One strategy for increasing physical activity is to create and enhance access to park space. We assessed the literature on the relationship of parks and objectively measured physical activity in ...population-based studies in the United States (US) and identified limitations in current built environment and physical activity measurement and reporting. Five English-language scholarly databases were queried using standardized search terms. Abstracts were screened for the following inclusion criteria: 1) published between January 1990 and June 2013; 2) US-based with a sample size greater than 100 individuals; 3) included built environment measures related to parks or trails; and 4) included objectively measured physical activity as an outcome. Following initial screening for inclusion by two independent raters, articles were abstracted into a database. Of 10,949 abstracts screened, 20 articles met the inclusion criteria. Five articles reported a significant positive association between parks and physical activity. Nine studies found no association, and six studies had mixed findings. Our review found that even among studies with objectively measured physical activity, the association between access to parks and physical activity varied between studies, possibly due to heterogeneity of exposure measurement. Self-reported (vs. independently-measured) neighborhood park environment characteristics and smaller (vs. larger) buffer sizes were more predictive of physical activity. We recommend strategies for further research, employing standardized reporting and innovative study designs to better understand the relationship of parks and physical activity.
•We reviewed research on parks and objectively measured physical activity.•Measurement and reporting of park density and proximity is not standardized.•The association of parks and physical activity was inconsistent across studies.•Standardized measurement and reporting are needed for future meta-analyses.
In 2014, the Navajo Nation Healthy Diné Nation Act (HDNA) was passed, combining a 2% tax on foods of 'minimal-to-no-nutritional value' and waiver of 5% sales tax on healthy foods, the first-ever such ...tax in the U.S. and globally among a sovereign tribal nation. The aim of this study was to measure changes in pricing and food availability in stores on the Navajo Nation following the implementation of the HDNA.
Store observations were conducted in 2013 and 2019 using the Nutrition Environment Measurement Survey-Stores (NEMS-S) adapted for the Navajo Nation. Observations included store location, type, whether healthy foods or HDNA were promoted, and availability and pricing of fresh fruits and vegetables, canned items, beverages, water, snacks and traditional foods. Differences between 2013 and 2019 and by store type and location were tested.
The matched sample included 71 stores (51 in the Navajo Nation and 20 in border towns). In 2019, fresh produce was available in the majority of Navajo stores, with 71% selling at least 3 types of fruit and 65% selling at least 3 types of vegetables. Compared with border town convenience stores, Navajo convenience stores had greater availability of fresh vegetables and comparable availability of fresh fruit in 2019. The average cost per item of fresh fruit decreased by 13% in Navajo stores (from $0.88 to $0.76) and increased in border stores (from $0.63 to $0.73), resulting in comparable prices in Navajo and border stores in 2019. While more Navajo stores offered mutton, blue corn and wild plants in 2019 compared to 2013, these changes were not statistically significant.
The findings suggest modest improvements in the Navajo store environment and high availability of fruits and vegetables. Navajo stores play an important role in the local food system and provide access to local, healthy foods for individuals living in this rural, tribal community.
Gender-based violence (GBV) is a significant problem in conflict-affected settings. Understanding local constructions of such violence is crucial to developing preventive and responsive interventions ...to address this issue.
This study reports on a secondary analysis of archived data collected as part of formative qualitative work - using a group participatory ranking methodology (PRM) - informing research on the prevalence of GBV amongst IDPs in northern Uganda in 2006. Sixty-four PRM group discussions were held with women, with men, with girls (aged 14 to 18 years), and with boys (aged 14 to 18 years) selected on a randomized basis across four internally displaced persons (IDP) camps in Lira District. Discussions elicited problems facing women in the camps, and - through structured participatory methods - consensus ranking of their importance and narrative accounts explaining these judgments.
Amongst forms of GBV faced by women, rape was ranked as the greatest concern amongst participants (with a mean problem rank of 3.4), followed by marital rape (mean problem rank of 4.5) and intimate partner violence (mean problem rank of 4.9). Girls ranked all forms of GBV as higher priority concerns than other participants. Discussions indicated that these forms of GBV were generally considered normalized within the camp. Gender roles and power, economic deprivation, and physical and social characteristics of the camp setting emerged as key explanatory factors in accounts of GBV prevalence, although these played out in different ways with respect to differing forms of violence.
