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Risk Behavioral Contexts in Adolescence of Obese Adults. J Adolesc Health 2022; 70:817-824. [PMID: 35165031 DOI: 10.1016/j.jadohealth.2021.11.028] [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: 05/27/2021] [Revised: 11/14/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Previous research suggests that poor nutrition, physical activity, sleep, and social/emotional climate are associated with weight gain. However, few empirical studies have examined how these factors relate to each other in adolescents who are later obese. Are these factors uniformly present, or do some co-occur or occur independently? This study seeks to identify subgroups of obese individuals at ages 24-32 years who exhibited unique, co-occurring behavioral and emotional contexts for obesity at ages 14-17 years. METHODS To identify subgroups of behavioral and contextual profiles in adolescence, the study applies latent class analysis to a sample of individuals who were obese in the fourth wave of the National Longitudinal Study of Adolescent to Adult Health (Add Health, N = 1,889). The study then explored covariates (e.g., gender, race) of class membership. RESULTS Considerable heterogeneity exists in risk profiles of adolescents obese as adults. For example, 21.1 percent of the sample is in a class with no differentiating risk factors, whereas two classes containing 22.1 percent of the sample exhibit high levels of depression, and nearly all the emotional factors are considered. Although some covariates are predictive of class membership, clear patterns are difficult to discern. However, poor physical health is clearly predictive of membership in the classes exhibiting a high risk of depression. DISCUSSION Clinicians should be aware that at younger ages, people who are ultimately obese display a range of factors linked to obesity. Although some exhibit behaviors such as high screen time and processed food consumption, others exhibit mainly poor social/emotional climate.
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Wyatt JP, Ampadu GG. Reclaiming Self-care: Self-care as a Social Justice Tool for Black Wellness. Community Ment Health J 2022; 58:213-221. [PMID: 34478022 PMCID: PMC8414023 DOI: 10.1007/s10597-021-00884-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/19/2021] [Indexed: 11/20/2022]
Abstract
Black communities face multiple stressors including racism, discrimination, and navigating systems of oppression, all of which affect their mental health and wellbeing. In recent years, the practice of self-care has gained popularity as a strategy to cope with stress and to improve overall health. However, the current discourse often focuses on individual self-care behaviors and excludes systemic and community level factors that encourage, sustain, or inhibit self-care practices. This paper contextualizes a conceptual model of self-care with intersectionality theory and the psychology of liberation framework, in relation to the lived experiences of Black communities. The paper aims to underscore the necessity of self and community care as a tool for social justice, preservation, and resistance against oppressive systems that threaten the mental health and wellness of this community.
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Affiliation(s)
- Janan P Wyatt
- Department of Psychiatry, Yale School of Medicine, Program for Recovery and Community Health, Erector Square, 319 Peck St., Bldg. 1, New Haven, CT, 06513, USA.
| | - Gifty G Ampadu
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 3340 Bainbridge Ave., Bronx, NY, 10467, USA
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3
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Subica AM, Link BG. Cultural trauma as a fundamental cause of health disparities. Soc Sci Med 2022; 292:114574. [PMID: 34808396 PMCID: PMC9006767 DOI: 10.1016/j.socscimed.2021.114574] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 01/03/2023]
Abstract
Health disparities disproportionately affect minority cultural groups (e.g., Indigenous, immigrant, refugee) worldwide; enduring across time, disease states, and risk factors despite co-occurring advancements in health and medicine. Fundamental cause theory holds that important social factors (e.g., socioeconomic status, stigma, racism) produce health disparities by restricting equitable access to health-protective resources. Yet, extant literature has not utilized fundamental cause theory to describe the health disparities impact of cultural trauma: an overwhelming, often ongoing physical or psychological assault by an oppressive dominant group on another group's cultural resources through force, threats of force, or oppressive policies. This paper presents a novel conceptual model detailing cultural trauma and the mechanisms through which it may disrupt health and create disparities by damaging three health-protective cultural resources: cultural modes, institutions, and lands. Following cultural trauma, we propose affected groups are socially disadvantaged and exposed to pervasive stress, stigma, and diminished resources, perpetuating health disparities across generations. Consequently, cultural trauma may represent an unrecognized fundamental cause of health disparities, offering potential avenues for promoting health equity through targeted research, interventions, and policies.
