Sex-specific associations between self-reported physical activity and PTSD among survivors of sexual violence.

This study examined sex-specific associations between sexual violence (SV) type and physical activity, and identified associations between PTSD symptoms and physical activity, all among cisgender men and women survivors of SV. Cross-sectional data from men (n = 197) and women (n = 356) survivors of SV were analyzed with stratified (men; women) hierarchical logistic regressions. Additionally, fully adjusted models for the total sample included interaction terms to further assess whether associations between SV type as well as PTSD symptoms (sum, clusters) and physical activity differed significantly by sex. Sexual assault was negatively associated with physical activity in the crude model among women (ORs: 0.58; p < 0.05). Harassment was positively associated with physical activity in the crude and adjusted models (ORs:1.92-2.16; ps<0.05) among women. Among men, there were no significant relationships. Regarding PTSD symptoms among women, crude and adjusted stratified models identified significant positive relationships with intrusion (ORs: 1.18-1.22; ps<0.05). Crude and adjusted models revealed significant positive relationships between avoidance and activity (ORs:1.38-1.41; ps<0.05) among men but not women. The interaction term for this difference in the association between avoidance and physical activity by sex was significant (OR: 0.65; 95%CI: 0.48-0.88; p < 0.01). Overall, findings provide evidence for sex-specific associations between SV and physical activity.

Violent Crime, Physical Inactivity, and Obesity: Examining Spatial Relationships by Racial/Ethnic Composition of Community Residents.

Violence is a public health issue that disproportionately affects communities of color in urban centers. There is limited understanding of how violent crime is associated with adult physical inactivity and obesity prevalence given the racial/ethnic composition of community residents. This research aimed to address this gap by examining census tract-level data in Chicago, IL. Ecological data gathered from a variety of sources were analyzed in 2020. Violent crime rate represented the number of police-reported incidents of homicide, aggravated assault, and armed robbery per 1,000 residents. Spatial error and ordinary least square regression models were evaluated to determine if violent crime rate was significant associated with prevalence (%) of adult physical inactivity and obesity among all Chicago census tracts (N = 798), majority non-Hispanic (NH) White tracts (n = 240), majority NH Black tracts (n = 280), majority Hispanic tracts (n = 169), and racially diverse tracts (n = 109). Majority was defined as ≥ 50% representation. After adjusting for socioeconomic and environmental measures (e.g., median income, grocery store availability, walkability index), violent crime rate was associated with % physical inactivity and % obesity at the census tract level in Chicago, IL (both p < 0.001). Associations were statistically significant among majority NH Black and Hispanic tracts, but not majority NH White and racially diverse tracts. Future studies should evaluate the structural drivers of violence and the influence these drivers have on adult physical inactivity and obesity risk, particularly in communities of color.

County-level associations between food retailer availability and violent crime rate.

BACKGROUND: Violent crime (i.e., homicide, armed robbery, aggravated assault, and rape) continues to be a major public health concern in America. Several studies have linked the availability and density of specific features of the retail food environment, such as convenience stores and liquor stores, to violent crime rates due to the criminal activity that often occurs in and near these retailers. Nevertheless, there continues to be limited understanding of how other features (e.g., grocery stores, supercenters, restaurants, etc.) are associated with violent crime occurrence. This study aimed to fill this gap in knowledge by examining U.S. county-level associations between food retailer availability and violent crime rate. METHODS: We analyzed 2014 data on 3108 counties from the U.S. Department of Agriculture's Food Environment Atlas and Department of Justice's Unified Crime Reporting Program. Per capita food retailer measures represented the number of stores per 10,000 county residents. Violent crime rate represented the number of police reported violent crimes per 10,000 county residents. We used spatial lag regression models to assess associations between per capita retailer availability and violent crime rate after adjusting for potential confounders (e.g., % under 18, % Black, % Hispanic, % poverty, population density, etc.). In addition, we examined stratified OLS regression models to evaluate associations by metropolitan county status. RESULTS: Adjusted spatial regression models revealed that greater supercenter availability [ß: 2.42; 95% CI: 0.91-3.93; p-value: 0.001] and greater fast food restaurant availability [ß: 0.30; 95% CI: 0.18-0.42; p-value: < 0.001] were associated with higher violent crime rate. Greater availability of farmers' markets [ß: -0.42; 95% CI: -0.77 - - 0.07); p-value: 0.02] was associated with lower violent crime rate. Associations varied between metropolitan and non-metropolitan counties. Stratified OLS models revealed that greater grocery store availability was associated with lower violent crime rate among metropolitan counties only. Greater fast food restaurant availability was associated with lower violent crime rate among non-metropolitan counties only. CONCLUSIONS: Certain features of the retail food environment appear to be associated with county-level violent crime rates in America. These findings highlight the need for additional research on the influence of food retail and food landscape on violent crime occurrence at the community level.

