This secondary analysis examined relationships between the environment and adherence to a walking intervention among 252 urban and suburban midlife African-American women. Participants received an enhanced or minimal behavioral intervention. Walking adherence was measured as the percentage of prescribed walks completed. Objective measures of the women’s neighborhoods included: walkability (land use mix, street intersection density, housing unit density, public transit stop density), aesthetics (physical deterioration, industrial land use), availability of outdoor (recreational open space) and indoor (recreation centers, shopping malls) walking facilities/spaces, and safety (violent crime incidents). Ordinary least squares regression estimated relationships. We found presence of one and especially both types of indoor walking facilities were associated with greater adherence. No associations were found between adherence and the other environmental variables. The effect of the enhanced intervention on adherence did not differ by environmental characteristics. Aspects of the environment may influence African-American women who want to be more active.
African Americans; Neighborhood; Walking
This study examines the association of neighborhood environment, as measured by housing factors, with physical activity among older African Americans. Context is provided on the effects of structural inequality as an inhibitor of health enhancing neighborhood environments. The study population included African Americans participating in the UAB Study of Aging (n=433). Participants demonstrated the ability to walk during a baseline in-home assessment. The strength and independence of housing factors were assessed using neighborhood walking for exercise as the outcome variable. Sociodemographic data, co-morbid medical conditions, and rural/urban residence were included as independent control factors. Homeownership, occupancy, and length of residency maintained positive associations with neighborhood walking independent of control factors. Housing factors appear to be predictive of resident engagement in neighborhood walking. Housing factors, specifically high rates of homeownership, reflect functional and positive neighborhood environments conducive for physical activity. Future interventions seeking to promote health-enhancing behavior should focus on developing housing and built-environment assets within the neighborhood environment.
Housing; Neighborhood; Neighborhood Disadvantage; African American; Physical Activity
Perceptions of neighborhood attributes for physical activity may be influenced by individual level income. This study examined differences in perceptions of neighborhood attributes for walking and bicycling in high and low income African American women. African American women (n = 388) aged 20–65 years completed the International Physical Activity Prevalence Study’s Environmental Survey Module. Independent t-tests determined differences in perceptions of neighborhood attributes by income group. Principal component factor analysis explored differences in factor structure for survey items. Low income African American women perceived their neighborhood as being less safe with regard to crime and traffic, having fewer free recreational opportunities, and having more public transportation stops nearby. Survey items weighed differently on each factor between income groups. Household income should be taken into consideration when interpreting perceptions of neighborhood for physical activity in African American women.
environment design; exercise; income; African American; female
Obesity is a public health problem that is due in part to low levels of physical activity. Physical activity levels are influenced by the built environment. We examined how changes in the built environment affected residents' physical activity levels in a low-income, primarily African American neighborhood in New Orleans.
We built a 6-block walking path and installed a school playground in an intervention neighborhood. We measured physical activity levels in this neighborhood and in 2 matched comparison neighborhoods by self-report, using door-to-door surveys, and by direct observations of neighborhood residents outside before (2006) and after (2008) the interventions. We used Pearson χ2 tests of independence to assess bivariate associations and logistic regression models to assess the effect of the interventions.
Neighborhoods were comparable at baseline in demographic composition, choice of physical activity locations, and percentage of residents who participated in physical activity. Self-reported physical activity increased over time in most neighborhoods. The proportion of residents observed who were active increased significantly in the section of the intervention neighborhood with the path compared with comparison neighborhoods. Among residents who were observed engaging in physical activity, 41% were moderately to vigorously active in the section of the intervention neighborhood with the path compared with 24% and 38% in the comparison neighborhoods at the postintervention measurement (P < .001).
Changes to the built environment may increase neighborhood physical activity in low-income, African American neighborhoods.
Effective interventions that increase adherence to physical activity (PA) are important for African American (AA) women because generally they are less active and more obese compared to white American women. The purpose of this study was to elicit from women who began a 12-month PA program between 2002 and 2005: 1) their recollections of outcome expectations and barriers, 2) feedback on program components, and 3) suggestions for program change. In 2007, we conducted qualitative post-intervention focus group interviews with women who had participated in the enhanced treatment group. Thirty-three AA women aged 44–69 years at the time of the study participated in one of four focus groups held at their community intervention site. Focus groups were formed on the basis of low (walked < 50% of expected walks) versus high (walked ≥50% of expected walks) adherence and low (0–2) versus high (3–4) attendance at the four workshops held during the 6-month adoption phase. Audio-taped sessions were transcribed and coded independently and then uploaded into NVivo7 for final coding and data analysis. Suggestions for future program components included a lifestyle PA prescription, pedometers for self-monitoring, ongoing group support and automated telephone support. Focus group participants can serve as experts to assist in content development for improving program effectiveness.
