Association Between Physical Activity and Proximity to Physical Activity Resources Among Low-Income, Midlife Women

INTRODUCTION: The association between levels of physical activity and perceived and objectively measured proximity to physical activity resources is unclear. Clarification is important so that future programs can intervene upon the measure with the greatest association. We examined correlations between perceived and objectively measured proximity to physical activity resources and then examined associations between both measures of proximity and objectively measured physical activity. METHODS: Participants (n = 199) were underinsured women from three counties in southeastern North Carolina. Perceived proximity to physical activity resources (e.g., parks, gyms, schools) was measured using surveys. Objectively measured proximity included geographic information systems road network distance to the closest resource and existence of resources within 1- and 2-mile buffers surrounding participants' homes. To examine the association between proximity to resources and activity, the dependent variable in multiple linear regression models was the natural logarithm of accelerometer-measured moderate to vigorous physical activity in minutes per day. RESULTS: Pearson correlation coefficients for perceptions of distance and objectively measured distance to physical activity resources ranged from 0.40 (gyms, schools) to 0.54 (parks). Perceived distance to gyms and objective number of schools within 1-mile buffers were negatively associated with activity. No statistically significant relationships were found between activity and perceived or objectively measured proximity to parks. CONCLUSION: Results indicate the need for both individual and environmental intervention strategies to increase levels of physical activity among underinsured, midlife women. More work is needed to determine the most effective strategies

Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model.

BackgroundStress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity.MethodWe conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression.ResultsWomen in MMT showed significant reductions in perceived stress (β = - 0.16) and depressive symptoms (β = - 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower glucose post-oral glucose tolerance test (β = - 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group.ConclusionA short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population. Clinical Trials.gov #NCT01307683

Grandmothers, Fathers, and Depressive Symptoms Are Associated with Food Insecurity among Low-Income First-Time African-American Mothers in North Carolina

African Americans experience household food insecurity—the limited availability of nutritionally adequate and safe food, or ability to acquire acceptable foods in socially acceptable ways—at three times the rate of non-Hispanic whites. Thirty percent of all African American children live in food insecurity households. The purpose of this study was to identify characteristics associated with household food insecurity among a high risk postpartum population. 206 low-income, African-American mother-infant dyads were recruited through WIC clinics. The six-item USDA food security scale was used to classify households as food secure, marginally food secure or food insecure. Multinomial logistic regression was used to estimate the association between selected maternal/household characteristics and household food security status. Fifty-three percent of households were food secure, 34% were marginally food secure and 13% were food insecure. Maternal education less than college (Relative Risk Ratio = 0.46, 95% Confidence Interval: 0.22, 0.98) was inversely associated with marginal food security. Depressive symptoms (RRR = 1.09, 95% CI: 1.02, 1.16) and having the baby’s father in the household (RRR = 3.46, 95% CI: 1.22, 9.82) were associated with household food insecurity, while having a grandmother in the household (RRR = 0.15, 95% CI: 0.03, 0.80) was inversely associated with experiencing household food insecurity. Findings from this study suggest that young low-income African American families with only one child are particularly susceptible to experiencing household food insecurity. Intergenerational support and transfer of knowledge may be a key protective attribute among low-income African American households

Perceptions of the Community Food Environment and Related Influences on Food Choice Among Midlife Women Residing in Rural and Urban Areas: A Qualitative Analysis

Introduction—Qualitative research on food choice has rarely focused on individuals’ perceptions of the community food environment. Women remain gatekeepers of the family diet and food purchasing. Therefore we assessed midlife, Southern women's perceptions of the food environment. Related influences on food choices at work and at home were also examined. Methods—We recruited 28 low- and moderate-income, midlife (37-67 years) women from rural and urban areas of southeastern North Carolina, using typical case and snowball sampling. They responded to questions about multilevel influences on food choice in semi-structured, in-depth interviews. Results—Women perceived differences between urban and rural food environments, with rural areas having fewer supermarkets and fast food restaurants compared to urban areas, which had fewer produce stands. Workplace food choices were affected by the social environment (co-workers), personal health concerns, and the surrounding food environment. Food chosen at home was primarily influenced by family members, health concerns, and convenient food sources. Discussion—While future studies should explore findings in more representative populations, potential intervention strategies can be inferred, including emphasizing healthful aspects of the food environment. Intervention and advocacy efforts are needed to improve aspects of the food environment that make healthy choices difficult. Originally published in Women & Health Vol. 49, No. 2-3, 2009

The vulnerability of public spaces: challenges for UK hospitals under the 'new' terrorist threat

This article considers the challenges for hospitals in the United Kingdom that arise from the threats of mass-casualty terrorism. Whilst much has been written about the role of health care as a rescuer in terrorist attacks and other mass-casualty crises, little has been written about health care as a victim within a mass-emergency setting. Yet, health care is a key component of any nation's contingency planning and an erosion of its capabilities would have a significant impact on the generation of a wider crisis following a mass-casualty event. This article seeks to highlight the nature of the challenges facing elements of UK health care, with a focus on hospitals both as essential contingency responders under the United Kingdom's civil contingencies legislation and as potential victims of terrorism. It seeks to explore the potential gaps that exist between the task demands facing hospitals and the vulnerabilities that exist within them

Validation of 3 Food Outlet Databases: Completeness and Geospatial Accuracy in Rural and Urban Food Environments