Community-Level Factors Associated With Geographic Access to Food Retailers Offering Nutrition Incentives in Chicago, Illinois.

INTRODUCTION: Nutrition incentive programs provide low-income populations with a monetary resource to make healthy foods affordable and accessible. This study aimed to use geospatial analysis to evaluate availability of the Link Match nutrition incentive program in Chicago, Illinois, to determine whether underresourced communities have access. METHODS: We obtained 2018 spatial data on census tract-level sociodemographic characteristics in Chicago. Fifty-seven retailers (eg, farmers markets, food cooperatives) offered Link Match across the city's 801 census tracts. We examined ordinary least squares and spatial lag regression models to identify census tract-level variables associated with distance (in miles) from the nearest Link Match retailer. Variables of interest included percentage of non-Hispanic Black residents, percentage of Hispanic residents, median household income, violent crime rate, per capita grocery store availability, and walkability. RESULTS: Most Link Match retailers were located on Chicago's South and West sides. Ordinary least squares regression models indicated that low-income census tracts were on average closer to a Link Match retailer than higher-income tracts were (P < .001). Tracts in the highest quartile of violent crime were also significantly closer to a Link Match retailer than tracts in the lowest quartile (P < .001). After accounting for spatial dependency of census tracts, only violent crime rate was significantly associated with distance to nearest Link Match retailer. CONCLUSION: Link Match retailers in Chicago appear to be in underresourced communities. However, these areas have high violent crime rates, which may negatively influence program use. Additional research is needed on how social and environmental factors influence availability and use of nutrition incentive programs.

Examining changes to food and beverage availability and marketing in a low-income community after the opening of a new supermarket.

OBJECTIVE: In 2016, a Whole Foods Market© opened in the Englewood community of Chicago, IL - a predominately low-income African American community. This study aimed to examine changes to food and beverage availability and marketing in Englewood's existing food stores after the opening of this supermarket. DESIGN: Quasi-experimental study. SETTING: Two low-income African American communities in Chicago, IL. PARTICIPANTS: Fieldworkers audited all small grocery and limited service stores (e.g. convenience stores, liquor stores and dollar/discount stores) located within one-square mile of the new supermarket and a one-square mile area of a demographically comparable community that also lacked a supermarket. Stores were audited before (2016) and after (2017 and 2018) the supermarket opened. RESULTS: Of the 78 stores audited at baseline, 71·8 % were limited service stores and 85·9 % accepted Supplemental Nutrition Assistance Program (SNAP) benefits. Overall, the availability of healthy food and beverage options in nearby small stores was low at baseline and both follow-up periods. Difference-in-difference regression models revealed a significant increase in: (1) the percentage of stores in the intervention community (i.e. Englewood) offering regular cheese and promoting salty snacks at check-out from 2016 to 2017; and (2) the percentage of stores in the comparison community with interior store promotions for other sweetened beverages from 2016 to 2018. CONCLUSIONS: Minimal changes in food and beverage availability and marketing occurred 1 and 2 years after the opening of a new supermarket. However, the wide range of staple food items offered by the supermarket expanded healthy food retail in Chicago's Englewood community.

