“I Love Fruit But I Can’t Afford It”: Using Participatory Action Research to Develop Community-Based Initiatives to Mitigate Challenges to Chronic Disease Management in an African American Community Living in Public Housing

A natural experiment: The opening of a supermarket in a public housing community and impacts on children's dietary patterns

Objective

The aim of the present study is to utilize a natural experiment and examine changes in dietary patterns of predominantly low-income, racial and ethnic minority children who live in a public housing community following the opening of a new supermarket.

Methods

Data comes from the Watts Neighborhood Health Study (WNHS), an ongoing study in South Los Angeles, United States, that follows residents of Jordan Downs, a public housing community undergoing redevelopment. Surveys were administered to children aged 9-17 years (n = 297), as well as an adult in the household. The second baseline data collection was conducted June-December 2019, and follow-up was conducted June 2020-April 2021, shortly after the introduction of the new supermarket in January 2020. ANCOVA linear regression models were estimated to examine the association between children's proximity to the new supermarket with dietary outcomes at follow-up. Interactions with barriers to food access were also explored.

Results

Living close to the new supermarket was not significantly associated with dietary outcomes at follow-up. However, for children who lived in households with no vehicle access, living close to the new supermarket was associated with increased fruit and vegetable consumption, compared to children in the comparison group.

Conclusion

Proximity to the new supermarket was not associated with improved dietary outcomes among children unless they had transportation barriers. This adds to the growing body of literature that suggests that the effects of neighborhood food environments may be modified by individuals' mobility, and that comprehensive interventions are needed.

'Nobody Shops at the Neighborhood Store': Leveraging a Community's Pediatric Fresh Produce Prescription Program to Inform Future Participating Store Redemption Locations

Research examining the nature of food shopping often considers proximity to the nearest or overall distance travelled to multiple stores. Such studies make up a portion of new work on so-called 'food deserts' and the issues inherent in the term, including that most people do not shop at their nearest store, and mobility challenges vary vastly from one person to the next. Increasing the knowledge base on shopping characteristics could be useful for behavioral interventions and programs aimed at increasing healthy food shopping. In this study, we examined the shopping characteristics of 627 caregivers whose children were enrolled in a pediatric fresh produce prescription program at one of three large pediatric clinics in Flint, Michigan. We compared these characteristics to the potential of a new food cooperative to improve geographic accessibility to healthy food. In particular, we propose the expansion of the prescription program to this new cooperative for health-related as well as local economic development reasons. Our work bridges topics of interest to researchers and practitioners working in nutrition, food access, and economic development.

Designing mobile health to align with the social determinants of health

The maternal health crisis in the United States is becoming increasingly worse, with disparities continuing to escalate among marginalized populations. mHealth can contribute to addressing the Social Determinants of Health (SDOH) that produce inequities in maternal morbidity and mortality. Reducing inequities through mHealth can be achieved by designing these technologies to align with SDOH. As mHealth developed to support maternal health has primarily supported the extension of clinical care, there is an opportunity to integrate frameworks and methods from human factors/ergonomics and public health to produce thorough comprehension of SDOH through intentional partnerships with marginalized populations. Potential for this opportunity is presented through a case study derived from a community-based participatory research process focused on transportation access to maternal health services. Through multi-faceted, interdisciplinary, and community-based approaches to designing mHealth that attends to the systemic factors that generate and escalate inequities, improvements in the maternal health crisis could be realized.

Addressing Financial Barriers to Health Care Among People Who are Low-Income and Insured in New York City, 2014–2017

While health care-associated financial burdens among uninsured individuals are well described, few studies have systematically characterized the array of financial and logistical complications faced by insured individuals with low household incomes. In this mixed methods paper, we conducted 6 focus groups with a total of 55 residents and analyzed programmatic administrative records to characterize the specific financial and logistic barriers faced by residents living in public housing in East and Central Harlem, New York City (NYC). Participants included individuals who enrolled in a municipal community health worker (CHW) program designed to close equity gaps in health and social outcomes. Dedicated health advocates (HAs) were explicitly paired with CHWs to provide health insurance and health care navigational assistance. We describe the needs of 150 residents with reported financial barriers to care, as well as the navigational and advocacy strategies taken by HAs to address them. Finally, we outline state-level policy recommendations to help ameliorate the problems experienced by participants. The model of paired CHW–HAs may be helpful in addressing financial barriers for insured populations with low household income and reducing health disparities in other communities.

