Recent Publications by Tulane Public Health Researchers


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The Department of Community Health Sciences
Selected Recent Publications

Researchers	Title	Publication	Abstract
Farley TA, Baker ET, Futrell L, Rice JC.	The ubiquity of energy-dense snack foods: a national multicity study.	Am J Public Health. 2010 Feb;100(2):306-11.	OBJECTIVES: We assessed the availability and accessibility of energy-dense snacks in retail stores whose primary merchandise was not food and whether these varied by store type, region, or socioeconomic factors. METHODS: We conducted systematic observations of 1082 retail stores in 19 US cities and determined the availability and accessibility of 6 categories of energy-dense snack foods. RESULTS: Snack food was available in 41% of the stores; the most common forms were candy (33%), sweetened beverages (20%), and salty snacks (17%). These foods were often within arm's reach of the cash register queue. We observed snack foods in 96% of pharmacies, 94% of gasoline stations, 22% of furniture stores, 16% of apparel stores, and 29% to 65% of other types of stores. Availability varied somewhat by region but not by the racial or socioeconomic characteristics of nearby census tracts. CONCLUSIONS: Energy-dense snack foods and beverages, implicated as contributors to the obesity epidemic, are widely available in retail stores whose primary business is not food. The ubiquity of these products may contribute to excess energy consumption in the United States.
Johnson CC, Lai YL, Rice J, Rose D, Webber LS.	ACTION live: using process evaluation to describe implementation of a worksite wellness program.	J Occup Environ Med. 2010 Jan;52 Suppl 1:S14-21.	OBJECTIVES: Process evaluation is a necessary component of randomized controlled field trials. This is a descriptive article that reviews process evaluation for the ACTION Wellness Program for Elementary School Personnel. METHODS:: Methods included self-report by participants, documentation by program staff, and school administrator report. Variables evaluated were program dose, fidelity and reach, exposure to materials and activities, and school factors that could influence program implementation and outcomes. RESULTS: Dose and exposure were high across intervention schools and intervention years. Reach was variable across schools and activities. Schools on the East Bank of the Mississippi River generally had slightly better reach than schools on the West Bank. Some nutrition activities had higher levels of participation than physical activities. CONCLUSIONS: High program dose reflected good effort and cooperation by program staff and schools. A disconnect between exposure and reach showed that high exposure did not always translate to high participation.
Farley TA, Rice J, Bodor JN, Cohen DA, Bluthenthal RN, Rose D.	Measuring the food environment: shelf space of fruits, vegetables, and snack foods in stores.	J Urban Health. 2009 Sep;86(5):672-82.	Dietary patterns may be influenced by the availability and accessibility within stores of different types of foods. However, little is known about the amount of shelf space used for healthy and unhealthy foods in different types of stores. We conducted measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County. Although supermarkets offered far more shelf space of fruits and vegetables than did other types of stores, they also devoted more shelf space to unhealthy snacks (mean 205 m for all of these items combined) than to fruits and vegetables (mean 117 m, p < 0.001). After supermarkets, drug stores devoted the most shelf space to unhealthy items. The ratio of the total shelf space for fruits and vegetables to the total shelf space for these unhealthy snack items was the lowest (0.10 or below) and very similar in convenience stores, drug stores, and liquor stores, was in a middle range (0.18 to 0.30) in small food stores, and was highest in medium-sized food stores (0.40 to 0.61) and supermarkets (0.55 to 0.72). Simple measurements of shelf space can be used by researchers to characterize the healthfulness of the food environment and by policymakers to establish criteria for favorable policy treatment of stores.
Johnson CC, Webber LS, Myers L, Boris NW, Berenson GS.	Co-use of alcohol and tobacco among ninth-graders in Louisiana.	Prev Chronic Dis. 2009 Jul;6(3):A85. Epub 2009 Jun 15.	INTRODUCTION: The co-use of alcohol and tobacco by adolescents is a public health problem that continues well into adulthood and results in negative behavioral, social, and health consequences. The purpose of this study was to examine the co-use of alcohol and tobacco among ninth-graders in south-central Louisiana. METHODS: We created a health habits survey to collect data from 4,750 ninth-grade students, mean age 15.4 years. Cross-sectional analysis used chi2, 1-way analysis of variance, and logistic regression methods. RESULTS: Almost 20% of students were co-users. Students who were white, performed poorly in school, did not expect to graduate high school, and had more discretionary money to spend were more likely to be co-users. Co-users had friends who got drunk weekly and were more likely to approve of alcohol use among friends than among adults. Significant differences in attitudes toward drinking and smoking were observed between co-users and nonusers. For adolescent drinkers, including girls, hard liquor was the preferred beverage. CONCLUSION: These data for high school students are applicable for prevention strategies at a critical age when harmful health behaviors can mark the start of lifelong habits. Intervention efforts will be successful only if they account for multiple levels of influence.
