is to add to the existing well of knowledge about health disparities in New York State by identif... more is to add to the existing well of knowledge about health disparities in New York State by identifying the environmental, socioeconomic and occupational factors that explain why COVID-19 has disproportionately harmed Black and Hispanic New Yorkers and to propose practical intervention strategies to eliminate these disparities and save lives.
Journal of Immigrant and Minority Health, May 27, 2006
Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults livin... more Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults living in the United States. Using data from a modified Behavioral Risk Factor Surveillance Survey and guided by the Anderson Model, this study examined the effect of nativity on CVD screening practices among 423 Mexican American adults living in Chicago. Dependent variables included having had a blood pressure and cholesterol screening and a routine check up in the past 2 years. Multivariate analyses were used to control for sociodemographic factors, while accounting for complex sampling design. Compared to those born in Mexico, US-born Mexican Americans had significantly greater odds of obtaining blood pressure (OR = 5.61), and cholesterol screenings (OR = 1.60) and having a routine checkup (OR = 2.69) in the past 2 years. Health professionals with an agenda to increase screenings for CVD risk factors among Mexican Americans living in northern cities should understand the impact of nativity on screening practices. Keywords Hispanic Americans. Mexican Americans. Immigrant. Health care utilization. Cardiovascular disease Background Like other Americans, Mexican Americans living in the United States are more likely to die from cardiovascular diseases (CVD) than any other disease [1]. Latinos have a high prevalence of many CVD risk factors and behaviors.
This cross-sectional study examined mental health and family environmental factors related to a s... more This cross-sectional study examined mental health and family environmental factors related to a sedentary lifestyle, including lack of leisure-time physical activity (LTPA) and high levels of television viewing, among low-income mothers/female guardians of preschool-aged children. A self-administered questionnaire was completed by 131 mothers in 2010. Primary outcome measures included television viewing time (minutes/day) and LTPA (< 150 versus ≥150 minutes per week). Independent variables included depressive symptoms, perceived stress and family functioning. Demographic factors (age, marriage, work status, education, number of children in the household and race/ethnicity) were examined as potential covariates. Participating women watched TV on average 186.1 minutes/day (i.e., >3 hours). Additionally, 36% of women engaged in less than the recommended 150-minute LTPA per week. Hierarchical multiple regression analyses indicated that greater depressive symptoms (B = 76.4, p<.01) and lower family functioning (B = 33.0, p < .05) were independently related to greater television viewing when controlling for other variables. No independent factors were identified for lack of LTPA when controlling for other covariates. Findings suggest that health promotion efforts to promote an active lifestyle among low-income women with young children should address mental health and family functioning factors, especially depressive symptoms.
Regular consumption of fruits and vegetables is associated with a decreased risk of cardiovascula... more Regular consumption of fruits and vegetables is associated with a decreased risk of cardiovascular disease and all-cause mortality. Access to fresh produce is limited for individuals and families experiencing food insecurity. Emergency food programs, including food pantries, are important institutions for assuring access to nutritional foods for this population, including fresh produce. Produce availability at such institutions is on the rise thanks to donation, gleaning, food bank purchases, recovery programs multiscale policy interventions. These efforts also have coupled economic and environmental benefits for producers and retailers as surplus food is redirected from the waste stream, where it would otherwise produce greenhouse gases that contribute to climate change. Although varied surplus produce recovery programs have been implemented around the country and the world, little modeling of potentially synergistic impacts has accompanied their implementation. Thus, there remains sparse understanding of system-wide joint implications economically, environmentally, nutritionally, and epidemiologically. The goal of this paper is to offer a novel dynamic modeling framework capable of assessing environmental, nutritional, and health impacts of policies and programs in the food recovery and redistribution system. This unique framework serves as a scientific basis for implementing best management practices and policies to improve the sustainability of U.S. food systems. 1 | INTRODUCTION Food insecurity has a complex etiology and is associated with social and structural inequalities in addition to individual-level socioeconomic and community-level factors including retail access, transportation, and food assistance (Jablonski, McFadden, & Colpaart, 2016). Adults experiencing food insecurity are at higher risk than the general population for a constellation of interrelated health conditions, including obesity, type 2 diabetes, hypertension, hyperlipidemia, heart
Introduction: Many people are not aware of stroke symptoms, the need for emergency care for those... more Introduction: Many people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1. Methods: The evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit-dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms. Results: A larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person. Conclusion: This multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.
