Ashley V. Medina

A Picture of the Healthful Food Environment in Two Diverse Urban Cities

Background Local food environments influence fresh produce purchase and consumption, and previous research has found disparities in local food environments by income and ethnicity. Other existing studies have begun to quantify the distribution of food sources, but there has been limited attention to important features or types of healthful food that are available or their quality or cost. Two studies assessed the type, quantity, quality and cost of healthful food from two diverse urban cities, Kansas City, Kansas and Missouri and Honolulu, Hawaii, and evaluated differences by neighborhood income and ethnic composition. Method A total of 343 food stores in urban neighborhoods were assessed using the one-page Understanding Neighborhood Determinants of Obesity (UNDO) Food Stores Assessment (FSA) measuring healthful foods. US Census data were used to define median household income and ethnic minority concentration. Results In Study 1, most low socioeconomic status (SES), high ethnic minority neighborhoods had primarily convenience, liquor or small grocery stores. Quality of produce was typically lower, and prices of some foods were more than in comparison neighborhoods. In Study 2, low SES neighborhoods had more convenience and grocery stores. Farmers’ markets and supermarkets had the best produce availability and quality, and farmers’ markets and pharmacies had the lowest prices. Conclusions Messages emphasizing eating more fruits and vegetables are not realistic in urban, low SES, high ethnic concentration neighborhoods. Farmers’ markets and supermarkets provided the best opportunities for fresh produce. Increasing access to farmers’ markets and supermarkets or reducing prices could improve the local food environment.

Mediating Effects of Group Cohesion on Physical Activity and Diet in Women of Color: Health Is Power

Purpose. To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention. Design. Longitudinal design. Setting. Harris County and Travis County, Texas. Participants. Community-dwelling African-American and Hispanic or Latina women. Intervention. Three hundred ten women were randomized to a PA (n = 204) or VF (n = 106) intervention group. Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption. Measures. Women completed the International PA Questionnaire, National Cancer Institute VF and fat screeners, PA Group Environment Questionnaire, and 7-day accelerometer protocol at baseline and post-intervention. Analyses. The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model, controlling for baseline values and covariates using path analysis. Results. Women were middle aged (mean = 44.4 years) and overweight or obese (mean body mass index = 34.0 kg/m2). PA increased and fat consumption decreased for both groups, whereas VF consumption increased for women in VF group only (all p <. 05). Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes. Conclusions. Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women, but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid.

Health is Power: an ecological, theory-based health intervention for women of color.

OBJECTIVE Physical inactivity and poor dietary habits plague Americans as health challenges, with women of color most vulnerable to their detrimental effects. Individually focused interventions have not demonstrated lasting success, possibly due to the lack of focus on sustainable social and physical environment factors. This manuscript describes the rationale, design and methodology of Health Is Power (HIP), a transcultural, community based, randomized controlled trial that investigated the effectiveness of a group cohesion intervention to increase physical activity and improve dietary habits in African American and Hispanic or Latina women in Houston and Austin, Texas. METHODS The intervention development was guided by group dynamics principles anchored within an ecologic model. RESULTS Women participated in three health assessments and a six month face to face intervention that included evidence-based behavioral methods - integrated into strategies to promote group cohesion - framed to account for environmental factors contributing to health disparities. Women participated in team building activities, environmental mapping exercises, and supervised walks or taste tests. CONCLUSIONS Neighborhood contextual and environmental measures are described to test ecologic factors that may contribute to behavioral maintenance. Theoretically guided interventions that account for multiple levels of influence in behavior initiation and maintenance stand to improve health outcomes in vulnerable populations.

Neighborhood sampling: how many streets must an auditor walk?

This study tested the representativeness of four street segment sampling protocols using the Pedestrian Environment Data Scan (PEDS) in eleven neighborhoods surrounding public housing developments in Houston, TX. The following four street segment sampling protocols were used (1) all segments, both residential and arterial, contained within the 400 meter radius buffer from the center point of the housing development (the core) were compared with all segments contained between the 400 meter radius buffer and the 800 meter radius buffer (the ring); all residential segments in the core were compared with (2) 75% (3) 50% and (4) 25% samples of randomly selected residential street segments in the core. Analyses were conducted on five key variables: sidewalk presence; ratings of attractiveness and safety for walking; connectivity; and number of traffic lanes. Some differences were found when comparing all street segments, both residential and arterial, in the core to the ring. Findings suggested that sampling 25% of residential street segments within the 400 m radius of a residence sufficiently represents the pedestrian built environment. Conclusions support more cost effective environmental data collection for physical activity research.

