Perceived Impacts of Urban Gardens and Peer Nutritional Counseling for People Living With HIV in the Dominican Republic

OBJECTIVE

Explore participants' perceptions of urban gardens and peer nutritional counseling intervention for people with HIV and food insecurity on antiretroviral therapy in the Dominican Republic.

METHODS

Semistructured endline interviews (n = 21) with intervention participants about their perceptions of diet, health, and quality of life. A codebook was applied to verbatim transcripts, and coded data were analyzed using matrices to identify themes.

RESULTS

Participants were mostly Dominican (86%; 14% Haitian); 57% were men; the mean age was 45 years. The most salient experiences described by intervention participants were improved dietary quality and diversity, improved food security, and saving money. Participants also emphasized improved social interactions, mental health, and emotional well-being.

CONCLUSIONS AND IMPLICATIONS

Urban gardens and peer nutritional counseling may improve participants' diet and psychosocial well-being. Nutrition programs with marginalized populations may need to improve access to healthy foods and build camaraderie and linkages to programs addressing structural factors.

The Importance of Community-Based and Community-Partnered COVID-19 Testing for Reducing Disparities Among African American Populations

Background

Health inequalities in African American communities have been further exacerbated by COVID-19. Public health departments and other safety-net providers across the United States have partnered with community-based organizations to address barriers to COVID-19 testing in disproportionately impacted communities. This narrative review summarizes lessons learned from published examples of these community-based COVID-19 testing efforts.

Methods

We searched online databases for peer-reviewed articles on community-based COVID-19 testing interventions in the United States aimed at increasing COVID-19 testing among African American populations. We abstracted information about each example and synthesized the primary lessons learned and key aspects that contributed to their success.

Results

Seven examples of community-based COVID-19 testing aimed at increasing testing among African Americans and other underserved populations were identified and described, across various U.S. locations and involving multiple types of partners (1) St. Paul, MN (faith, health centers, Mayo Clinic); (2) Chicago, IL (university hospital and health centers); (3) NC (health centers, Community Advisory Board); (4) Baltimore, MD (hospitals, community clinic, mobile clinic); (5) Marion County, FL (health department and community partners); (6) New Orleans, LA (health department and health system); and (7) New York City, NY health and hospital system, mobile clinic).

Discussion

Several key aspects of the COVID-19 testing models included the following: (1) close proximity of the testing site to affected communities and availability of walk-up and drive-through testing options; (2) partnerships between safety-net providers and broad community networks, which facilitated outreach and trust; (3) increased resources for safety-net providers; and (4) the use of data to identify areas of need and track impact. The merging of resources and relationships among well-equipped, safety-net providers and other health care institutions and culture-rich, community-centered organizations, to jointly address structural and systemic inequities, is key to cultivating health equity in the distribution of COVID-19 testing and other essential public health services.

Effects of a Faith-Based Obesity Intervention on African American and Latino Adults' Children

BACKGROUND

Faith-based interventions are promising for promoting healthy behaviors among adults, but their ripple effects on participants' children are unknown. This study is one of the first to assess the effects of a faith-based multilevel obesity intervention on adult participants' children.

METHODS

We analyzed quantitative data from a cluster randomized controlled trial with two African American and two Latino churches in South Los Angeles, California, which invited adult participants to enroll one child (5-17 years) in a sub-study. At baseline and 6-7 months follow-up, parents completed a child health survey, which included the family nutrition and physical activity screening tool, and child height and weight were measured (n = 50).

RESULTS

Results from linear regression models showed children of intervention participants, compared to control, had significantly better dietary patterns at follow-up.

CONCLUSIONS

Findings suggest the health benefits of a faith-based multilevel obesity intervention for adults can extend to children and may help address obesity disparities.

Vulnerability or Resiliency? A Two-Wave Panel Analysis of Social Network Factors Associated with Glycemic Levels among Mexican Immigrants in the Bronx, NYC, Before and During COVID-19

Latinos have high rates of type 2 diabetes mellitus (T2DM) yet are characterized as having health-promoting social networks. The impacts of COVID-19 on personal networks were complex, especially in urban areas with high proportion of immigrants such as the Bronx in NYC. Our objective was to test the extent to which network characteristics increase vulnerability or resiliency for glycemic control based on data gathered from Mexican-origin Bronx dwellers. We used two-wave panel study analyzing self-reported personal social networks (n=30participants; 600network members) and HbA1c levels via dried blood spots in 2019, before the COVID-19 pandemic, and in 2021, a time after initial lockdowns and when the pandemic was still ravaging the community of study. Regression models adjusted for individual-level variables including sociodemographic and health indicators (i.e., physical health including COVID-19 and mental health). We found that an increase in the proportion of network members with diabetes predicted an increase in participant's HbA1c levels from 2019 to 2021 (β=0.044, p < 0.05). Also, a greater proportion of network members consuming "an American diet" in 2019 predicted a decrease in participant's HbA1c levels (β=-0.028, p < 0.01), while a greater proportion of network members that encouraged participants' health in 2019 predicted an increase in participant's HbA1c levels (β=0.033, p < 0.05). Our study sheds light on specific social network characteristics relevant to individual diabetes outcomes, including potential longitudinal mechanistic effects that played out at the peak of the COVID-19 crisis.

Lessons Learned about Developing Faith and Public Health Partnerships to Address Health Disparities

Partnerships between public health and faith-based organizations draw on the strengths of both sectors to achieve a shared interest in promoting health and reducing disparities. However, information about implementation of faith and public health partnerships-particularly those involving diverse racial-ethnic groups-is limited. This paper reports on findings from qualitative interviews conducted with 16 public health and congregational leaders around the country as part of the early phase of the development of a faith and public health partnership to address health disparities in Los Angeles, CA. We identified eight themes regarding the barriers and facilitators to building faith and public health partnerships and distilled these into 10 lessons for developing such approaches. These interviews identified that engaging religious organizations often requires building congregational capacity of the congregation to participate in health programs; and that trust is a critically important element of these relationships. Further, trust is closely related to how well each organization involved in the partnership understands their partners' belief structures, approaches to addressing health and well-being and capacities to contribute to the partnership. Tailoring congregational health programs to match the interests, needs and capacity of partners was identified as an important approach to ensuring that the partnership is successful. But, this is complicated by working across multiple faith traditions and the racial-ethnic backgrounds, thus requiring increased and diverse communication strategies on the part of the partnership leadership. These lessons provide important information for faith and public health leaders interested in developing partnered approaches to address health in diverse urban communities.

Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional counselling intervention for people with HIV in the Dominican Republic

OBJECTIVE

Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up.

DESIGN

Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively.

SETTING

An HIV clinic in the northwest-central part of the Dominican Republic.

RESULTS

The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation.

CONCLUSION

An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.

