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Williams MS, McKinney SJ, Cheskin LJ. Social and Structural Determinants of Health and Social Injustices Contributing to Obesity Disparities. Curr Obes Rep 2024; 13:617-625. [PMID: 38878122 PMCID: PMC11306445 DOI: 10.1007/s13679-024-00578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE OF REVIEW: To analyze how social and structural determinants of health and social injustice impact the risk of obesity, its treatment and treatment outcomes, and to explore the implications for prevention and future treatment interventions. RECENT FINDINGS: Racial and ethnic minorities, such as non-Hispanic Black adults and Hispanic adults, and adults with a low socioeconomic status have a greater risk of obesity than non-Hispanic white adults and adults with a high socioeconomic status. The underlying causes of obesity disparities include obesogenic neighborhood environments, inequities in access to obesity treatment, and lack of access to affordable nutrient-dense foods. Experts have called for interventions that address the social and structural determinants of obesity disparities. Population-based interventions that focus on improving neighborhood conditions, discouraging the consumption of unhealthy foods and beverages, expanding access to obesity treatment, and ensuring equitable access to fruits and vegetables have been proven to be effective. There is a growing body of evidence that shows the relationship between social and structural determinants of health and injustice on disparities in obesity among racial and ethnic minorities and individuals with a low SES. Population-based, equity-focused interventions that address the underlying causes of obesity disparities are needed to reduce obesity disparities and improve the health outcomes of minoritized and marginalized groups.
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Affiliation(s)
- Michelle S Williams
- George Mason University, College of Public Health, Department of Global and Community Health, Fairfax, VA, 22030, United States
| | - Sheila J McKinney
- Jackson State University, School of Public Health, Department of Epidemiology and Biostatistics, Jackson, MS, 39217, United States
| | - Lawrence J Cheskin
- George Mason University, College of Public Health, Department of Nutrition and Food Studies, Fairfax, VA, 22030, United States.
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument Street, Baltimore, MD, 21205, USA.
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Onugha EA, Banerjee A, Vimalajeewa HD, Nobleza KJ, Nguyen DT, Racette SB, Dave JM. Dietary Sodium and Potassium Patterns in Adults with Food Insecurity in the Context of Hypertension Risk. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.01.24302167. [PMID: 38352358 PMCID: PMC10863033 DOI: 10.1101/2024.02.01.24302167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background Food insecurity (FIS), characterized by the lack of consistent access to nutritious food, is associated with hypertension and adverse health outcomes. Despite evidence of a higher prevalence of hypertension (HTN) in patients living with FIS, there is limited data exploring the underlying mechanism. Methods We conducted a cross-sectional analysis of 17,015 adults aged 18-65 years, using dietary recall data from the National Health and Nutrition Examination Survey (2011-2018). Univariate and multivariable analyses were used to examine the association between FIS, HTN, and dietary sodium and potassium levels. Results Individuals reporting FIS had a significantly lower mean intake of potassium (2.5±0.03 gm) compared to those in food-secure households (2.74±0.02 gm). No significant difference was found in the mean dietary sodium intake based on food security status. Non-Hispanic Black participants showed a high prevalence of HTN and FIS. While Non-Hispanic White and Hispanic participants had a high prevalence of FIS, it did not appear to influence their risk of HTN. Conclusions Adults with FIS and HTN were more likely to report a lower dietary potassium intake. Increasing access to healthy foods, particularly potassium-rich foods, for individuals facing FIS, may contribute to reducing the HTN prevalence and improving cardiovascular outcomes.
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Affiliation(s)
| | - Ankona Banerjee
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | | | - Duc T. Nguyen
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Susan B. Racette
- College of Health Solutions, Arizona State University, Phoenix, Arizona
| | - Jayna M. Dave
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- USDA/ARS Children’s Nutrition Research Center
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Hill AB, Kaur R, Sundermeir SM, Kasprzak C, Winkler M, John S, Dombrowski RD, Bode B, Gittelsohn J. Refining the Nutrition Environment Measures Survey (NEMS) for Healthy Community Stores: Adaptations to Capture Alternative Food Retailers and Align with Dietary Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912875. [PMID: 36232175 PMCID: PMC9566451 DOI: 10.3390/ijerph191912875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 05/27/2023]
Abstract
Inadequate consumption of healthy food is an ongoing public health issue in the United States. Food availability measures of supply versus consumption of healthy foods are disconnected in many studies. There is a need for an objective assessment of the food environment in order to assess how the food supply aligns with the Healthy Eating Index (HEI). Data were collected as part of the Healthy Community Stores Case Study Project, including a refined Nutrition Environment Measures Survey for Healthy Community Stores (NEMS-HCS) and an updated Healthy Food Availability Index that aligns with the Healthy Eating Index (HFAHEI). This paper will focus on the NEMS-HCS development process, findings, and HFAHEI application. All food items were more likely to be found at grocery stores rather than corner stores. Food pricing was often above the Consumer Price Index averages for six food items. The NEMS-HCS assessment better aligned with the HEI because it included a wider variety of meats, frozen fruits and vegetables, and an increased selection of whole grains. HFAHEI scoring was inclusive of non-traditional and alternative community stores with a health focus, making it suitable for use at the local level, especially in neighborhoods where supermarkets and large chain stores are less common.
