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The purpose of this paper is to describe the process of developing and implementing a transdisciplinary community-based research center, the Center for Health Equity Research (CHER) Chicago, to offer a model for designing and implementing research centers that aim to address structural causes of health inequality.
Scholars from diverse backgrounds and disciplines formed a multidisciplinary team for the Center, and adopted the structural violence framework as the organizing conceptual model. All Center activities were based on community partnership. The Center activities were organized within three cores: administrative, investigator development, and community engagement and dissemination cores. The key activities during the first year were to develop a pilot grant program for early stage investigators (ESIs) and to establish community partnership mechanisms.
CHER provided more than 60 consultations for ESIs, which resulted in 31 pilot applications over the three application cycles. Over 200 academic and community partners attended the community symposium and discussed community priority. Some challenges encountered were: to improve communication among investigators, to clarify roles and responsibilities of the three cores, and to build consensus on the definition and operationalization of the concept of structural violence.
There is an increasing need for local hubs to facilitate transdisciplinary collaboration and community engagement to effectively address health inequity. Building consensus around a shared vision among partners is a difficult and yet important step toward achieving equity.
Retention of participants has been an issue in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). It has been suggested that the perceived value of WIC may affect whether participants remain in the programme. The present study aimed to explore this phenomenon.
Using a constructivist approach, thirty-one individual in-depth interviews were conducted. Transcripts were analysed using constant comparative analysis. Social, cultural and environmental factors that contribute to the value of WIC were explored as the phenomenon of interest.
Eight WIC clinics across the State of Illinois, USA.
Thirty-one caregivers of children enrolled in WIC for at least 6 months.
Several factors influenced perceived value of WIC at the interpersonal (level of social support), clinic (value of WIC services v. programme administration issues), vendor (shopping difficulties), community and systems levels (other programme use, stigma and restrictions on food choice). Other themes existed along continua, which overlapped several levels (continuum of perceived need and perceived value of infant formula).
Many caregivers value WIC, especially before their child turns 1 year old. Improvements are needed at the clinic, during shopping and within the food packages themselves in order to increase perceived value of WIC.
Previous research indicates that low-income individuals often struggle to consume the recommended amount of fruits and vegetables (F&V). LINK Up Illinois is a farmers’ market incentive programme that aims to increase F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients by improving access to and affordability of locally grown foods. The present research aimed to identify barriers to F&V consumption that exist among users of the LINK Up Illinois programme.
Farmers’ markets in Chicago, Springfield, Northbrook, Woodstock, Aurora and Urbana, IL.
In 2016, a volunteer sample of 140 LINK Up Illinois users (mean age 42·5 years; 81·7 % female; 28·7 % African American; 44·0 % obese) completed a survey at participating farmers’ markets across the state. Information on demographics, food shopping behaviours, programme satisfaction, barriers to F&V consumption and frequency of F&V consumption was collected and examined.
Approximately 23 % of survey participants reported consuming F&V ≥3 times/d. The barriers to F&V consumption most often reported by survey participants were the cost of F&V (29·5 %), spoilage (18·6 %), knowing how to cook F&V (8·7 %) and not thinking about F&V when hungry (8·6 %). Results from multivariable-adjusted logistic regression models suggested that reporting one or more barriers was associated with reduced odds of consuming vegetables ≥3 times/d, but not fruits.
Cost, spoilage and knowledge of cooking are key barriers to F&V consumption that exist among LINK Up Illinois users. Strategies are needed to mitigate these barriers and increase F&V consumption in this population.
To assess caregivers’ perceptions of the extent to which the food marketing environment influences food consumption among African-American children (aged 3–11 years) in order to generate potential strategies to make the marketing environment more favourable to healthier eating.
Individual semi-structured interviews with caregivers were conducted by trained community leaders to ascertain their awareness of and perceptions about food marketing environments contributing to African-American children's food consumption.
Six predominantly African-American communities in metro Birmingham, Alabama, USA with high proportions of school-age children and lower-income residents.
Caregivers (n 25) were predominantly female (93 %) and either parents/guardians (64 %) or grandparents (28 %) of African-American children aged 3–11 years. Caregiver mean age was 43 years and 46 % had lived in their current residence for over 10 years.