The concordance of directly and indirectly measured built environment attributes and physical activity adoption

BackgroundPhysical activity (PA) adoption is essential for obesity prevention and control, yet ethnic minority women report lower levels of PA and are at higher risk for obesity and its comorbidities compared to Caucasians. Epidemiological studies and ecologic models of health behavior suggest that built environmental factors are associated with health behaviors like PA, but few studies have examined the association between built environment attribute concordance and PA, and no known studies have examined attribute concordance and PA adoption.PurposeThe purpose of this study was to associate the degree of concordance between directly and indirectly measured built environment attributes with changes in PA over time among African American and Hispanic Latina women participating in a PA intervention.MethodWomen (N = 410) completed measures of PA at Time 1 (T1) and Time 2 (T2); environmental data collected at T1 were used to compute concordance between directly and indirectly measured built environment attributes. The association between changes in PA and the degree of concordance between each directly and indirectly measured environmental attribute was assessed using repeated measures analyses.ResultsThere were no significant associations between built environment attribute concordance values and change in self-reported or objectively measured PA. Self-reported PA significantly increased over time (F(1,184) = 7.82, p = .006), but this increase did not vary by ethnicity or any built environment attribute concordance variable.ConclusionsBuilt environment attribute concordance may not be associated with PA changes over time among minority women. In an effort to promote PA, investigators should clarify specific built environment attributes that are important for PA adoption and whether accurate perceptions of these attributes are necessary, particularly among the vulnerable population of minority women.

SALSA: SAving lives staying active to promote physical activity and healthy eating

Physical inactivity, poor dietary habits, and obesity are vexing problems among minorities. SAving Lives, Staying Active (SALSA) was an 8-week randomized controlled crossover design, pilot study to promote regular physical activity (PA) and fruit and vegetable (FV) consumption as a means to preventing weight gain among women of color. Participants completed measures of demographics, PA, and dietary habits. Women (N = 50; M = 42 years) who participated were overweight (MBMI = 29.7 kg/m2; Mbody fat = 38.5%) and reported low levels of leisure time PA (M = 10.7 MET-min/wk) and FV consumption (M = 4.2 servings/day). All were randomized to a four-week (1) semiweekly Latin dance group or (2) internet-based dietary education group. All participants reported a significant increase in weekly leisure time PA from baseline (M = 10.7 MET-min/wk) to follow up (M = 34.0 MET-min/wk, P < .001), and FV consumption increased over time by group (P = .02). Data suggest that Latin dance interventions to improve PA and web-based interventions to improve dietary habits show promise for improving health among women of color.

Reach and representativeness of ethnic minority women in the Health Is Power Study: a longitudinal analysis.

Reach is a key factor in translating research to practical application. This study examined reach and representativeness of a multi-city, randomized controlled community health trial in African American (AA) and Hispanic or Latina (HL) women. Participants completed measures of demographics, body mass index (BMI), percent body fat, resting heart rate, and blood pressure followed by a run-in procedure and a randomization meeting. AA were more likely to be screened out initially; HL were more likely to drop out. Participation did not differ by city or recruitment method. Women who completed the post-intervention assessment were more likely to be AA, older, and have higher socioeconomic status (p values < .05). This study showed moderate levels of reach but overrepresented higher educated, wealthier, and older women at the completion of the study. Representativeness can change over the course of the study and impact the practicality of translating research to practice.

Erratum to: Reach and representativeness of ethnic minority women in the Health Is Power Study: a longitudinal analysis (Translational Behavioral Medicine, (2017), 7, 1, (106-114), 10.1007/s13142-016-0385-9)

Authors have no conflict of interest to report. Compliance with ethical standards: All procedures followed were in accordance with the ethical standards of the responsible committee onhuman experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. Center for Health Promotion and Disease Prevention, College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ 85004, USA Department of Psychology, Jackson State University, 1400 J.R. Lynch Street, LIB Rm 232, Jackson, MS 39217, USA Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA 16802, USA Texas Obesity Research Center, Department of Health and Human Performance, University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX 77204-6015, USA Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198, USA Correspondence to: R Lee releephd@yahoo.com