Johnson CC, Myers L, Webber LS, Boris NW, He H, Brewer D.	A school-based environmental intervention to reduce smoking among high school students: the Acadiana Coalition of Teens against Tobacco (ACTT).	Int J Environ Res Public Health. 2009 Apr;6(4):1298-316.	A school-based environmental program to reduce adolescent smoking was conducted in 20 schools (10 intervention; 10 control) in south central Louisiana. The 9th grade cohort (n = 4,763; mean age = 15.4 yrs; 51% female; 61% Caucasian; 30-day smoking prevalence at baseline = 25%) was followed over four years for 30-day smoking prevalence with the school as the unit of analysis. Although prevalence decreased in intervention schools and increased in control schools in Year 2 the significant difference between the two groups at baseline was not overcome by the intervention and increases in prevalence were observed in both groups in Years 3 and 4. The higher the percentage of white students in a school the higher the prevalence rates regardless of intervention/control status. Boys' and girls' smoking rates were similar. These outcome data, student feedback and process evaluation provide a basis for continuing to create more innovative adolescent tobacco control programs.
Beaudoin CE.	Bonding and bridging neighborliness: An individual-level study in the context of health.	Soc Sci Med. 2009 Apr 30. [Epub ahead of print].	Although previous research provides a compelling picture of social capital's role in predicting health outcomes, only a modicum of research has tested the more detailed roles of the dimensions of bonding and bridging social capital, with no research focusing exclusively on bonding and bridging neighborliness or ethnicity. To help fill this gap in the literature, the current study measures individual-level bonding and bridging neighborliness for four U.S. ethnic groups-and then, with cross-sectional data from a 2007 national telephone survey of U.S. adults, employs ordinal logistic regression and OLS regression to test the individual-level predictors of self-rated health and stress, when controlling for BMI and demographics. Bonding neighborliness was associated with self-rated health and inversely associated with stress, whereas bridging neighborliness was not significantly linked to either health outcome. When also controlling for neighborhood composition, the bonding neighborliness findings remained generally consistent, while the association between bridging neighborliness and self-rated health gained significance. These results indicate the protective effects that bonding neighborliness can have on health outcomes, as well as the more modest protective effects of bridging neighborliness. These findings have implications for future research and practice, highlighting the potential of health interventions and policies that target the development of bonding social capital.
Farley TA.	Reforming Health Care or Reforming Health?	Am J Public Health. 2009 Feb 5.	Published ahead of print. Check back soon for abstract.
Taylor CA, Guterman NB, Lee SJ, Rathouz PJ.	Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children.	Am J Public Health. 2009 Jan;99(1):175-83. Epub 2008 Nov 13.	Objectives: We examined the associations of intimate partner violence (IPV) and maternal risk factors with maternal child maltreatment risk within a diverse sample of mothers. Methods: We derived the study sample (N=2508) from the Fragile Families and Child Well-Being Study. We conducted regression analyses to examine associations between IPV, parenting stress, major depression, key covariates, and 4 proxy variables for maternal child maltreatment. Results: Mothers reported an average of 25 acts of psychological aggression and 17 acts of physical aggression against their 3-year-old children in the year before the study, 11% reported some act of neglect toward their children during the same period, and 55% had spanked their children during the previous month. About 40% of mothers had experienced IPV by their current partner. IPV and maternal parenting stress were both consistent risk factors for all 4 maltreatment proxy variables. Although foreign-born mothers reported fewer incidents of child maltreatment, the IPV relative risk for child maltreatment was greater for foreign-born than for US-born mothers. Conclusions: Further integration of IPV and child maltreatment prevention and intervention efforts is warranted; such efforts must carefully balance the needs of adult and child victims.
