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Chuquitarco-Morales A, Rivera-Navarro J, La Parra-Casado D, Fuster M, Franco M. Madrid immigrants' perceptions of urban food environments and their dietary behaviours. Appetite 2024; 199:107390. [PMID: 38703792 DOI: 10.1016/j.appet.2024.107390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 05/06/2024]
Abstract
Large cities are home to several groups of immigrants who undergo important changes in their environmental conditions and lifestyles that significantly modify their risk of chronic diseases. Quantitative evidence indicates that both their health and diet worsen over time; much less is known about the qualitative mechanisms that cause these changes. The aim of this article is to understand how immigrants in the city of Madrid perceive the relation between the urban food environment and dietary behaviour. Based on a Social Ecological Framework, we conducted a secondary qualitative analysis derived from data from 41 immigrant residents, collected in eight focus groups (FGs), conducted in two neighbourhoods in the city of Madrid. We identified the following main categories: 1) Transnational identity and dietary behaviour in the neighbourhood; 2) Transitions in dietary behaviour; and 3) Societal/structural factors determining dietary behaviour in the neighbourhood. The participants in the FGs mentioned that they try to maintain traditional dietary customs and perceive that the taste of their typical dishes is better than those of Spanish dishes. Contradictorily, some participants considered their traditional dietary patterns to be less healthy than Mediterranean ones (consuming olive oil, vegetables, fish). Some participants acknowledged having adapted to the latter voluntarily or through dietary negotiations with their children. Immigrant families with two working parents have difficulties cooking homemade food and resort to less healthy options, such as eating fast food or ready-made meals. Due to their low purchasing power, they buy both ethnic products and other products, as well as considering the prices and offers in supermarkets. Our study highlights several structural mechanisms connecting the physical and social urban food environment with dietary behaviours among immigrant residents of a large city.
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Affiliation(s)
| | - Jesús Rivera-Navarro
- Sociology and Communication Department, Social Sciences Faculty, Universidad de Salamanca, Salamanca, Spain
| | - Daniel La Parra-Casado
- Department of Sociology 2, Universidad de Alicante, San Vicente del Raspeig, Alicante, Spain.
| | - Melissa Fuster
- Department of Social, Behavioral, and Population Sciences, Tulane University, School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Manuel Franco
- Surgery and Medical and Social Sciences Department, Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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2
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Silva JP, Ribeiro AI. Using Qualitative Methods to Understand the Interconnections Between Cities and Health: A Methodological Review. Public Health Rev 2024; 45:1606454. [PMID: 38651134 PMCID: PMC11033357 DOI: 10.3389/phrs.2024.1606454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Objective: Using different perspectives and methods to investigate the links between the urban phenomenon and health is critical in an urbanizing world. This review discusses qualitative methods in the context of urban health research. Methods: We conducted a narrative review following these steps: We identified the qualitative data collection, analysis and sampling methods that could be more relevant for the problems researched in the urban health field. We conducted searches for methodological articles and other documents about those methods. We included some influential materials and examples of empirical urban health studies using those methods. Results: We included 88 studies and identified several qualitative data gathering, analysis and sampling methods relevant for urban health researchers. We present those methods, focusing their strengths and limitations, and providing examples of their use in the field of urban health. These methods are flexible and allow in-depth analysis of small samples by collecting and analyzing rich and nuanced data. Conclusion: This article should contribute to a better understanding of how, and when, qualitative methods may improve our knowledge on urban health.
