Food in the U.S. Food in U.S. is everywhere. Nevertheless income and related factors shape access In hundreds of neighborhoods across the country, nutritious, affordable, and high quality food is out of reach particularly low-income neighborhoods, communities of color, and rural areas. Excellent quote from the food trust and policy link reportentitled the Grocery Gap: Who has access to healthy food and why does it matter. Food Environment: Statistics
Of all U.S. households, 2.3 million (2.2%) live more than a mile from a supermarket and do not have access to a vehicle. An additional 3.4 million households (3.2%), live between one-half to 1 mile and do not have access to a vehicle. 23.5 million people live in low-income areas (areas where more than 40 percent of the population has income at or below 200 percent of Federal poverty thresholds) that are more than 1 mile from a supermarket or large grocery store. Data on time use and travel mode show that people living in low-income areas with limited access spend significantly more time (19.5 minutes) traveling to a grocery store than the national average (15 minutes). Context Neighborhood and Communities
Contribute to racial disparities in weight status Access to supermarkets linked to healthy food consumption and overall dietary quality Less access to supermarkets and diverse food outlets in low-income, African-American, and Native American communities Lower availability of healthful options in low-income and African-American communities (most FV) Sources: (Cheadle, 1991; Morland, Wing and Diez Roux, 2002; Morland et al., 2002; Laraia et al., 2004; Blair et al, 2005; Zenk et al, 2005) Inequality in Food Access
Chicago Detroit You go all the way out to the suburbsand you find everythingIts even a better variety in [chain supermarkets] when you go to their stores.Theres a difference. Youve got to go out in the suburbs now to get some decent food.And therefore, its not available for us in this community.By the time you get to that store and get some fresh fruits and vegetables, youre going to pass about 30 fast food joints and about 100 liquor stores. Not just terms impact people FOOD AS ECONOMIC DISINVESTMENT Challenges to Dietary Behaviors Risk for Poor Diets
High Exposure to Marketing Low Affordability Low Access Cycles of Food Deprivation and Overeating High Levels of Stress Based on ANGELO Analysis Grid for Environments Linked to Obesity Swinburn et al, Preventive Medicine, From Yancey AK et al, Prev Chronic Dis Jan;1(1):A09. Race and Ethnicity Income/SES Food access Food Justice Food Equity
Using cause of death data from the US Centers for Disease Control, Geronimus and colleagues calculated that if blacks died at the same rate as whites, 5.8 million African Americans would have died between 1970 and The actual number of black deaths over that timespan was 8.5 million, meaning that African Americans had 2.7 million "excess deaths", compared with whites. Overall, in the US, the mortality rate for blacks, across age and gender, is almost 18 per cent higher than the rate for whites Excess mortality in marginalized populations could be both a cause and an effect of political processes. Social Production of Health and Illness
Do we not always find the disease of the populace traceable to defects in society. Rudolf Virchow Father of Social Medicine Paradigm Shift: Social Determinants of Health
Social determinants of health are the economic and social conditions that influence the health of individuals, communities, and jurisdictions as a whole. Social determinants of health are about the quantity and quality of a variety of resources that a society makes available to its members. Paradigm Shift: Avoid the Lifestyle Trap
Lifestyle choices are heavily structured by life circumstances Lifestyle choices by themselves account for modest proportionsof health status Lifestyle choices are difficult to change without considering lifecontexts Lifestyle choice emphases can have unintended side-effects thatwork against health Eating Habits Physical Activity Body Weight
A COMMUNITY-CENTERED VIEW OF INFLUENCES ON EATING, ACTIVITY, AND BODY WEIGHT Influences of Culture and Mindset What are our social values? What do we believe in? What gives us pleasure? What gives comfort? How do we cope with stresses? What is fair treatment? Who earns our trust and our loyalty? Health and wellness High quality of life Do we have money to buy the things we need? What are our neighborhoods like? What type of food is available? How much does it cost? Where are opportunities for recreation and outdoor activities? Who sponsors community events? What messages do we get from TV, radio, outdoor ads, the web? What is our history? How does it affect the way we live now? What kinds of social institutions do we have? How do our faith communities support us? What are our families like? What are our community strengths? What is our collective strength for taking action? Environments to Navigate Eating Habits Physical Activity Body Weight Long life The African American Collaborative Obesity Research Network (AACORN) uses a community-centered approach for thinking through approaches to prevention and treatment of overweight and obesity.The underlying concept is that approaches to intervening on obesity are better framed in very people-oriented terms. We ask, How do eating, physical activity and weight reflect the opportunities, constraints, and issues in peoples everyday lives? What aspects of peoples everyday lives and circumstances must be considered in order to develop appropriate, effective, and sustainable intervention approaches? How can interventions on obesity support high quality of life and community priorities that are broader than food, activity, or weight? In other words, it is not simply a matter of teaching people about how many calories are in their food or how long they have to exercise to burn a certain number of calories.Far from it.Many people in African American communities already know this information. The issue is much more complicated. The model shown in the diagram calls for reflection of several different types of community-level factors that, in combination, influence: a) eating habits and physical activity and, ultimately, body weight and body fatness; and b) resources available to take positive actions to address health problems that may be associated with some aspects of current eating or activity habits or weight levels.This diagram is a companion to AACORNsexpanded obesity research paradigm,a model that is oriented primarily to researchers who design studies of obesity prevention and treatment (link).It has been created to