Reduced Prevalence of Obesity in 14 Disadvantaged Black Communities in the United States: A Successful 4-Year Place-Based Participatory Intervention.

OBJECTIVES: To assess the impact of a large-scale place-based intervention on obesity prevalence in Black communities. METHODS: The Racial and Ethnic Approaches to Community Health across the United States (REACH US) project was conducted in 14 predominantly Black communities in California, Illinois, Massachusetts, New York, Ohio, Pennsylvania, South Carolina, Virginia, Washington, and West Virginia. We measured trends from 2009 to 2012 in the prevalence of obesity. We used Behavioral Risk Factor Surveillance System data to compare these trends with trends among non-Hispanic Whites and non-Hispanic Blacks in the United States and in the 10 states where REACH communities were located, and with a propensity score-matched national sample of non-Hispanic Blacks. RESULTS: The age-standardized prevalence of obesity decreased in REACH US communities (P = .045), but not in the comparison populations (P = .435 to P = .996). The relative change was -5.3% in REACH US communities versus +2.4% in propensity score-matched controls (P value for the difference = .031). The net effect on the reduction of obesity prevalence was about 1 percentage point per year for REACH. CONCLUSIONS: Obesity prevalence was reduced in 14 disadvantaged Black communities that participated in the REACH project.

System-level change in cultural and linguistic competence (CLC): how changes in CLC are related to service experience outcomes in systems of care.

As US demographic trends shift toward more diversity, it becomes increasingly necessary to address differential needs of diverse groups of youth in mental health service systems. Cultural and linguistic competence (CLC) is essential to providing the most appropriate mental health services to youth and their families. The successful implementation of CLC often begins at the system level. Though various factors may affect change and system-level factors set the tone for broad acceptance of CLC within systems, there is limited empirical evidence linking culturally competent practices to outcomes. The purpose of the present study was to examine system-level CLC changes over time within systems of care and their associations with service experiences among youth and their families. Participants were 4,512 youth and their families enrolled in the national evaluation of the Children's Mental Health Initiative (CMHI). Results suggest that implementation of CLC at the system level improves over time in funded systems of care. Further, variation exists in specific system-level components of CLC. In addition, the changes in CLC at the system level are related to family/caregiver participation in treatment. Implications for supporting positive changes in CLC among systems of care communities, and specific strategies for community psychologists, are discussed.

Spousal agreement on preferred waiting time to next birth in sub-Saharan Africa.

This study investigates how various social, demographic and economic factors affect spousal agreement on preferred waiting time to next birth. Data for matched cohabiting couples from ten Demographic and Health Surveys in sub-Saharan Africa (Benin, Burkina Faso, Ghana, Guinea, Mali, Ethiopia, Kenya, Mozambique, Zambia and Zimbabwe), conducted between 2003 and 2006, were analysed to compare reported waiting time to next birth by the husband and the wife. Couples where the reported waiting time to next birth was the same for both partners (difference is 0 months) were defined as having agreement on waiting time to next birth. In sub-Saharan Africa, spousal agreement on waiting time to next birth was found to be associated with wanting the next child sooner. When the spouses disagree on waiting time to next birth, the wives want to wait longer than their husbands in most cases. Additionally, the study found that demographic factors are the primary determinants of spousal agreement on waiting time to next birth, not socioeconomic factors. The strongest predictors of spousal agreement on waiting time to next birth were number of living children, difference between the number of ideal and living children and wife's age. Couples with fewer children, a younger wife and those with a difference of five or more children between ideal and living number of children were more likely to agree on waiting time to next birth. Effects of socioeconomic factors, such as education and wealth status, on spousal agreement on waiting time to next birth were generally weak and inconsistent. The findings highlight some of the challenges in developing programmes to promote spousal communication and birth spacing and underscore the need for programmes to be gender-sensitive.

Measuring eating competence: psychometric properties and validity of the ecSatter Inventory.

OBJECTIVE: Assess validity of the ecSatter Inventory (ecSI) to measure eating competence (EC). DESIGN: Concurrent administration of ecSI with validated measures of eating behaviors using on-line and paper-pencil formats. SETTING: The on-line survey was completed by 370 participants; 462 completed the paper version. PARTICIPANTS: Participants included 863 adults with 832 usable surveys from respondents (mean age 36.2 +/- 13.4 years) without eating disorders, mostly female, white, educated, overweight, physically active, and food secure. Of those indicating intent to complete the on-line survey, 80.3% did so; 54% of mailed surveys were returned. VARIABLES MEASURED: Eating and food behaviors compared among EC tertiles and between dichotomous EC categories; internal consistency of ecSI. ANALYSIS: Analysis of variance, independent t tests, chi-square, factor analysis, logistic regression. Significance level was P < .05. RESULTS: Mean ecSI score was 31.1 +/- 7.5. ecSI included 4 subscales with internal reliability and content validity. Construct validity was supported by specific behavioral profiles for ecSI tertiles and ecSI dichotomized categories. Persons unsatisfied with weight were 54% less likely to be EC; unit increase in the food like index was associated with nearly 3 times greater likelihood of being EC. CONCLUSIONS AND IMPLICATIONS: The ecSatter Inventory is a valid measure of EC and can be used for descriptive and outcome measurements.

Opinions of African Americans about tobacco industry philanthropy.

OBJECTIVES: To investigate African Americans' opinions about the philanthropic contributions of the tobacco industry to Black organizations. METHODS: One thousand African Americans were randomly selected using a stratified cluster sample design of 10 U.S. congressional districts represented by African Americans. RESULTS: Almost two-thirds of African Americans favored accepting tobacco industry philanthropy as long as the recipients do not support smoking. A majority agreed that the tobacco industry gives money to African American communities to improve its image (71.2%), make money (83.2%), and to encourage people to smoke (60.5%). About one-third stated they believed it gave money to help the community (34.4%). Multiple logistic regression showed that women, the college educated, and current smokers were significantly (p<0.05) more likely to favor accepting tobacco industry philanthropy. Multiple logistic regression revealed significant differences by education, smoking status, and selective attitudinal and behavioral variables with regard to tobacco industry philanthropy. The 18-34 age group was significantly less likely to agree that the tobacco industry gives money to help the community, with or without covariate adjustment. CONCLUSION: Results of this study are important because despite the perceived benefits to these communities, tobacco industry contributions could mitigate community concerns about tobacco-related diseases, mask their significance, and undermine tobacco control strategies and policies.