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Affiliation(s)
- Andrew M. Subica
- University of California, Riverside School of Medicine, Department of Social Medicine, Population, and Public Health, 900 University Ave, Riverside, CA, 92521, USA,Corresponding author. (A.M. Subica)
| | - Bruce G. Link
- University of California, Riverside School of Public Policy, 900 University Ave, Riverside, CA, 92521, USA
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McManus KE, Bertrand A, Snelling AM, Cotter EW. In Their Own Words: Parents and Key Informants' Views on Nutrition Education and Family Health Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8155. [PMID: 34360448 PMCID: PMC8346135 DOI: 10.3390/ijerph18158155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Abstract
Parents, health professionals, and communities are integral in the development of nutrition behaviors that reduce children's risk for high body mass index (BMI) and chronic disease. The aim of this study was to conduct formative evaluations with key health informants and parents to understand the specific strategies that families use at mealtimes to promote their family's health, along with the barriers they face in attending current nutrition education programming. Focus groups (in English and Spanish) were conducted with parents (n = 22; 63.64% Black/African American, 13.64% Black but not African American, 18.18% Hispanic/Latinx) whose household was located in a community where 50% of residents' gross income was ≤185% of the federal poverty level. Semi-structured interviews were conducted with six key informants with expertise in family health and nutrition. Inductive thematic analysis was used to identify themes across interviews. Six general themes emerged from the interviews including perceptions of health, relationships, health behaviors, facilitators, barriers, and desired changes. Across the six themes, participants responded with suggestions for community-based health promotion programs such as incorporating a broader definition of health to better address the individual and systemic barriers that perpetuate health inequities and make healthy eating difficult. Participants identified stress reduction, health literacy, and cooking knowledge as areas of interest for future programming.
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Affiliation(s)
| | - Adrian Bertrand
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
| | - Anastasia M. Snelling
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
| | - Elizabeth W. Cotter
- Department of Health Studies, American University, Washington, DC 20016, USA; (A.B.); (A.M.S.); (E.W.C.)
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Lappan SN, Carolan M, Parra-Cardona JR, Weatherspoon L. Promoting Healthy Eating and Regular Physical Activity in Low-Income Families Through Family-Centered Programs: Implications for Practice. J Prim Prev 2020; 41:503-528. [PMID: 33125592 PMCID: PMC10732148 DOI: 10.1007/s10935-020-00612-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/29/2022]
Abstract
Research concerning children who are overweight has historically focused on providing services to the affected individuals, and limited attention has been paid to their families. Further, childhood obesity prevention and clinical programs continue to be impacted by contextual factors that increase the likelihood of attrition when targeting underserved populations. This paper provides data with relevance for interventions aimed at promoting healthy eating and regular physical activity with low-income families. Participants in a childhood obesity exploratory study provided recommendations to improve programs by reflecting on specific family and contextual issues related to children who are overweight and obese. Following a thematic analysis approach, we conducted semi-structured interviews with 16 low-income, single, female parents. All participants had, at the time of the interview, at least one overweight or obese child between the ages of 3 and 8. We report the critical role of context in the etiology and challenges of childhood obesity among disadvantaged populations. Findings also highlight the need for interventions to be culturally relevant and sensitive and to create opportunities to address and discuss participant experiences of discrimination, cultural factors, and family of origin influences. Interventions that do not address these contextual factors run the risk of being unsuccessful. Our findings are important for mental and public health professionals who are interested in the direct provision of services using a combination of social determinants of systemic perspectives.