facilitate discussions among community members and between academically based researchers and their community research partners. The focus on eating, physical activity, and body weight is at the center, because the ultimate goal is to identify how the various influences from daily life influence and reinforce these aspects of health status. The balance scale is a reminder of the reality that extra weight is gained when the amount of calories eaten is too high and the calories used is too low. Discussion of this model can begin with any of the circles and can go back and forth among the circles to use the questions as prompts to discuss the general issues in each category and to also discuss how they influence eating, activity, and weight. Like AACORNs research paradigm, this diagram was developed with a particular focus on African American communities.However, the concepts and the graphic have potential applicability to diverse communities. This model is geared to a collective or group perspective, i.e., what are the behaviors on average or that tend to be the most common.The our and we references in the questions assume that those engaged in the discussion identify as having something in common in a way that makes them participants in the same community.This could be a geographical community (neighborhood) but not necessarily so.This approach recognizes that individuals within the community have a lot of variation in what they eat, how active they are, or whether they are overweight, but focuses on the issue that improvements on these fronts are needed, on average, to foster health and wellness and therefore high quality of life and longevity. Historical and Social Factors African American Collaborative Obesity Research Network 17 Definition of CBPR A Partnership approach to research that equitably involves community members, organizational representatives and researchers in all aspects of the research processIsrael, BA et al. (2001) Joyce:The accent on both participation and action in CBPR reflects the roots of this approach in both the action research school developed by German social psychologist Kurt Lewin in the 1940s and the alternative research paradigms developed by Paulo freire and other 3rd world scholars in the 1970s.Lewins action research approach stresses actively involving people affected b a problem in practical problem solving.This approach continues to be popular in the uk. The other approach developed as a direct counter to the often colonizing nature of the research to whidh oppressed people in Latin American, Asia and Africa were subjected.Contemporary CBPR is composed of a varitey of research approaches s They share a core set of principles which Harmon will discuss in a few minutes. Values and Principles of CBPR
Recognizes community as self-determining unit Builds on strengths and resources Facilitates partnership in all research phases Promotes co-learning and capacity building Seeks balance between research and action Disseminates findings and knowledge to all Involves long-term process and commitment Israel, Schulz, Parker, Becker, Allen, Guzman, Critical Issues in developing and following CBPR principles, Community-Based Participatory Research in Health, Minkler and Wallerstein, Jossey Bass, 2000. Rationale for CBPR Complex health and social problems ill-suited to outside expert research History of research abuse and mistrust: helicopter or drive-by research Disappointing results in intervention research Increasing understanding of importance of local and cultural context/external validity Increasing interest in use of research to improve best practices/best processes Lack of implementation process eval Inappropriate measurement Lack of clarity of contextual issues related to moving from efficacy to effectiveness research Rationale for CBPR Eliminating health disparities is imperative
Translating evidence to practice requires the involvement of minority populations in research Involvement in research cannot be approached solely through individuals There is nothing new about poverty
There is nothing new about poverty. What is new, however, is that we now have the resources to get rid of it. The time has come for an all-out world war against poverty The well off and the secure have too often become indifferent and oblivious to the poverty and deprivation in their midst. Ultimately a great nation is a compassionate nation. No individual or nation can be great if it does not have a concern for the least of these. Where Do We Go From Here: Chaos or Community? Doing Me! Sisters Standing Together for a Healthy Mind and Body
4 month weight loss intervention in low-income African American neighborhood in Chicago Based on the Obesity Reduction Behavioral Intervention Trial-ORBIT (NCI: Fitzgibbon) University-based vs. Community-based Targets women years of age Funded by American Cancer Society-Illinois Division (PI: Odoms-Young) Modify ORBIT based using CBPR and translate into a community context Baseline Weight Perceptions
Measure % Very/Mostly Dissatisfied (n=60) Face 15% Hair 21% Lower Torso 48% Mid Torso 90% Upper Torso 46% Muscle Tone 72% Weight 89% Overall Appearance 25% Baseline Psychosocial Measures
Mean(SD) (n=60) Minimum Maximum John Henryism (0-48) 38.8 (5.6) 26 48 Acute Unfair Treatment (0-9) 2.4 (2.1) 8 Everyday Unfair Treatment (0-40) 12.3 (6.0) 28 Adverse Childhood Experiences (0-10) 2.7 (2.7) 10 Baseline Top 5 Most Reported Events of CRISYS
Questions % Class I Class II Class III Did your hear violence outside of your home? 58.1% 33.3% 30.6% 36.1% Did you look forjob? 46.9% 30% 26.7% 43.3% Did anything happen in your neighborhood or home that made you feel unsafe? 42.8% 26% 40.7% Did you see drug dealing in your building or neighborhood? 38.1% 20.8% 45.8% Did your income decrease by a lot? 37.5% 25% 41.7% Baseline Weight Perceptions
Measure % Very/Mostly Dissatisfied (n=60) Face 15% Hair 21% Lower Torso 48% Mid Torso 90% Upper Torso 46% Muscle Tone 72% Weight 89% Overall Appearance 25% Baseline Psychosocial Measures
Mean(SD) (n=60) Minimum Maximum John Henryism (0-48) 38.8 (5.6) 26 48 Acute Unfair Treatment (0-9) 2.4 (2.1) 8 Everyday Unfair Treatment (0-40) 12.3 (6.0) 28 Adverse Childhood Experiences (0-10) 2.7 (2.7) 10 Baseline Top 5 Most Reported Events of CRISYS
Questions % Class I Class II Class III Did your hear violence outside of your home? 58.1% 33.3% 30.6% 36.1% Did you look forjob? 46.9% 30% 26.7% 43.3% Did anything happen in your neighborhood or home that made you feel unsafe? 42.8% 26% 40.7% Did you see drug dealing in your building or neighborhood? 38.1% 20.8% 45.8% Did your income decrease by a lot? 37.5% 25% 41.7%