Ann Klassen

Background Addressing disparities in environmental tobacco exposure requires implementation of smoke-free policies in publicly-owned multi-unit housing. In 2009, HUD issued a notice that encouraged public housing authorities to institute smoke-free policies in some or all of their units; however, many localities began considering, or implemented, bans prior to 2009. The role of the news media in shaping public understanding and support for such public health initiatives is critical. We analyzed print news media coverage of smoking bans and smoke-free policies in public housing in order to understand potential opportunities for advocacy and improved messaging. Methods Using databases of U.S. English-language newspapers, we identified relevant local and national coverage between 1/1/1996 and 12/31/2011. Structured codes developed through an iterative multi-reader process identified topics and thematic content, sources cited, framing of issues and stakeholders, tone (positive, negative...

Introduction Residents of multi-unit housing are exposed to secondhand smoke (SHS), and public housing authorities are increasingly implementing smoke-free policies to reduce SHS exposure in their communities. To support the development of implementation strategies, a baseline evaluation was conducted in Philadelphia Housing Authority communities. Methods A mixed methods approach was developed to holistically assess community attitudes and practices related to smoking in homes and common areas, as well as to assess the tobacco use environment in each community. In four communities, residents were recruited to participate in a face to face interview. Passive nicotine monitors collected data in non-smoking households, as well as common areas, and ethnographic observations and photo-documentation were used to capture tobacco-related behaviors and material culture, such as debris. Results Interviews were completed with 172 households. Monitoring was completed on 33 public area and 29 ho...

Changing the environmental context of health behavior is a priority in industrialized countries, where the built environment (BE) can 1) make healthy behavior difficult to perform and/or 2) emphasize short-term benefits of unhealthy behaviors over long-term benefits of healthy ones. Recent theory hypothesizes that in such environments, individuals must exercise greater self-regulation to make good long-term choices. This may be especially important in older populations, as aging is associated with less mobilityincreasing the importance of neighborhood environmentand lower cognitive and self-regulatory resources. This research uses behavioral, environmental, and cognitive data from 976 older adults in the Baltimore Memory Study (2001-2003) to examine the association of BE and self-regulation resources with health behavior among older adults. Mean age of participants was 60.7 years; 66% were female, 41% were African-American, and 55% were white. Preliminary analyses estimate that 16% ...

Background Whether or not they allow smoking in their own homes, residents of multi-unit housing are exposed to significant second hand smoke (SHS). Exposure may be greater for families living in public housing, due to higher rates of tobacco use in these communities. Since 2009, HUD has supported local public housing authorities to enact policies to reduce SHS exposure, and many PHAs are working to develop and implement smoke-free policies. In Philadelphia, formative work was conducted in partnership with the Philadelphia Housing Authority (PHA) and the Philadelphia Department of Public Health, to better understand stakeholder readiness for smoke-free public housing. Methods During 2012, we conducted in-depth interviews (n=6) with PHA staff, resident leaders and other tobacco control stakeholders and focus groups (n=2) with public housing residents, both smokers and non-smokers. Data were transcribed and analyzed to identify themes related to current tobacco use in public housing c...

This presentation will describe the methods for a new study on the effects of neighborhood built and social environments on metabolic risk among Latino/a youth in the Los Angeles area. This secondary data analysis will incorporate metabolic, anthropometric, behavioral, and socio-demographic data from subjects enrolled in participating studies at the USC Childhood Obesity Research Center. We will combine and layer these data onto an existing built environments database from the Childrens' Health Study. Our 3 research aims, designed to assess the impact of food environment and opportunities for physical activity on outcomes in insulin resistance and accrual of visceral fat, are 1) a cross-sectional analysis of subjects with complete baseline measures on insulin sensitivity and visceral fat, 2) mediational analysis on a sub-sample with measures for diet and/or physical activity, 3) a longitudinal analysis for subjects with at least 3 waves of insulin visceral fat measures.

