Mixed method approaches to understanding cancer-related dietary risk reduction among public housing residents.
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ABSTRACT:
SUBMITTER: Klassen AC
PROVIDER: S-EPMC2704274 | biostudies-other | 2009 Jul
REPOSITORIES: biostudies-other
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Project description:BackgroundPublic housing residents face significant social, economic, and physical barriers to the practice of health behaviors for prevention of chronic disease. Research shows that public housing residents are more likely to report higher rates of obesity, current smoking, disability, and insufficient physical activity compared to individuals not living in public housing. Because these behaviors and conditions may be shaped by the built and social environments in which they live, we conducted a study to test an environmental level diet and physical activity intervention targeting obesity among urban public housing developments.MethodsThis study was a cluster randomized controlled trial of public housing developments, the unit of analysis and randomization. A total of 10 public housing developments were recruited and subsequently randomized to either receive the intervention package or to serve as comparison sites. The year-long intervention included components to change the dietary and physical activity-related environments of the developments. Surveys at baseline and one-year follow-up provided data on changes in behaviors and weight from participants in both intervention and control developments.ResultsIntervention participants significantly changed their eating and activity behaviors and body weight from baseline to one-year follow-up (p's < .05) while comparison participants reported no significant changes in any study variable.ConclusionsThese data provide initial support for the idea that interventions targeting the environment of public housing developments can assist residents to change unhealthy behaviors and can possibly reduce the high levels of chronic disease among public housing residents.
| S-EPMC6048807 | biostudies-literature
Project description:Social networks - or the web of relationships between individuals - may influence cardiovascular disease risk, particularly in low-income urban communities that suffer from a high prevalence of cardiovascular disease. Our objective was to describe the social networks of public housing residents - a low-income urban population - in Baltimore, MD and the association between these networks and blood pressure. We used cross-sectional survey data of randomly selected heads of household in two public housing complexes in Baltimore, MD (8/2014-8/2015). Respondents answered questions about 10 social network members, including attributes of their relationship and the frequency of interaction between members. We calculated measures of network composition (e.g., proportion of network members who were family members) and network structure (e.g., density), which we then dichotomized as "high" (upper quartile) and "low" (less than upper quartile). We used linear regression to test the association between network measures and mean systolic and diastolic blood pressure. The sample included 259 respondents (response rate: 46.6%). Mean age was 44.4 years, 85.7% were women, 95.4% Black, and 56.0% had a history of hypertension. A high proportion of older children (age 8-17 years) in the network (>30%) was associated with a 4.0% (95%CI [0.07, 8.07], p = 0.047) higher mean systolic blood pressure (~4.9 mmHg greater). Other network attributes had no association with blood pressure. Social network attributes, such as having a high proportion of older children in one's network, may have particular relevance to blood pressure among low-income public housing residents, reinforcing the potential importance of social relationships to cardiovascular health.
| S-EPMC7498937 | biostudies-literature
Project description:Housing conditions have been an enduring focus for public health activity throughout the modern public health era. However, the nature of the housing and health challenge has changed in response to an evolution in the understanding of the diverse factors influencing public health. Today, the traditional public health emphasis on the type and quality of housing merges with other wider determinants of health. These include the neighbourhood, community, and "place" where a house is located, but also the policies which make access to a healthy house possible and affordable for everyone. Encouragingly, these approaches to policy and action on housing have the potential to contribute to the "triple win" of health and well-being, equity, and environmental sustainability. However, more effective housing policies (and in public health in general) that adopt more systemic approaches to addressing the complex interactions between health, housing, and wider environment are needed. This paper illustrates some of the key components of the housing and health challenge in developed countries, and presents a conceptual model to co-ordinate activities that can deliver the "triple win." This is achieved by offering a perspective on how to navigate more effectively, inclusively and across sectors when identifying sustainable housing interventions.
