Paper of the Month
November 2009
The Efficacy of HIV/STI Behavioral Interventions for African American Females in the United States: A Meta-Analysis
Am J Public Health. 2009;99:2069-2078. doi:10.2105/AJPH.2008.139519)
Crepaz N, Marshall KJ, Aupont LW, Jacobs ED, Mizuno Y, Kay LS, Jones P, Hubbard McCree D, O’Leary A.
Corresponding author: Nicole Crepaz, PhD
Email: ncrepaz@cdc.gov
Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Prevention Research Branch, Atlanta, Georgia.
Objectives. We evaluated the efficacy of HIV behavioral interventions for African American females in the United States, and we identified factors associated with intervention efficacy.
Methods. We conducted a comprehensive literature review covering studies published from January 1988 to June 2007, which yielded 37 relevant studies. Data were analyzed using mixed-effects models and meta-regression.
Results. Overall, behavioral interventions had a significant impact on reductions in HIV-risk sex behaviors (odds ratio [OR]=0.63; 95%confidence interval [CI]=0.54, 0.75; n=11239; Cochrane Q32=84.73; P<.001) and sexually transmitted infections (STIs; OR=0.81; 95% CI=0.67, 0.98; n=8760; Cochrane Q16=22.77; P=.12). Greater intervention efficacy was observed in studies that specifically targeted African American females used gender- or culture-specific materials, used female deliverers, addressed empowerment issues, provided skills training in condom use and negotiation of safer sex, and used role-playing to teach negotiation skills.
Conclusions. Behavioral interventions are efficacious at preventing HIV and STIs among African American females. More research is needed to examine the potential contribution of prevention strategies that attend to community-level and structural-level factors affecting HIV infection and transmission in this population.
\This article can be downloaded here
October 2009
Health Disparities in the Latino Population
Epidemiol Rev. 2009 Aug 27. [Epub ahead of print]
Vega WA, Rodriguez MA, Gruskin E.
Corresponding author: William A. Vega
Email: wvega@mednet.ucla.edu
Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
ABSTRACT: In this review, the authors provide an approach to the study of health disparities in the US Latino population and evaluate the evidence, using mortality rates for discrete medical conditions and the total US population as a standard for comparison. They examine the demographic structure of the Latino population and how nativity, age, income, and education are related to observed patterns of health and mortality. A key issue discussed is how to interpret the superior mortality indices of Latino immigrants and the subsequent declining health status of later generations. Explanations for differences in mortality include selection, reverse selection, death record inconsistencies, inequalities in health status, transnational migration, social marginality, and adaptation to environmental conditions in the United States. The utility of the public health social inequality framework and the status syndrome for explaining Latino disparities is discussed. The authors examine excess mortality from 8 causes: diabetes, stomach cancer, liver cancer, cervical cancer, human immunodeficiency virus/acquired immunodeficiency syndrome, liver disease, homicide, and work-related injuries. The impact of intergenerational changes in health behavior within the Latino population and the contributory role of suboptimal health care are interpreted in the context of implications for future research, public health programs, and policies.
This article can be downloaded here
September 2009
Are immigrant enclaves healthy places to live? The Multi-ethnic Study of Atherosclerosis
Soc Sci Med. 2009 Jul;69(1):110-20.
Osypuk TL, Roux AV, Hadley C, Kandula NR.
Corresponding author: Theresa L. Osypuk
Email: t.osypuk@neu.edu
Northeastern University, Boston, MA
ABSTRACT:The growing size and changing composition of the foreign-born population in the USA highlights the importance of examining the health consequences of living in neighborhoods with higher proportions of immigrants. Using data from the Multi-ethnic Study of Atherosclerosis in four US cities, we examined whether neighborhood immigrant composition was associated with health behaviors (diet, physical activity) among Hispanic and Chinese Americans (n ¼ 1902). Secondarily we tested whether neighborhoods with high proportions of immigrants exhibited better or worse neighborhood quality, and whether these dimensions of neighborhood quality were associated with healthy behaviors. Neighborhood immigrant composition was defined based on the Census 2000 tract percent of foreign-born from Latin-America, and separately, percent foreign-born from China. After adjustment for age, gender, income, education, neighborhood poverty, and acculturation, living in a tract with a higher proportion of immigrants was associated with lower consumption of high-fat foods among Hispanics and Chinese, but with being less physically active among Hispanics. Residents in neighborhoods with higher proportions of immigrants reported better healthy food availability, but also worse walkability, fewer recreational exercise resources, worse safety, lower social cohesion, and lower neighborhood-based civic engagement. Associations of neighborhood immigrant composition with diet persisted after adjustment for reported neighborhood characteristics, and associations with physical activity were attenuated. Respondent-reported neighborhood healthy food availability, walkability, availability of exercise facilities and civic participation remained associated with behaviors after adjusting for immigrant composition and other covariates. Results show that living in an immigrant enclave is not monolithically beneficial and may have different associations with different health behaviors.