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Affiliation(s)
- Sara N Lappan
- Department of Human Studies, University of Alabama At Birmingham, 1720 2nd Ave. S, Birmingham, AL 35294, USA.
| | - Marsha Carolan
- Department of Human Development and Family Studies, Michigan State University, East Lansing, USA
| | | | - Lorraine Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, USA
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Douglas JA, Subica AM, Franks L, Johnson G, Leon C, Villanueva S, Grills CT. Using Participatory Mapping to Diagnose Upstream Determinants of Health and Prescribe Downstream Policy-Based Interventions. Prev Chronic Dis 2020; 17:E138. [PMID: 33155972 PMCID: PMC7665598 DOI: 10.5888/pcd17.200123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Participatory mapping is a powerful methodology for working with community residents to examine social and environmental determinants of public health disparities. However, this empowering methodology has only been applied sparingly in public health research and practice, with limited examples in the literature. To address this literature gap, we 1) review participatory mapping approaches that may be applied to exploring place-based factors that affect community health, and 2) present a mixed-methods participatory geographic information systems (PGIS) examination of neighborhood assets (eg, streetlights) and challenges (eg, spaces of crime and violence) related to access to public parks in South Los Angeles, California. By taking a participatory, fine-grained spatial approach to examining public park access with input from 40 South Los Angeles adolescent and adult residents, our community-engaged PGIS approach identified tobacco shops as previously unrecognized community institutions that are associated with increased neighborhood crime and violence. Our investigation revealed unique challenges in community-level public park access that would likely have been overlooked by conventional spatial epidemiology and social science methods, such as surveys and questionnaires. Furthermore, our granular community-informed approach supported resident and stakeholder advocacy efforts toward reducing the proliferation of tobacco shops through community organizing and policy change initiatives. We thus contend that it would benefit public health research and practice to further integrate empowering, grassroots-based participatory mapping approaches toward informing advocacy efforts and policies that promote health and well-being in disadvantaged communities.
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Affiliation(s)
- Jason A Douglas
- Chapman University, Crean College of Health and Behavioral Sciences, Department of Health Sciences, Orange, California.,Chapman University, Crean College of Health and Behavioral Sciences, Department of Health Sciences, One University Dr, Orange, CA 92866.
| | - Andrew M Subica
- University of California, Riverside School of Medicine, Department of Social Medicine, Population, and Public Health, Riverside, California
| | | | | | - Carlos Leon
- Community Coalition, Los Angeles, California
| | - Sandra Villanueva
- Loyola Marymount University, Psychology Applied Research Center, Los Angeles, California
| | - Cheryl T Grills
- Loyola Marymount University, Psychology Applied Research Center, Los Angeles, California
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Byker Shanks C, Ahmed S, Dupuis V, Houghtaling B, Running Crane MA, Tryon M, Pierre M. Perceptions of food environments and nutrition among residents of the Flathead Indian Reservation. BMC Public Health 2020; 20:1536. [PMID: 33046034 PMCID: PMC7549225 DOI: 10.1186/s12889-020-09584-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/21/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Indigenous food systems have been displaced with the emergence of colonization, industrialization, and cultural, economic, political, and environmental changes. This disruption can be seen in marked health and food environment disparities that contribute to high obesity and diabetes mellitus prevalence among Native American peoples. METHODS A Community-Based Participatory Research (CBPR) approach was used to document food environment experiences among residents of the Flathead Reservation in rural Montana. Participants were identified using purposive sampling techniques to participate in a survey and a semi-structured interview. Descriptive statistics helped to describe participant demographics, food access variables, and household food security status. Food environment perceptions were analyzed using the constant comparison method among trained researchers. RESULTS Participants completed surveys (n = 79) and interviews (n = 76). A large number participated in federal nutrition assistance programs. Many self-reported experiencing diet-related chronic diseases. Major themes included the community food environment, dietary norms, and food-health connections. Subthemes were represented by perceptions of food environment transitions and the important role of food in familial life. Further, opportunities and challenges were identified for improving community food environments. CONCLUSIONS Perceptions of the food environment were linked to strategies that could be targeted to improve dietary quality along a social-ecological model continuum. There is need for skill-based education that directly addresses the time and monetary constraints that were commonly experienced by residents. Coinciding food environment interventions to promote dietary quality that engage community members, store management, and government policy stakeholders are also needed to reestablish healthy Native American food systems and environments within this community.
