SchoolHEAT: Racial and Ethnic Inequity in School Temperature.

Exposure to high environmental temperature is detrimental to health through multiple pathways. This paper describes disparities in school-based high-temperature exposure at metropolitan schools in the United States. Using school location and sociodemographic data from the National Center for Education Statistics, neighborhood data from the US Census Bureau, and land surface temperature (LST) data from the Aqua Earth-observing satellite mission, we find that for every 10% more Black or Hispanic residents in the neighborhood, schools have LST 0.25 °C and 0.38 °C hotter, respectively. When the Black or Hispanic student population is greater than the neighborhood population, LST is an additional 0.20 °C and 0.40 °C for each 10% increase in students over neighborhood population, respectively. Black and Hispanic students are overrepresented in the hottest schools, making up 58.7% of students in the hottest 20% of schools, compared to only 30.0% of students in the coolest 20% of schools.

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.

Observed physical activity among Latinx and White men and women on a new urban trail.

OBJECTIVE: Despite efforts to increase physical activity through new green space infrastructure such as trails, disparities in physical activity may persist. The current study compared observed vigorous physical activity (VPA) engagement among White and Latinx men and women on a new urban trail, and whether engagement varied over time. DESIGN, SAMPLE, AND MEASURES: We used a modified System for Observing Play and Recreation in Communities (SOPARC) methodology to determine observed race/ethnicity, gender, and physical activity level of trail users (n = 15,109). RESULTS: Logistic regression analyses revealed the odds of engaging in VPA were lower for Latina women than all other population subgroups (vs. White men: OR 0.19, CI 0.17-0.22; vs. White women: OR 0.48, CI 0.42-0.54, vs. Latino men: OR 0.23, CI 0.19-0.26). VPA engagement by White and Latina women increased across the study years (OR 1.31, CI 1.17-1.46; OR 1.36, CI 1.08-1.71, respectively) but did not differ significantly by year for White and Latino men. CONCLUSION: Future efforts to address racial/ethnic-gender disparities in VPA should take an intersectional approach to ensure that the needs of the most vulnerable population subgroups are properly accounted for.

Did Playground Renovations Equitably Benefit Neighborhoods in Chicago?

Between 2013 and 2016, the Chicago Park District renovated 327 playgrounds in need of repair across Chicago through a $44 million investment. This study evaluated whether short-term and longer-term impacts of renovations on park use and park-based moderate-to-vigorous physical activity (MVPA) differed by neighborhood income level and neighborhood concentration of Black residents. A total of 39 parks with renovated playgrounds and 39 matched comparison parks with playgrounds that needed repair but not selected for renovation in year 1 were studied. Three waves of observational data were collected at each park: baseline, 12 months post-renovation, and 24 months post-renovation. Difference-in-differences mixed-effects Poisson regression models estimated renovation effects. The effects of renovations differed by the income level and concentration of Black residents in the neighborhoods where parks were located. In low-income neighborhoods, renovations were associated with reductions in park use and park-based MVPA over the longer term. In contrast, renovations were associated with short- and longer-term increases in park use and park-based MVPA in medium-income neighborhoods and with longer-term increases in MVPA in high-income neighborhoods. Renovations were generally not associated with any changes in park use or park-based MVPA in high-percent Black neighborhoods, but they were associated with increased park use and park-based MVPA in low-percent Black neighborhoods. This study suggests playground renovations in Chicago may have had unintended consequences, increasing neighborhood income and racial disparities in park use and park-based MVPA. Future playground renovation efforts may need to allocate more resources for renovating the broader park where in disrepair, more intensely involve neighborhood residents, and employ complementary strategies such as additional park programming to ensure renovations benefit all neighborhoods.

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.

Racial/ethnic and educational differences in perceptions and use of a new urban trail.

