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Physical inactivity has reached epidemic proportions in modern society. Abundant evidence points to a causal link between physical inactivity and increased risk for numerous noncommunicable diseases, such as some types of cancer and heart disease, as well as premature mortality. Yet, despite this overwhelming evidence, many individuals do not meet the recommended amount of physical activity required to achieve maximum health benefits. Because primary care physicians' advice is highly regarded, clinicians have the unique opportunity to play an important role in enabling patients to modify their behavior at the point of care with the goal of guiding patients to adopt and maintain an active lifestyle. In the current study, the authors evaluate pertinent literature from the fields of medicine/public health and economics/psychology to suggest a comprehensive approach to physical activity counseling at the primary care level. They first examine the public health approach to physical activity counseling, and then proceed to offer insights from behavioral economics, an emerging field that combines principles from psychology and economics. The application of key behavioral economics tools (eg, precommitment contracts, framing) to physical activity counseling in primary care is elaborated. CA Cancer J Clin 2017;67:233-244. © 2017 American Cancer Society.
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Aconselhamento , Economia Comportamental , Exercício Físico , Atenção Primária à Saúde/métodos , Saúde Pública , Exercício Físico/psicologia , HumanosRESUMO
BACKGROUND: Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving. METHODS: Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n = 35) or no-prep meals (n = 35). Participants completed questionnaires at baseline and two-week follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation. RESULTS: Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp²=0.16, F(1,64) = 11.78, p < .001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp²=0.36, F(1,64) = 36.38, p < .001) and food security (ηp²=0.36, F(1,64) = 36.38, p < .001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp²=0.09, F(1,64) = 6.28, p = .015). CONCLUSIONS: Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes. TRIAL REGISTRATION: This trial was registered on 25/10/2022 on ClinicalTrials.gov, identifier: NCT05593510.
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Assistência Alimentar , Abastecimento de Alimentos , Adulto , Humanos , Feminino , Masculino , Projetos Piloto , Dieta , Refeições , Segurança AlimentarRESUMO
OBJECTIVE: The COVID-19 pandemic initially doubled the rates of food insecurity across the USA and tripled rates among households with children. Despite the association among food insecurity, chronic disease and psychological distress, narratives depicting the experiences of already food insecure populations are notably underrepresented in the literature. The current study assessed the impact of COVID-19 on clients of a food pantry who were also enrolled in the Supplemental Nutrition Assistance Program (SNAP). DESIGN: A qualitative study probing the effects of the pandemic on daily living, food needs, food buying and food insecurity. Interview transcripts were analysed using a combined deductive and inductive approach. SETTING: Interviews were conducted via telephone between May and June of 2020. PARTICIPANTS: Equal numbers of English- and Spanish-speaking clients (n 40 total). RESULTS: Three main findings emerged: (1) the pandemic increased economic distress, such as from job loss or increased utility bills due to sustained home occupancy and (2) the pandemic increased food needs, food prices and food shortages. In combination with economic stressors, this led to greater food insecurity; (3) increased economic stress and food insecurity contributed to increased psychological stress, such as from fear of infection, isolation and children being confined at home. CONCLUSIONS: Despite federal legislation and state and local programmes to alleviate food insecurity, COVID-19 exacerbated economic hardship, food insecurity and psychological distress among urban SNAP and food pantry clients. Additional research is needed to identify the most effective policies and programmes to ameliorate the short- and long-term health and economic inequities exacerbated by the pandemic.
