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Fan Z, Xu M, Chen S, Wang J, Gong Y, Feng X, Yin X. Association of Socioeconomic Status and a Broad Combination of Lifestyle Factors With Adult-Onset Asthma: A Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00393-3. [PMID: 38631523 DOI: 10.1016/j.jaip.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The prevalence of asthma is gradually increasing worldwide, and there are socioeconomic inequalities in the risk of developing asthma. OBJECTIVE To evaluate whether the lifestyle is associated with asthma in adults, as well as whether and to what extent healthy lifestyles may modify socioeconomic status (SES) inequities in asthma. METHODS This study included a total of 223,951 participants from the UK Biobank. Smoking, physical activity, alcohol consumption, healthy diet patterns, sedentary time, and sleep duration items were used to construct the lifestyle score. Income, education, and occupation were used to assess SES. Cases of adult-onset asthma were identified on the basis of electronic health records. The Cox proportional hazards regression was used to explore the association of socioeconomic inequality and lifestyle factors with asthma. RESULTS Compared with the most healthy lifestyle category, the hazard ratios (95% CIs) of the moderately healthy lifestyle and least healthy lifestyle categories for asthma were 1.08 (1.01-1.15) and 1.29 (1.20-1.39), respectively. A significant interaction (Pinteraction < .05) was found between lifestyle categories and SES, and the association between them was more pronounced in participants with low SES (hazard ratioleast healthy vs most healthy, 1.58; 95% CI, 1.40-1.80). The joint analysis revealed that the risk of asthma was highest among participants with the lowest SES and the least healthy lifestyles (hazard ratio, 2.02; 95% CI, 1.74-2.33). CONCLUSIONS Unhealthy lifestyle factors are associated with an increased risk of asthma in adults, and socioeconomically disadvantaged groups are more negatively affected by unhealthy lifestyles. Public health strategies for asthma prevention may need to be tailored according to SES, and social policies to reduce poverty are needed alongside lifestyle interventions in areas of deprivation.
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Affiliation(s)
- Zina Fan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Minzhi Xu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shanquan Chen
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jing Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinglin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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D’Hooghe S, Inaç Y, De Clercq E, Deforche B, Dury S, Vandevijvere S, Van de Weghe N, Van Dyck D, De Ridder K. The CIVISANO protocol: a mixed-method study about the role of objective and perceived environmental factors on physical activity and eating behavior among socioeconomically disadvantaged adults. Arch Public Health 2022; 80:219. [PMID: 36199109 PMCID: PMC9533259 DOI: 10.1186/s13690-022-00956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 08/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overweight and obesity have a strong socioeconomic profile. Unhealthy behaviors like insufficient physical activity and an unbalanced diet, which are causal factors of overweight and obesity, tend to be more pronounced in socioeconomically disadvantaged groups in high income countries. The CIVISANO project aims to identify objective and perceived environmental factors among different socioeconomic population groups that impede or facilitate physical activity and healthy eating behavior in the local context of two peri-urban Flemish municipalities in Belgium. We also aim to identify and discuss possible local interventions and evaluate the participatory processes of the project. METHODS This study (2020-2023) will use community-based participatory tools, involving collaborative partnerships with civic and stakeholder members of the community and regular exchanges among all partners to bridge knowledge development and health promotion for socioeconomically disadvantaged citizens. Furthermore, a mixed-methods approach will be used. A population survey and geographic analysis will explore potential associations between the physical activity and eating behaviors of socioeconomically disadvantaged adults (25-65 years old) and both their perceived and objective physical, food and social environments. Profound perceptive context information will be gathered from socioeconomically disadvantaged adults by using participatory methods like photovoice, walk-along, individual map creation and group model building. An evaluation of the participatory process will be conducted simultaneously. DISCUSSION The CIVISANO project will identify factors in the local environment that might provoke inequities in adopting a healthy lifestyle. The combination of perceived and objective measures using validated strategies will provide a robust assessment of the municipality environment. Through this analysis, the project will investigate to what extent community engagement can be a useful strategy to reduce health inequities. The strong knowledge exchange and capacity-building in a local setting is expected to contribute to our understanding of how to maximize research impact in this field and generate evidence about potential linkages between a health enhancing lifestyle among socioeconomically disadvantaged groups and their physical, food and social environments.
