Project THANKS: A Socio-Ecological Framework For An Intervention Involving HIV Positive African American Women With Comorbidities

HIV-positive individuals are living longer today as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases such as diabetes, and hypertension. These conditions result in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished African American women may represent an especially high-risk group due to disparities in health care, racial discrimination, and limited resources. This article describes an intervention that is based on the conceptual framework of the socio-ecological model. Project THANKS uses a community-based participatory, and empowerment building approach to target the unique personal, social, and environmental needs of African American women faced with the dual diagnosis of HIV and one or more chronic diseases. The long-term goal of this project is to identify features in the social and cultural milieu of these women that if integrated into existing harm reduction services can reduce poor health outcomes among them

Assessing the Nutritional Health Outcomes of African American Women With HIV and Substance Abuse Disorders Using A Socioecological Approach

It is well established that poor nutritional status leaves HIV-positive substance abusers especially vulnerable to an increased risk of opportunistic infections and other illnesses. Socioecological frameworks have been useful for identifying multiple influences on health risks, leading to the development and evaluation of promising community-based interventions for diseases such as cancer and diabetes. This article presents a conceptual model, based on the socioecological approach, to examine the mechanisms and pathways by which the various contextual factors unique to HIV-positive African American women with substance abuse disorders intersect to impact their nutritional health outcomes. The mediating effects of the interpersonal, environmental, and psychological factors on the direct links between disease symptomology, demographic and socioeconomic variables, and nutritional health are emphasized. The long-term goal is to provide the empirical foundation necessary to design targeted interventions that meet the unique personal, social, and familial needs of this population with multiple vulnerabilities

Factors Influencing the Food Choices and Eating Habits of Restaurant Chefs in Northern New Jersey: A Pilot Study

This study was conducted to understand the factors influencing the food habits of restaurant chefs in northern New Jersey. Data was collected from participants (N = 12) using dietary recalls, and semi-structured interviews based on the socio-ecological model. Dietary recall analysis revealed multiple nutritional intake hazards including skipping meals, and substitution of foods rich in fats and sugar for fruits and vegetables, and increased consumption of alcohol. Qualitative data analysis revealed that their food habits were influenced by a repertoire of individual, organizational, and interpersonal factors. The relevance of these findings to nutrition intervention programs for this population is discussed

Changes in Food Habits of South Indian Hindu Brahmin Immigrants in State College, PA

This study was conducted to understand the factors influencing changes in the food habits of south Indian Brahmin immigrants in State College, PA. Data was collected from participants (n = 28) using a semi-structured interview based on the PRECEDE framework, and participant observations. Analysis of the data used grounded theory generated themes highlighting their food acculturation experience. Adjusting in State College was described as a delicate balance that meant maintaining their south Indian traditions while at the same time adapting to the cultural milieu of a town that favored north Indian cuisine, and blending in with the larger American society

Factors Influencing the Nutritional Health and Food Choices of African American HIV-Positive Marginally Housed and Homeless Female Substance Abusers

The toll of HIV/AIDS and drug abuse on economically disadvantaged women of color in the United States is a public health problem of epidemic proportions. Malnutrition, believed to be pervasive in this population, exacerbates the devastating health effects of addiction and HIV. This study documented dietary deficiencies in this population and examined factors influencing the food choices and eating patterns of marginally housed and homeless African American HIV-positive substance abusing women. Data were collected from 28 women ages 19-55 using two 24-hour dietary recalls and a semistructured interview guide. Data revealed multiple nutritional intake hazards including skipped meals, substitution of carbohydrate-laden foods for dairy foods rich in animal fat and proteins, and an absence of raw fruits and vegetables indicative of deficiencies in key macro and micronutrients. Food risks were increased for homeless women who were more likely to lack public assistance, have difficulty accessing free food service, and frequently eating food from dumpsters. Qualitative data analysis of interviews generated three major themes describing the context in which nutritional deficiencies emerged: (1) diet-disease and food-safety misconceptions; (2) socio-cultural and lifestyle barriers; and (3) lack of personal resources and neighborhood food availability and affordability. The relevance of these findings to nutrition intervention programs for this population is discussed

Changing Food Habits in A South Indian Hindu Brahmin Community: A Case of Transitioning Gender Roles and Family Dynamics

This study was conducted to explore the perceptions of 20 South Indian Hindu Brahmin women on the factors influencing their food habits upon immigrating to America. The competing demands of juggling a new career and managing their family’s nutritional needs at the same time, all without the support of extended family members, played an important role in steering these women away from cooking traditional healthy meals, and resorting to fast foods instead. Intervention strategies should be directed toward improving the barriers to eating healthy that were specifically identified within the confines of shifting gender roles and limited family support networks

