Preventive medicine
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Preventive medicine · Jun 2018
Neighborhood characteristics and lifestyle intervention outcomes: Results from the Special Diabetes Program for Indians.
Growing evidence reveals various neighborhood conditions are associated with the risk of developing type 2 diabetes. It is unknown, however, whether the effectiveness of diabetes prevention interventions is also influenced by neighborhood characteristics. The purpose of the current study is to examine the impact of neighborhood characteristics on the outcomes of a lifestyle intervention to prevent diabetes in American Indians and Alaska Natives (AI/ANs). ⋯ Meanwhile, participants from sites with higher neighborhood level of vehicle occupancy made more improvement in BMI and diet. Lifestyle intervention effectiveness was not optimal when the intervention was implemented at sites with disadvantaged neighborhood characteristics. Meaningful improvements in socioeconomic and other neighborhood disadvantages of vulnerable populations could be important in stemming the global epidemic of diabetes.
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Preventive medicine · Jun 2018
Subjective neighborhood assessment and physical inactivity: An examination of neighborhood-level variance.
Research suggests a linkage between perceptions of neighborhood quality and the likelihood of engaging in leisure-time physical activity. Often in these studies, intra-neighborhood variance is viewed as something to be controlled for statistically. However, we hypothesized that intra-neighborhood variance in perceptions of neighborhood quality may be contextually relevant. ⋯ Neighborhoods where the aggregated perception of neighborhood quality was poor also had a larger proportion of residents reporting being physically inactive. However, higher degrees of disagreement among residents within neighborhoods about their neighborhood quality was significantly associated with a lower proportion of residents reporting being physically inactive (p=0.001). Our results suggest that intra-neighborhood variability may be contextually relevant in studies seeking to better understand the relationship between neighborhood quality and behaviors sensitive to neighborhood environments, like physical activity.
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Preventive medicine · Jun 2018
The relative persuasiveness of narrative versus non-narrative health messages in public health emergency communication: Evidence from a field experiment.
Previous studies indicated that narrative health messages are more effective than non-narrative messages in influencing health outcomes. However, this body of evidence does not account for differences in health domain, and little is known about the effectiveness of this message execution strategy during public health emergencies. In this study, we examined the relative effectiveness of the two formats in influencing knowledge and perceived response efficacy related to prevention of pandemic influenza, and determined whether effects of message format vary across population sub-groups. ⋯ Results indicated that participants in the non-narrative condition reported greater knowledge and rated pandemic influenza prevention measures as more effective compared with those in the narrative condition. Message format effects did not vary across population sub-groups; post-viewing scores of knowledge and perceptions related to pandemic influenza were consistently higher in the non-narrative condition compared with the narrative condition across five socio-demographic groups: age, gender, education, race/ethnicity and income. We concluded that didactic, non-narrative messages may be more effective than narrative messages to influence knowledge and perceptions during public health emergencies.
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Preventive medicine · Jun 2018
Challenges in risk estimation using routinely collected clinical data: The example of estimating cervical cancer risks from electronic health-records.
Electronic health-records (EHR) are increasingly used by epidemiologists studying disease following surveillance testing to provide evidence for screening intervals and referral guidelines. Although cost-effective, undiagnosed prevalent disease and interval censoring (in which asymptomatic disease is only observed at the time of testing) raise substantial analytic issues when estimating risk that cannot be addressed using Kaplan-Meier methods. Based on our experience analysing EHR from cervical cancer screening, we previously proposed the logistic-Weibull model to address these issues. ⋯ The logistic-Weibull model performed well, except when event times didn't follow a Weibull distribution. We have demonstrated that methods for right-censored data, such as Kaplan-Meier, result in biased estimates of disease risks when applied to interval-censored data, such as screening programs using EHR data. The logistic-Weibull model is attractive, but the model fit must be checked against Turnbull non-parametric risk estimates.
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Preventive medicine · Jun 2018
Social capital and obesity among adults: Longitudinal findings from the Montreal neighborhood networks and healthy aging panel.
Curbing the worldwide increase in obesity requires upstream social interventions that modify the environment in which obesity emerges. Recent studies have suggested that social capital and networks may influence a person's risk of obesity. Yet, few longitudinal studies have assessed whether social capital and networks reduce obesity risk in adult populations. ⋯ Adults with higher network diversity (OR: 0.83, 95% CI: 0.72-0.96) and high generalized trust (OR: 0.52, 95% CI: 0.35-0.77) were at a lower the risk of obesity. The current study confirmed that higher network capital and trust were protective against obesity, while having kin ties was not. Disentangling the multidimensional role that social capital plays can lead to more effective interventions to reduce obesity.