Prevalence and Predictors of Substance Use Support Programming Among U.S. Religious Congregations

We conducted a cross-sectional secondary analysis of data from the 2012 National Congregation Study, a nationally representative survey of religious congregations in the United States ( N = 1,331). Multivariate logistic regression was used to identify congregational characteristics associated with providing substance use support programing. Nearly one-third (38%) of U.S. congregations indicated that they provided substance use support programming; approximately half (52%) of all congregational attendees were in a congregation that provided some type of substance use support. The internal factors associated with a congregation providing substance use programming include having members who are unemployed and younger, being conservative Protestant, engaging in the practice of speaking in tongues, and having the resources to support social services. The analysis also identifies external factors (i.e., assessing community needs and hosting social service speakers) as being associated with a congregation’s likelihood of providing substance use programming. Findings identify factors associated with congregations providing substance use support.

Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic

HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men's experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women's experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to "move on" and "look ahead." Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.

The co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study

People living with HIV and a non-communicable disease (NCD) experience multi-level barriers when co-managing multiple conditions. We explored the factors affecting living with multiple chronic conditions in the Dominican Republic. We conducted 21 in-depth interviews from October 2019-February 2020 with Dominican adults who participated in a food security intervention and managed HIV and at least one chronic NCD. Using thematic analysis, we explored participant lived experiences co-managing multiple chronic conditions. All participants (mean age = 45.5 years) were linked to HIV care, but only three were linked to NCD-specific care. Individual-level barriers to managing NCDs included limited education and limited self-efficacy for self-management. Interpersonally, barriers included limited rapport building with an NCD-specific specialist. Structural barriers to managing NCDs were no health insurance, poor referral systems, and limited financial assistance. Health system adaptation requires equitably considering the needs of individuals managing multiple chronic conditions. Key factors to address include patient-provider relationships, improved referral systems, accessibility and availability of specialists, and financial assistance.

Preliminary Effects of an Urban Gardens and Peer Nutritional Counseling Intervention on HIV Treatment Adherence and Detectable Viral Load Among People with HIV and Food Insecurity: Evidence from a Pilot Cluster Randomized Controlled Trial in the Dominican Republic

A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of "perfect" ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.Trial registry Clinical Trials Identifier: NCT03568682.

A parish-based multilevel cluster randomized controlled trial to reduce stigma and mental health treatment disparities among Latino communities

Latino communities within the U.S. are disproportionately affected by persistent, high levels of untreated mental illness. Limited mental health literacy, stigma, and cultural factors are major contributors to Latino mental health treatment disparities. Although Latino individuals may be reluctant to seek out mental health professionals, they often rely on religious congregations when confronted with mental illness. However, religious congregations report major obstacles to collaborating with the mental health sector including the lack of mental health training, staffing, and resources. Strategic partnerships between religious congregations and community-based organizations can be leveraged to target sources of Latino mental health treatment disparities. The National Alliance on Mental Illness (NAMI), the nation's largest grassroots mental health organization, has developed a host of programs tailored to the different needs and segments of the community affected by mental illness, including programs designed to address culturally diverse and faith-based communities. This cluster-randomized controlled trial leverages the collective resources of NAMI and the Diocese of San Bernardino to deliver and evaluate the effectiveness of a multi-level, parish-based, intervention to decrease stigma, increase mental health literacy, and improve access to mental health services among Latino parishioners. This study will enroll 1400 participants from 14 parishes that will be randomly assigned to receive the intervention immediately or a wait-list control condition. The intervention could enrich awareness of mental health issues, shape norms about mental illness, facilitate treatment access, and add support from religious congregations to target Latino mental health disparities using culturally and faith-based tailored approaches.

Correlates of HIV-Related Stigmas Among African American Church-Affiliated Populations in Kansas City

HIV-related stigmas contribute to disparities, and contact with HIV-positive individuals has been suggested to reduce stigma. Faith-based organizations have been recognized as important to stigma reduction efforts among African American populations; however, relatively few church-based studies have measured HIV-related stigma. This study uses baseline data (N = 1,448) from a study with 14 African American churches in Kansas City, Missouri and Kansas, to examine correlates of HIV-related stigmas among church members and community members accessing church social services using two previously validated scales that measure discomfort interacting with individuals with HIV and anticipated stigma or rejection. Knowing someone with HIV was associated with lower discomfort, even after adjusting for sociodemographic characteristics and sexual risk, HIV knowledge, previous communication about HIV at church, and mean drug and homosexuality stigmas. Knowing someone with HIV was not associated with anticipated stigma or rejection after adjustment. Contact-based interventions hold promise for reducing discomfort around people with HIV among church-affiliated populations.

Modifying Text Messages from a Faith-Based Physical Activity Intervention with Latino Adults in Response to the COVID-19 Pandemic

BACKGROUND

Text messages are useful for health promotion and can be modified during public health emergencies.

PURPOSE

Describe how we developed and implemented a physical activity (PA) text messaging component within a faith-based intervention, modified the text message content in response to the COVID-19 pandemic and evaluated participants' perceptions of the modified text messages.

RESEARCH DESIGN AND STUDY SAMPLE

PA promotion text messages were delivered to predominately Spanish-speaking, churchgoing Latino adults (n = 284) in Los Angeles, California. In 2020, we modified the messages to disseminate COVID-19-related information and support and share virtual PA resources.

DATA COLLECTION AND ANALYSIS

We analyzed quantitative and qualitative survey data to gauge participants' experiences with the text messages.

RESULTS

COVID-19 related text messages were a feasible, acceptable addition to a PA intervention for a sample of Latinos.

CONCLUSIONS

Throughout the pandemic, the messages enabled continued communication and support for PA and protection from COVID-19 in a population at high-risk of health inequities.

Linking churches and parks to promote physical activity among Latinos: Rationale and design of the Parishes & Parks cluster randomized trial

BACKGROUND

Regular physical activity (PA) contributes to positive health outcomes, but a minority of US adults meet minimum guidelines for moderate-to-vigorous PA (MVPA) and muscle-strengthening, and Latinos are less likely than whites to meet these guidelines. Public parks can be leveraged for community PA but tend to be underutilized, while churches have reach within Latino communities and can influence parishioners' health.

METHODS

We are conducting a cluster randomized controlled trial to examine the impact of a multilevel, faith-based intervention linking Catholic parishes (n = 14) to their local parks on adult Latino parishioners' (n = 1204) MVPA and health-related outcomes. Our approach targets multiple levels (individual, group, church, and neighborhood-park) to promote health-enhancing PA through park-based exercise classes led by kinesiology students, peer leader-led walking groups, park-based church events, church-based PA support activities, and environmental advocacy. Data are collected at churches by trained bilingual/bicultural research assistants using accelerometry, surveys, and biometric procedures. We will implement a set of hierarchical repeated-measure linear models to examine effects on the primary outcome (MVPA) and secondary outcomes (self-reported PA, heart rate/fitness, waist circumference, waist-to-hip ratio, body fat, mental health, and perceived social support for PA). We will also conduct a process evaluation.

CONCLUSION

To our knowledge, this will be the first study examining efficacy of an integrated church and park-based intervention on Latino adults' PA and represents a scalable model of PA programming for low-income communities. The intervention makes use of innovative partnerships within and across sectors - faith-based, local parks/city government, and local universities - further facilitating sustainability.

