Disparities in obesity among rural and urban residents in a health disparate region

BACKGROUND: The burden of obesity and obesity-related conditions is not borne equally and disparities in prevalence are well documented for low-income, minority and rural adults in the United States. The current literature on rural versus urban disparities is largely derived from national surveillance data which may not reflect regional nuances. There is little practical research that supports the reality of local service providers such as county health departments that may serve both urban and rural residents in a given area. Conducted through a community-academic partnership, the primary aim of this study is to quantify the current levels of obesity (BMI), fruit and vegetable (FV) intake and physical activity (PA) in a predominately rural health disparate region. Secondary aims are to determine if a gradient exists within the region in which rural residents have poorer outcomes on these indicators compared to urban residents. METHODS: Conducted as part of a larger ongoing community-based participatory research (CBPR) initiative, data were gathered through a random digit dial telephone survey using previously validated measures (n = 784). Linear, logistic and quantile regression models are used to determine if residency (i.e. rural, urban) predicts outcomes of FV intake, PA and BMI. RESULTS: The majority (72%) of respondents were overweight (BMI = 29 ± 6 kg/m(2)), with 29% being obese. Only 9% of residents met recommendations for FV intake and 38% met recommendations for PA. Statistically significant gradients between urban and rural and race exist at the upper end of the BMI distribution. In other words, the severity of obesity is worse among black compared to white and for urban residents compared to rural residents. CONCLUSIONS: These results will be used by the community-academic partnership to guide the development of culturally relevant and sustainable interventions to increase PA, increase FV intake and reduce obesity within this health disparate region. In particular, local stakeholders may wish to address disparities in BMI by allocating resources to the vulnerable groups identified

Environmental perceptions and objective walking trail audits inform a community-based participatory research walking intervention

<p>Abstract</p> <p>Background</p> <p>Given the documented physical activity disparities that exist among low-income minority communities and the increased focused on socio-ecological approaches to address physical inactivity, efforts aimed at understanding the built environment to support physical activity are needed. This community-based participatory research (CBPR) project investigates walking trails perceptions in a high minority southern community and objectively examines walking trails. The primary aim is to explore if perceived and objective audit variables predict meeting recommendations for walking and physical activity, MET/minutes/week of physical activity, and frequency of trail use.</p> <p>Methods</p> <p>A proportional sampling plan was used to survey community residents in this cross-sectional study. Previously validated instruments were pilot tested and appropriately adapted and included the short version of the validated International Physical Activity Questionnaire, trail use, and perceptions of walking trails. Walking trails were assessed using the valid and reliable Path Environmental Audit Tool which assesses four content areas including: design features, amenities, maintenance, and pedestrian safety from traffic. Analyses included Chi-square, one-way ANOVA's, multiple linear regression, and multiple logistic models.</p> <p>Results</p> <p>Numerous (n = 21) high quality walking trails were available. Across trails, there were very few indicators of incivilities and safety features rated relatively high. Among the 372 respondents, trail use significantly predicted meeting recommendations for walking and physical activity, and MET/minutes/week. While controlling for other variables, significant predictors of trail use included proximity to trails, as well as perceptions of walking trail safety, trail amenities, and neighborhood pedestrian safety. Furthermore, while controlling for education, gender, and income; for every one time per week increase in using walking trails, the odds for meeting walking recommendations increased 1.27 times, and the odds for meeting PA recommendation increased 3.54 times. Perceived and objective audit variables did not predict meeting physical activity recommendations.</p> <p>Conclusions</p> <p>To improve physical activity levels, intervention efforts are needed to maximize the use of existing trails, as well as improve residents' perceptions related to incivilities, safety, conditions of trail, and amenities of the walking trails. This study provides important insights for informing development of the CBPR walking intervention and informing local recreational and environmental policies in this southern community.</p

What’s Next for Tobacco Control Efforts? Health Equity Related Lessons Learned from a National Qualitative Study on Tobacco Control and Prevention