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Affiliation(s)
- Carmen Byker Shanks
- Department of Health and Human Development, Montana State University, Bozeman, MT 59717 USA
- Food and Health Lab at Montana State University, Montana State University, 960 Technology Boulevard Room 245, Bozeman, MT 59718 USA
| | - Selena Ahmed
- Department of Health and Human Development, Montana State University, Bozeman, MT 59717 USA
- Food and Health Lab at Montana State University, Montana State University, 960 Technology Boulevard Room 245, Bozeman, MT 59718 USA
| | | | - Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA 70803 USA
| | | | - Mike Tryon
- Wellness/Group Fitness Program Supervisor, Kalispell Regional Healthcare, Kalispell, MT 59901 USA
| | - Mike Pierre
- Food Department of Human Resources Development, The Confederated Salish and Kootenai Tribes, P.O. Box 278, Pablo, Montana 59855 USA
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Prevo L, Kremers S, Jansen M. The Power of Trading: Exploring the Value of a Trading Shop as a Health-Promoting Community Engagement Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134678. [PMID: 32610639 PMCID: PMC7369890 DOI: 10.3390/ijerph17134678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 11/16/2022]
Abstract
Involving and engaging vulnerable communities from the very beginning is important if we wish to enhance general well-being. With a focus on equal partnership with low-socioeconomic status (SES) families, a Trading Shop in Vaals was developed as a community engagement initiative. In the current study, we focused on the participation process, from preparation to sustaining the Trading Shop, in order to define whether the Trading Shop can be successful in engaging families through focusing specially on their needs and perceived positive health. A formative case study design was carried out to monitor, evaluate, and timely adjust the developments within the Trading Shop by using participatory action research. The Trading Shop was monitored from its preparation to its opening, as well as during the start and the steps taken towards continuation in the form of municipal policy. The results showed one central theme during all phases: the optimal navigation between top-down support from professionals and bottom-up developments among the volunteers in the Trading Shop. With the input from both approaches, it was possible to create an optimal environment for the volunteers to achieve personal development. The inclusivity and accessibility of the Trading Shop as a community engagement initiative offered the opportunity to volunteers to enhance their needs, realizing personal growth and development of their talents in several positive health domains.
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Affiliation(s)
- Lotte Prevo
- NUTRIM, Department of Health Promotion, Maastricht University, 6229 HA Maastricht, The Netherlands;
- Correspondence:
| | - Stef Kremers
- NUTRIM, Department of Health Promotion, Maastricht University, 6229 HA Maastricht, The Netherlands;
| | - Maria Jansen
- CAPHRI, Department of Health Services Research, Maastricht University, 6229 HA Maastricht, The Netherlands;
- CAPHRI, Academic Collaborative Center for Public Health, Public Health Service Southern Limburg, 6411 TE Heerlen, The Netherlands
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9
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Williamson DHZ, Yu EX, Hunter CM, Kaufman JA, Komro K, Jelks NO, Johnson DA, Gribble MO, Kegler MC. A Scoping Review of Capacity-Building Efforts to Address Environmental Justice Concerns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3765. [PMID: 32466474 PMCID: PMC7312702 DOI: 10.3390/ijerph17113765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022]
Abstract
Environmental justice (EJ) efforts aimed at capacity building are essential to addressing environmental health disparities; however, limited attention has been given to describing these efforts. This study reports findings from a scoping review of community-academic partnerships and community-led efforts to address environmental inequities related to air, water, and land pollution in the United States. Literature published in peer-reviewed journals from January 1986 through March 2018 were included, and community capacity theory was applied as a framework for understanding the scope of capacity-building and community change strategies to address EJ concerns. Paired teams of independent analysts conducted a search for relevant articles (n = 8452 citations identified), filtered records for content abstraction and possible inclusion (n = 163) and characterized selected studies (n = 58). Most articles implemented activities that were aligned with community capacity dimensions of citizen participation (96.4%, n = 53), community power (78%, n = 45), leadership (78%, n = 45), and networks (81%, n = 47); few articles identified a direct policy change (22%, n = 13), and many articles discussed the policy implications of findings for future work (62%, n = 36). This review synthesizes three decades of efforts to reduce environmental inequities and identifies strategic approaches used for strengthening community capacity.
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Affiliation(s)
- Dana H. Z. Williamson
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (K.K.); (M.C.K.)
| | - Emma X. Yu
- Gangarosa Department of Environmental Health, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (E.X.Y.); (C.M.H.); (M.O.G.)
| | - Candis M. Hunter
- Gangarosa Department of Environmental Health, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (E.X.Y.); (C.M.H.); (M.O.G.)
| | - John A. Kaufman
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (J.A.K.); (D.A.J.)
| | - Kelli Komro
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (K.K.); (M.C.K.)
