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Samuel-Hodge CD, Gizlice Z, Guy AR, Bernstein K, Victor AY, George T, Hamlett TS, Harrison LM. A Mixed-Method Evaluation of a Rural Elementary School Implementing the Coordinated Approach to Child Health (CATCH) Program. Nutrients 2023; 15:2729. [PMID: 37375633 PMCID: PMC10304257 DOI: 10.3390/nu15122729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Despite children living in rural US areas having 26% greater odds of being affected by obesity compared to those living in urban areas, the implementation of evidence-based programs in rural schools is rare. We collected quantitative data (weight and height) from 272 racially and ethnically diverse students at baseline, and qualitative data from students (4 focus groups), parents, and school staff (16 semi-structured interviews and 29 surveys) to evaluate program outcomes and perceptions. At the 2-year follow-up, paired data from 157 students, represented by racial/ethnic groups of 59% non-Hispanic White, 31% non-Hispanic Black, and 10% Hispanic, showed an overall mean change (SD) in BMI z-score of -0.04 (0.59), a decrease of -0.08 (0.69) in boys, and a significant -0.18 (0.33) decrease among Hispanic students. Boys had a mean decrease in obesity prevalence of 3 percentage points (from 17% to 14%), and Hispanic students had the largest mean decrease in BMI percentile. Qualitative data showed positive perceptions of the CATCH program and its implementation. This community-engaged research, with collaboration from an academic institution, a health department, a local wellness coalition, and a rural elementary school, demonstrated successful CATCH program implementation and showed promising outcomes in mean BMI changes.
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Affiliation(s)
- Carmen D. Samuel-Hodge
- Gillings School of Global Public Health, Department of Nutrition, Center for Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., Room 216, CB #7426, Chapel Hill, NC 27599-7426, USA
| | - Ziya Gizlice
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., CB #7426, Chapel Hill, NC 27599-7426, USA; (Z.G.); (A.R.G.); (K.B.); (A.Y.V.); (T.S.H.)
| | - Alexis R. Guy
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., CB #7426, Chapel Hill, NC 27599-7426, USA; (Z.G.); (A.R.G.); (K.B.); (A.Y.V.); (T.S.H.)
| | - Kathryn Bernstein
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., CB #7426, Chapel Hill, NC 27599-7426, USA; (Z.G.); (A.R.G.); (K.B.); (A.Y.V.); (T.S.H.)
| | - Aurore Y. Victor
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., CB #7426, Chapel Hill, NC 27599-7426, USA; (Z.G.); (A.R.G.); (K.B.); (A.Y.V.); (T.S.H.)
| | - Tyler George
- Division of General Medicine, School of Medicine, University of North Carolina at Chapel Hill, 102 Mason Farm Rd. #3100, Chapel Hill, NC 27599, USA;
| | - Trevor S. Hamlett
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., CB #7426, Chapel Hill, NC 27599-7426, USA; (Z.G.); (A.R.G.); (K.B.); (A.Y.V.); (T.S.H.)
| | - Lisa M. Harrison
- Granville Vance Public Health, 1032 College St., Oxford, NC 27565, USA;
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Oh DL, Schumacher K, Yang J, Wang K, Lin K, Gomez SL, Shariff-Marco S. Disparities in cancer incidence by rurality in California. J Natl Cancer Inst 2023; 115:385-393. [PMID: 36622036 PMCID: PMC10086626 DOI: 10.1093/jnci/djac238] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/14/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cancer rates in rural areas across the United States have different patterns than in urban areas. This study examines associations between rurality and incidence for the top 5 cancers in California and evaluates whether these associations vary jointly by sex, race, and ethnicity. METHODS We used 2015-2019 California Cancer Registry data to compare incidence rate ratios (IRRs) and trends for breast, prostate, lung, colorectal, and skin (melanoma) cancers. We leveraged census tract aggregation zones and 7 levels of percentage rural population (0%, >0% to <10%, 10% to <20%, 20% to <30%, 30% to <40%, 40% to <50%, and 50+%). RESULTS Zones with higher proportions of rural population were significantly associated with lower incidence of female breast cancer and prostate cancer, though the trends were not statistically significant overall. Zones with higher proportions of rural population were significantly associated with higher incidence of lung cancer and melanoma. There were no statistically significant trends for colorectal cancer overall. Comparing areas with 50% and over rural population with areas with 0% rural population, the IRR for lung cancer in Hispanic females was higher (IRR = 1.43, 95% confidence interval [CI] = 1.17 to 1.74) than in Hispanic males (IRR = 0.90, 95% CI = 0.72 to 1.11). Also, in areas with 50% or more rural population, the IRR for melanoma was higher in Hispanic females (IRR = 1.75, 95% CI = 1.23 to 2.45) than non-Hispanic White females (IRR = 0.87, 95% CI = 0.80 to 0.95). CONCLUSIONS Our findings show that rurality is associated with cancer incidence and underscore the importance of jointly examining rural disparities with sex, race, and ethnicity by cancer site.
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Affiliation(s)
- Debora L Oh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
| | - Karen Schumacher
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - Juan Yang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
| | - Katarina Wang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Katherine Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
- Greater Bay Area Cancer Registry, University of California, San Francisco, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, USA
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Measuring adolescents' eating in the absence of hunger in the home environment using subjective and objective measures. Appetite 2023; 180:106354. [PMID: 36309230 DOI: 10.1016/j.appet.2022.106354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022]
Abstract
Eating in the absence of hunger (EAH) has been identified as a behavioral phenotype for obesity. Few studies have reported on objective measures of EAH in adolescents, and fewer yet have objectively measured EAH in a naturalistic, home setting. The purpose of this paper was to examine relations between objective, adolescent-report and parent-report measures of EAH, and to examine variation by sex and race. Participants included 295 predominantly low-income and rural adolescents (mean age = 14.2 ± 0.6 years) and their parents, drawn from the Family Life Project. An EAH task was administered in the home following an ad-libitum meal and compulsory milkshake; EAH was also reported on a web-based survey (both adolescent and parent reports) and adolescents' BMIz was calculated from height and weight, measured in the home or self-reported on the web survey. A high degree of variability in EAH intake was observed (range = 8-741 kcals). Parent and adolescent reports of EAH were weakly correlated and unrelated to observed EAH consumption; only adolescent reports of EAH were related to their BMIz. Several relations varied by sex and race. Positive associations between reported and observed EAH was only observed in girls, and positive associations between observed EAH and BMI was only observed in boys and in white adolescents. Overall EAH consumption was significantly greater in boys and in white adolescents. These findings suggest that EAH can be measured in adolescents in the home. In this sample of youth experiencing rural poverty, this home-based measure appears most valid for white adolescent girls.
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Norman-Burgdolf H, DeWitt E, Gillespie R, Cardarelli KM, Slone S, Gustafson A. Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019-2022. Front Public Health 2023; 11:1142478. [PMID: 37124781 PMCID: PMC10140309 DOI: 10.3389/fpubh.2023.1142478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors.
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Affiliation(s)
- Heather Norman-Burgdolf
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
- *Correspondence: Heather Norman-Burgdolf,
| | - Emily DeWitt
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
| | - Rachel Gillespie
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Kathryn M. Cardarelli
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Stacey Slone
- Dr. Bing Zhang Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, KY, United States
| | - Alison Gustafson
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
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McClendon ME, Umstattd Meyer MR, Prochnow T, Ylitalo KR, Meyer AR, Bridges Hamilton CN, Sharkey JR. ¿Qué Pasa Con Papá? Exploring Paternal Responsibilities and Physical Activity in Mexican-Heritage Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168618. [PMID: 34444366 PMCID: PMC8393545 DOI: 10.3390/ijerph18168618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
Mexican-heritage children often achieve less physical activity (PA) than their counterparts and are at greater risk for associated comorbidities. Child PA is greatly influenced by their parents, yet researchers have rarely involved fathers in community health promotion. The purpose of this study is to examine Mexican-heritage fathers’ perceptions of responsibilities and self-reported activities. Promotoras recruited fathers (n = 300) from colonies on the Texas–Mexico border and administered Spanish-language surveys including paternal responsibilities, father PA, and PA co-participation. Two researchers coded responses. Open-ended items were coded and cross-tabulations between responsibilities and activities with children were examined. Fathers reported feeling monetary responsibilities most often. Fathers reported engaging in more activities with their sons than daughters; however, fathers engaged in very few activities specifically with their children. Feeling responsible for family expenses was associated with paternal PA co-participation with family and children. This study adds clarity to the role of Mexican-heritage fathers in child PA. Findings highlight potential areas for intervention including supporting fathers to take an active role in their children’s PA.
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Affiliation(s)
- Megan E. McClendon
- Texas A&M AgriLife Extension Service, Texas A&M University, College Station, TX 77843, USA;
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
| | - M. Renée Umstattd Meyer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
- Correspondence:
| | - Tyler Prochnow
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
- Department of Health & Kinesiology, Texas A&M University, College Station, TX 77843, USA
| | - Kelly R. Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
| | - Andrew R. Meyer
- Department of Health, Human Performance & Recreation, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA;
| | - Christina N. Bridges Hamilton
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76706, USA; (T.P.); (K.R.Y.); (C.N.B.H.)
- Department of Public Health & Health Education, SUNY Brockport, Brockport, NY 14420, USA
| | - Joseph R. Sharkey
- Department of Health Promotion & Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA;
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Thapa R, Dahl C, Aung WP, Bjertness E. Urban-rural differences in overweight and obesity among 25-64 years old Myanmar residents: a cross-sectional, nationwide survey. BMJ Open 2021; 11:e042561. [PMID: 33653748 PMCID: PMC7929804 DOI: 10.1136/bmjopen-2020-042561] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To investigate whether urban-rural location and socioeconomic factors (income, education and employment) are associated with body mass index (BMI) and waist-hip ratio (W/H-ratio), and to further explore if the associations between urban-rural location and BMI or W/H-ratio could be mediated through variations in socioeconomic factors. DESIGN Cross-sectional, WHO STEPS survey of non-communicable disease risk factors. SETTING Urban and rural areas of Myanmar. PARTICIPANTS A total of 8390 men and women aged 25 to 64 years included during the study period from September to December 2014. Institutionalised people (Buddhist monks and nuns, hospitalised patients) and temporary residents were excluded. RESULTS The prevalence of overweight and obesity was higher in the urban areas and increased with increasing socioeconomic status (SES) score. Mean BMI was higher among urban residents (ß=2.49 kg/m2; 95% CI 2.28 to 2.70; p<0.001), individuals living above poverty line, that is, ≥US$1.9/day (ß=0.74 kg/m2; 95% CI 0.43 to 1.05; p<0.001), and those with high education attainment (ß=1.48 kg/m2; 95% CI 1.13 to 1.82; p<0.001) when adjusting for potential confounders. Similarly, greater W/H-ratio was observed in participants living in an urban area, among those with earnings above poverty line, and among unemployed individuals. The association between urban-rural location and BMI was found to be partially mediated by a composite SES score (9%), income (17%), education (16%) and employment (16%), while the association between urban-rural location and W/H-ratio was found to be partially mediated by income (12%), education (6%) and employment (6%). CONCLUSION Residents living in urban locations had higher BMI and greater W/H-ratio, partially explained by differences in socioeconomic indicators, indicating that socioeconomic factors should be emphasised in the management of overweight and obesity in the Myanmar population. Furthermore, new national or subnational STEPS surveys should be conducted in Myanmar to observe the disparity in trends of the urban-rural differential.