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COVID-19 , Assistência Alimentar , Angústia Psicológica , COVID-19/epidemiologia , Criança , Insegurança Alimentar , Abastecimento de Alimentos , Humanos , PandemiasRESUMO
BACKGROUND: Cardiovascular disease is a leading economic and medical burden in the United States (US). As an important risk factor for cardiovascular disease, hypertension represents a critical point of intervention. Less is known about longitudinal effects of neighborhood deprivation on blood pressure outcomes, especially in light of new hypertension guidelines. METHODS: Longitudinal data from the Dallas Heart Study facilitated multilevel regression analysis of the relationship between neighborhood deprivation, blood pressure change, and incident hypertension over a 9-year period. Factor analysis explored neighborhood perception, which was controlled for in all analyses. Neighborhood deprivation was derived from US Census data and divided into tertiles for analysis. Hypertension status was compared using pre-2017 and 2017 hypertension guidelines. RESULTS: After adjusting for covariates, including moving status and residential self-selection, we observed significant associations between residing in the more deprived neighborhoods and 1) increasing blood pressure over time and 2) incident hypertension. In the fully adjusted model of continuous blood pressure change, significant relationships were seen for both medium (SBP: ßâ¯=â¯4.81, SEâ¯=â¯1.39, Pâ¯=â¯.0005; DBP: ßâ¯=â¯2.61, SEâ¯=â¯0.71, Pâ¯=â¯.0003) and high deprivation (SBP: ßâ¯=â¯7.64, SEâ¯=â¯1.55, Pâ¯<â¯.0001; DBP: ßâ¯=â¯4.64, SEâ¯=â¯0.78, Pâ¯<â¯.0001). In the fully adjusted model of incident hypertension, participants in areas of high deprivation had 1.69 higher odds of developing HTN (OR 1.69; 95% CI 1.02, 2.82), as defined by 2017 hypertension guidelines. Results varied based on definition of hypertension used (pre-2017 vs. 2017 guidelines). CONCLUSION: These findings highlight the potential impact of adverse neighborhood conditions on cardiometabolic outcomes, such as hypertension.
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Status Econômico , Hipertensão/epidemiologia , Áreas de Pobreza , Características de Residência/estatística & dados numéricos , Adulto , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Texas/epidemiologiaRESUMO
Low-socioeconomic status (SES) households have little income or wealth to buffer against the negative impacts of an adverse health event (health shock) among adult household members. However, these households may employ a variety of other coping strategies such as receiving help from family, friends, and social services. Administrative data from a non-profit food distribution center, electronic medical record (EMR) data from a safety-net healthcare system, and publicly available residential appraisal data were linked to provide insight into these coping strategies. Three broad types of coping strategies were examined: changes in household structure, residential mobility, and utilization of social services. Of 3,235 households, 20.2% had at least one adult member who experienced a health shock. These households were more likely to gain additional adult household members and employed household members, were more likely to move residence and to move distances greater than one mile, and were less likely to visit the food distribution center after the shock.
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BACKGROUND: Researchers measuring relationships between neighborhoods and health have begun using property appraisal data as a source of information about neighborhoods. Economists have developed a rich tool kit to understand how neighborhood characteristics are quantified in appraisal values. This tool kit principally relies on hedonic (implicit) price models and has much to offer regarding the interpretation and operationalization of property appraisal data-derived neighborhood measures, which goes beyond the use of appraisal data as a measure of neighborhood socioeconomic status. METHODS: We develop a theoretically informed hedonic-based neighborhood measure using residuals of a hedonic price regression applied to appraisal data in a single metropolitan area. We describe its characteristics, reliability in different types of neighborhoods, and correlation with other neighborhood measures (i.e., raw neighborhood appraisal values, census block group poverty, and observed property characteristics). We examine the association between all neighborhood measures and body mass index. RESULTS: The hedonic-based neighborhood measure was correlated in the expected direction with block group poverty rate and observed property characteristics. The neighborhood measure and average raw neighborhood appraisal value, but not census block group poverty, were associated with individual body mass index. CONCLUSION: We draw theoretically consistent methodology from the economics literature on hedonic price models to demonstrate how to leverage the implicit valuation of neighborhoods contained in publicly available appraisal data. Consistent measurement and application of the hedonic-based neighborhood measures in epidemiology will improve understanding of the relationships between neighborhoods and health. Researchers should proceed with a careful use of appraisal values utilizing theoretically informed methods such as this one.
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Comércio , Habitação , Obesidade/epidemiologia , Áreas de Pobreza , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Índice de Massa Corporal , Censos , Métodos Epidemiológicos , Humanos , Texas/epidemiologia , Estados Unidos/epidemiologiaRESUMO
INTRODUCTION: Food insecurity is negatively associated with health; however, health needs may differ among people participating in food assistance programs. Our objectives were to characterize differences in health among people receiving different types of food assistance and summarize strategies for targeted recruitment and outreach of various food insecure populations. METHODS: We examined health status, behaviors, and health care access associated with food insecurity and receipt of food assistance among US adults aged 20 years or older using data from participants (N = 16,934) of the National Health and Nutrition Examination Survey from 2005 through 2010. RESULTS: Food insecurity affected 19.3% of US adults (95% confidence interval, 17.9%-20.7%). People who were food insecure reported poorer health and less health care access than those who were food secure (P < .001 for all). Among those who were food insecure, 58.0% received no assistance, 20.3% received only Supplemental Nutrition Assistance Program (SNAP) benefits, 9.7% received only food bank assistance, and 12.0% received both SNAP and food bank assistance. We observed an inverse relationship between receipt of food assistance and health and health behaviors among the food insecure. Receipt of both (SNAP and food bank assistance) was associated with the poorest health; receiving no assistance was associated with the best health. For example, functional limitations were twice as prevalent among people receiving both types of food assistance than among those receiving none. CONCLUSION: Receipt of food assistance is an overlooked factor associated with health and has the potential to shape future chronic disease prevention efforts among the food insecure.
