A qualitative evaluation of the acceptability of shigellosis prevention recommendations among gay, bisexual, and other men who have sex with men.

BACKGROUND: Shigellosis is diarrheal disease caused by highly infectious Shigella bacteria. Shigella can spread in multiple ways, including sexual contact. Gay, bisexual, and other men who have sex with men are particularly at risk for shigellosis. METHODS: To evaluate the acceptability of three CDC-developed behavioral recommendations for the prevention of sexually transmitted shigellosis, virtual in-depth interviews were conducted among twenty-six gay or bisexual men in March-May 2021. RESULTS: Participants had a median age of 25; 65% were Non-Hispanic White, 12% were Hispanic White, 12% Asian, 4% Hispanic Black, and 8% multiracial/other. Respondents indicated willingness to engage in certain prevention behaviors (e.g., washing hands, genitals, and anus before and after sex), but were less willing to engage in behaviors that were viewed as outside social norms or difficult to practice (e.g., dental dams for oral-anal contact; latex gloves for fingering or fisting). Respondents thought recommendations may be more feasible if knowledge of shigellosis was greater; however, some perceived that the severity of shigellosis is low and did not warrant the effort of engaging in prevention behaviors. CONCLUSIONS: Educational efforts to increase awareness of shigellosis and other enteric diseases spread through sexual contact are needed and public health practitioners should consider the acceptability of how realistic it is for individuals to engage in certain prevention behaviors. Rather than recommending behaviors that do not have buy-in, it may be more efficacious to focus recommendations on adopting behaviors reported as acceptable to the target audience.

A qualitative assessment of cleaning and hand hygiene practices at shelters serving people experiencing homelessness during the COVID-19 pandemic, Atlanta, GA - May-June, 2020.

BACKGROUND: Cleaning practices and hand hygiene are important behaviors to prevent and control the spread of infectious disease, especially in congregate settings. This project explored hygiene- and cleaning-related experiences in shelters serving people experiencing homelessness (PEH) during May-June 2020 of the COVID-19 pandemic. METHODS: We conducted qualitative, in-depth interviews by phone with 22 staff from six shelters in Atlanta, Georgia. The interview guide included questions about cleaning routines, cleaning barriers and facilitators, cleaning promotion, hand hygiene promotion, and hand hygiene barriers and facilitators. We analyzed interview transcripts using thematic analysis. RESULTS: Multiple individuals, such as shelter individuals (clients), volunteers, and staff, played a role in shelter cleaning. Staff reported engaging in frequent hand hygiene and cleaning practices. Barriers to cleaning included staffing shortages and access to cleaning supplies. Staff reported barriers (e.g., differing perceptions of cleanliness) for clients who were often involved in cleaning activities. Barriers to hand hygiene included limited time to wash hands, forgetting, and inconvenient handwashing facilities. Specific guidance about when and how to clean, and what supplies to use, were requested. CONCLUSION: During the early months of the COVID-19 pandemic, shelters serving PEH in the Atlanta-metro area needed resources and support to ensure sufficient staffing and supplies for cleaning activities. As part of future pandemic planning and outbreak prevention efforts, shelters serving PEH could benefit from specific guidance and training materials on cleaning and hand hygiene practices.

Measuring the food environment and its effects on obesity in the United States: a systematic review of methods and results.

We identified fifty-one peer-reviewed studies that geospatially analyzed the relationship between the community nutrition environment (CNE) and obesity. Eighty percent of studies found at least one significant association between the CNE and obesity. However we calculated the proportion of studies that found at least one significant association between the CNE and obesity in the expected direction for each food store type and measurement technique, and the proportion across the different store types and measurement techniques was just 32%. Different methods for classifying, locating, and analyzing food stores produced mixed results and challenged direct study level comparison.

Let's go to the park today: the role of parks in obesity prevention and improving the public's health.

Let's go to the park today! This familiar phrase is heard routinely throughout the year in many U.S. households. Access to parks, trails, open spaces, and recreational facilities not only provides increased opportunities for children and adults to play and be physically active, but these venues also influence other behaviors. As the health and wellbeing of our children are impacted by the daily environment in which they live, learn, and play, the use of parks and other recreation spaces as a healthful venue is important to consider in a comprehensive view of childhood and family obesity prevention. This article briefly summarizes some of the obesity-related benefits of parks across the local, state, and national park systems and highlights specific initiatives as examples of the commitment by park agencies to benefit the public's health and play a role in obesity and chronic disease prevention.

Household motor vehicle use and weight status among Colombian adults: are we driving our way towards obesity?