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Affiliation(s)
- Rupa Thapa
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Dahl
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wai Phyo Aung
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Occupational and Environmental Health Division, Department of Public Health, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Espen Bjertness
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Tsui ST, Yang J, Zhang X, Tatarian T, Docimo S, Spaniolas K, Pryor AD. Health disparity in access to bariatric surgery. Surg Obes Relat Dis 2021; 17:249-255. [DOI: 10.1016/j.soard.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/20/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023]
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Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. Med J Aust 2021; 213 Suppl 11:S3-S32.e1. [PMID: 33314144 DOI: 10.5694/mja2.50881] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022]
Abstract
CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. STUDY DESIGN Rapid review of articles published between January 2000 and May 2020. DATA SOURCES We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. DATA SYNTHESIS Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. CONCLUSION Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. STUDY DESIGN We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. DATA SOURCES We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. DATA SYNTHESIS Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. CONCLUSION There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. STUDY DESIGN Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews. DATA SOURCES We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. DATA SYNTHESIS Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. CONCLUSION We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. STUDY DESIGN Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2 . DATA SOURCES We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. DATA SYNTHESIS We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3). CONCLUSION Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. STUDY DESIGN We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. DATA SOURCES We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites. DATA SYNTHESIS During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. CONCLUSION We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings. STUDY DESIGN Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. DATA SOURCES English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing, deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. DATA SYNTHESIS Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. CONCLUSION Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.
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Umstattd Meyer MR, Ylitalo KR, Prochnow T, Gómez LA, Sharkey JR. Physical Activity Space Methodology for Assessment and Prioritization (PASMAP): Combining systematic observations with community perceptions to identify community physical activity resource priorities. Health Place 2020; 66:102443. [PMID: 33010660 DOI: 10.1016/j.healthplace.2020.102443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 01/08/2023]
Abstract
Despite benefits of physical activity (PA), most Americans are not regularly active, with notable disparities for residents of low-income communities. PA is positively correlated with resource availability and quality, which can be measured and quantified by PA resource assessment tools. However, community members' perceptions are often not considered. This study incorporates community perceptions with systematic environmental observations to identify community PA resource priorities. The PA Space Methodology for Assessment and Prioritization (PASMAP) includes three phases. Phase 1: Promotora-researchers completed 57 PA Resource Assessments (PARAs) in colonias along the Texas-Mexico border assessing quantity and quality of features, amenities, and incivilities. Characteristics were ranked using average PARA scores from all PA spaces. Phase 2: community advisory board (CAB) members (n = 36 from 3 CABs) ranked the importance of each feature, amenity, and incivility respectively; rankings were averaged and ordered. Phase 3: differences between phases 1 and 2 were calculated. Large differences indicated high discordance between systematic observations and perceived importance. Phase 1: highest ranked PARA characteristics were sidewalks, non-street lighting, and noise. Phase 2: CAB members ranked trails/paths, sidewalks, play equipment, bathrooms, drinking fountains, substance abuse evidence, and litter most important. Phase 3: multiple characteristics had high discordance: trails/paths, fenced-in open fields (features), drinking fountains (amenity), and litter (incivility); low quantity/poor quality yet perceived as highly important. Discordant characteristics identified through PASMAP provide evidence-based, community-valued recommendations on PA resource priorities for planning and advocacy. Future work should incorporate perceptions from additional community members and apply PASMAP methods to other environmental assessments.
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Affiliation(s)
- M Renée Umstattd Meyer
- Baylor University, Robbins College of Health and Human Sciences, One Bear Place #97303, Waco, TX, 76798, USA.
| | - Kelly R Ylitalo
- Baylor University, Department of Public Health, One Bear Place #97343, Waco, TX, 76798, USA.
| | - Tyler Prochnow
- Baylor University, Robbins College of Health and Human Sciences, One Bear Place #97303, Waco, TX, 76798, USA.
| | - Luis A Gómez
- Texas A&M University School of Public Health, College Station, TX, 77843, USA.
| | - Joseph R Sharkey
- Texas A&M University School of Public Health, College Station, TX, 77843, USA.
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10
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Rural SNAP Participants and Food Insecurity: How Can Communities Leverage Resources to Meet the Growing Food Insecurity Status of Rural and Low-Income Residents? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176037. [PMID: 32825144 PMCID: PMC7504289 DOI: 10.3390/ijerph17176037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/30/2020] [Accepted: 08/16/2020] [Indexed: 12/11/2022]
Abstract
The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n = 152), most reported an annual household income less than USD 20,000 (n = 90, 60.4%), 29.1% reported food insecurity, and 39.5% reported receiving SNAP benefits within the last month. The overall mean FV intake was 3.46 daily servings (95% CI: 3.06–3.91) among all participants. SNAP participation was associated with food insecurity (p = 0.007) and those participating in SNAP were two times more likely to report being food insecure (OR = 2.707, 95% CI: 1.317, 5.563), relative to non-participants. These findings further depict the need for intervention, as the burden of food insecurity persists. Tailoring health-promoting initiatives to consider rurality and SNAP participation is vital for sustainable success among these populations.
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11
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Ratcliff CG, Torres D, Tullos EA, Geng Y, Lu Q. A systematic review of behavioral interventions for rural breast cancer survivors. J Behav Med 2020; 44:467-483. [PMID: 32813192 DOI: 10.1007/s10865-020-00174-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
Rural breast cancer survivors (RBCS) are at greater risk for poorer health outcomes and face greater treatment barriers compared to their urban counterparts, necessitating behavioral interventions tailored for the unique needs of RBCS. A systematic review of studies examining behavioral interventions delivered to RBCS living in the United States from 2000 to 2020 was conducted following PRIMSA guidelines. Nineteen unique studies were included: eight randomized controlled trials, two matched-control studies, six pre-post intervention feasibility studies, and three post-intervention satisfaction studies. Thirteen interventions aimed to improve psychosocial support, three to improve weight management, and three to improve education. Results indicate interventions' feasibility and acceptability. Six out of eight intervention conditions reported favorable outcomes compared to control conditions, suggesting promise for efficacy. However, variability in intervention objective, duration, delivery, and follow-up timing, and small sample sizes prevent overarching conclusions. Research involving larger sample sizes, higher quality control groups, and longer follow-up data is needed.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA. .,Baylor College of Medicine, Houston, TX, USA.
| | - Debbie Torres
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qian Lu
- Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Abstract
PURPOSE OF REVIEW Diabetes mellitus is a leading chronic disease worldwide. Access to diabetes care varies widely and is influenced by multiple factors including social, geographic, and economic conditions. The use of technology to expand healthcare may bridge these barriers and improve access. Our aim was to review the evidence for the role of telehealth to expand access to quality diabetes care. RECENT FINDINGS There is evidence that application of technology-based programs to deliver healthcare are both feasible and effective. These programs are accepted by both patients and providers, can reduce healthcare costs, and may redress inequalities in healthcare access. Technology-based care models can improve disease management, enhance efficiency and clinical decision-making, promote patient self-management skills, and promote patient centered care. Future research should focus on implementation of technology-based healthcare delivery programs on a larger scale.
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Affiliation(s)
- Anusha Verravanallur Appuswamy
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Marisa E Desimone
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
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13
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Oshan TM, Smith JP, Fotheringham AS. Targeting the spatial context of obesity determinants via multiscale geographically weighted regression. Int J Health Geogr 2020; 19:11. [PMID: 32248807 PMCID: PMC7132879 DOI: 10.1186/s12942-020-00204-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/12/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Obesity rates are recognized to be at epidemic levels throughout much of the world, posing significant threats to both the health and financial security of many nations. The causes of obesity can vary but are often complex and multifactorial, and while many contributing factors can be targeted for intervention, an understanding of where these interventions are needed is necessary in order to implement effective policy. This has prompted an interest in incorporating spatial context into the analysis and modeling of obesity determinants, especially through the use of geographically weighted regression (GWR). METHOD This paper provides a critical review of previous GWR models of obesogenic processes and then presents a novel application of multiscale (M)GWR using the Phoenix metropolitan area as a case study. RESULTS Though the MGWR model consumes more degrees of freedom than OLS, it consumes far fewer degrees of freedom than GWR, ultimately resulting in a more nuanced analysis that can incorporate spatial context but does not force every relationship to become local a priori. In addition, MGWR yields a lower AIC and AICc value than GWR and is also less prone to issues of multicollinearity. Consequently, MGWR is able to improve our understanding of the factors that influence obesity rates by providing determinant-specific spatial contexts. CONCLUSION The results show that a mix of global and local processes are able to best model obesity rates and that MGWR provides a richer yet more parsimonious quantitative representation of obesity rate determinants compared to both GWR and ordinary least squares.
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Affiliation(s)
- Taylor M Oshan
- Center for Geospatial Information Science, Department of Geographical Sciences, University of Maryland, College Park, MD, 20740, USA.
| | - Jordan P Smith
- School of Geographical Sciences & Urban Planning, Arizona State University, Tempe, AZ, 85281, USA
| | - A Stewart Fotheringham
- School of Geographical Sciences & Urban Planning, Arizona State University, Tempe, AZ, 85281, USA
- Spatial Analysis Research Center, School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ, 85281, USA
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14
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Patten CA, Juhn YJ, Ryu E, Wi CI, King KS, Bublitz JT, Pignolo RJ. Rural-urban health disparities for mood disorders and obesity in a midwestern community. J Clin Transl Sci 2020; 4:408-415. [PMID: 33244429 PMCID: PMC7681122 DOI: 10.1017/cts.2020.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Prior studies indicate greater disease burden for obesity among rural compared with urban residents but no differences for mood disorder based on geographic location. Recent attention has focused on the need to examine regional rural-urban disparities in disease burden. We focused on mood disorders and obesity prevalence within three southeastern Minnesota counties served by the Mayo Clinic Center for Translational Science Award, in Rochester, Minnesota, as these were top priorities identified in community health needs assessments. METHODS Cross-sectional study to assess the association of rural-urban locality on 5-year (2009-2014) prevalence of mood disorder and obesity obtained using the Rochester Epidemiological Project medical records linkage system, among subjects residing in three mixed rural-urban counties on April 1, 2014. Multivariable analyses adjusted for demographics, socioeconomic status using an individual housing-based measure, and counties. RESULTS The study cohort (percent rural location) included 91,202 (15%) for Olmsted, 10,197 (51%) in Dodge, and 10,184 (57%) in Wabasha counties. On multivariate analysis, 5-year prevalence of mood disorders and obesity was significantly greater for urban compared with rural residents, after adjusting for confounders; odds ratios (95% confidence intervals): 1.21 (1.17-1.26), P < 0.001, and 1.05 (1.01-1.10), P = 0.016, respectively. Observed effects were not modified in additional models adjusted for health care utilization (HCU; ≥1 general medical examination visit and flu vaccination). CONCLUSIONS Rural-urban health disparities for burden of mood disorders and obesity are independent of socioeconomic status and HCU in a Midwestern community. It is important to assess potential regional heterogeneity of rural-urban disparities on health outcomes.