| S-EPMC6267345 | biostudies-other
Project description:BackgroundGlobally, public housing is utilized to provide affordable housing for low-income households. Studies have shown an association between public housing and negative health outcomes. There is paucity of data pertaining to outpatient primary and tertiary healthcare resources utilization among public rental housing residents in Singapore.MethodsA retrospective cohort study was performed, involving patients under the care of SingHealth Regional Health System (SHRS) in Year 2012. Healthcare utilization outcomes evaluated included number of outpatient primary and specialist care clinic visits, emergency department visits and hospitalization in Year 2011. Multivariate logistical analyses were used to examine the association between public rental housing and healthcare utilization.ResultsOf 147,105 patients, 10,400 (7.1%) patients stayed in public rental housing. There were more elderly (54.8 ± 18.0 vs 49.8 ± 17.1, p < 0.001) and male patients [5279 (50.8%) vs 56,892 (41.6%), p < 0.001] residing in public rental housing. Co-morbidities such as hypertension and hyperlipidemia were more prevalent among public rental housing patients. (p < 0.05). After adjustment for covariates, public rental housing was not associated with frequent outpatient primary care clinic or specialist outpatient clinic attendances (p > 0.05). However, it was associated with increased number of emergency department visits (OR: 2.41, 95% CI: 2.12-2.74) and frequent hospitalization (OR: 1.56, 95% CI: 1.33-1.83).ConclusionResiding in public rental housing was not associated with increased utilization of outpatient healthcare resources despite patients' higher disease burden and frequency of emergency department visits and hospitalizations. Further research is required to elucidate their health seeking behaviours.
| S-EPMC6466644 | biostudies-literature
Project description:Tobacco smoke exposure (TSE) in public multi-unit housing (MUH) is of concern. However, the validity of self-reports for determining TSE among non-smoking residents in such housing is unclear.We analyzed data from 285 non-smoking public MUH residents living in non-smoking households in the Boston area. Participants were interviewed about personal TSE in various locations in the past 7 days and completed a diary of home TSE for 7 days. Self-reported TSE was validated against measurable saliva cotinine (lower limit of detection (LOD) 0.02 ng/ml) and airborne apartment nicotine (LOD 5 ng). Correlations, estimates of inter-measure agreement, and logistic regression assessed associations between self-reported TSE items and measurable cotinine and nicotine.Cotinine and nicotine levels were low in this sample (median = 0.026 ng/ml and 0.022 μg/m3, respectively). Prevalence of detectable personal TSE was 66.3% via self-report and 57.0% via measurable cotinine (median concentration among those with cotinine>LOD: 0.057 ng/ml), with poor agreement (kappa = 0.06; sensitivity = 68.9%; specificity = 37.1%). TSE in the home, car, and other peoples' homes was weakly associated with cotinine levels (Spearman correlations rs = 0.15-0.25), while TSE in public places was not associated with cotinine. Among those with airborne nicotine and daily diary data (n = 161), a smaller proportion had household TSE via self-report (41.6%) compared with measurable airborne nicotine (53.4%) (median concentration among those with nicotine>LOD: 0.04 μg/m3) (kappa = 0.09, sensitivity = 46.5%, specificity = 62.7%).Self-report alone was not adequate to identify individuals with TSE, as 31% with measurable cotinine and 53% with measurable nicotine did not report TSE. Self-report of TSE in private indoor spaces outside the home was most associated with measurable cotinine in this low-income non-smoking population.
