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Aris IM, Wu AJ, Lin PID, Zhang M, Farid H, Hedderson MM, Zhu Y, Ferrara A, Chehab RF, Barrett ES, Carnell S, Camargo CA, Chu SH, Mirzakhani H, Kelly RS, Comstock SS, Strakovsky RS, O’Connor TG, Ganiban JM, Dunlop AL, Dabelea D, Breton CV, Bastain TM, Farzan SF, Call CC, Hartert T, Snyder B, Santarossa S, Cassidy-Bushrow AE, O’Shea TM, McCormack LA, Karagas MR, McEvoy CT, Alshawabkeh A, Zimmerman E, Wright RJ, McCann M, Wright RO, Coull B, Amutah-Onukagha N, Hacker MR, James-Todd T, Oken E. Neighborhood Food Access in Early Life and Trajectories of Child Body Mass Index and Obesity. JAMA Pediatr 2024:2823466. [PMID: 39283628 PMCID: PMC11406455 DOI: 10.1001/jamapediatrics.2024.3459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/15/2024] [Indexed: 09/20/2024]
Abstract
Importance Limited access to healthy foods, resulting from residence in neighborhoods with low food access, is a public health concern. The contribution of this exposure in early life to child obesity remains uncertain. Objective To examine associations of neighborhood food access during pregnancy or early childhood with child body mass index (BMI) and obesity risk. Design, Setting, and Participants Data from cohorts participating in the US nationwide Environmental Influences on Child Health Outcomes consortium between January 1, 1994, and March 31, 2023, were used. Participant inclusion required a geocoded residential address in pregnancy (mean 32.4 gestational weeks) or early childhood (mean 4.3 years) and information on child BMI. Exposures Residence in low-income, low-food access neighborhoods, defined as low-income neighborhoods where the nearest supermarket is more than 0.5 miles for urban areas or more than 10 miles for rural areas. Main Outcomes and Measures BMI z score, obesity (age- and sex-specific BMI ≥95th percentile), and severe obesity (age- and sex-specific BMI ≥120% of the 95th percentile) from age 0 to 15 years. Results Of 28 359 children (55 cohorts; 14 657 [51.7%] male and 13 702 [48.3%] female; 590 [2.2%] American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander; 1430 [5.4%] Asian; 4034 [15.3%] Black; 17 730 [67.2%] White; and 2592 [9.8%] other [unspecified] or more than 1 race; 5754 [20.9%] Hispanic and 21 838 [79.1%] non-Hispanic) with neighborhood food access data, 23.2% resided in low-income, low-food access neighborhoods in pregnancy and 24.4% in early childhood. After adjusting for individual sociodemographic characteristics, residence in low-income, low-food access (vs non-low-income, low-food access) neighborhoods in pregnancy was associated with higher BMI z scores at ages 5 years (β, 0.07; 95% CI, 0.03-0.11), 10 years (β, 0.11; 95% CI, 0.06-0.17), and 15 years (β, 0.16; 95% CI, 0.07-0.24); higher obesity risk at 5 years (risk ratio [RR], 1.37; 95% CI, 1.21-1.55), 10 years (RR, 1.71; 95% CI, 1.37-2.12), and 15 years (RR, 2.08; 95% CI, 1.53-2.83); and higher severe obesity risk at 5 years (RR, 1.21; 95% CI, 0.95-1.53), 10 years (RR, 1.54; 95% CI, 1.20-1.99), and 15 years (RR, 1.92; 95% CI, 1.32-2.80). Findings were similar for residence in low-income, low-food access neighborhoods in early childhood. These associations were robust to alternative definitions of low income and low food access and additional adjustment for prenatal characteristics associated with child obesity. Conclusions Residence in low-income, low-food access neighborhoods in early life was associated with higher subsequent child BMI and higher risk of obesity and severe obesity. We encourage future studies to examine whether investments in neighborhood resources to improve food access in early life would prevent child obesity.
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Affiliation(s)
- Izzuddin M. Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Allison J. Wu
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pi-I D. Lin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Mingyu Zhang
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Huma Farid
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Yeyi Zhu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Rana F. Chehab
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Susan Carnell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carlos A. Camargo
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Su H. Chu
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hooman Mirzakhani
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachel S. Kelly
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah S. Comstock
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing
| | - Rita S. Strakovsky
- Department of Food Science and Human Nutrition, Michigan State University & Institute for Integrative Toxicology, Michigan State University, East Lansing
| | - Thomas G. O’Connor
- Departments of Psychiatry, Neuroscience, and Obstetrics and Gynecology, University of Rochester, Rochester, New York
| | - Jody M. Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
- Department of Pediatrics, Colorado Anschutz Medical Campus, Aurora
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Theresa M. Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Christine C. Call
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tina Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brittney Snyder
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sara Santarossa
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, East Lansing
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Andrea E. Cassidy-Bushrow
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
- Henry Ford Health + Michigan State University Health Sciences, Detroit
- Department of Pediatrics and Human Development, Michigan State University, East Lansing
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Lacey A. McCormack
- Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Margaret R. Karagas
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Cindy T. McEvoy
- Department of Pediatrics, Papé Pediatric Research Institute, Oregon Health & Science University, Portland
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, Massachusetts
| | - Emily Zimmerman
- Department of Communication Sciences & Disorders, Northeastern University, Boston, Massachusetts
| | - Rosalind J. Wright
- Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York
| | - Mariel McCann
- Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York
| | - Robert O. Wright
- Institute for Climate Change, Environmental Health, and Exposomics, Icahn School of Medicine at Mount Sinai, New York
| | - Brent Coull
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Michele R. Hacker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Brown L, Cambron C, Post WS, Brandt EJ. The Role of Social Determinants of Health in Atherosclerotic Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:451-461. [PMID: 38980573 DOI: 10.1007/s11883-024-01226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE OF REVIEW This review seeks to provide important information on each of the major domains of social determinants of health (SDOH) in the context of atherosclerotic cardiovascular disease. RECENT FINDINGS SDOH can be classified into five domains: social and community context, health care access and quality, neighborhood and built environment, economic stability, and education access and quality. SDOH are major drivers for cardiovascular health outcomes that exceed the impact from traditional risk factors, and explain inequities in health outcomes observed across different groups of individuals. SDOH profoundly impacts healthcare's receipt, delivery, and outcomes. Many patients fall within various disenfranchised groups (e.g., identify with minority race, low socioeconomic status, low educational attainment, LGBTQ+), which impact overall health status and care. Learning to understand, recognize, and address SDOH as the driving force of disparities are critical for achieving health equity in the prevention and adequate treatment of ASCVD.
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Affiliation(s)
- Logan Brown
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Dr, Lobby A, Ann Arbor, MI, 48103, USA.
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Ares G, Turra S, Bonilla L, Costa M, Verdier S, Brunet G, Alcaire F, Curutchet MR, Vidal L. WEIRD and non-consensual food deserts and swamps: A scoping review of operational definitions. Health Place 2024; 89:103315. [PMID: 39013213 DOI: 10.1016/j.healthplace.2024.103315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
The aim of the present study was to critically analyze operational definitions of food deserts and food swamps included in empirical studies published in peer-reviewed journals. A scoping review was conducted following the recommendations of the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. A search of the scientific literature was performed on August 2023 to identify empirical studies including operational definitions of food deserts and/or food swamps in three databases: Scopus, PubMed, and Scielo. A total of 932 scientific articles were identified in the three databases, from which 157 articles, published between 2002 and 2023, were included in the review. The included studies were mainly conducted in WEIRD (Western, Educated, Industrilaized, Rich and Democractic) countries. They presented a total of 107 operational definitions of food deserts and 30 operational definitions of food swamps. Large heterogeneity in the operational definitions of food deserts and food swamps was found. Published studies differed in all the elements of the operational definitions analyzed in the present work. Results stress the need for standardization and the development of more objective and multivariate continuous measures of physical food accessibility that reflect the complexity of modern food environments globally. A series of recommendations to advance food environment research are derived.
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Affiliation(s)
- Gastón Ares
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Uruguay.
| | - Sergio Turra
- Escuela de Nutrición, Universidad de la República, Av. Ricaldoni S/N, CP 11600, Montevideo, Uruguay
| | - Luciana Bonilla
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Piedras 165, CP 11000, Montevideo, Uruguay
| | - María Costa
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Piedras 165, CP 11000, Montevideo, Uruguay
| | - Sofía Verdier
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Piedras 165, CP 11000, Montevideo, Uruguay
| | - Gerónimo Brunet
- Espacio Interdisciplinario, Universidad de la República, José Enrique Rodó 1843, CP 11200, Montevideo, Uruguay
| | - Florencia Alcaire
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Uruguay
| | - María Rosa Curutchet
- Instituto Nacional de Alimentación, Ministerio de Desarrollo Social, Piedras 165, CP 11000, Montevideo, Uruguay
| | - Leticia Vidal
- Sensometrics & Consumer Science, Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la República, By Pass de Rutas 8 y 101 s/n, CP 91000, Pando, Uruguay
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Menichetti G, Barabási AL, Loscalzo J. Decoding the Foodome: Molecular Networks Connecting Diet and Health. Annu Rev Nutr 2024; 44:257-288. [PMID: 39207880 DOI: 10.1146/annurev-nutr-062322-030557] [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: 09/04/2024]
Abstract
Diet, a modifiable risk factor, plays a pivotal role in most diseases, from cardiovascular disease to type 2 diabetes mellitus, cancer, and obesity. However, our understanding of the mechanistic role of the chemical compounds found in food remains incomplete. In this review, we explore the "dark matter" of nutrition, going beyond the macro- and micronutrients documented by national databases to unveil the exceptional chemical diversity of food composition. We also discuss the need to explore the impact of each compound in the presence of associated chemicals and relevant food sources and describe the tools that will allow us to do so. Finally, we discuss the role of network medicine in understanding the mechanism of action of each food molecule. Overall, we illustrate the important role of network science and artificial intelligence in our ability to reveal nutrition's multifaceted role in health and disease.
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Affiliation(s)
- Giulia Menichetti
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
- Network Science Institute and Department of Physics, Northeastern University, Boston, Massachusetts, USA
- Harvard Data Science Initiative, Harvard University, Boston, Massachusetts, USA
| | - Albert-László Barabási
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
- Network Science Institute and Department of Physics, Northeastern University, Boston, Massachusetts, USA
- Department of Network and Data Science, Central European University, Budapest, Hungary
| | - Joseph Loscalzo
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
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Wei Z, Mukherjee S. An integrated approach to analyze equitable access to food stores under disasters from human mobility patterns. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024. [PMID: 39074846 DOI: 10.1111/risa.16873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Limited access to food stores is often linked to higher health risks and lower community resilience. Socially vulnerable populations experience persistent disparities in equitable food store access. However, little research has been done to examine how people's access to food stores is affected by natural disasters. Previous studies mainly focus on examining potential access using the travel distance to the nearest food store, which often falls short of capturing the actual access of people. Therefore, to fill this gap, this paper incorporates human mobility patterns into the measure of actual access, leveraging large-scale mobile phone data. Specifically, we propose a novel enhanced two-step floating catchment area method with travel preferences (E2SFCA-TP) to measure accessibility, which extends the traditional E2SFCA model by integrating actual human mobility behaviors. We then analyze people's actual access to grocery and convenience stores across both space and time under the devastating winter storm Uri in Harris County, Texas. Our results highlight the value of using human mobility patterns to better reflect people's actual access behaviors. The proposed E2SFCA-TP measure is more capable of capturing mobility variations in people's access, compared with the traditional E2SFCA measure. This paper provides insights into food store access across space and time, which could aid decision making in resource allocation to enhance accessibility and mitigate the risk of food insecurity in underserved areas.