Census-derived socioeconomic measures have wide acceptance among social science researchers both as small-area proxies for individual-level information when direct measurement is not feasible, as well as important constructs in their own right in specifically ecological models investigating the effect of the social environment and contextual resources. Many extensions of demographic data are utilized successfully in commercial areas such as marketing, including "geodemographics," the segmentation and definition of small geographic areas based on both demographics and consumer behavior. However, the utility of commercially prepared area-level behavioral data for health research is largely unknown. The aims of this exploratory investigation are to test the utility of area-level behavioral consumer profile data in explaining geographic disparities in cancer burden, and to refine area-level behavioral data methodologies for future studies. Specifically, we will present how we ...

The purpose of this cross-sectional study was to establish neighborhood built environment correlates of adiposity as measured by dual x-ray absorptiometry (DXA). The utility and methodological gains of using this measure for built environment research was further investigated by comparing model fit across parallel models on BMI z-scores and waist circumference. Pre-existing data collected from 2001-2001 on 576 overweight and obese Hispanic youth were compiled with built environment data, and 2000 Census data for analyses conducted in 2012. Walking-distance buffers were built around participants' residential locations. Variables for park space, food access, walkability, and neighborhood socio-cultural aspects were entered into a multivariate regression model predicting percent body fat. Parallel models were built for BMI z-score, and waist circumference. Significant associations were found between percent body fat and supermarket access for boys, and percent body fat and increased park space and decreased neighborhood linguistic isolation for girls. Neighborhood socio-cultural characteristics accounted for more variance in obesity compared to BMI z-score or waist circumference. Park access, food environment, and neighborhood socio-cultural characteristics are independent contributors to body fat in children, and the contribution of these risks differs by gender. There are incremental gains to using a more accurate measure of body fat in built environment obesity studies.

In breast cancer, worse disease characteristics are associated with fewer social resources and black race. However, it is unknown whether social gradients have similar impact across race, and whether behaviors, including tobacco use, may explain a portion of the social gradient. We modeled relationships between area-level social class, tobacco spending and tumor characteristics, using 50,062 white and black cases diagnosed from 1992-2003 in Maryland, a racially and economically diverse state on the east coast of the United States. Multi-level models estimated the effect of area-level social class and tobacco consumption on tumor grade, size, and stage at diagnosis. Adjusting for race, age and year of diagnosis, higher social class was associated with lower risk for tumors with histological grade 3 or 4 (O.R. 0.96, 95% C.I. 0.94,0.99), those diagnosed at SEER stage 2 or later (O.R. 0.89, 95% C.I. 0.86, 0.91), and tumor size >2 cm (O.R. 0.87, 95% C.I. 0.84, 0.90). Higher tobacco sp...

Low- and no-cost mammography programs have become a widespread strategy to increase access to breast cancer screening in low-income populations. However, rigorous evaluations of who remains unscreened in communities with these programs are lacking. We conducted a case-control study of African American older women in East Baltimore, Maryland, comparing attendees at a no-cost program to friends and neighbors not using no-cost venues. We recruited 288 women ages 50 and older, who attended a no-cost program at Johns Hopkins Hospital, to complete a 1(1/2) h home interview, answering semistructured and open-ended questions about cancer and health and a wide range of social and psychological items. For each case, we recruited one friend or neighbor, within 5 years of age, not receiving no-cost screening, to complete a similar control interview. Matched case-control analyses were used to compare program attendees to nonattendees within the target community. Women using the no-cost program at least once were generally more poorly screened than their neighborhood control prior to the program, but had better recent screening history 3 years after the program began. In multivariate analyses, program attendees were more likely to have <10,000 dollars annual income (OR = 2.34, 95% CI 1.55,3.61), more likely to have had more children (OR = 1.13, 95% CI 1.04,1.24), and less likely to have health insurance (OR = 0.42, 95% CI 0.25,0.68). They were more likely to see a female primary care provider (OR = 1.82, 95% CI 1.24,2.70) and to see multiple providers (OR = 3.38, 95% CI 1.52,8.60). Low-cost screening intervention programs reach women who might otherwise not receive screening. However, within target communities, improved partnerships with specific types of primary care providers could reach additional women.