Introduction: Stroke is the third leading cause of death and a leading cause of disability in New... more Introduction: Stroke is the third leading cause of death and a leading cause of disability in New York State. A New York study determined that only 19.9% of patients arrived at a designated stroke center within 3 hours of symptom onset. Yet, receiving treatment within 90 minutes of stroke symptom onset is optimal for improved outcomes. Delay in recognition of stroke symptoms and their severity contributes to treatment delay. Methods: A random-digit-dialed, list-assisted telephone survey about stroke knowledge was administered to 1789 adults aged 30 years or older in upstate New York in 2006. Bivariate and regression analysis were used to examine factors associated with intent to call 9-1-1 for symptoms of stroke. Results: The largest proportion of respondents (72.4%; 95% confidence interval [CI], 69.9%-74.8%) reported they would call 9-1-1 if they noticed they or someone else had difficulty speaking, and the fewest (33.3%; 95% CI, 30.7%-36.0%) respondents reported they would call 9-1-1 for trouble seeing or double vision. Multivariate analysis found that those who had a history of delay in getting medical care in the past 6 months had decreased odds of intending to call 9-1-1 for stroke symptoms (difficulty speaking: adjusted odds ratio [AOR], 0.76; 95% CI, 0.58-1.00; trouble seeing: AOR, 0.69; 95% CI, 0.53-0.91; facial droop: AOR, 0.85; 95% CI, 0.65-1.11; arm weakness: AOR, 0.80; 95% CI, 0.63-1.03). Age, education, and history of a stroke or heart event were not consistently associated with intent to call 9-1-1. Conclusion: Survey respondents do not interpret some stroke symptoms as urgent enough to activate the emergency medical system. History of delaying care is a behavioral pattern that influenced intent to call 9-1-1.
Background: The American Academy of Pediatrics recommends that parents restrict child screen time... more Background: The American Academy of Pediatrics recommends that parents restrict child screen time to two hours per day, but many preschool-aged children exceed this viewing recommendation. Modifying children's viewing habits will require collaborating with parents, but little is known about the factors that influence parents' capacity for effective screen-related parenting. This study aimed to identify the demographic, family and community contextual factors associated with low-income parents' restriction of child screen time. Methods: Parents (N = 146) of children (age 2-5 years) attending Head Start centers in the United States completed a self-report survey in 2010 assessing parent and child screen use (television, DVD, video, video games, and leisure-time computer use), parent restriction of child screen time, and family (parent stress, social support, and life pressures) and community (neighborhood safety and social capital) factors. Results: Children were more likely to meet the American Academy of Pediatrics screen time recommendation if their parent reported high restriction of child screen time. Parent and child demographic characteristics were not associated with parents' restriction of child screen time. In multivariate analysis, less parent screen time, fewer parent life pressures, and greater social support were associated with parents' high restriction of screen time. Conclusion: Family contextual factors may play an important role in enabling low-income parents to restrict their children's screen time. When counseling low-income parents about the importance of restricting child screen time, practitioners should be sensitive to family contextual factors that may influence parents' capacity to implement this behavior change.
International Journal of Behavioral Nutrition and Physical Activity, 2013
Background: Ineffective family interventions for the prevention of childhood obesity have, in par... more Background: Ineffective family interventions for the prevention of childhood obesity have, in part, been attributed to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with preschool-aged children enrolled in Head Start. Methods: During year 1 (2009-2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention. During year 2 (2010-2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents' awareness of their child's weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents' communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2-5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity-and media-related parenting practices and attitudes. Results: Compared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children's physical activity. Dose effects were observed for most outcomes. Conclusions: Empowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.
IntroductionMany people are not aware of stroke symptoms, the need for emergency care for those s... more IntroductionMany people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1.MethodsThe evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit–dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms.ResultsA larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person.ConclusionThis multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 2, 2013
ABSTRACT Community-based participatory research (CBPR) has been employed to address health dispar... more ABSTRACT Community-based participatory research (CBPR) has been employed to address health disparities by engaging multiple stakeholders in the research process. However, most often, CBPR engages community-based organization representatives who work on the ground in areas with underserved populations and social and health services professionals. Specifically, the use of CBPR in childhood obesity research is increasing, but parents, who are key stakeholders because they have direct influence over children&#39;s home environment and lifestyle choices, are still infrequently engaged (1). More typical stakeholders include school administrators, teachers, cooks, providers and other community-based professionals (2). Studies that engage parents, most often fall between Rung 3 and 5 of the Ladder of Participation in which parents provide input and are informed of study processes, often during formative of the study, but do not have decision making power. Although other studies have involved parents, there are no other known examples in which parents are engaged throughout the entire research process. Given the history of hierarchical relationships between low-income families and service or health professionals (3), engaging parents throughout the research process may serve to open communication, break down hierarchical relationships and build trust. Low-income parents are engaged as equal partners, providing unique expertise during the development, implementation and evaluation of a childhood obesity prevention initiative. The case study of Communities for Healthy Living (CHL), so named by the partnership, section of the learning institute will be a round table during which the aforementioned learning objectives will be met. Then there will be time for participants to ask questions of both parents and academics and discuss new ideas generated from sharing this parent-centered CBPR case study that engaged parents directly throughout the entire research process with the goal of fostering parent empowerment and encouraging co-learning across all stakeholders (4). The Communities for Healthy Living case study (2) takes place within the context of a study funded by the National Institute of Minority Health and Health Disparities of NIH, which funded 6 research studies utilizing CBPR in the development of interventions addressing health disparities. Because the studies were funded under the American Recovery and Reinvestment Act of 2009, each was constrained to a rapid two-year timeline to develop and pilot test the intervention. The goal of this study was to develop and pilot test a childhood obesity intervention for low-income families using a CBPR approach to actively engage parents across three phases, Phase 1: Partnership development, Phase 2: Community assessment and intervention development, and Phase 3: Intervention implementation and evaluation. The family-centered intervention targeted parent/caregivers with children participating in Head Start programs in Rensselaer County, NY (about 500 children ages 6 weeks to 5 years old) for childhood obesity prevention. Rensselaer County, in Upstate New York, has areas designated as Medically Underserved Areas (6), and 28% of all families with children under age 5 living below the poverty level (7).