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Affiliation(s)
- Zhiyuan Wei
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, New York, USA
| | - Sayanti Mukherjee
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, New York, USA
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Graven LJ, Durante A, Abbott L, Bassi E, Howren MB, Grant JS. Self-care Problems and Management Strategies Experienced by Rural Patient/Caregiver Dyads Living With Heart Failure: A Qualitative Study. J Cardiovasc Nurs 2024; 39:207-218. [PMID: 37955387 DOI: 10.1097/jcn.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF in managing HF in the home and how these problems are managed. OBJECTIVE The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed. METHODS Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached. RESULTS Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies. CONCLUSIONS The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF.
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Tang WL, Rodriguez F. Racial and Ethnic Disparities in the Management of Chronic Coronary Disease. Med Clin North Am 2024; 108:595-607. [PMID: 38548466 PMCID: PMC10979033 DOI: 10.1016/j.mcna.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Chronic coronary disease (CCD) comprises a continuum of conditions that include obstructive and non-obstructive coronary artery disease with or without prior acute coronary syndrome. Racial and ethnic representation disparities are pervasive in CCD guideline-informing clinical trials and evidence-based management. These disparities manifest across the entire spectrum of CCD management, spanning from non-pharmacological lifestyle changes to guideline-directed medical therapy, and cardiac rehabilitation to invasive procedures. Recognizing and addressing the historical factors underlying these disparities is crucial for enhancing the quality and equity of CCD management within an increasingly diverse population.
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Affiliation(s)
- Wilson Lay Tang
- Department of Medicine, Stanford University, 300 Pasteur Drive, L154, Stanford, CA 94305-5133, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Department of Medicine, Center for Academic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Blaustein JR, Quisel MJ, Hamburg NM, Wittkopp S. Environmental Impacts on Cardiovascular Health and Biology: An Overview. Circ Res 2024; 134:1048-1060. [PMID: 38662864 PMCID: PMC11058466 DOI: 10.1161/circresaha.123.323613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.
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Affiliation(s)
- Jacob R. Blaustein
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
| | - Matthew J. Quisel
- Department of Medicine, Boston University Chobanian and Avedision School of Medicine
| | - Naomi M. Hamburg
- Section of Vascular Biology, Whitaker Cardiovascular Institute, Chobanian and Avedisian School of Medicine, Boston University, Boston, USA
| | - Sharine Wittkopp
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
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Myers S, Kenzik K, Allee L, Dechert T, Theodore S, Jaffe A, Sanchez SE. Social Determinants of Health Associated With the Need for Urgent Versus Elective Cholecystectomy at an Urban, Safety-Net Hospital. Surg Infect (Larchmt) 2024; 25:101-108. [PMID: 38301176 DOI: 10.1089/sur.2023.229] [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: 02/03/2024] Open
Abstract
Background: Benign gallstone disease is the most frequent indication for cholecystectomy in the United States. Many patients present with complicated disease requiring urgent interventions, which increases morbidity and mortality. We investigated the association between individual and population-level social determinants of health (SDoH) with urgent versus elective cholecystectomy. Patients and Methods: All patients undergoing cholecystectomy (2014-2021) for benign gallstone disease were included. Demographic and clinical data were linked to population-level SDoH characteristics using census tracts. Data were analyzed using descriptive and inferential statistics. Results: A total of 3,197 patients met inclusion criteria; 1,913 (59.84%) underwent urgent cholecystectomy, 1,204 (37.66%) underwent emergent cholecystectomy, and 80 (2.5%) underwent interval cholecystectomy. On multinomial logistic regression, patients who were older (relative risk [RR], 1.010; p < 0.001), black (RR, 1.634; p = 0.008), and living in census tracts with a higher percent of poverty (RR, 0.017; p = 0.021) had a higher relative risk of presenting for urgent cholecystectomy. Patients who were female (RR, 0.462; p < 0.001), had a primary care provider (PCP; RR, 0.821; p = 0.018), and lived in census tracts with low supermarket access (RR, 0.764; p = 0.038) had a lower relative risk of presenting for urgent cholecystectomy. Only age (RR, 1.066; p < 0.001), female gender (RR, 0.227; p < 0.001), and having a PCP (RR, 1.984; p = 0.034) were associated with presentation for interval cholecystectomy. Conclusions: Patients who were older, black, and living in census tracts with high poverty levels had a higher relative risk of presenting for urgent cholecystectomy at our institution, whereas females and patients with PCPs were more likely to undergo elective cholecystectomy. Improved access to primary care and surgical clinics for all patients at safety-net hospitals may result in improved outcomes in the management of benign gallstone disease by increasing diagnosis and treatment in the elective setting.
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Affiliation(s)
- Sara Myers
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Lisa Allee
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sheina Theodore
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Abraham Jaffe
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
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Parekh T, Xue H, Al-Kindi S, Nasir K, Cheskin LJ, Cuellar AE. Food Environment Quality and Cardiovascular Disease Mortality in the United States: a County-Level Analysis from 2017 to 2019. J Gen Intern Med 2024; 39:176-185. [PMID: 37507552 PMCID: PMC10853151 DOI: 10.1007/s11606-023-08335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Upstream socioeconomic circumstances including food insecurity and food desert are important drivers of community-level health disparities in cardiovascular mortality let alone traditional risk factors. The study assessed the association between differences in food environment quality and cardiovascular mortality in US adults. DESIGN Retrospective analysis of the association between cardiovascular mortality among US adults aged 45 and above and food environment quality, measured as the food environment index (FEI), in 2615 US counties. FEI was measured by equal weights of food insecurity (limited access to a reliable food source) and food desert (limited access to healthy food), ranging from 0 (worst) to 10 (best). Age-adjusted cardiovascular mortality rates per 100,000 adults aged 45 and above in the calendar year 2017-2019. County-level association between CVD mortality rate and FEI was modeled using generalized linear regression. Data were weighted using county population. RESULT Median CVD deaths per 100,000 population were 645.4 (IQR 561.5, 747.0) among adults aged 45 years and above across US counties in 2017-2019. About 12.8% (IQR 10.7%, 15.1%) of residents were food insecure and 6.3% (IQR 3.6%, 9.9%) were living in food desert areas. Comparing counties by FEI quartiles, the CVD mortality rate was higher in the least healthy FE counties (704.3 vs 598.6 deaths per 100,000 population) compared to the healthiest FE counties. One unit increase in FEI was associated with - 12.95 CVD deaths/100,000 population. In the subgroup analysis of counties with higher income inequality, the healthiest food environment was associated with 46.4 lower CVD deaths/100,000 population than the least healthy food environment. One unit increase in FEI in counties with higher income inequality was associated with a fivefold decrease in CVD mortality difference in African American counties (- 18.4 deaths/100,000 population) when compared to non-African American counties (- 3.63 deaths/100,000 population). CONCLUSION In this retrospective multi-county study in the USA, a higher food environment index was significantly associated with lower cardiovascular mortality.
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Affiliation(s)
- Tarang Parekh
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA.
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA.
| | - Hong Xue
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Sadeer Al-Kindi
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
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Brostow DP, Donovan M, Penzenik M, Stamper CE, Spark T, Lowry CA, Ishaq SL, Hoisington AJ, Brenner LA. Food desert residence has limited impact on veteran fecal microbiome composition: a U.S. Veteran Microbiome Project study. mSystems 2023; 8:e0071723. [PMID: 37874170 PMCID: PMC10734509 DOI: 10.1128/msystems.00717-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/11/2023] [Indexed: 10/25/2023] Open
Abstract
IMPORTANCE Social and economic inequities can have a profound impact on human health. The inequities could result in alterations to the gut microbiome, an important factor that may have profound abilities to alter health outcomes. Moreover, the strong correlations between social and economic inequities have been long understood. However, to date, limited research regarding the microbiome and mental health within the context of socioeconomic inequities exists. One particular inequity that may influence both mental health and the gut microbiome is living in a food desert. Persons living in food deserts may lack access to sufficient and/or nutritious food and often experience other inequities, such as increased exposure to air pollution and poor access to healthcare. Together, these factors may confer a unique risk for microbial perturbation. Indeed, external factors beyond a food desert might compound over time to have a lasting effect on an individual's gut microbiome. Therefore, adoption of a life-course approach is expected to increase the ecological validity of research related to social inequities, the gut microbiome, and physical and mental health.
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Affiliation(s)
- Diana P. Brostow
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, Colorado, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Military and Veteran Microbiome Consortium for Research and Education, Aurora, Colorado, USA
| | - Meghan Donovan
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, Colorado, USA
| | - Molly Penzenik
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, Colorado, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christopher E. Stamper
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, Colorado, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Military and Veteran Microbiome Consortium for Research and Education, Aurora, Colorado, USA
| | - Talia Spark
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, Colorado, USA
| | - Christopher A. Lowry
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, Colorado, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Military and Veteran Microbiome Consortium for Research and Education, Aurora, Colorado, USA
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience and Center for Microbial Exploration, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Suzanne L. Ishaq
- School of Food and Agriculture, University of Maine, Orono, Maine, USA
| | - Andrew J. Hoisington
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, Colorado, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Military and Veteran Microbiome Consortium for Research and Education, Aurora, Colorado, USA
- Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Systems Engineering & Management, Air Force Institute of Technology, Wright-Patterson AFB, Dayton, Ohio, USA
| | - Lisa A. Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center (RMRVAMC), Aurora, Colorado, USA
- Department of Physical Medicine & Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Military and Veteran Microbiome Consortium for Research and Education, Aurora, Colorado, USA
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Divakaran S, Krawisz AK, Secemsky EA, Kant S. Sex and Racial Disparities in Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2023; 43:2099-2114. [PMID: 37706319 PMCID: PMC10615869 DOI: 10.1161/atvbaha.123.319399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
Several studies have shown that women and racial and ethnic minority patients are at increased risk of developing lower extremity peripheral artery disease and suffering adverse outcomes from it, but a knowledge gap remains regarding the underlying causes of these increased risks. Both groups are more likely to be underdiagnosed, have poorly managed contributory comorbidities, and incur disparities in treatment and management postdiagnosis. Opportunities for improvement in the care of women and racial and ethnic minorities with peripheral artery disease include increased rates of screening, higher rates of clinical suspicion (particularly in the absence of typical symptoms of intermittent claudication), and more aggressive risk factor management before and after the diagnosis of peripheral artery disease.
