The influence of community socioeconomic status on North Carolinians' health related quality of life

Community socioeconomic status (SES) influences the social, service, and physical environments of a community regardless of one's own socioeconomic position, and can in turn positively or negatively affect individual-level health outcomes. This study investigated the influence of community SES on the health related quality of life (HRQOL) of North Carolinians. Secondary data analyses were conducted on a subset of Social Determinants of Health Study participants (N=1217) residing in 32 North Carolina communities. Community-level data came from two sources: publicly-available data sources for non-aggregated attributes (contextual) and the US Census 2000 for aggregated attributes (compositional). Contextual domains examined were: Shopping/Grocery, Restaurants/Fast-Food, Recreational Facilities, Medical Services, and Transportation; compositional community SES was: % individuals in a community living below poverty. The outcome variable was HRQOL: unhealthy days, physical functioning, and self-rated health. Qualitative methodology including data triangulation and quantitative (multi-level modeling) methods were used for data analysis. Participants living in communities with public transportation reported fewer unhealthy days (B= -2.796, p=.004), better physical functioning (B= 3.215, p=.002), and better self-rated health (B= .244, p=.007). Participants living in communities with higher rates of restaurants reported better self-rated health (B= .044, p=.007); participants in communities with higher rates of hospital beds reported worse self-rated health (B= -.010, p=.038). Greater community poverty was predictive of participants reporting fewer unhealthy days (B=-.181, p=.001), however the relationship strength diminished with the addition of contextual community resources (B=-.147, p=.017). Community poverty did not significantly predict physical functioning (B= .027, p=.685); yet participants living in communities with public transportation reported higher physical functioning scores (B=3.052, p=.006). Community poverty did not significantly predict self-rated health; however participants reported better self-rated health if they lived in communities with public transportation (B=.229, p=0.018) and a higher rate of restaurants (B= .041, p=0.016), yet greater rate of community hospital beds predicted worse self-rated health (B= -.011, p=0.034). Healthy People 2010 and 2020 goals affirm examining `lives in context' through multiple perspectives, including a biological, genetic, social and environmental context. Better understanding of community characteristics could have policy implications for resource allocation, city and urban planning, and future health interventions to improve HRQOL

Perceptions of Individual and Community Environmental Influences on Fruit and Vegetable Intake, North Carolina, 2004

Introduction: Increases in obesity and other chronic conditions continue to fuel efforts for lifestyle behavior changes. However, many strategies do not address the impact of environment on lifestyle behaviors, particularly healthy dietary intake. This study explored the perceptions of environment on intake of fruits and vegetables in a cohort of 2,479 people recruited from 22 family practices in North Carolina. Methods: Participants were administered a health and social demographic survey. Formative assessment was conducted on a subsample of 32 people by using focus groups, semistructured individual interviews, community mapping, and photographs. Interviews and discussions were transcribed and content was analyzed using ATLAS.ti version 5. Survey data were evaluated for means, frequencies, and group differences. Results: The 2,479 participants had a mean age of 52.8 years, mean body mass index (BMI) of 29.4, and were predominantly female, white, married, and high school graduates. The 32 subsample participants were older, heavier, and less educated. Some prevalent perceptions about contextual factors related to dietary intake included taste-bud fatigue (boredom with commonly eaten foods), life stresses, lack of forethought in meal planning, current health status, economic status, the ability to garden, lifetime dietary exposure, concerns about food safety, contradictory nutrition messages from the media, and variable work schedules. Conclusion: Perceptions about intake of fruits and vegetables intake are influenced by individual (intrinsic) and community (extrinsic) environmental factors. We suggest approaches for influencing behavior and changing perceptions using available resources

Associations of perceived neighborhood environment on health status outcomes in persons with arthritis

To examine the association between four aspects of the perceived neighborhood environment (aesthetics, walkability, safety, and social cohesion) and health status outcomes in a cohort of North Carolinians with self-report arthritis, after adjustment for individual and neighborhood SES covariates

Coping with Prescription Medication Costs: a Cross-sectional Look at Strategies Used and Associations with the Physical and Psychosocial Health of Individuals with Arthritis

Prescription medication costs increase financial burden, often leading individuals to engage in intentional nonadherence. Little is known about what specific medication cost-coping strategies individuals with arthritis employ

