Renee E. Walker

Pathways connecting neighborhood influences and mental well-being: Socioeconomic position and gender differences ☆

Few studies have explored how participant socioeconomic position (SEP) and gender is related to perceptions of the pathways connecting neighborhood influences and mental well-being. This research used the concept mapping method, an intensive structured conceptualization process that produces pictorial views of how concepts are connected and interrelated. Thirty-six low and non-low SEP men and women from Toronto, Canada participated in the concept mapping sessions. One hundred and twenty unique neighborhood characteristics were felt to be related to mental well-being and those items were grouped into six distinct clusters. Notable differences in cluster importance by participant SEP status were found. While no overall differences were observed for males verses females, further stratification by both participant SEP and gender suggested that gendered perceptions are not uniform. Participant-created diagrams illustrated how the cluster domains are related to each other and to good mental well-being. These findings are important for uncovering the mechanisms by which neighborhoods differentially affect the mental health of residents from different SEPs and genders.

Do residents of food deserts express different food buying preferences compared to residents of food oases? A mixed-methods analysis

BackgroundMany people lack access to food stores that provide healthful food. Neighborhoods with poor supermarket access have been characterized as “food deserts” (as contrast with “food oases”). This study explored factors influencing food buying practices among residents of food deserts versus food oases in the city of Boston, USA.MethodsWe used the mixed-methods approach of concept mapping, which allows participants to identify, list, and organize their perceptions according to importance. Resulting maps visually illustrate priority areas.ResultsSixty-seven low-income adults completed the concept mapping process that identified 163 unique statements (e.g. relating to affordability, taste, and convenience) that influence food buying practices. Multivariate statistical techniques grouped the 163 statements into 8 clusters or concepts. Results showed that average cluster ratings and rankings were similar between residents of food deserts and food oases.ConclusionsThe implication of this study pertains to the importance of community resources and emergency food assistance programs that have served to minimize the burden associated with hunger and poor food access among low-income, urban populations.

Factors Influencing Food Buying Practices in Residents of a Low-Income Food Desert and a Low-Income Food Oasis:

Studies suggest that proximity to a supermarket influences access to healthy foods. However, little is known about factors that influence food buying practices within areas with limited supermarket access. This study identified these factors and explored how they are related and influence healthy eating. Twenty-five men and women engaged in the concept mapping process, a mixed methods approach allowing participants to identify, sort, and rate ideas. Participants generated 121 unique (nonduplicate) statements of factors that influence food buying practices and sorted them into 12 clusters that represented their perceptions. Average cluster ratings for residents with poor supermarket access were higher than residents with supermarket access. Awareness of these factors is important for increasing access to and consumption of healthy foods.

Use of Concept Mapping to Explore the Influence of Food Security on Food Buying Practices

Paradoxically, individuals with food insecurity have been observed to have higher rates of obesity compared with their counterparts with food security. The factors influencing food purchasing behaviors in households with food security vs food insecurity are poorly understood. Using the mixed methods approach of concept mapping, we examined the perceptions and preferences driving the food purchasing behaviors of households with food security vs food insecurity. Twenty-six men and women with food security and 41 men and women with food insecurity from four neighborhoods in Boston, MA, completed the concept mapping process during 2010. Prevalence of overweight and obesity was greater among participants with food insecurity (80.5%) compared with those with food security (61.5%). Participants identified 163 unique factors that influenced their food purchasing behavior. Using multivariate analyses, these factors were grouped into eight unique concepts or clusters that reflected their perceptions of factors hindering healthy eating. Average cluster ratings were similar between participants with food security and food insecurity, suggesting that similar food purchasing behaviors are employed and are perceived similarly in how they hinder or promote healthy eating. The use of emergency food assistance programs may play a role in minimizing the burden of food insecurity while providing access to foods with varying degrees of nutritional quality that may be associated with increased risk of overweight and obesity observed in individuals and households with food insecurity.

Patterns and predictors of health behaviors among racially/ethnically diverse residents of low-income housing developments.

Purpose. To examine behavioral patterns and sociodemographic predictors of diet, inactivity, and tobacco use among a diverse sample of residents from low-income housing developments. Design. In this cross-sectional survey study, households and residents were randomly selected using multistage cluster sampling. Setting. The study was conducted in 20 low-income housing developments in the Boston, Massachusetts, metropolitan area. Subjects. Subjects were 828 residents who completed the survey (response rate = 49.3%). Forty-one percent of participants were Hispanic and 38% were non-Hispanic Black. Measures. Outcomes measured were diet, inactivity, and tobacco use. Predictors measured were age, race/ethnicity, gender, education, country in which the subject was born, language spoken, and financial hardship. Analysis. Logistic regression analyses were conducted to examine the association of three health behaviors with sociodemographic factors. Results. Age, gender, language spoken, and financial hardship showed significant relationships with all three behaviors. For example, those who reported less financial hardship (odds ratio [OR] = 1.75) were more likely to eat healthier. Residents who spoke no English, or at least one language in addition to English, were significantly more likely to report healthier eating (OR = 2.78 and 3.30, respectively) than those who spoke English only. Men were significantly more likely to report less healthy eating (OR = 0.65) than were women. Similar trends emerged for inactivity and tobacco use. Conclusion. Effective health promotion interventions in low-income housing developments that leverage protective factors while addressing risk factors have the potential to reduce income-related health disparities in these concentrated resource-deprived neighborhoods.