Latinos are the largest and fastest growing ethnic group in New York State. Their population has ... more Latinos are the largest and fastest growing ethnic group in New York State. Their population has grown by 30% within the last 10 years. 1 They comprised 15% of the total population in 2002. 1,2 The majority of the Latino population in New York State is of Puerto Rican and Dominican origin, but there is a growing number of Latinos from other countries. The Capital District of New York, which is comprised of three small cities with surrounding suburban and rural communities, has been termed as a "new Latino destination." 3 The area has seen a 185% rise in Latino population from 1980 to 2000. 4 Latinos now comprise 3% of the approximately 800,000 people living in this area. 4 While all Latinos in the state face barriers to health care, Latinos in rural areas and in smaller communities may face different barriers than those in areas with larger Latino populations. 5
Journal of Health Care for the Poor and Underserved, 2013
The Communities for Healthy Living program used a community-based participatory research (CBPR) a... more The Communities for Healthy Living program used a community-based participatory research (CBPR) approach to empower Head Start parents in designing and pilot testing a multi-component family-centered obesity prevention program. One program component was a childhood obesity awareness campaign addressing common parental misconceptions about obesity. The campaign was designed by a community advisory board of parents to target specific issues identified within their own community. Results from pre-post intervention surveys (N=108) showed that campaign exposure was high; 92% of responding parents reported noticing the campaign. Parents also demonstrated significant increases in awareness of childhood obesity, along with decreases in obesity-related misconceptions. Findings, supported by growing literature on CBPR, suggest a CBPR approach to campaign development is an effective strategy to promote parent awareness of childhood obesity. Keywords Community-based participatory research; family health; child health; obesity; parents Childhood obesity is disproportionately characteristic of low-income children. 1 Lifestyle behaviors linked with obesity develop at a young age in the context of the family. 2 Research indicates that parents' and caregivers' (herein referred to as parents) attitudes, knowledge, and behavior influence children's dietary, physical activity, and screen-based behavioral
Objective: One challenge to healthy nutrition, especially among low-income individuals, is access... more Objective: One challenge to healthy nutrition, especially among low-income individuals, is access to and consumption of fresh fruits and vegetables. To address this problem, Veggie Rx, a healthy food incentive programme, was established within a community clinic to increase access to fresh produce for low-income patients diagnosed with obesity, hypertension and/or type 2 diabetes. The current research aimed to evaluate Veggie Rx programme effectiveness. Design: A retrospective pre/post design using medical records and programme data was used to evaluate the programme. The study was approved by the University of Albany Institutional Review Board and the Patient Interest Committee of a community clinic. Setting: The study was conducted in a low-income, urban neighbourhood in upstate New York. Subjects: Medical record data and Veggie Rx programme data were analysed for fifty-four eligible participants. An equal-sized control group of patients who were not programme participants were matched on age, ethnicity and co-morbidity status. Results: A statistically significant difference in mean BMI change (P = 0•02) between the intervention and the control group was calculated. The intervention group had a mean decrease in BMI of 0•74 kg/m 2. Conclusions: Greater improvement in BMI was found among Veggie Rx programme participants. This information will guide programme changes and inform the field on the effectiveness of healthy food incentive programmes for improving health outcomes for low-income populations. Keywords Obesity BMI Health promotion Community health centres Food access Healthy food incentive programme Consuming a balanced diet high in fruits and vegetables has been consistently associated with improved health outcomes and reduced risk for morbidity and mortality (1). At the same time, poor diet or nutrition is a contributing risk factor for overweight and obesity (2-4). Poor dietary practices and being overweight or obese are linked to at least four of the ten leading causes of death-CHD, some cancers, stroke and type 2 diabetesin the US adult population (5). Yet most Americans eat much less than the recommended amounts of fruits and vegetables; individuals with lower incomes represent population groups least likely to meet the US Department of Agriculture's guidelines for daily servings of fruits and vegetables (1,6,7). Among New York State residents in 2013, over 25 % were obese and an additional 36 % were overweight (8). The rate of obesity is disproportionately higher among those who earn an annual household income of less than $US 25 000 (31•9 %) (8). According to the Food Choice Process Model (9) , people's personal food system in which they make value
Intellectual and Developmental Disabilities, Feb 1, 2008
People with intellectual disabilities have few opportunities to actively participate in research ... more People with intellectual disabilities have few opportunities to actively participate in research affecting programs and policies. Employment of participatory action research has been recommended. Although use of this approach with people who have intellectual disabilities is growing, articles on specific participatory research methods are rare. Photovoice is a participatory method often used with underrepresented groups and is effective for engaging people with intellectual disabilities in research or program development. A literature review is presented for use with this population as is a description of Photovoice as a participatory research tool for engaging people with intellectual disabilities. An example of a participatory study among people with intellectual disabilities is provided. Benefits and challenges of employing Photovoice with this population are discussed.