CLINICALTRIALS

govID: NCT03858868.

COVID-19 Testing in African American Churches Using a Faith-Health- Academic Partnership

Increasing access to COVID-19 testing in influential, accessible community settings is needed to address COVID-19 disparities among African Americans. We describe COVID-19 testing intervention approaches conducted in Kansas City, Missouri, African American churches via a faith-health-academic partnership. Trained faith leaders promoted COVID-19 testing with church and community members by implementing multilevel interventions using a tailored toolkit and standard education information. The local health department conducted more than 300 COVID-19 tests during or after Sunday church services and outreach ministry activities. (Am J Public Health. 2022;112(S9):S887-S891. https://doi.org/10.2105/AJPH.2022.306981).

Exploring antiretroviral therapy adherence, competing needs, and viral suppression among people living with HIV and food insecurity in the Dominican Republic

Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.

Church Contextual Factors Associated With Latinx Physical Activity and Park Use

Churches can be important settings for promoting physical activity (PA) among Latinx populations. Little is known about what factors across the church context-social, organizational, and physical (outdoor spaces)-are associated with Latinx PA to inform faith-based PA interventions. This study investigated associations of church contextual factors with Latinx PA. We used cross-sectional data from a Latinx adult sample recruited from 6 churches that each had a nearby park in Los Angeles, California (n = 373). Linear or logistic regression models examined associations of church PA social support, PA social norms, perceived quality and concerns about the park near one's church, and church PA programming with 4 outcomes: accelerometer-based moderate-to-vigorous PA (MVPA) and self-reported adherence to PA recommendations, use of the park near one's church, and park-based PA. Park quality and concerns were positively associated with using the park near one's church. Church PA programming was positively associated with park-based PA. None of the factors were related to accelerometer-based MVPA or meeting PA recommendations. Findings suggest targeting church PA programming and nearby parks may be key to improving Latinx park use. Church and local parks department partnerships may help enhance park conditions to support churchgoing Latinx PA and health.

The Effects of Park-Based Interventions on Health-Related Outcomes Among Youth: A Systematic Review

OBJECTIVE

The purpose of the study is to present a comprehensive systematic review of the effects of park-based interventions on health outcomes among youth, defined as children and adolescents.

DATA SOURCE

Web of Science, MEDLINE, and Scopus databases searched through November 2020.

STUDY INCLUSION AND EXCLUSION CRITERIA

Interventions conducted in publicly accessible parks that evaluated health outcomes (i.e., physical, mental, and emotional); focused on children and adolescents (up to 18 years old, or up to 22 years old for individuals with developmental needs); and was published in English, Spanish, and Chinese.

DATA EXTRACTION

Two independent reviewers extracted data and assessed the quality of the 15 included studies using the Guide to Community Preventive Services tool.

DATA SYNTHESIS

Descriptive summary of study characteristics and summarized methodological quality of the studies.

RESULTS

Twelve studies were person-based interventions involving the evaluation of health outcome changes in cohorts, and the remaining studies were park-based, focused on changing the park environment and observing changes in youth participation in parks. All identified interventions were positively associated with individual-level and park-level outcomes ranging from body weight, moderate-to-vigorous-intensity physical activity, park utilization, and health behavior knowledge.

CONCLUSIONS

This systematic review demonstrated that parks as sites of interventions can provide an environment that promotes health and wellbeing for youth. Nevertheless, the number of relevant studies were limited, thus it is important to leverage and expand on existing knowledge of the utility of parks as sites of intervention to address health concerns at this critical juncture of the life course.

Examining the association between religiosity and medical mistrust among churchgoing Latinos in Long Beach, CA

Medical mistrust among racial/ethnic minorities has been associated with decreases in health care utilization, whereas religiosity has been separately linked with increases in this behavior. However, very few studies have examined the relationship between religiosity and medical mistrust among Latinos, a group with strong religious connections and potentially high mistrust. In-person, self-administered surveys were collected among 767 adult Latinos attending three Latino churches (one Catholic and two Pentecostal) in Long Beach, CA. Measures included a previously validated 12-item medical mistrust scale, religiosity (religious denomination, length and frequency of attendance, and number of groups or ministries involved in), health care access, and sociodemographic factors. Medical mistrust score was 2.47 (standard deviation [SD] = 0.77; range 1-5). Almost two-thirds of participants (62%) attended religious services frequently (once a week or more), and the majority attended a Catholic church (80%). About half of the participants had attended their church for ≥5 years (50%) and participated in one to two church groups or ministries (53%). Multivariable analyses show that Pentecostal church congregation and those identifying as Mexican/Chicano were negatively associated with medical mistrust. On the contrary, participating in church groups or ministries and having an immigrant parent were positively associated with medical mistrust. Our findings suggest that church-based health initiatives should consider church denomination, length of attendance, participation in groups or ministries, and ethnic differences to address medical mistrust issues among Latino congregants.

Perceptions and determinants of healthy eating for people with HIV in the Dominican Republic who experience food insecurity

OBJECTIVE

The current study aimed to understand how moderate and severe food-insecure people living with HIV (PLHIV) in the Dominican Republic perceive a healthy diet and explore facilitators and barriers to engaging in healthy dietary behaviours as a means of HIV self-management.

DESIGN

We conducted semi-structured interviews with PLHIV. We generated codes on food insecurity among PLHIV and used content analysis to organise codes for constant comparison between and within participants.

SETTING

Two urban HIV clinics in the Dominican Republic.

PARTICIPANTS

Thirty-two PLHIV participated in the interviews.

RESULTS

Factors that contributed to dietary behaviours include individual factors, such as knowledge of nutrition, views and attitudes on healthy dietary behaviours, beliefs about dietary needs for PLHIV and diet functionality. Interpersonal factors, including assistance from family and peers in providing food or funds, were deemed critical along with community and organisational factors, such as food assistance from HIV clinics, accessibility to a variety of food store types and the availability of diverse food options at food stores. Policy-level factors that influenced dietary behaviours were contingent on respondents' participation in the labour market (i.e. whether they were employed) and consistent access to government assistance. Food insecurity influenced these factors through unpredictability and a lack of control.

CONCLUSIONS

PLHIV who experience food insecurity face various barriers to engaging in healthy dietary behaviours. Their diets are influenced at multiple levels of influence ranging from individual to structural, requiring multi-level interventions that can address these factors concurrently.