OBJECTIVE: To determine the associations between household motor vehicle ownership and weight status among Colombian adults. METHODS: Secondary analysis of data from the 2005 Demographic and HealthSurvey of Colombia. Height, weight and waist circumference were objectively measured in 49,079 adults, ages 18 to 64 that resided in urban settings. Abdominal obesity was defined as a waist circumference >80 cm in women and >90 cm in men. RESULTS: Prevalence was 19.9% for motor vehicle ownership in household, 33.1% for BMI between 25 and 29.9 kg/m(2), 14.4% for BMI>30 kg/m(2), and 46% for abdominal obesity. Males reporting any household motor vehicle ownership were more likely to be overweight or obese, and to have abdominal obesity (p for genderexposure variables interaction=<0.001). CONCLUSIONS: Household motor vehicle ownership is associated with overweight, obesity, and abdominal obesity among Colombian men but not women.

Cost effectiveness of community-based physical activity interventions.

BACKGROUND: Physical inactivity is associated with the increased risk of many chronic diseases. Such risks decrease with increases in physical activity. This study assessed the cost-effectiveness of population-wide strategies to promote physical activity in adults and followed disease incidence over a lifetime. METHODS: A lifetime cost-effectiveness analysis from a societal perspective was conducted to estimate the costs, health gains, and cost-effectiveness (dollars per quality-adjusted life year [QALY] gained, relative to no intervention) of seven public health interventions to promote physical activity in a simulated cohort of healthy U.S. adults stratified by age, gender, and physical activity level. Interventions exemplifying each of four strategies strongly recommended by the Task Force on Community Preventive Services were evaluated: community-wide campaigns, individually adapted health behavior change, community social-support interventions, and the creation of or enhanced access to physical activity information and opportunities. Each intervention was compared to a no-intervention alternative. A systematic review of disease burden by physical activity status was used to assess the relative risk of five diseases (coronary heart disease, ischemic stroke, type 2 diabetes, breast cancer, and colorectal cancer) across a spectrum of physical activity levels. Other data were obtained from clinical trials, population-based surveys, and other published literature. RESULTS: Cost-effectiveness ratios ranged between $14,000 and $69,000 per QALY gained, relative to no intervention. Results were sensitive to intervention-related costs and effect size. CONCLUSIONS: All of the evaluated physical activity interventions appeared to reduce disease incidence, to be cost-effective, and--compared with other well-accepted preventive strategies--to offer good value for money. The results support using any of the seven evaluated interventions as part of public health efforts to promote physical activity.

Interventions to increase walking behavior.

Walking is the most prevalent and preferred method of physical activity for both work and leisure purposes, thus making it a prime target for physical activity promotion interventions. We identified 14 randomized controlled trials, which tested interventions specifically targeting and assessing walking behavior. Results show that among self-selected samples, intensive interventions can increase walking behavior relative to controls. Brief telephone prompts appear to be as effective as more substantial telephone counseling. Although more research is needed, individual studies support prescriptions to walk 5-7 versus 3-5 d.wk and at a moderate (vs vigorous) intensity pace, with no differences in total walking minutes when single or multiple daily walking bouts are prescribed. Mediated interventions delivering physical activity promotion materials through non-face-to-face channels may be ideal for delivering walking promotion interventions and have shown efficacy in promoting overall physical activity, especially when theory-based and individually tailored. Mass media campaigns targeting broader audiences, including those who may not intend to increase their physical activity, have been successful at increasing knowledge and awareness about physical activity but are often too diffuse to successfully impact individual behavior change. Incorporating individually tailored programs into broader mass media campaigns may be an important next step, and the Internet could be a useful vehicle.

Use of health impact assessment in the U.S.: 27 case studies, 1999-2007.

OBJECTIVES: To document the growing use in the United States of health impact assessment (HIA) methods to help planners and others consider the health consequences of their decisions. METHODS: Using multiple search strategies, 27 HIAs were identified that were completed in the U.S. during 1999-2007. Key characteristics of each HIA were abstracted from published and unpublished sources. RESULTS: Topics examined in these HIAs ranged from policies about living wages and after-school programs to projects about power plants and public transit. Most HIAs were funded by local health departments, foundations, or federal agencies. Concerns about health disparities were especially important in HIAs on housing, urban redevelopment, home energy subsidies, and wage policy. The use of quantitative and nonquantitative methods varied among HIAs. Most HIAs presented recommendations for policy or project changes to improve health. Impacts of the HIAs were infrequently documented. CONCLUSIONS: These completed HIAs are useful for helping conduct future HIAs and for training public health officials and others about HIAs. More work is needed to document the impact of HIAs and thereby increase their value in decision-making processes.

Conducting environmental assessments for physical activity: determining traffic volume in walkability audits in two West Virginia communities.