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Affiliation(s)
- Christi A. Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Euijung Ryu
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Katherine S. King
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Josh T. Bublitz
- Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN, USA
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15
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Obesity among U.S. rural adults: Assessing selection and causation with prospective cohort data. Health Place 2019; 61:102260. [PMID: 31791670 DOI: 10.1016/j.healthplace.2019.102260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 11/21/2022]
Abstract
Rural adults in the U.S. have disproportionately high rates of obesity, but it is unclear whether this association exists because of selective migration or a contextual effect of the rural environment. Using nationally representative longitudinal data, this study investigates: (1) whether people with obesity select into rural counties, and (2) whether living in a rural area increases body weight after accounting for selection bias. Results indicate that people with obesity are less likely to move to a different county than people without obesity even after controlling for individual and household differences. Next, individual fixed effects regression models, which implicitly control for all time-constant variables, are used to produce a more robust estimate of the effect of rural residence on body weight. Rural residence predicts a significant increase in probability of obesity and body mass index. These results suggest that the association between rural residence and obesity in the United States is likely bidirectional.
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16
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Altieri MS, Yang J, Yin D, Talamini MA, Spaniolas K, Pryor AD. Patients insured by Medicare and Medicaid undergo lower rates of bariatric surgery. Surg Obes Relat Dis 2019; 15:2109-2114. [PMID: 31734065 DOI: 10.1016/j.soard.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/23/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although the number of weight loss procedures is increasing, bariatric surgery is not used equitably in the United States. As obesity is more prevalent in minorities, higher priorities are placed toward improvement of access to care for these groups. OBJECTIVES To evaluate whether patient insurance status has any effect on use of bariatric surgery for patients in New York State. SETTING Administrative statewide database. METHODS The Statewide Planning and Research Cooperative System administrative database was used to identify all patients undergoing primary bariatric procedures between 2005 and 2016. Revision procedures were excluded from analysis. Multivariable logistic regression models were used to compare outcomes among patients with different payor status after controlling for confounding factors. RESULTS After the application of inclusion and exclusion criteria, there were 125,666 bariatric records from 2005 to 2016. Most patients had commercial insurance (n = 106,148, 84.5%), followed by Medicare (n = 9355, 7.4%), Medicaid (n = 7939, 6.3%), and other/unknown (n = 2224, 1.8%). The percentage of Medicaid was estimated to be increase by 12%/yr and the percentage of Medicare was estimated to be increase by 5%/yr during 2005 to 2016. Univariate analysis showed that patients with different insurance types were significantly different in terms of age, sex, race, region, subtype of surgeries, most co-morbidities, overall complication, 30-day readmission/emergency department visits, and length of stay (P values < .0001). After adjusting for other confounding factors, patients with Medicare insurance had significantly higher risk of having overall complications, 30-day readmissions/emergency department visits, and longer length of stay. CONCLUSIONS The majority of patients undergoing bariatric surgery are insured by private insurance, whereas only 13.7% of bariatric surgeries are performed on patients with public insurance.
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Affiliation(s)
- Maria S Altieri
- Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Donglei Yin
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | - Mark A Talamini
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Aurora D Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
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17
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Disparity of Colon Cancer Outcomes in Rural America: Making the Case to Travel the Extra Mile. J Gastrointest Surg 2019; 23:2285-2293. [PMID: 31152346 DOI: 10.1007/s11605-019-04270-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/10/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Rural patients experience disparities in cancer care compared to urban patients. We hypothesized that rural patients with colon cancer who traveled to high-volume centers for treatment have similar survival compared to urban patients who also traveled to high-volume centers to seek treatment for colon cancer. METHODS The National Cancer Database was interrogated for patients treated for stage I-III colon cancer (2004-2015). Travel distance to treatment centers and annual hospital volume were divided into quartiles. Two groups of patients were identified and compared: (1) rural patients who traveled to high-volume hospitals and (2) urban patients who also traveled to high-volume centers. The primary outcome was overall survival (OS). RESULTS Of 647,949 patients, 634, 447 were urban and 13,502 were rural. Rural patients were more likely to be Caucasian, with lower income, more comorbidities, and be treated at non-academic centers. In multivariable analysis, rural patients had worse OS compared to urban patients (hazard ratio [HR] 1.08; 95% confidence interval [CI] 1.04-1.12; p = < 0.001). There were 46,781 (7%) urban patients and 1276 (9%) rural patients who traveled a long distance (median 40 and 108 miles, respectively) to high-volume centers. There was no difference in adjusted OS between urban and rural patients who traveled to high-volume centers for treatment (HR 1.06; 95%CI 0.94-1.20; p = 0.36). CONCLUSIONS This nationwide analysis suggests that rural patients with colon cancer experience worse survival than urban patients, but that this disparity might be mitigated by rural patients traveling to high-volume centers for treatment.
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Nichols LJ, Gall S, Stirling C. Determining rural risk for aneurysmal subarachnoid hemorrhages: A structural equation modeling approach. J Neurosci Rural Pract 2019; 7:559-565. [PMID: 27695237 PMCID: PMC5006469 DOI: 10.4103/0976-3147.188627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An aneurysmal subarachnoid hemorrhage (aSAH) carries a high disability burden. The true impact of rurality as a predictor of outcome severity is unknown. Our aim is to clarify the relationship between the proposed explanations of regional and rural health disparities linked to severity of outcome following an aSAH. An initial literature search identified limited data directly linking geographical location, rurality, rural vulnerability, and aSAH. A further search noting parallels with ischemic stroke and acute myocardial infarct literature presented a number of diverse and interrelated predictors. This a priori knowledge informed the development of a conceptual framework that proposes the relationship between rurality and severity of outcome following an aSAH utilizing structural equation modeling. The presented conceptual framework explores a number of system, environmental, and modifiable risk factors. Socioeconomic characteristics, modifiable risk factors, and timely treatment that were identified as predictors of severity of outcome following an aSAH and within each of these defined predictors a number of contributing specific individual predictors are proposed. There are considerable gaps in the current knowledge pertaining to the impact of rurality on the severity of outcome following an aSAH. Absent from the literature is any investigation of the cumulative impact and multiplicity of risk factors associated with rurality. The proposed conceptual framework hypothesizes a number of relationships between both individual level and system level predictors, acknowledging that intervening predictors may mediate the effect of one variable on another.
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Affiliation(s)
- Linda Jayne Nichols
- School of Health Sciences, Faculty of Health Science, University of Tasmania, Hobart Tasmania, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart Tasmania, Australia
| | - Christine Stirling
- Menzies Institute for Medical Research, University of Tasmania, Hobart Tasmania, Australia
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19
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Healthy Food Labels Tailored to a High-Risk, Minority Population More Effectively Promote Healthy Choices than Generic Labels. Nutrients 2019; 11:nu11102272. [PMID: 31546697 PMCID: PMC6835742 DOI: 10.3390/nu11102272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/05/2023] Open
Abstract
The decades-long increase in obesity in the US has led to a number of policies aimed at improving diets, which are thought to play a significant role in obesity. Many of these policies seek to influence individuals' behaviors. Front-of-package labels providing salient, easily interpretable information to consumers have exhibited promise in helping people identify and choose healthier foods. However, behavioral economics may offer an opportunity to enhance label effectiveness. Tailoring labels to high-risk communities, including minority and rural populations, which have higher rates of diet-related diseases than the overall population, may increase the label's effectiveness. We conducted a choice experiment with supermarket shoppers on a rural American Indian reservation to test labels tailored to the local population relative to a generic label, which had previously been identified as highly effective in the general population. Results show that while the generic label continues to be quite effective in encouraging healthier choices, the label that is tailored to the local community is more effective, resulting in a marked increase in the premium shoppers were willing to pay for a healthy item. Tailoring healthy food labeling systems using insights from behavioral economics may increase their effectiveness.
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20
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Baranowski BJ, Hayward GC, Fajardo VA, MacPherson REK. Increased Prevalence of Obesity/Type 2 Diabetes and Lower Levels of Lithium in Rural Texas Counties May Explain Greater Alzheimer's Disease Risk. J Alzheimers Dis 2019; 64:303-308. [PMID: 29865052 DOI: 10.3233/jad-171150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/OBJECTIVE To compare Alzheimer's disease (AD) mortality rates and coinciding risk factors in rural and urban Texas populations. METHODS 155 Texas counties were divided into 73 rural and 82 urban areas using the U.S. Census Bureau definition of rurality. Changes in age-adjusted AD mortality across these counties were calculated using a 7-year aggregation model from 2000-2006 and 2009-2015. Data pertaining to gender, race, education, obesity, diabetes, physical inactivity, and lithium concentrations in tap water were also collected from readily available databases. RESULTS Change in age-adjusted AD mortality was higher in rural counties (9.5±1.4) versus urban (5.9±1.1) over the time period examined. Similarly, obesity (30.2±0.2% ), diabetes (11.0±0.1% ), and physical inactivity (29.4±0.2% ) levels were significantly higher in rural populations compared to urban (29.1±0.2%, 9.7±0.1%, and 26.7±0.3, respectively). In contrast, the percent of population with some college education (40.1±0.7% ) was lower compared to urban (29.4±0.2% and 44.4±0.9%, respectively). Lithium concentrations in tap water was significantly lower in rural counties compared to urban (63.3±8.2 and 33.4±4.7μg/L, respectively). No significant differences were observed among females and however, we did find significant differences in the percent of African American and Hispanics. Correlational analysis uncovered a negative association between education status and AD mortality over time (r = -0.17). Further analysis controlling for physical inactivity, education, and trace lithium concentrations results in a loss of statistical significance. CONCLUSIONS AD mortality rates are higher in rural counties when compared to urban counties, and this may be linked to greater physical inactivity, obesity, and diabetes, as well as lower trace lithium levels in tap water.
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Affiliation(s)
| | - Grant C Hayward
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Val A Fajardo
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada.,Centre for Bone and Muscle Health, Brock University, St. Catharines, ON, Canada
| | - Rebecca E K MacPherson
- Department of Health Sciences, Brock University, St. Catharines, ON, Canada.,Centre for Neuroscience, Brock University, St. Catharines, ON, Canada
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21
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Associations between frequency of food shopping at different food sources and fruit and vegetable intake among rural residents in upstate New York, USA. Public Health Nutr 2019; 22:2472-2478. [PMID: 31148533 DOI: 10.1017/s1368980019000843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine the frequency of shopping at different food sources and the associations between shopping at different food sources and fruit and vegetable (FV) intake among upstate New York rural residents. DESIGN Cross-sectional study. Descriptive statistics and linear mixed models were used. SETTING Eighty-two rural communities in upstate New York, USA. PARTICIPANTS Adults (n 465; 82·3 % female, mean age 51·5 years, mean BMI 31·7 kg/m2). RESULTS Within one's community, the majority of participants reported often going to supermarkets (73·1 %). Many participants sometimes or occasionally shopped at superstores (48·0 %), convenience stores (57·9 %), small grocery stores or local markets (57·2 %), farmers' markets or FV stores (66·6 %), dollar stores (51·5 %), pharmacies (46·0 %), or farm stands or community-supported agriculture (56·8 %). Most participants had never utilized food banks or food pantries (94·0 %), community gardens (92·7 %) or home food delivery (91·9 %). While frequent visits to farmers' markets or farm stands were associated with higher fruit intake (P < 0·001), frequent visits to food co-ops or food hubs were associated with lower fruit intake (P = 0·004). Frequent visits to convenience stores (P = 0·002) and dollar stores (P = 0·004) were associated with lower vegetable intake. When FV intakes were combined, frequent visits to farmers' markets or farm stands (P < 0·001) were associated with higher FV intake, and frequent visits to convenience stores (P = 0·005) were associated with lower FV intake. CONCLUSIONS Findings from the present study provide important insight for informing future food environment interventions related to helping rural residents consume adequate FV.
