Antibiotic use in goats: role of experience and education of Missouri veterinarians.

BACKGROUND: In a previous study, we found that rates of antibiotic residues in goat carcasses in Missouri were three times the published national average, warranting further research in this area. METHODS: We conducted a cross-sectional survey of goat veterinarians to determine attitudes and practices regarding antibiotics, recruiting 725 veterinarians listed on the American Association of Small Ruminant Practitioners (AASRP) website and 64 Missouri Veterinary Medical Association (MVMA) veterinarians. RESULTS: We collected 189 responses (26.1%) from AASRP members (170 valid) and 8 (12.5%) from MVMA veterinarians totalling 178 responses. While the vast majority of all veterinarians indicated that they prescribed antibiotics less than half of the time, Missouri veterinarians indicated that they spent more time treating goats for overt disease like intestinal parasites and less time on proactive practices such as reproductive herd health management comparatively. While veterinarians agreed that antibiotic resistance was a growing concern, veterinarians outside of Missouri seemed more confident that their own prescription practices was not a contributor. Although nationally most veterinarians felt that attending continuing education classes was beneficial, 73.4% in other states attended classes on antibiotic use compared to only four of the nine Missouri veterinarians. CONCLUSION: Missouri veterinarians had less veterinary experience than veterinarians in other states, and this, in conjunction with low continuing education requirements in Missouri relative to most other states, may hinder development of more proactive and effective client-veterinary relationships.

Determinants of organ donation registration.

Rates of organ donor registration range from 20% to 60% throughout the United States. The purpose of this study was to examine sociogeographic differences in organ donor registration rates throughout Missouri to identify varying patterns The organ donor registration rate from each Department of Motor Vehicle office in Missouri was extracted from the National Organ Registration database, office locations were geocoded, and census tract level sociodemographic characteristics were extracted. Spatial regression analyses were conducted to identify relationships between location of DMV offices and census tract-level concentrated disadvantage. Census tract-level concentrated disadvantage (education attainment, poverty, single-headed households) had a significant negative relationship with organ donor registration rates. Yet, census tract-level African American/Black resident concentration was not significantly related to organ donor registration rates. These findings suggest that race-based interventions to recruit organ donors may no longer be necessary. Yet, identifying how characteristics of concentrated disadvantage may be more influential in determining organ donor registration. Gaining a better understanding of how individual decisions are made is integral in the context of increased life expectancy in conjunction with the complex management of chronic conditions.

Armed Conflict in Central America and Immigrant Food Insecurity in the United States.

Central American immigrants to the United States are a growing population with rates of food insecurity that exceed national averages. We analyzed multiple years of data from the Center for System Peace and the Current Population Survey, Food Security Survey Module, from 1998 to 2015. We used ordered probit and probit regressions to quantify associations between premigration residence in a country exposed to armed conflict in Central America and the food insecurity of immigrants in the United States. The study sample included 5682 females and 5801 males between the ages of 19 and 69 years who were born in Central America and migrated to the United States. The mean age of individuals included in the study sample was 38.2 years for females (standard deviation, 11.0) and 36.8 years for males (standard deviation, 10.6). Premigration armed conflict was associated with a 10.7% point increase in postmigration food insecurity among females (95% confidence interval, 6.8-14.5), and a 9.5% point increase among males (95% confidence interval, 5.0-14.0).

Adaptation of a Modified DASH Diet to a Rural African American Community Setting.