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (J.A.K.); (D.A.J.)
| | | | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (J.A.K.); (D.A.J.)
| | - Matthew O. Gribble
- Gangarosa Department of Environmental Health, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (E.X.Y.); (C.M.H.); (M.O.G.)
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (J.A.K.); (D.A.J.)
| | - Michelle C. Kegler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (K.K.); (M.C.K.)
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Gailey AD, Schachter AE, Egendorf SP, Mielke HW. Quantifying soil contamination and identifying interventions to limit health risks. Curr Probl Pediatr Adolesc Health Care 2020; 50:100740. [PMID: 32008961 DOI: 10.1016/j.cppeds.2019.100740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 01/10/2023]
Abstract
Numerous toxicants contaminate soil and negatively affect the environments that children explore. Accurately measuring these toxicants and characterizing the level of soil contamination may be difficult and must include measurements of both the environmental concentrations and the exposure responses of human populations. This article reviews the current methods and technologies available for quantifying soil contamination. Several intervention strategies exist for limiting human exposure to contaminated soils and the strengths and weaknesses of these methods are discussed. Lastly, current policies on soil contamination and the importance of protecting vulnerable populations by developing means to improve health conditions for children are reviewed.
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Affiliation(s)
- Andrew D Gailey
- The University of North Carolina School of Medicine, Chapel Hill, NC 27516, United States
| | - Aubrey E Schachter
- Louisiana State University Health Science Center, New Orleans, LA 70112, United States
| | - Sara P Egendorf
- The Advanced Science Research Center at the Graduate Center and Brooklyn College, City University of New York, NY 10031, United States
| | - Howard W Mielke
- Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA 70112, United States.
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Subica AM, Brown BJ. Addressing Health Disparities Through Deliberative Methods: Citizens' Panels for Health Equity. Am J Public Health 2019; 110:166-173. [PMID: 31855474 DOI: 10.2105/ajph.2019.305450] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Health disparities adversely affect millions of people living in disadvantaged communities, resisting public health interventions that do not address the specific conditions, driving forces, or health problems in these communities. Drawing from the underutilized science of deliberative methods, we introduce the innovative citizens' panels for health equity approach-a novel methodology that engages public expertise and knowledge of community health needs, risks, and priorities to tailor public health research and interventions for greater relevance and impact on disadvantaged communities.By engaging affected residents and stakeholders in informed deliberation and decision-making about community health disparities, citizens' panels provide important guidance for (1) designing research studies to target the major health disparities affecting disadvantaged communities and (2) tailoring evidence-based interventions to the perspectives, practices, and preferences of disadvantaged residents.Employed as the primary methodology in 2 federally funded projects conducted in California and Arkansas between 2017 and 2019, citizens' panels offer a systematic method for obtaining rich community insight into health disparities, shaping community-informed solutions, and affording disadvantaged communities influence over public health decision-making to stimulate grassroots change and health equity.
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Affiliation(s)
- Andrew M Subica
- Andrew M. Subica and Brandon J. Brown are with the Department of Social Medicine, Population, and Public Health, Riverside School of Medicine, University of California, Riverside
| | - Brandon J Brown
- Andrew M. Subica and Brandon J. Brown are with the Department of Social Medicine, Population, and Public Health, Riverside School of Medicine, University of California, Riverside
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12
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Kumanyika SK. A Framework for Increasing Equity Impact in Obesity Prevention. Am J Public Health 2019; 109:1350-1357. [PMID: 31415203 PMCID: PMC6727309 DOI: 10.2105/ajph.2019.305221] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 11/04/2022]
Abstract
One of the most pressing unmet challenges for preventing and controlling epidemic obesity is ensuring that socially disadvantaged populations benefit from relevant public health interventions. Obesity levels are disproportionately high in ethnic minority, low-income, and other socially marginalized US population groups. Current policy, systems, and environmental change interventions target obesity-promoting aspects of physical, economic, social, and information environments but do not necessarily account for inequities in environmental contexts and, therefore, may perpetuate disparities.I propose a framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking policy, systems, and environmental change strategies. My core argument is that these approaches to improving options for healthy eating and physical activity should be linked to strategies that account for or directly address social determinants of health.I describe the framework rationale and elements and provide research and practice examples of its use in the US context. The approach may also apply to other health problems and in countries where similar inequities are observed.
