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White MJ, Duke NN, Howard J, Rodriguez J, Truong T, Green CL, Nmoh A, Gorveh M, Perrin EM. Positive Outliers: A Mixed Methods Study of Resiliency to Childhood Obesity in High-Risk Neighborhoods. Acad Pediatr 2024:S1876-2859(24)00110-4. [PMID: 38521385 DOI: 10.1016/j.acap.2024.03.011] [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] [Received: 11/28/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Despite the high prevalence of obesity and the clustering of risk by neighborhood, few studies have examined characteristics which promote healthy child weight in neighborhoods with high obesity risk. We aimed to identify protective factors for children living in neighborhoods with high obesity risk. METHODS We identified neighborhoods with high obesity risk using geolocated electronic health record data with measured body mass index (BMI) from well child visits (2012-2017). We then recruited caregivers with children aged 5-13 years who lived in census tracts with mean child BMI percentile >72 (February 2020- August 2021). We used sequential mixed methods (quantitative surveys, qualitative interviews) to compare individual, interpersonal and perceived neighborhood factors among families with children at healthy weight (positive outliers, PO) vs. families with ≥1 child with overweight or obesity (controls). Regression models and comparative qualitative analysis were used to identify protective characteristics. RESULTS Seventy-three caregivers participated in the quantitative phase (41% PO; 34% preferred Spanish) and twenty in the qualitative phase (50% PO; 50% preferred Spanish). Frequency of healthy caregiver behaviors was associated with being a PO (Family Health Behavior Scale Parent Score adjusted β 3.67; 95% CI 0.52-6.81 and qualitative data). Protective factors also included caregivers' ability to minimize the negative health influences of family members and adhere to family routines. CONCLUSIONS There were few differences between PO and control families. Support for caregiver healthy habits and adherence to healthy family routines emerged as opportunities for childhood obesity prevention in neighborhoods with high obesity risk. WHAT'S NEW In neighborhoods with high risk of child obesity, families with healthy weight children and families with children with overweight/obesity are behaviorally and socially similar. Parental modeling and support for healthy behaviors across children's environments may promote healthy child weight.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University Medical Center; 2301 Erwin Road; Durham, NC, 27705.
| | - Naomi N Duke
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University Medical Center; 2301 Erwin Road; Duke University Medical Center; Durham, NC, 27705.
| | - Janna Howard
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University Medical Center; 2301 Erwin Road; Duke University Medical Center; Durham, NC, 27705.
| | - Javier Rodriguez
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University Medical Center; 2301 Erwin Road; Duke University Medical Center; Durham, NC, 27705.
| | - Tracy Truong
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Duke University Medical Center; Durham, NC 27705.
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine; Duke Clinical Research Institute, Duke University Medical Center; 345 W Morgan St.; Durham, NC, 27701.
| | - Ashley Nmoh
- Duke University School of Medicine; 40 Duke Medicine Circle; Durham, NC, 27710.
| | - Moshen Gorveh
- Duke Clinical Research Institute (DCRI), Duke University; 300 W. Morgan Street, Suite 800; Durham, NC 27701.
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins Schools of Medicine and Nursing, 200 N. Wolfe Street, Rubenstein Building - 2075, Baltimore, MD 21287.
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Low assets predict persistent depression through living difficulties amid large-scale disasters: A cohort study. J Affect Disord 2022; 315:282-290. [PMID: 35872246 PMCID: PMC9304334 DOI: 10.1016/j.jad.2022.07.040] [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: 04/22/2022] [Revised: 06/18/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In face of large-scale disasters, persons with fewer assets are at greater risk of persistent poorer mental health than persons with more assets. Everyday daily routine disruptions and financial hardship could mediate this association. METHODS This prospective population-representative study in Hong Kong aimed to investigate the relation between assets during the acute phase of COVID-19 (February-August 2020, T1) and persistent probable depression from T1 to March-August 2021 (T2), as well as the mediating effects of daily routine disruptions and financial hardship on the assets-depression association. RESULTS Low assets at T1 prospectively related to persistent probable depression from T1 to T2. Primary routine disruptions (i.e., healthy eating and sleep) at T1 and financial hardship at T2 were found to fully mediate the association between T1 assets and persistent probable depression. LIMITATIONS Persistent probable depression reported on the PHQ-9 should be further verified with clinical diagnoses/interviews. CONCLUSIONS The COVID-19 pandemic was accompanied by a global economic downturn. Persons who have fewer assets could be at greater risk of depression during this period. Our findings suggest a need to provide behavioral and financial assistance to persons with fewer assets in the short run and a need to ensure that everyone has adequate assets to mitigate the mental health consequences of the COVID-19 pandemic in the long run.
