Elizabeth Garland

Community Supported Agriculture: A Commitment to a Healthier Diet

Community supported agriculture (CSA) is a model of distribution of local agricultural produce in which a farm pairs with a community group that purchases weekly “shares” of produce for a growing season, in the approximate amount of one large grocery bag per week per member. This prospective cohort study investigated whether CSA participation causes an increase in the consumption of fruit and vegetables and the frequency of home-cooked meals. An e-mail-linked survey was distributed to over 10 000 individuals affiliated with a CSA-promoting organization called Just Food in New York City. Those who received and participated in the survey were a mix of active CSA members and those who may be interested in CSA but were not participating that year. Individuals were surveyed twice: before the beginning of the CSA season and about 6 weeks later. The survey administered is an augmented version of the validated National Cancer Institutes (NCI) Eating at Americas Table “All Day Screener.” Of the 1278 individuals who returned the initial survey, 583 completed the follow-up survey. The response rate to the initial survey is unknown and the response rate to the follow-up survey was 46%. Paired data from those who completed both surveys were analyzed. Among CSA members, there was a statistically significant increase in surveyed fruit and vegetable consumption of 2.2 servings per week and 4.9 home-cooked meals per month compared to the CSA nonmembers. Additionally, a high majority of CSA members reported eating half or more of their weekly share individually, which is a substantial, though variable, quantity of produce. CSA participation is also associated with subjective reports of increased fruit and vegetable consumption.

Consumption of fish from polluted waters by WIC participants in east Harlem.

To minimize exposure to neurotoxins such as mercury, polychlorinated biphenyls (PCBs), dioxins, and pesticide residues, the New York State Department of Health issues health advisories about consumption of certain fish and shellfish caught from polluted local waters. Fetal exposure causes cognitive developmental deficits in children. Consumption of fish was assessed. We surveyed 220 WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) participants. Of the participants, 10% ate fish and shellfish caught in local polluted waters. Statistically significant factors associated with eating local, noncommercial fish included male gender and knowledge of the health advisory. Locally caught fish and crabs are consumed; thus, in utero and childhood exposure to these neurotoxins occurs. Interventions to promote safer choices of fish are needed.

Prevalence of Human Immunodeficiency Virus Testing in Patients With Hepatitis B and C Infection

OBJECTIVES To determine the proportion of patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) who are adequately assessed for human immunodeficiency virus (HIV) and to identify variables associated with absence of HIV testing. PATIENTS AND METHODS We retrospectively reviewed the medical records of patients who had positive serologic test results for reactive HBV and/or HCV between January 1999 and December 1999 and were followed up at a general internal medicine clinic in East Harlem, NY. Data were collected on patient demographics, HIV risk factors, and other variables that might influence the physicians decision to test the patient for HIV. Primary outcomes were HIV tests performed and documented discussions of at-risk HIV behavior. RESULTS The HIV tests were performed in 40% (95% confidence interval [CI], 32%-49%) of the 141 patients with reactive HBV and/or HCV serologic test results. Predictors of HIV testing on multivariate logistic regression were age younger than 50 years (odds ratio [OR], 25; 95% CI, 13-3.8), male sex (OR, 1.6; 95% CI, 1.1-2.2), and having an established primary care provider (OR, 2.3; 95% CI, 1.2-3.9). Injection drug use was not significantly associated with HIV testing. CONCLUSIONS Although HBV and HCV have clear epidemiological links with HIV, this study shows that a high percentage of these patients are not being tested. Although some of the factors associated with lack of testing were identified, further studies on the barriers to HIV testing are needed to reveal potential approaches to increase rates of HIV testing in this high-risk population.

