Robin Beckman

Diet And Perceptions Change With Supermarket Introduction In A Food Desert, But Not Because Of Supermarket Use

Placing full-service supermarkets in food deserts--areas with limited access to healthy food--has been promoted as a way to reduce inequalities in access to healthy food, improve diet, and reduce the risk of obesity. However, previous studies provide scant evidence of such impacts. We surveyed households in two Pittsburgh, Pennsylvania, neighborhoods in 2011 and 2014, one of which received a new supermarket in 2013. Comparing trends in the two neighborhoods, we obtained evidence of multiple positive impacts from new supermarket placement. In the new supermarket neighborhood we found net positive changes in overall dietary quality; average daily intakes of kilocalories and added sugars; and percentage of kilocalories from solid fats, added sugars, and alcohol. However, the only positive outcome in the recipient neighborhood specifically associated with regular use of the new supermarket was improved perceived access to healthy food. We did not observe differential improvement between the neighborhoods in fruit and vegetable intake, whole grain consumption, or body mass index. Incentivizing supermarkets to locate in food deserts is appropriate. However, efforts should proceed with caution, until the mechanisms by which the stores affect diet and their ability to influence weight status are better understood.

Distance to Store, Food Prices, and Obesity in Urban Food Deserts

BACKGROUND Lack of access to healthy foods may explain why residents of low-income neighborhoods and African Americans in the U.S. have high rates of obesity. The findings on where people shop and how that may influence health are mixed. However, multiple policy initiatives are underway to increase access in communities that currently lack healthy options. Few studies have simultaneously measured obesity, distance, and prices of the store used for primary food shopping. PURPOSE To examine the relationship among distance to store, food prices, and obesity. METHODS The Pittsburgh Hill/Homewood Research on Eating, Shopping, and Health study conducted baseline interviews with 1,372 households between May and December 2011 in two low-income, majority African American neighborhoods without a supermarket. Audits of 16 stores where participants reported doing their major food shopping were conducted. Data were analyzed between February 2012 and February 2013. RESULTS Distance to store and prices were positively associated with obesity (p<0.05). When distance to store and food prices were jointly modeled, only prices remained significant (p<0.01), with higher prices predicting a lower likelihood of obesity. Although low- and high-price stores did not differ in availability, they significantly differed in their display and marketing of junk foods relative to healthy foods. CONCLUSIONS Placing supermarkets in food deserts to improve access may not be as important as simultaneously offering better prices for healthy foods relative to junk foods, actively marketing healthy foods, and enabling consumers to resist the influence of junk food marketing.

Correlates of sex without serostatus disclosure among a national probability sample of HIV patients

We examined potential correlates of sex without HIV disclosure within a sample of 875 participants from the HIV Cost and Services Utilization Study. Interviews with each participant assessed sexual activities with up to six recent partners, and this study included both respondent and partnership characteristics. Compared with marriage and/or primary same-sex relationsips, occasional partnerships and one-time encounters were associated with sex with disclosure, and shorter relationships were more likely to involve sex without disclosure. Knowledge of partner scrostatus was also associated with sex without disclosure. Women were less likely to have sex without disclosure than men having sex with men. We found an association between the perceived duty to disclosure to all partners and sex without disclosure, while we found no association in multivariate analyses between outcome expectancies and sex without disclosure.

Substance use and high-risk sex among people with HIV: a comparison across exposure groups.

Substance use is associated with increased risk for HIV transmission by HIV-positive people to uninfected partners through sexual contact. The largest risk groups for infection, men who have sex with men (MSM) and injecting drug users (IDUs), have high rates of substance use, but little is known about their substance use post-HIV diagnosis. We compared the prevalence of substance use between these two groups and a third group, heterosexual men and women, and tested for differential association between substance use and sexual behaviors across exposure groups in a national sample of patients in treatment for HIV. Substance use was most prevalent among MSM. Substance use and current dependence were associated with being sexually active among MSM but not IDUs; marijuana, alcohol, and hard drug use were most strongly associated with being sexually active among MSM. Whereas substance use predicted high-risk sex, there were few differences among exposure groups in these associations.

The Association of Partner Abuse with Risky Sexual Behaviors Among Women and Men with HIV/AIDS

Prior studies have found that partner abuse is related to risky sexual behavior. However, few studies have explored gender, sexual orientation, or substance use differences in this association, especially among people with HIV. We examined data from the Risk and Prevention survey from the HIV Cost and Services Utilization Study (HCSUS) sample on 726 sexually-active individuals in three gender/orientation groups (286 women, 148 heterosexual men, and 292 gay/bisexual men). The study assessed whether individuals with HIV who experienced or perpetrated abuse within a close relationship were likely to engage in unprotected intercourse with that same partner. Both abuse perpetration and victimization were significantly associated with having any unprotected intercourse. In multivariate tests, gender/orientation and substance use during sex moderated the perpetration effects. Secondary HIV prevention interventions need to take into account potentially abusive contexts in which sexual activity may occur for both men and women.

Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet and BMI.