| S-EPMC4865127 | biostudies-other
Project description:Public housing residents have high intake of added sugars, which is associated with sugar-sweetened beverage (SSB) consumption in their social networks. In this feasibility study, we designed and tested a network-oriented intervention to decrease added sugar intake by encouraging reduced SSB consumption. We conducted a 6-month single-arm trial testing a small-group curriculum (9 sessions) that combined behavior change strategies to reduce added sugar intake by promoting SSB reduction with a peer outreach approach. We recruited and trained public housing residents to be "Peer Educators," who then communicated information and made changes to reduce SSB with their network members. We calculated the median number of group sessions attended and determined the percentage of individuals satisfied with the program. We estimated added sugar intake using a 5-factor dietary screener and compared baseline and 6-month median values using Wilcoxon signed rank tests. We recruited 17 residents and 17 of their network members (n?=?34). Mean age was 45.7?years, 79.4% were women, and 97.1% were African American. Median number of sessions attended was 9 (interquartile range: 4-9), and 88.2% were very satisfied with the program. Overall, baseline median added sugar intake was 38.0 tsp/day, which significantly declined to 17.2 tsp/day at 6?months (P?<?.001). Residents and network members achieved similar results at 6?months (17.4 vs 16.9 tsp/day, respectively). In conclusion, our results demonstrate that a social network intervention aimed at reducing SSB consumption is feasible and can produce significant decreases in adult added sugar intake, which warrants further investigation in a randomized controlled trial.
| S-EPMC7052458 | biostudies-literature
Project description:Secondhand smoke (SHS) exposure causes chronic illness and occurs at a higher prevalence in low-income communities than the general public. In 2018, the U.S. Department of Housing and Urban Development (HUD) instituted a smoke-free housing rule for Public Housing Authorities (PHAs) to address persistent health inequities. However, the success of smoke-free housing requires evidence to inform effective implementation approaches. A mixed-methods, cross-sectional survey was conducted in a national sample of PHAs. Questions focused on housing officials' use of specific implementation strategies. Adjusted odds ratios were used to assess associations between implementation approaches and variations among PHAs (i.e., region, size, or recency of policy adoption). Qualitative analyses were conducted to assess the perceived effectiveness of implementation strategies. Resident engagement, staff training, and smoking cessation support were the most frequently used implementation strategies. Engagement with local stakeholders was cited less frequently. Enforcement actions were limited with no violations referred to housing court. Support for policy adherence was identified as a sixth implementation strategy. While most PHAs used at least some evidence-informed implementation strategies, a lack of a systematic approach may limit overall effectiveness. Further research is required to resolve implementation barriers experienced disproportionately by a subset of PHAs, and to inform a best practice implementation framework that meets the needs of a heterogeneous population.
| S-EPMC8997519 | biostudies-literature
Project description:The American Heart Association has encouraged networks research focused on cardiovascular disease and its risk factors, such as obesity. However, little network research has focused on minorities or low-income populations. Our objective was to characterize the relationship between body mass index (BMI) with social network overweight/obesity among public housing residents in Baltimore, MD - a predominantly black, low-income group. We conducted a cross-sectional survey of randomly selected public housing residences (8/2014-8/2015). Adults had their height and weight measured and reported their network members' weight statuses using pictograms. Our dependent variable was respondents' BMI, and independent variable was perceived exposure to overweight/obesity in the social network. We also explored network exposure to overweight/obesity among 1) family members and 2) friends. We used multivariable linear regression adjusted for significant covariates. Our sample included 255 adults with mean age of 44.4 years, 85.5% women, 95.7% black, and mean BMI of 33.2 kg/m2. Most network members were overweight/obese (56.1%). For every 1% increase in network exposure to overweight/obesity, individuals' BMI decreased by 0.05 kg/m2 (p = 0.06). As network exposure to overweight/obesity among friends increased, individuals' BMI significantly decreased by 0.06 kg/m2 (p = 0.04). There was no significant relationship between BMI and network exposure to overweight/obesity among family members. In conclusion, among Baltimore public housing residents, a statistically significant, inverse association existed between individuals' BMI and overweight/obesity among friends in their social networks. Our results differ from relationships seen in prior studies of other populations, which may be due to racial and/or contextual differences between studies.
