Obesity across America: Geographic Variation in Disease Prevalence and Treatment Options

More than 4 in 10 adults in the US are affected by obesity, defined as experiencing an accumulation of body fat higher than what is considered healthy for a given height. Obesity is associated with increased risks for serious health conditions such as type 2 diabetes, hypertension, stroke, and various cancers. People of all genders, of all races and ethnicities, and in all geographic areas experience obesity.This report examines existing data and research to comprehensively describe the scope and prevalence of obesity and available obesity treatments in the US. We look at the current state-level prevalence of obesity and changes in state-level obesity prevalence from 2011 to 2020. We also examine current county-level obesity prevalence and which counties have the highest and lowest levels of obesity and related comorbidities. Then, we describe insurance coverage for four obesity treatment options (screening and counseling, nutritional counseling, pharmacotherapy, and bariatric surgery) for four insurance plans (fee-for-service Medicaid, Medicaid managed care, state employee health plans, and state essential health benefits benchmark plans)

Alcohol beverage control, privatization and the geographic distribution of alcohol outlets

BACKGROUND: With Pennsylvania currently considering a move away from an Alcohol Beverage Control state to a privatized alcohol distribution system, this study uses a spatial analytical approach to examine potential impacts of privatization on the number and spatial distribution of alcohol outlets in the city of Philadelphia over a long time horizon. METHODS: A suite of geospatial data were acquired for Philadelphia, including 1,964 alcohol outlet locations, 569,928 land parcels, and school, church, hospital, park and playground locations. These data were used as inputs for exploratory spatial analysis to estimate the expected number of outlets that would eventually operate in Philadelphia. Constraints included proximity restrictions (based on current ordinances regulating outlet distribution) of at least 200 feet between alcohol outlets and at least 300 feet between outlets and schools, churches, hospitals, parks and playgrounds. RESULTS: Findings suggest that current state policies on alcohol outlet distributions in Philadelphia are loosely enforced, with many areas exhibiting extremely high spatial densities of outlets that violate existing proximity restrictions. The spatial model indicates that an additional 1,115 outlets could open in Philadelphia if privatization was to occur and current proximity ordinances were maintained. CONCLUSIONS: The study reveals that spatial analytical approaches can function as an excellent tool for contingency-based “what-if” analysis, providing an objective snapshot of potential policy outcomes prior to implementation. In this case, the likely outcome is a tremendous increase in alcohol outlets in Philadelphia, with concomitant negative health, crime and quality of life outcomes that accompany such an increase

Neighborhood Context and Black Heterosexual Men’s Sexual HIV Risk Behaviors

The effects of neighborhood context on sexual risk behavior are understudied, particularly for Black heterosexual men who do not inject drugs or report heavy drug use. Evidence of a generalized HIV epidemic (>1 %) among Black heterosexuals in low-income urban U.S. communities underscores the importance of examining the effects of neighborhood context on Black heterosexual men's sexual risk, however. We used structural equation modeling to test the pathways between neighborhood context (neighborhood disorder, personal violence, neighborhood threats), depression, substance use, and sexual risk behavior. Participants were 526 self-identified Black heterosexual men, ages 18-45, recruited via randomized venue-based probability sampling in Philadelphia, PA. Analyses of model fit statistics from Mplus indicated statistically significant direct pathways between neighborhood context, depression, substance use, and sexual risk behavior. The total indirect effect of neighborhood context on sexual risk behavior through substance use was also significant. The study's results highlight a need for more research on neighborhood context and sexual HIV risk, and for multilevel interventions to address the effects of negative neighborhood context on Black heterosexual men's sexual HIV risk