The Built Environment as a Social Determinant of Health

Equitable Access to Lifestyle Medicine: FQHCs, YMCAs, Trauma-Informed Health Coaching, and "Community as Medicine"

Without intentional and collaborative input from stakeholders and members of the communities we serve, Lifestyle Medicine (LM) is at risk of evolving in ways that are inapplicable and even alienating to diverse and underserved populations. To mitigate this risk, this paper advocates for implementing transdiagnostic, culturally affirmative, trauma-informed, and integrative treatment frameworks that address mental, social, and physical health in tandem. It demonstrates how the Community as Medicine model can bridge the divide between clinical settings such as Federally Qualified Health Centers (FQHCs) and community settings, such as YMCAs, improving accessibility for diverse groups. It also shows how emerging professional identities-exemplified by health coaches-can be cultivated to expand the reach of care while simultaneously opening pathways to employment. By centering inclusivity, cultural affirmation, and interprofessional collaboration, LM can more effectively meet the needs of vulnerable communities and enhance overall public health outcomes.

Community as Medicine: A Novel Approach to Improve Health Behaviors and Mental Well-Being for Vulnerable Populations

Purpose

Evaluate a group-based, trauma-informed health coaching model based on Lifestyle Medicine pillars, delivered by community health coaches, to improve health behaviors and mental well-being for vulnerable populations.

Methods

This program evaluation analyzed quantitative longitudinal data with linear mixed models and qualitative data with reflexive thematic analysis. Participants (n = 720) were low-income adults referred through Federally Qualified Health Centers (FQHCs), who participated in weekly 90-120 minute groups for 3 months. Data were collected via monthly surveys, including the PHQ-9, GAD-7, UCLA 3-item loneliness, exercise as a vital sign, a 2-item dietary screener, and 3 qualitative questions.

Results

Participants saw significant reductions in depression, anxiety, and isolation, and significant increases in daily servings of fruits and vegetables, and weekly minutes of exercise. The qualitative analysis identified 4 themes related to the drivers and reinforcers of positive behavior change and improved mental well-being.

Conclusions

Initial data suggest this model helps reduce depression, anxiety, and isolation, and promotes positive behavior change within populations most impacted by health inequity. Qualitative results identified drivers of positive change, such as creating a sense of belonging and mutual support. Future research should consider how to continue to scale this program to a variety of populations and across different settings.

Disrupted and Disconnected Post Disaster: Associations Between the Social and Built Environment and Loneliness During COVID-19 in a U.S. Gulf Coast Sample

Loneliness, a significant public health issue, was exacerbated during the COVID-19 pandemic, particularly in disaster-prone regions like the U.S. Gulf Coast. This study examined how social and built environmental factors were associated with pandemic-related disruptions and loneliness among respondents from the third wave of the Survey of Trauma, Resilience, and Opportunity among Neighborhoods in the Gulf (STRONG). Using a retrospective measure of loneliness (pre-pandemic vs. during pandemic), we found that loneliness increased significantly during the pandemic. Using a measure of routine behavior disruptions and measures of both objective (e.g., parks, walkability, etc.) and subjective (e.g., neighborhood safety, social cohesion, etc.) environmental factors, we found that disruptions to daily routines strongly predicted higher loneliness, and subjective measures, such as neighborhood safety, social cohesion, and lacking post-disaster social support, were more salient predictors of loneliness than objective factors such as the number of parks in one's neighborhood. Difficulty accessing green spaces and housing distress were linked to greater COVID-19 disruptions, indirectly contributing to loneliness. These findings highlight the importance of safe, supportive, and accessible social and physical environments in mitigating loneliness and enhancing community resilience during crises.

Impact of Physicians' Perception of Social Determinants of Health (SDoH) on the Practice of Lifestyle Medicine. Findings From a Family Physicians Survey

Lifestyle Medicine emphasizes evidence-based lifestyle changes to address chronic conditions Yet, concerns have emerged regarding its ability to address broader social determinants of health (SDoH). This study examines how family physicians' perceptions of SDoH relate to their use of lifestyle medicine competencies. This cross-sectional survey was administered to 5770 family physicians. Participants rated the importance of LM core competencies and the impact of community conditions on patient health. Data analysis involved descriptive statistics, factor analysis, regression models, and t-tests. This study encompassed 447 responses. The findings revealed that while respondents recognized the effect of certain SDoH, such as access to unhealthy food (89%), alcohol (86%), and tobacco (83%), they showed less awareness of factors like racism and discrimination (53%), and access to parks (56%) or education (60%). Gender and the level of social deprivation in their area were significant factors influencing respondents' perception of SDoH impact. Additionally, those who valued and used lifestyle medicine core competencies were more likely to acknowledge the influence of SDoH on patient health. Our findings suggest that comprehensive education on SDoH, especially with a focus on community aspects, is crucial across all levels of medical training to address this gap and ensure equitable care.

Racial/ethnic disparities in the trajectories of insomnia symptoms from childhood to young adulthood

STUDY OBJECTIVES

To examine differences in the longitudinal prevalence of childhood insomnia symptoms across black/African American, Hispanic/Latinx, and non-Hispanic white groups.

METHODS

Participants were 519 children from the Penn State Child Cohort (baseline [V1] from 2000-2005) who were followed up 8 years later as adolescents (V2) and 15 years later as young adults (S3). Mean age at S3 was 24.1 ± 2.7 years. Approximately, 76.5% identified as non-Hispanic white, 12.9% as black/African American, 7.1% as Hispanic/Latinx, and 3.5% as "other" race/ethnicity. Insomnia symptoms were defined as parent-reported (childhood) or self-reported (adolescence and young adulthood) moderate-to-severe difficulties initiating/maintaining sleep. Longitudinal trajectories of insomnia symptoms were identified across three-time points and the odds of each trajectory were compared between racial/ethnic groups, adjusting for sex, age, overweight, sleep apnea, periodic limb movements, psychiatric/behavioral disorders, and psychotropic medication use.

RESULTS

Black/African Americans compared to non-Hispanic whites were at significantly higher odds of having a childhood-onset persistent trajectory through young adulthood (OR = 2.58, 95% CI [1.29, 5.14]), while Hispanics/Latinx were at nonsignificantly higher odds to have the same trajectory (OR = 1.81, 95% CI [0.77, 4.25]). No significant racial/ethnic differences were observed for remitted and waxing-and-waning trajectories since childhood or incident/new-onset trajectories in young adulthood.

CONCLUSIONS

The results indicate that disparities in insomnia symptoms among black/African American and, to a lesser extent, Hispanic/Latinx groups start early in childhood and persist into young adulthood. Identifying and intervening upon upstream determinants of racial/ethnic insomnia disparities are warranted to directly address these disparities and to prevent their adverse health sequelae.

CLINICAL TRIAL INFORMATION

N/A; Not a clinical trial.