2005 Poster abstracts

Work and Health Disparities in Rural Womem
Hester J. Lipscomb, PhD
Robin Argue, MPH
Mary Anne McDonald, DrPH
Rita Perry
Emma Pender
Christal Rankins
Chaniqua White
Hester J. Lipscomb (presenting author)

Introduction: Reduction of labor costs often occurs through hiring less advantaged groups – often women, immigrants, racial minorities – who are perceived to be less likely to organize and more likely to accept poorer conditions. Southern states have recruited industry through tax breaks, anti-union legislation, permissive regulations and promises of low wages resulting in placement of low wage industries in economically depressed areas with large minority populations.

Methods: We are conducting a community-based longitudinal study of African-American women employed in poultry processing in an economically depressed area of NC. Primary outcomes of interest include musculoskeletal disorders and acute injuries, but also health related quality of life and social consequences of employment. Quantitative and qualitative data are being collected from women through serial physical exams and interviews, as well as in-depth ethnographic interviews.

Results: Preliminary results from baseline measurements indicate high prevalence of musculoskeletal symptoms, particularly involving the upper extremities, consistent with the physical demands in this fast-paced industry. Ethnographic interviews and participants’ disclosures to community-based staff reveal important ways work, and the fear of losing work, can contribute to disparities in health including fear of seeking medical care.

Conclusion: Work places are an important component of the built environment with the potential to have tremendous influence on the health of the communities where they are placed. In economically depressed areas, immediate needs for jobs can outweigh concerns about long-term health effects in the eyes of the community at large, and in the eyes of workers, contributing to health disparities.


Healthy People 2010: The Environment and Health Disparities
Audrey Burwell, MHS
Miryam Granthon, MPH
Miryam Granthon (presenting author)

Introduction: The goal of the Healthy People 2010 chapter on Environmental Health is to “Promote health for all through a healthy environment.”

Methods: To address the broad range of human health issues affected by the environment, this chapter discusses six topics: outdoor air quality, water quality, toxics and waste, healthy homes and healthy communities, infrastructure and surveillance, and global environmental health issues. Review HHS activities promoting disease prevention and health promotion. Highlighting the Steps to a Healthier Nation grants recipients.

Results: Studies have linked race and socioeconomic status to increased exposure to environmental hazards, and information about gene-environment interactions improves the ability to determine who has increased risk of disease from these exposures. The presentation will summarize some inequities in the United States regarding exposure to selected potential environmental hazards for the four major racial ethnic population groups.

Conclusions: Improving the racial and ethnic quality and availability of environmental health data also will help meet the objectives. The Internet has increased dramatically access to environmental information. Databases such as TOXNET, Internet Grateful Med, and TRI may provide useful information about environmental hazards or other environmental problems in communities to health care providers, policymakers, and the public. An increase in public awareness of environmental health issues is key to achieving this chapter’s goal and objectives. Education–at all levels–is a cornerstone of broad prevention efforts.


The Role of the Built Environment in Promoting Healthy Lifestyles Among Rural African American Men
Derek M. Griffith
Eugenia Eng
Sara Ackerman
Elvira Mebane
Leo Allison
Derek M. Griffith, PhD (presenting author)

Introduction: A large body of literature exists that describes the poor health status of African American men (Williams, 2003). The majority of this research has focused on men in urban communities, though the rates of heart disease, cancer and diabetes are higher in rural communities than in urban areas, and people in rural communities are less likely to use preventive screening services or exercise regularly (Healthy People 2010). This paper examines how the built environment interacts with economic, social, and political factors over time to impact the health and well-being of rural African American men.

Methods: This community-based participatory research study included 19 interviews with community residents and service providers that examined the impact of the sociopolitical history of the environment on the health of rural African American men in an unincorporated community in central North Carolina. African American men from the community participated in all phases of the research.

Results: Economic, sociocultural, and political factors provided an important context for changes in the built environment over time. In this community, changes in the built environment during the 20th century led to men leading more isolated and sedentary lifestyles; limited access to preventive services, medical care, and healthy nutritional options; decreased social capital and social interactions; and created an unhealthy physical environment.

Conclusion: The built environment can play a major role in increasing risk factors for rural African American men’s health. Access to information, services, social support, and healthy alternatives are important to consider when developing health behavior change and health promotion programs for African American men.