Caregivers reported all aspects of the food marketing matrix as supporting unhealthy eating among African-American youth. Child preference for foods higher in fat and sugar, lower pricing of less healthy foods, limited access to healthier food retailers and targeted advertisements were particularly influential on the food selection, acquisition and consumption of children. Company loyalty, corporate sponsorship of local events and conflicts over parental v. food company responsibility contributed to less consensus about the overall impact (positive or negative) of food companies in African-American communities.
While caregivers perceived aspects of their food marketing environments as primarily contributing to unhealthy eating among African-American children, framing the demand for changes in the food marketing environments of African-American youth may be particularly challenging.
The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dietary intake and home food availability in low-income African-American and Hispanic parent/child dyads.
A natural experiment was conducted to assess if the revised WIC food package altered dietary intake, home food availability, weight and various lifestyle measures immediately (6 months) following policy implementation.
Twelve WIC clinics in Chicago, IL, USA.
Two hundred and seventy-three Hispanic and African-American children aged 2–3 years, enrolled in WIC, and their mothers.
Six months after the WIC food package revisions were implemented, we observed modest changes in dietary intake. Fruit consumption increased among Hispanic mothers (mean = 0·33 servings/d, P = 0·04) and low-fat dairy intake increased among Hispanic mothers (0·21 servings/d, P = 0·02), Hispanic children (0·34 servings/d, P < 0·001) and African-American children (0·24 servings/d, P = 0·02). Home food availability of low-fat dairy and whole grains also increased. Dietary changes, however, varied by racial/ethnic group. Changes in home food availability were not significantly correlated with changes in diet.
The WIC food package revisions are one of the first efforts to modify the nutrition guidelines that govern foods provided in a federal food and nutrition assistance programme. It will be important to examine the longer-term impact of these changes on dietary intake and weight status.
The present study examined food shopping behaviours, particularly distance to grocery shop, and exposure to discrimination.
Cross-sectional observational study utilizing data from a community survey, neighbourhood food environment observations and the decennial census.
Three communities in Detroit, Michigan, USA.
Probability sample of 919 African-American, Latino and white adults in 146 census blocks and sixty-nine census block groups.
On average, respondents shopped for groceries 3·1 miles (4·99 km) from home, with 30·9 % shopping within 1 mile (1·61 km) and 22·3 % shopping more than 5 miles (8·05 km) from home. Longer distance to shop was associated with being younger, African-American (compared with Latino), a woman, higher socio-economic status, lower satisfaction with the neighbourhood food environment, and living in a neighbourhood with higher poverty, without a large grocery store and further from the nearest supermarket. African-Americans and those with the lowest incomes were particularly likely to report unfair treatment at food outlets. Each mile (1·61 km) increase in distance to shop was associated with a 7 % increase in the odds of unfair treatment; this relationship did not differ by race/ethnicity.
The study suggests that unfair treatment in retail interactions warrants investigation as a pathway by which restricted neighbourhood food environments and food shopping behaviours may adversely affect health and contribute to health disparities. Efforts to promote ‘healthy’ and equitable food environments should emphasize local availability and affordability of a range of healthy food products, as well as fair treatment while shopping regardless of race/ethnicity or socio-economic status.
The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on perceived sales, product selection and stocking habits of small, WIC-authorized food stores.
A cross-sectional study involving in-depth interviews with store managers/owners.
Small, WIC-authorized food stores in eight major cities in the USA.
Fifty-two store managers/owners who had at least 1 year of experience in the store prior to study participation.
The WIC-approved food products (fresh, canned and frozen fruits; fresh, canned and frozen vegetables; wholegrain/whole-wheat bread; white corn/whole-wheat tortillas; brown rice; lower-fat milk (<2 %)) were acquired in multiple ways, although acquisition generally occurred 1–2 times/week. Factors such as customer requests (87 %), refrigerator/freezer availability (65 %) and profitability (71 %) were rated as very important when making stocking decisions. Most managers/owners perceived increases in sales of new WIC-approved foods including those considered most profitable (wholegrain/whole-wheat bread (89 %), lower-fat milk (89 %), white corn/whole wheat tortillas (54 %)), but perceived no changes in sales of processed fruits and vegetables. Supply mechanisms and frequency of supply acquisition were only moderately associated with perceived sales increases.
Regardless of type or frequency of supply acquisition, perceived increases in sales provided some evidence for the potential sustainability of these WIC policy efforts and translation of this policy-based strategy to other health promotion efforts aimed at improving healthy food access in underserved communities.
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