Neighborhood Environments, SNAP-Ed Eligibility, and Health Behaviors: An Analysis of the California Health Interview Survey (CHIS).
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ABSTRACT:
SUBMITTER: Cantor J
PROVIDER: S-EPMC7392966 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background COVID-19 forced California Supplemental Nutrition Assistance Program Education (SNAP-Ed) to suddenly shift planned strategies to meet SNAP-eligible population needs. K-12 schools, important SNAP-Ed partners for reaching children and families, were profoundly affected. Most (77%) local health departments (LHDs) reported they were unable to accomplish previously planned activities at school sites in 2020. Objective To understand pandemic-related changes to school-based SNAP-Ed and identify areas of opportunity. Study Design, Settings, Participants We conducted secondary mixed-methods analyses of California LHDs’ school-based SNAP-Ed activity and needs assessment data from fiscal years 2020-2021. Measurable Outcome/Analysis Outcomes include number and type of SNAP-Ed programs that were halted or newly implemented, number of participants reached, policies, systems, and environmental change strategies (PSEs) adopted, new methods of education delivery, and extent to which schools implemented nutrition and physical activity (Nut-PA) best practices. Qualitative analysis examined COVID-19-related barriers and facilitators to SNAP-Ed implementation. Results In 2020, 270 PSE interventions were initiated in schools; 21% were discontinued and 12% were created in response to COVID. New opportunities included using school meal distributions to provide free groceries, home gardening kits, and brief face-to-face nutrition education. Many LHDs transitioned to virtual Nut-PA education, increasing SNAP-Ed participant reach. In Fall 2020, as schools adjusted to alternative learning models, school-level assessments of Nut-PA practices indicated the most common area of opportunity was nutrition education. Over 75% of schools reported that PSE strategies requiring on-site/in-person implementation, such as improving lunchroom facilities, were not feasible. Facilitators of SNAP-Ed implementation included community support and strong partnerships between schools, community-based organizations, and SNAP-Ed implementing agencies; barriers included regulations and staff turnover. Conclusions SNAP-Ed programs nationwide can continue to serve SNAP-eligible children and families during crises like COVID-19 by partnering with schools and other community organizations. These partners identified the nutrition and physical activity needs of a community and the best practices to address them. Funding Supplemental Nutrition Assistance Program - Education
| S-EPMC9260036 | biostudies-literature
Project description:BackgroundExperiences of discrimination harm mental and physical health, with the strongest penalty on mental health. Among immigrants, it remains unclear how acculturation-the process by which immigrants acquire the beliefs and practices of a host culture-influences the mental health burden of navigating discrimination. On the one hand, acculturation can be associated with upward social mobility. Conversely, the acculturative process may increase exposure to, and recognition of, discrimination.ObjectivesWe examined the relationship between discrimination and mental illness across racial/ethnic groups, and pathways by which acculturation and age relate to the discrimination-mental health relationship.DesignA secondary data analysis using population data from the 2015-2016 California Health Interview Survey.Main measuresThe Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with K6 score ≥ 13 associated with severe mental illness. Discrimination was measured using a self-reported measure of lifetime experience of unfair treatment in getting medical care. We used a 5-point acculturation index (constructed by measures of nativity, years living in the USA, and home language use). A weighted logistic regression model predicted mental illness as a function of discrimination. We ran mediational analysis using the Karlson-Holm-Breen method and used predictive margins to present predicted probabilities of mental illness for people reporting discrimination at different acculturation and age levels.Key resultsThere were independent effects on mental illness associated with increased discrimination (OR 3.85, 95% CI = 2.46, 6.03, p < 0.001) and increased acculturation (OR 1.72, 95% CI = 1.24, 2.38, p = 0.001), including when stratified across racial/ethnic groups. Higher levels of acculturation led to a significant increase in discrimination's association with mental illness. There was a higher probability of mental illness in younger age groups than in older age groups.ConclusionsWhile discrimination is associated with poor mental health, a stronger link between discrimination and mental illness exists among younger immigrants and immigrants with increased acculturation. Health practitioners should not overlook the mental health needs of younger immigrants and immigrants who may seem more integrated into US society.
| S-EPMC7210364 | biostudies-literature
Project description:BackgroundPopulation-based data from the National Health Interview Survey were examined to provide estimates of a wide range of health behaviors in cancer survivors (ie, physical activity, sun protection, alcohol use, cigarette and e-cigarette use, sleep, and diet) and trends over time.MethodsData were collected from 92 257 participants across 3 waves of the National Health Interview Survey. A total of 8050 participants reported having had cancer (2428 in 2005, 2333 in 2010, 3289 in 2015). Weighted and adjusted odds ratios (OR) between cancer survivors and controls were calculated using logistic and multivariable regressions in SPSS, and trend analyses from 2005 to 2015 were conducted. All statistical tests are 2-sided.ResultsAfter adjusting for demographics (2005-2015), cancer survivors, compared with controls, were more likely to wear sunscreen (OR = 1.41, 95% confidence interval [CI] = 1.32 to 1.51) and protect their skin (P < .001) and were less likely to tan indoors (OR = 0.81, 95% CI = 0.69 to 0.95), but reported less sleep (OR = 0.91, 95% CI = 0.85 to 0.98). In adjusted models, no differences were found for physical activity, sunburns, alcohol use, smoking, e-cigarette use, and diet. Smoking rates for cancer survivors decreased from 2005 to 2015 (P < .001) and physical activity increased (P = .02), but physical activity was not statistically significant after adjusting for multiple comparisons. All other health behavior rates for cancer survivors were unchanged from 2005 to 2015 (P > .14).ConclusionAfter adjusting for covariates, cancer survivors exhibited healthier sun protection, but not sleep behaviors, compared with controls. Cancer survivors (and controls) exhibited decreased smoking rates over time. These results may inform interventions focused on improving cancer control and prevention of other chronic conditions among cancer survivors.