African American; Physical Activity; Qualitative Methods
The home and neighborhood environments may be important in obesity prevention by virtue of food availability, food preparation, cues and opportunities for physical activity, and family support. To date, little research has examined how home and neighborhood environments in rural communities may support or hinder healthy eating and physical activity. This paper reports characteristics of rural homes and neighborhoods related to physical activity environments, availability of healthy foods, and family support for physical activity and maintaining an ideal body weight.
In-depth interviews were conducted with 60 African American and White adults over 50 years of age in two rural counties in Southwest Georgia. Interviews were transcribed verbatim and coded independently by two members of the research team using standard methods of qualitative analysis. Themes were then identified and data matrices were used to identify patterns by gender or race.
Neighborhood features that supported physical activity were plenty of land, minimal traffic and living in a safe and friendly neighborhood. The major barrier was lack of recreational facilities. The majority of participants were not physically active with their family members due to schedule conflicts and lack of time. Family member-initiated efforts to encourage physical activity met with mixed results, with refusals, procrastination, and increased activity all reported. Participants generally reported it was easy to get healthy foods, although cost barriers and the need to drive to a larger town for a supermarket with good variety were noted as obstacles. Family conversations about weight had occurred for about half of the participants, with reactions ranging from agreement about the need to lose weight to frustration.
This study suggests that successful environmental change strategies to promote physical activity and healthy eating in rural neighborhoods may differ from those used in urban neighborhoods. The findings also provide insight into the complexities of family support for physical activity and maintaining a healthy weight. Addressing socio-ecologic factors has the potential to increase healthy behaviors and decrease the prevalence of obesity among rural residents.
The authors tested neighborhood context, negative life events, and negative affectivity as predictors of the onset of major depression among 720 African American women. Neighborhood-level economic disadvantage (e.g., percentage of residents below the poverty line) and social disorder (e.g., delinquency, drug use) predicted the onset of major depression when controlling for individual-level demographic characteristics. Neighborhood-level disadvantage/disorder interacted with negative life events, such that women who experienced recent negative life events and lived in high disadvantage/disorder neighborhoods were more likely to become depressed than were those who lived in more benign settings, both concurrently and over a 2-year period. Neighborhood disadvantage/disorder can be viewed as a vulnerability factor that increases susceptibility to depression following the experience of negative life events.
Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low- or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African–Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low- or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures—distance and public transportation travel time—is less strong in African–American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African–American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African–American residents. Thus, it appears that the spatial accessibility of low- and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.
African–American; Geographic information system (GIS); Health care accessd; Mammography; Neighborhood; Poverty; Urban health
It is unclear why rates of depression differ by race/ethnicity among young women. This study examines whether racial/ethnic differences in depressive symptoms are reduced by intimate partner violence (IPV), traumatic events, and posttraumatic stress disorder (PTSD) symptoms among a clinical sample of low-income women.
A cross-sectional sample of 2414 young African American, Hispanic, and white women completed a survey that included questions about depression, PTSD symptoms, IPV, and trauma. Binary logistic regression and Poisson regression determined whether reports of PTSD symptoms, IPV, and trauma among white, African American, and Hispanic women affected the differences in depression found in these groups.
Twenty-four percent reported a level of depressive symptoms that warranted further evaluation for major depressive disorders. White women had elevated levels of depressive symptoms and were more likely to report ≥4 symptoms. White women also reported higher rates of PTSD symptoms, IPV, and traumatic events than African American or Hispanic women. Differences in the likelihood of reporting ≥4 depressive symptoms by race/ethnicity were reduced after controlling for PTSD symptoms and trauma. PTSD symptoms attenuated the differences in the count of depressive symptoms between white and African American women. After controlling for PTSD symptoms, trauma attenuated the difference in the count of depressive symptoms between Hispanic and white women.
Elevated levels of trauma and PTSD symptoms among white women compared to African American or Hispanic women may play a role in observed racial/ethnic differences in depressive symptoms.
