A Comparative Analysis of State School Food Preparation Practices in NJ, GA & KY, 2006 - 2012

Background: Over the past decade, the U.S. has struggled to effectively address the childhood obesity epidemic. Healthy eating is paramount to child health, especially in terms of obesity prevention. The rate of obese adolescents in grades 9-12 between 2005 and 2013 remained about the same in Georgia, decreased in New Jersey, and increased in Kentucky. It is possible that school meals could be different amongst these states. Methods: This study analyzed changes and differences in school food preparation practices between 3 selected states. These regions were chosen based on their relatively low (New Jersey), intermediate (Georgia), and high (Kentucky) obesity rates. Both SHPPS 2006 and 2012 nutrition services data was chosen for this analysis to look at changes in school food preparation practices in each state and in the overall sample over time using independent samples t-tests and one way ANOVA. Results: Overall, statistically significant changes (p\u3c.05) in food preparation practices were observed in seven out of 22 food preparation practice variables between 2006 and 2012. New Jersey and Georgia improved their food preparation practices between 2006 and 2012 while Kentucky improved in some areas and worsened in others. Between states comparisons showed Kentucky had several practices different from New Jersey and Georgia in 2006 but by 2012 there were very few differences between states. Discussion: These states have improved in some areas of school food preparation practices while other areas still need improvement. The state with the highest adolescent obesity rate was the only state to show declines in the average use of healthier school food preparation practices. Public health efforts should seek to address barriers to providing healthy foods in schools for regions that show the need for intervention

Power, Place and Mental Health: Pathways between Neighborhood Vulnerability and Depressive Symptoms

Depression is the leading contributor to disability and the fourth leading cause of non-fatal disease burden worldwide. Over the past several decades, persistent race and gender differences in depression prevalence have been reported. Studies have shown women have twice the lifetime risk of first onset of depression compared to men, with differences in severity and chronicity between race and gender groups. In addition, structural factors such as those within the neighborhood context (poverty, unemployment, education, etc.) may contribute to depression outcomes. Race and gender appear to modify the influence of structural factors on depressive symptoms, making the etiology of this disorder of particular public health importance. Based on these observations, through this dissertation, we considered the role of neighborhood context and its contribution to the burden of depressive symptoms among race and gender groups. In the first study, we created a composite measure of exposure to neighborhood context, the Neighborhood Vulnerability Index (NVI). The NVI consists of 8 census tract indicators of social disadvantage and affluence using data from a nationally representative longitudinal population-based sample at five timepoints between 1986 and 2011; the findings highlighted stark inequities in which groups are exposed to neighborhood vulnerability. Furthermore, race by gender trajectories show the compounding effect of race and gender on neighborhood vulnerability, where Black women navigate the most vulnerable environments. The results highlight the persistent and reinforcing pattern of inequitable neighborhood conditions along racial and gender lines in the United States. Next, we examined the longitudinal association between neighborhood vulnerability and depressive symptoms and found a positive association with some heterogeneity between groups. Neighborhood vulnerability was most strongly associated with depressive symptoms for Black men, had the weakest association among Black women and a similar impact on white men and women. The impact of neighborhood vulnerability on depressive symptoms was consistent over the course of the 26 year follow up. Lastly, through the third aim of this dissertation we examined the roles of vigilance and discrimination, two types of race-related stress and coping, as mediators in the association between neighborhood vulnerability and depressive symptoms. We found evidence of strong mediation by vigilance and no evidence of mediation by discrimination. There were differences between race and gender groups, with an association more strongly mediated for Black Americans compared to whites and for men compared to women; however, many of the indirect effects were only marginally significant. Taken together, the results of this dissertation provide evidence of a significant contribution of neighborhood context to the development of depressive symptoms among U.S. adults. By taking an innovative approach that considers the structural and interpersonal aspects of neighborhood characteristics, we offer a more nuanced view of depression etiology among race and gender groups. The pattern of findings between groups suggests race and gender contribute to differences in vulnerability to the effect of neighborhood context and social stress on depressive symptoms. Consideration of neighborhood vulnerability in depression etiology and interventions may offer opportunities for improving the mental health of the U.S. adult population as they age.PHDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/167913/1/battlesd_1.pd

Reactions and Receptivity to Framing HIV Prevention Message Concepts About Pre-Exposure Prophylaxis for Black and Latino Men Who Have Sex with Men in Three Urban US Cities.

Men who have sex with men (MSM) of color are disproportionately affected by HIV in the United States. Pre-exposure prophylaxis (PrEP) using antiretroviral medications is a newer biomedical prevention modality with established efficacy for reducing the risk of acquiring HIV. We conducted formative qualitative research to explore audience reactions and receptivity to message concepts on PrEP as part of the development of prevention messages to promote PrEP awareness among black and Latino MSM in the United States. In 2013, 48 black and 42 Latino (total study sample = 90) mixed HIV serostatus MSM from Chicago, Ft. Lauderdale, and Kansas City participated in either an individual interview or focus group discussion. Men were recruited online and at community-based organizations in each city. We elicited feedback on the comprehensibility, credibility, and relevance of two draft messages on PrEP. The messages included efficacy estimates from iPrEx, a phase III clinical trial to ascertain whether the antiretroviral medication tenofovir/emtricitabine disoproxil fumarate (commercially known as Truvada®) could safely and effectively prevent HIV acquisition through sex among MSM and transgender women. With participants' consent, the interviews and focus groups were recorded and transcribed. The data were then summarized and analyzed using a qualitative descriptive approach. The majority of men were unfamiliar with PrEP. It was suggested that additional information about the medication and clinical trials establishing efficacy was needed to enhance the legitimacy and relevancy of the messages. Participants sought to form an opinion of PrEP that was grounded in their own interpretation of the efficacy data. However, confusion about nonadherence among clinical trial subjects and individual versus average risk limited comprehension of these messages. Thematic overlaps suggest that message believability was connected to participants' ability to derive meaning from the PrEP efficacy data. Despite being concerned that other MSM would interpret the messages to mean that condom use was unnecessary while taking PrEP, participants themselves primarily understood PrEP as a supplement rather than a replacement for condoms. Based on their experience with taking antiretroviral medication, HIV-positive men considered condom use a more feasible form of HIV prevention than PrEP. Participants' responses suggest that more information about PrEP and the clinical trial would support the legitimacy of PrEP and the messages as a whole. These details may enhance believability in the concept of PrEP and reinforce confidence in the validity of the efficacy result