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Drewnowski A, Arterburn D, Zane J, Aggarwal A, Gupta S, Hurvitz P, Moudon A, Bobb J, Cook A, Lozano P, Rosenberg D. The Moving to Health (M2H) approach to natural experiment research: A paradigm shift for studies on built environment and health. SSM Popul Health 2019; 7:100345. [PMID: 30656207 PMCID: PMC6329830 DOI: 10.1016/j.ssmph.2018.100345] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/22/2018] [Accepted: 12/26/2018] [Indexed: 12/02/2022] Open
Abstract
Improving the built environment (BE) is viewed as one strategy to improve community diets and health. The present goal is to review the literature on the effects of BE on health, highlight its limitations, and explore the growing use of natural experiments in BE research, such as the advent of new supermarkets, revitalized parks, or new transportation systems. Based on recent studies on movers, a paradigm shift in built-environment health research may be imminent. Following the classic Moving to Opportunity study in the US, the present Moving to Health (M2H) strategy takes advantage of the fact that changing residential location can entail overnight changes in multiple BE variables. The necessary conditions for applying the M2H strategy to Geographic Information Systems (GIS) databases and to large longitudinal cohorts are outlined below. Also outlined are significant limitations of this approach, including the use of electronic medical records in lieu of survey data. The key research question is whether documented changes in BE exposure can be linked to changes in health outcomes in a causal manner. The use of geo-localized clinical information from regional health care systems should permit new insights into the social and environmental determinants of health.
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Affiliation(s)
- A. Drewnowski
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA 98195-03410, USA
| | - D. Arterburn
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA 98101, USA
| | - J. Zane
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA 98195-03410, USA
| | - A. Aggarwal
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA 98195-03410, USA
| | - S. Gupta
- Center for Public Health Nutrition, 305 Raitt Hall, #353410, University of Washington, Seattle, WA 98195-03410, USA
| | - P.M. Hurvitz
- Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, 1107 NE 45th Street, Suite 535, Seattle, WA 98195-4802, USA
| | - A.V. Moudon
- Urban Form Lab, Department of Urban Design and Planning, College of Built Environments, University of Washington, 1107 NE 45th Street, Suite 535, Seattle, WA 98195-4802, USA
| | - J. Bobb
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA 98101, USA
| | - A. Cook
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA 98101, USA
| | - P. Lozano
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA 98101, USA
| | - D. Rosenberg
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave. Suite 1600, Seattle, WA 98101, USA
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Frayon S, Cherrier S, Cavaloc Y, Touitou A, Zongo P, Wattelez G, Yacef K, Caillaud C, Lerrant Y, Galy O. Nutrition behaviors and sociodemographic factors associated with overweight in the multi-ethnic adolescents of New Caledonia. ETHNICITY & HEALTH 2019; 24:194-210. [PMID: 28393546 DOI: 10.1080/13557858.2017.1315530] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
Objectives: New Caledonia is a multi-ethnic French territory in the Pacific, characterized by communities with widely varying nutritional habits. Little is currently known about adolescent food behaviors and habits and their association with overweight. This study therefore determined the sociodemographic factors and food behaviors associated with overweight and underweight in this population, as well as the factors associated with skipping breakfast. Methods: A cross-sectional survey was conducted among New Caledonian adolescents using a self-administered questionnaire; anthropometric measurements were also taken. Weight status was determined using international cutoffs, and the factors associated with overweight and underweight were identified with multiple logistic regression analysis. The factors associated with breakfast skipping were also determined. Results: Skipping breakfast, being Melanesian, living in a rural area and having low economic status were positively associated with overweight in these adolescents. Skipping breakfast was relatively infrequent, reported by 18% and 13% of the males and females, respectively. Logistic regression models found that the main factors associated with breakfast consumption habits were gender, weight status and ethnicity. Conclusions: Several factors are associated with overweight status in New Caledonian adolescents. Breakfast education should be improved for adolescents living in rural areas and from low socioeconomic status.
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Affiliation(s)
- Stéphane Frayon
- a Interdisciplinary Laboratory for Research in Education, School for Teaching and Education , University of New Caledonia , Noumea , New Caledonia
| | - Sophie Cherrier
- a Interdisciplinary Laboratory for Research in Education, School for Teaching and Education , University of New Caledonia , Noumea , New Caledonia
| | - Yolande Cavaloc
- a Interdisciplinary Laboratory for Research in Education, School for Teaching and Education , University of New Caledonia , Noumea , New Caledonia
| | - Amandine Touitou
- a Interdisciplinary Laboratory for Research in Education, School for Teaching and Education , University of New Caledonia , Noumea , New Caledonia
| | - Paul Zongo
- b Laboratory ACTES, EA 3596 , UFR STAPS Antilles , Pointe à Pitre , French West Indies
| | - Guillaume Wattelez
- a Interdisciplinary Laboratory for Research in Education, School for Teaching and Education , University of New Caledonia , Noumea , New Caledonia
| | - Kalina Yacef
- c School of Information Technologies , University of Sydney , Sydney , Australia
| | - Corinne Caillaud
- d Faculty of Health Sciences and Charles Perkins Centre , University of Sydney , Sydney , Australia
| | - Yannick Lerrant
- a Interdisciplinary Laboratory for Research in Education, School for Teaching and Education , University of New Caledonia , Noumea , New Caledonia
| | - Olivier Galy
- a Interdisciplinary Laboratory for Research in Education, School for Teaching and Education , University of New Caledonia , Noumea , New Caledonia
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Gustafson A, McGladrey M, Stephenson T, Kurzynske J, Mullins J, Peritore N, Cardarelli K, Vail A. Community-Wide Efforts to Improve the Consumer Food Environment and Physical Activity Resources in Rural Kentucky. Prev Chronic Dis 2019; 16:E07. [PMID: 30653447 PMCID: PMC6341827 DOI: 10.5888/pcd16.180322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Community interventions to improve access to food and physical activity resources can reduce obesity rates and improve obesity-related health outcomes. We describe a Kentucky community project that consisted of collaborating with grocery store managers to improve the consumer food environment and partnering with community members to improve walking trails, bicycle racks, and other physical activity resources. We surveyed 2 random samples of community residents in 6 participating rural counties, 741 in 2016 (year 1) and 1,807 in 2017 (year 2). Fruit and vegetable intake significantly increased from year 1 (mean servings fruits, 2.71; vegetables, 2.54) to year 2 (mean servings fruit, 2.94; vegetables, 2.72). Although moderate physical activity did not change from year 1 to year 2, concern among residents about places to be physically active improved (P = .04). Involving community members in promoting obesity prevention programs may improve dietary intake and alleviate community concern about physical activity.
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Affiliation(s)
- Alison Gustafson
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky.,Dietetics and Human Nutrition, University of Kentucky, 206g Funkhouser, Lexington, KY 40506.
| | - Margaret McGladrey
- UK Center for Research on Violence Against Women, University of Kentucky, Lexington, Kentucky
| | - Tammy Stephenson
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky
| | - Janet Kurzynske
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky
| | - Janet Mullins
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, Kentucky
| | - Nicole Peritore
- Department of Kinesiology, University of Augusta, Augusta, Georgia
| | - Kathryn Cardarelli
- Department of Health, Behavior, and Society, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Ann Vail
- College of Social Work, University of Kentucky, Lexington, Kentucky
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Gustafson CR, Kent R, Prate MR. Retail-based healthy food point-of-decision prompts (PDPs) increase healthy food choices in a rural, low-income, minority community. PLoS One 2018; 13:e0207792. [PMID: 30540771 PMCID: PMC6291186 DOI: 10.1371/journal.pone.0207792] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/06/2018] [Indexed: 12/03/2022] Open
Abstract
This study examines the potential for point-of-decision prompts (PDPs) to promote healthier food choices among shoppers in a rural, low-income, minority community. We hypothesized that a narrowly defined PDP (focused on fresh produce) would be easier for shoppers to remember than a broadly defined PDP (focused on any healthy items), resulting in a higher proportion of healthy items purchased. PDPs were placed at the entrance to a supermarket in Mission, South Dakota, United States of America, on the Rosebud Sioux Reservation for alternating time periods, July 9–10, 2017. Sales records from 653 transactions were retrieved from the supermarket, comprising periods in which PDPs were in place and control periods. We examined the proportion of selected items and proportion of total expenditures that were a) any healthy foods and b) fresh fruits and vegetables. Data were analyzed in 2018. The narrowly defined prompt consistently resulted in a higher proportion of items and expenditures on healthy foods than either the broad prompt or the control condition. Shoppers in the narrow prompt condition purchased and spent significantly more on any healthy foods and fresh produce than shoppers in the control condition. While shoppers in the narrow prompt condition purchased more healthy foods and fresh produce than shoppers in the broad prompt condition, the differences were not statistically significant. Shoppers exposed to the narrow PDP consistently purchased more healthy foods than shoppers in a control group, while shoppers in the broad PDP did not, highlighting the importance of considering cognitive processes when designing health promotion messages.
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Affiliation(s)
- Christopher R. Gustafson
- Department of Agricultural Economics, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
- * E-mail:
| | - Rachel Kent
- Rosebud Food Sovereignty Initiative, Mission, South Dakota, United States of America
| | - Michael R. Prate
- Rosebud Food Sovereignty Initiative, Mission, South Dakota, United States of America
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Geographic differences in obesity prevalence and its risk factors among Asian Americans: findings from the 2013-2014 California Health Interview Survey. Sci Rep 2018; 8:12510. [PMID: 30131498 PMCID: PMC6104071 DOI: 10.1038/s41598-018-29906-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/11/2018] [Indexed: 12/14/2022] Open
Abstract
Geography disparities exist in obesity and obesity related conditions. This study aimed to examine the geographic differences in obesity prevalence and its risk factors among Asian Americans in California. Data (n = 4,000) from the 2013–2014 California Health Interview Survey were used. Obesity (≥27.5 kg/m2) was defined according to the World Health Organization Asian body mass index cut points in Asian groups. Results suggest that 66.5% of Asians lived in urban areas. Among Asian adults, obesity prevalence was highest in Filipinos (33.8%) and lowest in Koreans (12.8%). Compared to rural Vietnamese, obesity prevalence was higher for urban Vietnamese (8.3% vs. 20.2%, p = 0.0318). Weighted multiple logistic regression analyses showed that being 45–64 years (vs. 65 years or above), being Japanese, Filipino, or other Asians (vs. Chinese) were associated with a higher odds of obesity among urban residents; whereas being 18–44 years and being 45–64 years (vs. 65 years or older), being male, having high school education (vs. having graduate education) were associated with a higher odds of obesity among rural residents. Being Vietnamese (vs. Chinese) was associated with 64% decreased odds of obesity only among rural residents (95% confidence interval = 0.14–0.94). The findings show geography disparities in obesity among Asians in California.