Access to emergency food is critical for the survival and health of vulnerable populations, but i... more Access to emergency food is critical for the survival and health of vulnerable populations, but its importance is not understood in the context of food deserts. Using a cross-sectional survey based on Albany and Troy, New York, we compared the two food desert models, one based on paid (e.g., grocery stores) and the other based on free food options (e.g., emergency food sites such as pantries and soup kitchens). Structural equation modeling was conducted to identify pathways among people’s access to food sites, food consumption patterns, food insecurity, and health conditions. Access to grocery stores did not show significant links to food insecurity or health conditions, whereas access to emergency food, especially time taken to such food outlets, was found to be a significant factor for increased consumption of fresh food. Among the diet-related variables, food insecurity showed the strongest link to negative health outcomes. Access to free or low-cost options needs to be taken into consideration when designing research and practice concerning food deserts, food insecurity, and subsequent health effects.
Although an often desired goal, true partnership between community members and university researc... more Although an often desired goal, true partnership between community members and university researchers can be difficult to achieve. Strategies implemented in a diabetes prevention and control program in a Latino community may be effective in overcoming hurdles to collaborative research. The development of selection criteria can be useful for objectively choosing a community organization as a partner agency. The implementation of formal partnership principles is proposed as a strategy for building a successful partnership. Partnership principles are a powerful mechanism to assure ethical relations between collaborators. As a strategy for process evaluation, they can help organize data on the extent to which intent has translated into action. They provide a structure for project stability that can outlast individual commitments and a mechanism to keep project commitment on course and maintain active engagement.
This article examines disparities in health and healthcare for Latina women. It draws on existing... more This article examines disparities in health and healthcare for Latina women. It draws on existing literature and descriptive data from a study with Latinas. Mortality rates, leading causes of death, and reproductive health are well-documented. Little information is available on the health and chronic health conditions severely inflicting Latinas such as heart disease and diabetes. Despite advances regarding reproductive care and screening procedures, Latinas still experience inequities in healthcare insurance and utilization. Study findings indicate higher rates of diabetes and hypertension than Latinas nationwide and reasons for delaying seeking healthcare. Directions for future research and policy recommendations are explored.
ABSTRACT To assess sociocultural factors associated with delaying routine healthcare among Latina... more ABSTRACT To assess sociocultural factors associated with delaying routine healthcare among Latinas. Using community-based participatory research; we interviewed 287 Latinas from the Capital District, NY. The Andersen model of healthcare utilization was used to assess predisposing, enabling and need factors influencing delay in seeking care. Modified Poisson regression was used to estimate prevalence risk ratios (PRR) and 95% confidence intervals. Overall 70% of women reported delaying care. After controlling for other factors, women who were not married (PRR 1.21), had chronic disease (PRR 1.24), preferred a Latino doctor (PRR 1.18), used alternative medicine (PRR 1.28), were uninsured (PRR 1.29), or had faced discrimination during earlier health care visits (PRR 1.23), were significantly more likely to delay care. Delay in seeking care among Latinas is determined by cultural and social factors that need to be incorporated in interventions aimed at improving access.
is to add to the existing well of knowledge about health disparities in New York State by identif... more is to add to the existing well of knowledge about health disparities in New York State by identifying the environmental, socioeconomic and occupational factors that explain why COVID-19 has disproportionately harmed Black and Hispanic New Yorkers and to propose practical intervention strategies to eliminate these disparities and save lives.