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Affiliation(s)
- Shiriki K Kumanyika
- Shiriki K. Kumanyika is with the Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA
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13
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Korn AR, Hennessy E, Tovar A, Finn C, Hammond RA, Economos CD. Engaging Coalitions in Community-Based Childhood Obesity Prevention Interventions: A Mixed Methods Assessment. Child Obes 2018; 14:537-552. [PMID: 30188181 PMCID: PMC6249669 DOI: 10.1089/chi.2018.0032] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Childhood obesity prevention interventions have engaged coalitions in study design, implementation, and/or evaluation to improve research outcomes; yet, no systematic reviews have been conducted on this topic. This mixed methods review aims to characterize the processes and dynamics of coalition engagement in community-based childhood obesity prevention interventions. METHODS Data Sources: Studies extracted from Ovid MEDLINE, PubMed, and Web of Science; complementary original survey and interview data among researchers of included studies. Eligible Studies: Multisetting community-based obesity prevention interventions in high-income countries targeting children 0-12 years with anthropometric, behavioral, or environmental/policy outcomes. The Community-Based Participatory Research (CBPR) Conceptual Model was used as an overarching framework. RESULTS Thirteen studies met inclusion criteria. Elements of CBPR were evident across all studies with community engagement in problem identification (n = 7), design/planning (n = 11), implementation (n = 12), evaluation (n = 4), dissemination (n = 2), and sustainability (n = 10) phases. Five studies reported favorable intervention effects on anthropometric (n = 4), behavioral (n = 1), and/or policy (n = 1) outcomes; descriptive associations suggested that these studies tended to engage community members in a greater number of research phases. Researchers involved in 7 of 13 included studies completed a survey and interview. Respondents recalled the importance of group facilitation, leadership, and shared understanding to multisector coalition work. Perceived coalition impacts included community capacity building and intervention sustainability. CONCLUSIONS This review contributes to a deeper understanding of intervention processes and dynamics within communities engaged in childhood obesity prevention. Future research should more rigorously assess and report on coalition involvement to assess the influence of coalitions on multiple outcomes, including child weight status.
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Affiliation(s)
- Ariella R. Korn
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Erin Hennessy
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Camille Finn
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Christina D. Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.,Address correspondence to: Christina D. Economos, PhD, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111
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14
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Senteio CR. Investigating the Enduring Impact of a Community-Based Health Education Program to Promote African American Elders' Use of Technology Designed to Support Chronic Disease Self-Management. Geriatrics (Basel) 2018; 3:E70. [PMID: 31011105 PMCID: PMC6371165 DOI: 10.3390/geriatrics3040070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 01/07/2023] Open
Abstract
Elders experience chronic disease disparities and barriers to access technology designed to support recommended self-management behaviors. Elders from racial minority groups are among those who experience particular disparities in chronic disease incidence, outcomes, and barriers to technology use. In order to investigate strategies to address barriers, the study team recruited elder African Americans with diabetes and young adults connected to the elders through naturally occurring familial or social networks. Participants attended a community-based health education session focused on enhancing self-efficacy for recommended self-management and using consumer-oriented technology accessible on their smartphones for self-management support. To assess enduring impact, the study team conducted a pilot study to investigate perceptions and use one month following the health education session. Both elders and young adults offered perspectives on what was effective in teaching elders how to use technology. Both age groups stressed that having patience was crucial, as is providing encouragement for the elders to try tasks on their own. Both elders and young adults also showed a statistically significant increase in aspirations to work together for additional intergenerational health and technology knowledge exchange. Several elder participants continued using technology that they first used during the session. This novel, pilot study describes how to promote self-management and technology use for individuals plagued by persistent chronic disease and technology use disparities.
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Affiliation(s)
- Charles R Senteio
- School of Communication and Information, Rutgers University, New Brunswick, NJ 08901, USA.