Kissinger P, Amedee A, Clark RA, Dumestre J, Theall KP, Myers L, Hagensee ME, Farley TA, Martin DH.	Trichomonas Vaginalis Treatment Reduces Vaginal HIV-1 Shedding.	Sex Transm Dis. 2009 Jan;36(1):11-6.	Background Vaginal HIV-1 shedding has been associated with Trichomonas vaginalis (TV) infection and could play a role in HIV transmission. The purpose of the study was to examine if effective TV treatment reduces the presence of vaginal HIV-1 RNA. Methods TV+ women attending an HIV outpatient clinic in New Orleans, LA, who resolved infection (n = 58) and TV-negative controls (n = 92), matched on antiretroviral therapy (ART) were examined and interviewed at baseline, 1, and 3 months. TV status was tested by culture and the amount of cell free HIV-1 RNA in the vaginal fluids was determined by the Amplicor HIV-1 Monitor ultrasensitive assay. Results Most women (81.3%) were black and the mean age was 37.5 (SD 8.7). At baseline, 46.0% had plasma HIV-1 RNA >/=10,000 copies/mL, 26.4% had CD4<200 cells/muL, 54.7% were taking ART, and only 26.0% had detectable HIV-1 RNA in their vaginal fluids. TV-positive women who were effectively treated for TV were less likely to shed HIV vaginally at 3-months post-treatment compared to baseline (R.R. 0.34, 95% CI: 0.12-0.92, P = 0.03), whereas there was no change for TV-negative women. Conclusion This study provides additional support that reducing TV infection among HIV-positive women may have an impact on the prevention of HIV transmission. Reasons for the delayed treatment effect and the effect on cervical shedding need further investigation.
Rose D, Chotard S, Oliveira L, Mock N, Libombo M.	A comparative evaluation of dietary indicators used in food consumption assessments of at-risk populations.	Food Nutr Bull. 2008 Jun;29(2):113-22.	Background: Easy-to-collect dietary indicators have been used increasingly for planning and evaluation of food security interventions. Various indicators have been employed, but rarely has a full set of indicators been compared using a common framework. Objective: This paper evaluates the performance of five dietary indicators for the assessment of household energy consumption using a common framework and recent data from Mozambique. Methods: Data were analyzed from a 2004 household survey, Current Vulnerability Analysis in Seven Provinces of Mozambique. Households (n = 4,358) were sampled from 42 rural districts using a two-stage design, and a quantitative 24-hour dietary recall was employed. Household energy intake ratios were calculated as the food energy consumed by household members divided by the sum of the members' recommended intakes. Five proxy indicators of household consumption in the previous day were developed: the number of meals, the number of food groups, the number of food items, a score based on a simple weighting of food groups consumed, and a predicted energy intake ratio based on weighting of food groups consumed with previously estimated regression coefficients. The performance of these indicators was assessed using correlations with energy intake, receiver operator characteristic analysis, efficiency of predictions, and prevalence estimate comparisons. Results: Although the predicted energy intake ratio performed best on all these performance criteria, and the simple food-group-weighted score performed second best, differences among the indicators on many of the criteria were relatively small. Conclusions: New assessment systems could take full advantage of easy-to-collect information by using one of these best-scoring indicators, although established systems could continue to use some of the other indicators explored here, such as the food item count, without much loss in accuracy.
Broussard DL, Magnus JH.	Influence of cardiovascular disease risk factors on the relationship between low bone mineral density and type 2 diabetes mellitus in a multiethnic US population of women and men: a cross-sectional study.	Gend Med. 2008 Sep;5(3):229-38.	Introduction: Higher bone mineral density (BMD) has been reported among white women and men with type 2 diabetes mellitus (DM) compared with nondiabetic white individuals, but there is scant evidence for nonwhite persons. It is also not known whether cardiovascular disease (CVD) risk factors may confound any association between BMD and type 2 DM. Objective: The present study examined the relationship between low BMD and type 2 DM in a multiethnic population of women and men while controlling for the influence of osteoporosis and CVD risk factors including body mass index (BMI), cigarette smoking, physical inactivity, total cholesterol and its components, blood pressure, and C-reactive protein. Methods: Data collected from 4929 African American, Mexican American, and white women and men aged 50 to 79 years who participated in the household interview and clinical examinations during the Third National Health and Nutrition Examination Survey were analyzed. CVD risk factors associated with type 2 DM in this study population were included as covariates in gender-specific multiple logistic regression models assessing the relationship between type 2 DM and low BMD while controlling for osteoporosis risk factors. Gender- and race/ethnicity-specific mean BMD values at the total hip for young adults aged 20 to 29 years were used to establish race/ethnicity and gender-specific low BMD T-scores. Results: The final study population included 2505 women and 2424 men. More women and men with type 2 DM than women and men without type 2 DM were nonwhite and had high BMI. Osteoporosis risk factors but not CVD risk factors were associated with low BMD in both women and men. Type 2 DM was not associated with low BMD among women (odds ratio [OR] = 0.77; 95% CI, 0.56-1.08). Based on a statistically significant interaction between type 2 DM status and race/ethnicity, white men with type 2 DM were less likely to have low BMD than were white men without type 2 DM (OR = 0.56; 95% CI, 0.37-0.86; P = 0.01). There was no significant BMD difference between diabetic and nondiabetic nonwhite men. Conclusion: CVD risk factors did not appear to influence the relationship between low BMD and type 2 DM in this study.
