Alec M. Chan-Golston

Proyecto MercadoFRESCO: A Multi-level, Community-Engaged Corner Store Intervention in East Los Angeles and Boyle Heights

Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents’ access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.

Substantial improvements not seen in health behaviors following corner store conversions in two Latino food swamps.

BackgroundThe effectiveness of food retail interventions is largely undetermined, yet substantial investments have been made to improve access to healthy foods in food deserts and swamps via grocery and corner store interventions. This study evaluated the effects of corner store conversions in East Los Angeles and Boyle Heights, California on perceived accessibility of healthy foods, perceptions of corner stores, store patronage, food purchasing, and eating behaviors.MethodsHousehold data (n = 1686) were collected at baseline and 12- to 24-months post-intervention among residents surrounding eight stores, three of which implemented a multi-faceted intervention and five of which were comparisons. Bivariate analyses and logistic and linear regressions were employed to assess differences in time, treatment, and the interaction between time and treatment to determine the effectiveness of this intervention.ResultsImprovements were found in perceived healthy food accessibility and perceptions of corner stores. No changes were found, however, in store patronage, purchasing, or consumption of fruits and vegetables.ConclusionsResults suggest limited effectiveness of food retail interventions on improving health behaviors. Future research should focus on other strategies to reduce community-level obesity.

Correlates of Social Support and Its Association with Physical Activity among Young Adolescents.

Background. A substantial proportion of adolescents, particularly girls and minority youth, fail to meet daily physical activity (PA) recommendations. Social support contributes to adolescent PA, but studies examining this relationship have yielded inconsistent results and rarely focus on diverse, urban populations. Aims. This study examines the correlates of support for PA from family and friends and its relationship with PA outcomes among young adolescents. Methods. Data were collected in a cross-sectional survey of 4,773 middle school students. Social support from family and friends was separately measured using the Sallis Support for Exercise Scales. Hierarchical logistic regression models were used to assess correlates of high support and the relationship between support and self-reported PA. Results. Approximately one quarter of students reported being active for at least an hour each day. 31.7% of students reported high family support for PA, while 17.8% reported high friend support. Differences in perceptions of support by gender, ethnicity, and language emerged. Support from family and friends were both consistently strong predictors of all three PA outcomes measured. Discussion. Findings highlight the need for multilevel interventions targeting both psychosocial influences on behavior in addition to addressing the physical environment. Given low rates of friend support for PA, there appears to be an opportunity to increase PA levels through promotion of supportive behaviors among peers. Conclusion. Support for PA from family and friends is a key contributor to increased PA among adolescents. Further research is needed to further understand the mechanisms by which these factors influence PA.

Consistency of Moderate to Vigorous Physical Activity in Middle School Physical Education

This study assessed the consistency of moderate to vigorous physical activity (MVPA) in a sample of middle school physical education lessons. Random intercept hierarchical linear regressions were employed to model the relationship between consistency of MVPA and independent variables, including lesson and teacher characteristics. Larger classes spent significantly more time in consistent MVPA in the absence of controlling for teacher characteristics. A significant interaction between class size and teacher experience suggests that experience may play a beneficial role in larger classes, and overall class size does not have to be a barrier to achieving high levels of MVPA.

A corner store intervention to improve access to fruits and vegetables in two Latino communities

OBJECTIVE Investments have been made to alter the food environment of neighbourhoods that have a disproportionate number of unhealthy food venues. Corner store conversions are one strategy to increase access to fruits and vegetables (F&V). Although the literature shows modest success, the effectiveness of these interventions remains equivocal. The present paper reports on the evaluation of Proyecto MercadoFRESCO, a corner store conversion intervention in two Latino communities. DESIGN A repeated cross-sectional design was employed. Data were stratified by intervention arm and bivariate tests assessed changes over time. Logistic and multiple regression models with intervention arm, time and the interaction of intervention and time were conducted. Supplementary analyses account for clustering of patrons within stores and staggering of store conversions. SETTING Three stores were converted and five stores served as comparisons in East Los Angeles and Boyle Heights, California, USA. SUBJECTS Store patrons were interviewed before (n550) and after (n407) the intervention. RESULTS Relative to patrons of comparison stores, patrons of intervention stores demonstrated more favourable perceptions of corner stores and increased purchasing of F&V during that store visit. Changes were not detected in store patronage, percentage of weekly dollars spent on food for F&V or daily consumption of F&V. CONCLUSIONS Consistent with some extant food environment literature, findings demonstrate limited effects. Investments should be made in multilevel, comprehensive interventions that target a variety retail food outlets rather than focusing on corner stores exclusively. Complementary policies limiting the availability, affordability and marketing of energy-dense, nutrient-poor foods should also be pursued.