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Alicea-Planas J, Sullivan K, Tran H, Cruz A. Planting Seeds to Grow Healthy Children: Strategic Community Partnerships. Health Promot Pract 2018; 20:78-84. [PMID: 29433341 DOI: 10.1177/1524839918757486] [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: 11/15/2022]
Abstract
More than one third of U.S adults are considered obese, and childhood obesity has more than doubled in the past 30 years. Food security can influence obesity, in particular, within inner cities where access to healthy food is often limited. The use of a mobile food truck program (with refrigeration) was implemented in two large inner cities in Connecticut as part of an initiative aimed at helping low-income families with young children gain access to healthy food and nutrition education. Collaborating with community child care centers was used. The experiences of the families who participated in the program were assessed via focus groups. Main ideas derived from the focus groups were participant satisfaction with money saving suggestions, ideas for how to make healthier choices, and excitement about opportunities to receive foods that they would not normally buy. This innovative mobile food truck program demonstrated the value of strategic community partnerships to influence health.
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Affiliation(s)
| | | | - Hang Tran
- 1 Fairfield University, Fairfield, CT, USA
| | - Anna Cruz
- 1 Fairfield University, Fairfield, CT, USA
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16
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Sharp RM, Brabander DJ. Lead (Pb) Bioaccessibility and Mobility Assessment of Urban Soils and Composts: Fingerprinting Sources and Refining Risks to Support Urban Agriculture. GEOHEALTH 2017; 1:333-345. [PMID: 32158980 PMCID: PMC7007118 DOI: 10.1002/2017gh000093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 05/24/2023]
Abstract
While the presence of legacy lead (Pb) in urban soil is well documented, less is known about the bioaccessibility, transport, and exposure pathways of urban soil Pb. We study Pb bioaccessibility in Roxbury and Dorchester, MA, urban gardens to assess exposure risk and identify remediation strategies, applicable locally and in urban gardens across the country. We work in partnership with The Food Project, which brings the goals and perspectives of local farmers to the center of the research process and enables efficient local application of results to reduce Pb exposure. We measure changes in Pb bioaccessibility as a function of growing material, grain size, and Pb source. In comparison to soils, compost has lower total Pb concentrations, has lower Pb solubility in gastric fluid, and limits fine particle resuspension. The mean bioaccessible Pb concentration of compost is 265 mg/kg, nearly an order of magnitude lower than that of soils, and compost contains 14% higher carbon content than soils, which may account for the observed 19% lower Pb bioaccessibility in compost. For all matrices (soil, raised bed fill, and compost) grain sizes <37 μm contain a disproportionate fraction of the total pool of bioaccessible Pb. Furthermore, the isotopic composition of Pb in the size fractions linked with resuspension and elevated blood lead levels is indicative of leaded gasoline and leaded paint even decades removed from the primary deposition of these sources.
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Affiliation(s)
| | - Daniel J. Brabander
- Environmental StudiesWellesley CollegeWellesleyMAUSA
- GeosciencesWellesley CollegeWellesleyMAUSA
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Effects of a School-Based Intervention on BMI z-Scores and Fitness Parameters in Mississippi Delta Children. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2017. [DOI: 10.5812/intjsh.13793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Douglas JA, Grills CT, Villanueva S, Subica AM. Empowerment Praxis: Community Organizing to Redress Systemic Health Disparities. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2016; 58:488-498. [PMID: 27859407 DOI: 10.1002/ajcp.12101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Social and environmental determinants of childhood obesity present a public health dilemma, particularly in low-income communities of color. Case studies of two community-based organizations participating in the Robert Wood Johnson Foundation's Communities Creating Healthy Environments (CCHE) childhood obesity initiative demonstrate multilevel, culturally situated community organizing strategies to address the root causes of this public health disparity. Informed by a 3-lens prescription-Social Justice, Culture-Place, and Organizational Capacity-contained in the CCHE Change Model and Evaluation Frame, we present examples of individual, organizational, and community empowerment to redress systemic inequities that manifest in poor health outcomes for people of color. These case studies offer compelling evidence that public health disparities in these communities may effectively be abated through strategies that employ bottom-up, community-level approaches for (a) identifying proximal and distal determinants of public health disparities, and (b) empowering communities to directly redress these inequities. Guided by this ecological framework, application of the CCHE evaluation approach demonstrated the necessity to document the granularity of community organizing for community health, adding to the community psychology literature on empowering processes and outcomes.
