food in the u.s. food in u.s. is everywhere. nevertheless income and related factors shape access
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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 report entitled the “Grocery Gap: Who has access to healthy food and why does it matter.TRANSCRIPT
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%