The Healthcare Experiences of African Americans with a Dual Diagnosis of HIV/AIDS and a Nutrition-Related Chronic Disease: A Pilot Study

For HIV-positive African Americans, the mistrust of medical providers due to anticipation of unequal treatment care, prejudice, and bias can become a major deterrent to medication and treatment adherence. Although programs and services incorporate strategies to improve patient–provider relationships, a deeper understanding of their healthcare experiences, especially among those with a dual diagnosis of HIV/AIDS and a nutrition-related chronic disease, is lacking. This qualitative study aimed to address this gap by conducting focus groups with participants who identified themselves as being African American, and having a dual diagnosis of HIV/AIDS, and a chronic disease. Content analysis generated several major themes, highlighting the impact of a negative healthcare experience on their ability to self-manage their health. Factors such as lack of consistency in care team, negative interactions with doctors, feelings of stigma due to prejudice and bias from healthcare staff, loss of privacy, and the need for comprehensive services that targeted their physical, emotional, and nutritional health emerged as recurring sub-themes. These findings provide the foundation for the design of a comprehensive intervention model that helps participants to communicate their medical needs more effectively, thus optimizing their overall health outcomes and quality of life

Salt, Chefs, and Public Health: An Exploratory Investigation of Hospitality Professionals’

Purpose-Public health policy has long called for significant reductions in salt intake. To date most research has been confined to processed foods. This approach fails to include the foodservice industry and its impact on population health. The purpose of this paper is to understand perceptions of what responsibility, if any, these professionals felt they had within the public health agenda. International comparisons were made to assess whether previous reductions of salt intake among UK adults was attributable to groundswell attitudinal changes at the chef/manager level, which US counterparts may not have embraced. Design/methodology/approach-This study took the qualitative approach of phenomenology as the research strategy to explore prevailing perceptions of the role and responsibility of food service regarding salt intake. Chefs and managers who deal directly with consumers were given in-depth semi-structured interviews designed to reveal the underlying themes that inform the participant’s perceptions of added salt. Findings-Major findings from both the USA and UK indicate that ground-level chef/managers do not feel a social responsibility to limit public salt consumption. Chef/managers of both countries exhibited little nutritional understanding of the health impacts of salt intake and strong reluctance to make any reductions in salt use in their daily operations. The participants cite a lack of consumer interest and the fear that any salt adjustment would change the food’s sensory acceptability putting them at a competitive disadvantage. Originality/value-To the authors’ knowledge this is the first study to examine professional foodservice personnel’s perceptions and knowledge of salt intake and the public health perspective

Perceived Barriers to Optimum Nutrition Among Congregate (Sheltered) Housing Residents in the USA

Objective: Malnutrition, secondary to decreased food intake, is a public health problem of epidemic proportions among older adults in the United States of America (USA). Compared to community-dwelling senior citizens, congregate (sheltered) housing residents are found to be frailer, with documented deficiencies in several major and minor nutrients, and associated health complications. While studies have quantified these problems, translational research examining the perceived factors influencing their daily food habits is lacking. Design: Using a qualitative approach, this study was undertaken to further and enhance understanding of this complex, under-researched area, and to form the basis for better nutritional management of this group. Setting: Participants (n = 46) were convenience sampled from four sheltered housing settings located in the suburbs of northern New Jersey, USA. Method: Data were collected using a brief demographic questionnaire, and a focus group guide designed utilizing constructs derived from socio-ecological theory. Results: Content analysis of the transcripts identified several themes suggesting that a repertoire of individual, interpersonal, and organizational factors may serve as barriers to optimum nutritional health among residents. With an emphasis on utilizing their perspectives to explain and interpret behaviour, the qualitative approach adopted offered a perfect vehicle for shifting the focus from measuring dietary outcomes to clarifying how participants arrive at the decisions they made. Conclusion: This study is a step forward in providing the empirical foundations necessary to design a comprehensive intervention with effective strategies to motivate and encourage sheltered housing residents to make healthier food choices and improve their overall health

Barriers and Opportunities for Recruitment for Nonintervention Studies on HIV Risk: Perspectives of Street Drug Users

This study used focus-group discussions in response to a video vignette to examine attitudes toward recruitment for nonintervention research involving HIV testing. Participants were 100 ethnically diverse, economically disadvantaged urban drug users, who were recruited from New York City and Hartford, Connecticut in the spring and summer of 2006. Content analyses revealed themes including (1) fears of stigma and legal trouble balanced by trustworthiness of the recruiter; (2) fears of learning one\u27s HIV status balanced by prospects for health benefits, and (3) the right to receive fair monetary compensation balanced by risks of coercion during periods of cravings. Limitations and implications for recruitment practices have been discussed here