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Culyba AJ, Riley AT, Corona G, Miller E, Carley KM. Adolescent-Adult Social Networks and Experiences of Violence Among Black Youth in Neighborhoods With High Levels of Community Violence. J Adolesc Health 2022; 71:494-501. [PMID: 35717325 PMCID: PMC10150589 DOI: 10.1016/j.jadohealth.2022.05.010] [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] [Received: 09/28/2021] [Revised: 04/19/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Adult support is inversely linked to health-affecting risk behaviors. This study aimed to describe adolescent-adult support network structure and quality, and to analyze associations among network properties, strength of emotional and instrumental support, and violence involvement among predominantly Black youth residing in neighborhoods with high levels of community violence. METHODS One hundred six youth from urban neighborhoods with high levels of community violence in Pittsburgh, PA completed egocentric social network surveys describing adult supports, measures of support across contexts, and past 30-day violence perpetration, victimization, and witnessing. Forty youth-identified adults completed complementary social network surveys. Poisson regression examined associations among strength of social support, adults' violence experiences, and youths' violence experiences. RESULTS Mean youth participant age was 16.7 years, 56% self-identified as female, and 84% as Black or African-American. Youth and adult participants reported high levels of violence exposure and involvement. Youth identified a mean of 4.8 adult supports. Identifying at least one immediate family member in their network was inversely related to violence perpetration (adjusted incidence rate ratio [aIRR] 0.44, 95% confidence interval [CI] 0.22-0.89), victimization (aIRR 0.42, 95% CI 0.25-0.72), and witnessing (aIRR 0.48, 95% CI 0.35-0.64). The percent of adult supports involved in violence was directly associated with violence perpetration (aIRR 1.81, 95% CI 1.07-3.07), victimization (aIRR 1.95, 95% CI 1.09-3.45), and witnessing (aIRR 1.85, 95% CI 1.25-2.73). Few associations emerged between the structure of youth-reported adolescent-adult social networks and violence. DISCUSSION Network-based interventions combined with healing-centered services attuned to violence experiences among Black youth and their adult supports may offer opportunities to leverage youths' existing adult support network and reduce violence.
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Affiliation(s)
- Alison J Culyba
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Alexander T Riley
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gabrielle Corona
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Kathleen M Carley
- Institute for Software Research, School of Computer Science, Carnegie Mellon University, Pittsburgh, Pennsylvania
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Burgette JM, Rankine J, Culyba AJ, Chu KH, Carley KM. Best Practices for Modeling Egocentric Social Network Data and Health Outcomes. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:18-34. [PMID: 33973482 DOI: 10.1177/19375867211013772] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE/AIM We describe best practices for modeling egocentric networks and health outcomes using a five-step guide. BACKGROUND Social network analysis (SNA) is common in social science fields and has more recently been used to study health-related topics including obesity, violence, substance use, health organizational behavior, and healthcare utilization. SNA, alone or in conjunction with spatial analysis, can be used to uniquely evaluate the impact of the physical or built environment on health. The environment can shape the presence, quality, and function of social relationships with spatial and network processes interacting to affect health outcomes. While there are some common measures frequently used in modeling the impact of social networks on health outcomes, there is no standard approach to social network modeling in health research, which impacts rigor and reproducibility. METHODS We provide an overview of social network concepts and terminology focused on egocentric network data. Egocentric, or personal networks, take the perspective of an individual who identifies their own connections (alters) and also the relationships between alters. RESULTS We describe best practices for modeling egocentric networks and health outcomes according to the following five-step guide: (1) model selection, (2) social network exposure variable and selection considerations, (3) covariate selection related to sociodemographic and health characteristics, (4) covariate selection related to social network characteristics, and (5) analytic considerations. We also present an example of SNA. CONCLUSIONS SNA provides a powerful repertoire of techniques to examine how relationships impact attitudes, experiences, and behaviors-and subsequently health.