Concern About Petrochemical Health Risk Before and After a Refinery Explosion

On March 23, 2005, a large explosion at an oil refinery in Texas City, Texas caused 15 deaths and approximately 170 injuries. Little is known about how such an industrial accident influences concern about environmental health risks. We used measures of environmental health concern about nearby petrochemical production with a sample of Texas City residents to understand patterns of concern and change in concern after an industrial accident, as well as individual and contextual factors associated with those patterns. Survey interviews with residents of Texas City, Texas (N =315) both pre- and postexplosion using a brief Concern About Petrochemical Health Risk Scale (CAPHRS) and other questions were used to collect pertinent predictor information. CAPHRS baseline, postexplosion, and change scores were compared and modeled using ordinary least squares (OLS) regression and a mixed model. Higher preexplosion CAPHRS scores were predicted by younger adults, foreign-born Hispanics, non-Hispanic blacks, lower- and middle-income groups, and those who live with someone who has worked at the petrochemical plants. Higher CAPHRS change scores are predicted by the same variables (except income), as well as proximity to, or perception of, the explosion, and reports of neighborhood damage. Findings suggest these groups’ concern scores could indicate a greater vulnerability to psychological and physical harm generated by concern and stress arising from local petrochemical activities. A clearer understanding of concern about actual environmental health risks in exposed populations may enhance the evolving theory of stress and coping and eventually enable public health professionals to develop appropriate mitigation strategies

Life course body mass index and risk of knee osteoarthritis at the age of 53 years: evidence from the 1946 British birth cohort study

Introduction: The authors examined how body mass index (BMI) across life is linked to the risk of midlife knee osteoarthritis (OA), testing whether prolonged exposure to high BMI or high BMI at a particular period has the greatest influence on the risk of knee OA. Methods: A population-based British birth cohort of 3035 men and women underwent clinical examination for knee OA at age 53 years.Heights and weights were measured 10 times from 2 to 53 years. Analyses were stratified by gender and adjusted for occupation and activity levels. Results: The prevalence of knee OA was higher in women than in men (12.9% (n=194) vs 7.4% (n=108)). In men, the association between BMI and later knee OA was evident at 20 years (p=0.038) and remained until 53 years (OR per z-score 1.38 (95% CI 1.11 to 1.71)). In women, there was evidence for an association at 15 years (p=0.003); at 53 years, the OR was 1.89 (95% CI 1.59 to 2.24) per z-score increase in BMI. Changes in BMI from childhood in women and from adolescence in men were also positively associated with knee OA. A structured modelling approach to disentange the way in which BMI is linked to knee OA suggested that prolonged exposure to high BMI throughout adulthood carried the highest risk and that there was no additional risk conferred from adolescence once adult BMI had been accounted for. Conclusion: This study suggests that the risk of knee OA accumulates from exposure to a high BMI through adulthood. <br/

Independent and combined influence of homeownership, occupation, education, income, and community poverty on physical health in persons with arthritis

To examine the independent and combined influence of individual and community-level socioeconomic (SES) measures with physical health status outcomes in people with self-reported arthritis

Coping with Prescription Medication Costs: a Cross-sectional Look at Strategies Used and Associations with the Physical and Psychosocial Health of Individuals with Arthritis

BACKGROUND: Prescription medication costs increase financial burden, often leading individuals to engage in intentional nonadherence. Little is known about what specific medication cost-coping strategies individuals with arthritis employ. PURPOSE: The purposes of this study are (1) to identify characteristics of individuals with arthritis who self-report prescription medication cost-coping strategies and (2) to examine the association between medication cost-coping strategies and health status. METHODS: Seven hundred twenty-nine people self-reporting arthritis and prescription medication use completed a telephone survey. Adjusted regression models examined medication cost-coping strategies and five health status outcomes. RESULTS: Participants reported engaging in cost-coping strategies due to medication costs. Those borrowing money had worse psychosocial health and greater disability; those with increasing credit card debt reported worse physical functioning, self-rated health, and greater helplessness. Medication underuse was associated with worse psychosocial health, greater disability, and depressive symptoms. CONCLUSION: Individuals with arthritis use multiple strategies to cope with medication costs, and these strategies are associated with adverse physical and psychosocial health status