Journal of Immigrant and Minority Health, May 27, 2006
Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults livin... more Cardiovascular diseases (CVD) are the leading causes of death among Mexican American adults living in the United States. Using data from a modified Behavioral Risk Factor Surveillance Survey and guided by the Anderson Model, this study examined the effect of nativity on CVD screening practices among 423 Mexican American adults living in Chicago. Dependent variables included having had a blood pressure and cholesterol screening and a routine check up in the past 2 years. Multivariate analyses were used to control for sociodemographic factors, while accounting for complex sampling design. Compared to those born in Mexico, US-born Mexican Americans had significantly greater odds of obtaining blood pressure (OR = 5.61), and cholesterol screenings (OR = 1.60) and having a routine checkup (OR = 2.69) in the past 2 years. Health professionals with an agenda to increase screenings for CVD risk factors among Mexican Americans living in northern cities should understand the impact of nativity on screening practices. Keywords Hispanic Americans. Mexican Americans. Immigrant. Health care utilization. Cardiovascular disease Background Like other Americans, Mexican Americans living in the United States are more likely to die from cardiovascular diseases (CVD) than any other disease [1]. Latinos have a high prevalence of many CVD risk factors and behaviors.
This cross-sectional study examined mental health and family environmental factors related to a s... more This cross-sectional study examined mental health and family environmental factors related to a sedentary lifestyle, including lack of leisure-time physical activity (LTPA) and high levels of television viewing, among low-income mothers/female guardians of preschool-aged children. A self-administered questionnaire was completed by 131 mothers in 2010. Primary outcome measures included television viewing time (minutes/day) and LTPA (< 150 versus ≥150 minutes per week). Independent variables included depressive symptoms, perceived stress and family functioning. Demographic factors (age, marriage, work status, education, number of children in the household and race/ethnicity) were examined as potential covariates. Participating women watched TV on average 186.1 minutes/day (i.e., >3 hours). Additionally, 36% of women engaged in less than the recommended 150-minute LTPA per week. Hierarchical multiple regression analyses indicated that greater depressive symptoms (B = 76.4, p<.01) and lower family functioning (B = 33.0, p < .05) were independently related to greater television viewing when controlling for other variables. No independent factors were identified for lack of LTPA when controlling for other covariates. Findings suggest that health promotion efforts to promote an active lifestyle among low-income women with young children should address mental health and family functioning factors, especially depressive symptoms.
Regular consumption of fruits and vegetables is associated with a decreased risk of cardiovascula... more Regular consumption of fruits and vegetables is associated with a decreased risk of cardiovascular disease and all-cause mortality. Access to fresh produce is limited for individuals and families experiencing food insecurity. Emergency food programs, including food pantries, are important institutions for assuring access to nutritional foods for this population, including fresh produce. Produce availability at such institutions is on the rise thanks to donation, gleaning, food bank purchases, recovery programs multiscale policy interventions. These efforts also have coupled economic and environmental benefits for producers and retailers as surplus food is redirected from the waste stream, where it would otherwise produce greenhouse gases that contribute to climate change. Although varied surplus produce recovery programs have been implemented around the country and the world, little modeling of potentially synergistic impacts has accompanied their implementation. Thus, there remains sparse understanding of system-wide joint implications economically, environmentally, nutritionally, and epidemiologically. The goal of this paper is to offer a novel dynamic modeling framework capable of assessing environmental, nutritional, and health impacts of policies and programs in the food recovery and redistribution system. This unique framework serves as a scientific basis for implementing best management practices and policies to improve the sustainability of U.S. food systems. 1 | INTRODUCTION Food insecurity has a complex etiology and is associated with social and structural inequalities in addition to individual-level socioeconomic and community-level factors including retail access, transportation, and food assistance (Jablonski, McFadden, & Colpaart, 2016). Adults experiencing food insecurity are at higher risk than the general population for a constellation of interrelated health conditions, including obesity, type 2 diabetes, hypertension, hyperlipidemia, heart
Introduction: Many people are not aware of stroke symptoms, the need for emergency care for those... more Introduction: Many people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1. Methods: The evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit-dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms. Results: A larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person. Conclusion: This multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.
Introduction: Stroke is the third leading cause of death and a leading cause of disability in New... more Introduction: Stroke is the third leading cause of death and a leading cause of disability in New York State. A New York study determined that only 19.9% of patients arrived at a designated stroke center within 3 hours of symptom onset. Yet, receiving treatment within 90 minutes of stroke symptom onset is optimal for improved outcomes. Delay in recognition of stroke symptoms and their severity contributes to treatment delay. Methods: A random-digit-dialed, list-assisted telephone survey about stroke knowledge was administered to 1789 adults aged 30 years or older in upstate New York in 2006. Bivariate and regression analysis were used to examine factors associated with intent to call 9-1-1 for symptoms of stroke. Results: The largest proportion of respondents (72.4%; 95% confidence interval [CI], 69.9%-74.8%) reported they would call 9-1-1 if they noticed they or someone else had difficulty speaking, and the fewest (33.3%; 95% CI, 30.7%-36.0%) respondents reported they would call 9-1-1 for trouble seeing or double vision. Multivariate analysis found that those who had a history of delay in getting medical care in the past 6 months had decreased odds of intending to call 9-1-1 for stroke symptoms (difficulty speaking: adjusted odds ratio [AOR], 0.76; 95% CI, 0.58-1.00; trouble seeing: AOR, 0.69; 95% CI, 0.53-0.91; facial droop: AOR, 0.85; 95% CI, 0.65-1.11; arm weakness: AOR, 0.80; 95% CI, 0.63-1.03). Age, education, and history of a stroke or heart event were not consistently associated with intent to call 9-1-1. Conclusion: Survey respondents do not interpret some stroke symptoms as urgent enough to activate the emergency medical system. History of delaying care is a behavioral pattern that influenced intent to call 9-1-1.