Magnus JH, Broussard DL.	Can self-rated health identify US women and men with low bone mineral density? A cross-sectional population study.	Gend Med. 2008 Sep;5(3):246-58.	Background: Despite its simplicity, self-rated health (SRH) is a significant dimension of health assessment, with demonstrated means to identify individuals at increased risk of morbidity and mortality. Objective: The aim of the present study was to assess whether SRH, age, and modifiable osteoporosis risk factors in a hypothetical screening situation could identify individuals with low bone mineral density (BMD). Methods: Data were analyzed from a multiethnic sample of 4905 women and men aged 50 to 79 years from the Third National Health and Nutrition Examination Survey. Low BMD was assessed according to the World Health Organization definition using gender- and race/ethnicity-specific young adult mean values to calculate T-scores. Multiple linear regression analysis was used to determine whether BMD was lower among those with poorer SRH; multiple logistic regression analysis was used to determine whether poor SRH was associated with low BMD. Results: The study population included 616 and 589 African American; 522 and 564 Mexican American; and 1312 and 1302 white women and men, respectively. The distributions of SRH responses differed for African American and Mexican American women and men compared with the distributions for same-gender whites, with significantly more white women and men reporting excellent or very good health (P < 0.05) and significantly greater proportions of African American and Mexican American women and men reporting poorer health (P < 0.05). Among women and nonwhite men, there was no evidence of an association between BMD and SRH. Linear trends of decreasing BMD with declining SRH were detected for all men with low or normal body mass index (P < 0.001) and overweight men (P < 0.001). When stratified by race/ethnicity, a linear trend of decreasing BMD with declining SRH was found for nonobese white men only (P-trend: <0.001). The likelihood of having low BMD among nonobese white men who reported excellent or very good health was two-thirds that of their male counterparts with poor SRH (P < 0.001). Conclusions: Independent of age and modifiable osteoporosis risk factors, poor SRH may be a relevant risk factor for low BMD among older nonobese white men. Further research is needed to determine whether SRH may be a useful risk assessment tool for low BMD in this group of men.
Hong, T.	Internet health information in patient-provider dialogue.	(2008). Cyberpsychol Behav, Oct;11(5):587-9.	A patient discussing Internet health information with a health care provider (referred to as "patient-provider communication about Internet health information") can contribute positively to health outcomes. Although research has found that once Internet access is achieved, there are no ethnic differences in Internet health information seeking, it is unclear if there are ethnic differences in patient-provider communication about Internet health information. To help fill this gap in the literature, the National Cancer Institute's Health Information National Trends Survey 2005 was analyzed with Stata 9. Two sets of logistic regression analyses were conducted, one for a subsample of Internet users (n = 3,244) and one for a subsample of Internet users who are first-generation immigrants (n = 563). The dependent variable was patient-provider communication about Internet health information, which assessed whether survey participants had discussed online health information with a health care provider. The predictor variables included trust of health care provider, trust of online health information, Internet use, health care coverage, frequency of visits to health care provider, health status, and demographics. Among all Internet users, Whites had higher levels of patient-provider communication about Internet health information than Blacks and Asians. Similarly, among Internet users who are immigrants, Whites had higher levels of patient-provider communication about Internet health information than Blacks and Asians. While the digital divide is narrowing in terms of Internet access, racial differences in patient-provider communication about Internet health information may undermine the potential benefits of the information age.
Beaudoin, CE	Assessment of a media campaign and related crisis help line following Hurricane Katrina.	(2008). Public Health Rep, 123(5):646-51.	Objectives: We evaluated the impact of a media campaign targeting stress and depression following Hurricane Katrina. We specifically examined public response to the campaign's recommendation that people could contact a telephone help line for further assistance if needed. Methods: Call data from Via Link allowed us to track trends in 800-number Crisis Line call volume (n = 29,659), which is the number recommended in the media campaign, and 2-1-1 Information and Referral Line call volume (n = 8,035), which is employed in a control-like manner. With data from April 1, 2006, through November 30, 2006, multivariate analysis was used to assess trends and differences among and within pre-intervention, intervention, and post-intervention. Results: Information and Referral Line call volume, which was unrelated to the campaign, did not change over time. In contrast, Crisis Line call volume, which was related to the campaign, increased significantly from pre-intervention to intervention, but not from intervention to post-intervention. Furthermore, the daily rate of Crisis Line call volume was constant during pre-intervention, increased during intervention, but decreased during post-intervention. Conclusion: There is support for the media campaign's influence on public behavior to contact Via Link in regard to stress and depression following Hurricane Katrina. Analysis helps undermine alternative explanations, including general trends in help line call volume and those specific to Crisis Line call volume.