| S-EPMC7583145 | biostudies-literature
Project description:BackgroundStable, affordable housing is an established determinant of health. As affordable housing shortages across the USA threaten to displace people from their homes, it is important to understand the implications of cost-related residential moves for healthcare access.ObjectiveTo examine the relationship between cost-related moves and unmet medical needs.DesignWe performed a cross-sectional analysis of 7 waves (2011-2017) of the California Health Interview Survey.ParticipantsWe included all respondents ages 18 and older.Main measuresThe primary predictor variable was residential move history in the past 5 years (cost-related move, non-cost-related move, or no move). The primary outcome was unmet medical needs in the past year (necessary medications and/or medical care that were delayed or not received).Key resultsOur sample included 146,417 adults (42-47% response rate), representing a weighted population of 28,518,590. Overall, 20.3% of the sample reported unmet medical needs in the past year, and 4.9% reported a cost-related move in the past 5 years. In multivariable logistic regression models, adjusted risk of unmet medical needs increased for adults with both cost-related moves (aOR 1.38; 95% CI 1.19-1.59) and non-cost-related moves (aOR 1.17; 95% CI 1.09-1.26) compared to those with no moves. Among people who had moved, those with cost-related moves were more likely to report unmet medical needs compared to people with non-cost-related moves (p = 0.03).ConclusionsPeople who have moved due to unaffordable housing represent a population at increased risk for unmet medical needs. Policy makers seeking to improve population health should consider strategies to limit cost-related moves and to mitigate their adverse effects on healthcare access.
| S-EPMC7769566 | biostudies-literature
Project description:IntroductionConsidering the joint association of neighborhood socioeconomic environment and individual-level health behaviors with health outcomes may help officials design effective disease prevention strategies. This study evaluates the joint influences of neighborhood socioeconomic environment and individual health behaviors on mortality in a cohort primarily comprising people with low individual-level SES.MethodsThe prospective Southern Community Cohort Study includes 77,896 white and African American participants recruited in the years 2002-2009; 55% of participants had a household income <$15,000 at baseline interview. Mortality from cancer (n=2,471), cardiovascular diseases (n=3,005), and all-causes (n=10,099) was identified from the National Death Index through December 31, 2013 (median follow-up, 8 years). Data were analyzed in 2016 and 2017. Associations were assessed between mortality, a neighborhood deprivation index composed of 11 census tract-level variables, five health behaviors, and a composite healthy lifestyle score.ResultsLiving in a neighborhood with the greatest socioeconomic disadvantage was associated with higher all-cause mortality in both men (hazard ratio=1.41, 95% CI=1.27, 1.57) and women (hazard ratio=1.77, 95% CI=1.57, 2.00). Associations were attenuated after adjustment for individual-level SES and major risk factors (hazard ratio for men=1.09, 95% CI=0.98, 1.22, and hazard ratio for women=1.26, 95% CI=1.12, 1.42). The dose-response association between neighborhood disadvantage and mortality was less apparent among smokers. Nevertheless, individuals who lived in disadvantaged neighborhoods and had the unhealthiest lifestyle scores experienced the highest mortality.ConclusionsDisadvantaged neighborhood socioeconomic environments are associated with increased mortality in a cohort of individuals of low SES. Positive individual-level health behaviors may help negate the adverse effect of disadvantage on mortality.
| S-EPMC5739075 | biostudies-literature
Project description:Cost-related nonadherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health-related and non-health-related pressures and the use of cost-reducing strategies among the US adult population with and without diabetes that may impact CRN.Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with health care, food insecurity, and cost-reducing strategies on CRN.Overall, 11% (n=4158) of adults reported diabetes; 14% with diabetes reported CRN, compared with 7% without diabetes. Greater perceived financial stress [prevalence ratio (PR)=1.07; 95% confidence interval (CI), 1.05-1.09], financial insecurity with health care (PR=1.6; 95% CI, 1.5-1.67), and food insecurity (PR=1.30; 95% CI, 1.2-1.4) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2; 95% CI, 0.2-0.3), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN.Half of the adults with diabetes perceived financial stress, and one fifth reported financial insecurity with health care and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.
