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Agurs-Collins T, Alvidrez J, ElShourbagy Ferreira S, Evans M, Gibbs K, Kowtha B, Pratt C, Reedy J, Shams-White M, Brown AG. Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity. Adv Nutr 2024; 15:100194. [PMID: 38616067 PMCID: PMC11031378 DOI: 10.1016/j.advnut.2024.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 04/16/2024] Open
Abstract
Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.
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Affiliation(s)
- Tanya Agurs-Collins
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States.
| | | | - Sanae ElShourbagy Ferreira
- National Center for Advancing Translational Sciences, Division of Clinical Innovation, Bethesda, MD, United States
| | - Mary Evans
- National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD, United States
| | - Kimberlea Gibbs
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Extramural Research, Pediatric Growth and Nutrition Branch, Bethesda, MD, United States
| | | | - Charlotte Pratt
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
| | - Jill Reedy
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Marissa Shams-White
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD, United States
| | - Alison Gm Brown
- National Heart, Lung, and Blood Institute, Division of Cardiovascular Sciences, Bethesda, MD, United States
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Ko H, Cho B, Lim KC, Jang SN, Chang SJ, Yi YM, Cho HR, Ryu SI, Noh EY, Park YH. Changes in the health status and health-related quality of life of community-dwelling older adults living alone: one-year follow-up from a cohort study. Front Public Health 2023; 11:1278008. [PMID: 38192567 PMCID: PMC10772141 DOI: 10.3389/fpubh.2023.1278008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
Background The percentage of older adults living alone is rapidly increasing, improving the health status and health-related quality of life (HRQoL) in this group is becoming a more significant public health issue. This study aimed to examine the changes in the HRQoL of older South Korean adults living alone and identify the factors that affect their HRQoL. Methods A longitudinal study design was followed. Data were collected at baseline and 1-year follow-up. Participants consisting of 789 older adults living alone in S*City aged>65 years completed a cohort survey regarding health status and HRQoL from August 2018 to August 2019. Trained interviewers conducted face-to-face interviews with the participants using a validated questionnaire (physical health, mental health, social health, and HRQoL). Generalized estimating equations were used to assess the change in health status and the interaction effect of time and gender. Then, a stepwise multiple logistic regression analysis was performed to identify factors related to HRQoL. Results Time differences were observed in the subjective evaluation of health status (SEH), IPAQ scores, frailty, nutritional status, and depression. Gender differences were observed in the SEH, IPAQ, frailty, loneliness, depression, and social support. The interaction between time and gender was observed in the IPAQ and HRQoL. At baseline, SEH, depressive symptoms, gender, frailty, and age were associated with HRQoL. After one year, HRQoL was associated with SEH, frailty, depressive symptoms, cost of living, suicidal thoughts, gender, social support, loneliness, and suicide attempts. Conclusion Our results highlight that HRQoL is associated with physical health, mental health, and social support. Future detailed studies are needed to determine whether governments and communities can prevent depression, loneliness, and suicidal thoughts through psychological support and provide economic support to improve the quality of life of older adults living alone.
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Affiliation(s)
- Hana Ko
- College of Nursing, Gachon University, Incheon, Republic of Korea
| | - Belong Cho
- Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Kyung-Choon Lim
- College of Nursing, Sungshin University, Seoul, Republic of Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Sun Ju Chang
- College of Nursing, Seoul National University, Seoul, Republic of Korea
- Institute of Nursing Science College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Yu Mi Yi
- College of Nursing, Kyungnam College of Information and Technology, Busan, Republic of Korea
| | - Hye Ryung Cho
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - So Im Ryu
- Department of Nursing, Changwon National University, Changwon-si, Republic of Korea
| | - Eun-Young Noh
- Department of Nursing, Konkuk University, Chungju, Republic of Korea
| | - Yeon-Hwan Park
- College of Nursing, Seoul National University, Seoul, Republic of Korea
- Institute of Nursing Science College of Nursing, Seoul National University, Seoul, Republic of Korea
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Wang X, Wu Y, Miao J, Pu K, Ming WK, Zang S. Factors associated with eating behaviors in older adults from a socioecological model perspective. BMC Public Health 2023; 23:1726. [PMID: 37670266 PMCID: PMC10481492 DOI: 10.1186/s12889-023-16651-2] [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] [Received: 01/31/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The eating behaviors of older adults are associated with multiple factors. To promote older adults' healthy diets, it is imperative to comprehensively study the factors associated with the eating behaviors of the aging population group. This study aimed to probe the associated factors of older adults' eating behaviors from a socioecological model (SEM) perspective. METHODS In 2021, a cross-sectional survey was performed to recruit participants in China. The survey data were analyzed using a multivariate generalized linear model to identify the factors associated with eating behaviors in older adults. Standardized regression coefficients (β) and 95% confidence intervals (CIs) were estimated using a multivariate generalized linear model. RESULTS The survey contained 1147 valid older adult participants. Multivariate generalized linear model results showed that older adults with older age [aged 71-80 (β = -0.61), ≥ 81 (β = -1.12)], conscientiousness personality trait (β = -0.27), and higher family health levels (β = -0.23) were inclined to have better eating behaviors. The older adults with higher education levels [junior high school and high school (β = 1.03), junior college and above (β = 1.71)], higher general self-efficacy (β = 0.09), more severe depression symptoms (β = 0.24), and employment (β = 0.82) tended to have poorer eating behaviors. CONCLUSIONS This study identified factors that are specifically associated with older adults' eating behaviors from an SEM perspective. The comprehensive multiple-angle perspective consideration may be a valuable idea for studying healthy eating behaviors in older adults.