Broussard DL, Magnus JH.	Coronary heart disease risk and bone mineral density among U.S. women and men.	J Womens Health (Larchmt). 2008 Apr;17(3):479-90.	Aims Low bone mineral density (BMD) has been shown to predict cardiovascular disease (CVD) and coronary heart disease (CHD) mortality in both women and men. The purpose of the current study was to determine whether a CHD risk assessment tool might be useful for identifying persons likely to have low BMD in a multiethnic population of women and men. Methods Cross-sectional data for 3881 women and men aged 50-74 years without overt CHD or stroke from the Third National Health and Nutrition Examination Survey (NHANES III) were used to explore the relationship between BMD and 10-year CHD risk, as estimated using the Framingham CHD risk prediction algorithm, in gender-stratified multiple logistic regression models. Results When compared with women who had a <10% CHD risk, women with a 10%-19% CHD risk were 45% more likely and those with a > or =20% CHD risk were 73% more likely to have low BMD. Similar increases in low BMD risk were not detected in men. Conclusions In the United States, 10-year Framingham CHD risk assessment may be useful for identifying older women who should be evaluated for osteoporosis and referred for BMD measurement. The impact of such a screening strategy on fracture prevention needs further elucidation.
Farley TA, Meriwether RA, Baker ET, Rice JC, Webber LS.	Where do the children play? The influence of playground equipment on physical activity of children in free play.	J Phys Act Health. 2008 Mar;5(2):319-31.	Background Promotion of physical activity in children depends on an understanding of how children use play equipment. Methods We conducted observations over 2 years of children in 2nd through 8th grades in a schoolyard with 5 distinct play areas with different amounts of play equipment. Results Children were more likely to play in areas with more installed play equipment, with densities of children in equipped areas 3.3 to 12.6 times higher than in an open grassy field. There were no significant differences by play area in the percent of children who were physically active at all, but children were more likely to be very active in areas with basketball goals and an installed play structure than in an open field. Conclusions Playground equipment appeared to have a strong influence on where children played and a moderate influence on levels of activity. To maximize physical activity in children, playgrounds should be designed with ample and diverse play equipment.
Farley T, Meriwether R, Baker E, Watkins L, Johnson C, Webber L.	Safe play to promote physical activity in inner-city children: results from a pilot study of an environmental intervention.	Am J Public Health 2007; 97(9):1625-1631.	Objectives We evaluated the effect of providing a safe play space on the physical activity level of inner-city schoolchildren. Methods In 1 of 2 matched neighborhoods, we opened a schoolyard and provided attendants to ensure children's safety. Over the next 2 years we directly observed the number of children and their physical activity levels in the school-yard, as well as in the surrounding intervention and comparison neighborhoods. We also surveyed children in the schools in the intervention and comparison neighborhoods regarding sedentary activities. Results After the schoolyard was opened, a mean of 71.4 children used it on weekdays and 25.8 used it on weekends during the school year. When observed, 66% of these children were physically active. The number of children who were outdoors and physically active was 84% higher in the intervention neighborhood than the comparison neighborhood. Survey results showed that children in the intervention school reported declines relative to the children in the comparison school in watching television, watching movies and DVDs, and playing video games on weekdays. Conclusion When children were provided with a safe play space, we observed a relative increase in their physical activity. Provision of safe play spaces holds promise as a simple replicable intervention.
Johnson C, Murray D, Elder J, Jobe J, Dunn A, Kubik M, Voorhees C, Schachter K.	Depressive symptoms and physical activity in adolescent girls.	Med Sci Sports Exerc.	Purpose To evaluate the relationship between depressive symptoms and physical activity in a geographically and ethnically diverse sample of sixth-grade adolescent girls. Methods The Trial of Activity for Adolescent Girls (TAAG) baseline measurement included a random sample (N = 1721) of sixth-grade girls in 36 schools at six field sites. Measurements were accelerometry and the 3-d Physical Activity Recall (3DPAR) for physical activity, and the Center for Epidemiological Studies-Depression scale (CES-D) for depressive symptoms. Results Girls with complete data (N = 1397), mean age 12 yr, had an average CES-D score of 14.7 (SD = 9.25) and engaged in an average of about 460 min of sedentary activity, < 24 min of moderate to vigorous physical activity (MVPA), and < 6 min of vigorous physical activity (VPA) in an 18-h day. Thirty-minute segments of MVPA ranged in number from 3.9 to 1.2, and METS for these segments ranged from > 3.0 to > 6.5. Mixed-model regression indicated no relationship between depressive symptoms and physical activity; however, a significant but modest inverse relationship between sedentary activity and depressive symptoms was observed. Conclusion A sufficient sample size, standardized procedures, and validated instruments characterized this study; however, a relationship between depressive symptoms and physical activity was not observed for sixth-grade girls from diverse geographic locations. The average CES-D score was lower than is considered clinically meaningful for either adolescents or adults, and MET-minutes of sedentary activity were high. This combination of data may be different from other studies and could have contributed to the unexpected finding. This unexpected finding is informative, however, because it shows the need for additional research that includes a wider range of possible combinations of data, especially with young adolescent girls.