Lack of physical activity among American adults is a serious public health concern. Many factors influence activity levels, and most research has focused on either individual factors, such as race and income, or on characteristics of the physical environement, such as the availability of parks. Our study used a cross-sectional multilevel design to examine the influences of individual-and neighborhood-level characteristics on participant’s perceptions of their neighborhood as an appropriate venue for physical activity. Study participants were 1,073 African American and white adults living in the St. Louis, Missouri, metropolitan area. Individual-level information was gathered from self-administered questionnaires; neighborhood-level data for these same individuals were obtained from the 2000 US Census. We found that both individual and neighborhood characteristics were significant predictors of how individuals perceived physical activity opportunities in their neighborhood, and that African Americans perceived their neighborhoods as less safe and less pleasant for physical activity than did whites, regardless of the racial composition of the neighborhood. We suggest that any evaluation of opportunities for physical activity within a neighborhood should includd consideration of resident’s perceptions of the safety and pleasantness of using them, and that the role of perceived and actual neighborhood conditions in explaining disparities in physical activity between African American and other populations should be examined further.
Environmental determinants; Multilevel modeling; Physical activity; Racial disparities
This study examined the association between perceptions of social and safety-related environmental attributes and physical activity (PA) and walking in African American and white adults.
In a random-digit–dial telephone survey, 1165 adults in a rural county in South Carolina answered questions about their perceptions of social and safety-related environmental supports for PA and their overall PA and walking behavior. Social perceptions included whether neighbors could be trusted or were perceived to be physically active. Safety-related perceptions included neighborhood safety, the safety of public recreation facilities, problems with unattended dogs, traffic volume, and streetlight quality. Logistic regression models were used to examine the associations between environmental supports and PA and walking stratified by race.
No association between perceived neighborhood environmental supports and PA or walking was observed in African Americans. Among whites, individuals who perceived their neighbors as active were twice (95% confidence interval [CI], 1.19–3.25) as likely to report meeting the recommendation for PA compared with individuals who did not report their neighbors as active. Whites who perceived their neighbors as active were 2.5 times (95% CI, 1.54–4.08) as likely to report meeting the recommendations for walking than whites who did not, and whites who perceived their neighborhoods as safe were 1.8 times (95% CI, 1.03–3.12) as likely to report meeting the recommendations for walking than whites who did not.
These data indicate that perceptions of certain social and safety-related environmental supports were strongly associated with meeting the recommendations for PA and walking among white but not African American adults.
There is a growing interest in understanding the effects of specific neighborhood conditions on psychological wellbeing. We examined cross-sectional associations of neighborhood stressors (perceived violence and disorder, physical decay and disorder) and social support (residential stability, family structure, social cohesion, reciprocal exchange, social ties) with depressive symptoms in 3105 adults in Chicago. Subjects lived in 343 neighborhood clusters, areas of about two census tracts. Depressive symptoms were assessed with an 11-item version of the CES-D scale. Neighborhood variables were measured using rater assessments, surveys, and the US Census. We used two-level gender-stratified models to estimate associations of neighborhood conditions with depressive symptoms after adjusting for individual-level covariates. Most social support variables were associated with lower levels of depressive symptoms in women but not men, while stressors were moderately associated with higher levels in all subjects. Adjusting concurrently for stressors and social support did not change results. This suggests both neighborhood stressors and social support are associated with depressive symptoms.
depression; residence characteristics; neighborhoods; stressors; social support
We examined the prevalence and psychological correlates of witnessing community violence among women of low socioeconomic status living in urban neighborhoods in the northeastern United States. Three hundred eighty-six women receiving their health care at an urban community health center were sampled to assess their violence exposures. Women were asked to report the location and timing of their exposure to witnessing violent neighborhood events in which they were not participants. The Brief Symptoms Inventory was used to assess anxiety and depressive symptoms. Controlling for marital status, educational attainment, age, and intimate partner violence victimization, women who witnessed violent acts in their neighborhoods were twice as likely to experience depressive and anxiety symptoms compared to women who did not witness community violence. Central American-born women had particularly high exposures. We conclude that witnessing neighborhood violence is a pervasive experience in this urban cohort, and is associated with anxiety and depressive symptoms, even among women who are not direct participants in violence to which they are exposed. Community violence interventions must incorporate efforts to protect the mental health of adult women who witness events in their neighborhoods.