This article can be viewed here (subscription may be required to view full article)
August 2009
Ecodevelopmental contexts for preventing type 2 diabetes in Latino and other racial/ethnic minority populations
J Behav Med. 2009 Feb;32(1):89-105.
González Castro F, Shaibi GQ, Boehm-Smith E.
Corresponding author: Felipe González Castro
Email: Felipe.Castro@asu.edu
Department of Psychology, Arizona State University, Tempe, AZ
ABSTRACT: Abstract Diabetes is the sixth leading cause of death in the United States and it is now cited along with obesity as a global epidemic. Significant racial/ethnic disparities exist in the prevalence of diabetes within the US, with racial and ethnic minorities disproportionately affected by type 2 diabetes and its complications. Racial/ethnic and socioeconomic factors influence the development and course of diabetes at multiple levels, including genetic, individual, familial, community and national. From an ecodevelopmental perspective, cultural variables assessed at one level (e.g., family level dietary practices) may interact with other types of variables examined at other levels (e.g., the availability of healthy foods within a low-income neighborhood), thus prompting the need for a clear analysis of these systemic relationships as they may increase risks for disease. Therefore, the need exists for models that aid in ‘‘mapping out’’ these relationships. A more explicit conceptualization of such multi-level relationships would aid in the design of culturally relevant interventions that aim to maximize effectiveness when applied with Latinos and other racial/ethnic minority groups. This paper presents an expanded ecodevelopmental model intended to serve as a tool to aid in the design of multi-level diabetes prevention interventions for application with racial/ethnic minority populations. This discussion focuses primarily on risk factors and prevention intervention in Latino populations, although with implications for other racial/ethnic minority populations that are also at high risk for type 2 diabetes.
This article can be downloaded here (pdf)
July 2009
Childhood poverty, chronic stress, and adult working memory
Proceedings of the National Academy of Sciences of the United States of America (PNAS). April 21, 2009 vol. 106 no. 16 6545-6549
Evans G, Schamberg M
Corresponding author: Gary W. Evans
Email: gwe1@cornell.edu
Departments of Design and Environmental Analysis and Human Development, Cornell University, Ithaca, NY
ABSTRACT: The income–achievement gap is a formidable societal problem, but little is known about either neurocognitive or biological mechanisms that might account for income-related deficits in academic achievement. We show that childhood poverty is inversely related to working memory in young adults. Furthermore, this prospective relationship is mediated by elevated chronic stress during childhood. Chronic stress is measured by allostatic load, a biological marker of cumulative wear and tear on the body that is caused by the mobilization of multiple physiological systems in response to chronic environmental demands.
This article can be downloaded here
June 2009
Physiogenomic analysis of the Puerto Rican population
Pharmacogenomics. April 2009, Vol. 10, No. 4, Pages 565-577
Ruaño G, Duconge J, Windemuth A, Cadilla C, Kocheria M, Villagra D, Renta J, Holford T, Santiago-Borrero P.
Corresponding author: Gualberto Ruaño
Email: g.ruano@genomas.net
Genomas Inc., 67 Jefferson Street, Hartford, CT
Aims: Admixture in the population of the island of Puerto Rico is of general interest with regards to pharmacogenetics to develop comprehensive strategies for personalized healthcare in Latin Americans. This research was aimed at determining the frequencies of SNPs in key physiological, pharmacological and biochemical genes to infer population structure and ancestry in the Puerto Rican population.