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Affiliation(s)
- Jacqueline M Burgette
- Department of Dental Public Health, 6614University of Pittsburgh School of Dental Medicine, PA, USA.,Department of Pediatric Dentistry, 12317University of Pittsburgh School of Dental Medicine, PA, USA
| | - Jacquelin Rankine
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, 12317University of Pittsburgh School of Medicine, PA, USA
| | - Alison J Culyba
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, 12317University of Pittsburgh School of Medicine, PA, USA
| | - Kar-Hai Chu
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, PA, USA
| | - Kathleen M Carley
- Center for Computational Analysis of Social and Organizational Systems, School of Computer Science, 6612Carnegie Mellon University, Pittsburgh, PA, USA
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Oh H, Um MY, Garbe R. Social Networks and Chronic Illness Management among Low-Income Tenants in Publicly Subsidized Housing: Findings from a Pilot Study. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:405-418. [PMID: 33771075 DOI: 10.1080/19371918.2021.1900012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Low-income tenants in publicly subsidized housing (PSH) have higher rates of chronic illnesses than non-PSH-based residents, making the implementation of chronic illness management (CIM) essential. Based on the person-in-environment framework used in social work practice, which emphasizes the importance of interactions between clients and their social environment, this pilot study used personal network analysis (PNA), a variant of social network analysis, to explore what attributes of social networks are relevant to CIM among 26 low-income tenants independently living in a PSH in the Southwest United States. Tenants with a smaller network size and effective size presented better self-efficacy to manage chronic disease (SEMCD) and lower levels of depressive symptoms. Being connected to a higher proportion of alters (i.e., network members) with whom they discussed health matters was also associated with high SEMCD. As for CIM implementation, being connected to a doctor and a lower proportion of alters who have chronic illnesses were associated with doing aerobic exercise. Tenants with a larger proportion of alters serving multiple functions reported more frequent vegetable and fruit consumption, while those with a higher share of kin alters and lower share of alters living in the same PSH reported less frequent high-fat food consumption. Our findings help social workers discover relevant social networks and dynamics that low-income tenants at PSH capitalize to locate resources for CIM. Further studies are recommended to adopt PNA to expand practice-related knowledge that social workers can use for health promotion among low-income tenants with chronic illness.
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Affiliation(s)
- Hyunsung Oh
- School of Social Work, Arizona State University, USA
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Oladele CR, Thompson TA, Wang K, Galusha D, Tran E, Martinez-Brockman JL, Adams OP, Maharaj RG, Nazario CM, Nunez M, Nunez-Smith M. Egocentric Health Networks and Cardiovascular Risk Factors in the ECHORN Cohort Study. J Gen Intern Med 2020; 35:784-791. [PMID: 31823310 PMCID: PMC7080938 DOI: 10.1007/s11606-019-05550-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/27/2019] [Accepted: 10/30/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Caribbean region. OBJECTIVE This study explored the concept of a health network, relationships focused on health-related matters, and examined associations with CVD risk factors in the Eastern Caribbean. DESIGN The Eastern Caribbean Health Outcomes Research Network Cohort Study is an ongoing longitudinal cohort being conducted in the US Virgin Islands, Puerto Rico, Trinidad and Tobago, and Barbados. PARTICIPANTS Participants (n = 1989) were English or Spanish-speaking adults 40 years and older, who were residents of the island for at least 10 years, and who intended to live on-island for the next 5 years. MAIN MEASURES Logistic regression was used to examine associations between health network characteristics and CVD risk factors: physical activity, hypertension, and smoking. A baseline survey asked questions about health networks using name generator questions that assessed who participants spoke to about health matters, whose opinions on healthcare mattered, and who they would trust to make healthcare decisions on their behalf. KEY RESULTS Health networks were mainly comprised of family members and friends. Healthcare professionals comprised 7% of networks, mean network size was four, and 74% of health network contacts were perceived to be in "good" to "excellent" health. Persons with larger health networks had greater odds of being physically active compared with those with smaller networks (OR = 1.07, CI = 1.01-1.14). CONCLUSIONS Health networks may be useful to intervention efforts for CVD risk factor reduction. More studies are needed to examine health networks in Caribbean contexts and explore associations with other CVD risk factors.