Addressing Food Insecurity through a Health Equity Lens: a Case Study of Large Urban School Districts during the COVID-19 Pandemic.

Reduced access to school meals during public health emergencies can accelerate food insecurity and nutritional status, particularly for low-income children in urban areas. To prevent the exacerbation of health disparities, there is a need to understand the implementation of meal distribution among large urban school districts during emergencies and to what degree these strategies provide equitable meal access. Our case study of four large urban school districts during the COVID-19 pandemic aims to address these knowledge gaps. Guided by the Getting to Equity (GTE) framework, we conducted a mixed-methods study evaluating emergency meal distribution and strategy implementation in four large urban school districts (Chicago Public Schools, Houston Independent School District, Los Angeles Unified School District, and New York City Department of Education). We gathered data from school district websites on (1) meal service and delivery sites and (2) district documents, policies, communication, and resources. Using qualitative coding approaches, we identified unique and shared district strategies to address meal distribution and communications during the pandemic according to the four components of the GTE framework: increase healthy options, reduce deterrents, build on community capacity, and increase social and economic resources. We matched district census tract boundaries to demographic data from the 2018 American Community Survey and United States Department of Agriculture food desert data, and used geographic information systems (GIS) software to identify meal site locations relative to student population, areas of high poverty and high minority populations, and food deserts. We found that all districts developed strategies to optimize meal provision, which varied across case site. Strategies to increase healthy options included serving adults and other members of the general public, providing timely information on meal site locations, and promoting consumption of a balanced diet. The quantity and frequency of meals served varied, and the degree to which districts promoted high-quality nutrition was limited. Reducing deterrents related to using inclusive language and images and providing safety information on social distancing practices in multiple languages. Districts built community capacity through partnering with first responder, relief, and other community organizations. Increased social and economic resources were illustrated by providing technology assistance to families, childcare referrals for essential workers, and other wellness resources. Geospatial analysis suggests that service locations across cities varied to some degree by demographics and food environment, with potential gaps in reach. This study identifies strategies that have the potential to increase equitable access to nutrition assistance programs. Our findings can support (1) ongoing efforts to address child food insecurity during the pandemic and (2) future meal provision through programs like the Summer Food Service Program and Seamless Summer Option. Future research should further examine the rationale behind meal site placement and how site availability changed over time.

Barriers to fruit and vegetable consumption among farmers' market incentive programme users in Illinois, USA.

OBJECTIVE: Previous research indicates that low-income individuals often struggle to consume the recommended amount of fruits and vegetables (F&V). LINK Up Illinois is a farmers' market incentive programme that aims to increase F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients by improving access to and affordability of locally grown foods. The present research aimed to identify barriers to F&V consumption that exist among users of the LINK Up Illinois programme. DESIGN: Cross-sectional. SETTING: Farmers' markets in Chicago, Springfield, Northbrook, Woodstock, Aurora and Urbana, IL. SUBJECTS: In 2016, a volunteer sample of 140 LINK Up Illinois users (mean age 42·5 years; 81·7 % female; 28·7 % African American; 44·0 % obese) completed a survey at participating farmers' markets across the state. Information on demographics, food shopping behaviours, programme satisfaction, barriers to F&V consumption and frequency of F&V consumption was collected and examined. RESULTS: Approximately 23 % of survey participants reported consuming F&V ≥3 times/d. The barriers to F&V consumption most often reported by survey participants were the cost of F&V (29·5 %), spoilage (18·6 %), knowing how to cook F&V (8·7 %) and not thinking about F&V when hungry (8·6 %). Results from multivariable-adjusted logistic regression models suggested that reporting one or more barriers was associated with reduced odds of consuming vegetables ≥3 times/d, but not fruits. CONCLUSIONS: Cost, spoilage and knowledge of cooking are key barriers to F&V consumption that exist among LINK Up Illinois users. Strategies are needed to mitigate these barriers and increase F&V consumption in this population.

Association of Food Desert Residency and Preterm Birth in the United States.