Materials & Methods: A noninterventional, cross-sectional, retrospective study design was implemented following a controlled, stratified-by-region, random sampling protocol. The sample was based on birthrates in each region of the island of Puerto Rico, according to the 2004 National Birth Registry. Genomic DNA samples from 100 newborns were obtained from the Puerto Rico Newborn Screening Program in dried-blood spot cards. Genotyping using a physiogenomic array was performed for 332 SNPs from 196 cardiometabolic and neuroendocrine genes. Population structure was examined using a Bayesian clustering approach as well as by allelic dissimilarity as a measure of allele sharing.
Results: The Puerto Rican sample was found to be broadly heterogeneous. We observed three main clusters in the population, which we hypothesize to reflect the historical admixture in the Puerto Rican population from Amerindian, African and European ancestors. We present evidence for this interpretation by comparing allele frequencies for the three clusters with those for the same SNPs available from the International HapMap project for Asian, African and European populations.
Conclusion: Our results demonstrate that population analysis can be performed with a physiogenomic array of cardiometabolic and neuroendocrine genes to facilitate the translation of genome diversity into personalized medicine.
The abstract for this article can be downloaded here. (subscription may be required to download pdf)
May 2009
Beyond Food Deserts: Measuring and Mapping Racial Disparities in Neighborhood Food Environments
Journal of Planning Education and Research, Vol. 27, No. 4, 469-482 (2008)
Raja, S. Ma, C. Yadav P.
Corresponding author: Samina Raja
Email: sraja@buffalo.edu
Department of Urban and Regional Planning at the State University of New York (SUNY) at Buffalo
ABSTRACT: Given the emerging focus on improving food environments and food systems through planning, this article investigates racial disparities in neighborhood food environments. An empirical case of Erie County, New York tests the hypothesis that people belonging to different racial groups have access to different neighborhood food destinations. Using multiple methods—Gini coefficients and Poisson regression—we show that contrary to studies elsewhere in the country there are no food deserts in Erie County. However, like other studies, we find an absence of supermarkets in neighborhoods of color when compared to white neighborhoods. Nonetheless, our study reveals an extensive network of small grocery stores in neighborhoods of color. Rather than soliciting supermarkets, supporting small, high-quality grocery stores may be a more efficient strategy for ensuring access to healthful foods in minority neighborhoods.
This article can be downloaded here. (subscription may be required to download pdf)
April 2009
Barriers to a Healthy Lifestyle: From Individuals to Public Policy—An Ecological Perspective
Journal of Extension. 2009 Feb;47(1), Article Number 1FEA3
Fitzgerald N., Spaccarotella K.
Corresponding author: Nurgul Fitzgerald
Email: nfitzgerald@rce.rutgers.edu
Department of Family & Community Health Sciences, Department of Nutritional Sciences Rutgers, The State University of New Jersey, New Brunswick, NJ
ABSTRACT: By using an ecological framework, this article provides a review of common barriers to healthful eating and being physically active. The barriers are described within the four levels (intrapersonal, interpersonal, community/institution, and macro/public policy) of an ecological model highlighting the need for multifaceted approaches to overcome these barriers. Examples of how Extension professionals can effectively target these barriers to promote healthier lifestyles and encourage the development of related policies and community programs are given. Practical examples of interventions that have successfully used an ecological model to promote behavior change are also provided.
This article can be downloaded here. (pdf)
March 2009
Neighborhood environments: disparities in access to healthy foods in the U.S.
Am J Prev Med. 2009 Jan;36(1):74-81. Epub 2008 Nov 1.
Larson NI, Story MT, Nelson MC.
Corresponding author: Nicole I. Larson
Email: larsonn@umn.edu
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
BACKGROUND: Poor dietary patterns and obesity, established risk factors for chronic disease, have been linked to neighborhood deprivation, neighborhood minority composition, and low area population density. Neighborhood differences in access to food may have an important influence on these relationships and health disparities in the U.S. This article reviews research relating to the presence, nature, and implications of neighborhood differences in access to food.
METHODS: A snowball strategy was used to identify relevant research studies (n=54) completed in the U.S. and published between 1985 and April 2008.