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Affiliation(s)
- José Pedro Silva
- EPIUnit—Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Instituto de Sociologia da Universidade do Porto, Porto, Portugal
| | - Ana Isabel Ribeiro
- EPIUnit—Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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de Loyola González-Salgado I, Rivera-Navarro J, Gutiérrez-Sastre M, Conde P, Franco M. Conducting member checking within a qualitative case study on health-related behaviours in a large European city: Appraising interpretations and co-constructing findings. Health (London) 2024; 28:3-21. [PMID: 35822544 DOI: 10.1177/13634593221109682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although member checking is a well-established strategy for appraising credibility, there is a lack of research reporting procedures and outcomes when using this strategy. In recent years, scholars have implemented new member checking strategies along with several epistemological stances. In this work, researchers conducted member checking in three neighbourhoods with different socioeconomic status in Madrid, Spain. Attendance at member checking meetings was lower than expected. Member checking meetings were conducted in public halls within each neighbourhood and lasted approximately 2 hours. During the first hour, researchers introduced the aim of the meetings and shared summarized research findings with attendees using a slideshow. During the second hour, attendees had the opportunity to comment on any aspect of the research. Researchers used grounded theory coding strategies and a constructivist approach informed the analysis of the transcribed member checking meetings. One core category emerged, and it was named 'Co-constructing findings and side effects of the interaction between researchers and participants in member checking'. Member checking attendees contributed to co-constructing findings by means of underscore and disagreement. It is possible that these meetings might have caused side effects such as unintended comparisons between neighbourhoods and negative health-related behaviours. Attendees wondered how the findings could improve their neighbourhoods. The meetings allowed interaction between participants and researchers and resulted in appraising and co-constructing qualitative research findings. More research is needed to advance knowledge about member checking.
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Affiliation(s)
| | | | | | | | - Manuel Franco
- University of Alcalá, Spain
- City University of New York, USA
- Johns Hopkins Bloomberg School of Public Health, USA
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4
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Rivera-Navarro J, de Loyola González-Salgado I, Ramos-Truchero G, Gravina L, Díez J, Caballero S, Franco M. Factors influencing dietary inequalities among adolescents in Madrid and Bilbao: a qualitative research project. GACETA SANITARIA 2023; 37:102325. [PMID: 37598578 DOI: 10.1016/j.gaceta.2023.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To describe the design and methodology of a qualitative study to explore the main factors influencing dietary inequalities in adolescents in Madrid and Bilbao, Spain. METHOD The study area included six neighborhoods (three in each city) of different socioeconomic status (SES): low, medium, and high. We sampled 12 secondary schools (six in each city: two per socioeconomic level). Our methodology comprised: 1) developing an ad hoc index to classify all neighborhoods according to their SES; 2) selecting the study area and sample; 3) conducting semi-structured interviews (n=36) and focus groups (n=24). Grounded theory and phenomenological analysis will be employed in data analysis. Initially, we found factors influencing in adolescents' diet such as gender, family environment, and SES. CONCLUSIONS Systematizing the selection of neighborhoods and secondary schools, along with using appropriate methods, could serve as a foundation for future studies on health inequalities among adolescents.
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Affiliation(s)
- Jesús Rivera-Navarro
- Sociology and Communication Department, Social Sciences Faculty, Salamanca University, Salamanca, Spain.
| | | | - Guadalupe Ramos-Truchero
- Sociology and Social Work Department, Education and Social Work Faculty, Valladolid University, Valladolid, Spain
| | - Leyre Gravina
- Nursing I Department, Nursing and Medicine Faculty, University of the Basque Country, País Vasco University, Bilbao, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Alcalá University, Madrid, Spain
| | - Silvia Caballero
- Nursing I Department, Nursing and Medicine Faculty, University of the Basque Country, País Vasco University, Bilbao, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Alcalá University, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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COVID-19 lockdown and housing deprivation across European countries. Soc Sci Med 2022; 298:114839. [PMID: 35228097 PMCID: PMC8861473 DOI: 10.1016/j.socscimed.2022.114839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/06/2022] [Accepted: 02/18/2022] [Indexed: 02/07/2023]
Abstract
Housing deprivation is a key determinant of the capacity to prevent infection and to recover from a disease because poor housing prevents adequate sheltering during a quarantine. We analyze the degree of housing deprivation faced by households in European countries when COVID-19 lockdown measures were enacted. To do so, we propose a synthetic measure that includes more dimensions than the official Eurostat indicator of severe housing deprivation. We use a fuzzy set approach to measure housing deprivation so that, unlike traditional deprivation approaches, based on a dichotomous variable, we can identify different degrees of housing deprivation for each household in the population. We find similar orderings of housing deprivation dimensions by country with the highest degree of deprivation in the living space dimension and the lowest one in the standard housing or technology deprivation dimension. Nonetheless, housing deprivation levels differ across countries, with Eastern European households being significantly more housing deprived than the rest when the lockdown began. This result shows that the effects of the lockdown on social well-being have not affected all Europeans equally and emphasizes the need for government measures that promote decent housing.