INTRODUCTION: Food deserts are a major public health concern. Inadequate access to healthy food has been associated with poor nutrition and the development of dietary related chronic conditions. OBJECTIVE: To determine the association between geographic access to nutritious food and preterm birth and whether gestational hypertension mediates this relationship. METHODS: Food access data was retrieved from the U.S. Department of Agriculture Food Access Research Atlas (2019) and used to quantify the percentage of Census tracts within each county that were food deserts: low-income tracts with limited access to grocery stores, supermarkets, or other sources of healthy, nutritious foods. These data were merged with US birth records from 2018 to 2019 by using the maternal county of residence (n = 7,533,319). We fit crude and adjusted logistic regression models with generalized estimating equations to determine the association between living in a food desert and the odds of preterm birth. We conducted a secondary within-group analysis by stratifying the fully adjusted model by race for non-Hispanic White and non-Hispanic Black birthing people. RESULTS: In the fully adjusted model, we found a dose-response relationship. As the prevalence of tract-level food deserts within counties increased, so did the likelihood of preterm birth (mid-range: odds ratio (OR) = 1.04, 95% confidence interval (C.I.) 1.01-1.07; high: OR = 1.07, 95% C.I. 1.03-1.11). Similar results were seen in the White-Black stratified models. However, a disparity remained as Black birthing people had the highest odds for preterm birth. Lastly, gestational hypertension appears to mediate the relationship between nutritious food access and preterm birth (natural indirect effect (NIE) = 1.01, 95% CI = 1.00, 1.01). CONCLUSION: It is salient, particularly for Black birthing people who experience high rates of adverse birth outcomes, that the role of food desert residency be explored within maternal and child health disparities.

Household Composition, Income, and Fast-Food Consumption among Black Women and Men.

Black adults are more likely to consume meals from fast-food restaurants than other racial/ethnic groups with implications for disparities in dietary quality and obesity outcomes. Family and economic characteristics are associated with fast-food consumption. The aim of this study was to determine the association between household composition, income, and fast-food consumption among Black women and men. A cross-sectional, secondary analysis of nationally representative data from the 2011-2018 National Health and Nutrition Examination Survey using multiplicative interaction terms and negative binomial regressions were used to assess whether household income moderated associations between number of children or older adults in the household and number of weekly fast-food meals consumed. Household composition was not associated with fast-food consumption among Black women overall. Yet, demonstrated by a significant interaction (incidence rate ratio (IRR) = 3.41, 95% confidence interval (CI) = 1.59-7.32), Black women with higher household income (≥ $75,000) and multiple young children consumed more fast-food compared to women with no children in the household. In contrast, Black men with one school-aged child in the home consumed fewer weekly fast-food meals than men with no school-aged children in the home (IRR = 0.69, 95% CI = 0.51-0.93). A significant interaction between number of older adults in the household and household income ≥ $75,000 (IRR = 3.56, 95% CI = 1.59-8.01) indicated that Black men with lower incomes and at least one older adult in the household consumed fewer weekly fast-food meals. These findings demonstrate that household composition and household income interact on fast-food consumption among Black women and men. Future studies should interrogate these differences, while programs and policies can be informed by the results of this study.

Differences in Nutrient Intake and Diet Quality among Non-Hispanic Black Adults by Place of Birth and Length of Time in the United States.

Prior research suggests that migrating to the United States (US) can negatively affect the diets and health of immigrants. There is limited information on how relocating to the US affects the diets of Black-identifying immigrants. To address this gap, this study examined differences in nutrient intake and diet quality among non-Hispanic Black adults by place of birth and length of time in the US. Cross-sectional data from the National Health and Nutrition Examination Survey (2005-2016) were analyzed. Approximately 6508 non-Hispanic Black adults were categorized into three groups: foreign-born (FB) living in the US <10 years (n = 167), FB living in the US ≥ 10 years (n = 493), and US-born (n = 5848). Multivariable-adjusted logistic and linear regression models were evaluated to identify differences in nutrient intake and diet quality (as measured by the Healthy Eating Index (HEI) of 2015) across the three groups when controlling for socio-demographics. Compared to US-born adults, both FB groups had significantly higher HEI-2015 scores and higher odds of meeting dietary recommendations for several nutrients: saturated fat, sodium, and cholesterol. There were no differences in nutrient intake between the two FB groups; however, FB (<10 years) adults had better diet quality than FB (≥10 years) ones. Place of birth and length of time in the US were associated with dietary intake among non-Hispanic Black adults. More research is needed to improve understanding of dietary acculturation among Black-identifying immigrants in the US.