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Assistência Alimentar/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Adulto , Doença Crônica/prevenção & controle , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Pobreza , Fatores de Risco , Estados UnidosRESUMO
Obesity has reached epidemic proportions in the US, with a significantly higher fraction of African Americans who are obese than whites. Yet there is little understanding of why some individuals become obese while others do not. We conduct a lab-in-field experiment in a low-income African American community to investigate whether risk and time preferences play a role in the tendency to become obese. We examine the relationship between incentivized measures of risk and time preferences and weight status (BMI), and find that individuals who are more tolerant of risk are more likely to have a higher BMI. This result is driven by the most risk tolerant individuals. Patience is not independently statistically related to BMI in this sample, but those who are more risk averse and patient are less likely to be obese.
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OBJECTIVE: The aim of this study is to examine a relationship between neighborhood-level socioeconomic deprivation and weight change in a multi-ethnic cohort from Dallas County, Texas and whether behavioral/psychosocial factors attenuate the relationship. METHODS: Non-movers (those in the same neighborhood throughout the study period) aged 18-65 (N=939) in Dallas Heart Study (DHS) underwent weight measurements between 2000 and 2009 (median 7-year follow-up). Geocoded home addresses defined block groups; a neighborhood deprivation index (NDI) was created (higher NDI=greater deprivation). Multi-level modeling determined weight change relative to NDI. Model fit improvement was examined with adding physical activity and neighborhood environment perceptions (higher score=more unfavorable perceptions) as covariates. A significant interaction between residence length and NDI was found (p-interaction=0.04); results were stratified by median residence length (11 years). RESULTS: Adjusting for age, sex, race/ethnicity, smoking, and education/income, those who lived in neighborhood >11 years gained 1.0 kg per one-unit increment of NDI (p=0.03), or 6 kg for those in highest NDI tertile compared with those in the lowest tertile. Physical activity improved model fit; NDI remained associated with weight gain after adjustment for physical activity and neighborhood environment perceptions. There was no significant relationship between NDI and weight change for those in their neighborhood ≤11 years. CONCLUSIONS: Living in more socioeconomically deprived neighborhoods over a longer time period was associated with weight gain in DHS.
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Etnicidade , Áreas de Pobreza , Características de Residência , Classe Social , Aumento de Peso/etnologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Texas , Adulto JovemRESUMO
BACKGROUND: The purpose of this study was to extend the analysis of neighborhood effects on child behavioral outcomes in two ways: (1) by examining the geographic extent of the relationship between child behavior and neighborhood physical conditions independent of standard administrative boundaries such as census tracts or block groups and (2) by examining the relationship and geographic extent of geographic peers' behavior and individual child behavior. METHODS: The study neighborhood was a low income, ethnic minority neighborhood of approximately 20,000 residents in a large city in the southwestern United States. Observational data were collected for 11,552 parcels and 1,778 face blocks in the neighborhood over a five week period. Data on child behavior problems were collected from the parents of 261 school-age children (81% African American, 14% Latino) living in the neighborhood. Spatial analysis methods were used to examine the spatial dependence of child behavior problems in relation to physical conditions in the neighborhood for areas surrounding the child's home ranging from a radius of 50 meters to a radius of 1000 meters. Likewise, the spatial dependence of child behavior problems in relation to the behavior problems of neighborhood peers was examined for areas ranging from a radius 255 meters to a radius of 600 meters around the child's home. Finally, we examined the joint influence of neighborhood physical conditions and geographic peers. RESULTS: Poor conditions of the physical environment of the neighborhood were related to more behavioral problems, and the geographic extent of the physical environment that mattered was an area with a radius between 400 and 800 meters surrounding the child's home. In addition, the average level of behavior problems of neighborhood peers within 255 meters of the child's home was also positively associated with child behavior problems. Furthermore, these effects were independent of one another. CONCLUSIONS: These findings demonstrate that using flexible geographies in the study of neighborhood effects can provide important insights into spatial influences on health outcomes. With regards to child behavioral outcomes, specifically, these findings support the importance of addressing the physical and social environment when planning community-level interventions to reduce child behavior problems.