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Youth and Adult Visitation and Physical Activity Intensity at Rural and Urban Parks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081760. [PMID: 30115825 PMCID: PMC6121499 DOI: 10.3390/ijerph15081760] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/15/2018] [Indexed: 01/02/2023]
Abstract
Less physical activity among rural residents may contribute to rural-urban health disparities. Parks can be ideal community resources for promoting physical activity. This study compared park visitation and activity intensity at 15 urban and 15 rural parks matched for acreage and amenities. Parks were observed in the morning, afternoon, and evening on 4 days to determine number of visitors, activity intensity, and amenity use. A total of 5486 visitors were observed with no differences in percentages of males (55.5% vs. 53.9%) and females (44.5% vs. 46.1%) or percentages of weekday (82.4% vs. 81.9%) and weekend (17.6% vs. 18.1%) visitors. The probability of visitors sitting was greater and in moderate intensity activity lower at rural parks. A greater proportion of children (25.0% vs. 14.5%) in rural parks, and teens in urban parks (8.0% vs. 69.6%), were observed on sport fields. A greater proportion of adults in urban areas (12.5% vs. 46.0%) were observed spectating sports. Greater proportions of rural children (10.9% vs. 3.5%), teens (34.1% vs. 12.4%), and adults (38.9% vs. 10.1%) were observed using shelters. Thus, when similar amenities are available, rural and urban parks are used differently, especially by youth. The urban park study results cannot be wholly applied to rural parks.
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Vintimilla RM, Large SE, Gamboa A, Rohlfing GD, O'Jile JR, Hall JR, O'Bryant SE, Johnson LA. The Link between Potassium and Mild Cognitive Impairment in Mexican-Americans. Dement Geriatr Cogn Dis Extra 2018; 8:151-157. [PMID: 29805381 PMCID: PMC5968281 DOI: 10.1159/000488483] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/12/2018] [Indexed: 12/16/2022] Open
Abstract
Background Recent evidence suggests that increasing dietary intake of minerals reduces the risk of dementia. This study aimed to examine the relationship between potassium and diagnosis of mild cognitive impairment (MCI) in a sample of older Mexican-Americans from rural and urban populations. Methods The sample was formed of a total of 139 participants with MCI and 371 normal controls from two independent cohorts: a rural cohort (Facing Rural Obstacles to Healthcare Now through Intervention, Education and Research [Project FRONTIER]) and an urban cohort (the Health and Aging Brain among Latino Elders [HABLE] study). Serum electrolytes examined were sodium and potassium. Age and education were entered in the model as covariates. Results Across both cohorts, the Project FRONTIER (OR = 3.1; p = 0.01) and the HABLE Project (OR = 2.0; p = 0.04), the results indicated that serum potassium levels significantly increased the risk of diagnosis of MCI. Conclusion Our finding suggested a link between serum potassium levels and a diagnosis of MCI in Mexican-Americans. The results of this study support a previous research which has suggested that the risk factors for MCI may vary by ethnicity.
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Affiliation(s)
- Raul M Vintimilla
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Stephanie E Large
- Department of Family Practice, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Adriana Gamboa
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Geoffrey D Rohlfing
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Judith R O'Jile
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - James R Hall
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas, USA.,Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA.,Department of Psychiatry, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Sid E O'Bryant
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Leigh A Johnson
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Urban-rural disparity of overweight/obesity distribution and its potential trend with breast cancer among Chinese women. Oncotarget 2018; 7:56608-56618. [PMID: 27489359 PMCID: PMC5302938 DOI: 10.18632/oncotarget.10968] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/19/2016] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate the urban-rural disparity of overweight/obesity and explore its potential trend with breast cancer among Chinese women. Results The prevalence of overweight/obesity for Chinese rural women (35.2%, 29.2% for overweight and 6.0% for obesity) was significantly higher than that for Chinese urban women (33.4%, 27.7% for overweight and 5.7% for obesity) (P < 0.001). For either rural or urban women, the prevalence of overweight/obesity was highest in north region, followed by east region for rural women and north-east region for urban women. For rural women, higher prevalence of overweight/obesity was significantly positively associated with elder age, Han nationality, low level of education, no occupation, high family income, less number of family residents, insurance, and elder age at marriage. Similar positive associations were also found for urban women, except negative associations for high family income, less number of family residents, and elder age at marriage. A non-significant positive trend between overweight/obesity and breast cancer was found for rural women [odds ratio (OR): 1.06; 95% confidence interval (CI): 0.87–1.29], but a significant positive trend for urban women (OR: 1.55; 95% CI: 1.19–2.02). Materials and Methods A total of 1 210 762 participants were recruited from the Chinese National Breast Cancer Screening Program. Overweight and obesity were defined as body mass index (BMI) ranged 24.0–27.9 kg/m2 and BMI ≥ 28.0kg/m2, respectively. Conclusions There was an obvious urban-rural disparity of overweight/obesity distribution among Chinese women, which could also lead to an obvious disparity of breast cancer distribution.
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James CV, Moonesinghe R, Wilson-Frederick SM, Hall JE, Penman-Aguilar A, Bouye K. Racial/Ethnic Health Disparities Among Rural Adults - United States, 2012-2015. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2017; 66:1-9. [PMID: 29145359 PMCID: PMC5829953 DOI: 10.15585/mmwr.ss6623a1] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PROBLEM/CONDITION Rural communities often have worse health outcomes, have less access to care, and are less diverse than urban communities. Much of the research on rural health disparities examines disparities between rural and urban communities, with fewer studies on disparities within rural communities. This report provides an overview of racial/ethnic health disparities for selected indicators in rural areas of the United States. REPORTING PERIOD 2012-2015. DESCRIPTION OF SYSTEM Self-reported data from the 2012-2015 Behavioral Risk Factor Surveillance System were pooled to evaluate racial/ethnic disparities in health, access to care, and health-related behaviors among rural residents in all 50 states and the District of Columbia. Using the National Center for Health Statistics 2013 Urban-Rural Classification Scheme for Counties to assess rurality, this analysis focused on adults living in noncore (rural) counties. RESULTS Racial/ethnic minorities who lived in rural areas were younger (more often in the youngest age group) than non-Hispanic whites. Except for Asians and Native Hawaiians and other Pacific Islanders (combined in the analysis), more racial/ethnic minorities (compared with non-Hispanic whites) reported their health as fair or poor, that they had obesity, and that they were unable to see a physician in the past 12 months because of cost. All racial/ethnic minority populations were less likely than non-Hispanic whites to report having a personal health care provider. Non-Hispanic whites had the highest estimated prevalence of binge drinking in the past 30 days. INTERPRETATION Although persons in rural communities often have worse health outcomes and less access to health care than those in urban communities, rural racial/ethnic minority populations have substantial health, access to care, and lifestyle challenges that can be overlooked when considering aggregated population data. This study revealed difficulties among non-Hispanic whites as well, primarily related to health-related risk behaviors. Across each population, the challenges vary. PUBLIC HEALTH ACTION Stratifying data by different demographics, using community health needs assessments, and adopting and implementing the National Culturally and Linguistically Appropriate Services Standards can help rural communities identify disparities and develop effective initiatives to eliminate them, which aligns with a Healthy People 2020 overarching goal: achieving health equity.
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Affiliation(s)
- Cara V. James
- Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | | | | | | | | | - Karen Bouye
- Office of the Director, CDC, Atlanta, Georgia
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The shelf space and strategic placement of healthy and discretionary foods in urban, urban-fringe and rural/non-metropolitan Australian supermarkets. Public Health Nutr 2017; 21:593-600. [DOI: 10.1017/s1368980017003019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveSupermarkets are a key influence on eating behaviours, but it is unknown if the promotion of food within stores varies on a geographic gradient from urban, to urban-fringe and non-metropolitan areas. The present study aimed to assess the shelf space and strategic placement of healthy and discretionary foods in each of urban, urban-fringe and non-metropolitan Australian supermarkets.Design/SettingIn-store audits were conducted in stores from one of the two major Australian supermarket chains in urban (n19), urban-fringe (n20) and non-metropolitan (n26) areas of Victoria. These audits examined selected food items (crisps/chips, chocolate, confectionery, soft drinks/sodas, fruits and vegetables) and measured the shelf space and the proportion of end-of-aisle and cash register displays containing these products. Store size was measured as the sum of aisle length. Differences in the supermarket food environment with respect to location were assessed, before and after adjustment for neighbourhood socio-economic position.ResultsThe strategic placement of discretionary foods was commonly observed in all supermarkets. Adjusting for store size (larger in urban-fringe and rural areas), urban stores had greater shelf space devoted to fruits and vegetables, and less checkouts with soft drinks, than urban-fringe and rural/non-metropolitan areas. Differences remained following adjustment for neighbourhood socio-economic position. No clear pattern was observed for end-of-aisle displays, or the placement of chocolate and confectionery at checkouts.ConclusionsThe shelf space of healthy and discretionary foods in urban-fringe and rural stores parallels the prevalence of overweight and obesity in these areas. Interventions in urban-fringe and rural stores targeting the shelf space of healthy foods and the placement of soft drinks at key displays may be useful obesity prevention initiatives.
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Cheasley R, Keller CP, Setton E. Lifetime excess cancer risk due to carcinogens in food and beverages: Urban versus rural differences in Canada. Canadian Journal of Public Health 2017; 108:e288-e295. [PMID: 28910252 DOI: 10.17269/cjph.108.5830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 03/23/2017] [Accepted: 02/25/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore differences in urban versus rural lifetime excess risk of cancer from five specific contaminants found in food and beverages. METHODS Probable contaminant intake is estimated using Monte Carlo simulations of contaminant concentrations in combination with dietary patterns. Contaminant concentrations for arsenic, benzene, lead, polychlorinated biphenyls (PCBs) and tetrachloroethylene (PERC) were derived from government dietary studies. The dietary patterns of 34 944 Canadians from 10 provinces were available from Health Canada's Canadian Community Health Survey, Cycle 2.2, Nutrition (2004). Associated lifetime excess cancer risk (LECR) was subsequently calculated from the results of the simulations. RESULTS In the calculation of LECR from food and beverages for the five selected substances, two (lead and PERC) were shown to have excess risk below 10 per million; whereas for the remaining three (arsenic, benzene and PCBs), it was shown that at least 50% of the population were above 10 per million excess cancers. Arsenic residues, ingested via rice and rice cereal, registered the greatest disparity between urban and rural intake, with LECR per million levels well above 1000 per million at the upper bound. The majority of PCBs ingestion comes from meat, with values slightly higher for urban populations and LECR per million estimates between 50 and 400. Drinking water is the primary contributor of benzene intake in both urban and rural populations, with LECR per million estimates of 35 extra cancers in the top 1% of sampled population. CONCLUSION Overall, there are few disparities between urban and rural lifetime excess cancer risk from contaminants found in food and beverages. Estimates could be improved with more complete Canadian dietary intake and concentration data in support of detailed exposure assessments in estimating LECR.