ABSTRACTObjectives: Obesity and its associated health risks are on the rise throughout the US due, in part, to an overall decline in physical activity. Although public green spaces, and in particular trails, show promise as population-level interventions to promote physical activity among adults, these amenities may have disparate impacts across racial/ethnic and socioeconomic groups within a community.Design: This cross-sectional study employed an intercept survey of users of a newly opened $95 million rail-to-trail development in Chicago, IL, immediately after its opening and one year later to examine differences by race/ethnicity and educational attainment in trail use behaviors, motivations for trail use, safety concerns, and change in physical activity attributed to the trail.Results: Although the overall impact of the trail was positive, Latino users were more likely to report frequent use (4+ times/week), health motivations for using the trail, and increased physical activity attributed to the trail. However, Latino users were also more likely to indicate safety concerns and less likely to use areas of the trail in predominately white communities, even after controlling for community of residence. The least educated trail users frequented fewer trail areas and were less likely to indicate health motivations for trail use.Conclusions: Although urban trails represent an opportunity for cost-effective community-wide health promotion, they may not benefit all groups equally. Urban trails may have particularly promising benefits for Latino users, but safety concerns and the possibility of community racial segregation being replicated on trails should be addressed to maximize and sustain these benefits. Less educated residents in particular may not benefit from such projects as intended.

Access to pharmacies and pharmacy services in New York City, Los Angeles, Chicago, and Houston, 2015-2020.

BACKGROUND: Despite the importance of pharmacies in ensuring medications and health care needs are met, there is limited up-to-date information regarding access to pharmacies or their services in the United States. OBJECTIVES: To evaluate trends and disparities in access to pharmacies in 4 largest cities in the United States, New York City, Los Angeles, Houston, and Chicago, by neighborhood racial and ethnic composition from 2015 to 2020. METHODS: Data from the National Council for Prescription Drug Programs (2015-2020) and the American Community Survey (2015-2019) were used. We examined neighborhoods (i.e., census tracts) and evaluated disparities in "pharmacy deserts" (low-income neighborhoods (1) whose average distance to the nearest pharmacy was at least 1 mile or (2) whose average distance to the nearest pharmacy was at least 0.5 mile and at least 100 households had no vehicle access). We also evaluated the differences in pharmacy closures and the availability of pharmacy services. RESULTS: From 2015 to 2020, the percent of neighborhoods with pharmacy deserts declined in New York City (from 1.6% to 0.9% of neighborhoods, P < 0.01), remained stable in Los Angeles (13.7% to 13.4%, P = 0.58) and Houston (27.0% to 28.5%, P = 0.18), and increased in Chicago (15.0% to 19.9%, P < 0.01). Pharmacy deserts were persistently more common in Black and Latino neighborhoods in all 4 cities. As of 2020, pharmacies in Black and Latino neighborhoods were also more likely to close and less likely to offer immunization, 24-hour, and drive-through services than pharmacies in other neighborhoods. CONCLUSION: To reduce disparities in access to medications and health care services, including those in response to the coronavirus disease 2019 pandemic (e.g., testing and vaccinations), policies that improve pharmacy access and expand the provision of pharmacy services in minority neighborhoods are critical.

Associations of the consumer food environment with eating behaviours and BMI.

OBJECTIVE: To examine cross-sectional associations of four aspects of the consumer food environment - price, availability, marketing and product placement - with BMI and fruit and vegetable intake. DESIGN: This cross-sectional study measured the consumer food environment using grocery store audits and surveys. Outcomes were measured through surveys and physical exams. Multivariable linear regression models were run; models were all adjusted for age, neighbourhood, education, race/ethnicity and financial burden. SETTING: Non-proportional quota sample of four socio-economically and racial/ethnically diverse neighbourhoods in Chicago, IL. PARTICIPANTS: Women (n 228) aged 18-44 years. RESULTS: Participants who reported seeing healthy food marketing had a higher vegetable intake (ß = 0·24, 95 % CI 0·06, 0·42). There was some suggestive evidence that participants who shopped at stores that were more expensive (ß = -0·90, 95 % CI -1·94, 0·14) had lower BMI, but this association was not statistically significant. Multivariable regression models did not indicate any significant association between any measure of the consumer food environment and fruit intake. CONCLUSIONS: Our findings add to the growing interest in the role of the consumer food environment in health behaviours. Further research is needed to better understand the role of price and marketing characteristics on eating behaviours and BMI.

