Spaces between home and school: The effect of eating location on adolescent nutrition

Using interview and self-administered survey data, this article examines how homes, schools, and the community spaces between these two locations affect adolescent nutrition in a low-income, urban setting. Results from this research show that eating location can play a significant role in the foods that adolescents consume. Food acquisition data provided by adolescents reveal that homes and schools provide spaces for the consumption of healthy foods while shops, restaurants, takeouts, and community centers contribute unhealthy snack foods to adolescent diets in a traditionally low-income, urban neighborhood in Northern Ireland. The results of this research show that eating location can provide a starting point for designing healthy eating interventions in low-income places to avoid overlap with spaces that already provide healthy foods to young people.     

Regional Food Consumption in the Northeast of Brazil by the Low-Income Population

Brazilian foods have been influenced by many cultures, colonizers, slaves, and native indians. Tracing the regional foods is important to analyze diets and discuss food culture. Objective: to evaluate the frequency and variety of regional foods consumed by Brazilians from the Northeast, users of a government program. Methods: This exploratory study analyzed food intake of low-income customers eating in community restaurants. 753 individuals participated, representing a sampling error smaller than 3.5% for national representativeness. The 24HR was used at the restaurants on two weekdays and one weekend day. Results Customers consumed 47 different regional preparations. The prefered ones were cuscuz, baião dois, and tapioca. Food intake was higher at dinner. An average of 1.3 regional preparations were consumed, for each 10 preparations. Conclusion: The mean consumption of regional foods was low. It may reveal higher intakes of ready-to-eat. Even this population does not take the time to prepare regional foods.     

The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries

Objective

To examine indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries.

Data Sources

2010–2018 Health and Retirement Study survey data linked to annual Medicare beneficiary summary files.

Study Design

We estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. We compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states.

Data Collection/Extraction Methods

The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and residing in the community.

Principal Findings

ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage (95% CI: 0.020–0.176), a 4.4 percentage point increase in having any institutional outpatient spending (95% CI: 0.005–0.083), and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment (95% CI: −0.003 to 0.050, p = 0.079).

Conclusions

ACA Medicaid expansion was associated with more institutional outpatient spending among older low-income Medicare beneficiaries. Increased care costs should be weighed against potential benefits from increased realized access to care.     

Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia

Abstract

Government–community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.     

Home Sweet Home: Conceptualizing and Coping With the Challenges of Aging and the Move to a Care Facility

This article presents findings from two studies that describe news portrayals of cancer causes and prevention in local TV and test the effects of typical aspects of this coverage on cancer-related fatalism and overload. Study 1 analyzed the content of stories focused on cancer causes and prevention from an October 2002 national sample of local TV and newspaper cancer coverage (n?=?122 television stations; n?=?60 newspapers). Informed by results from the content analysis, Study 2 describes results from a randomized experiment testing effects of the volume and content of news stories about cancer causes and prevention (n?=?601). Study 1 indicates that local TV news stories describe cancer causes and prevention as comparatively more certain than newspapers but include less information about how to reduce cancer risk. Study 2 reveals that the combination of stories conveying an emerging cancer cause and prevention behavior as moderately certain leads to an increased sense of overload, while a short summary of well-established preventive behaviors mitigates these potentially harmful beliefs. We conclude with a series of recommendations for health communication and health journalism practice.     

Working families' health insurance coverage, 1997-2001

Despite a booming U.S. economy, falling unemployment and moderate health insurance premium growth, the percentage of working Americans and their families with employer-sponsored health insurance failed to increase substantially between 1997 and 2001, according to findings from the Center for Studying Health System Change (HSC) Community Tracking Study Household Survey. There were, however, dramatic changes in the insurance status of people who lacked access to or did not take up employer coverage: fewer uninsured, more public program enrollment and a decline in coverage by individual insurance and other sources. While the State Children's Health Insurance Program (SCHIP) clearly reduced uninsurance among low-income children, evidence also suggests a fair amount of substitution of public insurance for private coverage.     