Jaycox LH, Tanielian TL, Sharma P, Morse L, Clum G, Stein B.	Schools' mental health responses after hurricanes Katrina and Rita.	Psychiatr Serv 2007 Oct; 58(10):1339-1343.	Objective After the displacement of students following hurricanes Katrina and Rita, schools in several states enrolled many students with potential mental health needs. This study sought to understand how schools perceived the mental health needs of these students and what mental health programs they implemented. Method Mental health personnel at 19 public schools or school systems and 11 private or parochial schools in Louisiana, Alabama, Texas, and Mississippi were interviewed at two time points(spring and fall-winter of 2006). Results Schools undertook diverse approaches to interventions, depending on the preexisting mental health infrastructure and personnel, the perceived needs of students, and the barriers or facilitators in each system. Interviewees described a rapid and comprehensive approach to the crisis in the immediate aftermath. Shortly afterward, some schools perceived little need for mental health services and refocused on their academic missions. Other school systems perceived student need but were unable to implement trauma-focused programs because staff were not prepared to deliver such services and funding was lacking. However, some systems and schools were able to implement new programs or extend programs to displaced students. Implementation challenges included difficulty communicating with parents, burnout among staff and program implementers, and efforts to balance the needs of the displaced students with those of the preexisting student population. Conclusions Despite significant efforts to support students affected by the hurricanes, schools were limited in their ability to implement disaster-focused programs. Extension of crisis plans to include precrisis training in mental health programming for students and staff who have ongoing difficulties after a disaster or crisis may be beneficial.
Taylor CA, Sorenson SB.	Intervention on behalf of children exposed to intimate partner violence: assessment of support in a diverse community-based sample.	Child Abuse and Neglect 2007; 31:1155-1168.	Objective The aim of this study is to assess community-based support for intervening on behalf of children exposed to intimate partner violence (IPV) and to determine what contextual and respondent characteristics are associated with that support. Method An experimental vignette design was used in a random-digit-dial survey of six ethnic groups in California. For each respondent (n = 3679), seven vignettes about IPV were generated using randomized categories of victim and assailant characteristics (i.e., gender and sexual orientation, age, ethnicity, nativity, occupational status, and relationship status) and situational characteristics (i.e., motivation, weapon use, type of abuse, alcohol use, frequency of the incident, and child present). All vignettes analyzed for this manuscript (n = 6556) mentioned that “there was a child in the other room” during the incident. Results In 70% of the IPV scenarios, respondents supported intervention on behalf of the child. Support was lowest when the IPV was purely psychological in nature (62–63%), higher when it involved threats, coercion, or limited physical abuse (68–71%), and highest when it involved severe physical abuse (76–81%). The odds of supporting intervention also were elevated when a weapon was involved, when the IPV occurred multiple times, and when the IPV involved gay men. Men and Vietnamese Americans had the lowest odds of favoring intervention. Conclusions Public opinion assessed in this survey is aligned with that of professionals who believe that the potential impact of IPV on children should not be ignored and who have suggested that criteria should be developed to guide a graded intervention response for such cases.
Rose D.	Food Stamps, the Thrifty Food Plan, and meal preparation: the importance of the time dimension for US nutrition policy.	J Nutr Educ Behav 2007 Jul-Aug; 39(4):226-32.	The Thrifty Food Plan (TFP) has a unique role in US Nutrition Policy, integrating both dietary guidance and antihunger policies. Not only are food items in the TFP market basket chosen based on the latest dietary recommendations, but the Plan serves as the basis for inflation adjustments to Food Stamp allotments. To be economical, the TFP logically assumes that most dishes are prepared from raw ingredients. This assumption likely contradicts welfare policy, which promotes increased labor force participation of low-income women. This article presents empirical evidence on meal preparation times in US households and compares this evidence to the TFP implicit assumptions about food preparation. The trade-offs between time and money inputs used in the preparation of meals are discussed using the economist's household production approach. Implications of policy contradictions are explored, as well as related needs for research and practice.