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Residents' Insights on Their Local Food Environment and Dietary Behaviors: A Cross-City Comparison Using Photovoice in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910134. [PMID: 34639435 PMCID: PMC8507815 DOI: 10.3390/ijerph181910134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 12/26/2022]
Abstract
Perceptions of local food environments and the ability of citizens to engage in participatory research may vary, even if participants share similar cultural and socioeconomic contexts. In this study, we aimed to describe participants’ narratives about their local food environment in two cities in Spain. We used the participatory methodology of Photovoice to engage participants in Madrid (n = 24) and Bilbao (n = 17) who took and discussed photographs about their local food environment (Madrid; n = 163 and Bilbao; n = 70). Common themes emerged across both cities (food insecurity, poverty, use of public spaces for eating and social gathering, cultural diversity and overconsumption of unhealthy foods); however, in Bilbao citizens perceived that there was sufficient availability of healthy foods despite that living in impoverished communities. Photovoice was a useful tool to engage participating citizens to improve their local food environments in both cities. This new approach allowed for a photovoice cross-city comparison that could be useful to fully understand the complexity and diversity of residents’ perceptions regardless of their place of residence.
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Fontán-Vela M, Rivera-Navarro J, Gullón P, Díez J, Anguelovski I, Franco M. Active use and perceptions of parks as urban assets for physical activity: A mixed-methods study. Health Place 2021; 71:102660. [PMID: 34454253 DOI: 10.1016/j.healthplace.2021.102660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
Parks are potential key urban assets for improved population health; however, their use is not equal among all social groups. Individual and contextual factors could influence residents' perceptions of parks and how they interact with and, eventually, benefit from them. The use of complementary methodologies provides a deeper understanding of the relationship between park use, physical activity (PA), and residents' perceptions. Thus, we designed a mixed-methods study to analyze differences in park use and PA, and the perceptions of parks as urban assets for PA. We selected six parks from three neighborhoods in Madrid (Spain) with different neighborhood socioeconomic status (NSES) for systematic social observation. We registered park users by age, PA level (low, medium, and high), gender, and NSES using the System for Observing Play and Recreation in Communities (SOPARC) audit tool adapted for iOS software (iSOPARC). We also conducted 37 semi-structured interviews and 29 focus groups to analyze residents' perceptions of parks as urban assets for PA in the same neighborhoods. We adopted a convergent-parallel design to analyze both quantitative and qualitative data, and to describe the convergence and divergence areas between them. Parks within the high-NSES were more visited, showing a higher proportion of people performing high PA (11.9%) as compared to residents of the middle (9.3%) and low-NSES (3.2%). Female visitors showed lower PA levels compared to men, especially for parks within high-NSES. The following issues were reported as influence urban park use and perceptions: park maintenance and area perception, works constraints, insecurity and crime, differential perceptions by age, and the availability of organized activities in the parks. Residents from high-NSES reported fewer barriers to park use compared to residents from the other areas, who reported limitations such as less leisure time due to job constrains or perceived insecurity in parks. Senior participants reported that having parks with organized activities and a design oriented towards different age-groups are valuable. Our study shows consistency between the fewer and less intense use of parks registered in the middle and low-NSES neighborhoods, and the more barriers for PA reported in this areas during the qualitative analysis. Mixed-methods provided an insight of the potential causes leading to the differences in park use and PA within cities, which is essential in terms of environmental justice and health equity. Thus, a mixed-methods comprehensive approach to public health problems can help designing public policies addressing relevant factors related to urban health inequities.