Predictors of Food and Water Stockpiling During the COVID-19 Pandemic Among Latinos and Non-Latino Black People.

OBJECTIVE: The study examined factors associated with food and water stockpiling (FWS) during the COVID-19 pandemic. METHODS: A secondary analysis of online survey data collected in two waves: April 2020 (wave 1) and June/July 2020 (wave 2), was conducted through REDCap web application. A total of 2,271 Non-Latino Black and Latino adults (mean age: 36.8 years (SD = 16.0); 64.3% female) living in Illinois were recruited. Participants self-reported if they stockpiled food and/or water (FWS) seven days prior to survey completion because of the pandemic. Logistic regression was used to determine if each variable was associated with the odds of reporting FWS. RESULTS: Nearly a quarter (23.3%) of participants reported FWS. The adjusted model revealed that odds of FWS increase as the number of household members increased (OR: 1.21; 95% CI: 1.05-1.41). Odds of FWS were lower among participants who were not self-quarantining compared to those self-quarantining all the time (OR: 0.32; 95% CI: 0.17 - 0.62). Furthermore, individuals with lower levels of concern about COVID-19 had lower odds of FWS than those extremely concerned. CONCLUSIONS: Household size, self-quarantine status, and concern about COVID-19 were significantly associated with FWS. These findings highlight the need to address the concerns of marginalized individuals to promote healthy behaviors.

Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework to Advance the Science and Practice of Healthy Food Retail.

Although healthy food retail strategies are widely used, there appears to be a limited understanding of the processes and determinants for successful adoption, implementation, and sustainment. To fill this gap, we recommend the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to be used to advance the science and practice of healthy food retail. In this perspective, we: (1) introduce EPIS and describe why it was chosen as a recommended implementation science framework for healthy food retail, (2) highlight healthy food retail evidence supporting EPIS, and (3) discuss research and practice needs moving forward.

Impact of Military Affiliation on Exercise Perceptions Among Survivors of Sexual Violence.

INTRODUCTION: Military service members disproportionately experience sexual violence (SV) and its related health concerns. Although recent work has shown physical activity to be an effective strategy for improving physical and mental health among trauma-exposed military populations, little of this work has focused specifically on military service members with a history of SV. To address these gaps in knowledge and practice, this study identified the most salient perceived benefits/barriers of exercise among men and women survivors of SV with military affiliations. Additionally, these analyses explore willingness to engage in exercise programs, and preferences for the structure/content of these programs, among men and women survivors of SV with military affiliations. MATERIALS AND METHODS: An online, cross-sectional survey of women (n = 355) and men (n = 198) survivors of SV was completed using Amazon Mechanical Turk. Inclusion criteria were men and women, age between 18 and 65 years, self-reported history of SV, and located in the United States. Information on sociodemographics and post-traumatic stress disorder symptoms was collected alongside perceived barriers and benefits to exercise, willingness to engage in exercise programs, and preferences for the structure/content of these programs. Analyses were stratified by sex. Comparisons by history of military involvement (active duty military or veteran; no military involvement/civilian) were reported. RESULTS: Both military-involved men (n = 68) and women (n = 139) were more likely to prefer at-home and online exercise options when compared to civilians (Ps < .05; Cramer's Vs 0.19-0.36). Additionally, both men and women with military involvement reported strongly favoring exercising with an instructor over no instructor and preferred that this instructor identifies with their same gender (Ps < .01; Cramer's Vs 0.28-0.36). Women with military involvement also preferred shorter program durations and exercising alone or in a group online or in person, whereas men with military involvement were open to longer program durations, when compared to their civilian counterparts (Ps < .05; Cramer's Vs 0.19-0.37). Women and men with military involvement were more likely than their civilian counterparts to perceive that exercise benefits their psychological outlook and social interactions. They were also more likely than civilians to indicate poor exercise environment, high time expenditure, and family discouragement as perceived barriers to exercise (Ps < .05; Cohen's ds 0.21-0.97). Military-involved women were also more likely than civilian women to endorse the perceived barrier of hard physical exercise (P < .05; Cohen's d = 0.25). CONCLUSIONS: This study identified perceived benefits and barriers to exercise, along with willingness to engage in exercise programs, and exercise preferences among men and women survivors of SV with military involvement. Targeting these factors in intervention planning will be important for physical activity promotion and program engagement among veterans to reduce the disproportionate impact of SV and disease burden among U.S. service members and veterans.