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Affiliation(s)
- Sanjay Divakaran
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna K Krawisz
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eric A Secemsky
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Shashi Kant
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Joseph S, Friedrich H. Analyzing drivers of organic food sales-A pooled spatial data analysis for Hamburg (Germany). PLoS One 2023; 18:e0285377. [PMID: 37792695 PMCID: PMC10550140 DOI: 10.1371/journal.pone.0285377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/22/2023] [Indexed: 10/06/2023] Open
Abstract
Shifting the food system to a more sustainable one requires changes on both sides of the supply chain, with the consumer playing a key role. Therefore, understanding the factors that positively correlate with increased organic food sales over time for an entire population can help guide policymakers, industry, and research to increase this transition further. Using a statistical approach, we developed a spatial pooled cross-sectional model to analyze factors that positively correlate with an increased demand for organic food sales over 20 years (1999-2019) for an entire region (the city-state of Hamburg, Germany), accounting for spatial effects through the spatial error model, spatially lagged X model, and spatial Durbin error model. The results indicated that voting behavior strongly correlated with increased organic food sales over time. Specifically, areas with a higher number of residents that voted for a political party with a core focus on environmental issues, the Greens and the Left Party in Germany. However, there is a stronger connection with the more "radical" Left Party than with the "mainstream" Green Party, which may provide evidence for the attitude-behavior gap, as Left Party supporters are very convinced of their attitudes (pro-environment) and behavior thus follows. By including time and space, this analysis is the first to summarize developments over time for a metropolitan population while accounting for spatial effects and identifying areas for targeted marketing that need further motivation to increase organic food sales.
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Affiliation(s)
- Sarah Joseph
- Kühne Logistics University (KLU), Hamburg, Germany
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Victor A, Gotine ARM, Falcão IR, Ferreira AJF, Flores-Ortiz R, Xavier SP, Vasco MD, de Jesus Silva N, Mahoche M, Rodrigues OAS, de Cássia Ribeiro R, Rondó PH, Barreto ML. Association between food environments and fetal growth in pregnant Brazilian women. BMC Pregnancy Childbirth 2023; 23:661. [DOI: https:/doi.org/10.1186/s12884-023-05947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
Abstract
Introduction
Birth weight is described as one of the main determinants of newborns’ chances of survival. Among the associated causes, or risk factors, the mother’s nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns.
Design
This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn’s size was defined as follows: appropriate for gestational age (between 10 and 90th percentile), SGA (< 10th percentile), LGA (> 90th percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest.
Results
We analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA [OR2nd tertile: 1.06 (1.05–1.07)] and LBW [OR2nd tertile: 1.11 (1.09–1.12)]. Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA [OR3rd tertile: 1.04 (1.02–1.06)] and LBW [OR2nd tertile: 1.13 (1.11–1.16)]. Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA [OR3rd tertile: 1.09 (1.01–1.18)] and [OR3rd tertile: 1.06 (1.04–1.09)], respectively, while Mixed-race women also had a higher chance of having newborns with LBW [OR3rd tertile: 1.17 (1.14–1.20)]. Indigenous women were associated with LGA [OR3rd tertile: 1.20 (1.01–1.45)].
Conclusion
The study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil.
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Victor A, Gotine ARM, Falcão IR, Ferreira AJF, Flores-Ortiz R, Xavier SP, Vasco MD, de Jesus Silva N, Mahoche M, Rodrigues OAS, de Cássia Ribeiro R, Rondó PH, Barreto ML. Association between food environments and fetal growth in pregnant Brazilian women. BMC Pregnancy Childbirth 2023; 23:661. [PMID: 37704954 PMCID: PMC10500732 DOI: 10.1186/s12884-023-05947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Birth weight is described as one of the main determinants of newborns' chances of survival. Among the associated causes, or risk factors, the mother's nutritional status strongly influences fetal growth and birth weight outcomes of the concept. This study evaluates the association between food deserts, small for gestational age (SGA), large for gestational age (LGA) and low birth weight (LBW) newborns. DESIGN This is a cross-sectional population study, resulting from individual data from the Live Birth Information System (SINASC), and commune data from mapping food deserts (CAISAN) in Brazil. The newborn's size was defined as follows: appropriate for gestational age (between 10 and 90th percentile), SGA (< 10th percentile), LGA (> 90th percentile), and low birth weight < 2,500 g. To characterize food environments, we used tertiles of the density of establishments which sell in natura and ultra-processed foods. Logistic regression modeling was conducted to investigate the associations of interest. RESULTS We analyzed 2,632,314 live births in Brazil in 2016, after appropriate adjustments, women living in municipalities with limited availability of fresh foods had a higher chance of having newborns with SGA [OR2nd tertile: 1.06 (1.05-1.07)] and LBW [OR2nd tertile: 1.11 (1.09-1.12)]. Conversely, municipalities with greater availability of ultra-processed foods had a higher chance of having newborns with SGA [OR3rd tertile: 1.04 (1.02-1.06)] and LBW [OR2nd tertile: 1.13 (1.11-1.16)]. Stratification by race showed that Black and Mixed/Brown women had a higher chance of having newborns with SGA [OR3rd tertile: 1.09 (1.01-1.18)] and [OR3rd tertile: 1.06 (1.04-1.09)], respectively, while Mixed-race women also had a higher chance of having newborns with LBW [OR3rd tertile: 1.17 (1.14-1.20)]. Indigenous women were associated with LGA [OR3rd tertile: 1.20 (1.01-1.45)]. CONCLUSION The study found that living in areas with limited access to healthy foods was associated with an increased risk of SGA and low birth weight among newborns, particularly among Black and Mixed/Brown women. Therefore, urgent initiatives aimed at reducing social inequalities and mitigating the impact of poor food environments are needed in Brazil.
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Affiliation(s)
- Audêncio Victor
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil.
- Department of Nutrition, Ministry of Health of Mozambique, Maputo, Mozambique.
- Iyaleta - Research, Science and Humanities, Salvador, Bahia, Brazil.
| | - Ana Raquel Manuel Gotine
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
| | - Ila R Falcão
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
| | - Andrêa J F Ferreira
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
- Center On Racism, Global Movements, and Population Health Equity Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Renzo Flores-Ortiz
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
| | - Sancho Pedro Xavier
- Institute of Collective Health, Federal University of Mato Grosso (UFMT), Cuiabá, MT, Brasil
| | - Melsequisete Daniel Vasco
- Faculty of Health Sciences, Lúrio University, Nampula, Mozambique
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Natanael de Jesus Silva
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
- Barcelona Institute for Global Health, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Manuel Mahoche
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil
| | | | - Rita de Cássia Ribeiro
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
- School of Nutrition, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Patrícia H Rondó
- Faculdade de Saúde Pública- USP, School of Public Health, University of São Paulo (USP), Avenida Doutor Arnaldo, 715, São Paulo, São Paulo, 01246904, Brazil
| | - Maurício L Barreto
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Sl 315. Rua Mundo, 121. Trobogy, Salvador, Bahia, 41745-715, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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Testa A, Mungia R, van den Berg A, C Hernandez D. Food deserts and dental care utilization in the United States. J Public Health Dent 2023; 83:389-396. [PMID: 38073040 DOI: 10.1111/jphd.12593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/15/2023] [Accepted: 11/03/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVES Although food deserts are known to impact health and healthcare utilization, no research has investigated the relationship between food deserts and dental care utilization. This study aimed to fill this gap by assessing the relationship between living in a food desert and self-reported dental care utilization in the past year. METHODS Data are from the National Longitudinal Study of Adolescent to Adult Health (N = 10,495). The association between food deserts and dental care utilization was assessed using covariate-adjusted multiple logistic regression. RESULTS Living in a food desert was associated with higher odds of not utilizing dental care in the past year. This association was concentrated among high-poverty areas (≥20% poverty rate). CONCLUSIONS The current study is the first to assess the relationship between living in a food desert and dental care utilization. The findings demonstrate that individuals living in low-income urban food deserts may be at increased risk for not utilizing dental care.
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Affiliation(s)
- Alexander Testa
- School of Public Health, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rahma Mungia
- School of Dentistry, Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Alexandra van den Berg
- School of Public Health, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Daphne C Hernandez
- Cizik School of Nursing, Department of Research, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Massey J, Wiese D, McCullough ML, Jemal A, Islami F. The Association Between Census Tract Healthy Food Accessibility and Life Expectancy in the United States. J Urban Health 2023; 100:572-576. [PMID: 37378819 PMCID: PMC10323062 DOI: 10.1007/s11524-023-00742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Accessibility of healthy food is an important predictor for several health outcomes, but its association with life expectancy is unclear. We evaluated the association between U.S. Department of Agriculture's Food Research Atlas measures of healthy food accessibility and life expectancy at birth across contiguous U.S. census tracts using spatial modeling analysis. Both income and healthy food accessibility were associated with life expectancy at birth, as indicated by shorter life expectancy in low-income census tracts when comparing tracts with similar healthy food accessibility level, and in low-access tracts when comparing tracts with similar income level. Compared to high-income/high-access census tracts, life expectancy at birth was lower in high-income/low-access (- 0.33 years; 95% confidence interval - 0.42, - 0.28), low-income/high-access (- 1.45 years; - 1.52, - 1.38), and low-income/low-access (- 2.29 years; - 2.38, - 2.21) tracts after adjusting for socio-demographic characteristics and incorporating vehicle availability. Effective interventions to increase healthy food accessibility may improve life expectancy.
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Affiliation(s)
- Jason Massey
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, 3380 Chastain Meadows Parkway, Suite 200, Kennesaw, Atlanta, Georgia, 30144, USA
| | - Daniel Wiese
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, 3380 Chastain Meadows Parkway, Suite 200, Kennesaw, Atlanta, Georgia, 30144, USA.
| | | | - Ahmedin Jemal
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, 3380 Chastain Meadows Parkway, Suite 200, Kennesaw, Atlanta, Georgia, 30144, USA
| | - Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, 3380 Chastain Meadows Parkway, Suite 200, Kennesaw, Atlanta, Georgia, 30144, USA
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Merchant T, Soyemi E, Roytman MV, DiTosto JD, Beestrum M, Niznik CM, Yee LM. Healthcare-based interventions to address food insecurity during pregnancy: a systematic review. Am J Obstet Gynecol MFM 2023; 5:100884. [PMID: 36739912 PMCID: PMC10194022 DOI: 10.1016/j.ajogmf.2023.100884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study was a systematic review aimed to assess published literature regarding healthcare-based interventions addressing food insecurity during pregnancy and their effects on patient-reported, pregnancy, or nutritional outcomes. DATA SOURCES A systematic search was performed in February 2022 (subsequently updated in August 2022) using Embase, Medline, Cochrane Library, and Scopus using terms related to food insecurity interventions during pregnancy. STUDY ELIGIBILITY CRITERIA Studies examining healthcare-based interventions addressing food insecurity during pregnancy with patient-reported outcomes (eg, program satisfaction), adverse pregnancy outcomes (eg, preterm birth), or nutritional outcomes (eg, dietary intake) were included. Studies using data before 1995, conducted outside the United States, or focused solely on dietary content or the Special Supplemental Nutrition Program for Women, Infants, and Children or Supplemental Nutrition Assistance Program as the intervention of interest were excluded. METHODS Of note, 3 authors screened the abstracts and full articles for inclusion. The final cohort included 5 studies. Moreover, 3 authors independently extracted data from each article and assessed the study quality using the Grading of Recommendations, Assessment, Development, and Evaluations and the risk of bias using the National Institutes of Health Study Quality Assessment tools. RESULTS Overall, 5 studies describing the interventions addressing food insecurity during pregnancy were included. Study designs included prospective cohort (n=1) and retrospective cohort (n=4) studies. There was heterogeneity in the type of intervention, with 3 using food vouchers, 1 focusing on a group prenatal service with nutrition and food management education, and 1 using a food connection program. Most studies (4 [80%]) shared patient-reported outcomes (eg, food security levels and program utilization rates), with 2 studies examining pregnancy-related outcomes (ie, glucose level, blood pressure, and preterm birth) and 2 studies examining nutritional outcomes. The interventions were associated with improved levels of food insecurity, reduced odds of preterm birth, and improved blood pressure trends; the findings demonstrated a 56% to 81% program utilization rate. All studies exhibited moderate to low study quality, with fair to good internal validity. CONCLUSION Although data on healthcare-based interventions targeted at food insecurity during pregnancy are limited, the few studies identified suggest that such interventions may affect pregnancy outcomes. A better understanding of the local scope and context of food insecurity and community-based organizations' efforts not captured by the literature in this area can help inform the development of interventions targeting food access during pregnancy.