Effects of park-based interventions on health-related outcomes: A systematic review

Increasing use of parks for physical activity has been proposed for improving population health, including mental health. Interventions that aim to increase park use and park-based physical activity include place-based interventions (e.g., park renovations) and person-based interventions (e.g., park-based walking or exercise classes). Using adapted methods from the Community Guide, a systematic review (search period through September 2019) was conducted to evaluate the effectiveness of park-based interventions among adults. The primary outcomes of interest were health-related, including physical and mental health and moderate-to-vigorous physical activity. Twenty-seven studies that met review criteria were analyzed in 2019 and 2020. Seven person-based studies included generally small samples of specific populations and interventions involved mostly exercise programming in parks; all but one had an average quality rating as "high" and all had at least one statistically significant outcome. Of the 20 place-based interventions, 7 involved only 1 or 2 parks; however, 7 involved from 9 to 78 parks. Types of interventions were predominantly park renovations; only 5 involved park-based exercise programming. Most of the renovations were associated with increased park-level use and physical activity, however among those implementing programming, park-level effects were more modest. Less than half of the place-based intervention studies had an average quality rating of "high." The study of parks as sites for physical activity interventions is nascent. Hybrid methods that combine placed-based evaluations and cohort studies could inform how to best optimize policy, programming, design and management to promote health and well-being.

An Integrated Urban Gardens and Peer Nutritional Counseling Intervention to Address Food Insecurity Among People With HIV in the Dominican Republic

Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, and (3) garden-based nutrition and cooking workshops. The intervention was developed using community-based participatory research over multiple years and stages of data gathering and implementation and evaluation. Lessons learned include the importance of cross-sectoral partnerships to achieve multifaceted, integrated, and sustainable interventions and a shared commitment among partners to an ongoing cycle of action-oriented research, and the need for home-based and community-based gardens to enhance food security and social support. The development process successfully combined an evidence-based framework and community engagement to yield a multicomponent yet integrated food security and nutrition intervention appropriate for people with HIV and potentially adaptable for other chronic conditions.

Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review

CONTEXT

Multilevel church-based interventions may help address racial/ethnic disparities in obesity in the United States since churches are often trusted institutions in vulnerable communities. These types of interventions affect at least two levels of socio-ecological influence which could mean an intervention that targets individual congregants as well as the congregation as a whole. However, the extent to which such interventions are developed using a collaborative partnership approach and are effective with diverse racial/ethnic populations is unclear, and these crucial features of well-designed community-based interventions.

OBJECTIVE

The present systematic literature review of church-based interventions was conducted to assess their efficacy for addressing obesity across different racial/ethnic groups (eg, African Americans, Latinos).

DATA SOURCES AND EXTRACTION

In total, 43 relevant articles were identified using systematic review methods developed by the Center for Disease Control and Prevention (CDC)'s Task Force on Community Preventive Services. The extent to which each intervention was developed using community-based participatory research principles, was tailored to the particular community in question, and involved the church in the study development and implementation were also assessed.

DATA ANALYSIS

Although 81% of the studies reported significant results for between- or within-group differences according to the study design, effect sizes were reported or could only be calculated in 56% of cases, and most were small. There was also a lack of diversity among samples (eg, few studies involved Latinos, men, young adults, or children), which limits knowledge about the ability of church-based interventions to reduce the burden of obesity more broadly among vulnerable communities of color. Further, few interventions were multilevel in nature, or incorporated strategies at the church or community level.

CONCLUSIONS

Church-based interventions to address obesity will have greater impact if they consider the diversity among populations burdened by this condition and develop programs that are tailored to these different populations (eg, men of color, Latinos). Programs could also benefit from employing multilevel approaches to move the field away from behavioral modifications at the individual level and into a more systems-based framework. However, effect sizes will likely remain small, especially since individuals only spend a limited amount of time in this particular setting.

Congregational involvement in HIV: A qualitative comparative analysis of factors influencing HIV activity among diverse urban congregations

Religious congregations can potentially reach disproportionately affected populations with HIV programming, however, factors that influence congregational involvement in HIV are not well-studied. Utilizing comparative case methods and in-depth qualitative data from a diverse sample of 14 urban congregations, we examine a range of attitudinal, organizational, resource, and demographic factors to systematically identify different case scenarios-i.e., combinations of characteristics-associated with the level and types of HIV activities in which the congregational cases tended to be involved. For example, White or mixed race congregations with active gay constituencies and an African-American congregation with a strong lay HIV champion were among the high HIV involvement case scenarios, compared to African-American congregations with a health emphasis but no lay HIV champion among the medium HIV involvement scenarios, and fundamentalist African-American and Latino congregations among the low HIV involvement scenarios. Two key factors that appeared influential across case scenarios included the existence of lay champions for HIV activities and the general theological orientation of the congregation.

The mediating role of perceived crime in gender and built environment associations with park use and park-based physical activity among park users in high poverty neighborhoods

Women use parks less for physical activity than men, and explanations include gendered concerns regarding personal safety and access to walking paths. This study conducted mediation analyses to examine the effects of gender and presence of park walking path on park use, participation in park programs, and park-based physical activity through the hypothesized mediator (perception of crime). The sample included 3213 park users from 48 parks in high poverty neighborhoods in Los Angeles surveyed between 2013 and 2015; park-level factors were assessed through systematic observations of study parks. Women reported fewer park visits than men in the last 7 days (β = -0.17, p = 0.02) and had significantly higher perceived crime (β = 0.12, p < 0.0001) and perceived crime partially mediated the gender association with park visits (βgender, direct = -0.09, p = 0.19; βgender, indirect = -0.07, p < 0.0001). Similarly, the existence of a walking path in the park was significantly related to increased park use (β = 0.27, p = 0.006) and a lower level of perceived crime (β = -0.25, p = 0.0034) and perceived crime partially mediated the association of walking path with park visits (βwalking path, direct = 0.18, p = 0.10; βwalking path, indirect = 0.15, p = 0.005). The associations between gender, walking path, and park-based exercise and program participation were not meaningfully mediated by perceived crime. Among park users in majority Latino, high poverty neighborhoods, addressing crime concerns are likely necessary to increase park use among women and adults whose parks do not have a walking path. For park-based exercise and participation in park programs, gendered preferences regarding park-based physical activity should be explored.

A religiously-tailored, multilevel intervention in African American churches to increase HIV testing: Rationale and design of the Taking It to the Pews cluster randomized trial

HIV continues to disproportionately impact African American (AA) communities. Due to delayed HIV diagnosis, AAs tend to enter HIV treatment at advanced stages. There is great need for increased access to regular HIV testing and linkage to care services for AAs. AA faith institutions are highly influential and have potential to increase the reach of HIV testing in AA communities. However, well-controlled full-scale trials have not been conducted in the AA church context. We describe the rationale and design of a 2-arm cluster randomized trial to test a religiously-tailored HIV testing intervention (Taking It to the Pews [TIPS]) against a standard information arm on HIV testing rates among AA church members and community members they serve. Using a community-engaged approach, TIPS intervention components are delivered by trained church leaders via existing multilevel church outlets using religiously-tailored HIV Tool Kit materials and activities (e.g., sermons, responsive readings, video/print testimonials, HIV educational games, text messages) to encourage testing. Church-based HIV testing events and linkage to care services are conducted by health agency partners. Control churches receive standard, non-tailored HIV information via multilevel church outlets. Secondarily, HIV risk/protective behaviors and process measures on feasibility, fidelity, and dose/exposure are assessed. This novel study is the first to fully test an HIV testing intervention in AA churches - a setting with great reach and influence in AA communities. It could provide a faith-community engagement model for delivering scalable, wide-reaching HIV prevention interventions by supporting AA faith leaders with religiously-appropriate HIV toolkits and health agency partners.

