Person:

Bennett, Gary

Background: This paper presents the study design, intervention components, and baseline data from Open Doors to Health, a study designed to address social contextual factors in colorectal cancer (CRC) prevention for low-income, racial/ethnic minority populations. Methods: A cluster randomized design with 12 housing sites as the primary sampling units was used: 6 sites were assigned to a "Peer-led plus Screening Access" (PL) condition, and 6 were assigned to "Screening Access only" (SCR) condition. Study-related outcomes were CRC screening, physical activity (measured as mean steps/day), and multivitamin use. Results: At baseline (unweighted sample size = 1554), two-thirds self-reported that they were current with screening recommendations for CRC (corrected for medical records validation, prevalence was 52%), with half having received a colonoscopy (54%); 96% had health insurance. Mean steps per day was 5648 (se mean = 224), and on average 28% of the sample reported regular multivitamin use. Residents reported high levels of social support [mean = 4.40 (se = .03)] and moderately extensive social networks [mean = 2.66 (se = .02)]. Conclusion: Few studies have conducted community-based studies in public housing communities; these data suggest areas for improvement and future opportunities for intervention development and dissemination. Findings from the randomized trial will determine the effectiveness of the intervention on our health-related outcomes as well as inform future avenues of research.

Background: Despite its health benefits, physical inactivity is pervasive, particularly among those living in lower-income urban communities. In such settings, neighborhood safety may impact willingness to be regularly physically active. We examined the association of perceived neighborhood safety with pedometer-determined physical activity and physical activity self-efficacy. Methods and Findings: Participants were 1,180 predominantly racial/ethnic minority adults recruited from 12 urban low-income housing complexes in metropolitan Boston. Participants completed a 5-d pedometer data-collection protocol and self-reported their perceptions of neighborhood safety and self-efficacy (i.e., confidence in the ability to be physically active). Gender-stratified bivariate and multivariable random effects models were estimated to account for within-site clustering. Most participants reported feeling safe during the day, while just over one-third (36%) felt safe at night. We found no association between daytime safety reports and physical activity among both men and women. There was also no association between night-time safety reports and physical activity among men (p = 0.23) but women who reported feeling unsafe (versus safe) at night showed significantly fewer steps per day (4,302 versus 5,178, p = 0.01). Perceiving one's neighborhood as unsafe during the day was associated with significantly lower odds of having high physical activity self-efficacy among both men (OR 0.40, p = 0.01) and women (OR 0.68, p = 0.02). Conclusions: Residing in a neighborhood that is perceived to be unsafe at night is a barrier to regular physical activity among individuals, especially women, living in urban low-income housing. Feeling unsafe may also diminish confidence in the ability to be more physically active. Both of these factors may limit the effectiveness of physical activity promotion strategies delivered in similar settings.

Background: Obesity is disproportionately prevalent among many racial/ethnic minority communities. The efficacy of weight control efforts in these groups may depend on individual's ability to accurately perceive their weight status. We examined whether racial/ethnic differences exist in weight status misperception among overweight adults. Methods: Nationally-representative data from the National Health and Nutrition Examination Survey (NHANES) 1999–2002 were examined. Participants included overweight and obese adult men (n = 3115) and women (n = 3437). Weight status misperception was identified among respondents who self-reported being "about the right weight/underweight." Results: Blacks (OR = 2.06, 95% CI: 1.71, 2.54) were twice as likely and Hispanics (OR = 1.70, 95%CI: 1.33, 2.17) were 70-percent more likely than Whites to misperceive their weight, in models adjusted for age, education, income, marital status, self-reported health, and self-reported medical diagnosis of overweight. Black overweight (OR = 2.03, 95% CI: 1.26, 3.26) and obese (OR = 3.56, 95% CI: 1.57, 8.11) women were considerably more likely to exhibit misperception compared to their White female counterparts. Odds of misperception were higher among overweight Black (OR = 2.20, 95%CI: 1.54, 3.15), Hispanic (OR = 1.89, 95% CI: 1.30, 2.75), and obese Black men (OR = 2.84, 95% CI: 1.54, 5.22), compared to White men. Conclusion: Weight status misperceptions among the overweight are more common among Blacks, and Hispanic men. The persistence of racial/ethnic differences after adjustment for medical diagnosis of overweight may suggest some resistance to physician weight counseling. Identifying strategies to correct weight status misperceptions status may be necessary to ensure the efficacy of clinical and public health obesity interventions conducted among these groups.

Gary Bennett and colleagues discuss the ways in which the dramatic rise in home foreclosures, particularly in the US, may have health consequences. Summary Points: (1) While policy makers worldwide have scrambled to counter its economic effects, the potential health implications of home foreclosure have received little empirical attention. (2) Home foreclosure can be viewed as a stressful life event of prolonged duration, with multiple phases of variable intensity. (3) Although no studies to date have reported the specific health effects of home foreclosure, we posit that foreclosure may be associated with a range of psychological and health behavior outcomes that, in turn, might increase chronic disease risk. (4) Susceptibility to home foreclosure might involve both compositional and contextual dimensions. (5) Delinquency management policies designed to prevent foreclosures from occurring are arguably best suited to protect the health of those at greatest risk.