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Affiliation(s)
- Tazim Merchant
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Merchant, Ms. Soyemi, Mses Roytman and DiTosto, and Niznik and Dr Yee)
| | - Elizabeth Soyemi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Merchant, Ms. Soyemi, Mses Roytman and DiTosto, and Niznik and Dr Yee); Brown University, Providence, RI (Ms Soyemi)
| | - Maya V Roytman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Merchant, Ms. Soyemi, Mses Roytman and DiTosto, and Niznik and Dr Yee); Loyola University Chicago, Chicago, IL (Ms Roytman)
| | - Julia D DiTosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Merchant, Ms. Soyemi, Mses Roytman and DiTosto, and Niznik and Dr Yee); Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Ms DiTosto)
| | - Molly Beestrum
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Beestrum)
| | - Charlotte M Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Merchant, Ms. Soyemi, Mses Roytman and DiTosto, and Niznik and Dr Yee)
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Ms Merchant, Ms. Soyemi, Mses Roytman and DiTosto, and Niznik and Dr Yee).
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Lloyd M, Amos ME, Milfred-Laforest S, Motairek IK, Pascuzzi K, Petermann-Rocha F, Elgudin Y, Nasir K, Freedman D, Al-Kindi S, Pell J, Deo SV. Residing in a Food Desert and Adverse Cardiovascular Events in US Veterans With Established Cardiovascular Disease. Am J Cardiol 2023; 196:70-76. [PMID: 37094491 DOI: 10.1016/j.amjcard.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/28/2023] [Accepted: 03/12/2023] [Indexed: 04/26/2023]
Abstract
Residents living in a "food desert" are known to be at a higher risk for developing cardiovascular disease (CVD). However, national-level data regarding the influence of residing in a food desert in patients with established CVD is lacking. Data from veterans with established atherosclerotic CVD who received outpatient care in the Veterans Health Administration system between January 2016 and December 2021 were obtained, with follow-up information collected until May 2022 (median follow-up: 4.3 years). A food desert was defined using the United States Department of Agriculture criteria, and census tract data were used to identify Veterans in these areas. All-cause mortality and the occurrence of major adverse cardiovascular events (MACEs; a composite of myocardial infarction/stroke/heart failure/all-cause mortality) were evaluated as the co-primary end points. The relative risk for MACE in food desert areas was evaluated by fitting multivariable Cox models adjusted for age, gender, race, ethnicity, and median household income, with food desert status as the primary exposure. Of the 1,640,346 patients (mean age 72 years, women 2.7%, White 77.7%, Hispanic 3.4%), 25,7814 (15.7%) belonged to the food desert group. Patients residing in food deserts were younger; more likely to be Black (22% vs 13%)or Hispanic (4% vs 3.5%); and had a higher prevalence of diabetes mellitus (52.7% vs 49.8%), chronic kidney disease (31.8% vs 30.4%,) and heart failure (25.6% vs 23.8%). Adjusted for covariates, food desert patients had a higher risk of MACE (hazard ratio 1.040 [1.033 to 1.047]; p <0.001) and all-cause mortality (hazard ratio 1.032 [1.024 to 1.039]; p <0.001). In conclusion, we observed that a large proportion of US veterans with established atherosclerotic CVD reside in food desert census tracts. Adjusting for age, gender, race, and ethnicity, residing in food deserts was associated with a higher risk of adverse cardiac events and all-cause mortality.
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Affiliation(s)
- Mackenzie Lloyd
- Department of Pharmacy, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Mary Ellen Amos
- Department of Pharmacy, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | | | - Issam Kamel Motairek
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Kristina Pascuzzi
- Department of Pharmacy, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Fanny Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile; School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Yakov Elgudin
- Division of Cardiothoracic Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Khurram Nasir
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Darcy Freedman
- Department of Population Health and Quantitative Sciences, Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Sadeer Al-Kindi
- Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio.
| | - Jill Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Salil Vasudeo Deo
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Division of Cardiothoracic Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Case School of Medicine, Case Western Reserve University, Cleveland, Ohio.
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20
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Victor A, Silva RDCR, Silva NDJ, Ferreira A, Barreto ML, Campello T. Influence of Unhealthy Food Environment on Premature Cardiovascular Disease Mortality in Brazil: An Ecologic Approach. Am J Prev Med 2023; 64:285-292. [PMID: 36437143 DOI: 10.1016/j.amepre.2022.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Cardiovascular disease is the main cause of general and premature death of adults aged 30-69 years in Brazil and around the world. Unhealthy food environments have been implicated as one of the factors associated with cardiovascular disease morbimortality because they affect people's health conditions and nutrition. This study aims to explore the association between unhealthy food environments (deserts/swamps) and premature cardiovascular disease mortality in the Brazilian population. METHODS This is an ecologic study using data from 5,558 Brazilian municipalities in 2016. The cardiovascular disease mortality data were obtained from the Mortality Information System of the Ministry of Health. The study on mapping food deserts in Brazil, developed by the Interministerial Chamber of Food and Nutrition Security, was used to evaluate the physical dimension of food access. The authors calculated the standardized rates of premature general and specific cardiovascular disease (stroke and ischemic heart disease) causes of death in the same period. To characterize food environments, the density of unprocessed and ultraprocessed foods per 10,000 population in tertiles was used. Crude and adjusted negative binomial regression models were used to study the associations of interest. RESULTS After the necessary adjustments (human development index, gross domestic product per capita, unemployment rate, Gini index and Family Health Strategy coverage), it was found that municipalities with low unprocessed food supply were at the highest risk of increased mortality among women with ischemic heart disease (rate ratio first tertile: 1.08 [95% CI=1.01, 1.15]). Conversely, the municipalities where there was a greater offer of ultraprocessed foods showed a higher risk of death from cardiovascular diseases (rate ratio second tertile: 1.17 [95% CI=1.12, 1.22]; rate ratio third tertile: 1.20 [95% CI=1.14, 1.26]), from strokes (rate ratio second tertile: 1.19 [95% CI=1.13, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.15, 1.30]), and ischemic heart disease (rate ratio second tertile: 1.19 [95% CI=1.12, 1.25]; rate ratio third tertile: 1.22 [95% CI=1.13, 1.29]). CONCLUSIONS This study's findings show an increase in the risk of cardiovascular disease, stroke, and ischemic heart disease mortality, especially in the municipalities where there was a greater offer of ultraprocessed foods. Initiatives aiming to minimize the effects of these food environments are urgently needed in the Brazilian context.
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Affiliation(s)
- Audêncio Victor
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; School of Public Health, University of São Paulo, São Paulo, Brazil; Department of Nutrition, Ministry of Health of Mozambique, Zambezia, Mozambique.
| | - Rita de Cássia Ribeiro Silva
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil; School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | | | - Andrêa Ferreira
- Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil; The Ubuntu Center on Racism, Global Movements, and Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Maurício L Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Tereza Campello
- School of Public Health, University of São Paulo, São Paulo, Brazil; Fiocruz School of Government, Oswaldo Cruz Foundation, Brasília, Brazil; University of Nottingham, Nottingham, United Kingdom
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21
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Gondi KT, Larson J, Sifuentes A, Alexander NB, Konerman MC, Thomas KS, Hummel SL. Health of the Food Environment Is Associated With Heart Failure Mortality in the United States. Circ Heart Fail 2022; 15:e009651. [PMID: 36281754 DOI: 10.1161/circheartfailure.122.009651] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Food environment factors contribute to cardiovascular disease, but their effect on population-level heart failure (HF) mortality is unclear. METHODS We utilized the National Vital Statistics System and USDA Food Environment Atlas to collect HF mortality rates (MR) and 2 county food environment indices: (1) food insecurity percentage (FI%) and (2) food environment index (FEI), a scaled index (0-10, 10 best) incorporating FI% and access to healthy food. We used linear regression to estimate the association between food environment and HF MR Results: Mean county FI% and FEI were 13% and 7.8 in 2956 included counties. Counties with FI% above the national median had significantly higher HF MR (30.7 versus 26.7 per 100 000; P<0.001) compared with FI% below the national median. Counties with HF MR above the national median had higher FI%, lower FEI, lower density of grocery stores, poorer access to stores among older adults, and lower Supplemental Nutrition Assistance Program participation rate (P<0.001 for all). Lower county FI% (β=-1.3% per 1% decrease) and higher county FEI (β=-3.6% per 1-unit increase in FEI) were significantly associated with lower HF MR after adjustment for county demographic, socioeconomic, and health factors. This association was stronger for HF MR compared with non-HF cardiovascular disease MR and all-cause MR The relationship between food environment and HF MR was stronger in counties with the highest income inequity and poverty rate. CONCLUSIONS Healthier food environment is significantly associated with lower HF mortality at the county level. This reinforces the role of food security on cardiovascular outcomes.