Neighborhood violence; Women’s health; Neighborhood effects on health
To determine whether there is a relationship between depressive symptoms and cortisol assessed at first morning awakening, 6PM, and 9PM in a population-based sample of midlife women. If this relationship is not linear, we aim to test whether this relationship is nonlinear, only present in those with more severe depressive symptoms, better accounted for by diurnal slope, or only apparent under uncontaminated conditions.
We investigated the cross-sectional association between cortisol and depressive symptoms, assessed by the Center for Epidemiological Studies Depression Scale (CES-D) in 408 midlife women (45.7% African-Americans, 54.3% white; mean age = 50.4) participating in the Chicago site of the Study of Women’s Health Across the Nation (SWAN).
Diurnal cortisol slope is significantly flatter for women with higher CES-D scores than for less depressed women (p<.05 for the interaction). This relationship remains significant even after adjusting for age, smoking status, race, education, income, menopausal status, hormone replacement therapy (HRT), body mass index (BMI), medications, and wake time as well as possibly contaminating factors including physical activity, smoking, eating, or caffeine or alcohol consumption prior to saliva collection. Results using depression assessed categorically (CES-D cutoff ≥ 16) were similar to those using continuous depression in both unadjusted and adjusted analyses (p=.005 for the interaction of CES-D by time).
In this population-based sample of midlife women, greater depressive symptoms were associated with a significantly flatter diurnal cortisol slope than those with fewer symptoms, even after adjusting for covariates and possibly contaminating behaviors.
diurnal cortisol; depressive symptoms; midlife women; women’s health
Research indicates that neighborhood context can have a significant effect on the health of elders. The evidence suggests that there may be physical health benefits afforded to Mexican Americans living in ethnically homogenous neighborhoods, despite the relatively high economic risk in such neighborhoods. However, few studies have considered the impact of neighborhood ethnic density on mental health outcomes in older adults. This study evaluates the association between neighborhoods with a high proportion of Mexican Americans and depressive symptoms among very old Mexican Americans. Hierarchical linear modeling was used to examine data from Wave 5 (2004–2005) of the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE). Subjects included 1,875 community-dwelling Mexican Americans aged 75 and older living in 386 neighborhoods across five states in the Southwestern United States (Arizona, California, Colorado, New Mexico, Texas). Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D, α =0.88). Results showed that among very old men, there was a significant negative association between percent Mexican Americans in the neighborhood and depressive symptoms (P=.011). Although among women the direction of the association was the same, the effect was not significant. These findings suggest that the proportion of Mexican Americans in the neighborhood matter more for very old Mexican American men than women. Further research may inform screening and treatment for depressive symptoms based on differences in neighborhood composition. Recommendations include culturally tailored programs that offer older Mexican Americans greater mobility and access to programs and opportunities in culturally identifiable neighborhoods.
Neighborhood context; gender; Mexican Americans; depressive symptoms
African American women exhibit a higher mortality rate from breast cancer than do white women. African American women are more likely to gain weight at diagnosis, which may increase their risk of cancer recurrence and comorbidities. Physical activity has been shown to decrease body mass index and improve quality of life in cancer survivors. This study was designed to evaluate the feasibility and impact of a community-based exercise intervention in African American breast cancer survivors.
A theory-based eight-week community intervention using pedometers with scheduling, goal setting, and self-assessment was tested in a convenience sample of African American breast cancer survivors (n = 24). Data were collected at three time points to examine changes in steps walked per day, body mass index, and other anthropometric measures, attitudes, and demographic variables.
Statistically significant increases in steps walked per day and attitude toward exercise as well as significant decreases in body mass index, body weight, percentage of body fat, and waist, hip, and forearm circumferences, as well as blood pressure, were reported from baseline to immediate post-intervention. Positive changes were retained or improved further at three-month follow-up except for attitude toward exercise. Participant retention rate during eight-week intervention was 92%.
Increasing walking for exercise, without making other changes, can improve body mass index, anthropometric measures, and attitudes, which are associated with improved quality of life and reduced risk of cancer recurrence. The high participant retention rate, along with significant study outcomes, demonstrate that among this sample of African American breast cancer survivors, participants were motivated to improve their exercise habits.
Depressive symptomatology during pregnancy has been associated with negative health outcomes for both the mother and child. This study examines the potential associations between depression and depressive symptoms in poor women and African-American women and their lifelong experiences of discrimination.