The Resilience of the Health Care Safety Net, 1996–2001

Objective .  To determine how the capacity and viability of local health care safety nets changed over the last six years and to draw lessons from these changes.
Data Source .  The first three rounds (May 1996 to March 2001) of Community Tracking Study site visits to 12 communities.
Study Design .  Researchers visited the study communities every two years to interview leaders of local health care systems about changes in the organization, delivery, and financing of health care and the impact of these changes on people. For this analysis, we collected data on safety net capacity and viability through interviews with public and not-for-profit hospitals, community health centers, health departments, government officials, consumer advocates, academics, and others. We asked about the effects of market and policy changes on the safety net and how the safety net responded, as well as the impact of these changes on care for the low-income uninsured.
Principal Findings .  The safety net in three-quarters of the communities was stable or improved by the end of the study period, leading to improved access to primary and preventive care for the low-income uninsured. Policy responses to pressures such as the Balanced Budget Act and Medicaid managed care, along with effective safety net strategies and supportive conditions, helped reinforce the safety net. However, the safety net in three sites deteriorated and access to specialty services remained inadequate across the 12 sites.
Conclusions.  Despite pessimistic predictions and some notable exceptions, the health care safety net grew stronger over the past six years. Given considerable community variation, however, this analysis indicates that policymakers can apply a number of lessons from strong and improving safety nets to strengthen those that are weaker, particularly as the current economy poses new challenges.     

Correlates of Healthy Eating Habits in Low-Income Black Women and Latinas

Background. Few factors related to healthy or unhealthy eating habits in low-income, ethnic minority groups have been identified. In this study, factors associated with healthy and unhealthy eating habits and intent to change eating habits were examined in a sample of law-income Black and Latino women. Methods. Survey questionnaires designed to identify correlates of healthy eating habits were administered to 243 Black and Latino women whose children were enrolled in Head Start programs in South Central Los Angeles. Results. Having health insurance, lower perceived susceptibility to cancer, and higher levels of social support were significantly related to healthy eating habits. Exposure to domestic violence, lower income and knowledge of risk factors, and lower perceived efficacy in changing health outcome were associated with lower levels of intent to change eating habits. Conclusions. Economic factors such as insurance coverage and level of social support should be considered in evaluating and addressing eating habits in low-income, ethnic minority women. Exposure to domestic violence and self-efficacy may also be related to intent to change eating habits in these groups.     

Improving the quality of packed lunches in primary school children

Background: The National Diet and Nutrition Survey of young people in Britain aged 4–18 years suggested that for many children intakes of saturated fat and sugars were high (Gregory et al., 2000). Children were eating less than half the recommended five portions of fruit and vegetables a day and 20% of 4–18 year olds ate no fruit at all in an average week (Department of Health, 2004). Community dietitians addressed healthy eating in schools through the development of School Nutrition Action Groups. The aim was to encourage children to make healthy choices at lunch. Methods: During October 2005 to July 2008, 2751 packed lunches from 5–11‐year‐old children were surveyed by a dietitian and dietetic assistant in nine West Berkshire primary schools. The survey was conducted before and 6 months after healthy eating initiatives around the lunchtime meal were introduced. Collected data included the number of food groups (dairy, vegetable/fruit, carbohydrate, protein), the number of fat and sugary foods, and type of drink in a packed lunch . Data analysis was carried out using SPSS (SPPS Inc., Chicago, IL, USA). Inferential statistics of chi‐squared and the Mann–Whitney U‐test were used to determine significant differences between variables (P < 0.05). Results: The analysis showed that post‐intervention packed lunches included significantly less high fat high sugar items and sugary drinks (Table 1) and significantly more fruit and vegetables (Table 2).