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Affiliation(s)
- Mario Fontán-Vela
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Preventive Medicine Department, Infanta Leonor University Hospital, 28031, Madrid, Spain
| | - Jesús Rivera-Navarro
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Department of Sociology and Communication, University of Salamanca, 37007, Salamanca, Spain
| | - Pedro Gullón
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; School of Global, Urban and Social Studies, RMIT University, Melbourne, Australia.
| | - Julia Díez
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain
| | - Isabelle Anguelovski
- Catalan Institution for Research and Advanced Studies (ICREA), Universitat Autònoma de Barcelona (UAB), Institute for Environmental Sciences and Technology (ICTA), Barcelona Laboratory for Urban Environmental Justice and Sustainability, Medical Research Institute Hospital Del Mar (IMIM), 08003, Barcelona, Spain
| | - Manuel Franco
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Rivera-Navarro J, Bonilla L, Gullón P, González-Salgado I, Franco M. Can we improve our neighbourhoods to be more physically active? Residents' perceptions from a qualitative urban health inequalities study. Health Place 2021; 77:102658. [PMID: 34462206 DOI: 10.1016/j.healthplace.2021.102658] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
The objective of our study was to identify neighbourhood factors which prevent and encourage physical activity, according to the residents' perspective. We used qualitative methods, conducting 37 semi-structured interviews and 29 focus groups. The main results were that the type of physical activity that took place in every neighbourhood was different; access to sports facilities varied due to prices and safety issues; garbage and obstacles on sidewalks were a serious limitation to physical activity; economic instability had an impact on physical activity. These results might lead the perception and insights of residents to be considered in public health interventions.
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Affiliation(s)
- Jesús Rivera-Navarro
- Sociology and Communication Department, Social Sciences Faculty, Universidad de Salamanca, Salamanca, Spain.
| | - Lidia Bonilla
- Sociology and Communication Department, Social Sciences Faculty, Universidad de Salamanca, Salamanca, Spain
| | - Pedro Gullón
- Surgery and Medical and Social Sciences Department, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Ignacio González-Salgado
- Sociology and Communication Department, Social Sciences Faculty, Universidad de Salamanca, Salamanca, Spain
| | - Manuel Franco
- Surgery and Medical and Social Sciences Department, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Rivera-Navarro J, Brey E, Franco M. Immigration and use of public spaces and food stores in a large city: A qualitative study on urban health inequalities. J Migr Health 2021; 1-2:100019. [PMID: 34405171 PMCID: PMC8352102 DOI: 10.1016/j.jmh.2020.100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022] Open
Abstract
In the low- and middle-SES neighbourhoods there were a difficult coexistence with immigrants. Some of the interviewees and participants in FGs identified the immigrants who lived in their neighbourhoods as a threat, specially in the use of the public space. The food stores managed by immigrants were rejected and denounced by scarce quality of their foods. Demand for small traditional food stores in all neighbourhoods. The lack of social contact can be harmful for the health of immigrants and native residents.
The analysis of urban health transformations must include the study of how neighbourhoods are influenced by demographic changes such as immigration. The objective of this study was to analyse how the relationship between native and immigrant residents in neighbourhoods with different socio-economic levels influenced the use of urban health assets, such as public spaces and food stores. Three Madrid neighbourhoods of different socio-economic levels were selected and studied by conducting 37 semi-structured interviews and 29 focus groups. Data analysis was based on qualitative sequential discourse. The main finding was that the presence of immigrants in Madrid neighbourhoods, especially with low and medium socio-economic levels, was perceived negatively, affecting the use of public spaces and food stores. This negative perception unfolded in three dimensions: (1) difficulties for natives and immigrants to live together; (2) limitations on using public spaces caused by a feeling of insecurity; (3) criticism of immigrant food stores, especially Chinese-run food stores. Our findings showed a worrisome lack of social contact between immigrants and native residents, which affected the use of urban health assets, such as public spaces and food stores.