RESULTS: Research suggests that neighborhood residents who have better access to supermarkets and limited access to convenience stores tend to have healthier diets and lower levels of obesity. Results from studies examining the accessibility of restaurants are less consistent, but there is some evidence to suggest that residents with limited access to fast-food restaurants have healthier diets and lower levels of obesity. National and local studies across the U.S. suggest that residents of low-income, minority, and rural neighborhoods are most often affected by poor access to supermarkets and healthful food. In contrast, the availability of fast-food restaurants and energy-dense foods has been found to be greater in lower-income and minority neighborhoods.
CONCLUSIONS: Neighborhood disparities in access to food are of great concern because of their potential to influence dietary intake and obesity. Additional research is needed to address various limitations of current studies, identify effective policy actions, and evaluate intervention strategies designed to promote more equitable access to healthy foods.
The abstract for this article can be downloaded here. (subscription may be required to download pdf)
February 2009
Food security, poverty, and human development in the United States
Ann N Y Acad Sci. 2008;1136:193-209. Epub 2007 Oct 22.
Cook JT, Frank DA.
Corresponding author: John Cook
Email: john.cook@bmc.org
Department of Pediatrics, Boston University School of Medicine, Boston University Medical Center
ABSTRACT. Access to food is essential to optimal development and function in children and adults. Food security, food insecurity, and hunger have been defined and a U.S. Food Security Scale was developed and is administered annually by the Census Bureau in its Current Population Survey. The eight child-referenced items now make up a Children's Food Security Scale. This review summarizes the data on household and children's food insecurity and its relationship with children's health and development and with mothers' depressive symptoms. It is demonstrable that food insecurity is a prevalent risk to the growth, health, cognitive, and behavioral potential of America's poor and near-poor children. Infants and toddlers in particular are at risk from food insecurity even at the lowest levels of severity, and the data indicate an "invisible epidemic" of a serious condition. Food insecurity is readily measured and rapidly remediable through policy changes, which a country like the United States, unlike many others, is fully capable of implementing. The food and distribution resources exist; the only constraint is political will.
The abstract for this article can be downloaded here. (subscription may be required to download pdf)
January 2009
Determinants of physical activity among a convenience sample of Puerto Rican women residing in the Northeastern United States
J Strength Cond Res. 2008 Sep;22(5):1515-21
Pescatello LS, Alonso M, Schaffino R, Leavitt R
Corresponding author: Linda Pescatello
Email: linda.pescatello@uconn.edu
Department of Kinesiology, School of Education, University of Connecticut, Storrs
ABSTRACT. The research examining determinants of physical activity among Hispanics focuses on Mexican Americans, although Puerto Ricans are the second largest Hispanic subgroup in the United States. The purpose of this study was to explore factors influencing physical activity among Puerto Rican women in the urban northeastern United States. Two bilingual female investigators administered the Women and Physical Activity Survey by telephone to a convenience sample of Puerto Rican women (n = 28). Women were categorized as physically active if they performed moderate-intensity physical activity for at least 30 minutes a day at least 5 days a week or vigorous-intensity physical activity for at least 20 minutes a day at least 3 days a week. Women not meeting these criteria were classified as physically inactive. Chi-squared testing revealed whether the physically active and inactive women differed among physical activity determinants. Respondents had a mean age of 36 years and were predominately college-educated (64%) and physically active (68%). More physically active women (90%) had an annual income of more than $35,000 than did the inactive women (10%) (p < 0.05). More physically active women belonged to community groups (42% versus 0%), lived in communities where people exercise (95% versus 11%), and felt their community was good for their family (100% versus 67%) than did the inactive women, respectively (p < 0.05). The physically active women reported the presence of exercise facilities (p = 0.084) and well-maintained sidewalks (p = 0.087) to be more important for exercise accessibility than did the inactive women. Annual income, sense of community, and exercise accessibility were the most important physical activity determinants in this convenience sample of Puerto Rican women. Factors influencing the physical activity levels of Puerto Rican women should continue to be explored so that targeted, culturally appropriate strategies can be developed to promote physically activity in this population.
The abstract for this article can be downloaded here. (subscription may be required to download pdf)
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