Background: It is well documented that perceived neighborhood environment is associated with card... more Background: It is well documented that perceived neighborhood environment is associated with cardiovascular (CV) health factors but little is known about how neighborhood environment perception (NEP) relates to routine healthcare utilization, a likely determinant of CV health outcomes. Methods: Using cross-sectional Dallas Heart Study data, we examined the relationship between NEP and routine healthcare utilization. NEP was defined via total score and sub-scores using factor analysis [perceived neighborhood violence, physical environment (i.e. aesthetics), and social cohesion; higher score=more unfavorable perception]. Routine healthcare utilization was based on self-reported time since last visit to a healthcare provider for routine checkup. We used linear regression to determine the relationship between NEP scores and routine healthcare visits, adjusting for age, sex, race/ethnicity, income, education, health insurance status, CV disease burden, and neighborhood deprivation index ...
Additional file 4: Table S3. Associations between neighborhood social cohesion and depressive sym... more Additional file 4: Table S3. Associations between neighborhood social cohesion and depressive symptoms stratified by age and gender among JHS participants.
Background: Racial and ethnic minority groups have a higher prevalence of both diabetes and hyper... more Background: Racial and ethnic minority groups have a higher prevalence of both diabetes and hypertension, which may be influenced by neighborhood-level food environment and sociodemographic factors. We evaluated whether the imbalance between available healthy and unhealthy food options was associated with cardiometabolic markers (A1C and Systolic Blood Pressure [SBP]) in an urban adult patient population. Methods: We analyzed data from 4,729 patients from a hospital and outpatient system in Washington, DC with valid A1C, SBP, and home address data. We operationalized individuals\u27 neighborhood food environment using the Centers for Disease Control and Prevention\u27modified retail food environment index (mRFEI) reported at the census tract level, which ranged from 0 in the least healthy food environments to 33in the healthiest in our study sample. We used Geographically Weighted Regression to predict A1C and SBP levels separately based on mRFEI controlling for age, neighborhood socioeconomic status, neighborhood racial composition, and distance to the primary care center. Results: Overall, there was a small, but significant relationship between neighborhood food environments both clinical outcomes. For both A1C and SBP there was a slight negative relationship with improved food environment scores ( -0.00627, p-value: 0.00; -.39284, p-value: 0.00). However, after adjusting for additional covariates, the impact of food environments decrease for both A1C and SBP ( -0.00023, p-value: 0.21; -0.1169, p-value: 0.01). For A1C, the impact of food environment decreases as additional neighborhood variables are added into the model. Conclusions: We found that neighborhood-level variables are correlated with particular clinical outcomes. Food environments may be important in managing chronic disease. However, this impact solely may be clinically minute, but important on a population level. Identifying the relationship between food environments, additional neighborhood variables, and cardiometabolic outcomes could be instrumental in improving the health conditions of urban residents
Social determinants of health (SDOH), or the conditions in which people are born, live, learn, wo... more Social determinants of health (SDOH), or the conditions in which people are born, live, learn, work, and age, influence health behavior and health outcomes. Often, in health education and behavior literature, emphasis is placed on individual behavior. However, scholars are beginning to move more upstream and incorporate SDOH frameworks into public health research. Thus, teaching SDOH is necessary for the next generation of public health scholars. In the COVID-19 pandemic era, SDOH are more prominent than ever as we educate and advocate to increase health equity. We present four strategies on teaching SDOH to master-level candidates in a virtual “Zoom-fatigue” environment during high-profile world events such as the COVID-19 pandemic, racialized police violence, and a contested election.
International Journal of Behavioral Nutrition and Physical Activity, 2020
Background Little is known about the associations between perceived neighborhood social environme... more Background Little is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA. Methods We used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multi...
IntroductionAlthough physical activity (PA) reduces cardiovascular disease (CVD) risk, physical i... more IntroductionAlthough physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women.Methods and analysisAn mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named ‘tailored-to-place’) to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervent...
Background Cardiovascular disease (CVD) is the leading cause of death in the world. Given the rol... more Background Cardiovascular disease (CVD) is the leading cause of death in the world. Given the role of immune cells in atherosclerosis development and progression, effective methods for characterizing immune cell populations are needed, particularly among populations disproportionately at risk for CVD. Results By using a variety of antibodies combined in one staining protocol, we were able to identify granulocyte, lymphocyte, and monocyte sub-populations by CD-antigen expression from 500 µl of whole blood, enabling a more extensive comparison than what is possible with a complete blood count and differential (CBC). The flow cytometry panel was established and tested in a total of 29 healthy men and women. As a proof of principle, these 29 samples were split by their race/ethnicity: African-Americans (AA) (N = 14) and Caucasians (N = 15). We found in accordance with the literature that AA had fewer granulocytes and more lymphocytes when compared to Caucasians, though the proportion of...
