Nancy Romero-Daza

A comparison of the nutritional status and food security of drug-using and non-drug-using Hispanic women in Hartford, Connecticut

This study compared food insecurity, nutritional status (as measured through anthropometry and dietary intake), and food preparation patterns of low-income Puerto Rican female out-of-treatment drug users with that of low-income Puerto Rican women who reported no drug use. A convenience sample of 41 drug users was compared with 41 age-matched non-drug-users from inner-city Hartford, Connecticut. A culturally appropriate food frequency questionnaire was administered and anthropometric measurements were taken. The findings suggest a high degree of poverty among all study participants, but in particular among drug users. Drug users were more likely than the controls to be food insecure (P < 0.05) and to be exposed to increasingly severe food sufficiency problems. The daily frequency of consumption of vegetables was lower (P = 0.03) for drug users than non-drug-users. Conversely, the frequency of consumption for sweets/desserts was significantly higher for drug users than the controls (P = 0.0001). Drug users, who were classified as food insecure were less likely to consume vegetables (P = 0.004) and fish (P = 0.03) than were controls who were food insecure. When comparing drug users with controls, the former group reported consuming fewer meals during a usual week than the latter group (P < 0.0001). Drug users were more likely to fry foods (P = 0.02) while the controls were more likely to bake (P = 0.005), boil (P = 0.02), and steam (P = 0.002) foods. All anthropometric measurements, except for height, were significantly lower for drug users. The results show that drug users generally maintain poorer nutritional status than non-drug-users. Nutrition interventions as part of drug treatment are needed.

Addressing the HIV/AIDS–food insecurity syndemic in sub-Saharan Africa

Recently a few vocal health experts have suggested that some of the billions of dollars currently used to prevent and treat HIV and AIDS be reallocated to address more basic problems such as malnutrition, tuberculosis, malaria, and enteric and diarrheal disease caused by lack of access to clean water. While not universally agreed upon, this reassessment of policy priorities acknowledges that there are multiple other health problems that deserve renewed attention from the international community. It also highlights the fact that the impacts of the HIV pandemic are exacerbated by widespread poverty, food insecurity and malnutrition, and gender inequality. Nowhere is this more evident than in sub-Saharan Africa, where multiple epidemics conflate and seriously compromise the survival of individuals and communities. Given the widespread occurrence of famine in sub-Saharan Africa, issues of food and economic security become of paramount importance in efforts to address the regions HIV epidemics. This paper examines the historical, political-economic, and cultural dimensions of the HIV epidemic in the context of the growing problem of food and economic insecurity. Furthermore, using theoretical frameworks that emphasize the dynamic interrelation between HIV/AIDS and food insecurity, we present suggestions for combining traditional HIV-prevention strategies with food production and nutritioneducation programming. In light of the complex interactions between HIV/AIDS and food insecurity and the lack of accessible treatment modalities, such programming could potentially reduce the risk for transmission of HIV through behavioural changes and improved nutritional and immune status, and increase the life expectancy of people living with HIV or AIDS.

Community-Based AIDS Prevention: Preliminary Outcomes of a Program for African American and Latino Injection Drug Users

This paper presents preliminary outcomes of a community-based AIDS prevention program for drug users called Project COPE II, the National Institute on Drug Abuse (NIDA) cooperative agreement study in Hartford, Connecticut. COPE IIs efficacy study compares the NIDA standard intervention against two culturally targeted, enhanced interventions, one for African Americans and one for Puerto Ricans. A sample of 188 out-of-treatment injection drug users (IDUs) with matched baseline and 6-month follow-up interviews were compared for changes in monthly injection rates and proportionate use of new and pre-used needles and used injection supplies. Effects of injection outliers, attrition, and ethnic differences were examined for impact on outcome measures and to identify subgroups within the study population for whom the intervention had differential effects. These preliminary analyses suggest that attendance in culturally targeted enhanced interventions may increase the likelihood of positive program outcome, including drug-related risk reduction for some populations. However, subgroups of IDUs, such as extremely high injectors or individuals who drop out before initiating or completing the program, may require different intervention approaches. Further research is needed to understand the relationship between intervention and behavior change, reasons for attrition, and moderating factors affecting project outcomes.

Food habits of drug‐using Puerto Rican women in inner‐city Hartford

Research on the impact of heroin, cocaine, and other drugs on the dietary patterns of drug users is limited. This paper presents qualitative data from Project SANA (Salud y Nutricion en Addicion/Health and Nutrition in Addiction) on the food habits of drug‐using Puerto Rican women in inner‐city Hartford, Connecticut. The results indicate that both the quantity and the quality of food intake are inadequate in this group of women. The physiological and psychological effects of drugs, coupled with poverty, homelessness, and difficulty in accessing food assistance, jeopardize the health and well‐being of drug users and their children. The results underscore the importance of integrating nutrition education with drug‐treatment services for drug‐using women in the inner city.

Traditional Medicine in Africa

Traditional medicine is the main, and often the only, source of medical care for a great proportion of the population of the developing world. Systems of traditional medicine are usually rooted in long-standing cultural traditions, take a holistic approach to health, and are community based. The World Health Organization has long recognized the central role traditional systems of care can play in efforts to provide primary health care, especially in rural areas. This article provides an overview of national policies adopted by African governments following World Health Organization recommendations for the incorporation of traditional and allopathic systems of care.