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Affiliation(s)
| | | | - Karen Wang
- Yale University School of Medicine, New Haven, CT, USA
| | - Deron Galusha
- Yale University School of Medicine, New Haven, CT, USA
| | - Emma Tran
- Yale University School of Medicine, New Haven, CT, USA
| | | | - Oswald P Adams
- Faculty of Medical Sciences, The University of The West Indies Cave Hill Campus, Bridgetown, P.O. Box 64, Barbados
| | - Rohan G Maharaj
- Unit of Public Health and Primary Care, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | | | - Maxine Nunez
- The University of the US Virgin Islands, Charlotte Amalie, USA
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Bowen DJ, Quintiliani LM, Bhosrekar SG, Goodman R, Smith E. Changing the housing environment to reduce obesity in public housing residents: a cluster randomized trial. BMC Public Health 2018; 18:883. [PMID: 30012120 PMCID: PMC6048807 DOI: 10.1186/s12889-018-5777-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/28/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Public housing residents face significant social, economic, and physical barriers to the practice of health behaviors for prevention of chronic disease. Research shows that public housing residents are more likely to report higher rates of obesity, current smoking, disability, and insufficient physical activity compared to individuals not living in public housing. Because these behaviors and conditions may be shaped by the built and social environments in which they live, we conducted a study to test an environmental level diet and physical activity intervention targeting obesity among urban public housing developments. METHODS This study was a cluster randomized controlled trial of public housing developments, the unit of analysis and randomization. A total of 10 public housing developments were recruited and subsequently randomized to either receive the intervention package or to serve as comparison sites. The year-long intervention included components to change the dietary and physical activity-related environments of the developments. Surveys at baseline and one-year follow-up provided data on changes in behaviors and weight from participants in both intervention and control developments. RESULTS Intervention participants significantly changed their eating and activity behaviors and body weight from baseline to one-year follow-up (p's < .05) while comparison participants reported no significant changes in any study variable. CONCLUSIONS These data provide initial support for the idea that interventions targeting the environment of public housing developments can assist residents to change unhealthy behaviors and can possibly reduce the high levels of chronic disease among public housing residents.
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Affiliation(s)
- Deborah J. Bowen
- University of Washington, 1959 Pacific Street NE, Box 357120, Seattle, WA 98195 USA
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Vuolo M, Kelly BC, Kadowaki J. Independent and Interactive Effects of Smoking Bans and Tobacco Taxes on a Cohort of US Young Adults. Am J Public Health 2016; 106:374-80. [PMID: 26691133 PMCID: PMC4758814 DOI: 10.2105/ajph.2015.302968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the mutual effects of smoking bans and taxes on smoking among a longitudinal cohort of young adults. METHODS We combined a repository of US tobacco policies at the state and local level with the nationally representative geocoded National Longitudinal Survey of Youth 1997 (2004-2011) from ages 19 to 31 years and Census data, to examine the impact of tobacco policies on any current and daily pack smoking. The analytic sample amounts to 19,668 observations among 4341 individuals within 487 cities. RESULTS For current smoking, we found significant effects for comprehensive smoking bans, but not excise taxes. We also found an interaction effect, with bans being most effective in locales with no or low taxes. For daily pack smoking, we found significant effects for taxes, but limited support for bans. CONCLUSIONS Social smoking among young adults is primarily inhibited by smoking bans, but excise taxes only deter such smoking in the absence of a ban. Heavy smokers are primarily deterred by taxes. Although both policies have an impact on young adult smoking behaviors, their dual presence does not intensify each policy's efficacy.
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Affiliation(s)
- Mike Vuolo
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
| | - Brian C Kelly
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
| | - Joy Kadowaki
- Mike Vuolo is with the Department of Sociology, The Ohio State University, Columbus, OH. Brian C. Kelly and Joy Kadowaki are with the Department of Sociology, Purdue University, West Lafayette, IN
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Kennedy-Hendricks A, Schwartz HL, Griffin BA, Burkhauser S, Green HD, Kennedy DP, Pollack CE. Health implications of social networks for children living in public housing. Health Place 2015; 36:145-51. [PMID: 26598958 DOI: 10.1016/j.healthplace.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 08/30/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
This study sought to examine whether: (1) the health composition of the social networks of children living in subsidized housing within market rate developments (among higher-income neighbors) differs from the social network composition of children living in public housing developments (among lower-income neighbors); and (2) children's social network composition is associated with children's own health. We found no significant differences in the health characteristics of the social networks of children living in these different types of public housing. However, social network composition was significantly associated with several aspects of children's own health, suggesting the potential importance of social networks for the health of vulnerable populations.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, Baltimore, MD 21205, United States.
| | - Heather L Schwartz
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Beth Ann Griffin
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Susan Burkhauser
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Harold D Green
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - David P Kennedy
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Craig Evan Pollack
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, Baltimore, MD 21205, United States; Johns Hopkins School of Medicine, Division of General Internal Medicine, 2024 E. Monument Street, Baltimore, MD 21287, United States
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