Impact of LEED-Certified Affordable Housing on Asthma in the South Bronx

Background: Green housing reduces energy costs and may mitigate indoor allergens and pollutants, improving asthma morbidity. High asthma burden is seen in low-income neighborhoods. Past studies show improvements in respiratory symptoms when living in green homes. Objective: Develop partnership with Blue Sea Development Company to determine impacts of living in Melrose Commons V (MCV), a Leadership in Energy and Environmental Design (LEED) Platinum-certified affordable housing complex, on asthma in the South Bronx. Methods: Participants completed a home-based respiratory health questionnaire before moving into MCV. Follow-up occurred at 6, 12, and 18 months post-move. A home-based educational module was delivered on indoor environmental interventions to avoid asthma triggers. A pretest was given before the module and a posttest was given 9 months later, including an evaluation of behavioral practice changes. Results: Outcomes included decreases in continuous daily respiratory symptoms (p < .001), asthma symptoms disrupting sleep in the past month (p = .028), and urgent visits to a healthcare professional for asthma in the past 3 months (p = .038). Clinically relevant outcomes included fewer days with asthma symptoms; asthma episodes; days of work, school, or daycare missed; and emergency department visits. Education changes from pretest to posttest included increased knowledge about dust mites, roaches, mold, and chemical irritants (p = .007). Common behavioral changes included using hypoallergenic mattress covers, using green cleaning products, and eliminating bedroom carpets. Conclusions: Findings support the beneficial effect of LEED Platinum-certified buildings on respiratory health. Trends may be clinically and economically relevant. Advocacy efforts should promote the expansion of green housing and emphasize the development of healthy communities.

HPV vaccination: Population approaches for improving rates

ABSTRACT Objective: To review the literature on interventions to increase HPV vaccinations and assess whether The Community Preventive Services Task Force recommendations are supported by current evidence. Methods: We used a PubMed search to identify studies that assessed interventions that looked at provider assessment and feedback, provider reminders, client reminder and recall, and clinic based education programs. Results: Of the 13 studies identified, 8 included client reminder and recall interventions, 4 included provider assessment and feedback and/or provider reminders and 2 included clinic based education. 11 of the 13 studies demonstrated a positive effect on HPV vaccine initiation or completion. Provider assessment and feedback studies were more likely to report a positive effect on HPV vaccine initiation than on series completion, while client reminder recall interventions more frequently produced an effect on series completion than on initiation. Conclusions: There is evidence to support the application of the Community Preventive Services Task Force recommendations specifically to HPV vaccination both for client reminder and recall programs and for provider assessment and feedback interventions. Multiple targeted approaches will be needed to substantially impact HPV vaccine rates.

Stand Up to Work: assessing the health impact of adjustable workstations

Purpose Sedentary behavior is linked to health risks, and prolonged sitting is prevalent among office workers. Adjustable workstations (AWS) promote health by allowing transitions between sitting and standing. Stand Up to Work compares workers with AWS to traditional desks (TD). The paper aims to discuss these issues. Design/methodology/approach Employees were randomly selected from one office floor to receive AWS, two identical floors maintained TD. Participants received workplace wellness and ergonomic training, completed self-administered questionnaires, and responded to repeated micropolling at baseline (T0), 3 (T1), 6 (T2), and 12 (T3) months in Atlanta, 2015-2016. Groups were compared using two-sample t-tests and nonparametric Wilcoxon tests. Findings Compared to TD (n = 24), participants with AWS (n = 24) reported significantly less sedentary behavior at T1 and T2 after AWS installation (p<0.05), with a retention rate at T2 of 80 and 65 percent for the AWS and TD group, respectively. In all, 47 percent of participants with AWS reported decline in upper back, shoulder, and neck discomfort (p=0.04); 88 percent of AWS participants reported convenience to use, 65 percent reported increased productivity, and 65 percent reported positive impact outside the workplace. Individuals with normal or underweight body mass index (BMI) reported a significantly greater decline in percent of time sitting compared to participants with overweight or obese BMI at all three time points. Originality/value AWS are beneficial in reducing sedentary behavior in and outside the workplace. Behavioral changes were sustained over time and associated with less self-reported muscle pain, more self-reported energy, and awareness of standing. When considering total worker health, employers should include options for AWS to promote reducing sedentary behavior.