T255. WHO PARTICIPATED IN FAMILY WORK IN THE US RAISE-ETP FIRST EPISODE SAMPLE?

Abstract Background The Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) is a US NIMH-funded 34 site cluster randomized controlled trial which evaluated the benefits of participation in a multicomponent intervention, entitled NAVIGATE, for first episode psychosis (FEP). Previously, participation in NAVIGATE was reported to yield significant participant benefits, compared to customary care (Kane et al, 2016). NAVIGATE included tailored medication, individual resiliency training, family education, and supported education and employment. Here we examine the absolute rate of family engagement in professional support services in the intent to treat sample, as well identify predictors of participation. Methods A total of 404 individuals between ages 15 and 40 were enrolled. DSM-IV diagnoses of non-affective psychosis were included. All participants had experienced only one episode of psychosis, had been prescribed less than 6 months of lifetime psychotic medication, spoke English, and provided informed consent. Participants were offered a minimum of two years of NAVIGATE or customary care (CC). At baseline, participants provided demographic and clinical history information; they were administered the Heinrichs-Carpenter Quality of Life Scale (QOL) and the Positive and Negative Symptom Scale (PANSS). Site research assistants interviewed participants monthly to capture participation in the four types of NAVIGATE interventions, allowing treatment groups to be compared on receipt of key services. Results One hundred nineteen of the 404 participants (29.4%) reported their relatives attending five or more family sessions within the first year of randomization (102 families (45.74%) in NAVIGATE; 17 (9.39%) in CC). In a simultaneous logistic regression analysis predicting meeting this five family sessions threshold or not, significant independent predictors (all p <. 05) included treatment group, consumer negative symptoms, consumer self-reported quality of family relationship, race, and consumer residence. Relatives were more likely to attend family sessions if their loved one was 1) randomized to NAVIGATE, 2) had greater negative symptoms on the PANSS, 3) self-reported as emotionally closer to the family, 4) was Caucasian, and 5) lived with family. Other consumer PANSS and QOL scores, consumer age, ethnicity, health insurance status, cigarette smoking status, and consumers’ mother education were not significant independent predictors. Discussion Although the benefits of family support and education have been highlighted for persons with a recent onset of psychosis, the results here suggest that engaging relatives in these services, at least in the US, can be challenging. Even given a relatively low threshold of attendance at least 5 family sessions in the first year of treatment, the majority of this sample did not meet the criterion, although participation rates were significantly higher in NAVIGATE. This increase likely reflects the effort NAVIGATE teams expended to engage relatives. It is perhaps not surprising that families of consumers who live with them and/or report feeling closer to them are more likely to attend clinic sessions. Interestingly, higher levels of consumer negative, but not positive symptoms, were also associated with greater attendance at family sessions; this finding suggests that living with a consumer who appears unmotivated and withdrawn may be particularly challenging and prompt relatives to seek more assistance. Finally, our data on race suggest, as other have noted, that greater outreach may be needed to engage non-Caucasian families in services.