Urban Religious Congregations' Responses to Community Substance Use: An Exploratory Study of Four Cases

Faith-based drug treatment programs are common, and many are implemented through congregations; however, little is documented about how congregations conceptualize and implement these programs. We use case study analysis to explore congregational approaches to drug treatment; qualitative findings emerged in three areas: (1) religion's role in congregational responses to substance use, (2) relationships between program participants and the broader congregation, and (3) interactions between congregational programs and the external community. Congregational approaches to drug treatment can be comprehensive, but work is needed to evaluate such efforts. Congregants' attitudes may influence whether program participants become members of a sustaining congregational community.

Feasibility and acceptability of a mobile messaging program within a church-based healthy living intervention for African Americans and Latinos

Church-based programs can act on multiple levels to improve dietary and physical activity behaviors among African Americans and Latinos. However, the effectiveness of these interventions may be limited due to challenges in reaching all congregants or influencing behavior outside of the church setting. To increase intervention impact, we sent mobile messages (text and email) in English or Spanish to congregants (n = 131) from predominantly African American or Latino churches participating in a multi-level, church-based program. To assess feasibility and acceptability, we collected feedback throughout the 4-month messaging intervention and conducted a process evaluation using the messaging platform. We found that the intervention was feasible to implement and acceptable to a racially ethnically diverse study sample with high obesity and overweight rates. While the process evaluation had some limitations (e.g. low response rate), we conclude that mobile messaging is a promising, feasible addition to church-based programs aiming to improve dietary and physical activity behaviors.

Park Use and Park-Based Physical Activity in Low-Income Neighborhoods

Routine physical activity is important for everyone, and most urban areas have an infrastructure of neighborhood parks that are intended to serve as a setting for recreation and leisure. However, parks are not used proportionally by all age groups, genders, and socioeconomic groups. This paper explores factors associated with park use by different age and gender groups in low-income neighborhoods in Los Angeles, CA. We found that women's visits to parks generally centered around children, whereas men's visits were more likely to be associated with their own physical activity. Barriers for seniors are associated with limited facilities and programming that meet their needs. Park managers should consider park renovations that include social meeting places, comfortable sitting areas, and walking paths to better serve women and seniors.

Eat, Pray, Move: A Pilot Cluster Randomized Controlled Trial of a Multilevel Church-Based Intervention to Address Obesity Among African Americans and Latinos

PURPOSE

To implement a multilevel, church-based intervention with diverse disparity populations using community-based participatory research and evaluate feasibility, acceptability, and preliminary effectiveness in improving obesity-related outcomes.

DESIGN

Cluster randomized controlled trial (pilot).

SETTING

Two midsized (∼200 adults) African American baptist and 2 very large (∼2000) Latino Catholic churches in South Los Angeles, California.

PARTICIPANTS

Adult (18+ years) congregants (n = 268 enrolled at baseline, ranging from 45 to 99 per church).

INTERVENTION

Various components were implemented over 5 months and included 2 sermons by pastor, educational handouts, church vegetable and fruit gardens, cooking and nutrition classes, daily mobile messaging, community mapping of food and physical activity environments, and identification of congregational policy changes to increase healthy meals.

MEASURES

Outcomes included objectively measured body weight, body mass index (BMI), and systolic and diastolic blood pressure (BP), plus self-reported overall healthiness of diet and usual minutes spent in physical activity each week; control variables include sex, age, race-ethnicity, English proficiency, education, household income, and (for physical activity outcome) self-reported health status.

ANALYSIS

Multivariate linear regression models estimated the average effect size of the intervention, controlling for pair fixed effects, a main effect of the intervention, and baseline values of the outcomes.

RESULTS

Among those completing follow-up (68%), the intervention resulted in statistically significantly less weight gain and greater weight loss (-0.05 effect sizes; 95% confidence interval [CI] = -0.06 to -0.04), lower BMI (-0.08; 95% CI = -0.11 to -0.05), and healthier diet (-0.09; 95% CI = -0.17 to -0.00). There was no evidence of an intervention impact on BP or physical activity minutes per week.

CONCLUSION

Implementing a multilevel intervention across diverse congregations resulted in small improvements in obesity outcomes. A longer time line is needed to fully implement and assess effects of community and congregation environmental strategies and to allow for potential larger impacts of the intervention.

National Trends in Food Insecurity and Congregation-Based Food Provision between 1998 and 2012

Food insecurity has been a persistent problem in the U.S., and yet over the past three decades, federally funded food programs have become more restrictive. Scholars and policymakers have inquired whether the nonprofit sector is increasing its food provision activities to address this unmet need. This study analyzes data from the U.S. Census and a nationally representative survey of religious congregations in the U.S. to examine trends in food insecurity and congregation-based food provision between 1998 and 2012. The objective of the study is to investigate the extent to which congregation-based food provision fluctuated with national food insecurity prevalence for the overall population, and for subgroups vulnerable to this condition. Results show an over-time correspondence between the prevalence of food-insecure households and the prevalence of congregations that provide food. Parallel patterns are observed between food insecurity in disproportionately affected subpopulations (e.g., African-Americans and immigrants) and food provision in the congregations likely to serve those households. These findings indicate that congregations are helping meet the needs of food-insecure households. However, research suggests that congregations and nonprofits are not an adequate substitute for federally funded programs. Policy recommendations include expanding access to federally funded programs like the Supplemental Nutrition Assistance Program (SNAP) to more immigrants and other groups vulnerable to food insecurity, as well as providing more systematic financial or federal support and quality control of congregation-based efforts.

Promoting Health from the Pulpit: A Process Evaluation of HIV Sermons to Reduce HIV Stigma and Promote Testing in African American and Latino Churches

Embedding health messages into sermons is a potentially valuable strategy to address HIV and other health disparities in churches that predominantly serve racial and ethnic minorities. This study explores implementation of an HIV sermon as part of a multi-component intervention in three churches (Latino Catholic, Latino Pentecostal, and African American Baptist) in high HIV prevalence areas of Los Angeles County, California. Clergy were given an HIV sermon guide that included local public health data, stigma reduction cues, HIV testing messages, and a sample sermon. Findings are based on a process evaluation (i.e., reach, dose delivered, fidelity, and implementation) and in-depth content analysis to explore HIV frames and messages used by clergy. Sermons were audio-recorded, transcribed verbatim, and coded using an inductive approach. Complementary data were collected through systematic observation. Overall, five clergy delivered nine HIV sermons to majority African American or Latino audiences. On average, 174 congregants were reached per sermon. We found large variation in fidelity to communicating key HIV messages from the sermon guide. While promoting HIV testing from the pulpit seemed viable and acceptable to all the participating clergy, fewer embedded explicit stigma reduction cues. Most spoke about HIV using compassionate and non-judgmental terms, however, issue framing varied across clergy. Structured training of clergy may be necessary to implement the more theoretically driven stigma reduction cues included in the sermon guide. More research is needed on the viability and acceptability of embedding specific health promotion messages into sermons.