| S-EPMC6378834 | biostudies-literature
Project description:Our objective was to characterize the relationship between public housing residents' diet/exercise habits with similar behaviors among their social network. We conducted a cross-sectional survey of randomly selected households in Baltimore, Maryland, from August 2014 to August 2015. Adult heads of household completed questions on diet, exercise, and perceived habits among network members. Our dependent variables were high added sugar intake (≥39.9 teaspoons/day), high fruit/vegetable intake (≥6.1 servings/day), and being physically active (≥moderately activity). Our network exposures were proportion of members perceived to daily consume (1) sugar-sweetened beverages, (2) sweets, (3) fruits, and (4) vegetables, as well as to weekly exercise (1) vigorously or (2) moderately. We used multivariate logistic regression to examine associations between habits with relevant network exposures. Our sample included 266 adults with mean age of 44.5 years, 86.1% women and 95.5% African American. We found a statistically significant association between study participants' high daily intake of added sugar with perceived network exposure to daily sugar-sweetened beverages (odds ratio [OR] = 1.10, 95% confidence interval [CI] [1.02, 1.20]) and daily sweets (OR = 1.10, 95% CI [1.02, 1.20]). Greater network exposure to weekly vigorous exercise was significantly associated with personally being physically active (OR = 1.15, 95% CI [1.04, 1.28]), but not network exposure to weekly moderate exercise. Among public housing residents, associations exist between individuals' and perceived networks' lifestyle habits of high added sugar foods consumption and vigorous exercise, which may hold promise for future social network interventions.
| S-EPMC6480305 | biostudies-literature
Project description:BACKGROUND:The Dutch Ministry of Health has formulated ambitious goals concerning the use of telehealth, leading to subsequent changes compared with the current health care situation, in which 93% of care is delivered face-to-face. Since most care is delivered to older people, the prospect of telehealth raises the question of whether this population is ready for this new way of receiving care. To study this, we created a theoretical framework consisting of 6 factors associated with older people's intention to use technology. OBJECTIVE:The objective of this study was to understand community-dwelling older people's readiness for receiving telehealth by studying their intention to use videoconferencing and capacities for using digital technology in daily life as indicators. METHODS:A mixed-method triangulation design was used. First, a cross-sectional survey study was performed to investigate older people's intention to use videoconferencing, by testing our theoretical framework with a multilevel path analysis (phase 1). Second, for deeper understanding of older people's actual use of digital technology, qualitative observations of older people executing technological tasks (eg, on a computer, cell phone) were conducted at their homes (phase 2). RESULTS:In phase 1, a total of 256 people aged 65 years or older participated in the survey study (50.0% male; median age, 70 years; Q1-Q3: 67-76). Using a significance level of .05, we found seven significant associations regarding older people's perception of videoconferencing. Older people's (1) intention to use videoconferencing was predicted by their performance expectancy (odds ratio [OR] 1.26, 95% CI 1.13-1.39), effort expectancy (OR 1.23, 95% CI 1.07-1.39), and perceived privacy and security (OR 1.30, 95% CI 1.17-1.43); (2) their performance expectancy was predicted by their effort expectancy (OR 1.38, 95% CI 1.24-1.52); and (3) their effort expectancy was predicted by their self-efficacy (OR 1.55, 95% CI 1.42-1.68). In phase 2, a total of 6 men and 9 women aged between 65 and 87 years participated in the qualitative observation study. Of the primary themes, 5 themes were identified that could provide greater understanding of older people's capacities and incapacities in using digital technology: (1) "self-efficacy and digital literacy," (2) "obstacles to using technology," (3) "prior experience and frequency of use," (4) "sources of support and facilitating conditions," and (5) "performance expectancy." These 5 themes recurred in all 15 observations. CONCLUSIONS:Performance expectancy, effort expectancy, and perceived privacy and security are direct predictors of older people's intention to use videoconferencing. Self-efficacy appeared to play a role in both older people's intention to use, as well as their actual use of technology. The path analysis revealed that self-efficacy was significantly associated with older people's effort expectancy. Furthermore, self-efficacy and digital literacy appeared to play a major role in older people's capacities to make use of digital technology.
| S-EPMC5910535 | biostudies-other