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Affiliation(s)
- Suzannah D’Hooghe
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium ,grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium
| | - Yasemin Inaç
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium ,grid.5342.00000 0001 2069 7798Ghent University, Faculty of Sciences, Department of Geography, Ghent, Belgium
| | - Eva De Clercq
- grid.508031.fSciensano, Department of Chemical and Physical Health Risks, Brussels, Belgium
| | - Benedicte Deforche
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Brussels, Belgium
| | - Sarah Dury
- grid.8767.e0000 0001 2290 8069Vrije Universiteit Brussel (VUB), Faculty of Psychology and Educational Sciences, Adult Educational Sciences, Brussels, Belgium
| | - Stefanie Vandevijvere
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium
| | - Nico Van de Weghe
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Sciences, Department of Geography, Ghent, Belgium
| | - Delfien Van Dyck
- grid.5342.00000 0001 2069 7798Ghent University, Faculty of Medicine and Health Sciences, Department of Movement and Sports Sciences, Brussels, Belgium
| | - Karin De Ridder
- grid.508031.fSciensano, Department of Epidemiology and Public Health, Brussels, Belgium
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Serafim P, Borges CA, Cabral-Miranda W, Jaime PC. Ultra-Processed Food Availability and Sociodemographic Associated Factors in a Brazilian Municipality. Front Nutr 2022; 9:858089. [PMID: 35529462 PMCID: PMC9067397 DOI: 10.3389/fnut.2022.858089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Abstract
The availability of ultra-processed foods in a municipality tends to be related to different types of food retailers and their location in the territory, besides social, economic, and demographic factors. The aim of this study was to evaluate the availability of ultra-processed foods according to different types of food retailers and sociodemographic factors. This is a cross-sectional observational study carried out with audit data from food retailers in the municipality of Jundiaí, SP. Using a validated instrument, data on the availability of 18 types of ultra-processed foods were used to create a score of ultra-processed foods, ranging from 0 to 100 points, and five subscores referring to the ultra-processed food subgroups. Descriptive statistics and means comparison tests were performed to verify differences in the ultra-processed food availability score, according to the food retail type, household income, number of household members, and percentage of people of the color population in the census tract in which food retailers were located. Geo-referenced maps were used to characterize the score of ultra-processed in the territory, according to sociodemographic variables. A total of 649 food retailers were analyzed, most of which were classified as neighborhood markets (25.4%). The supermarkets were the category with the highest ultra-processed food availability score. Among the subgroups of ultra-processed foods analyzed, candies, soft drinks, and snacks were available in 60% of the food retailers. Higher ultra-processed food availability score was observed in regions with lower income, higher percentage of people of color population, and higher number of members per household. The findings show that the greater availability of ultra-processed foods is related to supermarkets and markets and regions of greater social vulnerability, which can put this population at nutritional risk.