Despite interest in the built food environment, little is known about the validity of commonly used secondary data. The authors conducted a comprehensive field census identifying the locations of all food outlets using a handheld global positioning system in 8 counties in South Carolina (2008–2009). Secondary data were obtained from 2 commercial companies, Dun & Bradstreet, Inc. (D&B) (Short Hills, New Jersey) and InfoUSA, Inc. (Omaha, Nebraska), and the South Carolina Department of Health and Environmental Control (DHEC). Sensitivity, positive predictive value, and geospatial accuracy were compared. The field census identified 2,208 food outlets, significantly more than the DHEC (n = 1,694), InfoUSA (n = 1,657), or D&B (n = 1,573). Sensitivities were moderate for DHEC (68%) and InfoUSA (65%) and fair for D&B (55%). Combining InfoUSA and D&B data would have increased sensitivity to 78%. Positive predictive values were very good for DHEC (89%) and InfoUSA (86%) and good for D&B (78%). Geospatial accuracy varied, depending on the scale: More than 80% of outlets were geocoded to the correct US Census tract, but only 29%–39% were correctly allocated within 100 m. This study suggests that the validity of common data sources used to characterize the food environment is limited. The marked undercount of food outlets and the geospatial inaccuracies observed have the potential to introduce bias into studies evaluating the impact of the built food environment

Early Adversity and the Prospective Prediction of Depressive and Anxiety Disorders in Adolescents

The current study was a prospective exploration of the specificity of early childhood adversities as predictors of anxiety and depressive disorders in adolescents. Participants were 816 adolescents (414 males, 402 females) with diagnostic information collected at age 15; information on early adversities had been collected from the mothers during pregnancy, at birth, age 6 months, and age 5 years for a related study. Adolescents with "pure" anxiety disorders were compared with adolescents with "pure" depressive disorders (major depressive disorder, dysthymia), and these groups were compared to never-ill controls. Analyses controlled for gender and maternal depression and anxiety disorders. Results indicated that adolescents with anxiety disorders were more likely than depressed youth to have been exposed to various early stressors, such as maternal prenatal stress, multiple maternal partner changes, and more total adversities, whereas few early childhood variables predicted depressive disorders. Even when current family stressors at age 15 were controlled, early adversity variables again significantly predicted anxiety disorders. Results suggest that anxiety disorders may be more strongly related to early strees exposure, while depressive disorders may be related to more proximal stressors or to early stressors not assessed in the current study

Eating for 1, Healthy and Active for 2; feasibility of delivering novel, compact training for midwives to build knowledge and confidence in giving nutrition, physical activity and weight management advice during pregnancy

Gold OABackground: Women in Wales are more likely to be obese in pregnancy than in any other United Kingdom (UK) country. Midwives are ideally placed to explore nutrition, physical activity and weight management concerns however qualitative studies indicate they lack confidence in raising the sensitive issue of weight. Acknowledging this and the reality of finite time and resources, this study aimed to deliver compact training on nutrition, physical activity and weight management during pregnancy to increase the knowledge and confidence of midwives in this subject. Methods A compact training package for midwives was developed comprising of evidence based nutrition, physical activity and weight management guidance for pregnancy. Training was promoted via midwifery leads and delivered within the Health Board. Questionnaires based on statements from national public health guidance were used to assess changes in self-reported knowledge and confidence pre and post training. Descriptive statistics were applied and 95% confidence intervals were calculated. Results 43 midwives registered for training, 32 (74%) attended and completed the questionnaires. Although, pre training knowledge and confidence varied between participants, statistically significant improvements in self-reported knowledge and confidence were observed post training. 97% indicated knowledge of pregnancy specific food and nutrition messages as ‘better’ (95% CI 85 to 100), as opposed to 3% stating ‘stayed the same’ – 60% stated ‘much better’. 83% indicated confidence to explain the risks of raised BMI in pregnancy was either ‘much’ or ‘somewhat better’ (95% CI 66 to 93), as opposed to 17% stating ‘stayed the same’. 89% indicated confidence to discuss eating habits and physical activity was ‘much’ or ‘somewhat better’ (95% CI 73 to 97) as opposed to 11% stating ‘stayed the same’. Emergent themes highlighted that training was positively received and relevant to midwifery practice. Conclusions This study provides early indications that a compact nutrition, physical activity and weight management training package improves midwives self-reported knowledge and confidence. Cascading training across the midwifery service in the Health Board and conducting further studies to elicit longer term impact on midwifery practice and patient outcomes are recommended

Is proximity to a food retail store associated with diet and BMI in Glasgow, Scotland?

<p><b>Background:</b> Access to healthy food is often seen as a potentially important contributor to diet. Policy documents in many countries suggest that variations in access contribute to inequalities in diet and in health. Some studies, mostly in the USA, have found that proximity to food stores is associated with dietary patterns, body weight and socio-economic differences in diet and obesity, whilst others have found no such relationships. We aim to investigate whether proximity to food retail stores is associated with dietary patterns or Body Mass Index in Glasgow, a large city in the UK.</p> <p><b>Methods:</b> We mapped data from a 'Health and Well-Being Survey' (n = 991), and a list of food stores (n = 741) in Glasgow City, using ArcGIS, and undertook network analysis to find the distance from respondents' home addresses to the nearest fruit and vegetable store, small general store, and supermarket.</p> <p><b>Results:</b> We found few statistically significant associations between proximity to food retail outlets and diet or obesity, for unadjusted or adjusted models, or when stratifying by gender, car ownership or employment.</p> <p><b>Conclusions:</b> The findings suggest that in urban settings in the UK the distribution of retail food stores may not be a major influence on diet and weight, possibly because most urban residents have reasonable access to food stores.</p&gt