F249. FAMILY BURDEN IN THE US RAISE-ETP PROGRAM: TREATMENT EFFECTS AND PREDICTORS

Abstract Background The Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) is a US NIMH-funded 34 site cluster randomized controlled trial evaluating the benefits of participation in a multicomponent intervention for first episode psychosis (FEP). Previously, participation in the RAISE-ETP comprehensive specialty care (CSC) program, entitled NAVIGATE, was reported to yield significant participant clinical and functional improvements, compared to customary care (Kane et al, 2016). NAVIGATE included tailored medication, individual resiliency training, family education, and supported education and employment. Family burden has been identified as a key factor in FEP, with high levels of distress often found in relatives. Here, we look at the presence and predictors of family burden in relatives in the RAISE-ETP sample over the two years of study participation. Methods A total of 404 individuals between ages 15 and 40 were enrolled. DSM-IV diagnoses of non-affective psychosis were included. All participants had experienced only one episode of psychosis, had been prescribed less than 6 months of lifetime psychotic medication, spoke English, and provided informed consent. Participants were offered a minimum of two years of CSC or customary care. At baseline, participants provided demographic and clinical history information; they were administered the Heinrichs-Carpenter Quality of Life Scale (QOL) and the Positive and Negative Symptom Scale (PANSS) regularly throughout the study. Each participant was asked to nominate a family member for administration of the Burden Assessment Scale (BAS) throughout the study. The BAS yields a total score, as well as subscales assessing disrupted activities, personal distress, guilt, time perspective, and worry. Results Fifty-seven percent of the participants nominated a relative who was assessed with the BAS. Interestingly, the only statistically significant independent predictors of baseline family burden were relatives’ reports of their loved ones’ dependence and lack of help with chores; no consumer demographic, PANSS, or QOL variables were identified. BAS total scores improved significantly in both conditions, but significantly more in NAVIGATE. Consumer report of better family relationship quality on the QOL was associated with significantly less family burden on the BAS over time, but neither PANSS positive, negative or symptom total, total QOL, nor participation in specific CSC psychosocial components mediated the observed BAS total burden reductions. With regard to the BAS burden components, there was a main effect of improvement over time on family disrupted activities, guilt, time perspective, and worry, with disrupted activities, personal distress, and guilt all evidencing a time by group interaction favoring greater reductions in NAVIGATE. Discussion As anticipated, family burden is widely evidenced in the relatives of US FEP consumers who are new to treatment. This burden does not appear to reflect unique consumer characteristics. There appears to be a reduction in family burden during the loved one’s FEP treatment, with that reduction enhanced when the consumer is participating in a more intensive CSC program. Interestingly, while many potential intervening variables were tested as mediators of the CSC impact on family burden, none were identified. The overall pattern of results suggests that it maybe the very fact of a loved one being enrolled in a treatment program, especially if it is a comprehensive FEP intervention, rather than engagement in specific program components or consumer improvements, that are associated with reductions in family burden over the first year of treatment.

Physical Activity Correlates in Middle School Adolescents: Perceived Benefits and Barriers and Their Determinants:

The purpose of this study was to examine the determinants of benefits and barriers and their relationship with physical activity (PA) among predominantly Latino middle school students. Data were collected in a cross-sectional survey of 4,773 seventh-grade students recruited from a large, urban school district in Los Angeles. Hierarchical logistic regression models were used to assess determinants of benefits and barriers as well as their association with self-reported PA. Differences in benefits and barriers were observed by gender, ethnicity, and body size. Barriers were negatively correlated with all three PA outcomes while benefits were positively associated with exercising at least 60 min daily. A deeper understanding of benefits and barriers can facilitate the development of interventions and collaborative efforts among physical education teachers, school nurses, and administrators to implement comprehensive approaches that encourage students’ participation in PA inside and outside of the classroom.

Assessing quality of care through client satisfaction at an interprofessional student-run free clinic

ABSTRACT Student-run free clinics (SRFCs) have become important contributors not only to improve access to primary-care services for homeless and uninsured populations but also to enhance health sciences student education. In order for SRFCs to reliably provide high quality healthcare services and educationally benefit students, it is imperative to assess client perceptions of the quality of care provided. The objective of this study was to evaluate the delivery of healthcare services through a client satisfaction questionnaire at the University of California, Los Angeles Mobile Clinic Project (UCLA MCP). From 2012 to 2015, 194 questionnaires that addressed demographic information, satisfaction with services and client outcomes were analysed. Satisfaction scores were evaluated on a four-point scale and differences in the composite satisfaction scores were assessed using Mann–Whitney U-tests. Half (50%) of the client respondents report that UCLA MCP is their primary source of health care (MCP primary care clients), while 81.3% reported that the clinic improved access to other healthcare resources. Overall, clients are highly satisfied with their experiences (Range: 3.5–3.9) and 62% have recommended our services to others. While MCP primary-care clients report significantly higher satisfaction scores than non-primary-care clients on average (p < 0.01), the mean composite scores for all subgroups are consistently high. The UCLA MCP clients perceive the clinic to provide high-quality healthcare services. This article presents a framework that may help other SRFCs evaluate clients’ perception of the quality of their care, an essential building block for effective physician–client relationships.

Community Residents’ Beliefs About Neighborhood Corner Stores in 2 Latino Communities: Implications for Interventions to Improve the Food Environment

ABSTRACT We assessed community residents’ perceptions of corner stores to better understand what facilitates and deters patronage at these food outlets. Data came from 978 household interviews in 2 Latino communities undergoing corner store interventions. Chi-square tests, an independent sample t test, and a multivariate logistic regression were conducted to assess the relationship between residents’ perceptions about corner stores and their reported patronage at these food outlets. Residents reported that corner stores do not sell a variety of fruits and vegetables and are not places where one can get information about healthy eating. Convenience, cleanliness, positive customer service, availability of culturally appropriate items, and availability of quality fresh fruit increased the odds of store patronage. Simply providing healthy foods will not incentivize patrons to purchase them. Corner store interventions can be more effective if they address the characteristics that community residents prioritize.