Who shops at their nearest grocery store? A cross-sectional exploration of disparities in geographic food access among a low-income, racially/ethnically diverse cohort in Central Texas

We examined whether Central Texans shop at their nearest supermarket, how far they travel for groceries, and explored differences by race/ethnicity, urbanicity, motivations for store selection and other demographic characteristics. Using cross-sectional data and GIS, continuous network distances from participants' homes to nearest and usual supermarkets were calculated and multivariate linear regression assessed differences. <19% shopped at their nearest supermarket. Regression models found that urbanicity played a large role in distance traveled to preferred supermarket, but other factors varied by race/ethnicity. Our findings demonstrate racial/ethnic and urbanicity disparities in food access and multiple domains of food access need greater consideration.

Heterogeneity in grocery shopping patterns among low-income minority women in public housing

BACKGROUND

Public housing residents, who tend to be predominantly female and racial/ethnic minorities, are at a particularly high risk for chronic health conditions. Prior studies have suggested that a lack of access to healthy and affordable food may be an important barrier in public housing communities, but evidence is mixed on the association between the neighborhood food environment and dietary quality, suggesting the need to examine food access patterns in low-income, minority communities more deeply. The purpose of this study was to examine the variability in grocery shopping patterns, and the factors that predict them, among low-income minority women in public housing.

METHODS

Interviewer-administered surveys and body composition measurements were collected in the Watts Neighborhood Health Study, an ongoing longitudinal cohort study of low-income urban public housing residents located in South Los Angeles. Descriptive analyses were conducted to understand the variation in grocery shopping patterns among women. Logistic and ordered logistic regression models were estimated to examine the association between resident characteristics and grocery shopping patterns.

RESULTS

There was considerable variability in grocery shopping patterns, including the types of grocery stores accessed, distance travelled, frequency of shopping, and reasons behind grocery store choice. Grocery shopping patterns were associated with several participant characteristics, including race/ethnicity, working status, access to a car, income, and education. Hispanic participants were less likely to shop at a supermarket, travel further distances to shop, shop more frequently, and were more likely to prioritize price in their choice of primary grocery store than non-Hispanic Black women participants.

CONCLUSIONS

There was considerable variability in grocery shopping patterns, even within this low-income, minority community despite access to the same neighborhood food environment. Convenience and quality, in addition to price, were priorities for choice of primary grocery store, and differences by race/ethnicity suggest that initiatives to improve the neighborhood food environment should consider quality of food, cultural factors, and availability of foods desired by the surrounding community, in addition to price and proximity of grocery stores.

The Importance of Citizen Scientists in the Move Towards Sustainable Diets and a Sustainable Food System

To enhance sustainability, the food system requires significant shifts in the production, processing and supply of food. Ideally, a sustainable food system should operate, not only to protect the biosphere, but also to provide nutritious, high-quality food, and to support social values, an equitable economy, and human and animal health. It should also be governed responsibly within a supportive policy environment. Implementing these shifts is a task of immense scale; but citizen participation/engagement has the potential to help make sustainability a reality through distributed learning, dynamic sensing, and knowledge generation. Technological advancements in sensing and data processing have enabled new forms of citizen participation in research. When food system research is embedded within society it can help us to understand which changes towards sustainability work and which do not. Indeed, citizen engagement in food systems research has the potential to help bring citizens on side, supporting the growth of a food culture of resilience and of sustainable practises (including dietary change). This commentary provides examples of how existing research and alternative food production systems and agroecological practises may provide possible frameworks for citizen participation in food system studies. We highlight potential future food and citizen science approaches. Widening citizen participation and encouraging the involvement of other food system actors, including those in local, national and international governance, is essential to capture the full potential of citizen science in enabling transition to a sustainable food system. For the research community citizen science offers engagement and empowerment of wider communities with science; collecting and analysing data; and creating viable solutions to food system and diet issues.

Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map

Background

By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value.

Objectives

This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence.

Search Methods

We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov).

Selection Criteria

Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps.

Data Collection and Analysis

We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist.

Main Results

After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues.

Authors' Conclusions

There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.

Evidence-Informed strategies for promoting equitability in brownfields redevelopment

Brownfields redevelopment creates opportunities for enhanced environmental conditions, improved physical and mental health, community cohesion, and economic prosperity. However, brownfields cleanup and recycling projects sometimes fail due to a lack of community engagement. Recent research suggests that such failures can stem from a lack of equitability in the planning process, especially when it comes to decision making. This paper examines issues of equitability in a recent brownfields redevelopment project in Tampa, Florida funded by the U.S. Environmental Protection Agency. The project focused on an underserved and under-resourced community with long-term environmental burdens and health disparities. Our ethnographic research shows that, while the project engaged in multiple and intersecting efforts to include a diversity of community voices in the decision-making process, ultimately structural and organizational power imbalances in sustainability transitions influenced participation in redevelopment initiatives. This study suggests that attending to issues of power articulated through expressions of local and authoritative knowledge about environmental cleanup and redevelopment can lead to deeper levels of community engagement.

Enhancing self-resources in patients with chronic diseases: development and initial validation of the Disease and Care Management Score

Introduction:

Despite the importance of the assessment in the primary care of the self-resources among patients with chronic diseases, there is not available a measurement that allows this kind of comprehensive assessment. For this reason, the aim of this study was to develop a multi-dimensional score to determine the level of self-resources in chronic patients, describing its initial validation through face and content validity. The developed score was labelled as Disease and Care Management Score.

Methods:

We performed a methodological study, encompassing two main phases. The first phase was aimed to develop the Disease and Care Management score, choosing the most suitable measurement to assess each pre-identified determinant of wellbeing in chronic patients. The second phase was aimed to determine the Disease and Care Management score face and content validity through the views of 20 experts.

Results:

Disease and Care Management score shows evidence of face and content validity. All the obtained quantitative content validity indices (i.e. Content Validity Ratio, Content Validity Indices) were higher than 0,70, showing the pertinence and the adequacy of each pre-identified measure to compute Disease and Care Management score.

Conclusion:

Disease and Care Management score has the potential of addressing the health coaching interventions in primary care for chronic patients. Future research should show its predictive performance, as well as the cut-off to discriminate patients. (www.actabiomedica.it)

Changing the housing environment to reduce obesity in public housing residents: a cluster randomized trial

BACKGROUND

Public housing residents face significant social, economic, and physical barriers to the practice of health behaviors for prevention of chronic disease. Research shows that public housing residents are more likely to report higher rates of obesity, current smoking, disability, and insufficient physical activity compared to individuals not living in public housing. Because these behaviors and conditions may be shaped by the built and social environments in which they live, we conducted a study to test an environmental level diet and physical activity intervention targeting obesity among urban public housing developments.

METHODS

This study was a cluster randomized controlled trial of public housing developments, the unit of analysis and randomization. A total of 10 public housing developments were recruited and subsequently randomized to either receive the intervention package or to serve as comparison sites. The year-long intervention included components to change the dietary and physical activity-related environments of the developments. Surveys at baseline and one-year follow-up provided data on changes in behaviors and weight from participants in both intervention and control developments.

RESULTS

Intervention participants significantly changed their eating and activity behaviors and body weight from baseline to one-year follow-up (p's < .05) while comparison participants reported no significant changes in any study variable.

CONCLUSIONS

These data provide initial support for the idea that interventions targeting the environment of public housing developments can assist residents to change unhealthy behaviors and can possibly reduce the high levels of chronic disease among public housing residents.