OBJECTIVE To provide a richer understanding of food access and purchasing practices among US urban food desert residents and their association with diet and BMI. DESIGN Data on food purchasing practices, dietary intake, height and weight from the primary food shopper in randomly selected households (n 1372) were collected. Audits of all neighbourhood food stores (n 24) and the most-frequented stores outside the neighbourhood (n 16) were conducted. Aspects of food access and purchasing practices and relationships among them were examined and tests of their associations with dietary quality and BMI were conducted. SETTING Two low-income, predominantly African-American neighbourhoods with limited access to healthy food in Pittsburgh, PA, USA. SUBJECTS Household food shoppers. RESULTS Only one neighbourhood outlet sold fresh produce; nearly all respondents did major food shopping outside the neighbourhood. Although the nearest full-service supermarket was an average of 2·6 km from their home, respondents shopped an average of 6·0 km from home. The average trip was by car, took approximately 2 h for the round trip, and occurred two to four times per month. Respondents spent approximately

Patterns and correlates of deliberate abstinence among men and women with HIV / AIDS.

US 37 per person per week on food. Those who made longer trips had access to cars, shopped less often and spent less money per person. Those who travelled further when they shopped had higher BMI, but most residents already shopped where healthy foods were available, and physical distance from full-service supermarkets was unrelated to weight or dietary quality. CONCLUSIONS Improved access to healthy foods is the target of current policies meant to improve health. However, distance to the closest supermarket might not be as important as previously thought, and thus policy and interventions that focus merely on improving access may not be effective.

Unprotected Sex of Homeless Women Living in Los Angeles County: An Investigation of the Multiple Levels of Risk

OBJECTIVES We examined correlates of deliberate sexual abstinence among gay/bisexual men, heterosexual men, and women in a national probability sample of adults with HIV. METHODS Participants in the HIV Cost and Services Utilization Study (HCSUS; n=1339) answered questions about oral, anal, or vaginal sexual intercourse in the past 6 months; those who reported none of these behaviors (n=415) were asked about their reasons for abstinence. Of these, 201 participants (11% of gay/bisexual men, 18% of women, 18% of heterosexual men) indicated that their abstinence was deliberate. Multivariate models were used to predict deliberate abstinence. RESULTS In multivariate analyses, not having a primary relationship partner/spouse was a significant correlate of deliberate abstinence for all 3 groups. Higher perceived responsibility for limiting disease transmission and nondrinking status were related to deliberate abstinence only among gay/bisexual men. Worse health was associated with deliberate abstinence only among heterosexual men. CONCLUSIONS Perhaps because HIV is more common in gay communities, abstinence choices may be more closely linked to a higher sense of responsibility for reducing transmission among gay/bisexual men, and their illness may be less of an impediment to sexual activity.

Practice redesign to improve care for falls and urinary incontinence: primary care intervention for older patients

This research uses multi-level modeling to investigate the context of unprotected sex of homeless women. Based on interviews with 429 randomly selected women living in temporary shelter settings in Los Angeles, this project investigates multiple levels of influence on unprotected sex with particular partners. Previous studies have investigated condom use of homeless women primarily at the individual level. This project investigates unprotected sex at the level of the partnership, the individual woman, and her social network. Homeless women who believe in the efficacy of condoms to prevent HIV infection, believe that they have low susceptibility to HIV and have a greater proportion of their non-sex partner social network ties with whom they speak about HIV are less likely to engage in unprotected sex. Women are more likely to engage in risky sexual behavior in relationships in which they have high commitment to their partner and experience physical violence.

Abuse in the close relationships of people with HIV.

BACKGROUND In primary care, medical care for age-associated conditions, such as falls and urinary incontinence (UI), is inadequate. In collaboration with the American College of Physicians, we augmented the Assessing Care of Vulnerable Elders practice redesign intervention to improve falls and UI care. METHODS We performed a controlled trial in 5 nonrandomly selected primary care intervention (26 physicians across sites) and control (18 physicians) practices from diverse communities. Patients 75 years and older who screened positive for falls or fear of falling and UI were included in the study. We conducted a multicomponent intervention between October 30, 2006, and December 31, 2007, that included efficient collection of data, medical record prompts, patient education materials, and physician decision support. Main outcome measures were quality of care for falls and UI comparing intervention and control sites. RESULTS Of 6051 patients screened, 2847 (47.1%) screened positive for falls or UI (46.1% in the intervention group and 48.8% in the control group). Across the 5 practices, 1211 patient medical records were evaluated after stratified random selection. Intervention patients received 60.0% of recommended care for falls vs 37.6% provided by control health care professionals (P < .001). Similarly, intervention health care professionals provided more recommended care for UI (47.2% vs 27.8%, P < .001). Intervention health care professionals more often performed a falls history, orthostatic blood pressure measurement, gait and balance examination, and UI history and tried UI behavioral treatments first. Knowledge about falls and UI increased more among intervention than control group health care professionals. CONCLUSIONS Practice redesign can improve the care that community-based primary care physicians provide for older patients with falls and UI. Outcomes of such care improvements require further evaluation.