Socioeconomic Disparity is Linked with Disparity in Type and Availability of Physical Activity Facilities
Melissa C. Nelson, RD
Penny Gordon-Larsen, PhD
Barry M. Popkin, PhD
Melissa C. Nelson, RD (presenting author)

Introduction: Little is known about environmental determinants of physical activity underlying recent dramatic increases in obesity, despite national recognition of the importance of research in this area. This study examined modifiable environmental factors that may contribute to the differential distribution of activity and obesity patterns by ethnicity and socioeconomic status (SES).

Methods: This sample included 23,481 census block groups, based on a nationally representative sample of US youth. Using Geographic Information Systems, US Census 2000 data was linked with physical activity facilities data (primarily from Digital Yellow Pages). Physical activity facilities were categorized by type (e.g., private, public, instructional). Two neighborhood profiles were defined. Low SES neighborhoods (n=1688) were block groups in the highest quintile of minority population, highest quintile of households (HH) with income [lt]$30,000, and lowest quintile of HH with greater than high school education. In contrast, high SES neighborhoods (n=729) were in the lowest quintile of minority population, lowest quintile of income, and highest quintile of education. T-tests were conducted using Bonferroni corrections for multiple comparisons.

Results: Low SES neighborhoods were less likely to have public (p=0.0026), private (p[lt]0.0001), and instructional (p[lt]0.0001) physical activity facilities compared to high SES areas. Government-funded facilities were more equally distributed across diverse SES contexts (schools: p=0.27, parks: p=0.60). Less urbanized areas contained fewer public (p[lt]0.0001) and instructional (p=0.0009) facilities.

Conclusion: Addressing the disparity in accessible and affordable resources for physical activity in low SES neighborhoods will be an important direction for public policy.


Elements of Transportation Plans in North Carolina Communities
S.A. Aytur, MPH
D.A. Rodríguez, PhD

K.R. Evenson, PhD
Semra A. Aytur, MPH (presenting author)

Introduction: Environments supportive of transit and non-motorized transportation are important for the health of all Americans. We examined specific elements in North Carolina (NC) transportation plans, and whether these elements were differentially distributed by race.

Methods: In 2003, planning officials in NC municipalities with >10,000 residents (n=64) were surveyed by mail regarding the characteristics of land use and transportation plans. Respondents (n=47, 73%) reported whether these elements were present and implemented in their community’s transportation/thoroughfare plan: 1) road improvements, 2) transit routes, 3) pedestrian/sidewalk plans, 4) greenway plans, 5) bicycle plans. Using the 2000 U.S. Population Census, municipalities were categorized as “low minority” (<25% non-white; n=17) or “high minority” (>=25% non-white; n=30).

Results: All transportation elements examined were implemented less frequently in high-minority communities. Transit routes differed least by race, implemented in 35% of low- and 28% of high-minority communities, followed by road improvements (71% vs. 62%), pedestrian/sidewalk plans (53% vs. 35%), and bicycle plans (37% vs. 21%). Greenway plans showed the greatest discrepancy by race, implemented in 53% of low-minority communties but in only 17% of high-minority communities.

Conclusions: In NC, communities with higher proportions of minority residents appear less likely to have implemented transportation elements compared to communities with larger white populations, especially non-motorized elements. In order to address these disparities, public health and urban planning professionals must collaboratively explore the role of local policies and socioeconmic factors that shape mobility choices.


The Impact of a Regional Medical School on Health Status in Eastern North Carolina
Peter J. Kragel

Introduction: As part of the local “built environment,” Brody Medical School’s mission was to improve the health status of the regional population and provide opportunity for disadvantaged students in a way that medical schools located outside the region could not.

Methods: Premature mortality figures were compared for eastern North Carolina and North Carolina. Minority student enrollment at the Brody School of Medicine was quantified and compared to other medical schools. The number of physicians placed in eastern North Carolina was quantified.

Results: From the time of the school’s founding, premature mortality decreased for the entire population and for minority populations in eastern North Carolina, but a gap in health status between the East and the rest of the state persisted. The medical school and sponsored residency programs placed approximately 340 physicians in the East. Numbers of underrepresented minorities over the last 5 years ranged from 19% to 26% of the class, approximately 1.5 times the national average.

Conclusions: The Brody School of Medicine has placed physicians in eastern North Carolina and enrolled underrepresented minorities. While a causal relationship between the presence of a medical school and decreasing but persistent gaps in health status has not been established, we suggest that additional strategies are necessary to eliminate this gap. Such strategies should include attention to economic development, individual health behavior and cultural change, further decentralization and enhanced access to health services, creation of multidisciplinary centers focused on specific regional health needs, and the role of the built environment.