Background: The American Academy of Pediatrics recommends that parents restrict child screen time... more Background: The American Academy of Pediatrics recommends that parents restrict child screen time to two hours per day, but many preschool-aged children exceed this viewing recommendation. Modifying children's viewing habits will require collaborating with parents, but little is known about the factors that influence parents' capacity for effective screen-related parenting. This study aimed to identify the demographic, family and community contextual factors associated with low-income parents' restriction of child screen time. Methods: Parents (N = 146) of children (age 2-5 years) attending Head Start centers in the United States completed a self-report survey in 2010 assessing parent and child screen use (television, DVD, video, video games, and leisure-time computer use), parent restriction of child screen time, and family (parent stress, social support, and life pressures) and community (neighborhood safety and social capital) factors. Results: Children were more likely to meet the American Academy of Pediatrics screen time recommendation if their parent reported high restriction of child screen time. Parent and child demographic characteristics were not associated with parents' restriction of child screen time. In multivariate analysis, less parent screen time, fewer parent life pressures, and greater social support were associated with parents' high restriction of screen time. Conclusion: Family contextual factors may play an important role in enabling low-income parents to restrict their children's screen time. When counseling low-income parents about the importance of restricting child screen time, practitioners should be sensitive to family contextual factors that may influence parents' capacity to implement this behavior change.
International Journal of Behavioral Nutrition and Physical Activity, 2013
Background: Ineffective family interventions for the prevention of childhood obesity have, in par... more Background: Ineffective family interventions for the prevention of childhood obesity have, in part, been attributed to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with preschool-aged children enrolled in Head Start. Methods: During year 1 (2009-2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention. During year 2 (2010-2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents' awareness of their child's weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents' communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2-5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity-and media-related parenting practices and attitudes. Results: Compared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children's physical activity. Dose effects were observed for most outcomes. Conclusions: Empowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.
IntroductionMany people are not aware of stroke symptoms, the need for emergency care for those s... more IntroductionMany people are not aware of stroke symptoms, the need for emergency care for those symptoms, and that calling 9-1-1 is recommended. The New York State Department of Health developed and implemented a multimedia campaign to increase stroke symptom awareness and awareness of the need to call 9-1-1.MethodsThe evaluation of the campaign's impact was a pre/post intervention matched comparison design. A random-digit–dialed list-assisted telephone survey was administered to measure reach of the campaign and change in intention to seek emergency care for stroke by calling 9-1-1 in response to 4 signs or symptoms.ResultsA larger proportion of respondents in the intervention region than in the comparison region reported seeing a stroke advertisement and reported the advertisement's message was to call 9-1-1. There was a significant increase between baseline and follow-up in intention to call 9-1-1 for the 4 stroke symptoms. These increases were greater in the intervention region than the comparison region. The differences between intervention and comparison groups in the increases in intention to call 9-1-1 ranged from 9% to 12% for specific stroke symptoms identified in oneself and from 4% to 12% for symptoms identified in another person.ConclusionThis multimedia campaign effectively increased intention to call 9-1-1 for stroke symptoms in the intervention region compared with a region matched for demographics and stroke rates. Multimedia campaigns are effective in increasing awareness of stroke symptoms and intention to immediately call 9-1-1.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 2, 2013
ABSTRACT Community-based participatory research (CBPR) has been employed to address health dispar... more ABSTRACT Community-based participatory research (CBPR) has been employed to address health disparities by engaging multiple stakeholders in the research process. However, most often, CBPR engages community-based organization representatives who work on the ground in areas with underserved populations and social and health services professionals. Specifically, the use of CBPR in childhood obesity research is increasing, but parents, who are key stakeholders because they have direct influence over children&#39;s home environment and lifestyle choices, are still infrequently engaged (1). More typical stakeholders include school administrators, teachers, cooks, providers and other community-based professionals (2). Studies that engage parents, most often fall between Rung 3 and 5 of the Ladder of Participation in which parents provide input and are informed of study processes, often during formative of the study, but do not have decision making power. Although other studies have involved parents, there are no other known examples in which parents are engaged throughout the entire research process. Given the history of hierarchical relationships between low-income families and service or health professionals (3), engaging parents throughout the research process may serve to open communication, break down hierarchical relationships and build trust. Low-income parents are engaged as equal partners, providing unique expertise during the development, implementation