Table 1. The number of children eating two or more fatty/sugary foods and number of children having high sugar drinks pre‐ and post‐intervention

Coverage of Aboriginal and Torres Strait Islander nutrition in the Koori Mail

Objective : To examine the extent and nature of coverage of nutrition in the Koori Mail. Methods : Content and framing analysis were used to examine articles in the Koori Mail published between 2013 and 2017 that included the terms ‘nutrition?’, ‘diet?’, ‘food’, ‘eating’, ‘weight’, ‘tucker’ or ‘sugary drinks’. The analysis focused on the portrayal of Aboriginal and Torres Strait Islander people/communities, inclusion of First Peoples’ voices and the framing of nutrition issues. Results : A total of 102 articles were included. Most articles (88%, n=90) portrayed Aboriginal and Torres Strait Islander communities in a neutral or positive way and more than half (53%, n=54) included an Aboriginal or Torres Strait Islander voice. While nutrition was often framed as an individual or community responsibility, articles predominantly promoted programs or initiatives undertaken in local communities. Conclusion : Despite the limited prominence of Aboriginal and Torres Strait Islander nutrition in the mainstream media, the coverage of nutrition issues in the Koori Mail demonstrates the salience of this topic for local communities. This study highlights how journalism can better reflect the diversity and strengths of First Peoples. Implications for public health : Including more Aboriginal and Torres Strait Islander voices and using a strengths‐based approach in press releases may improve media advocacy.     

The food consumption patterns and perceptions of dietary advice of older people

Background Prevention policies do not have an upper age limit, and as the overwhelming majority of older people continue to reside in the community there is a growing role for community dietetics and primary care team members in the promotion of healthy eating.
Method The multi-method project ascertained the dietary beliefs and practices of older people residing in high-income, low-income and rural localities of Scotland. One hundred and fifty-two people aged 75 years and over were interviewed using a semistructured interview schedule and 24-h food recall questionnaire.
Results An analysis of the food recall questionnaire demonstrated that the diets of the elderly appear to differ little from the Scottish population as a whole. In all groups there was an under consumption of fruits and vegetables reported. Findings from the interviews demonstrated that dietary beliefs were found to be firmly rooted in childhood and lifetime experiences. Participants defined healthy eating as 'proper meals', 'proper foods', and a variety of foods eaten in moderation. These definitions were based upon the consumption of fresh foods which would be considered healthy. Changing and conflicting advice on health and nutrition was contrasted with personal experiences. Few knew of the role of the dietitian or community dietitian.
Conclusions This study demonstrates a contrast between stated beliefs and actual consumption patterns. Access to food, and the cost and quality of foods impacted upon food practices. The role of the community dietitian should be promoted. Advice on healthy eating must work with contemporary practices and beliefs building upon positive aspects of diet and eating and involving the food industry, retail sector and health services.     

Mineral content of traditional leafy vegetables from western Kenya

Socio-economic changes that have taken place in Africa have influenced people's eating habits in both rural and urban set-ups. Most people prefer introduced foods to traditional foods, including plant foods whose consumption is widely regarded as a primitive culture manifesting poor lifestyles. However, recent studies on traditional plant foods have shown that some are highly nutritious; containing high levels of both vitamins and minerals. They also have potential as a remedy to counter food insecurity since most are well adapted to the local environment, enabling them to resist pests, drought and diseases. This paper describes the mineral (calcium, iron and zinc) contents in some 54 traditional vegetable species collected from Nyang'oma area of Bondo district, western Kenya. Atomic absorption spectroscopy was used to determine the mineral content. We found that most traditional leafy vegetables, domesticated and wild, generally contain higher levels of calcium, iron and zinc compared with the introduced varieties such as spinach (Spanacia oleracea), kale (Brassica oleracea var. acephala) and cabbage (Brassica oleracea var. capitata). The results of this study could contribute towards identification, propagation and subsequent domestication and cultivation promotion of nutrient-rich and safe species within the farming systems of the local communities in Kenya, sub-Saharan Africa or elsewhere.     

'We should change ourselves, but we can't': accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts.

Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones.

Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be ‘dangerous’ and detrimental to their diabetes control. Respondents described such foods as ‘strength-giving’, and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines.

Conclusions. Perceptions that South Asian foodstuffs necessarily comprise ‘risky’ options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed.     

Using Geographic Information Systems and Local Food Store Data in California's Low-Income Neighborhoods to Inform Community Initiatives and Resources

Objectives. We examined conditions in California low-income neighborhoods that affect obesity to inform program planning, nutrition education, community participation, investment of resources, and involvement of stakeholders.Methods. Staff members in 18 local health departments were trained to use an online geographic information system (GIS) and conduct field surveys. GIS data were aggregated from 68 low-income neighborhoods of 1 or more census tracts. Data were collected in 2007 to 2009 from 473 grocery stores in 62 neighborhoods.Results. Thirty-one percent of neighborhoods mapped had no supermarket within any of their census tract boundaries, but health department staff members estimated that 74.2% of residents had access to a large grocery store within 1 mile. Eighty-one percent of small markets sold produce, and 67.6% offered 4 or more types of fresh vegetables.Conclusions. Small markets and corner stores in California''s low-income neighborhoods often have fresh produce available for sale. Stores providing healthy options in typically underserved areas can be part of community efforts to promote healthy eating behaviors.As the obesity epidemic continues to escalate across the nation,^1–5 community factors most likely to reverse the trend become increasingly important. The Centers for Disease Control and Prevention recently recommended community strategies to prevent obesity, including improving access to healthy local foods, providing incentives for food retailers to carry healthier options, and limiting advertisements of less healthy foods.⁶ The American Reinvestment and Recovery Act seeks to mobilize communities to create neighborhoods that sustainably support healthy lifestyles and ameliorate the obesity epidemic.⁷Reliable data on the local food environment can inform decisions about which actions are appropriate at the community level and which neighborhoods are at highest need for resources. Local data derived from geographic information system (GIS) mapping and field surveys that describe the neighborhood environment and the types of food available in neighborhoods can help guide local efforts. The Network for a Healthy California (the Network) of the California Department of Public Health uses GIS mapping and store surveys to examine food store conditions in low-income neighborhoods as part of the program Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention (CX³).     

Community nutrition education for people with coronary heart disease—who attends?

Abstract: A qualitative food-frequency questionnaire was administered by mail to a representative sample of 137 people previously diagnosed with possible or definite myocardial infarct. Seventy-eight per cent of subjects returned a completed questionnaire and were subsequently invited to attend local tastings of foods with the National Heart Foundation Tick of Approval. These tastings were organised and promoted with the active involvement of the local branch of the Australian Cardiac Association. The purpose of this study was to measure voluntary participation by people with coronary heart disease in community nutrition education and to identify any self-selection bias with respect to eating habits among the participants. A dietary risk score, which was the proportion of all food choices that were high in fat, was calculated from the data. Eighteen per cent of subjects who answered also participated in the food tastings; there was a statistically significant association between membership of the Australian Cardiac Association and being a participant. Participants had a significantly lower risk score (P < 0.01) after adjustment for age, sex and membership of the association. The results suggest that voluntary participation by people with heart disease in community nutrition education is low and that there is a self-selection bias, with those at highest dietary risk being least likely to attend. The use of existing community networks to recruit participants is also discussed.     

Can we count? Enumerating births in two remote Aboriginal communities in the Northern Territory