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Affiliation(s)
- Roslyn Cheasley
- Department of Geography, University of Victoria, PO Box 3060, Ring Road, Victoria, BC, V8N 1V3, Canada
| | - C Peter Keller
- Department of Geography, University of Victoria, PO Box 3060, Ring Road, Victoria, BC, V8N 1V3, Canada
| | - Eleanor Setton
- Department of Geography, University of Victoria, PO Box 3060, Ring Road, Victoria, BC, V8N 1V3, Canada.
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Rushakoff JA, Zoughbie DE, Bui N, DeVito K, Makarechi L, Kubo H. Evaluation of Healthy2Go: A country store transformation project to improve the food environment and consumer choices in Appalachian Kentucky. Prev Med Rep 2017; 7:187-192. [PMID: 28706778 PMCID: PMC5501879 DOI: 10.1016/j.pmedr.2017.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/20/2022] Open
Abstract
Rates of obesity and type 2 diabetes in Kentucky's Cumberland Valley region are among the highest in the United States and limited access to healthy food contributes to these epidemics. The aim of Healthy2Go (H2G), a country store transformation project launched by Spread the Health Appalachia (STHA), was to improve awareness and availability of healthy options in small, rural stores. Ten country stores participated in H2G and received training and technical assistance to increase availability and awareness of healthy foods. Stores made inventory changes; installed point-of-purchase educational and in-store marketing materials directing shoppers to healthier options; provided nutrition education such as healthy recipes; and altered the display and location of healthy items. To measure changes within stores and the potential impact on resident eating and purchasing habits, STHA used four instruments: a modified version of the Nutrition Environs Measures Survey - Corner Stores at baseline and follow-up, a bimonthly store inventory assessment, a final store owner survey, and a Community Nutrition Survey at baseline (n = 287) and follow-up (n = 281). The stores in the H2G program (n = 10) had a 40% increase in stocking fresh produce, a 20% increase in produce variety, and trends towards increasing healthy inventory. During the same period, surveyed residents reported a statistically significant increase in the frequency of healthy food consumption. Small store transformation programs can improve availability of and access to healthy food in rural settings and influence local purchasing patterns.
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Affiliation(s)
| | | | - Nancy Bui
- Microclinic International, San Francisco, CA, United States
| | | | | | - Hitomi Kubo
- Microclinic International, San Francisco, CA, United States
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VanKim NA, Austin SB, Jun HJ, Corliss HL. Physical Activity and Sedentary Behaviors Among Lesbian, Bisexual, and Heterosexual Women: Findings from the Nurses' Health Study II. J Womens Health (Larchmt) 2017; 26:1077-1085. [PMID: 28816590 DOI: 10.1089/jwh.2017.6389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Lesbian and bisexual (LB) women are at greater risk of obesity than heterosexuals. However, few studies have examined sexual orientation differences in physical activity (PA) and even fewer have examined differences in sedentary behaviors. This study assessed PA more comprehensively than previous research by including aerobic PA, strengthening PA, and sitting time, to explore sexual orientation differences among adult women. METHODS Nearly 100,000 women from Nurses' Health Study II were included in multivariable-adjusted repeated measures analyses. PA and sedentary behaviors were assessed in 1989, 1991, 1997, 2001, 2005, and 2009 (age range: 24-64 years). Aerobic PA was converted to metabolic equivalent task (MET)-hours/week, whereas strengthening PA and sedentary behaviors were measured in hours/week. About 1.3% of the sample identified as lesbian (n = 926) or bisexual (n = 415). RESULTS On average over repeated measures, LB women reported engaging in 2-3 MET-hours/week more of total aerobic PA (β [95% confidence interval, CI]: lesbian: 2.0 MET-hours/week [0.6-3.4]; bisexual: 2.8 MET-hours/week [0.7-4.7]) than heterosexual women. Bisexual women reported engaging in 0.2 hours/week more of strengthening PA (95% CI: 0.06-0.42) than heterosexuals; there were no differences between lesbians and heterosexuals in strengthening PA. LB women reported sitting an average of 4-5 hours/week more than heterosexuals (lesbian: 4.1 hours/week [3.1-5.2]; bisexual: 5.1 hours/week [3.6-6.7]). CONCLUSIONS Interventions promoting less sitting time among LB women may be warranted. Additionally, findings highlight need for more research into other modifiable factors besides PA, such as minority stress or disordered eating behaviors that may contribute to greater obesity among LB women.
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Affiliation(s)
- Nicole A VanKim
- 1 Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts , Amherst, Massachusetts
| | - S Bryn Austin
- 2 Division of Adolescent and Young Adult Medicine, Boston Children's Hospital , Boston, Massachusetts.,3 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,4 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health , Boston, Massachusetts
| | - Hee-Jin Jun
- 5 Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University , San Diego, California
| | - Heather L Corliss
- 3 Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,5 Institute for Behavioral and Community Health, Graduate School of Public Health, San Diego State University , San Diego, California
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Characterization of Non-Nutritive Sweetener Intake in Rural Southwest Virginian Adults Living in a Health-Disparate Region. Nutrients 2017; 9:nu9070757. [PMID: 28708096 PMCID: PMC5537871 DOI: 10.3390/nu9070757] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/05/2017] [Accepted: 07/12/2017] [Indexed: 01/16/2023] Open
Abstract
Few data assessing non-nutritive sweetener (NNS) intake are available, especially within rural, health-disparate populations, where obesity and related co-morbidities are prevalent. The objective of this study is to characterize NNS intake for this population and examine the variance in demographics, cardio-metabolic outcomes, and dietary intake between NNS consumers and non-consumers. A cross-sectional sample (n = 301) of Virginian adults from a randomized controlled trial (data collected from 2012 to 2014) targeting sugar-sweetened beverage (SSB) intake completed three 24-h dietary recalls, and demographics and cardio-metabolic measures were assessed. The frequency, types, and sources of NNS consumption were identified. Thirty-three percent of participants reported consuming NNS (n = 100). Sucralose was the largest contributor of mean daily NNS intake by weight (mg), followed by aspartame, acesulfame potassium, and saccharin. NNS in tabletop sweeteners, diet tea, and diet soda were the top contributors to absolute NNS intake. The most frequently consumed NNS sources were diet sodas, juice drinks, and tabletop sweeteners. Although mean body mass index (BMI) was greater for NNS consumers, they demonstrated significantly lower food, beverage, and SSB caloric intake and energy density, and higher overall dietary quality. It remains unclear whether NNS use plays a role in exacerbating weight gain. NNS consumers in this sample may have switched from drinking predominantly SSB to drinking some NNS beverages in an effort to cope with weight gain. Future studies should explore motivations for NNS use across a variety of weight and health categories.
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Ard JD, Carson TL, Shikany JM, Li Y, Hardy CM, Robinson JC, Williams AG, Baskin ML. Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial. J Intern Med 2017; 282:102-113. [PMID: 28514081 PMCID: PMC6136898 DOI: 10.1111/joim.12622] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Obesity is highly prevalent in African American women, especially those in the rural southern USA, resulting in persistent health disparities. OBJECTIVE To test the effectiveness of an evidence-based behavioural weight loss intervention delivered by community health advisors to African American women in the rural south. DESIGN AND METHODS Overweight or obese African American women (30-70 years) from eight counties in Mississippi and Alabama participated in a 24-month randomized controlled trial of an evidence-based behavioural weight loss programme augmented with community strategies to support healthy lifestyles (Weight Loss Plus, N = 154) compared to the weight loss programme alone (Weight Loss Only, N = 255). This study reports on 6-month outcomes on primary (weight change) and secondary (waist circumference, blood pressure, lipids, fasting blood glucose) outcomes, coinciding with the completion of the intensive weight loss phase. RESULTS Weight Loss Only participants lost an average of 2.2 kg (P < 0.001). Weight Loss Plus participants lost an average of 3.2 kg (P < 0.001). The proportion of the total sample that lost at least 5% of their body weight was 27.1% with no difference between treatment groups. Similarly, we observed statistically significant reductions in blood pressure, waist circumference and triglycerides in each treatment group, with no statistical differences between groups. CONCLUSION Trained lay health staff and volunteers from the rural southern USA were able to deliver a translation of a high-intensity behavioural intervention targeted to African American women, resulting in clinically meaningful weight loss and improvement in other metabolic outcomes in a significant proportion of participants.
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Affiliation(s)
- J D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - T L Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Y Li
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - C M Hardy
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J C Robinson
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - A G Williams
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - M L Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Baker EA, Elliott M, Barnidge E, Estlund A, Brownson RC, Milne A, Kershaw F, Hashimoto D. Implementing and Evaluating Environmental and Policy Interventions for Promoting Physical Activity in Rural Schools. THE JOURNAL OF SCHOOL HEALTH 2017; 87:538-545. [PMID: 28580669 DOI: 10.1111/josh.12522] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 10/17/2016] [Accepted: 01/27/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Schools are an important setting for improving behaviors associated with obesity, including physical activity. However, within schools there is often a tension between spending time on activities promoting academic achievement and those promoting physical activity. METHODS A community-based intervention provided administrators and teachers with a training on evidence-based public health and then collaborated with them to identify and implement environmental (walking track) and local school policy interventions (brain breaks). The evaluation included conducting in-depth interviews and SOPLAY observations to assess the facilitators and barriers and impact of the dissemination of environmental and policy changes. RESULTS Individual, organizational, intervention, and contextual factors influenced dissemination. Teachers reported that brain breaks increased student focus and engagement with classroom material and decreased student behavioral problems. Students decreased sedentary behavior and increased vigorous behavior. Of the 4 schools, 2 increased walking. CONCLUSIONS Active dissemination of environmental and policy interventions by engaging school administrators and teachers in planning and implementation shows potential for increasing physical activity in rural school settings.
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Affiliation(s)
- Elizabeth A Baker
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63130
| | - Michael Elliott
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63130
| | - Ellen Barnidge
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63130
| | - Amy Estlund
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63130
| | - Ross C Brownson
- Brown School, Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130
| | - Anne Milne
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63130
| | - Freda Kershaw
- Saint Louis University College for Public Health and Social Justice, 3545 Lafayette Ave., St. Louis, MO 63130
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Campbell EA, Shapiro MJ, Welsh C, Bleich SN, Cobb LK, Gittelsohn J. Healthy Food Availability Among Food Sources in Rural Maryland Counties. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2017; 12:328-341. [PMID: 29242739 DOI: 10.1080/19320248.2017.1315328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Most studies examining the association of the food environment and health outcomes have focused on urban settings. However, rural adults and children have high rates of obesity, which may be related to their food environments. This study examines the food environment in 7 rural counties in Maryland. A cross-sectional study was conducted at 244 retail food stores from 2012 to 2013. Data on store-level characteristics were collected and a healthy food availability index (HFAI) ranging from 0 to 31 points was calculated for each store. Convenience stores (18.9%) and other nontraditional stores (16.8%) were the most common store types, and box stores were the least (4.9%). Supermarkets had the highest mean HFAI (24.8), whereas gas stations (8.7) had the lowest; convenience stores were also low (11.1). In rural Maryland, the most common food source types have low healthy food availability, and nontraditional food sources are an important part of the food environment.