How does food security impact residents of a food desert and a food oasis

This study explored how factors that influence food buying practices make it harder for food secure and food insecure households to eat healthy. Twenty-five men and women participated in the concept mapping process, a mixed methods approach that allows participants to identify, sort, and rate ideas according to their perceptions. Participants identified 121 unique statements and sorted them into 12 clusters that represented their perceptions. Cluster ratings were higher among food-insecure participants compared to food-secure participants. A secondary aim was to explore how food security and food desert statuses are perceived to hinder healthy eating. Food secure participants in a food desert perceived clusters as more important to hindering healthy eating than food-secure participants in a food oasis. Similar perceptions were noted among food-insecure residents in either a food desert or a food oasis. Findings contribute to our understanding of how perceptions differ by food desert and food security statuses.

Physically active, low-income African American women: an exploration of activity maintenance in the context of sociodemographic factors associated with inactivity.

Increasing physical activity among low-income African American women is an important target for addressing racial and economic disparities in chronic conditions and related risk factors. While barriers to physical activity for women have been examined empirically, successful strategies for navigating those barriers among physically active, low-income women have not been thoroughly explored. Informed by grounded theory, we conducted in-depth individual interviews between 2007–2010 with 14 low-income African American women who were physically active at nationally recommended levels for one year or more. We analyzed the data using thematic analysis techniques. Key themes emerged in three main categories: motivation for maintaining active lifestyle, strategies for maintaining physical activity, and challenges to maintaining physical activity. Important motivations included getting or staying healthy, social connections, and gratification. Two planning strategies emerged: flexibility and freedom. Critical challenges included financial constraints, physical strain and history of sedentary relapse. The motivations, strategies and challenges reported by low-income African American women who successfully maintained an active lifestyle provided important information for developing effective health promotion strategies for their inactive and underactive counterparts. A qualitative, asset-based approach to physical activity research contributes rich data to bridge the gap between epidemiological knowledge and community health improvement.

Quantifying the foodscape: A systematic review and meta-analysis of the validity of commercially available business data

This paper reviews studies of the validity of commercially available business (CAB) data on food establishments (“the foodscape”), offering a meta-analysis of characteristics associated with CAB quality and a case study evaluating the performance of commonly-used validity indicators describing the foodscape. Existing validation studies report a broad range in CAB data quality, although most studies conclude that CAB quality is “moderate” to “substantial”. We conclude that current studies may underestimate the quality of CAB data. We recommend that future validation studies use density-adjusted and exposure measures to offer a more meaningful characterization of the relationship of data error with spatial exposure.

The Use of Lifestyle and Behavioral Modification Approaches in Obesity Interventions for Black Women: A Literature Review

The alarming obesity prevalence in Black women is well documented yet poorly understood. Obesity interventions for Black women have failed to produce long-term reductions in weight. Recommendations to incorporate a lifestyle and behavioral modification approach have been made to address obesity in this population. The purpose of this article was to provide a comprehensive review of the literature to identify lifestyle and behavioral modification obesity intervention studies for Black women. We included articles published between February 1992 and January 2013. This search identified 28 articles from the PsycInfo, MEDLINE, CINAHL, and SPORTDiscus databases. Results of these studies were summarized primarily into six categories. The importance of modest improvements in health outcomes that result from adapting healthier behaviors was highlighted. Future research is required for identifying the most salient intervention component or combination of components that lead to the best outcomes for ensuring intervention success and minimizing weight regain postintervention.

Neighborhood racial composition and poverty in association with pre-pregnancy weight and gestational weight gain

Background Studies of neighborhood racial composition or neighborhood poverty in association with pregnancy-related weight are limited. Prior studies of neighborhood racial density and poverty has been in association with adverse birth outcomes and suggest that neighborhoods with high rates of poverty and racial composition of black residents are typically segregated and systematically isolated from opportunities and resources. These neighborhood factors may help explain the racial disparities in pre-pregnancy weight and inadequate weight gain. This study examined whether neighborhood racial composition and neighborhood poverty was associated with weight before pregnancy and weight gain during pregnancy and if this association differed by race. Methods We used vital birth records of singleton births of 73,061 non-Hispanic black and white women in Allegheny County, PA (2003–2010). Maternal race and ethnicity, pre-pregnancy body-mass-index (BMI), gestational weight gain and other individual-level characteristics were derived from vital birth record data, and measures of neighborhood racial composition (percentage of black residents in the neighborhood) and poverty (percentage of households in the neighborhood below the federal poverty) were derived using US Census data. Multilevel log binomial regression models were performed to estimate neighborhood racial composition and poverty in association with pre-pregnancy weight (i.e., overweight/obese) and gestational weight gain (i.e., inadequate and excessive). Results Black women as compared to white women were more likely to be overweight/obese before pregnancy and to have inadequate gestational weight gain (53.6% vs. 38.8%; 22.5% vs. 14.75 respectively). Black women living in predominately black neighborhoods were slightly more likely to be obese prior to pregnancy compared to black women living in predominately white neighborhoods (PR 1.10; 95% CI: 1.03, 1.16). Black and white women living in high poverty areas compared with women living in lower poverty areas were more likely to be obese prior to pregnancy; while only white women living in high poverty areas compared to low poverty areas were more likely gain an inadequate amount of weight during pregnancy. Conclusions Neighborhood racial composition and poverty may be important in understanding racial differences in weight among childbearing women.