INTRODUCTION: Cardiovascular disease is the leading cause of death among African Americans in the U.S., with high blood pressure and obesity being two of the main determinants. The Dietary Approaches to Stop Hypertension diet is effective in changing behaviors associated with these health concerns, but has not been adapted to community settings. METHODS: Men on the Move: Growing Communities (MOTMGC) was evaluated using a quasi-experimental cross-sectional design. Surveys were conducted with rural African Americans aged ≥18 years prior to the intervention (2008) and at the end of the project (2013), with the final analysis conducted in 2015. Using a community-based participatory research approach, MOTMGC provided culturally appropriate education and changes to the environment to improve access to fruits and vegetables, low-fat, and low-sodium foods. RESULTS: Declines in prevalence of overweight and obese respondents and hypertension were seen in the intervention but not the comparison county. Participants with high levels of participation reported eating five or more servings of fruits and vegetables a day, a greater variety of fruits and vegetables, less salt, and seasoning their vegetables with less fat more often than those who did not participate in educational activities. Participants reported that as a result of their access to MOTMGC gardens, they were more likely to eat more fruits, vegetables, and locally grown food, and less processed food and fast food. CONCLUSIONS: Adapting the Dietary Approaches to Stop Hypertension diet to community settings through culturally appropriate community-based efforts can improve dietary behaviors, BMI, and blood pressure.

A Participatory Regional Partnership Approach to Promote Nutrition and Physical Activity Through Environmental and Policy Change in Rural Missouri.

BACKGROUND: Rural residents are less likely than urban and suburban residents to meet recommendations for nutrition and physical activity. Interventions at the environmental and policy level create environments that support healthy eating and physical activity. COMMUNITY CONTEXT: Healthier Missouri Communities (Healthier MO) is a community-based research project conducted by the Prevention Research Center in St. Louis with community partners from 12 counties in rural southeast Missouri. We created a regional partnership to leverage resources and enhance environmental and policy interventions to improve nutrition and physical activity in rural southeast Missouri. METHODS: Partners were engaged in a participatory action planning process that included prioritizing, implementing, and evaluating promising evidence-based interventions to promote nutrition and physical activity. Group interviews were conducted with Healthier MO community partners post intervention to evaluate resource sharing and sustainability efforts of the regional partnership. OUTCOME: Community partners identified the benefits and challenges of resource sharing within the regional partnership as well as the opportunities and threats to long-term partnership sustainability. The partners noted that the regional participatory process was difficult, but the benefits outweighed the challenges. INTERPRETATION: Regional rural partnerships may be an effective way to leverage relationships to increase the capacity of rural communities to implement environmental and policy interventions to promote nutrition and physical activity.

Association between community garden participation and fruit and vegetable consumption in rural Missouri.

BACKGROUND: Fruit and vegetable consumption reduces chronic disease risk, yet the majority of Americans consume fewer than recommended. Inadequate access to fruits and vegetables is increasingly recognized as a significant contributor to low consumption of healthy foods. Emerging evidence shows the effectiveness of community gardens in increasing access to, and consumption of, fruits and vegetables. METHODS: Two complementary studies explored the association of community garden participation and fruit and vegetable consumption in rural communities in Missouri. The first was with a convenience sample of participants in a rural community garden intervention who completed self-administered surveys. The second was a population-based survey conducted with a random sample of 1,000 residents in the intervention catchment area. RESULTS: Participation in a community garden was associated with higher fruit and vegetable consumption. The first study found that individuals who worked in a community garden at least once a week were more likely to report eating fruits and vegetables because of their community garden work (X² (125) = 7.78, p = .0088). Population-based survey results show that 5% of rural residents reported participating in a community garden. Those who reported community garden participation were more likely to report eating fruits 2 or more times per day and vegetables 3 or more times per day than those who did not report community garden participation, even after adjusting for covariates (Odds Ratio [OR] = 2.76, 95% Confidence Interval [CI] = 1.35 to 5.65). CONCLUSION: These complementary studies provide evidence that community gardens are a promising strategy for promoting fruit and vegetable consumption in rural communities.

Understanding and addressing barriers to implementation of environmental and policy interventions to support physical activity and healthy eating in rural communities.