National Environmental Health Indicators for Minority and Low Income Populations: A Proposal for Tracking Environmental Health Disparities
Payne-Sturges, DrPH
Gilbert Gee, PhD
Devon Payne-Sturges, DrPH (presenting author)

Introduction: There is continuing concern that minority and economically disadvantaged communities bear a disproportionate share of the risks and exposure and or exposure-related health effects from environmental pollutants. These issues gained national attention through publications such as the 1987 report by the Commission on Racial Justice of the United Church of Christ, Toxic Waste and Race in the United States. In 1994, President Clinton signed an executive order requiring all federal agencies to work towards ending the disproportionate exposures of minority and poor people to many environmental hazards. Yet, more than a decade later we do not have a framework to assess, from a national perspective, the impact of efforts to improve environmental health of minority and disadvantaged communities. Further, it remains unclear how psychosocial and environmental conditions interact to create health disparities and how to measure these conditions.

Methods:
We conducted a review of the environmental justice, social science and environmental health literature that focused on minority and low income communities and previous work on environment health indicators (e.g. EPA’s America’s Children and the Environment).

Results: Based on our literature review, we present 1) a conceptual framework for how social and physical environmental factors may create health disparities and 2) candidate national indicators that may aid in the measurement and tracking of environmental health disparities.

Conclusion: A number of challenges are identified for creating national indicators. As for next steps, we plan to evaluate which measures are most cost-effective and suitable for tracking, and prioritize candidate indicators. We hope to create a national dialogue to spur conceptual and methodological advancement.



Survey of Microbial Contamination in Ground and Surface Water Supplies in An Underserved African-American Community in Alamance and Orange Counties, North Carolina

Christopher D. Heaney

Introduction: There is high vulnerability of groundwater contamination in rural areas with populations that are likely to have failing on-site septic tank soil absorption systems and private, unregulated drinking water wells of inadequate depth and construction quality. Surveillance for microbial indicators in ground and surface waters of three underserved African-American (A-A) communities in Alam. and Or. Co., NC was undertaken to aid in policy decisions concerning public health risks and the need for provision of a public, regulated drinking water supply and sewer system.

Methods: Water was collected and analyzed for fecal coliforms, E. coli, enterococci, and coliphages from 60 residences in 3 A-A enclaves.

Results: Samples were negative, except one that was positive for coliphages. 17 surface water samples were collected and microbially analyzed from 7 streams in close proximity to houses with failing septic systems. A round of 7 surface water samples collected during extreme drought conditions showed no evidence of contamination. Second and third sampling rounds of 5 samples each resulted in contamination exceeding USEPA single sample MCLs for fecal coliforms, E. coli, and enterococci. Third round samples also were positive for coliphages, with concentrations ranging from 1.5 to 46 infectious units per 100ml.

Conclusion: This study suggests a need to address failing septic systems in these A-A, NC communities. The presence of coliphages in a household water sample suggests possible contamination of community drinking water supplies, the need for further investigation of drinking water microbial quality, and consideration of the provision of a regulated, public water supply and sewer system.



Prevalence of Environmental Barriers for Physical Activity in Two US Communities

Aileen P McGinn, MS (presenting author)
Kelly R Evenson, PhD


Introduction:
It has been hypothesized that barriers in the neighborhood environment can hinder one’s ability to be physically active. Since perceptions of these barriers are not well documented, this study reports the prevalence of perceived environmental barriers.

Methods: Perception of individual’s environment was assessed using a random digit dialed telephone survey conducted in Forsyth County, NC and Jackson, MS. Participants were asked if certain environmental attributes were a problem in their neighborhood. The four level response was dichotomized for the 1,657 (white n=978, non-white n=679) respondents. Sample prevalence estimates were weighted by age and gender to reflect each community’s adult population.

Results: Of the thirteen environmental attributes, the overall prevalence ranged from 16% to 51% [lack of sidewalks (51%), lack of trails (45%), presence of hills or steep slopes (42%), speeding cars (42%), heavy traffic (34%), lack of parks (34%), lack of crosswalks (30%), unattended dogs (28%), noise (22%), trash (19%), lack of trees that provide shade (18%), pollution (16%) and weather (16%)]. The prevalence of barriers among non-whites was significantly higher (p<0.1) for lack of parks, unattended dogs, noise, trash, lack of trees for shade, pollution and weather. However, the prevalence of hills was reported significantly more often by whites than non-whites.

