Association between Proximity to Food Sources and Dietary Behaviors in Black and White College Graduates.

OBJECTIVES: Unequal access to healthy food environments is often implicated in racial inequities in health and behaviors that are largest among college graduates. The aim of this study was to determine associations between perceived proximity to food sources and dietary behaviors between black and white college graduates. METHODS: In a cross-sectional online survey of dietary behaviors between black and white adults who have a ≥ 4-year bachelor's degree, respondents were asked how long it typically takes for them to get to grocery stores and fast-food restaurants from home. We used ordinal logit regression models to assess associations between perceived proximity to food sources and dietary behaviors. RESULTS: Among black men, perceiving that a grocery store was ≥ 10 minutes from their home was associated with lower fruit consumption (beta=-0.94, SE=0.48). Perceiving that a grocery store was ≥ 10 minutes from their home was associated with more frequent fast-food consumption among black men (beta=1.21, SE=0.39), Black women (beta=0.98, SE=0.34), and white men (beta=0.74, SE=0.30). CONCLUSIONS: The associations between perceived proximity to food sources and dietary behaviors differ by race and sex among college graduates with important implications for racial disparities in diet quality and obesity across SES.

Advancing Cultural Competency Toward Sexual and Gender Minorities: Innovation in Maternal and Child Health Pedagogy.

PURPOSE: The purpose of this project was to develop and disseminate an innovative teaching activity to increase cultural competency toward sexual and gender minority (SGM) populations within the maternal and child health (MCH) context. DESCRIPTION: Over 4.5% of the population (16 million people in the US) identify as SGM, and this population is an often-overlooked group within the traditional MCH context. SGM individuals have specific healthcare needs, including reproductive healthcare needs, that are currently left unaddressed. Given these gaps, the future MCH workforce should be prepared with cultural competency skills to address reproductive health inequities from many perspectives, including SGM populations. An innovative SGM activity was developed and disseminated to supplement the MCH and Reproductive Health curricula. ASSESSMENT: The objectives of this SGM Reproductive Health activity were: (1) to understand SGM populations, terminology, culture, and health inequities within an MCH context; (2) enhance cultural competency and the communication skills appropriate for this population; and (3) develop culturally competent resources for practice. The teaching activity includes a lesson plan, lecture with script, recorded lecture, assignment description, and grading rubric, designed for a U.S. based curriculum. The activity was evaluated and modified based on feedback from students, and pilot tested in practice in a graduate-level reproductive health course. CONCLUSION: Future MCH leaders must have the skills to provide culturally competent care to the populations they serve, including SGM populations. Through teaching about SGM populations and cultural competence, educators can equip future MCH leaders with a culturally competent skillset to prepare them to work in cross-cultural situations.

Familial Financial Assistance and Body Mass Index in Black College Graduates.

Racial disparities in obesity are larger between Black and White college graduates compared to disparities among those who did not complete high school. A possible explanation is that Black adults with higher socioeconomic status (SES) experience unique obesogenic determinants. Black adults who have completed a 4-year college degree can report "uplift stress" from providing financial assistance to family members. The aim of this study is to determine whether the association between familial financial assistance and body mass index (BMI) varies among college-educated Black women and men. This study utilized data from an online survey of Qualtrics standing panels including 451 non-Hispanic Black college graduates. Respondents were asked if they had provided or received any monetary gift or financial help from a family member in the past 12 months as well as their height and weight. Using linear regression and multiplicative interaction terms, the association between familial financial assistance and BMI was assessed by sex. Those who reported both giving and receiving familial financial assistance had higher BMI than those who neither gave nor received assistance (ß = 2.80, standard error (s.e.) = 1.16). There was a significant interaction such that this association was observed among women only (ß = 6.67, s.e. = 2.32). Future studies should seek to understand the gendered impact of familial financial assistance on BMI in college-educated Black women.

Theory and empiricism: A comment on "Interrogating the environmental affordances model" by Pamplin and colleagues.

We strongly support efforts to generate, rigorously test, and falsify hypotheses derived from the Environmental Affordances (EA) Model of Health Disparities, as originated by the late Dr. James S. Jackson (1940-2020). Such efforts are critical to establishing robust, theoretically grounded scientific frameworks that explain the fundamental causes of racial disparities in health and wellbeing. Pamplin et al. (2021) fundamentally misrepresents the EA Model as a framework that (falsely) reifies the role of race as a determinant of health behaviors and health outcomes. Further, both their study design and analytic approach are inappropriate for testing predictions of this framework. We address these issues with the goal of recentering the scholarly conversation about how stress contributes to health, and disparities in health, over the life course.

Discordance Between Perinatal Alcohol Use Among Women and Provider Counseling for Alcohol Use: An Assessment of the Pregnancy Risk Assessment Monitoring System.

OBJECTIVE: In the United States, guidelines indicate all pregnant women should be screened for and counseled on alcohol use to prevent adverse perinatal outcomes due to alcohol consumption. The objective of this study was to describe sociodemographic factors associated with receipt of prenatal alcohol counseling and perinatal alcohol use among US women. METHODS: State health departments collected data for the Pregnancy Risk Assessment Monitoring System Phase 7 during 2012-2015, and we restricted the sample to a complete case analysis (N = 135 111). The 3 dichotomous outcomes were preconception alcohol use (3 months before pregnancy), prenatal alcohol use (during last 3 months of pregnancy), and prenatal alcohol counseling. Predictor variables were age, race, Hispanic ethnicity, education, marital status, health insurance status, and previous live births. We estimated survey-weighted logistic regression models for each outcome. RESULTS: Half (56.0%) of pregnant women reported preconception alcohol use, 70.5% received prenatal alcohol counseling, and 7.7% reported prenatal alcohol use during the last 3 months of pregnancy. Black women were significantly less likely than White women (odds ratio [OR] = 0.49; 95% CI, 0.46-0.52) and Hispanic women were significantly less likely than non-Hispanic women (OR = 0.62; 95% CI, 0.58-0.66) to report preconception alcohol use. We found similar patterns for prenatal alcohol use among Black women. Black women were significantly more likely than White women (OR = 1.66; 95% CI, 1.55-1.77) and Hispanic women were significantly more likely than non-Hispanic women (OR = 1.51; 95% CI, 1.40-1.61) to receive prenatal alcohol counseling. We found similar patterns for age, education, and health insurance status. CONCLUSION: Disparities in alcohol counseling occurred despite the national recommendation for universal screening and counseling prenatally. Continued integration of universal screening for alcohol use during pregnancy is needed.