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Transtornos do Comportamento Infantil/economia , Transtornos do Comportamento Infantil/etnologia , Comportamento Infantil/etnologia , Pobreza/economia , Características de Residência , Análise Espacial , Adolescente , Criança , Transtornos do Comportamento Infantil/diagnóstico , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
INTRODUCTION: Insufficient physical activity is an established risk factor for numerous chronic diseases and for premature death. Accumulating evidence reveals that prolonged sedentary time is detrimental, independent of the protective effects of physical activity. Although studies have explored correlates of physical activity among ethnic minority populations, few have examined factors related to sedentary behavior. Therefore, we conducted a preliminary investigation into urban adults' perceptions of sedentary behavior alongside perceived barriers and enablers to physical activity. METHODS: In-depth semi-structured interviews were used to evaluate perceptions of physical activity and sedentary behavior in a sample of low-income, ethnic minority adults. The framework approach guided researchers in analyzing the qualitative data. RESULTS: Participants were well aware of the positive health benefits of physical activity. However, most admitted not regularly engaging in physical activity and cited numerous barriers to activity, such as lack of time, insufficient finances, and neighborhood crime. Enablers included weight loss, the presence of social support, and the availability of safe parks conducive to exercise. In comparison, participants were primarily unfamiliar with the term "sedentary behavior" and did not perceive a relationship between sedentary behavior and health outcomes. CONCLUSION: Our findings illustrate the need to increase the awareness of negative health implications of prolonged sedentary time while continuing to address the multiple impediments to physical activity as a way to combat chronic disease.
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Exercício Físico/psicologia , Comportamentos Relacionados com a Saúde , Comportamento Sedentário , População Urbana , Adulto , Negro ou Afro-Americano , Coleta de Dados , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , TexasRESUMO
Background: Food pantry clients have high rates of food insecurity and greater risk for and prevalence of diet-related diseases. Many clients face time, resource, and physical constraints that limit their ability to prepare healthy meals using foods typically provided by pantries. We compared two novel approaches to alleviate those barriers and encourage healthier eating: meal kits, which bundle ingredients with a recipe on how to prepare a healthy meal, and nutritious no-prep meals, which can be eaten after thawing or microwaving. Methods: Participants were adult pantry clients from a large food pantry in the Southern sector of Dallas, Texas. We conducted a repeated measures between-subjects study with 70 clients randomized to receive 14-days of meal kits (n=35) or no-prep meals (n=35). Participants completed questionnaires at baseline and twoweek follow-up on demographics, hedonic liking of study meals, perceived dietary quality, and food security. Two-way repeated measures analysis of variance was used to examine group and time effects, and group by time interactions. We also describe feasibility and satisfaction outcomes to inform future implementation. Results: Sixty-six participants completed the study (94%). Participants were predominantly Hispanic or Latino(a) (63%) and African American or Black (31%) women (90%). There was a significant interaction on hedonic liking of study meals (ηp2=0.16, F(1,64)=11.78, p<.001), such that participants that received meal kits had greater improvements in hedonic liking over time than participants in the no-prep group. We observed significant improvements in perceived dietary quality (ηp2=0.36, F(1,64)=36.38, p<.001) and food security (ηp2=0.36, F(1,64)=36.38, p<.001) across both groups over time, but no between group differences or significant interactions indicating one intervention was more effective than the other. Program satisfaction was high across both groups, but higher among the meal kit group (ηp2=0.09, F(1,64)=6.28, p=.015). Conclusions: Results suggest nutritious meal kits and no-prep meals may be desirable nutrition intervention strategies for pantry clients and have potential to increase food security and perceived dietary quality in the short-term. Our findings are limited by a small sample and short follow-up. Future studies should continue to test both interventions, and include longer follow-up, objective measures of dietary quality, and relevant clinical outcomes. Trial Registration: This trial was registered on 25/10/2022 on Clinicaltrials.gov, identifier: NCT05593510.
