Socioeconomic Influences on Affordable Housing Residents: Problem Definition and Possible Solutions

Socioeconomic status (SES) is a powerful social determinant of health. Often, affordable housing is an important step in promoting reliable economic and social health among individuals living in poverty. However, we argue that we must go further to improve the long-term health outcomes of these individuals and families. First, we use survey data and geographical analysis to identify the socioeconomic status of neighborhoods and residents of affordable housing in a major urban center. SES levels are certainly lower among affordable housing residents, and SES was significantly lower in public housing development neighborhoods than other neighborhoods. We offer solutions from our own and other research experiences that identify potential changes to affordable housing to promote and maximize health of residents. These data have implications for multilevel intervention

The role of attitude, control and intention to explain fruit and vegetable intake among racial/ethnic minority women with low socioeconomic status

OBJECTIVE: Fruit and Vegetable (FV) intake-a modi able risk factor for chronic diseases-is lower among racial/ethnic minorities and low Socio- Economic Status (SES) groups when compared to other populations. The Theory of Planned Behavior (TPB) is one theoretical model studied to explain and in uence individual health behaviors, including FV intake, in middle class populations, but not exclusively in diverse, low SES groups. This cross-sectional study evaluated the utility of select TPB variables to explain intention to consume and intake of FV in this population. DESIGN: Demographics, BMI, select TPB variables, and FV intake were measured via survey. Bivariate analyses were conducted to explore relationships between variables. Hierarchical regression analyses were used to t two models: one to explain intention and one to explain behavior with regard to FV vegetable intake. RESULTS: Participants (n=114) age 25-69 years and were mostly African American/Black and Hispanic (21.9% and 73%, respectively). The TPB variable perceived behavioral control was the only signi cant predictor of intention to consume FV (OR=2.55, 95% CI OR: 1.23, 5.27), and with BMI, FV intake (R2=0.08; F [2,130] =5.72, p=0.0042). CONCLUSION: Perceived behavioral control and BMI are the most signi cant predictors of FV intake but explain only 8% of the variability in intake in our cohort. Our results support prior research which suggests an attenuation of the intention-behavior relationship by SES, and may question the utility of the TPB as it is currently operationalized as a foundational model for future health behavior change research and programs in low SES racial/ethnic minorities

Pilot and feasibility test of an implementation intention intervention to improve fruit and vegetable intake among women with low socioeconomic status

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI again 1-month following the intervention. Feasibility data were collected for recruitment, randomization, retention, and assessment procedures and compared to predetermined targets. Semi-structured interview data was analyzed for emergent themes regarding acceptability of the trial. Preliminary efficacy of the intervention to improve FVI was analyzed descriptively. Feasibility targets were met for randomization (100% vs. ≥80% target), retention (93.5% vs. ≥70% target) and the assessment metrics missing data points (2% vs. ≤10% target) and days from intervention to follow up (mean=69.2, sd=42.6 vs.days). Targets for recruitment were not met with the exception of participants giving informed consent (100% vs. ≥70% target). Participants described the intervention as enjoyable and reported behavioral constructs outside of those measured as important to improve FVI. Limited efficacy analysis suggested that both groups increased their FVI (experimental: +0.17 servings per day, 95% CI: -0.85, 1.20; control: +0.50 servings per day, 95% CI: -0.56, 1.58). Further research which examines interventions based upon behavior change models to improve dietary health behaviors in marginalized groups is needed

Stress mediates the relationship between sexual orientation and behavioral risk disparities

BACKGROUND: Growing evidence documents elevated behavioral risk among sexual-minorities, including gay, lesbian, and bisexual individuals; however, tests of biological or psychological indicators of stress as explanations for these disparities have not been conducted. METHODS: Data were from the 2005-2010 National Health and Nutrition Examination Survey, and included 9662 participants; 9254 heterosexuals, 153 gays/lesbians and 255 bisexuals. Associations between sexual orientation and tobacco, alcohol, substance, and marijuana use, and body mass index, were tested using the chi-square test. Stress, operationalized as depressive symptoms and elevated C-reactive protein, was tested as mediating the association between sexual orientation and behavioral health risks. Multiple logistic regression was used to test for mediation effects, and the Sobel test was used to evaluate the statistical significance of the meditating effect. RESULTS: Gays/lesbians and bisexuals were more likely to report current smoking (p < .001), a lifetime history of substance use (p < .001), a lifetime history of marijuana use (p < .001), and a lifetime period of risky drinking (p = .0061). The largest disparities were observed among bisexuals. Depressive symptoms partially mediated the association between sexual orientation and current smoking (aOR 2.04, 95% CI 1.59, 2.63), lifetime history of substance use (aOR 3.30 95% CI 2.20, 4.96), and lifetime history of marijuana use (aOR 2.90, 95% CI 2.02, 4.16), among bisexuals only. C-reactive protein did not mediate the sexual orientation/behavior relationship. CONCLUSION: Higher prevalence of current smoking and lifetime history of substance use was observed among sexual minorities compared to heterosexuals. Among bisexuals, depressive symptoms accounted for only 0.9-3% of the reduction in the association between sexual orientation and marijuana use and tobacco use, respectively. More comprehensive assessments of stress are needed to inform explanations of the disparities in behavioral risk observed among sexual minorities