and evaluation of a childhood obesity prevention initiative. The case study of Communities for Healthy Living (CHL), so named by the partnership, section of the learning institute will be a round table during which the aforementioned learning objectives will be met. Then there will be time for participants to ask questions of both parents and academics and discuss new ideas generated from sharing this parent-centered CBPR case study that engaged parents directly throughout the entire research process with the goal of fostering parent empowerment and encouraging co-learning across all stakeholders (4). The Communities for Healthy Living case study (2) takes place within the context of a study funded by the National Institute of Minority Health and Health Disparities of NIH, which funded 6 research studies utilizing CBPR in the development of interventions addressing health disparities. Because the studies were funded under the American Recovery and Reinvestment Act of 2009, each was constrained to a rapid two-year timeline to develop and pilot test the intervention. The goal of this study was to develop and pilot test a childhood obesity intervention for low-income families using a CBPR approach to actively engage parents across three phases, Phase 1: Partnership development, Phase 2: Community assessment and intervention development, and Phase 3: Intervention implementation and evaluation. The family-centered intervention targeted parent/caregivers with children participating in Head Start programs in Rensselaer County, NY (about 500 children ages 6 weeks to 5 years old) for childhood obesity prevention. Rensselaer County, in Upstate New York, has areas designated as Medically Underserved Areas (6), and 28% of all families with children under age 5 living below the poverty level (7).
Latinos are the largest and fastest growing ethnic group in New York State. Their population has ... more Latinos are the largest and fastest growing ethnic group in New York State. Their population has grown by 30% within the last 10 years. 1 They comprised 15% of the total population in 2002. 1,2 The majority of the Latino population in New York State is of Puerto Rican and Dominican origin, but there is a growing number of Latinos from other countries. The Capital District of New York, which is comprised of three small cities with surrounding suburban and rural communities, has been termed as a "new Latino destination." 3 The area has seen a 185% rise in Latino population from 1980 to 2000. 4 Latinos now comprise 3% of the approximately 800,000 people living in this area. 4 While all Latinos in the state face barriers to health care, Latinos in rural areas and in smaller communities may face different barriers than those in areas with larger Latino populations. 5
Journal of Health Care for the Poor and Underserved, 2013
The Communities for Healthy Living program used a community-based participatory research (CBPR) a... more The Communities for Healthy Living program used a community-based participatory research (CBPR) approach to empower Head Start parents in designing and pilot testing a multi-component family-centered obesity prevention program. One program component was a childhood obesity awareness campaign addressing common parental misconceptions about obesity. The campaign was designed by a community advisory board of parents to target specific issues identified within their own community. Results from pre-post intervention surveys (N=108) showed that campaign exposure was high; 92% of responding parents reported noticing the campaign. Parents also demonstrated significant increases in awareness of childhood obesity, along with decreases in obesity-related misconceptions. Findings, supported by growing literature on CBPR, suggest a CBPR approach to campaign development is an effective strategy to promote parent awareness of childhood obesity. Keywords Community-based participatory research; family health; child health; obesity; parents Childhood obesity is disproportionately characteristic of low-income children. 1 Lifestyle behaviors linked with obesity develop at a young age in the context of the family. 2 Research indicates that parents' and caregivers' (herein referred to as parents) attitudes, knowledge, and behavior influence children's dietary, physical activity, and screen-based behavioral
Objective: One challenge to healthy nutrition, especially among low-income individuals, is access... more Objective: One challenge to healthy nutrition, especially among low-income individuals, is access to and consumption of fresh fruits and vegetables. To address this problem, Veggie Rx, a healthy food incentive programme, was established within a community clinic to increase access to fresh produce for low-income patients diagnosed with obesity, hypertension and/or type 2 diabetes. The current research aimed to evaluate Veggie Rx programme effectiveness. Design: A retrospective pre/post design using medical records and programme data was used to evaluate the programme. The study was approved by the University of Albany Institutional Review Board and the Patient Interest Committee of a community clinic. Setting: The study was conducted in a low-income, urban neighbourhood in upstate New York. Subjects: Medical record data and Veggie Rx programme data were analysed for fifty-four eligible participants. An equal-sized control group of patients who were not programme participants were matched on age, ethnicity and co-morbidity status. Results: A statistically significant difference in mean BMI change (P = 0•02) between the intervention and the control group was calculated. The intervention group had a mean decrease in BMI of 0•74 kg/m 2. Conclusions: Greater improvement in BMI was found among Veggie Rx programme participants. This information will guide programme changes and inform the field on the effectiveness of healthy food incentive programmes for improving health outcomes for low-income populations. Keywords Obesity BMI Health promotion Community health centres Food access Healthy food incentive programme Consuming a balanced diet high in fruits and vegetables has been consistently associated with improved health outcomes and reduced risk for morbidity and mortality (1). At the same time, poor diet or nutrition is a contributing risk factor for overweight and obesity (2-4). Poor dietary practices and being overweight or obese are linked to at least four of the ten leading causes of death-CHD, some cancers, stroke and type 2 diabetesin the US adult population (5). Yet most Americans eat much less than the recommended amounts of fruits and vegetables; individuals with lower incomes represent population groups least likely to meet the US Department of Agriculture's guidelines for daily servings of fruits and vegetables (1,6,7). Among New York State residents in 2013, over 25 % were obese and an additional 36 % were overweight (8). The rate of obesity is disproportionately higher among those who earn an annual household income of less than $US 25 000 (31•9 %) (8). According to the Food Choice Process Model (9) , people's personal food system in which they make value