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RATIONALE: Geographic clusters of low vaccination uptake reduce the population-level efficacy of vaccination programs. However, little is known about the mechanisms that drive geographic patterns in vaccination rates. Traditional economic theory considers vaccination as a classic public good and suggests that free riding-individuals taking advantage of public goods by relying on others' immunization behavior without contributing toward them-is a primary cause of low vaccination rates. However, behavioral economics suggests that free riding does not fully explain observed individual behavior, and the presence of both high and low clusters of vaccination rates suggest that this theory alone does not fully explain geographic patterns of vaccination. OBJECTIVE: We assessed geographic clustering of HPV vaccination uptake and examined the evidence for or against free riding in HPV vaccination decisions. METHODS: We analyzed HPV vaccination decisions of low-income adolescent females (Nâ¯=â¯601) residing in urban neighborhoods in Dallas, Texas, USA during 2011-2012. Spatial econometric models were estimated to assess the relationship between neighborhood vaccination rates and individual vaccination decisions. RESULTS: We found a positive and significant relationship between individual HPV vaccination choices and the average neighborhood vaccination rate at the time parents were making vaccine decisions for their adolescent daughters while controlling for neighborhood sorting and other confounders. CONCLUSION: Individuals were more likely to complete the HPV vaccination series when others in their neighborhood had already completed the series. We do not find evidence for free riding in HPV vaccination decisions.
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We identified overlapping geographic clusters of food insecurity and health across U.S. counties to identify potential shared mechanisms for geographic disparities in health and food insecurity. By analyzing health variables compiled as part of the 2014 Robert Wood Johnson Foundation County Health Rankings, we constructed four health indices and compared their spatial patterns to spatial patterns found in food insecurity data obtained from 2014 Feeding America's County Map the Meal Gap data. Clusters of low and high food security that overlapped with clusters of good or poor health were identified using Local Moran's I statistics. Next, multinomial logistic regressions were estimated to identify sociodemographic, urban/rural, and economic correlates of counties lying within overlapping clusters. In general, poor health and high food insecurity clusters, "unfavorable cluster overlaps", were present in the Mississippi Delta, Black Belt, Appalachia, and Alaska. Overlapping good health and low food insecurity clusters, "favorable cluster overlaps", were less common and located in the Corn Belt and New England. Counties with higher black populations and higher poverty were associated with an increased likelihood of lying within overlapping clusters of poor health and high food insecurity. Generally consistent patterns in spatial overlaps between food security and health indicate potential for shared causal mechanisms. Identified regions and county-level characteristics associated with being located inside of overlapping clusters may be used in future place-based intervention and policy.
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The few available population-based longitudinal studies examining the link between change in neighborhood condition and weight change to date have only examined neighborhood changes generated by residential mobility. Applying a difference-in-difference analytic framework to data from the Dallas Heart Study (DHS), a multi-ethnic, population-based cohort in Dallas County, TX, we evaluated the relationship between changes in neighborhood condition and weight change for both movers and non-movers over an approximate seven-year follow-up period. We employed a novel measure of neighborhood condition based on property appraisal data to capture temporally consistent measures of change in neighborhood condition regardless of residential mobility. We observed an inverse relationship between weight change and change in neighborhood condition which was more pronounced for non-movers (1.9 fewer kilograms gained per 1-standard deviation improvement in neighborhood condition) than for movers (1.5 fewer kilograms gained per 1-standard deviation improvement in neighborhood condition).
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Obesidade/etnologia , Dinâmica Populacional/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Aumento de Peso/etnologia , Adulto , Índice de Massa Corporal , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Dinâmica Populacional/tendências , Fatores de Risco , Classe Social , TexasRESUMO
In this study, we show how household health, economic instability, and food insecurity are inextricably linked; disruptions in individual health or income create cumulative and interdependent challenges faced by multiple household members. Drawing upon semi-structured focus groups with English- and Spanish-speaking clients of an urban food pantry, we demonstrate: (1) the impact of economic scarcity on health, (2) the impact of one household member's health on the health and food security of all household members, and (3) food sharing behaviors among family and social networks, including multi-generational families and non-kin individuals. We identify the gap between household-level assessments of food insecurity and individual-level health reports, which may obscure poor health among other household members. Understanding the social and family context of health and food insecurity may inform future interventions that address the interrelated challenges of diverse and disadvantaged households and communities.