Conclusion: Non-whites perceived environmental barriers more often than whites, which may help explain some of the disparity seen in the prevalence of leisure activity between whites and non-whites. Further research is needed to examine the association of perceived environmental barriers with physical activity behaviors.


Mapping Environmental Influences on Latino Dietary Behaviors and Physical Activity
Kelley De Leeuw, BA (presenting author)
Sean Hanley, BS, BA

Guadalupe X. Ayala PhD, MPH

Introduction: Understanding environmental influences on dietary and physical activity behaviors is necessary when designing effective community interventions. This is especially true among recent immigrant Latinos, who must adapt to new physical and cultural environments in the United States. Towards this end, formative research was done with Latino families in Burlington, North Carolina.

Methods: In-depth home interviews were conducted with fourteen Latino families (78.5% Mexican origin; 14 mothers, mean age=40.5, SD=3.8; 14 adolescents, mean age=13.3, SD=1.7, 85.7% female). Mean years living in the United States was 8.0 (SD=3.2). Families completed a cooperative manual mapping activity to identify the family’s daily routes and locations of potential dietary and exercise influence in their environment. Subsequently, eight adolescents photographed these influences.

Results: Worksites, schools, grocery stores, restaurants, churches and city parks were commonly represented in the maps. Super Wal-mart was identified most often (78.6%) as the primary source for groceries. Buffet restaurants (American or Chinese) commonly ranked as the family’s favorite restaurant (64.3%). A majority identified city parks (71.4%) and churches (57.1%) as locations they frequent weekly. Many adolescents (64.3%) participated in organized sports. Families appeared to follow well-established patterns of navigating their environments. The use of in-depth interviews and a mapping activity revealed discrepancies in reported influences, suggesting the advantage of employing a multimodal assessment.

Conclusion: All families displayed an understanding in identifying dietary and exercise influences in their community through the mapping activity. Identified sites merit further investigation in cooperation with the Latino community for possible dietary and physical activity interventions.


Unequal Respiratory Health Risk: Using a GIS to Explore Hurricane Related Flooding of Schools in Eastern NC
Virgina Thompson Guidry, MPH (presenting author)

Introduction: This cross-sectional study investigated whether schools serving populations at high risk of developing respiratory infections in North Carolina were disproportionately burdened by flooding from Hurricane Floyd.

Methods: We used Geographic Information System (GIS) techniques to combine a satellite-derived image of the flooded land with school geographic locations. We identified 81 Flooded schools and 369 Non-Flooded schools in 36 counties. We then characterized these schools based on the income, race/ethnicity, and age of their student populations.

Results: Prevalence ratios (PRs) revealed that Majority Black schools had twice the risk of being flooded compared to the referent group (Majority Non-Black, Non-Low Income). Majority Black, Non-Low Income schools had a PR of 2.01 (95% Confidence Interval (CI), 1.14, 3.57) and Majority Black, Low Income schools had a PR of 1.96 (95% CI, 1.24, 3.09).

Conclusion: This analysis suggests that schools serving populations already at elevated risk of respiratory illness were disproportionately affected by the flooding of Hurricane Floyd. GIS techniques combined with other available data can be used to identify quickly and prioritize schools for remediation following natural disasters.


Connecting Physical Activity, Health and the Community Environment
Jimmy Newkirk

Introduction: The NC Division of Public Health, Physical Activity and Nutrition Branch, promotes Active Community Environments (ACEs) in an effort to combat chronic diseases as well as the epidemic increases of obesity and diabetes. Physical inactivity costs North Carolinians over $6.2 Billion dollars per year. Low Socio-Economic Status (SES) households are disproportionately affected by chronic diseases and are less likely to be physically active or eat healthy. Low SES families are often unprepared to participate in creating community change fostering physical activity opportunities. A reduction of community barriers is important to improving health status.

Methods: The Division of Public Health (DPH) has produced community change tools designed for the lay audience. These tools are practical “how to” guides for creating Active Community Environments.

Results: DPH tools include an ACES guide entitled “Winning with ACEs! How you can work towards Active Community Environments”. The guide is policy primer, tailored to NC systems, and a practical “how to” guide. The guide includes community assessment tools and addresses “windows of opportunity” to become involved with the community change process. Other tools include the Walking and Bicycling Suitability Assessment and the NC Walks To School Module. The NC Walks To School Module is a complete package of material usable for developing programs associated with walking to school and is an easy introduction to active community environments.

Conclusion: Creating Active Community Environments is necessary for increasing physical activity levels. Tools, such as those created by NCDPH, can guide community members in the change process.