Traditionally, neuropsychological deficits due to Sickle Cell Disease (SCD) have been understudied in adults. We have begun to suspect, however, that symptomatic and asymptomatic Cerebrovascular Events (CVE) may account for an alarming number of deficits in this population. In the current brief review, we critically evaluated the pediatric and adult literatures on the neurocognitive effects of SCD. We highlighted the studies that have been published on this topic and posit that early detection of CVE via neurocognitive testing, neuropsychiatric evaluations, and neuroimaging may significantly reduce adult cognitive and functional morbidities.

Introduction: Using the Internet to promote behavior change is becoming more desirable as Internet use continues to increase among diverse audiences. Yet we know very little about whether this medium is useful or about different strategies to encourage Internet use by various populations. This pilot study tested the usefulness of a Web-based intervention designed to deliver nutrition-related information to and increase fruit and vegetable consumption among adults from working-class neighborhoods. Methods: Participants (N = 52) had access to the Web site for 6 weeks and received three e-mail reminders encouraging them to eat fruits and vegetables. The Web site provided information about overcoming barriers to healthy eating, accessing social support for healthy eating, setting goals for healthy eating, and maintaining a healthy diet, including recipes. We collected data on participants' use of the Web site, their Internet access and use, and their fruit and vegetable consumption. Results: The mean age of the participants was 46 years, 73% were white, 46% did not have a college degree, and 12% had household incomes at or below 185% of the federal poverty index. They reported consuming an average of 3.4 servings of fruits and vegetables per day. More than half of the participants owned a computer, 75% logged onto the Web site at least once, and those who visited the site averaged 3.8 visits and viewed an average of 24.5 pages. The number of log-ons per day declined over the study period; however, reminder e-mails appeared to motivate participants to return to the Web site. Roughly 74% of participants viewed information on goal setting, 72% viewed information on dietary tracking, and 56% searched for main course recipes. Conclusion: The results of this pilot study suggest that Internet-based health messages have the potential to reach a large percentage of adults from working-class neighborhoods who have access to the Internet.

Introduction: Few papers address the methodological challenges in recruiting participants for studies of cancer prevention interventions designed for multiracial and multiethnic working-class populations. This paper reports the results of the sample selection and survey methods for two group-randomized intervention studies. Methods: The two group-randomized intervention studies, Healthy Directions–Small Business (HD–SB) and Healthy Directions–Health Centers (HD–HC), included a worksite-based study in 26 small manufacturing businesses and a study in 10 outpatient health centers. We used selection and recruitment methods to obtain a multiracial and multiethnic working-class study sample. In 2000 and 2001, we assessed baseline measures of sociodemographic characteristics and behavioral outcomes by self-report. We then computed intraclass correlation coefficients (ICCs). Results: Of the 1740 participants in the HD–SB study, 68% were non-Hispanic whites, and 76% had working-class occupations. In the HD–HC study, 59% of 2219 participants were non-Hispanic whites. Among those who worked, 51% had working-class occupations. Large percentages of both samples reported not meeting recommended guidelines for the target behaviors. For example, 86% of members of both samples consumed fewer than the recommended five servings of fruits and vegetables per day. The ICCs for the four target behaviors in HD–SB were between 0.006 and 0.02. In the HD–HC study, the ICCs ranged from 0.0004 to 0.003. Conclusion: The two studies were successful in recruiting multiracial and multiethnic working-class participants. Researchers will find the estimates of the primary outcomes and their ICCs useful for planning future studies.

Background

While discrimination has been identified as a potential determinant of existing racial/ethnic health disparities, no studies have investigated whether racial discrimination contributes to disparities in physical activity.

Purpose

The primary aim of the current study was to examine the association between interpersonal racial discrimination and physical activity.

Methods

Baseline data were collected during 2004–2005 among a predominately black and Hispanic sample of adult residents living in 12 low income–housing sites in Boston, Massachusetts (n=1055). Residents reported experiences of lifetime racial discrimination during interview-administered surveys and wore a pedometer for 5 days to measure physical activity. For analyses, performed in 2009, linear regression models with a cluster design were conducted to predict physical activity, measured as steps per day.

Results

Nearly 48% of participants reported ever experiencing racial discrimination, and discrimination was most commonly experienced on the street or in a public setting. No association was found between discrimination and physical activity, when examined in bivariate, multivariable, or race-stratified models.

Conclusions

The current results indicate that self-reported racial discrimination is not a key determinant of physical activity among residents living in lower-income housing. However, additional research is warranted to address current limitations of this study.