Prenatal cigarette smoking as a mediator between racism and depressive symptoms: The Biosocial Impact on Black Births Study.

OBJECTIVE: This study examined whether cigarette smoking mediated the association of racial discrimination with depressive symptoms among pregnant Black women. DESIGN: Cross-sectional. SAMPLE: Two hundred Black women at 8-29 weeks gestation. MEASUREMENTS: Women completed questionnaires including the Experiences of Discrimination and the Center for Epidemiologic Studies-Depression (CES-D) scales, as well as questions about sociodemographic characteristics and cigarette smoking. RESULTS: The mean age of the sample was 26.9 ± 5.7 years and the mean gestational age at data collection was 15.6 ± 5.7 weeks. Approximately 17% of women reported prenatal cigarette smoking; 27% had prenatal CES-D scores ≥23, which have been correlated with depression diagnoses; and 59% reported ever (lifetime) experiencing discrimination in at least one situation (e.g., at work). Path analysis results indicated that the standardized indirect effect of experiences of racial discrimination on CES-D scores through prenatal smoking was statistically significant (standardized indirect effect = 0.03; 95% CI: 0.001, 0.094; p = .042). CONCLUSION: Cigarette smoking during pregnancy partially mediated the association between lifetime experiences of racial discrimination and prenatal depressive symptoms among pregnant Black women. Smoking cessation programs should focus on identifying and treating depressive symptoms among pregnant Black women.

Does the built environment influence the effectiveness of behavioral weight management interventions?

Outcomes of behavioral lifestyle interventions for promoting weight loss vary widely across participants. The effectiveness of a weight management intervention may depend on a person's environmental context. This study compared short- and longer-term effects of a structured nationwide weight management program for people living in neighborhoods with different levels of walkability and different access to recreational places (parks, fitness facilities). Drawing on the health production model, we tested competing hypotheses for whether treatment effects of the program complement environmental supports or substitute for environmental constraints. We studied the US Department of Veterans Affairs (VA) MOVE! weight management program using VA electronic heath record data (2009-2014) and a difference-in-differences design with an inverse propensity score matched comparison group. A total of 114,256 program participants and 498,494 non-participants comprised the sample. Built environment features were measured within one-mile of each person's home. We estimated program effects on body mass index (BMI) for subgroups with different built environments at 6-, 12-, 18-, and 24-month follow-up using linear regressions with person and year fixed effects. At 6 months, the program reduced BMI by 0.4-0.6 kg/m2 among men and 0.3-0.5 kg/m2 among women. The effect diminished at 12, 18, and 24 months. The program effect did not vary significantly across subgroups with different walkability, park access, or fitness facility access. The MOVE! program was not sensitive to environmental context. Results did not lend support to either hypothesis that the MOVE! program complements or substitutes for a person's built environment to affect weight management outcomes.

Foreclosures and weight gain: Differential associations by longer neighborhood exposure.

While home foreclosure can lead to mental and physical health declines in persons experiencing the foreclosure, whether neighborhood foreclosures can affect the health of other residents is debatable. Using a racially/ethnically diverse sample of Chicago metropolitan area residents linked to foreclosure data from 2008 to 2014, we assessed whether exposure to neighborhood foreclosure fillings was associated with changes in objectively measured body mass index (BMI) over time. Using a retrospective longitudinal design, we employed fixed-effects regression models that controlled for individual- and neighborhood-level covariates to test the association of neighborhood foreclosures and BMI in >60,000 individuals and for individuals who did not move during the follow-up period. We also adjusted for the non-linear association of age and BMI and comorbidities and employed a series of sensitivity analysis to test for robustness. In fully adjusted models, a standard-deviation increase in neighborhood foreclosure filings within 500 m was associated with increases in BMI for individuals who did not move (nonmovers) (mean = 0.03 BMI units, 95% confidence interval: 0.01, 0.06). Neighborhood foreclosure rates were not associated with changes in BMI for the full sample. Given the potential deleterious effects of neighborhood foreclosure on individuals with longer exposure to the local vicinity, clarifying the potential health effects of neighborhood foreclosures would help policymakers when planning actions to prevent home losses, predatory home loans, and that aim to more efficiently return foreclosure properties to productive uses.

Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos.

BACKGROUND: The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: HCHS/SOL participants were age 18-74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). RESULTS: Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. CONCLUSION: Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.

Contextual correlates of energy-dense snack food and sweetened beverage intake across the day in African American women: An application of ecological momentary assessment.

This study examined relationships between contextual factors and within-person variations in snack food and sweetened beverage intake in African American women (n = 79), aged 25-65 years living in metropolitan Chicago. For seven days, participants wore a global positioning system (GPS) logger and were signaled five times per day to complete an ecological momentary assessment (EMA) survey assessing behaviors and environmental, social, and other contextual factors via smartphones. Within-person associations between snack food and beverage intake and contextual factors were analyzed using three-level logistic regressions. Participants reported consuming a snack food at 38.4% of signals and a sweetened beverage at 17.9% of signals. Fast food restaurant and convenience store density within the daily activity space was not associated with either snack food or sweetened beverage intake. However, perceptions of close proximity to fast food restaurants and convenience stores making it easier to eat/drink, while accounting for one's usual proximity, were associated with increased odds of snack intake (O.R. 2.1; 95% C.I. 1.4, 3.0) but not sweetened beverage. We also found engaging in activities such as watching television (O.R. 1.8; 95% C.I. 1.2, 2.7) and talking (O.R. 1.7; 95% C.I. 1.1, 2.6) while eating were associated with higher snack intake. These factors were not related to sweetened beverage intake. Public health interventions addressing fast food restaurant and convenience store accessibility and food offerings and marketing within these outlets may help reduce snack food intake. Additionally, to reduce concurrent activities while eating, real-time interventions using smart technology could be used to enhance attentive eating in this population.

Assessment of the influence of food attributes on meal choice selection by socioeconomic status and race/ethnicity among women living in Chicago, USA: A discrete choice experiment.

Large and persistent obesity disparities exist in the US by socioeconomic status (SES) and race/ethnicity, and weight loss interventions have traditionally been less effective in these populations. Thus, a better understanding is needed of the behavioral, economic, and geographic factors that influence obesity risk factors such as eating behaviors. We used a discrete choice experiment to evaluate the impact of different meal attributes on meal choice and to test whether the relative importance of these attributes varied by SES and race/ethnicity. Study participants (n = 228) were given a series of 10 choice tasks and asked to choose among 4 meals, each rated based on the following attributes: taste; healthfulness; preparation time; travel time to food outlet for meal/ingredients; and price. SES was measured using education and self-reported difficulty paying for basics. Race/ethnicity was categorized as Hispanic/Latina, non-Hispanic black, non-Hispanic white, and non-Hispanic other. Data were analyzed using mixed logit regression models with interaction terms to determine whether meal attributes influenced meal choices differentially by SES and race/ethnicity. Healthfulness and taste were the most important attributes for all participants. Price was a more important attribute among those in the lowest SES group compared with those in the higher SES groups. Travel was the least important attribute for low SES participants, and it was not significantly related to meal choice in these groups. Discrete choice experiments as illustrated here may help pinpoint the most salient targets for interventions to improve eating behaviors and reduce obesity disparities. Specifically, our findings suggest interventions should incorporate strategies to target the pricing of healthy and unhealthy food options.

Addressing the Public Health Crisis of Maternal Mortality: A National Research Agenda.

This Viewpoint discusses the National Institutes of Health initiative that focuses on research that reduces preventable maternal mortality, decreases severe maternal morbidity, and promotes health equity.