All groups acknowledged GBV to represent a significant threat - among other major concerns such as transportation, water, shelter, food and security - for women residing in the camps. Given evidence of the significantly higher risk in the camp of intimate partner violence and marital rape, the relative prominence of the issue of rape in all rankings suggests normalization of violence within the home. Programs targeting reduction in GBV need to address community-identified root causes such as economic deprivation and social norms related to gender roles. More generally, PRM appears to offer an efficient means of identifying local constructions of prevailing challenges in a manner that can inform programming.
In 2014, the Navajo Nation Council passed the Healthy Diné Nation Act (HDNA), a 2% tax on unhealthy foods and beverages and a waiver of the 5% sales tax on healthy foods and water, to support health ...promotion and disease prevention among the Navajo people. Very little research has assessed implementation accuracy of food or beverage taxes and none were implemented within a sovereign Tribal nation. This study assessed the accuracy ofHDNA tax implementation among 47 stores located on the Navajo Nation.A pair of tax-exempt items e.g. a bottle of water and fresh fruit and a pair of HDNA-tax eligible items e.g. sugary beverage and candy bar were purchased between July-December 2019. Receipts were retained to assess taxation. A total of 87.2% ofstores accurately implemented the 2% tax on unhealthy items while 55.3% of the stores accurately implemented the 6% tax waiver on healthy items. In all, 51.1% of the stores accurately applied both taxes. There were no significant differences across store type (convenience or grocery stores and trading posts) or geographic region. In conclusion, almost all stores on the Navajo Nation accurately applied a 2% tax on unhealthy foods and beverages, while the proportion of stores applying a waiver on healthy foods was lower. Successful HDNA tax implementation among stores remains an important priority in achieving the goal to support health promotion and disease prevention among Navajo communities.
Criminal justice involvement is harmful to physical and mental health. However, research hasfocused primarily on the health effects of incarceration without investigating other, more common, formsof ...justice-involvement such as probation. This dissertation aimed to compare the impact of probation withincarceration on metabolic syndrome and access to health care, using data from the National LongitudinalStudy of Adolescent to Adult Health (AddHealth). A scoping literature review found few studies haveexplored this topic, with a relatively greater number of studies focused on health care access thanmetabolic syndrome. The studies in the review mainly presented descriptive statistics and unadjustedanalyses, did not formally test causal mechanisms, and highlighted how lack of standard definitions forexposure limits comparison of forms of justice involvement. Following the review, two empirical aimstested the relationship between probation, incarceration, or no justice involvement and metabolicsyndrome or access to health care among young adults ages 24–32. The findings from the first empiricalaim suggest that metabolic syndrome risk was not higher among young adults with incarceration orprobation experiences, and this relationship was not causally mediated by lack of access to normalcredentials such as housing, employment, or education. In addition, some, but not all, of the mediatorswere related to criminal justice exposure and metabolic syndrome. The results of the second empiricalaim aligned with the hypothesis that incarceration or probation experiences reduce access to health care(i.e., unmet need for health care and lack of insurance). The findings showed individuals withincarceration or probation experiences had increased risk of unmet need and uninsurance, comparedwith no justice involvement, though there was no discernible difference between the two forms of justiceinvolvement. In sum, the results of this dissertation support the hypothesis that criminal justiceinvolvement negatively impacts access to health care and some normal credentials (educationalattainment and financial stress) but does not increase risk for metabolic syndrome. Methodological factorssuch as timing, lack of longitudinal follow-up data, exposure measurement, and common outcomes mayhave contributed to the inconsistent findings.
Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare ...providers and a local nonprofit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to 6 y of age and their caregivers are enrolled in the 6-mo program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program.
We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children.
Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, and minutes of physical activity; healthcare providers also measured children’s body mass index BMI (kg/m2) z score at initiation and completion of the program. We calculated changes in health behaviors, BMI, and food security at the end of the program, compared with baseline values.
A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (P < 0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (P < 0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z score at program completion (P < 0.001). Sixty-five percent of children were retained in the program.
The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.
On April 8, 2020, the Navajo Nation issued an administrative order limiting business operations. Facing high coronavirus disease 2019 (COVID-19) rates and limited food infrastructure, a survey was ...conducted among Navajo Nation store managers to assess: (1) COVID-19 adaptations; (2) challenges; (3) changes in customer volume and purchasing; and (4) suggestions for additional support. Purposive sampling identified 29 stores in Navajo communities. Representatives from 20 stores (19 store managers/owners, 1 other; 7 grocery, and 13 convenience/other stores) were interviewed by phone or in-person to reach saturation (new information threshold < 5%). Responses were coded using frequencies and inductive thematic analysis. All 20 stores implemented COVID-19 guidelines (Centers for Disease Control and Prevention CDC/Navajo Nation) and most received orientation/support from local chapters, community organizations, or health centers. Stores implemented staff policies (50%, handwashing, vaccinations, protective personal equipment (PPE), sick leave, temperature checks), environmental changes (50%, hand sanitizer, checkout dividers), customer protocols (40%, limit customers, mask requirements, closed restrooms), and deep cleaning (40%). Most stores (65%) reported challenges including stress/anxiety, changing guidelines, supply chain and customer compliance; 30% reported infection or loss of staff. Weekday customer volume was slightly higher vs. pre-COVID, but weekend lower. Stores reported consistent or more healthy food purchases (50%), more nonfood essentials (20%), or shelf-stable foods (10%). Desired support included further orientation (30%), leadership support (20%), overtime/time to learn guidelines (20%), and signage/handouts (15%). Despite a high COVID-19 burden and limited food store infrastructure, Navajo Nation stores adapted by implementing staff, environmental and customer policies. Local support, staffing, and small store offerings were key factors in healthy food access.
In 2014, the Navajo Nation Healthy Diné Nation Act (HDNA) was enacted and permanently approved in 2020; HDNA places a 2% surtax on unhealthy foods and beverages, while other 2014 legislation exempted ...healthy food items from the 6% regular sales tax. Little is known about Navajo Nation store manager/owner perspectives toward the HDNA and how best to support stores to implement the legislation. Purposive sampling was used to ensure a balanced sample of correct HDNA implementers, incorrect HDNA implementers, and stores which made healthy store changes over the past 6 years. Three community-based interviewers collected surveys by phone or in-person. Frequency of closed-ended questions was quantified, and open-ended responses were coded using thematic analysis. Of 29 identified sample stores, 20 were interviewed to reach saturation. Eleven of 20 stores made changes improving their healthy food environments. Barriers included lack of equipment (6/20) and low consumer demand (5/20). Facilitators included consumer awareness and increased produce supply options (5/20). Sixteen of 20 stores supported HDNA continuation. Facilitators to HDNA implementation included orientation and informational materials (6/20) and promotion of tax-free items (5/20). Barriers included confusion about the tax (6/20) and tax exemption (5/20). Suggestions for support included printed materials (6/20) and store training (5/20). HDNA benefits included greater awareness of healthy choices among staff (7/20) and customer-community members (2/20). Most managers and owners expressed receiving support for healthy store changes and HDNA, but also identified a need for added resources and support. Findings inform legislative action to promote timely and appropriate uptake of HDNA, and support equitable, healthy food systems.
Identifying potential duplicate cancer cases across state boundaries has been a topic of interest for many years. Duplicate cases could distort our understanding of the burden of cancer in a state, ...region, or even nationally, and waste cancer surveillance resources. This paper reports a pilot quality improvement project to use a publicly available tool to encrypt a standard set of patient identifiers and then link cases across state boundaries as a way to identify and reconcile possible duplicate cases among a group of neighboring states. The paper describes the protocol, challenges, and preliminary results, and suggests future efforts.
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