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Affiliation(s)
- Keerthi T Gondi
- Department of Internal Medicine (K.T.G., J.L., A.S.), University of Michigan, Ann Arbor
| | - John Larson
- Department of Internal Medicine (K.T.G., J.L., A.S.), University of Michigan, Ann Arbor
| | - Aaron Sifuentes
- Department of Internal Medicine (K.T.G., J.L., A.S.), University of Michigan, Ann Arbor
| | - Neil B Alexander
- Division of Geriatric and Palliative Medicine (N.B.A.), University of Michigan, Ann Arbor.,Geriatric Research Education Clinical Center (N.B.A.), Veterans Affairs Ann Arbor Health System, MI
| | - Matthew C Konerman
- Division of Cardiovascular Medicine (M.C.K., S.L.H.), University of Michigan, Ann Arbor
| | - Kali S Thomas
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI (K.S.T.)
| | - Scott L Hummel
- Division of Cardiovascular Medicine (M.C.K., S.L.H.), University of Michigan, Ann Arbor.,Section of Cardiology (S.L.H.), Veterans Affairs Ann Arbor Health System, MI
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22
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Hargrave AS, Sumner JA, Ebrahimi R, Cohen BE. Posttraumatic Stress Disorder (PTSD) as a Risk Factor for Cardiovascular Disease: Implications for Future Research and Clinical Care. Curr Cardiol Rep 2022; 24:2067-2079. [PMID: 36306020 DOI: 10.1007/s11886-022-01809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Posttraumatic stress disorder (PTSD) may be an important risk factor for cardiovascular disease (CVD). We explore the literature linking PTSD to CVD, potential mechanisms, interventions, and clinical implications. We outline gaps in current literature and highlight necessary future research. RECENT FINDINGS PTSD has been independently associated with deleterious effects on cardiovascular health through biological, behavioral, and societal pathways. There are evidence-based psychotherapeutic interventions and pharmacotherapies for PTSD that may mitigate its impact on CVD. However, there are limited studies that rigorously analyze the impact of treating PTSD on cardiovascular outcomes. Trauma-informed CVD risk stratification, education, and treatment offer opportunities to improve patient care. These approaches can include a brief validated screening tool for PTSD identification and treatment. Pragmatic trials are needed to test PTSD interventions among people with CVD and evaluate for improved outcomes.
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Affiliation(s)
- Anita S Hargrave
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, 94110, USA. .,Medical Service, San Francisco VA Health Care System, San Francisco, CA, 94121, USA.
| | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA, 90095-1563, USA
| | - Ramin Ebrahimi
- Department of Medicine, Cardiology Section, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA.,Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, 90095, USA
| | - Beth E Cohen
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, 94110, USA.,Medical Service, San Francisco VA Health Care System, San Francisco, CA, 94121, USA
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23
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Choi YJ, Crimmins EM, Ailshire JA. Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans. Prev Med Rep 2022; 29:101912. [PMID: 35911578 PMCID: PMC9326331 DOI: 10.1016/j.pmedr.2022.101912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
Food insecurity, reflecting a household's low ability to purchase healthy food, is a public health concern that is associated with poor diet and obesity. Poor food environments, characterized as a neighborhood with low access to healthy, affordable food, may amplify the negative impact of food insecurity on diet and obesity. This study aims to investigate whether food insecurity and food environments are jointly associated with an increased risk of poor diet quality and obesity. We used data from a nationally representative sample of community-dwelling older adults in the Health and Retirement Study Health Care and Nutrition Survey and the National Neighborhood Data Archive to investigate the role of household and neighborhood characteristics on diet and obesity. Weighted regression models were estimated to examine the relationship between food insecurity and food environments as well as their interaction with diet quality and obesity. Food insecure respondents had lower Healthy Eating Index scores and were more likely to be obese than food secure respondents. Living in a poor food environment was associated with lower Healthy Eating Index scores, but not with obesity. We did not find any interaction between food insecurity and food environment in determining either healthy eating or obesity. Reducing food insecurity and increasing access to healthy food environments may encourage healthier eating among older adults, while alleviating food-related hardship may also reduce their obesity risk.
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Affiliation(s)
- Yeon Jin Choi
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
| | - Eileen M. Crimmins
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
| | - Jennifer A. Ailshire
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218, Los Angeles, CA, USA
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24
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Masdor NA, Mohammed Nawi A, Hod R, Wong Z, Makpol S, Chin SF. The Link between Food Environment and Colorectal Cancer: A Systematic Review. Nutrients 2022; 14:nu14193954. [PMID: 36235610 PMCID: PMC9573320 DOI: 10.3390/nu14193954] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Food and diet are critical risk factors for colorectal cancer (CRC). Food environments (FEs) can contribute to disease risk, including CRC. This review investigated the link between FEs and CRC incidence and mortality risk. The systematic search of studies utilised three primary journal databases: PubMed, Scopus, and Web of Science. Retrieved citations were screened and the data were extracted from articles related to the FE-exposed populations who were at risk for CRC and death. We evaluated ecological studies and cohort studies with quality assessment and the Newcastle-Ottawa Quality Assessment Form for Cohort Studies, respectively. A descriptive synthesis of the included studies was performed. Out of 89 articles identified, eight were eligible for the final review. The included studies comprised six ecological studies and two cohort studies published from 2013 to 2021. Six articles were from the US, one was from Africa, and one was from Switzerland. All eight studies were of good quality. The significant finding was that CRC incidence was associated with the availability of specific foods such as red meat, meat, animal fats, energy from animal sources, and an unhealthy FE. Increased CRC mortality was linked with the availability of animal fat, red meat, alcoholic beverages, and calorie food availability, residence in food deserts, and lower FE index. There were a variety of associations between CRC and the FE. The availability of specific foods, unhealthy FE, and food desserts impact CRC incidence and mortality. Creating a healthy FE in the future will require focus and thorough planning.
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Affiliation(s)
- Noor Azreen Masdor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Correspondence:
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Zhiqin Wong
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Suzana Makpol
- Department of Biochemistry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Siok-Fong Chin
- UKM Medical Molecular Biology Institute, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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25
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Canakis JP, Swink SM, Valle NP, Rivers DA, Lim KM, Oberlender S, Purcell S, Bartus C. Cutaneous Manifestations of Nutritional Deficiencies in the Context of Food Deserts of United States. Cureus 2022; 14:e29464. [DOI: 10.7759/cureus.29464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
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26
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Massengale KE, Jones MA, Liao J, Park C, Old M. Priority Areas for Child Diaper Access: Low-Income Neighborhoods with Limited Retail Access to the Basic Need of Diapers. Health Equity 2022; 6:767-776. [PMID: 36225666 PMCID: PMC9536341 DOI: 10.1089/heq.2021.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Although a requirement for the health and hygiene of young children, millions of US families with low-incomes have unmet needs for diapers. The present study explored retail options in Durham County, NC for purchasing diapers in low-income neighborhoods in effort to increase our understanding of the overall context of diaper need. Methods: During June 2018, we visited 63 retailers selling 2460 child diaper products in 29 census tracts with a median household income ≤200% of the federal poverty guideline. Corner stores were the only retailers to sell products without original packaging, including one corner store selling loose diapers for $1.49 each. Next, we calculated bus routes to determine accessibility of the retailer with the lowest prices and greatest selection. One-way bus travel from all other census tracts to a big-box store required taking two buses combined with an average of 11 min walking for an average travel time of 43 min. We deemed census tracts as “priority areas for diaper access” when they were characterized as: (1) low income and (2) low access with no retailer selling all of the 10 most common child diaper sizes. Results: Nearly half (n=13) of the census tracts in our sample met our criteria for priority areas. We compared neighborhood characteristics of priority areas with all other county census tracts. Families living in priority areas were statistically significantly more likely to: identify as Black or African American, face challenges affording housing costs, have homes or automobiles in need of repair, experience neighborhood violence, and have less educational attainment.
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Affiliation(s)
| | - Melissa A. Jones
- Department of Informatics and Analytics, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Juncheng Liao
- Department of Statistical Science, Duke University, Durham, North Carolina, USA
| | - Christine Park
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Michelle Old
- Diaper Bank of North Carolina, Durham, North Carolina, USA
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27
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Marquez E, Coughenour C, Gakh M, Tu T, Usufzy P, Gerstenberger S. A Mixed-Methods Assessment of Residential Housing Tenants’ Concerns about Property Habitability and the Implementation of Habitability Laws in Southern Nevada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148537. [PMID: 35886389 PMCID: PMC9317624 DOI: 10.3390/ijerph19148537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022]
Abstract
Housing is a key health determinant. Habitability laws set minimum standards for adequate housing. However, accessing them to ensure adequate housing may be a challenge for many tenants. This paper explores the need for rental housing policy that would better support adequate and safe housing, particularly for low-income renters. A mixed-methods approach assessed residential tenant habitability concerns in Clark County, Nevada, through calls relayed to the Clark County Landlord–Tenant Hotline (CCLTH). Of the 2865 calls, 74.3% were from ZIP codes that were 80% of the median income and below. There was a significant relationship between the ZIP code-level income and the reporting of at least one essential habitability concern. Of the 266 participants that responded to a follow-up call, 34.6% reported that their complaint was resolved and there was no association between resolution and income. Qualitative data analysis from phone interviews revealed two central themes: (1) resources to navigate landlord–tenant laws are limiting and (2) housing policies need to be strengthened to help tenants and keep people housed. Understanding tenant concerns regarding substandard housing and related inequities can help inform rental housing policy and its implementation to promote healthy homes and improve health outcomes for communities burdened by poor rental housing conditions.
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28
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Zwack CC, McDonald R, Tursunalieva A, Lambert GW, Lambert EA. Exploration of diet, physical activity, health knowledge and the cardiometabolic profile of young adults with intellectual disability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:517-532. [PMID: 35137997 PMCID: PMC9303213 DOI: 10.1111/jir.12917] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Young adults with intellectual disability (ID) are experiencing early mortality, and it is suggested that they are living with undiagnosed cardiovascular and metabolic risk factors (hereafter referred to as cardiometabolic). METHODS We investigated the association between modifiable risk factors and cardiometabolic health profile in adults with ID aged 18-45 years through clinical evaluation of traditional cardiometabolic parameters, and assessment of physical activity levels, diet and associated health knowledge. RESULTS We found that young adults with ID have an increased obesity (mean body mass index; ID group: 32.9 ± 8.6 vs. control group: 26.2 ± 5.5, P = 0.001), are engaging in less physical activity than the age-matched general population (total activity minutes per week; ID group: 172.2 ± 148.9 vs. control group: 416.4 ± 277.1, P < 0.001), and overall have unhealthier diets. Additionally, knowledge about nutrition and physical activity appears to be an important predictor of cardiometabolic risk in this population. If young people with ID are to improve their cardiometabolic health to reduce morbidity and early mortality, we need to further explore how to consistently apply health messaging to get lasting behavioural change in this population.
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Affiliation(s)
- C. C. Zwack
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
- School of Health SciencesUniversity of SydneyNew South WalesAustralia
| | - R. McDonald
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
| | - A. Tursunalieva
- Department of Econometrics and Business StatisticsMonash UniversityClaytonVictoriaAustralia
| | - G. W. Lambert
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
| | - E. A. Lambert
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyHawthornVictoriaAustralia
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29
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Strengthening Support for Black Women With Hypertension Through Food Is Medicine Initiatives. J Cardiovasc Nurs 2022; 37:199-201. [DOI: 10.1097/jcn.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Graham J, Scott E, Tinc P, Hirabayashi L. The modern gut-hammer: Understanding the eating habits of loggers through Photovoice. Appetite 2022; 171:105882. [PMID: 34954304 DOI: 10.1016/j.appet.2021.105882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/23/2021] [Accepted: 12/19/2021] [Indexed: 11/19/2022]
Abstract
"Give Us Your Best Shot" is a Photovoice project designed to shed a light on loggers' food choices, attitudes toward and challenges around eating. This research focused on answering the question: What do you typically eat on a workday and where do you get it (breakfast, lunch, dinner, snacks, and drinks)? Consider: What makes it hard to eat healthier? If you feel you eat healthy, how do you do it? Participants were asked to take a photo to answer our research question at least once a week for a six-week period in autumn 2019. Photos and comments were exported from REDCap and imported into NVivo 12, a qualitative analysis software. Two members of the research team analyzed these data. In total, six male Maine loggers, ages 33 to 64, took part in the Photovoice project. Several themes emerged from these data including, but not limited to, the conflict between stated feelings about diet and health and actual consumption habits, the priority of health among many demands, and perceived healthfulness. Data analysis revealed time and family to be significant influential factors affecting loggers' attitudes and ability to eat healthfully. Modern trends toward processed and pre-made food resulting in less home cooking, impacts how and what loggers eat. This project served to show that food choice and diet are modulated by complex outside forces and that improving diet is not a straightforward task. Maine loggers are coping with the same struggles that many workers face, with the added hardship of dealing with extremely long work hours and commutes, leaving little time for anything else. These factors should be taken into consideration when planning any nutrition related interventions with logging workers.