Intellectual and Developmental Disabilities, Feb 1, 2008
People with intellectual disabilities have few opportunities to actively participate in research ... more People with intellectual disabilities have few opportunities to actively participate in research affecting programs and policies. Employment of participatory action research has been recommended. Although use of this approach with people who have intellectual disabilities is growing, articles on specific participatory research methods are rare. Photovoice is a participatory method often used with underrepresented groups and is effective for engaging people with intellectual disabilities in research or program development. A literature review is presented for use with this population as is a description of Photovoice as a participatory research tool for engaging people with intellectual disabilities. An example of a participatory study among people with intellectual disabilities is provided. Benefits and challenges of employing Photovoice with this population are discussed.
Access to emergency food is critical for the survival and health of vulnerable populations, but i... more Access to emergency food is critical for the survival and health of vulnerable populations, but its importance is not understood in the context of food deserts. Using a cross-sectional survey based on Albany and Troy, New York, we compared the two food desert models, one based on paid (e.g., grocery stores) and the other based on free food options (e.g., emergency food sites such as pantries and soup kitchens). Structural equation modeling was conducted to identify pathways among people’s access to food sites, food consumption patterns, food insecurity, and health conditions. Access to grocery stores did not show significant links to food insecurity or health conditions, whereas access to emergency food, especially time taken to such food outlets, was found to be a significant factor for increased consumption of fresh food. Among the diet-related variables, food insecurity showed the strongest link to negative health outcomes. Access to free or low-cost options needs to be taken into consideration when designing research and practice concerning food deserts, food insecurity, and subsequent health effects.
Although an often desired goal, true partnership between community members and university researc... more Although an often desired goal, true partnership between community members and university researchers can be difficult to achieve. Strategies implemented in a diabetes prevention and control program in a Latino community may be effective in overcoming hurdles to collaborative research. The development of selection criteria can be useful for objectively choosing a community organization as a partner agency. The implementation of formal partnership principles is proposed as a strategy for building a successful partnership. Partnership principles are a powerful mechanism to assure ethical relations between collaborators. As a strategy for process evaluation, they can help organize data on the extent to which intent has translated into action. They provide a structure for project stability that can outlast individual commitments and a mechanism to keep project commitment on course and maintain active engagement.
This article examines disparities in health and healthcare for Latina women. It draws on existing... more This article examines disparities in health and healthcare for Latina women. It draws on existing literature and descriptive data from a study with Latinas. Mortality rates, leading causes of death, and reproductive health are well-documented. Little information is available on the health and chronic health conditions severely inflicting Latinas such as heart disease and diabetes. Despite advances regarding reproductive care and screening procedures, Latinas still experience inequities in healthcare insurance and utilization. Study findings indicate higher rates of diabetes and hypertension than Latinas nationwide and reasons for delaying seeking healthcare. Directions for future research and policy recommendations are explored.
ABSTRACT To assess sociocultural factors associated with delaying routine healthcare among Latina... more ABSTRACT To assess sociocultural factors associated with delaying routine healthcare among Latinas. Using community-based participatory research; we interviewed 287 Latinas from the Capital District, NY. The Andersen model of healthcare utilization was used to assess predisposing, enabling and need factors influencing delay in seeking care. Modified Poisson regression was used to estimate prevalence risk ratios (PRR) and 95% confidence intervals. Overall 70% of women reported delaying care. After controlling for other factors, women who were not married (PRR 1.21), had chronic disease (PRR 1.24), preferred a Latino doctor (PRR 1.18), used alternative medicine (PRR 1.28), were uninsured (PRR 1.29), or had faced discrimination during earlier health care visits (PRR 1.23), were significantly more likely to delay care. Delay in seeking care among Latinas is determined by cultural and social factors that need to be incorporated in interventions aimed at improving access.
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Papers by Janine Jurkowski