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Affiliation(s)
- Jesús Rivera-Navarro
- Sociology and Communication Department, Social Sciences Faculty, Universidad de Salamanca, Salamanca, Spain
| | - Elisa Brey
- Applied Sociology Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.,Surgery and Medical and Social Sciences Department, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Rivera-Navarro J, Conde P, Díez J, Gutiérrez-Sastre M, González-Salgado I, Sandín M, Gittelsohn J, Franco M. Urban environment and dietary behaviours as perceived by residents living in socioeconomically diverse neighbourhoods: A qualitative study in a Mediterranean context. Appetite 2020; 157:104983. [PMID: 33045303 DOI: 10.1016/j.appet.2020.104983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
Scholars have determined that low socioeconomic status (SES) is associated with unhealthy dietary behaviours and that local food environments shape food inequality. Less is known about how residents' perceptions of their food environment affect their dietary behaviours. We conducted 37 semistructured interviews and 29 focus groups in three socioeconomically distinct neighbourhoods in Madrid. We identified the following main categories related to social and physical food environments: (a) perceptions of healthy and unhealthy dietary behaviours, (b) children's relationships with food, (c) precariousness and (d) residential food retailer types. Older adults were perceived as healthier consumers, whereas younger people were identified as fast-food consumers. In the low- and middle-SES neighbourhoods, residents saw home-cooked legume-based stews as healthy food. In the high-SES neighbourhood, television cooking programs were highlighted as a positive influence. In the low- and middle-SES neighbourhoods, grandparents played an essential role in the transmission of healthy eating habits to their grandchildren. In the high-SES neighbourhood, children's diets at home were determined by school menus. In the low- and middle-SES neighbourhoods, participants talked about a black market where food could be purchased. Food retailers with low-quality foods were also highlighted. In all neighbourhoods, residents missed traditional food stores, and in the low- and middle-SES neighbourhoods, immigrant-run food stores were not well accepted. Our study presents the concepts shaping how neighbourhood SES differences affect dietary behaviours according to residents of a large Mediterranean city.
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Affiliation(s)
- Jesús Rivera-Navarro
- Sociology and Communication Department, Social Sciences Faculty, Universidad de Salamanca, Salamanca, Spain.
| | - Paloma Conde
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Julia Díez
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.
| | - Marta Gutiérrez-Sastre
- Sociology and Communication Department, Social Sciences Faculty, Universidad de Salamanca, Salamanca, Spain
| | - Ignacio González-Salgado
- Sociology and Communication Department, Social Sciences Faculty, Universidad de Salamanca, Salamanca, Spain
| | - María Sandín
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Surgery and Medical and Social Sciences Department, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Joel Gittelsohn
- Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Publica Health, Baltimore, MD, United States
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Surgery and Medical and Social Sciences Department, School of Medicine and Health Sciences, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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González-Salgado IDL, Rivera-Navarro J, Sureda X, Franco M. Qualitative examination of the perceived effects of a comprehensive smoke-free law according to neighborhood socioeconomic status in a large city. SSM Popul Health 2020; 11:100597. [PMID: 32478163 PMCID: PMC7251368 DOI: 10.1016/j.ssmph.2020.100597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Smoke-free legislations aim to protect non-smokers from second-hand smoke (SHS) exposure and improve population health outcomes. The aim of this study was to explore residents' perceptions to understand how people living in distinctive SES neighborhoods are differently affected by comprehensive smoke-free laws in a large city like Madrid, Spain. We conducted a qualitative project with 37 semi-structured interviews and 29 focus group discussions in three different SES neighborhoods within the city of Madrid. Constructivist grounded theory was used to analyze the transcripts. One core category arose in our analyses: Neighborhood inequalities in second-hand smoke (SHS) exposure in outdoor places. The enactment of the comprehensive smoke-free law resulted in unintended consequences that affected neighborhoods differently: relocation of smokers to outdoor setting, SHS exposure, noise disturbance and cigarette butt littering. Changes in the urban environment in the three neighborhoods resulted in the denormalization of smoking in outdoor public places, which was more clearly perceived in the high SES neighborhood. Changes in the built environment in outdoor areas of hospitality venues were reported to actually facilitate smoking. Comprehensive smoke-free laws resulted in denormalization of smoking, which might be effective in reducing SHS exposure. Extending smoking bans to outdoor areas like bus stops and hospitality venues is warranted and should include a public health inequalities perspective.