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Affiliation(s)
- Alex B. Hill
- Detroit Food Map Initiative and Department of Urban Studies and Planning, College of Liberal Arts and Sciences, Wayne State University, Detroit, MI 48202, USA
| | - Ravneet Kaur
- Division of Health Research and Evaluation, Department of Family and Community Medicine, College of Medicine, University of Illinois, Rockford, IL 61107, USA
| | - Samantha M. Sundermeir
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Christina Kasprzak
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14260, USA
| | - Megan Winkler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Sara John
- Center for Science in the Public Interest, Washington, DC 20005, USA
| | - Rachael D. Dombrowski
- Departments of Public Health and Kinesiology, College of Education, Health and Human Services, California State University San Marcos, San Marcos, CA 92096, USA
| | - Bree Bode
- Division of Kinesiology, Heath and Sport Studies, College of Education, Detroit, MI 48202, USA
| | - Joel Gittelsohn
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Sundermeir SM, Winkler MR, John S, Colón-Ramos U, Kaur R, Hickson A, Dombrowski RD, Hill AB, Bode B, DeAngelo J, Gittelsohn J. A Commentary on the Healthy Community Stores Case Study Project: Implications for Retailers, Policy, and Future Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8824. [PMID: 35886677 PMCID: PMC9324473 DOI: 10.3390/ijerph19148824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022]
Abstract
In the United States, low-income, underserved rural and urban settings experience poor access to healthy, affordable food. Introducing new food outlets in these locations has shown mixed results for improving healthy food consumption. The Healthy Community Stores Case Study Project (HCSCSP) explored an alternative strategy: supporting mission-driven, locally owned, healthy community food stores to improve healthy food access. The HCSCSP used a multiple case study approach, and conducted a cross-case analysis of seven urban healthy food stores across the United States. The main purpose of this commentary paper is to summarize the main practice strategies for stores as well as future directions for researchers and policy-makers based on results from the prior cross-case analyses. We organize these strategies using key concepts from the Retail Food Environment and Customer Interaction Model. Several key strategies for store success are presented including the use of non-traditional business models, focus on specific retail actors such as store champions and multiple vendor relationships, and a stores' role in the broader community context, as well as the striking challenges faced across store locations. Further exploration of these store strategies and how they are implemented is needed, and may inform policies that can support these types of healthy retail sites and sustain their efforts in improving healthy food access in their communities.
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Affiliation(s)
- Samantha M. Sundermeir
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Megan R. Winkler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Sara John
- Center for Science in the Public Interest, Washington, DC 20005, USA; (S.J.); (A.H.)
| | - Uriyoán Colón-Ramos
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA;
| | - Ravneet Kaur
- Department of Family and Community Medicine, University of Illinois College of Medicine, Rockford, IL 61107, USA;
| | - Ashley Hickson
- Center for Science in the Public Interest, Washington, DC 20005, USA; (S.J.); (A.H.)
| | - Rachael D. Dombrowski
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (R.D.D.); (B.B.)
| | - Alex B. Hill
- Urban Studies and Planning and Detroit Food Map Initiative, Wayne State University, Detroit, MI 48202, USA;
| | - Bree Bode
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (R.D.D.); (B.B.)
| | - Julia DeAngelo
- Departments of Health Policy Management & Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
| | - Joel Gittelsohn
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
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John S, Winkler MR, Kaur R, DeAngelo J, Hill AB, Sundermeir SM, Colon-Ramos U, Leone LA, Dombrowski RD, Lewis EC, Gittelsohn J. Balancing Mission and Margins: What Makes Healthy Community Food Stores Successful. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8470. [PMID: 35886315 PMCID: PMC9315622 DOI: 10.3390/ijerph19148470] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022]
Abstract
Mission-driven, independently-owned community food stores have been identified as a potential solution to improve access to healthy foods, yet to date there is limited information on what factors contribute to these stores' success and failure. Using a multiple case study approach, this study examined what makes a healthy community food store successful and identified strategies for success in seven community stores in urban areas across the United States. We used Stake's multiple case study analysis approach to identify the following key aims that contributed to community store success across all cases: (1) making healthy food available, (2) offering healthy foods at affordable prices, and (3) reaching community members with limited economic resources. However, stores differed in terms of their intention, action, and achievement of these aims. Key strategies identified that enabled success included: (1) having a store champion, (2) using nontraditional business strategies, (3) obtaining innovative external funding, (4) using a dynamic sourcing model, (5) implementing healthy food marketing, and (6) engaging the community. Stores did not need to implement all strategies to be successful, however certain strategies, such as having a store champion, emerged as critical for all stores. Retailers, researchers, philanthropy, and policymakers can utilize this definition of success and the identified strategies to improve healthy food access in their communities.