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Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, China
| | - Yibo Wu
- School of Public Health, Peking University, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Juanxia Miao
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, China
| | - Keping Pu
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, No.31 To Yuen Street, Hong Kong, 999077, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, China.
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Ma W, Wu B, Yu Y, Zhong R. Longitudinal associations between social relationships and cognitive function among Chinese older adults: The mediating role of healthy lifestyles. Geriatr Nurs 2023; 53:102-108. [PMID: 37478806 DOI: 10.1016/j.gerinurse.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND We aimed to explore whether social relationships and cognitive function were reciprocally related and whether healthy lifestyles mediate their association. METHODS This study included 3372 Chinese adults from the years 2014-2018 wave of the Chinese Longitudinal Healthy Longevity Survey. RESULTS Baseline social relationships were negatively associated with a change in cognitive function (β = -0.030, p = 0.043). Participants with a 1 standard deviation (SD) increase in social relationships had an approximately 6% reduced risk of developing cognitive impairment. However, baseline cognitive function did not independently predict social relationships. The association between △social relationships and △cognitive function was partially mediated by △a healthy lifestyle (B = 0.025, 95% CI = 0.013-0.041). CONCLUSIONS The association between social relationships and cognitive function may be unidirectional. Policies that promote cognitive function based on social relationships would benefit by taking into account lifestyle factors.
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Affiliation(s)
- Weibo Ma
- School of Public Administration, Faculty of Economics and Management, East China Normal University, Shanghai, China
| | - Bei Wu
- NYU Aging Incubator and Hartford Institute for Geriatric Nursing, New York, USA
| | - Ying Yu
- Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Renyao Zhong
- School of Public Administration, Faculty of Economics and Management, East China Normal University, Shanghai, China.
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Mills CM, Keller HH, DePaul VG, Donnelly C. Nutrition risk varies according to social network type: data from the Canadian Longitudinal Study on Aging. Fam Med Community Health 2023; 11:fmch-2022-002112. [PMID: 36813466 PMCID: PMC9950914 DOI: 10.1136/fmch-2022-002112] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk. DESIGN A retrospective cross-sectional study. SETTING Data from the Canadian Longitudinal Study on Aging (CLSA). PARTICIPANTS 17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA. RESULTS CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk. CONCLUSIONS Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk.
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Affiliation(s)
| | - Heather H Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada,Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Vincent Gerard DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada,Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada,Health Services and Policy Research Institute, Queen's University, Kingston, Ontario, Canada
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Chumpunuch P, Jaraeprapal U. The social determinants of health influencing obesity for the aged in the Pakpoon community context: A qualitative study. Int J Nurs Sci 2022; 9:211-221. [PMID: 35509696 PMCID: PMC9052257 DOI: 10.1016/j.ijnss.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 10/26/2022] Open
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Hwang G, Cho YH, Kim EJ, Woang JW, Hong CH, Roh HW, Son SJ. Differential Effects of Sleep Disturbance and Malnutrition on Late-Life Depression Among Community-Dwelling Older Adults. Front Psychiatry 2022; 13:820427. [PMID: 35599763 PMCID: PMC9122027 DOI: 10.3389/fpsyt.2022.820427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Late-life depression is a complex phenomenon that cannot be fully understood simply as depression occurring in older adults, prompting researchers to suggest that it represents a component of geriatric syndrome. Given the inherent complexity and multifactorial nature of geriatric syndrome, understanding the interactions between the comorbid conditions involved is important for establishing appropriate preventive strategies. While sleep disturbance and malnutrition are common manifestations of geriatric syndrome, they have also been regarded as indicators of late-life depression. However, the differential effects of sleep disturbance and malnutrition on late-life depression and their interrelationships remain unclear. OBJECTIVE The objective of this study was to examine the effects of sleep disturbance and malnutrition on depression and the interactions between them among community-dwelling older adults. METHODS Sleep disturbance and malnutrition in 1,029 community-dwelling older adults from Suwon Geriatric Mental Health Center were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Mini Nutritional Assessment (MNA), respectively. The Korean version of the Short Form of the Geriatric Depression Scale (SGDS-K) was used to evaluate depressive symptoms. Sociodemographic parameters were recorded. A multiple linear regression analysis was conducted to examine the effects of sleep and nutrition on depressive symptoms after adjusting for covariates. The effect size and conditional effects of sleep disturbance and malnutrition on late-life depression were assessed using Cohen's f2 values and the Johnson-Neyman technique, respectively. RESULTS After possible confounders were adjusted, the SGDS-K score was positively associated with the PSQI score (standardized beta = 0.166, P < 0.001) and negatively associated with the MNA score (standardized beta = -0.480, P < 0.001). The local effect size of the associations was small for PSQI and medium for MNA. A significant interaction was observed between the PSQI and MNA scores. The result of the Johnson-Neyman technique indicated that the influence of PSQI on SGDS-K became weaker and insignificant as nutritional status worsened. However, the association between the MNA and SGDS-K scores was significant regardless of PSQI. CONCLUSION Both sleep disturbance and malnutrition were significantly associated with late-life depression, although malnutrition may be more critically associated with depression than sleep disturbance in community-dwelling older adults.