Objective: To examine the accuracy of birth counts for two remote Aboriginal communities in the Top End of the Northern Territory. Methods: We compared livebirth counts from community birth records with birth registration numbers and perinatal counts. Results: For 2004–06, for Community 1, there were 204 recorded local livebirths, 190 birth registrations and 172 livebirths in perinatal data. In Community 2, the counts were 244, 222 and 208, respectively. The mean annual number of babies, indicating service requirements for babies and their mothers, ranged from 57 to 68 (depending on source) in Community 1, and from 69 to 81 in Community 2. Most differences were for births to Aboriginal mothers. Births to ‘visitors’ accounted for 16 births in Community 1 and 30 cases in Community 2. Conclusion: Birth registration and perinatal data apparently underestimate community birth counts at a local level. Mobility of Aboriginal women seems to partly explain this. Implications: The differences in birth counts have important implications for local planning in relation to demand on housing, health and education services. The number of births is also a critical data requirement for measuring infant health status, including mortality rates, with measures of disadvantage strongly influenced by the number of births. Aboriginal mobility is not a ‘data problem’, but an integral part of Aboriginal life that needs to be catered for in administrative data collections in the Northern Territory.     

Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community

Community problems have been associated with higher, and community resources and social cohesion with lower, blood pressure. However, prior studies have not accounted for potential confounding by residential racial segregation. This study tested associations between community characteristics and blood pressure levels and prevalent hypertension in a racially integrated community. The Exploring Health Disparities in Integrated Communities Study measured blood pressure in residents of two contiguous racially integrated and low-income US Census Tracts. Community characteristics included a standardized community problem score and binary indicators for community social cohesion, having a community leader available, and having at least one community resource observed on the participant’s block. In adjusted models, greater community problems and proximity to resources were associated with lower systolic (β = −2.020, p = 0.028; β = −4.132, p = 0.010) and diastolic (β = −1.261, p = 0.038; β = −2.290, 0.031) blood pressure, respectively, among whites (n = 548). Social cohesion was associated with higher systolic (β = 4.905, p = 0.009) and diastolic blood pressure (β = 3.379, p = 0.008) among African Americans (n = 777). In one racially integrated low-income community, community characteristics were associated with blood pressure levels, and associations differed by race. Directions of associations for two findings differed from prior studies; greater community problem was associated with lower blood pressure in whites and community social cohesion was associated with higher blood pressure in African Americans. These findings may be due to exposure to adverse environmental conditions and hypertensive risk factors in this low-income community.     

Development of the Community Healthy Living Index: A tool to foster healthy environments for the prevention of obesity and chronic disease

ObjectivesThis paper presents a new, comprehensive tool for communities to assess opportunities for active living and healthy eating and to mobilize all sectors of society to conquer obesity and chronic disease.MethodRelevant existing tools and input from an expert panel were considered to draft the Community Healthy Living Index (CHLI). CHLI covers five major sectors where people live, work, learn, and play: schools, afterschools, work sites, neighborhoods, and the community-at-large. CHLI and the accompanying procedures enable community teams to assess programs, the physical environment, and policies related to healthy living and to plan improvement strategies. In 2008, with local YMCAs acting as conveners, community assessment teams from six US communities pilot-tested CHLI for cognitive response testing, inter-rater reliability, and implementation feasibility. CHLI was revised to reflect the test results.ResultsPilot analyses demonstrated that the process was feasible, with most questions being interpreted as intended and showing substantial to almost perfect agreement between raters. The final CHLI is being disseminated nationally.ConclusionsPreliminary data illustrate CHLI obtains reliable results and is feasible to implement. CHLI is a promising tool for community-based prevention efforts to draw attention to opportunities for healthy living and create impetus for community changes.     

Peer Reviewed: Community Health: A Critical Approach to Addressing Chronic Diseases

Many public health solutions to chronic diseases involve individual lifestyle choices: eating more healthfully, increasing physical activity, and quitting smoking. This approach neglects barriers in the community environment that make modifying unhealthy behaviors challenging. Addressing environmental barriers is an essential strategy to supporting behavioral changes. Changing community environments that contribute to unhealthy behaviors can improve community health.

Community indicator reports can be used to strengthen community environments for optimum health. The reports are comprehensive evaluations of community well-being that reflect community factors that influence health. Prevention Institute studied community indicator reports for The California Endowment and produced Good Health Counts: A 21st Century Approach to Health and Community for California. This commentary on that document highlights recommendations for the use of community indicator reports.