Development of a Color-Coded Bilingual Food Label for Low-Literacy Latino Caretakers

Abstract The purpose of this study was to develop a bilingual, user-friendly food label (UFFL) for low-literacy audiences. The UFFL developed was based on (a) a quantitative and qualitative needs assessment of Food and Drug Administration (FDA) food label understanding and use, (b) the development of a UFFL, and (c) a qualitative evaluation of the UFFL. Subjects consisted of a convenience sample (N = 150) of low-income Latino caretakers living in Hartford with children under 6 years of age, who were recruited from local community agencies.The primary outcomes measured in this study were food label use, knowledge, and understanding. Chi-square analyses were conducted to determine relationships between subjects’ socioeconomic status and demographic characteristics with food label use, knowledge, and understanding. Although 96% of respondents were familiar with the FDA food label, only 30% used it routinely when grocery shopping. FDA food label knowledge was positively associated (p ≤ .05) with younger age, level of education, and being an English speaker. A UFFL was developed that included color coding, bilingual text, and a shaded Food Guide Pyramid. Results indicated that participants found the UFFL easy to understand. The UFFL can be used as a nutrition education tool and the methodology developed may help food policy makers to improve the nutrition education value of the FDA food label.

Eliminating “Hunger” in the U.S.: Changes in Policy Regarding the Measurement of Food Security

In 2006, the United States Department of Agriculture (USDA) announced that the word “hunger” would be removed from official policy statements, substituting it with “very low food security.” Technically, this change is valid given that the term “hunger” can have various meanings and that, while the Food Security Supplement (FSS) in the Current Population Survey (CPS) identifies problems with food access and nutritional adequacy at the household level, it does not objectively measure hunger among individuals. Yet, this reframing of policy does not convey the lived experience of “hunger” among Americans in terms of food insecurity. This article examines the potential consequences of this change in policy, and the reasons behind it. To contextualize this discussion, we offer a brief overview of the way in which “hunger” has been defined, and of the history of hunger policy, food assistance, and food security measures in the U.S. In the end, we suggest that although the exclusion of “hunger” may be technically valid, it is important that this term remain part of the food policy lexicon. Omitting “hunger” will only mask the dire conditions experienced by millions of Americans who struggle day-by-day to provide food for their families. This is especially true given the marked increases in the cost of food since mid–2008 and the fact that we are experiencing the worst recession since the Great Depression.

The space between: globalization, liminal spaces and personal relations in rural Costa Rica

Globalization facilitates the movement of people, goods, ideologies and even diseases across borders and into local communities. This article explores the liminal space created by tourism in the rural Costa Rican community of Monteverde as a site where the movement of people, especially Western women (women from the global North), intersects, contests and even reinforces existing heteropatriarchal ideologies. Theories from feminist geography and anthropology provide a lens for understanding and interpreting how Western women and local residents (both male and female) perceive, construct and interact with each other. We argue that ‘liminality’ or the sense of being ‘betwixt and between’ – physically, socially and ideologically – allows Western women a space to both challenge the hegemony of heteropatriarchal ideology and reconstitute it in their sexual relationships with local men. We also explore the implications that sexual relationships between Western women and local men have for local women. We stress the urgency to understand and articulate the nature of these sexual relationships in light of the growing HIV/AIDS epidemic.

Human Papillomavirus Vaccine Knowledge and Attitudes, Preventative Health Behaviors, and Medical Mistrust Among a Racially and Ethnically Diverse Sample of College Women

IntroductionMedical mistrust is associated with disparities in a variety of health outcomes. The human papillomavirus (HPV) vaccine has the potential to decrease disparities in cervical cancer by preventing infection with the virus that causes these malignancies. No study has examined associations between medical mistrust and preventative health behaviors including the HPV vaccine among young minority women.MethodsSelf-reported racial/ethnic minority students completed a web-based survey in fall of 2011. Wilcoxon and Kruskal-Wallis were used to test differences in medical mistrust scores by demographics and health behaviors.ResultsMedical mistrust varied significantly by race with Black women reporting the highest scores. Women with no regular health-care provider (HCP) or who had difficulty talking to their provider had higher mistrust. Higher medical mistrust was associated with a preference to receive HPV vaccine recommendation from a HCP of the same race or ethnicity among unvaccinated women. Black and Asian women who had not received the HPV vaccine had higher mistrust scores than vaccinated women. Perceived difficulty in talking to a HCP was associated with ever having a Pap smear.DiscussionAwareness of medical mistrust and the influence on health behaviors may aid in increasing delivery of quality health services for racial and ethnic minority populations. Further research among different populations is needed to elucidate impacts of medical mistrust and provider communication on preventative health behaviors.

Anthropological perspectives on the challenges to monitoring and evaluating HIV and AIDS programming in Lesotho

This article focuses on how numerous international nongovernmental organisations (INGOs) have stepped forward to provide services related to HIV and AIDS prevention and treatment in Lesotho. We highlight some widely recognised challenges associated with the INGO approach and describe how people working in that sector in Lesotho experience similar challenges, focusing especially on weak or inadequate monitoring and evaluation (M&E). Partially in response to such weaknesses, Lesotho is implementing its ‘Partnership Framework to Support Implementation of the Lesotho National HIV and AIDS Response.’ A major goal for this initiative is to strengthen procedures and methods for M&E. Through examination of a partnership that the authors are cultivating with Catholic Relief Services in Lesotho, we discuss some ways that anthropologists can contribute to formulating M&E processes and procedures that can provide sound measures of outcomes and have the potential to inform programme development.