Perceived Barriers and Benefits of Exercise Among Women Survivors of Sexual Violence by Physical Activity Level and Posttraumatic Stress Disorder Status.

An online, cross-sectional survey of women survivors of sexual violence (SV; N = 355) gathered information on perceived barriers and benefits of exercise, along with exercise level and posttraumatic stress disorder (PTSD) symptoms. This study reports exercise perceptions and provides comparisons by exercise level and PTSD status. Differences by exercise level were found in life enhancement, physical performance, psychological outlook, and social interaction (ps < 0.05; rs = -0.04-0.25). Differences were found by PTSD status in physical performance, social interaction, and preventative health and exercise milieu, time expenditure, and family discouragement (ps < 0.05; rs = -0.39-0.21). Findings provide new information relevant for promoting exercise among women survivors of SV.

Perceived Barriers and Benefits of Exercise Among Men with Histories of Sexual Violence: Impact of PTSD and Physical Activity Status.

This study reported on perceived benefits and barriers of exercise among men with histories of sexual violence (SV) and compared these perceptions by activity level and post-traumatic stress disorder (PTSD) status. An online, cross-sectional, survey of men with histories of SV (N = 198) was completed using Amazon Mechanical Turk. Inclusion criteria were identifying sex at birth as male, age between 18 and 65 years, self-reported history of SV, and living in the United States (U.S.). A total of 1,260 men were screened for the study, of which 316 met the inclusion criteria, and 198 met all data quality requirements and were included in the study. Sociodemographic information, exercise behavior, PTSD symptoms, and perceived exercise barriers/benefits were collected. Comparisons by activity and PTSD status were analyzed. Additionally, two open-ended qualitative research questions were included to provide nuance to perceived barriers/benefits of exercise. The most salient benefits included physical performance, psychological outlook, and preventative health. Open-ended responses also noted the mental and physical benefits of exercise. The most salient barrier was physical exercise, with open-ended responses emphasizing lack of time, chronic pain and health concerns, and poor mental health and lack of motivation as impediments to exercise. Significant differences were found in benefits (psychological outlook, physical performance) and barriers (exercise environment, high time expenditure, and family discouragement) between active and insufficiently active men with histories of SV (ps < .05; Cohen's ds = 0.32-0.57). Significant differences were found by PTSD status on benefits (physical performance, social interaction, and preventative health) and barriers (exercise milieu, time expenditure, hard physical exercise, family discouragement) (ps < .05; Cohen's ds = 0.40-1.10). Findings provide new gender-specific strategies for promoting exercise among men with histories of SV: integrating exercise physiologists into trauma recovery programs, psychoeducation, engaging friends and family members, peer-support, and building self-efficacy.

Structural racism and geographic access to food retailers in the United States: A scoping review.

This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.

Local Measures to Curb Dollar Store Growth: A Policy Scan.