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BACKGROUND: Behavioral economics studies have found that individuals with more patient time preferences (ie, greater willingness to forgo current costs for future benefits) are more likely to save money. Although research has observed significant relationships between time preferences and health-promoting behaviors, scant evidence exists with physical activity as an outcome. METHODS: We examined the association between monetary saving behaviors and physical activity among adults of low-income who reside in an urban community. Specifically, we assessed the relationship between saving behaviors (checking/saving account, monthly savings, and planning family finances), and future orientation to physical activity as a dichotomous (meeting guidelines) and continuous (total and domain specific) endpoint. RESULTS: In multivariable regression, being future-oriented and having a checking/saving account were related to a 1.3 and 2.1 times higher (respectively) likelihood of meeting physical activity guidelines (P < .05). When examining physical activity continuously, all measures were significantly related to leisure-time activity (P < .05). CONCLUSIONS: Our study findings establish a relationship between future time preferences and increased levels of physical activity among low-income adults. Future research should prospectively explore the efficacy of various schemes that help individuals overcome impatient time preferences to determine a causal relationship.
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Economia Comportamental/estatística & dados numéricos , Fidelidade a Diretrizes , Atividade Motora/fisiologia , Pobreza/psicologia , População Urbana/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Renda , Atividades de Lazer , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Despite a proposed connection between neighborhood environment and obesity, few longitudinal studies have examined the relationship between change in neighborhood socioeconomic deprivation, as defined by moving between neighborhoods, and change in body weight. The purpose of this study is to examine the longitudinal relationship between moving to more socioeconomically deprived neighborhoods and weight gain as a cardiovascular risk factor. METHODS: Weight (kilograms) was measured in the Dallas Heart Study (DHS), a multiethnic cohort aged 18-65 years, at baseline (2000-2002) and 7-year follow-up (2007-2009, N=1,835). Data were analyzed in 2013-2014. Geocoded addresses were linked to Dallas County, TX, census block groups. A block group-level neighborhood deprivation index (NDI) was created. Multilevel difference-in-difference models with random effects and a Heckman correction factor (HCF) determined weight change relative to NDI change. RESULTS: Forty-nine percent of the DHS population moved (263 to higher NDI, 586 to lower NDI, 47 within same NDI), with blacks more likely to move than whites or Hispanics (p<0.01), but similar baseline BMI and waist circumference were observed in movers versus non-movers (p>0.05). Adjusting for HCF, sex, race, and time-varying covariates, those who moved to areas of higher NDI gained more weight compared to those remaining in the same or moving to a lower NDI (0.64 kg per 1-unit NDI increase, 95% CI=0.09, 1.19). Impact of NDI change on weight gain increased with time (p=0.03). CONCLUSIONS: Moving to more-socioeconomically deprived neighborhoods was associated with weight gain among DHS participants.
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Obesidade/etnologia , Características de Residência/estatística & dados numéricos , Classe Social , Aumento de Peso/etnologia , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Doenças Cardiovasculares , Feminino , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Fatores de Risco , Fatores Socioeconômicos , Texas , Circunferência da Cintura , Adulto JovemRESUMO
BACKGROUND: Persons accessing food from nonprofit distribution sites face numerous challenges and typically have significant unmet health needs. However, given limited and intermittent healthcare system engagement, this vulnerable population is underrepresented in clinical research. We sought to better understand the health needs of a nonclinical population to inform future research and interventions. METHODS: Focus groups were conducted in English (n = 4) and Spanish (n = 4) with clients of Crossroads Community Services (CCS), the largest distributor of North Texas Food Bank. Discussions probed participants' health status, healthcare utilization, understanding and utilization of mammography, and attitudes toward participation in research. RESULTS: Participants included 42 CCS clients, primarily Hispanic or African American women. Participants reported multiple comorbid conditions among household members, yet utilization of health services was often limited by cost. The majority expressed interest in participating in research to communicate their health concerns and obtain emotional support. CONCLUSION: CCS clients represent a high-need, under-reached population willing to engage in health-related research that affords them opportunity to connect with peers in group settings and obtain information to improve management of daily life challenges. The Community Assistance Research (CARe) Initiative, a community-academic collaboration, establishes a much-needed opportunity for ongoing clinical research and intervention among this underserved population.