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Affiliation(s)
- Judy Graham
- Northeast Center for Occupational Health and Safety in Agriculture, Forestry, and Fishing, Bassett Medical Center, One Atwell Road, Cooperstown, NY, USA.
| | - Erika Scott
- Northeast Center for Occupational Health and Safety in Agriculture, Forestry, and Fishing, Bassett Medical Center, One Atwell Road, Cooperstown, NY, USA.
| | - Pam Tinc
- Northeast Center for Occupational Health and Safety in Agriculture, Forestry, and Fishing, Bassett Medical Center, One Atwell Road, Cooperstown, NY, USA.
| | - Liane Hirabayashi
- Northeast Center for Occupational Health and Safety in Agriculture, Forestry, and Fishing, Bassett Medical Center, One Atwell Road, Cooperstown, NY, USA.
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31
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Bayne D, Srirangapatanam S, Hicks CR, Armas-Phan M, Showen A, Suskind A, Seligman H, Bibbins-Domingo K, Stoller M, Chi TL. Community Income, Healthy Food Access, and Repeat Surgery for Kidney Stones. Urology 2022; 160:51-59. [PMID: 34813836 PMCID: PMC9851910 DOI: 10.1016/j.urology.2021.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine if limited food access census tracts and food swamp census tracts are associated with increased risk for repeat kidney stone surgery. And to elucidate the relationship between community-level food retail environment relative to community-level income on repeat stone surgery over time. METHODS Data were abstracted from the University of California, San Francisco Information Commons. Adult patients were included if they underwent at least one urologic stone procedure. Census tracts from available geographical data were mapped using Food Access Research Atlas data from the United States Department of Agriculture Economic Research Service. Kaplan-Meier curves were employed to illustrate time to a second surgical procedure over 5 years, and log-rank tests were used to test for statistically significant differences. A multivariate Cox regression model was used to generate hazard ratios for undergoing second surgery by group. RESULTS A total of 1496 patients were included in this analysis. Repeat stone surgery occurred in 324 patients. Kaplan-Meier curves demonstrated a statistically significant difference in curves depicting patients living in low income census tracts (LICTs) vs those not living in LICTs (P <.001). On Cox regression models, patients in LICTs had significantly higher risk of undergoing repeat surgery (P = .011). Patients from limited food access census tracts and food swamp census tracts did not have a significantly higher adjusted risk of undergoing second surgery (P = .11 and P = .88, respectively). CONCLUSION Income more so than food access associates with increased risk of repeat kidney stone surgery. Further research is needed to explore the interaction between low socioeconomic status and kidney stone outcomes.
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Affiliation(s)
- David Bayne
- Urology, University of California San Francisco, San Francisco, CA.
| | | | - Cameron R Hicks
- Urology, University of California San Francisco, San Francisco, CA
| | | | - Amy Showen
- Urology, University of California San Francisco, San Francisco, CA
| | - Anne Suskind
- Urology, University of California San Francisco, San Francisco, CA
| | - Hilary Seligman
- Urology, University of California San Francisco, San Francisco, CA
| | | | - Marshall Stoller
- Urology, University of California San Francisco, San Francisco, CA
| | - Thomas L Chi
- Urology, University of California San Francisco, San Francisco, CA
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Sisson N, Starke J. Promotores de Salud in Montana: An Analysis of a Rural Health Care Intervention Rooted in Catholic Social Teaching and its Place in Medical Curricula. Linacre Q 2022; 89:21-35. [PMID: 35321492 PMCID: PMC8935425 DOI: 10.1177/00243639211059346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Latino population in the United States faces significant health disparities compared to their White counterparts. Community-based processes in Gallatin County, Montana, through academic-community partnerships have identified strategies to overcome these barriers. One such strategy includes the utilization of community health workers (CHWs) in the Latino population-in Spanish, "Promotores de Salud." CHWs are often selected to target community health problems because they share the cultural, social, and demographic features of the population they serve. This paper explores the inherent ties between Catholic Social Teaching and the CHW health care model while focusing on a community-academic partnership in Montana that is implementing a CHW program. Catholic health care providers are called to apply CST principles to their health care systems and communities in order to achieve health equity for their patients. This paper proposes that community organizing and advocacy should be taught in medical school curricula across the country in order to promote physician involvement in solving public health disparities. Additionally, the authors suggest that practicing Catholic health care providers immediately incorporate community organizing through the use of CHWs to attain health equity for their patient panels.
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Affiliation(s)
- Nathaniel Sisson
- School of Medicine, University of Washington, Seattle, WA, USA,Nathaniel Sisson, School of Medicine, University of Washington, 1959 NE Pacific St, A-300 Health Sciences Center, Box 356340, Seattle, WA 98195-0005, USA.
| | - Jenna Starke
- School of Medicine, University of Washington, Seattle, WA, USA
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Javed Z, Valero-Elizondo J, Maqsood MH, Mahajan S, Taha MB, Patel KV, Sharma G, Hagan K, Blaha MJ, Blankstein R, Mossialos E, Virani SS, Cainzos-Achirica M, Nasir K. Social determinants of health and obesity: Findings from a national study of US adults. Obesity (Silver Spring) 2022; 30:491-502. [PMID: 35088551 DOI: 10.1002/oby.23336] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/06/2021] [Accepted: 10/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined the association between social determinants of health (SDOH) burden and overweight/obesity in a nationally representative sample of adults in the United States. METHODS Data for 161,795 adults aged ≥18 years from the 2013 to 2017 National Health Interview Survey were used. A total of 38 SDOH were aggregated to create a cumulative SDOH score, which was divided into quartiles (Q1-Q4) to denote levels of SDOH burden. Prevalence of overweight and obesity was examined across SDOH quartiles in the total population and by age, sex, and race/ethnicity. Multinomial logistic regression models were used to analyze the association between SDOH quartiles and overweight/obesity, adjusting for relevant covariates. RESULTS There was a graded increase in obesity prevalence with increasing SDOH burden. At nearly each quartile, overweight and obesity rates were higher for middle-aged and non-Hispanic Black adults compared with their counterparts; additional differences were observed by sex. In fully adjusted models, SDOH-Q4 was associated with 15%, 50%, and 70% higher relative prevalence of overweight, obesity class 1 and 2, and obesity class 3, respectively, relative to SDOH-Q1. CONCLUSIONS Cumulative social disadvantage, denoted by higher SDOH burden, was associated with increased odds of obesity, independent of clinical and demographic factors.
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Affiliation(s)
- Zulqarnain Javed
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Javier Valero-Elizondo
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | | | - Shiwani Mahajan
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
| | - Garima Sharma
- Division of Cardiology, Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University School of Medicine, The John Hopkins University, Baltimore, Maryland, USA
| | - Kobina Hagan
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Michael J Blaha
- Division of Cardiology, Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University School of Medicine, The John Hopkins University, Baltimore, Maryland, USA
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics, London, UK
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
- Section of Cardiology, Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Miguel Cainzos-Achirica
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Khurram Nasir
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
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Determinants of rating of the seriousness of health issues facing Americans. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-020-01238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kronenfeld JP, Goel N. An Analysis of Individual and Contextual-Level Disparities in Screening, Treatment, and Outcomes for Hepatocellular Carcinoma. J Hepatocell Carcinoma 2021; 8:1209-1219. [PMID: 34611524 PMCID: PMC8487287 DOI: 10.2147/jhc.s284430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and affects patients of all genders, races, ethnicities, and socioeconomic status. While the causes of HCC are numerous, the primary etiology is cirrhosis from alcohol and non-alcoholic fatty liver disease in the United States and from infectious agents such as Hepatitis B and Hepatitis C in the developing world. In patients at-risk for developing HCC, screening is recommended with ultrasound imaging and alpha fetoprotein laboratory tests. In socioeconomically vulnerable patients, however, individual-level barriers (eg, insurance status) and contextual-level disparities (eg, health facilities) may not be readily available, thus limiting screening. Additional challenges faced by racial/ethnic minorities can further challenge the spectrum of HCC care and lead to inadequate screening, delayed diagnosis, and unequal access to treatment. Efforts to improve these multilevel factors that lead to screening and treatment disparities are critical to overcoming challenges. Providing health insurance to those without access, improving societal challenges that confine patients to a lower socioeconomic status, and reducing challenges to seeking healthcare can decrease the morbidity and mortality of these patients. Additionally, engaging with communities and allowing them to collaborate in their own healthcare can also help to attenuate these inequities. Through collaborative multidisciplinary change, we can make progress in tackling disparities in vulnerable populations to achieve health equity
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Affiliation(s)
- Joshua P Kronenfeld
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Lovasi GS, Johnson NJ, Altekruse SF, Hirsch JA, Moore KA, Brown JR, Rundle AG, Quinn JW, Neckerman K, Siscovick DS. Healthy food retail availability and cardiovascular mortality in the United States: a cohort study. BMJ Open 2021; 11:e048390. [PMID: 34244272 PMCID: PMC8273445 DOI: 10.1136/bmjopen-2020-048390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/26/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We investigated the association of healthy food retail presence and cardiovascular mortality, controlling for sociodemographic characteristics. This association could inform efforts to preserve or increase local supermarkets or produce market availability. DESIGN Cohort study, combining Mortality Disparities in American Communities (individual-level data from 2008 American Community Survey linked to National Death Index records from 2008 to 2015) and retail establishment data. SETTING Across the continental US area-based sociodemographic and retail characteristics were linked to residential location by ZIP code tabulation area (ZCTA). Sensitivity analyses used census tracts instead, restricted to urbanicity or county-based strata, or accounted for non-independence using frailty models. PARTICIPANTS 2 753 000 individuals age 25+ living in households with full kitchen facilities, excluding group quarters. PRIMARY AND SECONDARY OUTCOME MEASURES Cardiovascular mortality (primary) and all-cause mortality (secondary). RESULTS 82% had healthy food retail (supermarket, produce market) within their ZCTA. Density of such retail was correlated with density of unhealthy food sources (eg, fast food, convenience store). Healthy food retail presence was not associated with reduced cardiovascular (HR: 1.03; 95% CI 1.00 to 1.07) or all-cause mortality (HR: 1.05; 95% CI 1.04 to 1.06) in fully adjusted models (with adjustment for gender, age, marital status, nativity, Black race, Hispanic ethnicity, educational attainment, income, median household income, population density, walkable destination density). The null finding for cardiovascular mortality was consistent across adjustment strategies including minimally adjusted models (individual demographics only), sensitivity analyses related to setting, and across gender or household type strata. However, unhealthy food retail presence was associated with elevated all-cause mortality (HR: 1.15; 95% CI 1.11 to 1.20). CONCLUSIONS In this study using food establishment locations within administrative areas across the USA, the hypothesised association of healthy food retail availability with reduced cardiovascular mortality was not supported; an association of unhealthy food retail presence with higher mortality was not specific to cardiovascular causes.