In recent years, advocates have expressed concern about the exponential growth of dollar stores in low-income communities, given their limited stock of healthy foods, and several municipalities in the U.S. have passed novel policies to curb the proliferation of these stores. The purpose of this scan is to create a legal database to inform future healthy retail policies and programs. Legal mapping methods were used to identify local policies aimed at moderating dollar store proliferation. A search yielded 25 policies that met the inclusion criteria, all enacted between 2018 and 2020. Recent policies aiming to slow local dollar store growth were mostly passed in low-income communities of color. All identified policies were passed in either the Midwest or South. The majority of municipalities that passed the policies had populations where more than half of residents identified as non-Hispanic Black or Hispanic and where the poverty rate was greater than the national average. Twelve (48%) municipalities imposed temporary moratoria halting new dollar stores from opening, and ten (40%) banned new construction within a specified distance of an existing dollar store. Key themes identified from analysis of policies' purpose statements included increasing healthy food availability, diversifying local businesses, and improving community safety. These findings may be useful to leaders in other communities seeking to potentially moderate the impact of dollar stores on community health, as well as researchers and policy makers seeking to evaluate the efficacy of existing policies.

Availability of Drinking Water Source and the Prevalence of Diarrhea among Nigerian Households.

Diarrhea is highly prevalent in Nigeria and accounts for 16% of deaths among Nigerian children. The WHO classifies water source into two categories: improved and unimproved. This study aimed to examine the association between type of water source and the prevalence of diarrhea among members of a nationally representative sample of Nigerian households while controlling for key sociodemographic and household factors. This study used cross-sectional data from 22,571 households participating in the 2018 Water, Sanitation and Hygiene-National Outcome Routine Mapping survey. Data collectors visited and interviewed household members across all 36 states in the country. Logistic regression was used to assess associations between water source type and the odds of a family member reporting diarrhea, after controlling for financial status, availability of soap/detergent for handwashing, availability of a refrigerator in the home, toilet type, and urban/rural status. After controlling for explanatory variables in the adjusted model, having an unimproved water source was associated with greater odds of diarrhea among a family member (odds ratio, 1.59; 95% CI, 1.44-1.77). Not having a refrigerator and not having soap/detergent for handwashing were also associated with greater odds of diarrhea. In summary, this study found an association between water-source type and diarrhea prevalence among Nigerian households. This study is in line with prior studies in Nigeria and elsewhere, and the results call for greater commitment and action by stakeholders to improve water sources and, ultimately, reduce the prevalence of diarrhea in Nigeria.

Investigating implementation of school health policies through a health equity lens: A measures development study protocol.

Background: School-based policies that ensure provision of nutrition, physical activity, and other health-promoting resources and opportunities are essential in mitigating health disparities among underserved populations. Measuring the implementation of such policies is imperative to bridge the gap between policy and practice. Unfortunately, limited practical, psychometrically strong measures of school policy implementation exist. Few available explicitly focus on the issues of equity and social justice as a key component of implementation, which may result in underassessment of the equity implications of policy implementation. The purpose of this study is to develop equity-focused measures in collaboration with practitioners, researchers, and other key implementation partners that will facilitate evaluation of policy implementation determinants (i.e., barriers and facilitators), processes, and outcomes. Methods: We will actively seek engagement from practitioners, researchers, and advocacy partners (i.e., stakeholders) who have expertise in school health policy throughout each phase of this project. We propose a multi-phase, 1-year project comprising the following steps: (1) selection of relevant constructs from guiding frameworks related to health equity and implementation science; (2) initial measure development, including expert feedback on draft items; (3) pilot cognitive testing with representatives from key target populations (i.e., school administrators, teachers, food service staff, and students and parents/guardians); and (4) measure refinement based on testing and assessment of pragmatic properties. These steps will allow us to establish initial face and content validity of a set of instruments that can undergo psychometric testing in future studies to assess their reliability and validity. Discussion: Completion of this project will result in several school policy implementation measurement tools which can be readily used by practitioners and researchers to evaluate policy implementation through a health equity lens. This will provide opportunities for better assessment and accountability of policies that aim to advance health equity among school-aged children and their families. Trial registration: Open Science Framework Registration doi: 10.17605/OSF.IO/736ZU.