Patterns and predictors of health behaviors among racially/ethnically diverse residents of low-income housing developments.

PURPOSE: To examine behavioral patterns and sociodemographic predictors of diet, inactivity, and tobacco use among a diverse sample of residents from low-income housing developments. DESIGN: In this cross-sectional survey study, households and residents were randomly selected using multistage cluster sampling. Setting . The study was conducted in 20 low-income housing developments in the Boston, Massachusetts, metropolitan area. SUBJECTS: Subjects were 828 residents who completed the survey (response rate = 49.3%). Forty-one percent of participants were Hispanic and 38% were non-Hispanic Black. Measures . Outcomes measured were diet, inactivity, and tobacco use. Predictors measured were age, race/ethnicity, gender, education, country in which the subject was born, language spoken, and financial hardship. Analysis . Logistic regression analyses were conducted to examine the association of three health behaviors with sociodemographic factors. RESULTS: Age, gender, language spoken, and financial hardship showed significant relationships with all three behaviors. For example, those who reported less financial hardship (odds ratio [OR] = 1.75) were more likely to eat healthier. Residents who spoke no English, or at least one language in addition to English, were significantly more likely to report healthier eating (OR = 2.78 and 3.30, respectively) than those who spoke English only. Men were significantly more likely to report less healthy eating (OR = 0.65) than were women. Similar trends emerged for inactivity and tobacco use. CONCLUSION: Effective health promotion interventions in low-income housing developments that leverage protective factors while addressing risk factors have the potential to reduce income-related health disparities in these concentrated resource-deprived neighborhoods.

Financial hardship and self-rated health among low-income housing residents.

BACKGROUND: Self-rated health (SRH) has been shown to be predictive of morbidity and mortality. Evidence also shows that SRH is socioeconomically patterned, although this association differs depending on the indicator of socioeconomic status used. The purpose of this study was to determine the association between SRH and financial hardship among residents of low-income housing. METHODS: We analyzed cross-sectional data from the Health in Common Study (N = 828), an observational study to investigate social and physical determinants of cancer risk-related behaviors among residents of low-income housing in three cities in the Boston metropolitan area. Modified Poisson regression models were used to obtain the relative risk of low SRH (fair or poor), adjusting for demographic and socioeconomic characteristics. RESULTS: Unadjusted models revealed that the respondents reporting financial hardship were 53% more likely to report low SRH compared with those not reporting financial hardship. After controlling for demographic characteristics, socioeconomic characteristics, and psychological distress, the results showed that those reporting financial hardship were 44% more likely to report low SRH. CONCLUSION: Our results suggest that financial hardship is a robust predictor of SRH; and over and above the influence of demographic and traditional socioeconomic indicators, and even psychological distress, financial hardship remains strongly associated with low SRH. Additional research needs to be conducted to further elucidate this pathway and to better understand the determinants of variability in financial hardship among low-income housing residents to ensure the most appropriate policy levers (e.g., housing-related policy, food-related policy) are chosen to improve health outcomes in this population.

Elements of external validity of tools for health: an intervention for construction laborers.

PURPOSE: To examine the external validity of an efficacious tailored smoking cessation and nutrition improvement telephone intervention. DESIGN: Comparison of characteristics of participants and nonparticipants (representativeness); examination of the extent of intervention implementation. SETTING: Cancer center collaboration with a labor union. SUBJECTS: Unionized construction laborers. INTERVENTION: Tailored feedback report, telephone counseling, and supplementary educational materials focused on smoking cessation and improved nutrition. MEASURES: Background survey identifying socio-demographic and behavioral characteristics; process evaluation data; and final efficacy survey to determine participant satisfaction. ANALYSIS: Cross-classification and the chi(2) test of homogeneity were used with categorically measured variables comparing participants and nonparticipants. We compared the means in the two groups for continuously scaled measures using the Student t-test and investigated the multivariable association of the characteristics of participation with a multiple logistic regression. For process data we present frequencies, percentages, and means. RESULTS: Characteristics associated with participation included self-efficacy to change fruit and vegetable consumption (p = .0009) and self-identification with union's problems (p = 0.05). Eighty-six percent of non-smokers and 61% of smokers completed between 1 and 4 counseling sessions. Over one-half of non-smokers (61%) and smokers (53%) completed 4 or more calls and more smokers (34%) than non-smokers (11%) completed the 5+ sessions. CONCLUSIONS: These results provide a snapshot of characteristics of construction laborers to whom this intervention can be generalized and indicators of feasibility necessary for translating research into practice.

Multiple health behavior changes in a cancer prevention intervention for construction workers, 2001-2003.

INTRODUCTION: Few multiple behavior change interventions have addressed tobacco use in conjunction with fruit and vegetable consumption, particularly among high-risk blue-collar workers. Tools for Health, a cancer prevention intervention for construction laborers, was effective in achieving behavior change for smoking cessation and fruit and vegetable consumption separately. This study examines whether addressing smoking and fruit and vegetable consumption was successful in achieving positive change for both behaviors. We also explored possible explanations for the relationship between behavior changes in these 2 behavioral domains. METHODS: We retrospectively analyzed data from a randomized controlled trial testing a smoking cessation and fruit and vegetable consumption intervention for construction workers. We used survey data from 300 intervention participants to answer our primary research question: Did participants who reported being smokers at baseline successfully quit smoking and increase their fruit and vegetable consumption by the end of the intervention? We used qualitative data from 16 small group discussions to help interpret these results. RESULTS: Tools for Health participants achieved substantial levels of smoking cessation and increased their fruit and vegetable consumption, concurrently, during the course of the intervention. CONCLUSION: This study provides evidence that pairing smoking cessation with increasing fruit and vegetable consumption can be successful in a multiple behavior change intervention designed for high-risk blue-collar workers. Further, our findings provide potential directions for examining why this pairing might be complementary.