Contributions of Neighborhood Parks to Physical Activity in High-Poverty Urban Neighborhoods

Neighborhood parks are important venues for the urban population to do moderate-to-vigorous physical activity in leisure time. Parks can be particularly important for low-income neighborhoods, whose residents suffer from high rates of chronic diseases and may have less access to fee-based fitness exercise facilities. This study assessed the contribution of parks to local populations' physical activity in 48 high-poverty neighborhoods in the city of Los Angeles, using systematic observation of park use and surveys of park users and residents conducted between 2013 and 2015. We found that parks accounted for approximately 2.1% (between-park SD = 1.4%) of moderate physical activity time and 3.1% (between-park SD = 2.1%) of vigorous physical activity time of the local population, both of which were notably lower than the city-level average previously reported. Parks' contribution to physical activity was positively associated with park size (β = 0.13, p < 0.0001) and negatively associated with poverty (β = - 0.10, p < 0.0001) and local population density (β = - 0.25, p = 0.005). Parks in high-poverty neighborhoods in Los Angeles are underutilized, and more efforts are needed to fully realize their potential for population health.

Developing Pilot Interventions to Address Food Insecurity and Nutritional Needs of People Living With HIV in Latin America and the Caribbean: An Interinstitutional Approach Using Formative Research

BACKGROUND

Food insecurity and malnutrition present challenges to HIV management, but little research has been done in Latin America and the Caribbean (LAC).

OBJECTIVE

To assess levels of food insecurity and malnutrition among people living with HIV (PLHIV) across multiple countries in LAC to inform pilot projects and policy.

METHODS

Through interinstitutional collaboration, we collected data on sociodemographics, household food security, anthropometry, and commonly consumed foods among adults seeking care at HIV clinics in Bolivia, Honduras, and the Dominican Republic (DR; N = 400) and used the results for pilot projects.

RESULTS

Most PLHIV had moderate or severe household food insecurity (61% in Bolivia, 71% in Honduras, and 68% in DR). Overweight and obesity were also highly prevalent, particularly among women (41%-53% had body mass index ≥25). High body fat was also prevalent, ranging from 36% to 59%. Among salient foods, fruits and vegetables were lacking. Country-specific pilot projects incorporated locally tailored nutrition counseling with a monthly household food ration, linkage to income-generating projects, or urban gardens. Nutritional counseling was conducted initially by professionals and later modified for peer counselors given the lack of nutritionists.

CONCLUSION

High levels of food insecurity and overweight among PLHIV in LAC have important implications, since prior interventions to address food insecurity among PLHIV have focused on underweight and wasting. Formative research and intersectoral collaboration facilitated locally appropriate nutritional materials and interventions, enhanced local capacities, and helped incorporate nutritional guidelines into policies and practice. Addressing human capital constraints in resource-poor settings and developing complementary strategies were key recommendations.

A Community-Partnered Approach to Developing Church-Based Interventions to Reduce Health Disparities Among African-Americans and Latinos

Faith and public health partnerships offer promise to addressing health disparities, but examples that incorporate African-Americans and Latino congregations are lacking. Here we present results from developing a multi-ethnic, multi-denominational faith and public health partnership to address health disparities through community-based participatory research (CBPR), focusing on several key issues: (1) the multi-layered governance structure and activities to establish the partnership and identify initial health priority (obesity), (2) characteristics of the congregations recruited to partnership (n = 66), and (3) the lessons learned from participating congregations' past work on obesity that informed the development of a multi-level, multi-component, church-based intervention. Having diverse staff with deep ties in the faith community, both among researchers and the primary community partner agency, was key to recruiting African-American and Latino churches. Involvement by local health department and community health clinic personnel provided technical expertise and support regarding health data and clinical resources. Selecting a health issue-obesity-that affected all subgroups (e.g., African-Americans and Latinos, women and men, children and adults) garnered high enthusiasm among partners, as did including some innovative aspects such as a text/e-mail messaging component and a community mapping exercise to identify issues for advocacy. Funding that allowed for an extensive community engagement and planning process was key to successfully implementing a CBPR approach. Building partnerships through which multiple CBPR initiatives can be done offers efficiencies and sustainability in terms of programmatic activities, though long-term infrastructure grants, institutional support, and non-research funding from local foundations and health systems are likely needed.

Sources of Care for Alcohol and Other Drug Problems: The Role of the African American Church

African Americans experience significant disparities in treatment access, retention, and quality of care for alcohol and drug use (AOD) problems. Religious congregations, often the first point of contact for help with AOD problems, can play an integral role in improving access to treatment. However, little is known about the role of African American churches in addressing AOD problems. We administered a survey to a faith-based collaborative of 169 African American churches in Los Angeles to examine how AOD problems are identified in congregations, the types of support provided, barriers to providing treatment referrals, and factors associated with the provision of treatment referrals. Seventy-one percent of churches reported caring often for individuals with AOD problems. AOD problems came to the attention of congregations most commonly via a concerned family member (55%) and less frequently through individuals with AOD problems directly approaching clergy (30%). In addition to providing spiritual support, a substantial proportion of churches reported linking individuals to AOD services through referrals (62%) and consultation with providers (48%). Barriers to providing treatment referrals included lack of affordable programs (50%), stigma (50%), lack of effective treatments (45%), and insufficient resources or staff (45%). The likelihood of providing treatment referrals was greater among mid-sized versus smaller-size congregations (OR 3.43; p < .05) and among congregations with clergy that had attended seminary (OR 3.93; p < .05). Knowing how to effectively coordinate informal sources of care provided by African American churches with the formal service sector could make a significant impact on AOD treatment disparities.

Violent Crime and Park Use in Low-Income Urban Neighborhoods

INTRODUCTION

Crime and safety are often cited as potential hurdles to park use and park-based physical activity. Using comprehensive data sources including both objective and subjective measurements at the park level and the individual level, this study aimed to assess the association between crime rates and use of local parks in low-income urban neighborhoods.

METHODS

The authors observed 48 parks and conducted local resident surveys in low-income neighborhoods in Los Angeles during a 2-year study period (2013-2015). Crime data were geocoded within a 1-mile radius of parks' addresses and longitudinal models were fitted to estimate the association between crime rates and park use outcomes in 2017.

RESULTS

One gun-related violent crime per 10,000 people during the 6-month period prior to data collection was associated with an average of 13.5%-15.8% reduction in observed park use and park-based moderate to vigorous physical activity (p<0.05) in the 6-month observation period. The relationship was significant in seniors (33%-40% reduction) and adults (13%-18%), but insignificant for teenagers (2%-4%) and children (10%-12%). Homicide rates were also significantly related to lower self-reported park use (p<0.05).

CONCLUSIONS

Gun-related violent crimes have relatively long-term negative associations with population health by reducing utilization of outdoor park space. There can be additional population health benefits from controlling and reducing gun-related violent crimes beyond immediate impacts on public safety and mortality.