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Affiliation(s)
- Elizabeth A Campbell
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Myra J Shapiro
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Sara N Bleich
- Harvard T.H. Chan School of Public Health, Health Policy and Management Department, Boston, Massachusetts, USA
| | | | - Joel Gittelsohn
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Dean C, Fogleman AJ, Zahnd WE, Lipka AE, Malhi RS, Delfino KR, Jenkins WD. Engaging rural communities in genetic research: challenges and opportunities. J Community Genet 2017; 8:209-219. [PMID: 28477297 DOI: 10.1007/s12687-017-0304-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 04/27/2017] [Indexed: 12/13/2022] Open
Abstract
Statistical analyses of health and disease in rural communities is frequently limited by low sample counts. Still, some studies indicate increased risk for some diseases even after adjustment for known risk factors. It has been hypothesized that the context of community formation in rural areas facilitates the propagation of genetic founder effects-potentially impacting disease susceptibility. However, outright examination of genetic diversity in such communities has not been performed. Our objective was to engage otherwise research-inexperienced rural communities of largely European descent in genomic research in the context of cancer susceptibility. From September 2015 to February 2016, we implemented a systematic process of progressive community engagement. This iterative method sought project buy-in from first the town mayor, then village council. If approved by both, a focus group of community members examined how residents might view the research, informed consent and specimen collection, and issues of privacy. We were successful in engaging three of the four communities approached for the research project. There was universal enthusiasm for the project by all mayors and village councils. The focus groups' main point of discussion involved wording in the informed consent, with little concern regarding the research question or privacy. Perhaps contrary to popular thought, we found each community we approached to be both welcoming and enthusiastic about collaborating in research on genomic diversity. The systematic method of engagement did much to preserve community respect and autonomy and facilitated buy-in.
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Affiliation(s)
- Caress Dean
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Amanda J Fogleman
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Whitney E Zahnd
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Alexander E Lipka
- Department of Crop Sciences, University of Illinois, W-201B Turner Hall, 1102 S Goodwin Ave, Urbana, IL, 61801, USA
| | - Ripan Singh Malhi
- Departments of Anthropology & Animal Biology, Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, 209F Davenport Hall, 607 Matthews Ave., Urbana, IL, 61801, USA
| | - Kristin R Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62794-9664, USA
| | - Wiley D Jenkins
- Population Health Science Program, Southern Illinois University School of Medicine, 201 E. Madison St, Springfield, IL, 62794-9664, USA.
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Wen M, Fan JX, Kowaleski-Jones L, Wan N. Rural-Urban Disparities in Obesity Prevalence Among Working Age Adults in the United States: Exploring the Mechanisms. Am J Health Promot 2017; 32:400-408. [PMID: 29214811 DOI: 10.1177/0890117116689488] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Higher prevalence rates of overweight and obesity in rural America have been consistently reported, but sources of these disparities are not well known. This study presented patterns and mechanisms of these disparities among working age Americans. DESIGN Cross-sectional study. SETTING United States of America. PARTICIPANTS The study included 10 302 participants of the 2003-2008 National Health and Nutrition Examination Survey (NHANES) who were 20 to 64 years old, not pregnant, and with a body mass index ranging from 18.5 to 60. MEASURES Individual-level data were from NHANES including age, gender, race/ethnicity, immigrant status, education, and family income. The outcomes were prevalence of obesity and prevalence of overweight and obesity combined. Neighborhood data were constructed from the 2000 US Census providing tract-level information on family median income and built environmental features and from the 2006 ESRI ArcGIS 9.3 Data DVD providing tract-level park location information. ANALYSIS Geographic information system (GIS) methods were used to create a measure of spatial distance to local parks capturing park accessibility. Random intercept logistic and ordinal logit regression analyses were performed. FINDINGS Multivariate regression results showed that the odds of obesity was higher in rural areas compared to urban areas (odds ratio = 1.358, P < .001) net of demographic controls and that this gap was largely attributable to individual educational attainment and neighborhood median household income and neighborhood built environmental features. After controlling for these hypothesized mediators, the elevated odds associated with rural residence was reduced by nearly 94% and rendered statistically insignificant. CONCLUSIONS In this nationally representative cross-sectional sample, rural-urban obesity disparities were large and explained by rural-urban educational differences at the individual level and economic and built environmental differences at the neighborhood level.
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Affiliation(s)
- Ming Wen
- 1 Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Jessie X Fan
- 2 Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, USA
| | - Lori Kowaleski-Jones
- 2 Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, USA
| | - Neng Wan
- 3 Department of Geography, University of Utah, Salt Lake City, UT, USA
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Dietary Patterns during Adulthood among Lesbian, Bisexual, and Heterosexual Women in the Nurses' Health Study II. J Acad Nutr Diet 2016; 117:386-395. [PMID: 27889314 DOI: 10.1016/j.jand.2016.09.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 09/26/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Lesbian and bisexual women are at greater risk of being obese than heterosexual women; however, there is little research on dietary intake among lesbian and bisexual women. OBJECTIVE This study estimated differences in dietary quality and intake during adulthood comparing heterosexual women to lesbian and bisexual women. DESIGN Biennial mailed questionnaires were used to collect data from a cohort between 1991 and 2011. Heterosexual-identified women were the reference group. PARTICIPANTS/SETTING More than 100,000 female registered nurses in the United States, aged 24 to 44 years, were recruited in 1989 to participate in the Nurses' Health Study II. More than 90% of the original sample are currently active in the study. About 1.3% identified as lesbian or bisexual. MAIN OUTCOME MEASURES Dietary measures were calculated from a 133-item food frequency questionnaire administered every 4 years. Measures included diet quality (Alternative Healthy Eating Index-2010 and Dietary Approaches to Stop Hypertension); calorie, fat, and fiber intake; and glycemic load and index. STATISTICAL ANALYSES Multivariable adjusted repeated measures linear regression models were fit. RESULTS On average, lesbian and bisexual women reported better diet quality (P<0.001) and diets lower in glycemic index (P<0.001) than heterosexual women. In the whole cohort, diet quality scores increased as participants aged, and were lower among women living in rural compared to urban regions. Comparisons in dietary intake across sexual orientation groups were generally similar across age and rurality status. However, differences between lesbian and heterosexual women in Alternative Healthy Eating Index-2010 were larger during younger compared to older ages, suggesting that diet quality estimates among sexual orientation groups converged as women aged. CONCLUSIONS Lesbian and bisexual women reported higher diet quality than heterosexuals. More research examining how diet affects risk for chronic conditions, such as diabetes, among sexual minorities is needed. Physical activity, sedentary behavior, disordered eating behaviors, and psychosocial and minority stress should be explored as potential contributors to higher rates of obesity among sexual minority women.
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Reichenberger DA, Hilmert CJ, Irish LA, Secor-Turner M, Randall BA. Associations Between Sleep and Health-Risk Behaviors in a Rural Adolescent Population. J Pediatr Health Care 2016; 30:317-22. [PMID: 26471515 DOI: 10.1016/j.pedhc.2015.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Insufficient sleep has been associated with engagement in a number of health-risk behaviors in adolescents, including substance use and sexual activity. Associations between sleep and health-risk behaviors in adolescents living in rural areas of the United States are not well investigated. In rural settings, adolescents' sleep patterns, lifestyle factors, and health-risk opportunities may differ from those of urban adolescents, making the independent study of sleep and health behavior associations necessary. METHOD This study examined data from the Rural Adolescent Health Survey (N = 322) administered in rural North Dakota. RESULTS Rural adolescents who reported engaging in smoking, alcohol use, or drug use slept significantly less than adolescents who did not report engaging in these activities. DISCUSSION Sleep was not associated with chewing tobacco use or risky sexual activity, which may reflect an effect of rural cultural values on sleep and health-risk behavior associations.
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Jenkins W, Lipka A, Fogleman A, Delfino K, Malhi R, Hendricks B. Variance in disease risk: rural populations and genetic diversity. Genome 2016; 59:519-25. [DOI: 10.1139/gen-2016-0077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over 19% of the US population resides in rural areas, where studies of disease risk and disease outcomes are difficult to assess due to smaller populations and lower incidence. While some studies suggest rural disparities for different chronic diseases, the data are inconsistent across geography and definitions of rurality. We reviewed the literature to examine if local variations in population genomic diversity may plausibly explain inconsistencies in estimating disease risk. Many rural communities were founded over 150 years ago by small groups of ethnically and ancestrally similar families. These have since endured relative geographical isolation, similar to groups in other industrialized nations, perhaps resulting in founder effects impacting local disease susceptibility. Studies in Europe and Asia have found that observably different phenotypes may appear in isolated communities within 100 years, and that genomic variation can significantly vary over small geographical scales. Epidemiological studies utilizing common “rural” definitions may miss significant disease differences due to assumptions of risk homogeneity and misinterpretation of administrative definitions of rurality. Local genomic heterogeneity should be an important aspect of chronic disease epidemiology in rural areas, and it is important to consider for designing studies and interpreting results, enabling a better understanding of the heritable components of complex diseases.
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Affiliation(s)
- W.D. Jenkins
- Population Health Science Program, Southern Illinois University School of Medicine, 801 N. Rutledge St., Springfield, IL 62794-9664, USA
| | - A.E. Lipka
- Department of Crop Sciences, University of Illinois, W-201B Turner Hall, 1102 S Goodwin Ave., Urbana IL 61801, USA
| | - A.J. Fogleman
- Center for Clinical Research, Southern Illinois University School of Medicine, 801 N. Rutledge St., Springfield, IL 62794-9664, USA
| | - K.R. Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, 801 N. Rutledge St., Springfield, IL 62794-9664, USA
| | - R.S. Malhi
- Depts. of Anthropology & Animal Biology, Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign, 209F Davenport Hall, 607 Matthews Ave., Urbana, IL 61801, USA
| | - B. Hendricks
- Department of History, Southern Illinois University, 1000 Faner Drive, Rm 3374, Carbondale, IL 62901, USA
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Warren JC, Smalley KB, Barefoot KN. Differences in Psychosocial Predictors of Obesity Among LGBT Subgroups. LGBT Health 2016; 3:283-91. [PMID: 27228031 DOI: 10.1089/lgbt.2015.0076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of the current study was to examine the overall presence of and differences in rates of overweight/obesity among a large, nationally diverse sample of lesbian, gay, bisexual, transgender (LGBT)-identified individuals (i.e., cisgender lesbians, cisgender gay men, cisgender bisexual women, cisgender bisexual men, transgender women, and transgender men) and to identify specific psychosocial predictors of obesity within each of the six LGBT subgroups. METHODS A total of 2702 LGBT-identified participants participated in the online study. Participants completed a series of demographic questions (including weight and height) and the Depression Anxiety Stress Scale 21. RESULTS The percentage of participants who were overweight/obese did not differ significantly across LGBT subgroups, with 61.1% of the total sample being overweight/obese. However, the percentage of participants who self-reported body mass indexes in the obese range differed significantly across the six LGBT subgroups, with the highest prevalence in transgender men (46.0%). In addition, the predictors of obesity varied by subgroup, with age a significant predictor for cisgender lesbians, cisgender gay men, and cisgender bisexual women, relationship status for cisgender bisexual women, employment status for both cisgender gay men and cisgender bisexual women, education level for cisgender lesbians, and depression, anxiety, and stress for cisgender gay men. None of the examined psychosocial factors emerged as predictors of obesity for cisgender bisexual men, transgender women, or transgender men. CONCLUSION These findings suggest that there are substantial variations in the presence and predictors of obesity across LGBT subgroups that support the need for culturally tailored healthy weight promotion efforts within the LGBT community.