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Affiliation(s)
| | - Jesús Rivera-Navarro
- Sociology and Communication Department, Social Science Faculty, University of Salamanca, Salamanca, Spain
| | - Xisca Sureda
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, United States
- Tobacco Control Research Group, Institut d’Investigació Biomèdica de Bellvitge-IDIBELL, l’Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Gravina L, Jauregi A, Estebanez A, Fernández-Aedo I, Guenaga N, Ballesteros-Peña S, Díez J, Franco M. Residents' perceptions of their local food environment in socioeconomically diverse neighborhoods: A photovoice study. Appetite 2019; 147:104543. [PMID: 31794819 DOI: 10.1016/j.appet.2019.104543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022]
Abstract
The influence of unhealthy food environments on residents' eating behaviors has been previously documented. Yet, socioeconomic differences across areas are less studied. Participatory studies provide relevant knowledge to better inform future nutrition interventions. We conducted a participatory Photovoice project in which residents interpreted the influence of the local food environment on eating behaviors across three neighborhoods of contrasting area-level socioeconomic status (SES) in Bilbao, Spain. From April to July 2017, a total of 23 residents participated in the three Photovoice groups. Each group critically discussed their photographs (N = 110) in groups of 6-9 participants along six group sessions. Through a consensus-building process, participants identified 27 emerging categories choosing finally 39 related photographs, which followed six conceptual main themes characterizing their local food environment: 1) unhealthy eating behaviors, 2) cultural diversity, 3) retail transformation, 4) social relationships, 5) precariousness, and 6) healthy eating. Although high food quality and fresh products may portray a general healthy food environment in all three neighborhoods, participants discussed why some residents still adopt unhealthy eating behaviors characterized by an excessive consumption of alcohol (high-SES area), sugar loaded foods (high- and middle-SES) and fast food (middle and low-SES). This photovoice participatory methodology helps highlighting important similarities and differences regarding food environment perceptions in the whole socioeconomic spectrum of any given city. This type of participatory approach helps guiding local policies and interventions promoting healthier local food environments.
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Affiliation(s)
- Leyre Gravina
- Department of Nursing, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain.
| | - Amets Jauregi
- Department of Nursing, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain.
| | - Ainhoa Estebanez
- Department of Nursing, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain.
| | | | - Nahia Guenaga
- Department of Nursing, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain.
| | - Sendoa Ballesteros-Peña
- Department of Nursing, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain; Bibao-Basurto Integrated Healthcare Organisation, Bilbao, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Julia Díez
- Public Health and Epidemiology Research Group, Universidad de Alcalá, Alcalá de Henares, 28805, Madrid, Spain.
| | - Manuel Franco
- Public Health and Epidemiology Research Group, Universidad de Alcalá, Alcalá de Henares, 28805, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
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Sandín Vázquez M, Rivera J, Conde P, Gutiérrez M, Díez J, Gittelsohn J, Franco M. Social Norms Influencing the Local Food Environment as Perceived by Residents and Food Traders: The Heart Healthy Hoods Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E502. [PMID: 30754690 PMCID: PMC6388162 DOI: 10.3390/ijerph16030502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/21/2022]
Abstract
Exploring subjective elements of the food environment remains key to understand why and how residents purchase food. Our aim was to explore and describe the social norms relating to the local food environment and food purchasing behaviors, as perceived by residents and food traders in Madrid, Spain. This qualitative study took place in a middle socioeconomic status neighborhood of Madrid between January 2015 and May 2016. We conducted 35 semi-structured interviews. We used stratified purposive sampling to recruit residents, neighborhood workers (N = 20) and food traders (N = 15) representing different levels of involvement with food purchasing behaviors. We analyzed these data using an interpretative phenomenological analysis approach. Participants highlighted social aspects of the food environment in relation to food purchasing behaviors. First, interpersonal and relational food environment elements were emphasized, including trust and tradition. Participants also identified generational demographic trends in relation to changes in the way residents purchased food: the new pace of life and the lack of time to buy fresh food and to cook at home. All these elements were influenced by the economic crisis. Food environment interventions aiming to improve food purchasing behaviors and residents' diets should consider intermediate social aspects of the food environment like trust and tradition and the fast pace of life of younger generations.
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Affiliation(s)
- María Sandín Vázquez
- Surgery and Medical and Social Sciences Department, School of Medicine, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
| | - Jesús Rivera
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
- Sociology and Communication Department, Social Sciences Faculty, Salamanca University, 37008 Salamanca, Spain.
| | - Paloma Conde
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
| | - Marta Gutiérrez
- Sociology and Communication Department, Social Sciences Faculty, Salamanca University, 37008 Salamanca, Spain.
| | - Julia Díez
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
| | - Joel Gittelsohn
- Center for Human Nutrition and Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Manuel Franco
- Surgery and Medical and Social Sciences Department, School of Medicine, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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