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Affiliation(s)
- Jason A Douglas
- Environmental Studies, College of Social Sciences, San Jose State University, San Jose, CA, USA
| | - Cheryl T Grills
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA, USA
| | - Sandra Villanueva
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA, USA
| | - Andrew M Subica
- Center for Healthy Communities, School of Medicine, University of California, Riverside, CA, USA
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19
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Subica AM, Grills CT, Villanueva S, Douglas JA. Community Organizing for Healthier Communities: Environmental and Policy Outcomes of a National Initiative. Am J Prev Med 2016; 51:916-925. [PMID: 27712948 DOI: 10.1016/j.amepre.2016.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Childhood obesity is disproportionately prevalent in communities of color, partially because of structural inequities in the social and built environment (e.g., poverty, food insecurity, pollution) that restrict healthy eating and active living. Community organizing is an underexamined, grassroots health promotion approach that empowers and mobilizes community residents to advocate for, and achieve, environmental and policy changes to rectify these structural inequities. This paper presents outcomes of the Robert Wood Johnson Foundation's Communities Creating Healthy Environments initiative: the first national program to apply community organizing to combat childhood obesity-causing structural inequities in communities of color. METHODS Twenty-one community-based organizations and tribal nations (grantees) conducted 3-year community organizing-based interventions primarily designed to increase children's healthy food and safe recreational access. Grantees' policy wins (environmental and policy changes resulting from grantee interventions) were measured from 2009 to 2014 using semi-structured interviews conducted quarterly and 6 months post-grant, and independently coded and reviewed in 2015 by researchers and expert community organizers. RESULTS The 21 grantees achieved 72 policy wins (mean=3.43, SD=1.78) across six domains: two directly addressed childhood obesity by enhancing children's healthy food (37.50%) and recreational access (33.33%), whereas four indirectly addressed obesity by promoting access to quality health care (8.33%); clean environments (9.73%); affordable housing (8.33%); and discrimination- and crime-free neighborhoods (2.78%). CONCLUSIONS These findings provide compelling evidence that community organizing-based interventions designed and led by community stakeholders can achieve diverse environmental and policy solutions to the structural inequities that foment childhood obesity in communities of color.
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Affiliation(s)
- Andrew M Subica
- Center for Healthy Communities, University of California Riverside School of Medicine, Riverside, California
| | - Cheryl T Grills
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, California.
| | - Sandra Villanueva
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, California
| | - Jason A Douglas
- Environmental Studies, San Jose State University, San Jose, California
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Grant-Guimaraes J, Feinstein R, Laber E, Kosoy J. Childhood Overweight and Obesity. Gastroenterol Clin North Am 2016; 45:715-728. [PMID: 27837784 DOI: 10.1016/j.gtc.2016.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Childhood overweight and obesity are increasing in prevalence and are a growing health concern. The diseases and their comorbidities have devastating consequences to children and adults as well as families, communities, and the nation. Comorbidities are cardiorespiratory, endocrinologic, gastrointestinal, orthopedic, and psychosocial. Health care providers are facing this crisis with limited medical, community, and federal resources and insufficient reimbursement. This article reviews recent trends in the assessment and treatment of this disease as well as trends in reimbursement, financial implications, and the need for further research and advocacy.
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Affiliation(s)
- Jamilah Grant-Guimaraes
- Hofstra Northwell School of Medicine, Cohen Children's Medical Center, 269-01, 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Ronald Feinstein
- Hofstra Northwell School of Medicine, Cohen Children's Medical Center, 269-01, 76th Avenue, New Hyde Park, NY 11040, USA
| | - Erica Laber
- Hofstra Northwell School of Medicine, Cohen Children's Medical Center, 269-01, 76th Avenue, New Hyde Park, NY 11040, USA
| | - Jennifer Kosoy
- Hofstra Northwell School of Medicine, Cohen Children's Medical Center, 269-01, 76th Avenue, New Hyde Park, NY 11040, USA
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