Data from 2,731 African-American and White participants in the Pregnancy Outcomes and Community Health (POUCH) Study were analyzed. Multiple regression analyses were used to investigate relations between depressive symptoms and total discrimination, and between depressive symptoms and three discrimination types (gender, race, and socioeconomic).
Initial results showed that African-American women had greater levels of depressive symptoms than White women. Self-reported total discrimination and discrimination types were each positively associated with depressive symptomatology in all women. After adjusting for sociodemographic characteristics (maternal age, education, employment status, partner status, and Medicaid status) and examining significant interactions, the race difference in depressive symptomatology was evident only in employed women. The addition of total discrimination to the multi-covariate model eliminated race differences in the adjusted mean level of depressive symptoms. When the three discrimination types were modeled simultaneously with all other covariates, only gender and economic discrimination remained positively associated with depressive symptoms in African-American and White women.
These results should be cautiously interpreted due to: 1) the study design; i.e., ascertainment of maternal discrimination and depressive symptoms at a single time point; and 2) limitations of the discrimination measure. Despite these limitations, the study points to potential links between lifetime discrimination and depressive symptoms in pregnancy.
depression; depressive symptoms; discrimination; race; pregnancy; race comparison; mental health
Depression affects over 15 million Americans in a given year. Compared to physical health, less is known about the affect of diet quality on symptoms of depression.
This study investigated the relationship between diet quality and reported symptoms of depression in a low-income urban population.
Subjects included 1,118 African American and white adults, aged 30–64 years, living in Baltimore, MD and represented a sub-sample of the initial examination and recruitment phase of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study.
Nutrition data were based on two 24-hour dietary recalls collected by trained interviewers using the United States Department of Agriculture (USDA) Automated Multiple Pass Method (AMPM). Diet quality was calculated using the USDA's Healthy Eating Index (HEI)-2005. Depressive symptoms were assessed by a trained interviewer using the Center for Epidemiologic Studies Depression (CES-D) scale.
Both linear and logistic regression analyses were used to examine whether or not diet quality was associated with depressive symptoms. The dependent variable was depressive symptoms and independent variables included HEI-2005, race, sex, age, education, income, and food assistance program participation.
Mean HEI-2005 score (± SEM) was 52.17 ± 0.40 (out of 100). Mean CES-D score was 11.64 ± 0.25 (out of 40). Diet quality was significantly associated with reported symptoms of depression. However, income was a significantly stronger predictor of depression compared to diet quality, education and sex.
Registered dietitians should be aware of relationship between psychological status and nutritional health when assisting clients to better manage their food choices to improve their overall health and quality of life.
Healthy Eating Index; depression; healthy aging
Although racial/ethnic differences have been found in the use of mental health services for depression in the general population, research among Veterans has produced mixed results. This study examined racial/ethnic differences in the use of mental health services among 148 Operation Enduring/Iraqi Freedom (OEF/OIF) Veterans with high levels of depression and posttraumatic stress disorder (PTSD) symptoms and evaluated whether religious coping affected service use. No differences between African American, Hispanic, and Non-Hispanic white Veterans were found in use of secular mental health services or religious counseling. Women Veterans were more likely than men to seek secular treatment. After controlling for PTSD symptoms, depression symptom level was a significant predictor of psychotherapy attendance but not medication treatment. African American Veterans reported higher levels of religious coping than whites. Religious coping was associated with participation in religious counseling, but not secular mental health services.
In approaching the study of racial discrimination and health, the neighborhood- and individual-level antecedents of perceived discrimination need further exploration. We investigated the relationship between neighborhood- and individual-level socioeconomic position (SEP), neighborhood racial composition, and perceived racial discrimination in a cohort of African-American and White women age 40–79 from Connecticut, USA.
The logistic regression analysis included 1249 women (39% African-American and 61% White). Neighborhood-level SEP and racial composition were determined using 1990 census tract information. Individual-level SEP indicators included income, education, and occupation. Perceived racial discrimination was measured as lifetime experience in seven situations.
For African-American women, living in the most disadvantaged neighborhoods was associated with fewer reports of racial discrimination (odds ratio (OR) 0.44; 95% confidence interval (CI) 0.26, 0.75), with results attenuated after adjustment for individual-level SEP (OR 0.54, CI: 0.29, 1.03), and additional adjustment for neighborhood racial composition (OR 0.70, CI: 0.30, 1.63). African-American women with 12 years of education or less were less likely to report racial discrimination, compared with women with more than 12 years of education (OR 0.57, CI: 0.33, 0.98 (12 years); OR 0.51, CI: 0.26, 0.99 (less than 12 years)) in the fully adjusted model. For White women, neither neighborhood-level SEP nor individual-level SEP was associated with perceived racial discrimination.