PURPOSE: Rural residents are at greater risk of obesity than urban and suburban residents. Failure to meet physical activity and healthy eating recommendations play a role. Emerging evidence shows the effectiveness of environmental and policy interventions to promote physical activity and healthy eating. Yet most of the evidence comes from urban and suburban communities. The objectives of this study were to (1) identify types of environmental and policy interventions being implemented in rural communities to promote physical activity or healthy eating, (2) identify barriers to the implementation of environmental or policy interventions, and (3) identify strategies rural communities have employed to overcome these barriers. METHODS: Key informant interviews with public health professionals working in rural areas in the United States were conducted in 2010. A purposive sample included 15 practitioners engaged in planning, implementing, or evaluating environmental or policy interventions to promote physical activity or healthy eating. FINDINGS: Our findings reveal that barriers in rural communities include cultural differences, population size, limited human capital, and difficulty demonstrating the connection between social and economic policy and health outcomes. Key informants identified a number of strategies to overcome these barriers such as developing broad-based partnerships and building on the existing infrastructure. CONCLUSION: Recent evidence suggests that environmental and policy interventions have potential to promote physical activity and healthy eating at the population level. To realize positive outcomes, it is important to provide opportunities to implement these types of interventions and document their effectiveness in rural communities.

Exploring community health through the Sustainable Livelihoods framework.

Health disparities are a major concern in the United States. Research suggests that inequitable distribution of money, power, and resources shape the circumstances for daily life and create and exacerbate health disparities. In rural communities, inequitable distribution of these structural factors seems to limit employment opportunities. The Sustainable Livelihoods framework, an economic development model, provides a conceptual framework to understand how distribution of these social, economic, and political structural factors affect employment opportunities and community health in rural America. This study uses photo-elicitation interviews, a qualitative, participatory method, to understand community members' perceptions of how distribution of structural factors through creation and maintenance of institutional practices and policies influence employment opportunities and, ultimately, community health for African Americans living in rural Missouri.

Tools for building clinic-community partnerships to support chronic disease control and prevention.

PURPOSE: Developing partnerships among health care clinics and community organizations is an important strategy for increasing resources and supports for chronic disease care and management. Although several tools assessing partnership characteristics exist, tools to assess the progression from partnership development to the achievement of specific short-term, intermediate, and long-term outcomes have not been developed to date. The purpose of this article is to introduce tools developed by the Diabetes Initiative of the Robert Wood Johnson Foundation to fill that gap. CONCLUSION: The Diabetes Initiative used a group process with program grantees to better delineate the phases of partnership development that contribute to the achievement of a shared long-term goal. The Framework for Building Clinic-Community Partnerships to Support Chronic Disease Control and Prevention presented in this article was developed as a result of this process. To apply the framework, 3 checklists were created to correspond to each stage of the framework. The final tools include the framework; 3 checklists with items to assess partnership development, agency capacity within and between agencies, and intermediate and long-term outcomes; and a form to facilitate changes to improve the partnership. Overall, these tools seek to aid partnerships in achieving the best possible chronic disease outcomes.

The association of sidewalk walkability and physical disorder with area-level race and poverty.

INTRODUCTION: There are significant differences in physical inactivity in various geographical areas and among demographic groups. Previous research suggests that walking is the most common form of physical activity; however, not all built environments support walking for recreational or transportation purposes. OBJECTIVE: The purpose of this study was to assess the extent to which area-level factors, poverty rate and racial distribution, are associated with aspects of the street-scale environment (i.e. sidewalk walkability and physical disorder) using community audits. METHODS: Street segments were randomly selected from 210 block groups. Pairs of trained auditors walked each street segment using an audit tool designed to capture aspects of the street environment. Multilevel logistic regression was used to assess the degree of neighborhood (i.e. block group) variation in sidewalk unevenness, sidewalk obstruction and the presence of physical disorder and the association with area-level characteristics. RESULTS: 1780 street segments were audited. Block groups that were predominantly African-American were 38 times more likely to have a lot of unevenness, 15 times more likely to have many obstructions, and 12 times more likely to have physical disorder. Poverty rate was not independently associated with sidewalk walkability; however, block groups with the highest poverty rates were 21 times more likely to have physical disorder. CONCLUSION: The results indicate that aspects of the built environment vary by characteristics of the neighborhood. This suggests that there is a differential investment in community infrastructures and resources in neighborhoods that are mostly African-American. This differential investment is likely to influence disparities in rates of physical activity.