Severe food insecurity is associated with overweight and increased body fat among people living with HIV in the Dominican Republic

Food insecurity is an important risk factor for overweight and obesity among low-income populations in high income countries, but has not been well-studied among people living with HIV (PLHIV), particularly in resource-poor settings. To explore the association between food insecurity and overweight and obesity among PLHIV in the Dominican Republic, we conducted a cross-sectional study of 160 HIV-infected adults between March-December 2012 in four geographically-dispersed health centers (Santo Domingo, Puerto Plata, San Juan, and Higuey). We collected information on household food insecurity, anthropometric measurements, and socio-demographic data and ran descriptive and multivariate analyses, controlling for fixed effects of clinics and using robust standard errors. Mean age ± SD of participants was 39.9 ± 10.5 years; 68% were women, and 78% were on antiretroviral therapy (ART). A total of 58% reported severe household food insecurity. After controlling for age, gender, income, having children at home, education, and ART status, severe food insecurity was associated with increased body mass index (BMI) (β = 1.891, p = 0.023) and body fat (β = 4.004, p = 0.007). Age and female gender were also associated with increased body fat (β = 0.259, p < 0.001 and β = 8.568, p < 0.001, respectively) and age and ART status were associated with increased waist circumference (β = 0.279, p = 0.011 and β = 5.768, p = 0.046, respectively). When overweight was examined as a dichotomous variable (BMI ≥ 25.0), severe food insecurity was associated with an increased odds of 3.060 (p = 0.013); no other covariates were independently associated with overweight. The association of severe food insecurity with increased BMI, body fat, and overweight among PLHIV has important implications for clinical care as well as food security and nutrition interventions in resource-poor settings. Integrated programs that combine nutrition education or counseling with sustainable approaches to addressing food insecurity among PLHIV are needed to improve long-term health outcomes of this vulnerable population.

Prevalence and Predictors of Mental Health Programming Among U.S. Religious Congregations

OBJECTIVE

This study assessed the prevalence of and factors associated with congregation-based programming in support of people with mental illness.

METHODS

To estimate the proportion of congregations that provide mental health programming, this study reports analyses of survey responses from the 2012 National Congregations Study, a nationally representative survey of religious congregations in the United States (N=1,327). The analysis used multivariate logistic regression to identify congregational characteristics associated with the provision of mental health programming.

RESULTS

Nearly one in four U.S. congregations (23%) provided some type of programming to support people with mental illness. Approximately 31% of all attendees belonged to a congregation that provided mental health programming. Congregational characteristics associated with providing mental health programming included having more members and having members with higher incomes, employing staff for social service programs, and providing health-focused programs. Other significant predictors included engaging with the surrounding community (that is, conducting community needs assessments and hosting speakers from social service organizations) and being located in a predominantly African-American community.

CONCLUSIONS

Greater coordination between mental health providers and congregations with programs that support people with mental illness could foster more integrated and holistic care, which in turn may lead to improved recovery outcomes.

Gender Disparities in Park Use and Physical Activity among Residents of High-Poverty Neighborhoods in Los Angeles

INTRODUCTION

Physical inactivity is more prevalent among women than men and is related to poor health outcomes. Neighborhood parks constitute an important resource for physical activity (PA), however, previous studies of park users have found fewer women being physically active.

METHODS

We conducted a hierarchical mixed-effect regression analysis of the independent associations between gender and park use and PA among a population-based sample in high-poverty neighborhoods in Los Angeles. Data sources included 1) structured interviews with adults (≥18 years of age) in randomly selected households within 1 mile of study parks (n = 2,973), 2) systematic observations of study parks (n = 48), and 3) neighborhood characteristics from the 2010 U.S. Census.

RESULTS

After controlling for race/ethnicity, education, body mass index of 30 kg/m2 or greater, health status, proximity to park, having children under the age of 18, perceived park safety, estimated screen time, and park- and neighborhood-level variables, statistically significant differences were found between women and men on all outcomes. Compared with men, women reported fewer park visits in the past week (-0.28 times/week; p < .001) and shorter durations of a typical park visit (-11.11 min/visit; p < .001). Women were also less likely than men to report levels of PA that meet national guidelines (≥150 minutes of moderate to vigorous PA per week; risk difference = -0.06; p < .01) or to exercise in the park (risk difference = -0.13; p < .001) or elsewhere (risk difference = -0.13; p < .001).

CONCLUSIONS

Women living in high-poverty neighborhoods use parks less for PA than men. Improved park-level design, programming, and other policy interventions may be needed to mitigate disparities in park use and PA for all.

Process Evaluation of a Peer-Driven, HIV Stigma Reduction and HIV Testing Intervention in Latino and African American Churches

Purpose: Faith-based organizations may be effective in addressing HIV-related disparities, but few interventions have been implemented across diverse churches. The Facilitating Awareness to Increase Testing for HIV (FAITH) intervention harnessed peer leadership to decrease HIV stigma and promote HIV testing in African American and Latino congregations. A pilot study found more consistent effects among Latino congregations. This process evaluation evaluates implementation of FAITH to better understand the pilot study's findings.

Methods: Data sources included HIV education and peer leader workshop evaluation forms, participant views of the community's perspective of HIV, and peer leader follow-up interviews. Data were triangulated with systematic observation notes and analyzed using process-related themes of recruitment, reach, context, implementation, dose-delivered, and fidelity.

Results: At the Latino churches (compared to the African American church), facilitators spent more time addressing community-based misconceptions about HIV. The peer leader model was well received, especially among Latino participants, and most said that after the workshop they felt comfortable speaking with others about HIV-related topics. Latino peer leaders reported speaking with up to 20 people within their social networks (particularly with family members); African Americans reported up to 4. Implementation challenges at the African American church may have contributed to the limited intervention effects. Nevertheless, we found the peer motivator model feasible and acceptable across diverse faith settings.

Conclusion: Peer-based models within faith settings are promising for addressing HIV. However, differences among groups in HIV knowledge, social network characteristics and norms, and church preferences may influence overall effectiveness.

Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study

Background

Food insecurity contributes to poor health outcomes among people living with HIV. In Latin America and the Caribbean, structural factors such as poverty, stigma, and inequality disproportionately affect women and may fuel both the HIV epidemic and food insecurity.

Methods

We examined factors contributing to food insecurity among women living with HIV (WLHIV) in the Dominican Republic (DR). Data collection included in-depth, semi-structured interviews in 2013 with 30 WLHIV with indications of food insecurity who resided in urban or peri-urban areas and were recruited from local HIV clinics. In-person interviews were conducted in Spanish. Transcripts were coded using content analysis methods and an inductive approach to identify principal and emergent themes.