Individual- and neighborhood-level SEP may be important in understanding how racial discrimination is perceived, reported, processed, and how it may influence health. In order to fully assess the role of racism in future studies, inclusion of additional dimensions of discrimination may be warranted.
African-Americans; discrimination (psychology); prejudice; residence characteristics; socioeconomic factors
Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services.
A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data.
Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans: (2) Barriers to Seeking Treatment for Older African-Americans: and (3) Cultural Coping Strategies for Depressed African-American Older Adults.
Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors. which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.
depression; beliefs/attitudes; health service use; stigma; aging
To assess the association of depressive symptoms with diabetes self-management regimens among older adults with type 2 diabetes in a rural, ethnically diverse community.
Data from 696 rural older African Americans, American Indians and whites were used to assess depressive symptoms (modified CES-D) and diabetes self-management (physical activity, blood glucose self-monitoring, self foot checks, following a healthful eating plan, and medication adherence).
In bivariate analyses, high CES-D scores were associated with decreased adherence to a healthful eating plan and physical activity, and increased foot checks; the latter 2 remained significant in multivariate analyses.
Older adults with diabetes and depression are less likely to adhere to self-management, increasing their risk of complications.
depressive symptoms; type 2 diabetes; African Americans; American Indians; diabetes self-management
The purpose of this assessment is to increase our understanding of how safety and environmental factors influence physical activity among African American residents living in a low-income, high-crime neighborhood and to get input from these residents about how to best design physical activity interventions for their neighborhood. Twenty-seven African American adult residents of a low-income, high-crime neighborhood in a suburban southeastern community participated in three focus groups. Participants were asked questions about perceptions of what would help them, their families, and their neighbors be more physically active. Two independent raters coded the responses into themes. Participants suggested three environmental approaches in an effort to increase physical activity: increasing law enforcement, community connectedness and social support, and structured programs. Findings suggest that safety issues are an important factor for residents living in disadvantaged conditions and that the residents know how they want to make their neighborhoods healthier.
assessment; environment; safety; community solutions; physical activity
We examined associations between neighborhood socioeconomic disadvantage, perceived neighborhood safety and cardiometabolic risk factors, adjusting for health behaviors and socioeconomic status (SES) among African Americans.
Study participants were non-diabetic African Americans (n = 3,909) in the baseline examination (2000–2004) of the Jackson Heart Study. We measured eight risk factors: the metabolic syndrome, its five components, insulin resistance and cardiovascular inflammation. We assessed neighborhood socioeconomic disadvantage with US Census 2000 data. We assessed perceived neighborhood safety, health behaviors and SES via survey. We used generalized estimating equations to estimate associations with a random intercept model for neighborhood effects.
After adjustment for health behaviors and SES, neighborhood socioeconomic disadvantage was associated with the metabolic syndrome in women (PR 1.13, 95% CI 1.01, 1.27). Lack of perceived safety was associated with elevated glucose (OR 1.36, 95% CI 1.03, 1.80) and waist circumference (PR 1.06, 95% CI 1.02, 1.11) among women, and with elevated glucose (PR 1.30, 95% CI 1.02, 1.66) and insulin resistance (PR 1.25, 95% CI 1.08, 1.46) among men.
Neighborhood socioeconomic disadvantage and perceived safety should be considered as targets for intervention to reduce cardiometabolic risks among African Americans.
Drug abuse has serious consequences for the wellbeing of persons with HIV/AIDS but suboptimal rates of client engagement limit the efficacy of interventions. The present study examines and compares client characteristics that predicted engagement (defined as attendance at two or more sessions) in a family intervention (SET) and a group intervention within a randomized trial aimed at preventing relapse and improving medication adherence for 126 predominantly African American HIV+ women in drug abuse recovery. Intervention engagement (60% overall) was not significantly different across the two interventions. Fewer physical and mental symptoms (malaise) (P < 0.05), living independently (P < 0.05), living with children (P < 0.05), and readiness to change (P < 0.05) were associated with engagement across the two interventions. Results from this study can be used to inform outreach and engagement approaches for women dually affected by drug abuse and HIV/AIDS.
HIV/AIDS; Drug abuse; Engagement; Women