Background: Despite well-documented evidence that one’s neighborhood environment and resource acc... more Background: Despite well-documented evidence that one’s neighborhood environment and resource access are associated with cardiovascular (CV) risk, little is known about how physical activity (PA) resource access availability and type are related to vigorous PA (VPA) in urban communities. Methods: Using cross-sectional data from the Washington DC CV Health and Needs Assessment, a sample of 37 black adults living in low-income, limited-resource DC communities, we created one outcome: self-reported VPA hours/week. We used Geographic Information Systems to create three exposure variables: counts of parks, recreation facilities, and private gyms within 800 and 1600-meter (m) line-based road network buffers around homes. We examined the relationship between the three exposures and VPA in models adjusted for demographics (age, sex, and income) and neighborhood factors, including neighborhood deprivation index (NDI), neighborhood environment perception (NEP), or walk score (WS), separately....
BACKGROUND Community-based participatory research is an effective tool for improving health outco... more BACKGROUND Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. OBJECTIVE This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. METHODS We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participan...
There has been limited evaluation of tools for teaching social determinants of health (SDOH). We ... more There has been limited evaluation of tools for teaching social determinants of health (SDOH). We evaluated a field trip as a tool for teaching SDOH to incoming medical interns. Incoming interns from The George Washington University participated in a bus field trip of Washington, DC, guided by community partners. The field trip introduced trainees to local neighborhoods. Pre- and postactivity surveys developed by the authors were analyzed using a Wilcoxon signed rank test. Reflection responses were recorded and counted for recurrent themes. Incoming interns participated in 2015 (85 of 90, 94%) and in 2016 (96 of 116, 83%). Postactivity, basic knowledge of DC geographic health disparities increased, and a greater percentage of interns reported being at least somewhat comfortable understanding the neighborhoods from which their patients come (2015: 58% versus 89%, P < .0001; 2016: 65% versus 88%, P < .0001); identifying challenges to health care that affect low-income patients (2...
Relying on nationally representative data from the most recent wave of the National Survey of Bla... more Relying on nationally representative data from the most recent wave of the National Survey of Black Americans (NSBA), the current study examines how past and present neighborhood racial composition is associated with feelings of closeness toward black Americans, black Africans, and black West Indians. In addition, this research tests whether race-based socialization messages received from caregivers or religious socialization messages explain this relationship among a sample from the adult black US population. The findings show that past neighborhood composition is associated with present feelings of closeness toward black Americans and black West Indians but are not associated with close feelings toward black Africans. Current neighborhood racial composition is not associated with feelings of closeness toward any of the groups. Racial socialization messages are associated with closeness towards them all but are found to be largely a function of having a two-parent family during chi...
Background: It is well documented that perceived neighborhood environment is associated with card... more Background: It is well documented that perceived neighborhood environment is associated with cardiovascular (CV) health factors but little is known about how neighborhood environment perception (NEP) relates to routine healthcare utilization, a likely determinant of CV health outcomes. Methods: Using cross-sectional Dallas Heart Study data, we examined the relationship between NEP and routine healthcare utilization. NEP was defined via total score and sub-scores using factor analysis [perceived neighborhood violence, physical environment (i.e. aesthetics), and social cohesion; higher score=more unfavorable perception]. Routine healthcare utilization was based on self-reported time since last visit to a healthcare provider for routine checkup. We used linear regression to determine the relationship between NEP scores and routine healthcare visits, adjusting for age, sex, race/ethnicity, income, education, health insurance status, CV disease burden, and neighborhood deprivation index ...
Additional file 4: Table S3. Associations between neighborhood social cohesion and depressive sym... more Additional file 4: Table S3. Associations between neighborhood social cohesion and depressive symptoms stratified by age and gender among JHS participants.
Background: Racial and ethnic minority groups have a higher prevalence of both diabetes and hyper... more Background: Racial and ethnic minority groups have a higher prevalence of both diabetes and hypertension, which may be influenced by neighborhood-level food environment and sociodemographic factors. We evaluated whether the imbalance between available healthy and unhealthy food options was associated with cardiometabolic markers (A1C and Systolic Blood Pressure [SBP]) in an urban adult patient population. Methods: We analyzed data from 4,729 patients from a hospital and outpatient system in Washington, DC with valid A1C, SBP, and home address data. We operationalized individuals\u27 neighborhood food environment using the Centers for Disease Control and Prevention\u27modified retail food environment index (mRFEI) reported at the census tract level, which ranged from 0 in the least healthy food environments to 33in the healthiest in our study sample. We used Geographically Weighted Regression to predict A1C and SBP levels separately based on mRFEI controlling for age, neighborhood socioeconomic status, neighborhood racial composition, and distance to the primary care center. Results: Overall, there was a small, but significant relationship between neighborhood food environments both clinical outcomes. For both A1C and SBP there was a slight negative relationship with improved food environment scores ( -0.00627, p-value: 0.00; -.39284, p-value: 0.00). However, after adjusting for additional covariates, the impact of food environments decrease for both A1C and SBP ( -0.00023, p-value: 0.21; -0.1169, p-value: 0.01). For A1C, the impact of food environment decreases as additional neighborhood variables are added into the model. Conclusions: We found that neighborhood-level variables are correlated with particular clinical outcomes. Food environments may be important in managing chronic disease. However, this impact solely may be clinically minute, but important on a population level. Identifying the relationship between food environments, additional neighborhood variables, and cardiometabolic outcomes could be instrumental in improving the health conditions of urban residents
Social determinants of health (SDOH), or the conditions in which people are born, live, learn, wo... more Social determinants of health (SDOH), or the conditions in which people are born, live, learn, work, and age, influence health behavior and health outcomes. Often, in health education and behavior literature, emphasis is placed on individual behavior. However, scholars are beginning to move more upstream and incorporate SDOH frameworks into public health research. Thus, teaching SDOH is necessary for the next generation of public health scholars. In the COVID-19 pandemic era, SDOH are more prominent than ever as we educate and advocate to increase health equity. We present four strategies on teaching SDOH to master-level candidates in a virtual “Zoom-fatigue” environment during high-profile world events such as the COVID-19 pandemic, racialized police violence, and a contested election.