BACKGROUND: In this article, we examine the possibility of reducing time to conduct traffic volume audits through (1) reducing time for manual traffic counting and (2) using Department of Transportation (DOT) information. METHODS: In audits of 824 road segments in 2 West Virginia (WV) communities, manual traffic counts were recorded for 1, 2, and 5 min in duration. Annual Average Daily Traffic (AADT) was calculated from counts. Available AADT from DOT was also collected. Percent agreement and a weighted kappa were calculated between 5-min count and 1- and 2-min count AADT categories and between 5-min count and DOT AADT categories. RESULTS: One- and 2-min counts produced identical AADT categories as 5-min counts in 93.4% and 95.0% of segments, respectively. Weighted kappa was 0.79 (95% CI = 0.74-0.85) and 0.85 (95% CI = 0.80-0.89), respectively. Forty-two segments (5.1%) had DOT data. CONCLUSIONS: DOT AADT was available for a small percentage of road segments assessed. The high agreement between AADT categories produced by 1- and 2-min counts and 5-min counts makes it reasonable to consider using 1- or 2-min manual traffic counts if time or staffing constraints make it necessary. Possible generalizability of this methodology to other communities, particularly larger urban and suburban areas, will require further research.

Ageless health needs assessment on the U.S.-Mexico border: Ciudad Júarez.

OBJECTIVES: The Ageless Health Needs Assessment Study examined the self-reported health of the 60 and older population along the U.S.-Mexico border. METHODS: A health survey was administered in Ciudad Júarez, Chihuahua, Mexico to 507 Mexican descendents by telephone (n = 296) and in-person (n = 211). The health survey examined measures of physical and psychosocial health. RESULTS: All participants were aged 60 and older and born in Mexico. Most reported achieving an elementary school education or less and many lived in poverty. Results from a MANCOVA showed significant differences between groups: men, individuals with higher education, and sufficient amounts of physical activity reported better health scores compared to women, individuals with lower education, and insufficient physical activity. CONCLUSIONS: These findings suggest that higher levels of education and physical activity may be associated with better health outcomes among elderly Mexicans dwelling on the border.

Growing the field of health impact assessment in the United States: an agenda for research and practice.

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health.

Examining the relationships among built environment, physical activity, and body mass index in El Paso, TX.

OBJECTIVE: The current study examined the relationships among built environment, physical activity, and body mass index (BMI) in a primarily Hispanic border community in El Paso, TX. METHODS: Data from a 2001 community-wide health survey were matched to environmental data using geocoding techniques in ARC VIEW software. A total of 996 adults were surveyed by phone and 452 were successfully geocoded. RESULTS: The sample was 71% female, 79% Hispanic, 42 +/- 17 years old, moderately acculturated, and had socioeconomic status (SES) levels of semi-skilled workers. Increasing BMI was related to less moderate intensity physical activity (P = 0.05), higher SES (P = 0.0003), worse overall health (P = 0.0004), and living in areas with greater land-use mix (less residential; P = 0.03). The relationship between overall health and BMI was in part mediated by higher numbers of barriers to physical activity in those with poor health, which lead to a decrease in moderate physical activity. These variables explained 20% of the variance in BMI. CONCLUSIONS: This is one of the first studies to find a positive relationship between land-use mix and BMI in a predominantly Hispanic, low-income community. The positive association between BMI and land-use mix may be due to the inclusion of individual SES as a controlling variable in the analyses, suggesting that SES may have a differential effect on how the built environment influences BMI in low- to moderate-income minority communities.

Perceived health needs of elderly Mexicans living on the U.S.--Mexico border.

UNLABELLED: This descriptive study explores the health beliefs of an underserved elderly group to gain insight regarding their self-perceived health needs. Focus groups were conducted with 112 elderly Mexicans living on the U.S.-Mexico border. Participants were asked questions regarding positive aspects of aging, self-perception of health status, and health care service needs. DISCUSSION: Many felt having knowledge gained from life experience and raising a family was positive; participants indicated their overall health status was poor; and they believed it was difficult to access quality health care services. Many participants self-reported that health status depended on socioeconomic status, family support, chronic diseases, and previous lifestyle. These findings can help develop culturally appropriate interventions designed to improve the overall health of the elderly living on the U.S.-Mexico border.

Older women on the U.S.-Mexico border: exploring the health of Hispanics and non-Hispanics Whites.

Research on ethnicity and socioeconomic status (SES) suggests that Hispanics are more likely than non-Hispanic Whites to experience poverty and low levels of education, which may relate to poorer health status. This study used a health survey to examine income, education, ethnicity, birthplace, and age on self-reported health factors of women age 60 and older on the U.S.-Mexico border. Results show that income, age, and education were significantly associated with several health factors (Physical Health, Emotional Health, General Health, Energy Level, and Activity Potential). Older women with lower SES, regardless of ethnicity, reported poorer health than younger-old women with higher SES.