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Affiliation(s)
- Gina S Lovasi
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Norman J Johnson
- Center for Administrative Records and Research Applications, Census Bureau, Washington, District of Columbia, USA
| | - Sean F Altekruse
- National Heart Lung and Blood institute, Division of Cardiovascular Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Jana A Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Kari A Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Janene R Brown
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Andrew G Rundle
- Built Environment and Health Research Group, Columbia University, New York, New York, USA
| | - James W Quinn
- Built Environment and Health Research Group, Columbia University, New York, New York, USA
| | - Kathryn Neckerman
- Built Environment and Health Research Group, Columbia University, New York, New York, USA
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Cohen S, Yan F, Taylor H, Sims M, Li C, Quyyumi AA, Mubasher M, Lewis TT, Baltrus P. Food Access and Cardiovascular Outcomes in Metropolitan Atlanta Census Tracts With Residents at Low Risk and High Risk of Cardiovascular Disease: The Morehouse-Emory Cardiovascular Center for Health Equity Study. Prev Chronic Dis 2021; 18:E42. [PMID: 33964124 PMCID: PMC8139486 DOI: 10.5888/pcd18.200316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Perceived and actual access to healthy foods may differ in urban areas, particularly among Black people. We assessed the effect of objective and perceived neighborhood food access on self-reported cardiovascular disease (CVD) among Black people living in areas of high risk and low risk for the disease in Atlanta, Georgia. We hypothesized that perceived and objective food access would independently predict self-reported CVD. Methods We used survey data from the Morehouse–Emory Cardiovascular (MECA) Center for Health Equity Study. Study participants consisted of 1,402 Black adults, aged 35 to 64, residing in urban Atlanta census tracts with high rates or low rates of CVD. We assessed perceived neighborhood healthy food access by self-reported selection and quality of produce and low-fat food options. We assessed objective food access by the 2015 US Department of Agriculture Food Access Research Atlas. Low access was defined as census tracts with at least 500 people living more than 1 mile from a large food retailer. Self-reported CVD included related conditions and/or procedures. We used multilevel logistic models adjusted for demographic characteristics to examine the association between objective and perceived food access and self-reported CVD. Results Overall, self-reported CVD was not significant for perceived (odds ratio = 0.87; 95% CI, 0.59–1.29) or objective (odds ratio = 0.74; 95% CI, 0.48–1.12) healthy food access. Similar results were obtained among adults living in areas with higher-than-expected rates of CVD. Conclusion Results of this study suggest the odds for self-reported CVD events were not significantly affected by perceived or objective access to healthy foods.
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Affiliation(s)
- Shakeria Cohen
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia.,Cardiovascular Research Institute, Morehouse School of Medicine, 720 Westview Dr, SW, Atlanta, GA 30310.
| | - Fengxia Yan
- Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Herman Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Chaohua Li
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamed Mubasher
- Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Tené T Lewis
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Peter Baltrus
- Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
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Dolin CD, Compher CC, Oh JK, Durnwald CP. Pregnant and hungry: addressing food insecurity in pregnant women during the COVID-19 pandemic in the United States. Am J Obstet Gynecol MFM 2021; 3:100378. [PMID: 33932628 DOI: 10.1016/j.ajogmf.2021.100378] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
Food insecurity is a major social determinant of health affecting more than 10% of Americans. Social determinants of health are increasingly recognized as a driving force of health inequities. It is well established that food insecurity leads to adverse health outcomes outside of pregnancy, such as obesity, hypertension, diabetes mellitus, and mental health problems. However, limited data exist about the impact of food insecurity during pregnancy on maternal and neonatal outcomes. Food insecurity and other social determinants of health are rarely addressed as part of routine obstetrical care. The COVID-19 pandemic has only exacerbated the crisis of food insecurity across the country, disproportionally affecting women and racial and ethnic minorities. Women's health providers should implement universal screening for maternal food insecurity and offer resources to women struggling to feed themselves and their families. Reducing maternal health inequities in the United States involves recognizing and addressing food insecurity, along with other social determinants of health, and advocating for public policies that support and protect all women's right to healthy food during pregnancy.
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Affiliation(s)
- Cara D Dolin
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Dolin, Oh, and Durnwald).
| | - Charlene C Compher
- Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA (Dr Compher)
| | - Jinhee K Oh
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Dolin, Oh, and Durnwald)
| | - Celeste P Durnwald
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs Dolin, Oh, and Durnwald)
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Moughames E, Woo H, Galiatsatos P, Romero-Rivero K, Raju S, Tejwani V, Hoffman EA, Comellas AP, Ortega VE, Parekh T, Krishnan JA, Drummond MB, Couper D, Buhr RG, Paine R, Kaufman JD, Paulin LM, Putcha N, Hansel NN. Disparities in access to food and chronic obstructive pulmonary disease (COPD)-related outcomes: a cross-sectional analysis. BMC Pulm Med 2021; 21:139. [PMID: 33906617 PMCID: PMC8077917 DOI: 10.1186/s12890-021-01485-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Millions of Americans are living in food deserts in the United States, however the role of the local food environment on COPD has not been studied. The aim of this study is to determine the association between food deserts and COPD-related outcomes. METHOD In this cross-sectional analysis we linked data collected from SPIROMICS (SubPopulations and InteRmediate Outcome Measures in COPD Study) between 2010 and 2015 and food desert data, defined as an underserved area that lacks access to affordable healthy foods, from the Food Access Research Atlas. COPD outcomes include percentage of predicted forced expiratory volume in one second (FEV1%), St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), 6-min walk distance test (6MWD), exacerbations, and air trapping. We used generalized linear mixed models to evaluate the association between living in food deserts and respiratory outcomes, adjusting for age, gender, race, education, income, marital status, BMI, smoking status, pack years, and urban status RESULTS: Among 2713 participants, 22% lived in food deserts. Participants living in food deserts were less likely to be white and more likely to have a lower income than those who did not live in food deserts. In the adjusted model controlling for demographics and individual income, living in food deserts was associated lower FEV1% (β = - 2.51, P = 0.046), higher air trapping (β = 2.47, P = 0.008), worse SGRQ (β = 3.48, P = 0.001) and CAT (β = 1.20, P = 0.003) scores, and 56% greater odds of severe exacerbations (P = 0.004). Results were consistent when looking at food access alone, regardless of whether participants lived in low income areas. CONCLUSIONS Findings suggest an independent association between food desert and food access alone with COPD outcomes. Health program planning may benefit from addressing disparities in access to food.
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Affiliation(s)
- Eric Moughames
- Department of Medicine, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Han Woo
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Karina Romero-Rivero
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Sarath Raju
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Vickram Tejwani
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Eric A Hoffman
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Victor E Ortega
- Department of Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Trisha Parekh
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Jerry A Krishnan
- Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Michael B Drummond
- Department of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - David Couper
- Department of Biostatistics, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Russell G Buhr
- Department of Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | - Robert Paine
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Joel D Kaufman
- Department of Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | - Laura M Paulin
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care, Johns Hopkins University, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
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Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021; 26:443-452. [PMID: 33594785 DOI: 10.1002/onco.13729] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
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Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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Fong AJ, Lafaro K, Ituarte PHG, Fong Y. Association of Living in Urban Food Deserts with Mortality from Breast and Colorectal Cancer. Ann Surg Oncol 2021; 28:1311-1319. [PMID: 32844294 PMCID: PMC8046424 DOI: 10.1245/s10434-020-09049-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Food deserts are neighborhoods with low access to healthy foods and are associated with poor health metrics. We investigated association of food desert residence and cancer outcomes. METHODS In this population-based study, data from the 2000-2012 California Cancer Registry was used to identify patients with stage II/III breast or colorectal cancer. Patient residence at time of diagnosis was linked by census tract to food desert using the USDA Food Access Research Atlas. Treatment and outcomes were compared by food desert residential status. RESULTS Among 64,987 female breast cancer patients identified, 66.8% were < 65 years old, and 5.7% resided in food deserts. Five-year survival for food desert residents was 78% compared with 80% for non-desert residents (p < 0.0001). Among 48,666 colorectal cancer patients identified, 50.4% were female, 39% were > 65 years old, and 6.4% resided in food deserts. Five-year survival for food desert residents was 60% compared with 64% for non-desert residents (p < 0.001). Living in food deserts was significantly associated with diabetes, tobacco use, poor insurance coverage, and low socioeconomic status (p < 0.05) for both cancers. There was no significant difference in rates of surgery or chemotherapy by food desert residential status for either diagnosis. Multivariable analyses showed that food desert residence was associated with higher mortality. CONCLUSION Survival, despite treatment for stage II/III breast and colorectal cancers was worse for those living in food deserts. This association remained significant without differences in use of surgery or chemotherapy, suggesting factors other than differential care access may link food desert residence and cancer outcomes.
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Affiliation(s)
- Abigail J Fong
- Department of Surgery, Cedar-Sinai Hospital, Los Angeles, CA, USA
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Kelly Lafaro
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Philip H G Ituarte
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
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Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021. [PMID: 33594785 DOI: 10.1002/onco.13729.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
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Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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Schnell PM, Papadogeorgou G. Mitigating unobserved spatial confounding when estimating the effect of supermarket access on cardiovascular disease deaths. Ann Appl Stat 2020. [DOI: 10.1214/20-aoas1377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
OBJECTIVE To evaluate whether women living in areas deemed food deserts had higher rates of pregnancy morbidity, specifically preeclampsia, gestational hypertension, gestational diabetes, prelabor rupture of membranes, preterm labor, than women who did not live in food deserts at the time of their pregnancy and delivery. METHODS This was a retrospective observational study in which we reviewed electronic medical records of all patients who delivered at Loyola University Medical Center in Maywood, Illinois in 2014. The Economic Research Service of the U.S. Department of Agriculture publishes the Food Access Research Atlas, which presents a spatial overview of food access indicators for low-income and other Census tracts using different measures of supermarket accessibility. A spatial join between the Food Access Research Atlas and patient coordinates was performed to identify patient point locations and determine whether each patient was located within or outside of a food desert. RESULTS Data for 1,003 deliveries at Loyola University Medical Center in 2014 were provided by the Loyola University Chicago Clinical Research Database. Two deliveries were excluded owing to inability to map address coordinates; thus 1,001 deliveries were analyzed. Of the 1,001 patients, 195 (19.5%) women were designated to food deserts. Multivariable analysis was done by adjusting for age, race, and medical insurance class. Having at least one morbid condition was the only variable that demonstrated a significant association with the food desert in multivariable analyses (47.2% vs 35.6%) (odds ratio [OR] 1.62, 95% CI 1.18-2.22) (adjusted OR 1.64, 95% CI 1.18-2.29). CONCLUSION The odds of having at least one of the studied morbid conditions in pregnancy were greater for patients living in a food desert. As there is an association of morbidity in pregnancy with living in a food desert, intervention trials to improve the built food environment or mitigate the effect otherwise are needed.