Scott A, Ellen J, Clum G, Leonard L.	HIV and housing assistance in four U.S. cities: variations in local experience.	AIDS Behav 2007 May 18; [Epub ahead of print]	This paper provides an account of how young, HIV-positive women manage their lives on limited budgets in four United States cities: New York City, New Orleans, Miami, and Chicago. The study findings elucidate city-to-city variability in housing assistance, and how this manifests in locality specific differences in the experience of HIV. Our research suggests that the receipt of housing assistance has ramifications for women's engagement in care, and for their health. Women not receiving aid often move frequently in and out of homelessness, or "double up" with others in complex household arrangements to share costs. Women with long-term housing assistance, while still struggling financially, possess a stable base from which to approach daily life and HIV care. This account suggests a need for empirical research assessing the impact of local variations in housing assistance on specific health outcomes for those with HIV. It also highlights the importance of understanding local contexts when designing housing interventions at both the individual and structural levels.
Trent M, Clum G, Roche Km.	Sexual victimization and reproductive health outcomes in urban youth.	Ambul Pediatr 2007 Jul-Aug;7(4):313-6.	Objective Adolescents and adults with a history of sexual victimization (SV) are at increased risk of engaging in sexual risk behaviors. This study seeks to examine race- and gender-based differences in SV as well as the association between SV and reproductive health outcomes (pregnancy and sexually transmitted infections [STIs]) among young adults from an urban community with high rates of both outcomes. Methods This study used cross-sectional data from the Young Adult Survey of the Baltimore Prevention Program's intervention trials. Participants initially enrolled as first graders were interviewed for the Young Adult Survey as they entered adulthood. A total of 1698 participants were asked about SV, pregnancy, and STIs. Data were analyzed by logistic regression analysis. Results History of SV did not vary by racial background, but female participants were more likely to report SV than their male peers. Results for models predicting STIs revealed a significant interaction between gender and SV. Adolescent girls who reported a SV were significantly more likely to have an STI than adolescent girls who did not report victimization. Both adolescent boys and girls who reported SV were more likely to report involvement in a pregnancy. Conclusions Youth in urban communities with a history of SV are far more likely than those without victimization histories to have a pregnancy or STI before young adulthood. Further research is needed to explore the mediators of these outcomes and the value of sexual safety and child protection programs for pregnancy and STI prevention in urban environments.
Beaudoin CE, Fernandez C, Wall JL, Farley TA	Promoting healthy eating and physical activity: short-term effects of a mass media campaign	Am J of Preventive Medicine. Mar 2007. 32(3):217-23	Background Soaring obesity levels present a severe health risk in the United States, especially in low-income minority populations. Intervention: high-frequency paid television and radio advertising, as well as bus and streetcar signage. Setting/Participants: a mass media campaign in New Orleans to promote walking and fruit and vegetable consumption in a low-income, predominantly African-American urban population. Messages were tailored with consideration of the African-American majority. Design Random-digit-dial telephone surveys using cross-sectional representative samples at baseline in 2004 and following the onset of the campaign in 2005. Measures Survey items on campaign message recall; attitudes toward walking, snack food avoidance, and fruit and vegetable consumption; and behaviors related to fruit and vegetable consumption, snack food consumption, and utilitarian and leisure walking. Results From baseline, there were significant increases in message recall measures, positive attitudes toward fruit and vegetable consumption, and positive attitudes toward walking. Behaviors did not change significantly. In 2005, message recall measures were associated with positive levels of each of the outcome variables. Conclusions Over 5 months, the media campaign appeared to have stimulated improvements in attitudes toward healthy diet and walking behaviors addressed by the campaign. These findings encourage the continuation of the media campaign, with future evaluation to consider whether the behavioral measures change.