Context: Despite gains in the tobacco prevention and control movement, tobacco products remain a threat, with specific populations at greater risk. Objective: The purpose of this paper is to examine the role that leaders in the tobacco prevention and control movement have played in progress achieved to date and identify recommendations for the future using a health equity framework. The purpose of this paper is to examine the role that leading organizations in the tobacco prevention and control movement have played in progress achieved to date, identify future recommendations within the context of current public health priorities (e.g., obesity prevention), and explore potential for tobacco prevention and control using a health equity framework. Design: Qualitative key informant interviews were conducted with representatives from four key tobacco prevention and control organizations and their partners. Setting: Interviews were conducted on-site at tobacco prevention and control organization offices or by telephone. Participants: Key informant interviews (n=87) were conducted during July-December of 2017. Main outcome measures: Interviewees describe their work in providing technical assistance to leading public health and policy efforts in tobacco prevention and control. Interviews were transcribed verbatim and coded for meaning units. This analysis was conducted November 2017-January 2018. This study was determined exempt from review by the University of Nebraska Medical Center Institutional Review Board. Results: Three overarching themes emerged from our analysis: (1) maintaining tobacco prevention and control as a public health issue, (2) the importance of health equity in tobacco prevention and control work, and (3) planning for the next generation of tobacco prevention and control advocates. Certain populations remain untouched by broad public health approaches to reduce tobacco use. Conclusions: Tailored, focused, and comprehensive approaches to address health equity in tobacco prevention and control work across specific communities are needed. Adopting a health equity lens across public health priority areas (e.g., obesity, opioids, and tobacco prevention and control) could reduce prevalence among vulnerable groups for multiple conditions

Abdominal cancer symptoms: evaluation of the impact of a regional public awareness campaign.

Objective: A regional ‘Be Clear on Cancer’ (BCoC) campaign developed by Public Health England aimed to promote public awareness of key abdominal cancer symptoms in people aged 50 years and over. Methods: Data were analysed for metrics at different stages in the patient care pathway including public awareness, GP attendance and referrals, to cancer diagnosis. Results: There was significantly higher recognition of the BCoC abdominal campaign in the campaign region compared to the control area (Post Campaign/Control, n = 401/406; 35% vs. 24%, p [less than] 0.05). The campaign significantly improved knowledge of ‘bloating’ as a symptom (p = 0.03) compared to pre-campaign levels. GP attendances for abdominal symptoms increased significantly by 5.8% (p = 0. 03), although the actual increase per practice was small (average 16.8 visits per week in 2016 to 17.7 in 2017). Urgent GP referrals for suspected abdominal cancer increased by 7.6%, compared to a non-significant change (0.05%) in the control area. For specific abdominal cancers, the number diagnosed were similar to or higher than the median in the campaign area but not in the control area in people aged 50 and over: colorectal (additional n = 61 cancers), pancreatic (additional n = 102) and stomach cancers (additional n = 17). Conclusions: This campaign had a modest impact on public awareness of abdominal cancer symptoms, GP attendances and cancers diagnosed

Preschool Executive Control, Temperament, and Adolescent Dietary Behaviors

Background Child temperament styles characterized by increased emotionality or pleasure seeking may increase risk for less healthful eating patterns, while strong executive control (EC) may be protective. The interaction of these characteristics with longitudinal outcomes has not yet been examined. Purpose The aim of this study was to examine the association of preschool temperament and EC, as well as their interaction with adolescent eating. Methods Preschoolers (N = 313) were recruited into a longitudinal study, with behavioral measurement of EC at age 5.25 years, temperament assessed multiple times across preschool, and eating outcomes assessed in adolescence (mean age = 15.34 years). Results Separate latent moderated structural equation models demonstrated that weaker EC was associated with eating less healthful foods, including high sugar foods, sugar-sweetened beverages (SSBs), and convenience foods (p \u3c .05). In the moderation models, negative affectivity temperament was correlated with eating less healthful foods, high sugar foods, and SSBs (p \u3c .05). Children lower in surgency/extraversion temperament were more likely to drink SSBs. There was an interaction between temperament and EC, such that children high in negative affectivity with weaker EC were particularly more likely to consume less healthful foods, high sugar foods, and SSBs (p \u3c .05). There was no interaction of surgency with EC and food consumption. Conclusions Child characteristics measured early in development were associated with later adolescent eating behaviors. Adequate EC could be necessary to counteract the drive toward eating associated with temperaments high in negative affectivity. Lay Summary A preschool temperament style called Negative Affectivity, characterized by high levels of reactivity and negative emotion, predicted eating patterns a decade later. These children were more likely to eat less healthful foods and drink sugary drinks as adolescents. Strong executive function skills were important for redirecting toward healthful eating in children with Negative Affectivity

