This study examined the contributions of both individual socioeconomic status (SES) and community disadvantage in explaining the higher body mass index (BMI) of black adults in the US. Data from a national survey of adults (1986 American's Changing Lives Study) were combined with tract-level community data from the 1980 census. Results of multilevel regression analyses showed that black women had an age-adjusted BMI score three points higher than non-black women. Individual SES (income, education, assets) was negatively associated with BMI in women, but it only reduced the association between race and BMI from 2.99 to 2.50. Adding community socioeconomic disadvantage index further reduced the race coefficient slightly from 2.50 to 2.21. Nevertheless, living in communities with higher socioeconomic disadvantage was associated with higher BMI net of age, race, individual SES, smoking, physical activity, stress, and social support. Community income inequality (Gini) had an independent positive association with BMI, but did not substantially reduce racial differences among women. Community percent black was not associated with BMI. Results for men demonstrated no statistically significant racial differences in BMI, and no association between BMI and either individual SES or community disadvantage. Although individual SES and community socioeconomic disadvantage each partly explained the higher average BMI among black women, clear racial disparities persisted. Moreover, race, individual SES, community socioeconomic disadvantage, and individual health behaviors were each independent predictors of BMI among women. Unexplained within- and between-community variance in BMI remained among both women and men, with most unexplained variation due to within-community variance. Because our evidence for women suggests that the determinants of obesity are multiple and multilevel, attempts to address this growing social problem will similarly require a multi-faceted and multilevel approach.
"These associations remained significant after adjustment for level 1 variables: age, gender, education, and consumption of meat with visible fat. This study confirms previous results indicating that the environmental determinants partly explain the variation in health outcomes, i.e., they are a result of a hierarchical structure (Robert and Reither, 2004). Fig. 1. "
[Show abstract][Hide abstract] ABSTRACT: This study identified environmental variables associated with obesity in the adult population of a city in Brazil. It was conducted using the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2008 to 2010. The body mass index (BMI) was calculated from the participants' self-reported weight and height. Obesity was defined as a BMI ≥ 30 kg/m2. The food establishments, georeferenced areas conducive to physical activity, total income of the neighbourhood, homicide rate and population density were used to characterise the environment. In addition, individual variables were considered. A multilevel logistic regression was performed. A total of 5,273 individuals were evaluated. The odds of obesity was found to be significantly decreased with increases in the number of establishments that sell healthy food, number of restaurants, number of places for physical activity and total income - in different models. In addition, these associations remained significant after adjustment for age, gender, education and consumption of meat with visible fat. This study contributes to a better understanding of the complex interaction between environmental and individual determinants of obesity and may aid in the development of effective interventions, such as the expansion of obesity control programs.
"Although the addition of a pricing intervention did not appear to influence purchase of healthy items overall, individuals in the subsample who were overweight/obese exhibited a greater sensitivity to the addition of a pricing intervention relative to individuals who were normal weight. It is possible that the greater sensitivity of overweight/obese persons to the signage + taste testing + price reduction intervention may reflect heightened price sensitivity due to their relatively lower SES, as individuals of lower SES tend to have higher body weights compared to those of higher SES [67,68]. These results contrast with those of Epstein et al. , who observed that obese mothers were less price sensitive than their nonobese counterparts. "
[Show abstract][Hide abstract] ABSTRACT: Nudging is an approach to environmental change that alters social and physical environments to shift behaviors in positive, self-interested directions. Evidence indicates that eating is largely an automatic behavior governed by environmental cues, suggesting that it might be possible to nudge healthier dietary behaviors. This study assessed the comparative and additive efficacy of two nudges and an economic incentive in supporting healthy food purchases by patrons at a recreational swimming pool.
An initial pre-intervention period was followed by three successive and additive interventions that promoted sales of healthy items through: signage, taste testing, and 30% price reductions; concluding with a return to baseline conditions. Each period was 8 days in length. The primary outcome was the change in the proportion of healthy items sold in the intervention periods relative to pre- and post-intervention in the full sample, and in a subsample of patrons whose purchases were directly observed. Secondary outcomes included change in the caloric value of purchases, change in revenues and gross profits, and qualitative process observations. Data were analyzed using analysis of covariance, chi-square tests and thematic content analysis.
Healthy items represented 41% of sales and were significantly lower than sales of unhealthy items (p < 0.0001). In the full sample, sales of healthy items did not differ across periods, whereas in the subsample, sales of healthy items increased by 30% when a signage + taste testing intervention was implemented (p < 0.01). This increase was maintained when prices of healthy items were reduced by 30%, and when all interventions were removed. When adults were alone they purchased more healthy items compared to when children were present during food purchases (p < 0.001), however parental choices were not substantially better than choices made by children alone.
This study found mixed evidence for the efficacy of nudging in cueing healthier dietary behaviors. Moreover, price reductions appeared ineffectual in this setting. Our findings point to complex, context-specific patterns of effectiveness and suggest that nudging should not supplant the use of other strategies that have proven to promote healthier dietary behaviors.
International Journal of Behavioral Nutrition and Physical Activity 01/2014; 11(1):6. DOI:10.1186/1479-5868-11-6 · 4.11 Impact Factor
"However, given that on average, our sample was fairly well educated, a lack of awareness of the benefits of lifestyle change is unlikely. Yet, other factors such as limited access to stores that have fresh fruits and vegetables and limited safe areas for regular physical exercise may be more relevant reasons for our sample's limited practice of these behaviors (Larson, Story, & Nelson, 2009; Lee, Mama, Medina, Ho, & Adamus, 2012; Lopez & Hynes, 2006; Robert & Reither, 2004). It is plausible that acceptance of such limitations may serve to reinforce the belief that the totality of lifestyle modification behaviors add little value to BP control. "
[Show abstract][Hide abstract] ABSTRACT: Guided by Leventhal's common sense model of illness representations, this study examined the relationship between hypertension beliefs and self-care behaviors necessary for blood pressure (BP) control in a sample of 111 community-dwelling African Americans with hypertension. Participants completed the revised Illness Perception Questionnaire, BP Self-Care Scale, and a demographic data sheet, and had BP measured. Analyses revealed that beliefs about the causes of hypertension differed by gender and educational level. Stress-related causal attributions accounted for 34.7% of the variance in hypertension beliefs. Participants who believed stress or external factors caused hypertension were less likely to engage in healthy self-care behaviors (e.g., keeping doctor visits, eating low-salt, low-fat diets). Results suggest that patients who are nonadherent with hypertension self-care recommendations may hold hypertension beliefs that are not consistent with the medically endorsed views of this disease. To more effectively treat and control BP, providers should assess patients' hypertension beliefs.
Western Journal of Nursing Research 06/2013; 36(2). DOI:10.1177/0193945913491837 · 1.03 Impact Factor
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