A study examining the usefulness of a new measure of research engagement

INTRODUCTION: Engagement of relevant stakeholders\u27 ideas, opinions, and concerns is critical to the success of modern research projects. We have developed a tool to measure stakeholder engagement, called the Research Engagement Survey Tool (REST). The purpose of this paper is to present the implementation and uptake of the stakeholder engagement measure REST among research teams, including the assessment of barriers and facilitating factors for use of the new research engagement measure in practice. METHODS: In this implementation study, project team members participated in baseline and follow-up web-based surveys. Web-based interviews were conducted with a subset of project teams that implemented the REST. On the baseline survey, project teams were asked to provide details about up to three ongoing or recently completed projects, were asked if they agreed with compensation for REST completion, and were asked if they would like to send the survey to stakeholders or would prefer our project team to email their project stakeholders. Follow-up surveys contained questions on reactions to implementing REST and results of REST. RESULTS: Project team members/researchers who completed the baseline survey (n=86) were mostly female (79%) and Non-Hispanic/Latino(a) White (76%). Those who implemented REST were also mostly female (86%) and Non-Hispanic/Latino(a) White (71%), with an average of 11 years in academic research. About 98% of all participants completing the baseline survey had the capacity to survey partners, while 100% of all teams who implemented REST did. A small portion of respondents indicated the time commitment of REST would be a barrier (29% of baseline survey respondents, 10% of those who implemented REST) and indicated workload would be a barrier (31% of baseline survey respondents, 14% of those who implemented REST). DISCUSSION: The data presented here indicate that REST implementation is feasible in a volunteer group of ongoing research projects

Theory of Planned Behavior and implementation intentions to improve fruit and vegetable intake in women of low socioeconomic status

Fruit and vegetable intake (FVI) is an important modifiable risk factor for chronic diseases. Low socioeconomic status (SES) populations demonstrate lower FVI and higher rates of chronic diseases than higher SES groups. Theory-based models and interventions like the Theory of Planned Behavior (TPB) and implementation intentions (II) have been used effectively to explain and influence health behaviors, including FVI, in middle class populations, but have not been evaluated in exclusively low SES populations. This research investigates the efficacy, feasibility and acceptability of the TPB and an II intervention to explain and influence FVI in women of low SES.Participants: Adult female residents of Boston Public Housing developments. TPB constructs and FVI were measuredvia survey. We conducted pilot and feasibility randomized controlled and one-group II intervention studies (n=31) to promote FVI and a qualitative analysis of semi-structured interview data (n=8) to evaluate intervention efficacy, feasibility and acceptability.Intervention and control groups did not increase FVI (intervention + 0.26 servings per day, t(17)=0.73,p=0.476; control +0.50 servings per day, t(9)=1.07,p=0.3111) and no difference in FVI between groups t(26)=0.40,p=0.6934). Feasibility goals were met for randomization (100%vs ≥80%), retention(93.5%vs ≥70%), missing data (2%vs <10%), days to follow up (mean=69.27±42.67 vs <180 days), and not for recruitment(38.1% vs≥70%). Interviewed participants characterized the intervention as “beneficial”, and reported autonomy, positive regard and having support facilitated dietary behavior change. Overall, our analysis of an II intervention suggests that simply intervening on TPB variables may not be enough to change dietary behavior and, although acceptable, participants reported constructs not included in the TPB as facilitators of dietary behavior change. Future research is needed to determine how/if the TPB and II can be used as a theoretical foundation and intervention to describe and influence dietary behavior change in women of low SES

Pilot and Feasibility Test of an Implementation Intention Intervention to Improve Fruit and Vegetable Intake Among Women with Low Socioeconomic Status