International Journal of Behavioral Nutrition and Physical Activity, 2020
Background Little is known about the associations between perceived neighborhood social environme... more Background Little is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA. Methods We used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multi...
IntroductionAlthough physical activity (PA) reduces cardiovascular disease (CVD) risk, physical i... more IntroductionAlthough physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women.Methods and analysisAn mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named ‘tailored-to-place’) to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervent...
Background Cardiovascular disease (CVD) is the leading cause of death in the world. Given the rol... more Background Cardiovascular disease (CVD) is the leading cause of death in the world. Given the role of immune cells in atherosclerosis development and progression, effective methods for characterizing immune cell populations are needed, particularly among populations disproportionately at risk for CVD. Results By using a variety of antibodies combined in one staining protocol, we were able to identify granulocyte, lymphocyte, and monocyte sub-populations by CD-antigen expression from 500 µl of whole blood, enabling a more extensive comparison than what is possible with a complete blood count and differential (CBC). The flow cytometry panel was established and tested in a total of 29 healthy men and women. As a proof of principle, these 29 samples were split by their race/ethnicity: African-Americans (AA) (N = 14) and Caucasians (N = 15). We found in accordance with the literature that AA had fewer granulocytes and more lymphocytes when compared to Caucasians, though the proportion of...
Background: Despite well-documented evidence that one’s neighborhood environment and resource acc... more Background: Despite well-documented evidence that one’s neighborhood environment and resource access are associated with cardiovascular (CV) risk, little is known about how physical activity (PA) resource access availability and type are related to vigorous PA (VPA) in urban communities. Methods: Using cross-sectional data from the Washington DC CV Health and Needs Assessment, a sample of 37 black adults living in low-income, limited-resource DC communities, we created one outcome: self-reported VPA hours/week. We used Geographic Information Systems to create three exposure variables: counts of parks, recreation facilities, and private gyms within 800 and 1600-meter (m) line-based road network buffers around homes. We examined the relationship between the three exposures and VPA in models adjusted for demographics (age, sex, and income) and neighborhood factors, including neighborhood deprivation index (NDI), neighborhood environment perception (NEP), or walk score (WS), separately....
BACKGROUND Community-based participatory research is an effective tool for improving health outco... more BACKGROUND Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. OBJECTIVE This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. METHODS We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participan...
There has been limited evaluation of tools for teaching social determinants of health (SDOH). We ... more There has been limited evaluation of tools for teaching social determinants of health (SDOH). We evaluated a field trip as a tool for teaching SDOH to incoming medical interns. Incoming interns from The George Washington University participated in a bus field trip of Washington, DC, guided by community partners. The field trip introduced trainees to local neighborhoods. Pre- and postactivity surveys developed by the authors were analyzed using a Wilcoxon signed rank test. Reflection responses were recorded and counted for recurrent themes. Incoming interns participated in 2015 (85 of 90, 94%) and in 2016 (96 of 116, 83%). Postactivity, basic knowledge of DC geographic health disparities increased, and a greater percentage of interns reported being at least somewhat comfortable understanding the neighborhoods from which their patients come (2015: 58% versus 89%, P < .0001; 2016: 65% versus 88%, P < .0001); identifying challenges to health care that affect low-income patients (2...
Relying on nationally representative data from the most recent wave of the National Survey of Bla... more Relying on nationally representative data from the most recent wave of the National Survey of Black Americans (NSBA), the current study examines how past and present neighborhood racial composition is associated with feelings of closeness toward black Americans, black Africans, and black West Indians. In addition, this research tests whether race-based socialization messages received from caregivers or religious socialization messages explain this relationship among a sample from the adult black US population. The findings show that past neighborhood composition is associated with present feelings of closeness toward black Americans and black West Indians but are not associated with close feelings toward black Africans. Current neighborhood racial composition is not associated with feelings of closeness toward any of the groups. Racial socialization messages are associated with closeness towards them all but are found to be largely a function of having a two-parent family during chi...
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