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Fong AJ, Lafaro K, Fong Y. ASO Author Reflections: Access to Healthcare Does Not Mean Access to Health: Food Deserts in the Land of Plenty. Ann Surg Oncol 2020; 28:2508-2509. [PMID: 32910279 DOI: 10.1245/s10434-020-09059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Abigail J Fong
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Kelly Lafaro
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA, USA.
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Abstract
OBJECTIVE This study assesses the association between living in a food desert and cardiovascular health risk among young adults in the USA, as well as evaluates whether personal and area socioeconomic status moderates this relationship. DESIGN A cross-sectional analysis was performed using data from Wave I (1993-1994) and Wave IV (2008) from the National Longitudinal Study of Adolescent to Adult Health. Ordinary least squares regression models assessing the association between living in a food desert and cardiovascular health were performed. Mediation and moderation analyses assessed the degree to which this association was conditioned by area and personal socioeconomic status. SETTING Sample of respondents living in urban census tracts in the USA in 2008. PARTICIPANTS Young adults (n 8896) aged 24-34 years. RESULTS Net of covariates living in a food desert had a statistically significant association with cardiovascular health risk (range 0-14) (β = 0·048, P < 0·01). This association was partially mediated by area and personal socioeconomic status. Further analyses demonstrate that the adverse association between living in a food desert and cardiovascular health is concentrated among low socioeconomic status respondents. CONCLUSIONS The findings from this study suggest a complex interplay between food deserts and economic conditions for the cardiovascular health of young adults. Developing interventions that aim to improve health behaviour among lower-income populations may yield benefits for preventing the development of cardiovascular health problems.
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Smith EJT, Ramirez JL, Wu B, Zarkowsky DS, Gasper WJ, Finlayson E, Conte MS, Iannuzzi JC. Living in a Food Desert is Associated with 30-day Readmission after Revascularization for Chronic Limb-Threatening Ischemia. Ann Vasc Surg 2020; 70:36-42. [PMID: 32628994 DOI: 10.1016/j.avsg.2020.06.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Living in a food desert has been associated with increased cardiovascular risk; however, its impact on vascular surgery outcomes is unknown. This study hypothesized that living in a food desert would be associated with increased postoperative complications in patients undergoing revascularization for chronic limb-threatening ischemia (CLTI). METHODS This was a single-center retrospective analysis of open and endovascular infrainguinal revascularization for CLTI between April 2013 and December 2015. A food desert was defined using the US Department of Agriculture's Food Access Research Atlas. Bivariate analyses were performed appropriate to the data. Binary logistic regression was performed assessing the association of food desert status with 30-day postoperative complications. RESULTS In total, 152 cases were included, of which 17% (n = 26) resided in food deserts. Patients in the food desert cohort were less likely to be low income (27% vs. 54%, P = 0.01). Living in a food desert was associated with increased 30-day readmission [(39% vs. 20%, P = 0.04), unadjusted OR: 2.5 (CI: 1.0-6.2)]. FD cases also had a higher proportion of wound complications [12 (46%) vs. 28 (22%), P = 0.01)]. The overall wound complication rate was 27% with the majority being due to infections (63%). On multivariable analysis, food desert status remained associated with increased odds of 30-day readmission (OR: 2.7, CI: 1.2-8.4, P = 0.047). Reasons for readmission in the food desert group were all due to wound complications (100% vs. 72%, P = 0.08). CONCLUSIONS Living in a food desert was associated with nearly three times the odds of 30-day readmission after lower extremity revascularization for CLTI. This increase in readmission may be explained through increased wound complications. These findings support considering access to healthy food as a potential modifiable risk factor for adverse outcomes, particularly in CLTI revascularization.
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Affiliation(s)
- Eric J T Smith
- Department of Surgery, University of California, San Francisco, CA
| | - Joel L Ramirez
- Department of Surgery, University of California, San Francisco, CA
| | - Bian Wu
- Department of Surgery, University of California, San Francisco, CA
| | | | - Warren J Gasper
- Department of Surgery, University of California, San Francisco, CA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, CA
| | - Michael S Conte
- Department of Surgery, University of California, San Francisco, CA
| | - James C Iannuzzi
- Department of Surgery, University of California, San Francisco, CA.
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McDoom MM, Cooper LA, Hsu YJ, Singh A, Perin J, Thornton RLJ. Neighborhood Environment Characteristics and Control of Hypertension and Diabetes in a Primary Care Patient Sample. J Gen Intern Med 2020; 35:1189-1198. [PMID: 32043258 PMCID: PMC7174485 DOI: 10.1007/s11606-020-05671-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 01/13/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Hypertension control and diabetes control are important for reducing cardiovascular disease burden. A growing body of research suggests an association between neighborhood environment and hypertension or diabetes control among patients engaged in clinical care. OBJECTIVE To investigate whether neighborhood conditions (i.e., healthy food availability, socioeconomic status (SES), and crime) were associated with hypertension and diabetes control. DESIGN Cross-sectional analyses using electronic medical record (EMR) data, U.S. Census data, and secondary data characterizing neighborhood food environments. Multivariate logistic regression analyses adjusted for potential confounders. Analyses were conducted in 2017. PARTICIPANTS Five thousand nine hundred seventy adults receiving primary care at three Baltimore City clinics in 2010-2011. MAIN MEASURES Census tract-level neighborhood healthy food availability, neighborhood SES, and neighborhood crime. Hypertension control defined as systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. Diabetes control defined as HgbA1c < 7. KEY RESULTS Among patients with hypertension, neighborhood conditions were not associated with lower odds of blood pressure control after accounting for patient and physician characteristics. However, among patients with diabetes, in fully adjusted models accounting for patient and physician characteristics, we found that patients residing in neighborhoods with low and moderate SES had reduced odds of diabetes control (OR = 0.74 (95% CI = 0.57-0.97) and OR = 0.75 (95% CI = 0.57-0.98), respectively) compared to those living in high-SES neighborhoods. CONCLUSIONS Neighborhood disadvantage may contribute to poor diabetes control among patients in clinical care. Community-based chronic disease care management strategies to improve diabetes control may be optimally effective if they also address neighborhood SES among patients engaged in care.
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Affiliation(s)
- M Maya McDoom
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Lisa A Cooper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA.,Johns Hopkins School of Nursing, Baltimore, MD, USA.,Johns Hopkins Center for Health Equity, 5200 Eastern Avenue, Suite 4200, Baltimore, MD, 21224, USA
| | - Yea-Jen Hsu
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Abhay Singh
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jamie Perin
- Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
| | - Rachel L J Thornton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Johns Hopkins Center for Health Equity, 5200 Eastern Avenue, Suite 4200, Baltimore, MD, 21224, USA.
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Kelli HM, Kim JH, Samman Tahhan A, Liu C, Ko YA, Hammadah M, Sullivan S, Sandesara P, Alkhoder AA, Choudhary FK, Gafeer MM, Patel K, Qadir S, Lewis TT, Vaccarino V, Sperling LS, Quyyumi AA. Living in Food Deserts and Adverse Cardiovascular Outcomes in Patients With Cardiovascular Disease. J Am Heart Assoc 2020; 8:e010694. [PMID: 30741595 PMCID: PMC6405658 DOI: 10.1161/jaha.118.010694] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Food deserts (FDs), defined as low‐income communities with limited access to healthy food, are a growing public health concern. We evaluated the impact of living in FDs on incident cardiovascular events. Methods and Results We recruited 4944 subjects (age 64±12, 64% male) undergoing cardiac catheterization into the Emory Cardiovascular Biobank. Using the US Department of Agriculture definition of FD, we determined whether their residential addresses had (1) poor access to healthy food, (2) low income, or (3) both (=FD). Subjects were prospectively followed for a median of 3.2 years for myocardial infarction (MI) and death. Fine and Gray's subdistribution hazard models for MI and Cox proportional hazard models for death/MI were used to examine the association between area characteristics (FD, poor access, and low income) and the rates of adverse events after adjusting for traditional risk factors. A total of 981 (20%) lived in FDs and had a higher adjusted risk of MI (subdistribution hazard ratio, 1.44 [95% CI, 1.06–1.95]) than those living in non‐FDs. In a multivariate analysis including both food access and area income, only living in a low‐income area was associated with a higher adjusted risk of MI (subdistribution hazard ratio, 1.40 [1.06–1.85]) and death/MI (hazard ratio, 1.18 [1.02–1.35]) while living in a poor‐access area was not significantly associated with either (subdistribution hazard ratio, 1.05 [0.80–1.38] and hazard ratio, 0.99 [0.87–1.14], respectively). Conclusions Living in an FD is associated with a higher risk of adverse cardiovascular events in those with coronary artery disease. Specifically, low area income of FDs, not poor access to food, was significantly associated with worse outcomes.
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Affiliation(s)
- Heval M Kelli
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jeong Hwan Kim
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Ayman Samman Tahhan
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Chang Liu
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Yi-An Ko
- 2 Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Muhammad Hammadah
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Samaah Sullivan
- 3 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Pratik Sandesara
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Ayman A Alkhoder
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Fahad K Choudhary
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - M Mazen Gafeer
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Keyur Patel
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Saqib Qadir
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Tené T Lewis
- 3 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Viola Vaccarino
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,3 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Laurence S Sperling
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Arshed A Quyyumi
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
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Knowledge Visualizations to Inform Decision Making for Improving Food Accessibility and Reducing Obesity Rates in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041263. [PMID: 32079089 PMCID: PMC7068274 DOI: 10.3390/ijerph17041263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/26/2020] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
The aim of this article is to promote the use of knowledge visualization frameworks in the creation and transfer of complex public health knowledge. The accessibility to healthy food items is an example of complex public health knowledge. The United States Department of Agriculture Food Access Research Atlas (FARA) dataset contains 147 variables for 72,864 census tracts and includes 16 food accessibility variables with binary values (0 or 1). Using four-digit and 16-digit binary patterns, we have developed data analytical procedures to group the 72,684 U.S. census tracts into eight and forty groups respectively. This value-added FARA dataset facilitated the design and production of interactive knowledge visualizations that have a collective purpose of knowledge transfer and specific functions including new insights on food accessibility and obesity rates in the United States. The knowledge visualizations of the binary patterns could serve as an integrated explanation and prediction system to help answer why and what-if questions on food accessibility, nutritional inequality and nutrition therapy for diabetic care at varying geographic units. In conclusion, the approach of knowledge visualizations could inform coordinated multi-level decision making for improving food accessibility and reducing chronic diseases in locations defined by patterns of food access measures.
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