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Affiliation(s)
- Gyubeom Hwang
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Yong Hyuk Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Eun Jwoo Kim
- Suwon Geriatric Mental Health Center, Suwon, South Korea
| | - Ji Won Woang
- Suwon Geriatric Mental Health Center, Suwon, South Korea
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea.,Suwon Geriatric Mental Health Center, Suwon, South Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea.,Suwon Geriatric Mental Health Center, Suwon, South Korea
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Goto R, Ozone S, Kawada S, Yokoya S. Gender-Related Differences in Social Participation Among Japanese Elderly Individuals During the COVID-19 Pandemic: A Cross-Sectional Survey. J Prim Care Community Health 2022; 13:21501319221111113. [PMID: 35818674 PMCID: PMC9280796 DOI: 10.1177/21501319221111113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction/Objectives: The health of elderly individuals is known to benefit from maintaining societal involvement and relationships with other people, such as through social participation. We aimed to determine trends in the percentage of Japanese elderly people who engaged in social participation before and during the coronavirus disease 2019 (COVID-19) pandemic in one municipality in Japan, and compared differences in this status by gender. Methods: We conducted a cross-sectional questionnaire survey. Questionnaires were sent by mail to 3000 people aged 65 to 85 years who were randomly selected by the administrative staff of the city. Participant characteristics (age, gender, working status, residential status) and their economic status, daily physical activity, and social participation status were obtained at 3 time points: (1) before the COVID-19 pandemic in January 2020; (2) immediately prior to the declaration of a state of emergency in April 2020; and (3) in January 2021, 1 year after (1). Results: A total of 1301 people responded to the survey. The mean age was 73.3 (SD 5.5) years, and 690 (53.0%) were women. There were significant gender differences in terms of living alone, employment status, and amount of physical activity. The number of people reporting social participation gradually decreased from 543 respondents (41.7%) at (1) to 319 (24.5%) at (2) and 251 (19.3%) at (3). Women were more likely to demonstrate reduced social participation. Conclusions: Elderly individuals, particularly women, reported decreased social participation during the pandemic.
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Affiliation(s)
- Ryohei Goto
- Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sachiko Ozone
- Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shogo Kawada
- Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shoji Yokoya
- Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Rueter J, Brandstetter S, Curbach J, Lindacher V, Warrelmann B, Loss J. How Older Citizens in Germany Perceive and Handle Their Food Environment-A Qualitative Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6940. [PMID: 32977391 PMCID: PMC7579540 DOI: 10.3390/ijerph17196940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 12/18/2022]
Abstract
Apart from individual factors like knowledge or personal motivation, the environment also influences a person's eating behaviour. Food environments can be described as the collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people's food choices and nutritional status. In order to explore how older citizens in rural Germany perceive and handle their food environment, we conducted semi-structured face-to-face interviews with 35 older adults (71 ± 7 years), asking about micro-, meso- and macro-level influences on eating habits. Participants reported social factors to be crucial in shaping their diets, such as preferences of family members or social expectations connected to roles (guest, host). On a physical level, structural aspects and resources in their nearby surroundings influenced shopping and eating behaviour (for example access to an own vegetable garden, local shopping facilities and restaurants). Macro-level influences such as the food industry were hardly mentioned. Participants noticed that the environment affects their diets but dealt with undesired influences using strategies of adaptation and behaviour change, rather than challenging the environmental influences. Public health projects should raise the awareness of the multiple environmental influences on eating behaviour and also help people to create healthier food environments.
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Affiliation(s)
- Jana Rueter
- Medical Sociology, Department for Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Straße 17, 93051 Regensburg, Germany; (S.B.); (J.C.); (V.L.); (B.W.); (J.L.)
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