levels of the Social Ecologic Model (SEM- child, caregiver, organizational, community, policy).  Each jurisdiction reported monthly on CHL intervention activities in their community. A hierarchical model tested the influence of the number of CHL intervention activities on the behaviors and health outcomes by each of the five levels of the social ecologic model (SEM).

Results: None of the food target intervention activities aimed at the child or caregiver SEM level were effective in eliciting child food behavior change in intervention communities, relative to control after adjusting for organization, community and policy SEM level. The higher SEM levels (organization, community and policy) effected the observed changes.  When examining food related activities and the outcome of child overweight and obesity prevalence change, water activities overall decreased child overweight and obesity in intervention communities relative to control communities, though caregiver and community water activities modestly protected against child overweight and obesity.  Sugar sweetened beverage activities modestly protected against child overweight and obesity at the same SEM levels.  Fruit, vegetable and sugar sweetened beverage activities significantly decreased prevalence of acanthosis nigricans, with the highest levels of the social ecologic model showing the strongest effect.

Conclusion: CHL intervention also targeted physical activity, screen time, sleep hours and sleep disturbance behaviors, which also contributed to effects seen. Multiple levels and components of the CHL intervention were needed and were likely interactive, in order to nudge improvements.