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Affiliation(s)
- Patricia Serafim
- Post-Graduate Program in Nutrition and Public Health, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Camila Aparecida Borges
- Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, Brazil
| | - William Cabral-Miranda
- Faculty of Philosophy, Letters and Human Sciences, University of São Paulo, São Paulo, Brazil
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Babashahi M, Omidvar N, Joulaei H, Zargaraan A, Zayeri F, Veisi E, Doustmohammadian A, Kelishadi R. Scrutinize of healthy school canteen policy in Iran's primary schools: a mixed method study. BMC Public Health 2021; 21:1566. [PMID: 34407797 PMCID: PMC8375065 DOI: 10.1186/s12889-021-11587-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Schools provide an opportunity for developing strategies to create healthy food environments for children. The present study aimed to analyze the Healthy School Canteen (HSC) policy and identify challenges of its implementation to improve the school food environment in Iran. METHODS This mixed method study included two qualitative and quantitative phases. In the qualitative phase, triangulation approach was applied by using semi-structured interviews with key informants, documents review and direct observation. Data content analysis was conducted through policy analysis triangle framework. In the quantitative phase, food items available in 64 canteens of primary schools of Tehran province were gathered. The food's nutrient data were evaluated using their nutrition facts label. The number and proportion of foods that met the criteria based on Iran's HSC guideline and the World Health Organization nutrient profile model for the Eastern Mediterranean Region (WHO-EMR) were determined. RESULTS The main contextual factors that affected adoption of HSC policy included health (nutritional transition, high prevalence of non-communicable diseases and unhealthy food environment in and around the schools), political (upstream supportive policies and joint memorandums about health children between the Ministry of Health and Medical Education and Ministry of Education), structural (the lack of unified stewardship, inadequate human resource capacity, poor inter-sectional cooperation), economic (school financial problems, poor fiscal supportive of food policies), and socio-cultural (mothers working outside the home, the role of children's peer group, low nutrition knowledge of school principals) factors. Assessment of the school canteens showed that a large proportion of available foods did not comply with the national guidelines (54.7 ± 2.54%) and WHO-EMR model (85.6 ± 2.34%). The main reasons identified for incomplete implementation of the policy were inadequate physical and economic infrastructure to set up standard school canteens, lack of scientific criteria for food categorization, poor monitoring, high price of healthy foods, and conflict of interest among the actors. CONCLUSION The majority of foods and beverages available in the school canteens did not comply with national and regional standards. Iran HSC policy needs to be improved by using an evidence-based approach and active interaction between all key actors.
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Affiliation(s)
- Mina Babashahi
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azizollaah Zargaraan
- Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Zayeri
- Proteomics Research Center and Department of Biostatistics, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Veisi
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Doustmohammadian
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Fuster M, Pouget ER, Handley MA, Ray K, Elbel B, Sakowitz EN, Halvey K, Huang T. Ethnic Restaurant Nutrition Environments and Cardiovascular Health: Examining Hispanic Caribbean Restaurants in New York City. Ethn Dis 2020; 30:583-592. [PMID: 32989358 DOI: 10.18865/ed.30.4.583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To adapt and apply the Nutrition Environment Measures Survey for Restaurants (NEMS-R) to Hispanic Caribbean (HC) restaurants and examine associations between restaurant characteristics and nutrition environment measures. Methods We adapted the NEMS-R for HC cuisines (Cuban, Puerto Rican, Dominican) and cardiovascular health-promoting factors, and applied the instrument (NEMS-HCR) to a random sample of HC restaurants in New York City (NYC) (N=89). Multivariable linear regression was used to assess independent associations between NEMS-HCR score and restaurant characteristics (cuisine, size, type [counter-style vs sit-down] and price). Results None of the menus in the restaurants studied listed any main dishes as "healthy" or "light." More than half (52%) offered mostly (>75%) nonfried main dishes, and 76% offered at least one vegetarian option. The most common facilitator to healthy eating was offering reduced portion sizes (21%) and the most common barrier was having salt shakers on tables (40%). NEMS-HCR scores (100-point scale) ranged from 24.1-55.2 (mean=39.7). In multivariable analyses, scores were significantly related to cuisine (with Puerto Rican cuisine scoring lower than Cuban and Dominican cuisines), and size (with small [<22 seats] restaurants scoring lower than larger restaurants). We found a significant quadratic association with midpoint price, suggesting that scores increased with increasing price in the lowest price range, did not vary in the middle range, and decreased with increasing price in the highest range. Conclusions Our application of the NEMS-R to HC restaurants in NYC revealed areas for potential future interventions to improve food offerings and environmental cues to encourage healthful choices.