Fruit and vegetable intake (FVI), a modifiable risk factor for chronic diseases, is lower in low socioeconomic status (SES) populations. Implementation intentions (a specific type of planning that extends the Theory of Planned Behavior) has been studied to improve FVI, but not exclusively with low SES groups. Using mixed methods, we evaluated the feasibility, acceptability, and preliminary efficacy of an implementation intention intervention (versus a general plan) to increase FVI in women with low SES. For the pilot randomized controlled trial, demographics, body mass index, attitude, perceived behavioral control, goal intention strength, and FVI were measured at baseline and FVI again 1-month following the intervention. Feasibility data were collected for recruitment, randomization, retention, and assessment procedures and compared to predetermined targets. Semi-structured interview data was analyzed for emergent themes regarding acceptability of the trial. Preliminary efficacy of the intervention to improve FVI was analyzed descriptively. Feasibility targets were met for randomization (100% vs. ≥80% target), retention (93.5% vs. ≥70% target) and the assessment metrics missing data points (2% vs. ≤10% target) and days from intervention to follow up (mean=69.2, sd=42.6 vs.days). Targets for recruitment were not met with the exception of participants giving informed consent (100% vs. ≥70% target). Participants described the intervention as enjoyable and reported behavioral constructs outside of those measured as important to improve FVI. Limited efficacy analysis suggested that both groups increased their FVI (experimental: +0.17 servings per day, 95% CI: -0.85, 1.20; control: +0.50 servings per day, 95% CI: -0.56, 1.58). Further research which examines interventions based upon behavior change models to improve dietary health behaviors in marginalized groups is needed

Factors affecting the initiation of a shared decision making program in obstetric practices

As healthcare systems progress toward initiatives that increase patient engagement, stake-holder hopes are that shared decision making (SDM) will become routine practice. Yet, there is limited empirical evidence to guide such SDM program implementations, particularly in obstetric practices. The first stage of any project implementation is the “initiation stage”, in which project leaders define a project’s purpose and stakeholders and structures are put in place to support the new initiative. Our study’s objective was to identify factors affecting the initiation stage of an SDM program implementation project for TOLAC, trial of labor after Cesarean. We conducted a multiple-case study of an SDM program implementation in three obstetric settings in Washington State. The research design and analysis were guided by implementation science frameworks and project management literature. Data sources included interviews with key informants from the State, SDM tool vendors, and three project sites, as well as implementation documents. The study results provide insight into how the identified project implementation factors provide an essential foundation for informing project planning, execution, and reflection/evaluation. In this study, the State’s decision aid certification program pressured the project sites to shape the project purpose and engage stakeholders that would meet immediate project requirements (specifically, state require-ments). The study reveals that external demands may not be in perfect alignment with the internal necessities required for an SDM program’s long-term viability and sustainability. Findings may be used by implementers and researchers to model and strategize the early stages of SDM program implementation projects, particularly in the obstetric setting

Feasibility and acceptability of dietary intake assessment via 24-hour recall and food frequency questionnaire among women with low socioeconomic status

BACKGROUND: Comprehensive evaluation of dietary interventions depends on effective and efficient measurement to quantify behavior change. To date, little is known regarding which self-reported measure of dietary intake is most feasible and acceptable for use in evaluation of the effectiveness of diet intervention studies among underserved populations. OBJECTIVE: This research focused on evaluating feasibility and acceptability of two self-report measures of diet. DESIGN: Cross-sectional. PARTICIPANTS/SETTING: Two interviewer-administered 24-hour recalls and a 110-item food frequency questionnaire (FFQ) were administered to both English- and Spanish-speaking participants (n=36) by native English- and Spanish-speaking research assistants. On completion of both dietary assessments, participants were interviewed regarding their preference of measure. MAIN OUTCOME MEASURES: Feasibility for completion of the dietary assessment measures was determined for contacts and retention. Acceptability of the measures was determined through responses to open- and closed-ended questions. RESULTS: During the 5-month trial, 36 participants were enrolled; 29 completed both intake measures, and 26 completed both measures and the interview. Participants were mainly Hispanic/Latina (72%), with a mean age of 37.0 (±7.6) years. Feasibility targets were met for contacts (1.9, 1.6, 1.8 contact attempts to complete each diet assessment measure with a target of ≤2) and for retention with 89% and 91% completing two 24-hour recalls and the FFQ, respectively. Participants indicated both diet assessment methods were generally acceptable; both positive and negative comments were received for use of the FFQ. CONCLUSION: Dietary assessment with the use of 24-hour recalls or an FFQ can be feasible and acceptable among women with low socioeconomic status, although care should be taken to address cultural appropriateness in the selection of the measurement method. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.IRG 72 001-36 - American Cancer Societ