| S-EPMC4945373 | biostudies-literature
Project description:Women residing in neighborhoods of low socioeconomic status are more likely to experience adverse reproductive outcomes; however, few studies explore which specific neighborhood features are associated with poor maternal health behaviors and pregnancy outcomes. Based upon our conceptual model, directly observed street-level data from four North Carolina US counties were used to create five neighborhood indices: physical incivilities (neighborhood degradation), social spaces (public space for socializing), walkability (walkable neighborhoods), borders (property boundaries), and arterial features (traffic safety). Singleton birth records (2001-2005) were obtained from the North Carolina State Center for Vital Statistics and maternal health behavior information (smoking, inadequate or excessive weight gain) and pregnancy outcomes (pregnancy-induced hypertension/pre-eclampsia, low birthweight, preterm birth) were abstracted. Race-stratified random effect models were used to estimate associations between neighborhood indices and women's reproductive behaviors and outcomes. In adjusted models, higher amounts of physical incivilities were positively associated with maternal smoking and inadequate weight gain, while walkability was associated with lower odds of these maternal health behaviors. Social spaces were also associated with inadequate weight gain during pregnancy. Among pregnancy outcomes, high levels of physical incivilities were consistently associated with all adverse pregnancy outcomes, and high levels of walkability were inversely associated with pregnancy-induced hypertension and preterm birth for Non-Hispanic white women only. None of the indices were associated with adverse birth outcomes for Non-Hispanic black women. In conclusion, certain neighborhood conditions were associated with maternal health behaviors and pregnancy outcomes.
| S-EPMC4951203 | biostudies-literature
Project description:ObjectiveTo assess the independent association of food insecurity with processes of care and delays in filling prescriptions.Data source2007 California Health Interview Survey.Study designAssociations of food insecurity with processes of care and delays in filling prescriptions were examined using multivariable logistic regression analyses adjusted for sociodemographic characteristics, barriers to accessing care, and health status.Data extractionData were analyzed from adults currently receiving treatment for type 2 diabetes and who had seen a doctor in the prior 12 months (N = 3,401).Principal findingsFor diabetes patients currently receiving medical care, food insecurity was not associated with lower rates of performance of recommended processes of care, but it was associated with delays in filling prescriptions (aOR = 2.15, 95 percent CI 1.25, 3.71).ConclusionsFood insecurity may increase delays in filling prescriptions in daily life, even though the performance of recommended processes of care in the clinic is not diminished.
| S-EPMC3523369 | biostudies-literature
Project description:ObjectiveTo assess the patterns of emergency department (ED) utilisation among those with and without criminal justice contact in California in 2014, comparing variation in ED use, visit frequency, diagnoses and insurance coverage.DesignRetrospective, cross-sectional study.SettingAnalyses included ED visits to all licensed hospitals in California using statewide data on all ED encounters in 2014.ParticipantsStudy participants included 3 757 870 non-elderly adult ED patients who made at least one ED visit in 2014.Primary and secondary outcome measuresWe assessed the patterns and characteristics of ED visits among those with criminal justice contact-patients who were either admitted to or discharged from the ED by a correctional institution-with patients who did not have criminal justice contact recorded during an ED visit.ResultsED patients with criminal justice contact had higher proportions of frequent ED users (27.2% vs 9.4%), were at higher risk of an ED visit resulting in hospitalisation (26.6% vs 15.2%) and had higher prevalence of mental health conditions (52.8% vs 30.4%) compared with patients with no criminal justice contact recorded during an ED visit. Of the top 10, four primary diagnoses among patients with criminal justice contact were related to behavioural health conditions, accounting for 19.0% of all primary diagnoses in this population. In contrast, behavioural health conditions were absent from the top 10 primary diagnoses in ED patients with no observed criminal justice contact. Despite a high burden of disease, a lack of health insurance coverage was more common among those with criminal justice contact than those without (41.3% vs 14.1%).ConclusionsGiven that a large proportion of ED patients with criminal justice contact are frequent users with considerable mental health conditions, current efforts in California's Medicaid programme to identify individuals in need of coordinated services could reduce costly ED utilisation among this group.
| S-EPMC6042586 | biostudies-literature
Project description:PURPOSE: To determine the prevalence of self-reported myopia nationwide in Taiwan and its association with degrees of urbanization and education levels. METHODS: Data were obtained from the 2005 Taiwan National Health Interview Survey, a nationwide survey using multistage stratified systematic sampling. The presence of myopia, current residential areas, and education levels were ascertained by a structured questionnaire in participants ≥ 12 years of age. RESULTS: A total of 20,609 eligible persons were included in this study. The overall weighted prevalence of myopia in Taiwan was 46.7% (95% confidence interval: 45.9, 47.5%). The prevalence of myopia for persons aged 12-19, 20-39, 40-64, and ≥ 65 years was 70.3%, 65.4%, 30.4%, and 5.6%, respectively. Women had significantly higher rates of myopia than men for persons younger than 40 years of age (P<0.001). Myopia was significantly associated with both higher degrees of urbanization of current residential areas and higher education levels (both P<0.001). In young adult and adult groups, the effect of education levels on myopia was stronger than that of degrees of urbanization. CONCLUSION: The study provides a nation-wide prevalence data on myopia in Taiwan. Both degrees of urbanization and education levels are risk factors for myopia.
| S-EPMC3351071 | biostudies-other