Neighborhood Resources to Support Healthy Diets and Physical Activity Among US Military Veterans.

INTRODUCTION: Among the nearly 21 million military veterans living in the United States, 64.0% of women and 76.1% of men are overweight or obese, higher rates than in the civilian population (56.9% of women and 69.9% of men). Attributes of the residential environment are linked to obesity. The objective of this study was to characterize the residential environments of the US veteran population with respect to availability of food and recreational venues. METHODS: We used American Community Survey data to determine the concentration of veterans (the percentage of veterans among the adult population) in all continental US census tracts in 2013, and we used proprietary data to construct measures of availability of food and recreational venues per census tract. Using descriptive statistics and ordinary least-squares regression, we examined associations between the concentration of veterans per census tract and those residential environmental features. RESULTS: In census tracts with high concentrations of veterans, residents had, on average, 0.5 (interquartile range, 0-0.8) supermarkets within a 1-mile radius, while residents in census tracts with low concentrations of veterans had 3.2 (interquartile range, 0.6-3.7) supermarkets. Patterns were similar for grocery and convenience stores, fast food restaurants, parks, and commercial fitness facilities. In adjusted analyses controlling for census-tract-level covariates, veteran concentration remained strongly negatively associated with availability of those food and recreational venues. In nonmetropolitan tracts, adjusted associations were greatly attenuated and even positive. CONCLUSION: Where veterans live is strongly associated with availability of food outlets providing healthy (and unhealthy) foods and with recreational venues, raising questions about the contributions of veterans' residential environments to their high obesity rates. Additional research is needed to address those questions.

Environmental and personal correlates of physical activity and sedentary behavior in African American women: An ecological momentary assessment study.

The authors of this study examined within-person associations of environmental factors (weather, built and social environmental barriers) and personal factors (daily hassles, affect) with moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) in African American women aged 25-64 years living in metropolitan Chicago (n = 97). In 2012-13, for seven days, women wore an accelerometer and were signaled five times per day to complete a survey covering environmental and personal factors on a study-provided smartphone. Day-level measures of each were derived, and mixed regression models were used to test associations. Poor weather was associated with a 27.3% reduction in daily MVPA. Associations between built and social environmental barriers and daily MVPA or SB were generally not statistically significant. Negative affect at the first daily signal was associated with a 38.6% decrease in subsequent daily MVPA and a 33.2-minute increase in subsequent daily SB. Each one-minute increase in MVPA during the day was associated with a 2.2% higher likelihood of positive affect at the end of the day. SB during the day was associated with lower subsequent positive affect. Real-time interventions that address overcoming poor weather and negative affect may help African American women increase MVPA and/or decrease SB.

Retail Food Store Access in Rural Appalachia: A Mixed Methods Study.

OBJECTIVE: To describe how characteristics of food retail stores (potential access) and other factors influence self-reported food shopping behavior (realized food access) among low-income, rural Central Appalachian women. DESIGN AND SAMPLE: Cross-sectional descriptive. Potential access was assessed through store mapping and in-store food audits. Factors influencing consumers' realized access were assessed through in-depth interviews. Results were merged using a convergent parallel mixed methods approach. Food stores (n = 50) and adult women (n = 9) in a rural Central Appalachian county. RESULTS: Potential and realized food access were described across five dimensions: availability, accessibility, affordability, acceptability, and accommodation. Supermarkets had better availability of healthful foods, followed by grocery stores, dollar stores, and convenience stores. On average, participants lived within 10 miles of 3.9 supermarkets or grocery stores, and traveled 7.5 miles for major food shopping. Participants generally shopped at the closest store that met their expectations for food availability, price, service, and atmosphere. Participants' perceptions of stores diverged from each other and from in-store audit findings. CONCLUSIONS: Findings from this study can help public health nurses engage with communities to make affordable, healthy foods more accessible. Recommendations are made for educating low-income consumers and partnering with food stores.