The Influence of Health Literacy on Reach, Retention, and Success in a Worksite Weight Loss Program

To examine if employee health literacy (HL) status moderated reach, retention, and weight outcomes in a worksite weight loss program

Who participates in internet-based worksite weight loss programs?

<p>Abstract</p> <p>Background</p> <p>The reach and representativeness are seldom examined in worksite weight loss studies. This paper describes and illustrates a method for directly assessing the reach and representativeness of a internet-based worksite weight loss program.</p> <p>Methods</p> <p>A brief health survey (BHS) was administered, between January 2008 and November 2009, to employees at 19 worksites in Southwest Virginia. The BHS included demographic, behavioral, and health questions. All employees were blinded to the existence of a future weight loss program until the completion of the BHS.</p> <p>Results</p> <p>The BHS has a participation rate of 66 percent and the subsequent weight loss program has a participation rate of 30 percent. Employees from higher income households, with higher education levels and health literacy proficiency were significantly more likely to participate in the program (p's < .01).</p> <p>Conclusions</p> <p>Worksite weight loss programs should include targeted marketing strategies to engage employees with lower income, education, and health literacy.</p

A randomized controlled trial to test the effectiveness of two technology-enhanced diabetes prevention programs in primary care: The DiaBEAT-it study

ObjectiveTo evaluate the effectiveness of two technology-enhanced interventions for diabetes prevention among adults at risk for developing diabetes in a primary care setting.MethodsThe DiaBEAT-it study employed a hybrid 2-group preference (Choice) and 3-group randomized controlled (RCT) design. This paper presents weight related primary outcomes of the RCT arm. Patients from Southwest Virginia were identified through the Carilion Clinic electronic health records. Eligible participants (18 and older, BMI ≥ 25, no Type 2 Diabetes) were randomized to either Choice (n = 264) or RCT (n = 334). RCT individuals were further randomized to one of three groups: (1) a 2-h small group class to help patients develop a personal action plan to prevent diabetes (SC, n = 117); (2) a 2-h small group class plus automated telephone calls using an interactive voice response system (IVR) to help participants initiate weight loss through a healthful diet and regular physical activity (Class/IVR, n = 110); or (3) a DVD with same content as the class plus the same IVR calls over a period of 12 months (DVD/IVR, n = 107).ResultsOf the 334 participants that were randomized, 232 (69%) had study measured weights at 6 months, 221 (66%) at 12 months, and 208 (62%) at 18 months. Class/IVR participants were less likely to complete weight measures than SC or DVD/IVR. Intention to treat analyses, controlling for gender, race, age and baseline BMI, showed that DVD/IVR and Class/IVR led to reductions in BMI at 6 (DVD/IVR −0.94, p &lt; 0.001; Class/IVR −0.70, p &lt; 0.01), 12 (DVD/IVR −0.88, p &lt; 0.001; Class/IVR-0.82, p &lt; 0.001) and 18 (DVD/IVR −0.78, p &lt; 0.001; Class/IVR −0.58, p &lt; 0.01) months. All three groups showed a significant number of participants losing at least 5% of their body weight at 12 months (DVD/IVR 26.87%; Class/IVR 21.62%; SC 16.85%). When comparing groups, DVD/IVR were significantly more likely to decrease BMI at 6 months (p &lt; 0.05) and maintain the reduction at 18 months (p &lt; 0.05) when compared to SC. There were no differences between the other groups.ConclusionsThe DiaBEAT-it interventions show promise in responding to the need for scalable, effective methods to manage obesity and prevent diabetes in primary care settings that do not over burden primary care clinics and providers.Registrationhttps://clinicaltrials.gov/ct2/show/NCT02162901, identifier: NCT02162901