Results

Respondents identified economic instability as the primary driver of food insecurity, precipitated by enacted stigma in the labor and social domains. Women described experiences of HIV-related labor discrimination in formal and informal sectors. Women commonly reported illegal HIV testing by employers, and subsequent dismissal if HIV-positive, especially in tourism and free trade zones. Enacted stigma in the social domain manifested as gossip and rejection by family, friends, and neighbors and physical, verbal, and sexual abuse by intimate partners, distancing women from sources of economic and food support. These experiences with discrimination and abuse contributed to internalized stigma among respondents who, as a result, were fearful and hesitant to disclose their HIV status; some participants reported leaving spouses and/or families, resulting in further isolation from economic resources, food and other support. A minority of participants described social support by friends, spouses, families and support groups, which helped to ameliorate food insecurity and emotional distress.

Conclusions

Addressing food insecurity among WLHIV requires policy and programmatic interventions to enforce existing laws designed to protect the rights of people living with HIV, reduce HIV-related stigma, and improve gender equality.

Promoting physical activity in high-poverty neighborhood parks: A cluster randomized controlled trial

Although physical activity can help mitigate or prevent multiple chronic diseases, most people in the U.S., especially high-poverty minority groups, engage in insufficient levels of physical activity. To test ways to promote more physical activity in high-poverty area public parks we conducted a randomized controlled intervention trial. After completing baseline measures of park-based physical activity using systematic direct observation three times/day each month for six months and assessing preferences for park programming among 1445 residents living within 1 mile of study parks, we randomized 48 parks in high poverty neighborhoods in the City of Los Angeles, California during 2013-2014 to four study arms: 1) free physical activity classes over a 6-month period, 2) a frequent user program where participants could win prizes based upon the number of visits they made to the park, 3) both the programs, and 4) neither one (control condition). We re-measured park use in 2014-2015 using the same methods during the six months the intervention programs were in operation. A total of 2047 free park classes were offered attracting 16,718 participants. The frequent user programs enrolled 1452 individuals and prizes were awarded to 830. Residents in the two study arms with free classes were more likely to report being aware of and participating in park-based physical activity programs; however, overall observed park-based physical activity increased similarly across all study arms. The process evaluation uncovered several barriers to program implementation, including inconsistent scheduling of classes, partly due to safety concerns among instructors. Multiple social factors interfere with leisure time physical activity among low-income populations, suggesting modest interventions may be insufficient to overcome these issues. Although new park programs can attract users, new programs alone may be insufficient to increase overall park use in low-income neighborhoods at times when the programs are not taking place.

Gender and physician specialization and practice settings in Ecuador: a qualitative study

Background

The increasing proportion of women in the medical profession is a worldwide phenomenon often called the “feminization of medicine.” However, it is understudied in low and middle-income countries, particularly in Latin America.

Methods

Using a qualitative, descriptive design, we explored the influence of gender and other factors on physician career decision-making and experiences, including medical specialty and public vs. private practice, in Quito, Ecuador, through in-depth, semi-structured interviews (n = 31) in 2014. Theoretical sampling was used to obtain approximately equal numbers of women and men and a range of medical specialties and practice settings; data saturation was used to determine sample size. Transcripts were analyzed using content coding procedures to mark quotations related to major topics and sub-themes included in the interview guide and inductive (grounded theory) approaches to identify new themes and sub-themes.

Results

Gendered norms regarding women’s primary role in childrearing, along with social class or economic resources, strongly influenced physicians’ choice of medical specialty and practice settings. Women physicians, especially surgeons, have had to “pay the price” socially, often remaining single and/or childless, or ending up divorced; in addition, both women and men face limited opportunities for medical residency training in Ecuador, thus specialty is determined by economic resources and “opportunity.” Women physicians often experience discrimination from patients, nurses, and, sometimes, other physicians, which has limited their mobility and ability to operate independently and in the private sector. The public sector, where patients cannot “choose” their doctors, offers women more opportunities for professional success and advancement, and the regular hours enable organizing work and family responsibilities. However, the public sector has generally much less flexibility than the private sector, making it more difficult to balance work and family responsibilities.

Conclusion

Women may outnumber men in medicine in Ecuador and across many parts of the world, but a number of structural issues-economic, social, and cultural-must be addressed for women to establish themselves in a wide variety of medical specialties and practice settings and for countries to realize the benefit of the investments being made to train and employ them.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1917-1) contains supplementary material, which is available to authorized users.

CicLAvia: Evaluation of participation, physical activity and cost of an open streets event in Los Angeles

Physical activity is beneficial for health, but there are limited opportunities in urban areas to safely access public streets for traffic-free cycling, skating or walking. Ciclovías are open streets programs that close major roads to motor vehicles so they can be exclusively used by bicyclists and pedestrians. We estimated participation in one Los Angeles Ciclovía event (CicLAvia) using intercept surveys and 14 surveillance cameras which were placed along the 6-mile route in April 2014. We also applied estimates of the distance and speed traveled from the use of GPS data acquired from subsequent CicLAvia events. CicLAvia attracted between 37,700 and 53,950 active participants generating 176,500 to 263,000 MET-hours of energy expenditure, at an estimated cost borne by tax dollars of $1.29 to $1.91 per MET-hour. Among participants, 37% had never previously participated in CicLAvia, but 40% of individuals said that if they were not at CicLAvia they would have been physically active elsewhere and 45% would have been sedentary. Given its large reach, it makes sense to increase the frequency of Ciclovías to occur more than a few times a year to promote population health.

Effects of a Pilot Church-Based Intervention to Reduce HIV Stigma and Promote HIV Testing Among African Americans and Latinos

HIV-related stigma and mistrust contribute to HIV disparities. Addressing stigma with faith partners may be effective, but few church-based stigma reduction interventions have been tested. We implemented a pilot intervention with 3 Latino and 2 African American churches (4 in matched pairs) in high HIV prevalence areas of Los Angeles County to reduce HIV stigma and mistrust and increase HIV testing. The intervention included HIV education and peer leader workshops, pastor-delivered sermons on HIV with imagined contact scenarios, and HIV testing events. We surveyed congregants at baseline and 6 month follow-up (n = 1235) and found statistically significant (p < 0.05) reductions in HIV stigma and mistrust in the Latino intervention churches but not in the African American intervention church nor overall across matched African American and Latino pairs. However, within matched pairs, intervention churches had much higher rates of HIV testing (p < 0.001). Stigma reduction and HIV testing may have synergistic effects in community settings.

The Paradox of Parks in Low-Income Areas: Park Use and Perceived Threats

Concerns about safety and perceived threats have been considered responsible for lower use of parks in high poverty neighborhoods. To quantify the role of perceived threats on park use we systematically observed 48 parks and surveyed park users and household residents in low-income neighborhoods in the City of Los Angeles. Across all parks, the majority of both park users and local residents perceive parks as safe or very safe. We noted apparently homeless individuals during nearly half of all observations, but very few instances of fighting, intimidating groups, smoking and intoxication. The presence of homeless individuals was associated with higher numbers of park users, while the presence of intoxicated persons was associated with lower numbers. Overall the strongest predictors of increased park use were the presence of organized and supervised activities. Therefore, to increase park use, focusing resources on programming may be more fruitful than targeting perceived threats.