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There have been increasing calls for the application of an intersectionality framework to understand and address discrimination and health inequities among diverse communities. Yet there have been theoretical debates regarding to whom intersectionality applies and how intersectional experiences of discrimination are associated with health outcomes. The current study aimed to contribute to these theoretical debates and inform practical applications to reduce health inequities. Data were drawn from a community health survey in New Haven, CT (N=1,293 adults) and analysed using latent class analysis. Results yielded 4 classes. Members of the 4 classes were similar sociodemographically. Three classes of participants reported experiencing discrimination, and members of these classes had greater stress, higher rates of smoking and sleep disruption, and worse overall health than members of the class reporting no discrimination. Members of 2 classes made multiple, or intersectional, attributions for discrimination, and members of these classes reported the most frequent discrimination. Findings suggest that community members who are sociodemographically similar may have diverse discrimination experiences. Multilevel interventions that address multiple forms of discrimination (e.g., racism and sexism) may hold promise for reducing discrimination and, ultimately, health inequities within low-resource urban community settings.
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Perceptions of neighborhood safety shape the well-being of individuals and communities, affecting neighborhood walkability, associated physical activity behaviors, and health conditions. However, less is known about the factors that determine perceptions of safety. One factor that may affect perceptions of neighborhood safety is the length of time someone has lived in their neighborhood. We use a representative, adult sample of urban low-income residents from the 2015 New Haven Health Survey (n = 1189) to investigate the associations between length of residence (new residents of < 1 year in neighborhood versus longer-term residents of 1 or more years in neighborhood) and perceptions of neighborhood safety (whether feeling unsafe to walk at night). We then examine the potential moderating effect of exposure to neighborhood violence on these associations. We find that the association between length of residence and perceived safety differs by exposure to neighborhood violence. Among those unexposed to neighborhood violence, longer-term neighborhood residents were more likely to feel unsafe compared to new residents (OR = 2.03, 95% CI 1.19, 3.45). Additionally, the effect of exposure to violence on feelings of safety was larger for new residents (OR = 9.10, 95% CI 2.72, 30.44) compared to longer-term residents (OR = 1.88, 95% CI 1.28, 2.77). Our findings suggest that length of residence may have implications for feelings of safety, and that experiences of violence may uniquely contribute to feelings of unsafety among new residents. These findings hold implications for interventions and policy efforts aimed at neighborhood safety improvements through community development, housing, or city urban planning initiatives, particularly for new neighborhood residents or those who experience neighborhood violence.
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PURPOSE: Our objective is to evaluate the "reach" component of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework by comparing prediabetics who were and were not interested in enrolling in a free work site diabetes prevention program (DPP) during the first year of the program. Reach is defined as the proportion of eligible participants who enroll in a health program., DESIGN: A cross-sectional study design was used., SETTING: The setting was a large health system in the Midwest., PARTICIPANTS: Prediabetic health plan enrollees and spouses (N = 2158)., MEASURES: An online health survey, annual voluntary biometric screenings delivered by a trained health-care professional using standardized protocols via point-of-care testing, and records from the DPP office were the sources of data for this study., ANALYSIS: Health behaviors and biometric screening results were simultaneously compared using multivariable logistic regression., RESULTS: The study population was 63% female, 79% white, and 16% black, and the mean age was 50.2 years (SD = 10.2). The reach of this program was 10%. Prediabetics were more likely to express interest in the DPP, if they were female (adjusted odds ratio [AOR]: 2.4; 95% confidence interval [95% CI]: 1.55-3.72; P < .001), black (AOR = 2.23; 95% CI: 1.43-3.47; P < .001), older in age (AOR: 1.08; 95% CI: 0.99-1.17; P = .05), or had a high-risk waist circumference (AOR = 1.44; 95% CI: 0.98-2.13; P = .07), lower self-efficacy to make healthy changes (AOR = 0.48; 95% CI: 0.26-0.91; P = .03), and 5 or more doctor visits in the last year (AOR = 2.13; 95% CI: 0.99-4.57; P = .05), after controlling for other covariates., CONCLUSION: Current recruitment and implementation strategies are reaching only a small group of individuals who are not representative of the larger prediabetic population. These findings inform future engagement strategies, and we recommend that public health practitioners evaluate reach to ensure that health promotion programs are of high value.
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Introduction The purpose of the study is to evaluate delivery method and breastfeeding initiation in women enrolled in group prenatal care (CenteringPregnancy) and in traditional prenatal care. Methods Data were obtained from medical records of a hospital-based midwifery practice in south central Connecticut that offered both types of prenatal care programs. Medical information from 307 women enrolled in this practice was included in the analysis. Out of the 307, 80 were enrolled in group prenatal care. Socio-demographic, lifestyle, and previous and current obstetrical information from medical records formed the basis of comparison. Bivariate and logistic regression analyses were carried out. Results Women in Centering had fewer planned cesarean sections (1.3 vs. 12.8%) and had a higher breastfeeding initiation (88.7 vs. 80.0%). However, Centering women were found to have a higher portion of unplanned cesarean sections (27.5 vs. 11.0%). Both the unadjusted and the adjusted odds ratios of having a cesarean planned delivery were lower in the group care. Women in Centering had 2.44 (95% CI 1.05, 5.66) times the odds of breastfeeding initiation compared to the odds for women in traditional prenatal care after adjusting for maternal age, smoking status, gestation and race. Discussion CenteringPregnancy can have positive impact for the woman and baby. This program implementation saw lower rates of elective cesarean sections and increased breastfeeding compared to women in traditional care.