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Affiliation(s)
- Melissa Fuster
- Department of Health and Nutrition Science, Brooklyn College, City University of New York, Brooklyn, NY
| | - Enrique R Pouget
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA
| | - Krishnendu Ray
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | - Brian Elbel
- Department of Population Health, Grossman School of Medicine, and Wagner Graduate School of Public Service, New York University, New York, NY
| | - Eddie N Sakowitz
- Department of Health and Nutrition Science, Brooklyn College, City University of New York, Brooklyn, NY
| | - Kayla Halvey
- Department of Health and Nutrition Science, Brooklyn College, City University of New York, Brooklyn, NY
| | - Terry Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
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Kitunen A, Carins J, Rundle-Thiele S. Motivating Military Trainee Healthy Eating: Insight from Two Sites. Foods 2020; 9:foods9081053. [PMID: 32759775 PMCID: PMC7466327 DOI: 10.3390/foods9081053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/21/2022] Open
Abstract
This paper investigates eating behaviours and motivations of early career military trainees from two pathways (officer cadets and army recruits) to understand whether, and to what extent, healthful eating behaviours were present, and what motivates eating in general and healthful habits specifically. The study also sought to understand whether groups need strategies that are pathway specific or are transferrable across different trainee populations. Participants were recruited via email to complete an online survey and through in-person invitations to ensure a diverse cross section of trainees (n = 195) and recruits (n = 297). Two-step cluster analysis revealed three distinct segments with education, opportunity and motivation being the most important variables within a wider multivariate segment formation and stepwise linear regression was performed to identify the most optimal model with the least number of predictors for each segment. The ideal model for the uninterested segment contained nine predictors, seven predictors for the Breakfast skippers segment and eight predictors for the Weight conscious segment. This study found that there is room for improvement in the eating habits of military trainees across military training pathways. Eating motivations, and their associations with healthful eating habits, indicate a need for strategies that are broader than instilling or reinforcing health motivations. Strategies that can be implemented to support healthful eating for military trainees include provision of food preparation and cooking skills training, coupled with provision of social support and environments that facilitate healthful eating. Furthermore, three distinct segments were discovered within the trainee population, indicating that strategies for positively changing trainees’ eating behaviours may not need to be pathway specific, rather it may be possible to introduce the same group of segmented strategies across both pathways. Future research directions and limitations are outlined.
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Affiliation(s)
- Anna Kitunen
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (J.C.); (S.R.-T.)
- Correspondence: ; Tel.: +61-737-357-673
| | - Julia Carins
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (J.C.); (S.R.-T.)
- Food and Nutrition, Land Division, Defence Science and Technology, Scottsdale, TAS 7260, Australia
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (J.C.); (S.R.-T.)
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Kitunen A, Rundle-Thiele S, Carins J. Segmenting Young Adult University Student's Eating Behaviour: A Theory-Informed Approach. Nutrients 2019; 11:nu11112793. [PMID: 31731796 PMCID: PMC6893594 DOI: 10.3390/nu11112793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/26/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022] Open
Abstract
The purpose of this paper is to extend behavioural theory and segmentation application. Specifically, this paper draws on three segmentation bases and behavioural theory that extends focus beyond individual psychological predispositions to form segments within the healthy eating context for young adult university students (20–35 years) in Queensland, Australia. Participants were invited to take part in an online survey via email and through face to face intercept to ensure a diverse cross section was obtained. Structural equation modelling revealed that the Motivation, Opportunity, and Ability (MOA) framework can be utilised to explain healthful eating behaviour and two-step cluster analysis uncovered two distinct segments with education, motivation to eat healthily and Turconi’s eating behaviour scores being the most important variables within the wider multivariate segment formation. This paper contributes to literature in the following ways. First, it confirms the importance of behavioural bases in segment formation and supports inclusion of other bases, namely demographics and psychographics. Next, it provides evidence of the value of including behavioural theory, which extends focus beyond what individuals think to understand how the environment may support them. Finally, this paper demonstrates that the MOA framework together with eating behaviour and demographic factors (education) can produce theoretically informed segments.
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Affiliation(s)
- Anna Kitunen
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
- Correspondence: ; Tel.: +61-737-357-673
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
| | - Julia Carins
- Social Marketing @ Griffith, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia; (S.R.-T.); (J.C.)
- Food and Nutrition, Land Division, Defence Science and Technology, Scottsdale, TAS 7260, Australia
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