Xiong X, Wightkin J, Magnus JH, Pridjian G, Acuna JM, Buekens P	Birth weight and infant growth: optimal infant weight gain versus optimal infant weight	Maternal & Child Health J. Jan 2007. 11(1):57-63	Objective Infant growth assessment often focuses on "optimal" infant weights and lengths at specific ages, while de-emphasizing infant weight gain. The objective of this study was to examine infant growth patterns by measuring infant weight gain relative to birth weight. Methods We conducted this study based on data collected in a prospective cohort study including 3,302 births with follow up examinations of infants between the ages of 8 and 18 months. All infants were participants in the Louisiana State Women, Infants, and Children Supplemental Food Program between 1999 and 2001. Growth was assessed by infant weight gain percentage (IWG%, defined as infant weight gain divided by birth weight) as well as by mean z-scores and percentiles for weight-for-age, length-for-age, and weight-for-length calculated based on growth charts published by the US Centers for Disease Control (CDC). Results An inverse relationship was noted between birth weight category and IWG% (from 613.9% for infants with birth weights <1500 g to 151.3% for infants with birth weights of 4000 g or more). In contrast, low birth weight infants had lower weight-for-age, weight-for-length z-scores and percentiles compared to normal birth weight infants according to CDC growth charts. Conclusions Although low birth weight infants had lower anthropometric measures compared to a national reference population, they had significant catch-up growth. We suggest that growth assessments should compare infants' anthropometric data to their own previous growth measures as well as to a reference population. Further studies are needed to identify optimal ranges of infant weight gain.
Farley TA	Sexually transmitted diseases in the Southeastern United States: location, race, and social context	Sexually transmitted diseases. Jul 2006. 33(7 Suppl):S58-64	Abstract Heterosexual transmission of HIV in the United States appears to be following the epidemiologic pattern of bacterial sexually transmitted diseases (STDs) such as syphilis and gonorrhea, disproportionately affecting blacks in the Southeastern region. Nationwide, rates of syphilis and gonorrhea are nearly 30 times higher in blacks than in whites, and this racial disparity underlies most of the regional and county-level differences in rates. The racial disparity cannot be explained by traditional measures of socioeconomic differences, and it cannot be explained by individual-level determinants of sexual behavior, but rather reflects deeper group-level social and environmental factors for which race is a marker. A theoretical model based on previous ecologic studies is proposed to explain the relationship between racial discrimination and elevated rates of STDs in blacks. Key factors in the model include: 1) chronic joblessness, 2) drug and alcohol marketing, 3) social disorganization (or social capital), and 4) male incarceration.
Kissinger P, Schmidt N, Mohammed H, Leichliter JS, Gift TL, Meadors B, Sanders C, Farley TA	Patient-delivered partner treatment for Trichomonas vaginalis infection: a randomized controlled trial	Sexually Transmitted Diseases. Jul 2006. 33(7):445-50	Objectives Infections with Trichomonas vaginalis (TV) are common and recurrence rates are high. Better methods of treating partners of women with trichomoniasis are needed. GOAL: To determine if patient-delivered partner treatment (PDPT) is better and more cost-effective than partner referral. Study Design Women attending a family planning clinic who were culture-positive and treated for TV (N = 463) were randomized to either standard partner referral (PR), booklet-enhanced partner referral (BEPR), or PDPT. At baseline and 1 month, women were interviewed and cultured for TV. Detailed cost information was also collected. Results Most women had 1 partner, were less than 24 years old, and were black. The percentage of women reporting that their partners were treated was similar for PDPT but significantly lower for BEPR compared to PR. TV follow-up rates were similar. PDPT cost less and was cost saving compared to PR and BEPR. Conclusion Among women with TV, PDPT did not result in more partners taking the medicine or lower follow-up rates than PR but was less costly.
Farley TA, Mason K, Rice J, Habel JD, Scribner R, Cohen DA	The relationship between the neighbourhood environment and adverse birth outcomes	Paediatric and Perinatal Epidemiology. May 2006. 20(3):188-100	Background Intrauterine growth retardation and preterm birth are more frequent in African-American women and women of lower socio-economic status, but the reasons for these disparities are not fully understood. The physical and social environments in which these women live may contribute to these disparities. Methods We conducted a multilevel study to explore whether conditions of mothers' neighbourhood of residence contribute to adverse birth outcomes independent of individual-level determinants. We analysed data from 105 111 births in 1015 census tracts in Louisiana during 1997-98, merging it with data from other existing sources on neighbourhood socio-economic status, neighbourhood physical deterioration, and neighbourhood density of retail outlets selling tobacco, alcohol and foods. After controlling for individual-level sociodemographic factors, tract-level median household income was positively associated with both birth weight-for-gestational-age and gestational age at birth. Neighbourhood physical deterioration was associated with these birth outcomes in ecological analyses but only inconsistently associated with them after controlling for individual-level factors. Neither gestational age nor birth weight-for-gestational-age was associated with neighbourhood density of alcohol outlets, tobacco outlets, fast-food restaurants or grocery supermarkets. Conclusions We conclude that measures of neighbourhood economic conditions are associated with both fetal growth and the length of gestation independent of individual-level factors, but that readily available measures of neighbourhood retail outlets are not. Additional studies are needed to better understand the nature of environmental influence on birth outcomes.
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