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Affiliation(s)
- Jacob C Warren
- 1 Center for Rural Health and Health Disparities, Mercer University School of Medicine , Macon, Georgia .,2 Department of Community Medicine, Mercer University School of Medicine , Macon, Georgia
| | - K Bryant Smalley
- 3 Rural Health Research Institute, Georgia Southern University , Statesboro, Georgia .,4 Department of Psychology, Georgia Southern University , Statesboro, Georgia
| | - K Nikki Barefoot
- 3 Rural Health Research Institute, Georgia Southern University , Statesboro, Georgia
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Hart PD. Meeting Recommended Levels of Physical Activity and Health-Related Quality of Life in Rural Adults. J Lifestyle Med 2016; 6:1-6. [PMID: 27358834 PMCID: PMC4915761 DOI: 10.15280/jlm.2016.6.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/16/2016] [Indexed: 11/25/2022] Open
Abstract
Background Little is known about physical activity (PA) and health-related quality of life (HRQOL) among rural adults. The purpose of this study was to investigate the relationship between meeting recommended levels of PA and HRQOL in a rural adult population. Methods This study analyzed data from 6,103 rural adults 18 years of age and older participating in a 2013 survey. Respondents reporting at least 150 minutes a week of moderate-intensity (or moderate-vigorous combination) PA during the past month were categorized as meeting PA guidelines. Five health variables were used to assess HRQOL. A continuous HRQOL ability score was also created using item response theory (IRT). Results Rural adults who met recommended levels of PA were significantly more likely to report good HRQOL in adjusted models of physical health (OR: 1.99; 95% CI: 1.54–2.56), mental health (OR: 1.96; 95% CI: 1.46–2.64), inactivity health (OR: 2.14; 95% CI: 1.54–2.97), general health (OR: 1.69; 95% CI: 1.35–2.13), and healthy days (OR: 1.98; 95% CI: 1.58–2.47), compared to those who did not meet recommended levels. Furthermore, rural adults meeting recommended levels of PA also had a significantly greater HRQOL ability score (51.7 ± 0.23, Mean ± SE), compared to those not meeting recommended levels (48.4 ± 0.33, p < .001). Conclusion This study found that meeting recommended levels of PA increases the likelihood of reporting good HRQOL in rural adults. These results should be used to promote the current PA guidelines for improved HRQOL in rural populations.
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Affiliation(s)
- Peter D Hart
- Health Promotion, Montana State University - Northern, Havre, MT, USA; Research and Statistical Consultant, Health Demographics, Havre, MT, USA
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Bullock SL, Jilcott Pitts SB, Listenfelt B, McGuirt JT, Stanley K, Beth D, Kolbe MB, Rushing J, Wu Q, Ward RK, Mayo Acheson ML, Dortche CJM, Ammerman AS. Availability of Farmers’ Markets and Supplemental Nutrition Assistance Program/Electronic Benefit Transfer Systems and Associations With Rurality, Poverty, Race/Ethnicity, and Obesity Among North Carolina Counties. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2016. [DOI: 10.1080/19320248.2015.1045665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lemacks JL, Ilich JZ, Liu PY, Shin H, Ralston PA, Cui M, Wickrama KAS. Dietary Influence on Calcitropic Hormones and Adiposity in Caucasian and African American Postmenopausal Women Assessed by Structural Equation Modeling (SEM). J Nutr Health Aging 2016; 20:602-10. [PMID: 27273349 DOI: 10.1007/s12603-015-0637-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine differences in hydroxycholecalciferol (25(OH)D) and parathyroid hormone (PTH) concentrations between Caucasian and African American (AA) postmenopausal women, as well as the effects of dietary calcium, protein and vitamin D intakes on 25(OH)D, PTH, and body adiposity using structural equation modeling (SEM). DESIGN Population-based prospective cohort study. SETTING Academic research using the baseline data from two longitudinal studies. Participants Included n=113 Caucasian and n=40 African American, postmenopausal women who completed the baseline data collection and met inclusion criteria (dietary calcium intake <900 mg/day and being generally healthy) between 2006 and 2010. MAIN OUTCOME Dietary intake of calcium and vitamin D, assessed by dietary records, were examined in relation to calcitropic hormones concentrations and adiposity markers. Independent t-tests, confirmatory factor analysis, SEM and multi-group analyses were conducted to examine the aforementioned relationships as well as group differences among hormones, dietary intake, anthropometrics, age and other factors. RESULTS Dietary calcium and protein intakes were significantly lower in AA women. Years since menopause were significantly higher in AA compared to Caucasian women. PTH and 25(OH)D levels were significantly lower in AA compared to Caucasian women. Dietary calcium and protein intakes did not influence body adiposity in either group of women. Dietary vitamin D had minimal indirect (via 25(OH)D levels) influence on adiposity. CONCLUSION The study confirmed the positive relationship of 25(OH)D with adiposity markers and both AA and Caucasian women. The study provides a unique example of the use of SEM in nutrition research within a clinical context. This model should be further tested in other populations.
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Affiliation(s)
- J L Lemacks
- Jennifer L. Lemacks, Nutrition and Food Systems Department, The University of Southern Mississippi, 118 College Drive #5172, Hattiesburg, Mississippi, United States; ; Tel.: +1-601-266-6825; Fax: +1-601-266-6343
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Trajectories of Body Mass Index from Young Adulthood to Middle Age among Canadian Men and Women. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/121806] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Knowledge regarding the heterogeneity of BMI trajectories is limited for the Canadian population. Using latent class growth modelling, four distinct BMI trajectories of individuals from young adulthood to middle age were identified for both women and men from the longitudinal data of the National Population Health Survey. The associations between BMI trajectories and the individuals’ sociodemographic characteristics and behavioural factors were also examined. Aboriginal women were found more likely to be in the long-term overweight or obese groups. It reveals that increased years of smoking, drinking, and being physically active were associated with lowering the BMI trajectory in all groups for both women and men, with some exceptions in the long-term normal weight group for men. Increased years of rural living, being employed, and living with low income were associated with raising the BMI trajectory in all groups for women and in some groups for men. Food insecurity was associated with raising the BMI trajectory in each group for both women and men.
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Hansen AY, Umstattd Meyer MR, Lenardson JD, Hartley D. Built Environments and Active Living in Rural and Remote Areas: a Review of the Literature. Curr Obes Rep 2015; 4:484-93. [PMID: 26364307 DOI: 10.1007/s13679-015-0180-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rural children and adults are more likely to have obesity than their urban counterparts even after adjustment for individual-level behaviors, suggesting that rural environments may promote obesity. The rural built environment may be an important area of research that can help us understand rural-urban disparities in obesity. The purpose of this review is to summarize the rural built environment and active living literature, and to address key issues, gaps, and observations in the field. A literature review was conducted in spring 2015 to identify research published from 2000 to 2015. Our review suggests that limited active living built environments in rural communities and unique rural barriers to physical activity may contribute to a higher prevalence of obesity compared to urban populations. More empirical research is needed to build the evidence-base for the association between rural built environments, active living, and obesity. School- and community-based policies that expand active living opportunities in rural areas should also be closely examined.
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Affiliation(s)
- Anush Yousefian Hansen
- Maine Rural Health Research Center, University of Southern Maine, 404G Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - M Renée Umstattd Meyer
- Department of Health, Human Performance, and Recreation, Robbins College of Health and Human Sciences, Baylor University, One Bear Place, #97313, Waco, TX, 76798, USA.
| | - Jennifer D Lenardson
- Maine Rural Health Research Center, University of Southern Maine, 432B Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
| | - David Hartley
- Maine Rural Health Research Center, University of Southern Maine, 418 Wishcamper Center, 34 Bedford Street, Portland, ME, 04104, USA.
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Flynt A, Daepp MIG. Diet-related chronic disease in the northeastern United States: a model-based clustering approach. Int J Health Geogr 2015; 14:25. [PMID: 26338084 PMCID: PMC4559302 DOI: 10.1186/s12942-015-0017-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/14/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Obesity and diabetes are global public health concerns. Studies indicate a relationship between socioeconomic, demographic and environmental variables and the spatial patterns of diet-related chronic disease. In this paper, we propose a methodology using model-based clustering and variable selection to predict rates of obesity and diabetes. We test this method through an application in the northeastern United States. METHODS We use model-based clustering, an unsupervised learning approach, to find latent clusters of similar US counties based on a set of socioeconomic, demographic, and environmental variables chosen through the process of variable selection. We then use Analysis of Variance and Post-hoc Tukey comparisons to examine differences in rates of obesity and diabetes for the clusters from the resulting clustering solution. RESULTS We find access to supermarkets, median household income, population density and socioeconomic status to be important in clustering the counties of two northeastern states. The results of the cluster analysis can be used to identify two sets of counties with significantly lower rates of diet-related chronic disease than those observed in the other identified clusters. These relatively healthy clusters are distinguished by the large central and large fringe metropolitan areas contained in their component counties. However, the relationship of socio-demographic factors and diet-related chronic disease is more complicated than previous research would suggest. Additionally, we find evidence of low food access in two clusters of counties adjacent to large central and fringe metropolitan areas. While food access has previously been seen as a problem of inner-city or remote rural areas, this study offers preliminary evidence of declining food access in suburban areas. CONCLUSIONS Model-based clustering with variable selection offers a new approach to the analysis of socioeconomic, demographic, and environmental data for diet-related chronic disease prediction. In a test application to two northeastern states, this method allows us to identify two sets of metropolitan counties with significantly lower diet-related chronic disease rates than those observed in most rural and suburban areas. Our method could be applied to larger geographic areas or other countries with comparable data sets, offering a promising method for researchers interested in the global increase in diet-related chronic disease.
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Affiliation(s)
- Abby Flynt
- Department of Mathematics, Bucknell University, 701 Moore Ave, 17837, Lewisburg, PA, USA.
| | - Madeleine I G Daepp
- Integrated Studies in Land and Food Systems, The University of British Columbia Vancouver, 2329 West Mall, V6T 1Z4, Vancouver, BC, Canada.
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