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Affiliation(s)
- Sara John
- Center for Science in the Public Interest, Washington, DC 20005, USA
| | - Megan R. Winkler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Ravneet Kaur
- Division of Health Research and Evaluation, Department of Family and Community Medicine, University of Illinois College of Medicine, Rockford, IL 61107, USA;
| | - Julia DeAngelo
- Departments of Health Policy Management & Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
| | - Alex B. Hill
- Urban Studies and Planning and Detroit Food Map Initiative, Wayne State University, Detroit, MI 48202, USA;
| | - Samantha M. Sundermeir
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
| | - Uriyoan Colon-Ramos
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA;
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14260, USA;
| | - Rachael D. Dombrowski
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA;
| | - Emma C. Lewis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
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Kaur R, Winkler MR, John S, DeAngelo J, Dombrowski RD, Hickson A, Sundermeir SM, Kasprzak CM, Bode B, Hill AB, Lewis EC, Colon-Ramos U, Munch J, Witting LL, Odoms-Young A, Gittelsohn J, Leone LA. Forms of Community Engagement in Neighborhood Food Retail: Healthy Community Stores Case Study Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6986. [PMID: 35742235 PMCID: PMC9222525 DOI: 10.3390/ijerph19126986] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/05/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022]
Abstract
Community engagement is well established as a key to improving public health. Prior food environment research has largely studied community engagement as an intervention component, leaving much unknown about how food retailers may already engage in this work. The purpose of this study was to explore the community engagement activities employed by neighborhood food retailers located in lower-income communities with explicit health missions to understand the ways stores involve and work with their communities. A multiple case study methodology was utilized among seven retailers in urban U.S. settings, which collected multiple sources of data at each retailer, including in-depth interviews, store manager sales reports, store observations using the Nutrition Environment Measures Survey for Stores, public documents, and websites. Across-case analysis was performed following Stake's multiple case study approach. Results indicated that retailers employed a wide variety of forms of community engagement within their communities, including Outreach, Building Relationships through Customer Relations, Giving Back, Partnering with Community Coalitions, and Promoting Community Representation and Inclusiveness. Strategies that built relationships through customer relations were most common across stores; whereas few stores demonstrated community inclusiveness where members participated in store decision making. Findings provide a more comprehensive view of the ways local food retailers aim to develop and sustain authentic community relationships. Additional research is needed to evaluate the impact of community engagement activities on improving community health.
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Affiliation(s)
- Ravneet Kaur
- Department of Family and Community Medicine, University of Illinois College of Medicine, Rockford, IL 61107, USA
| | - Megan R. Winkler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA;
| | - Sara John
- Center for Science in the Public Interest, 1250 I St NW, Floor 5, Washington, DC 20005, USA; (S.J.); (A.H.)
| | - Julia DeAngelo
- Departments of Health Policy Management & Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA;
| | - Rachael D. Dombrowski
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (R.D.D.); (B.B.)
| | - Ashley Hickson
- Center for Science in the Public Interest, 1250 I St NW, Floor 5, Washington, DC 20005, USA; (S.J.); (A.H.)
| | - Samantha M. Sundermeir
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
| | - Christina M. Kasprzak
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14260, USA; (C.M.K.); (L.A.L.)
| | - Bree Bode
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA; (R.D.D.); (B.B.)
| | - Alex B. Hill
- Urban Studies and Planning and Detroit Food Map Initiative, Wayne State University, Detroit, MI 48202, USA;
| | - Emma C. Lewis
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
| | - Uriyoan Colon-Ramos
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA; (U.C.-R.); (L.L.W.)
| | - Jake Munch
- School of Natural Sciences and Mathematics, The University of Texas at Dallas, Richardson, TX 75080, USA;
| | - Lillian L. Witting
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA; (U.C.-R.); (L.L.W.)
| | - Angela Odoms-Young
- Division of Nutritional Science, College of Human Ecology, Cornell University, Ithaca, NY 14853, USA;
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA; (S.M.S.); (E.C.L.); (J.G.)
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY 14260, USA; (C.M.K.); (L.A.L.)
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