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Biomedical subjects

Jonathan E Fielding

Publications and source records attributed to Jonathan E Fielding.

At least 19 recordsLinked to original sources
PubMed2006

Ethnic and sex variations in overweight self-perception: relationship to sedentariness.

OBJECTIVE: With increasing frequency, health promotion messages advocating physical activity are claiming weight loss as a benefit. However, messages promoting physical activity as a weight loss strategy may have limited effectiveness and cross-cultural relevance. We recently found self-perceived overweight to be a more robust correlate of sedentary behavior than BMI in Los Angeles County adults. In this study, we examined ethnic and sex differences in overweight self-perception and their association with sedentariness in this sample. RESEARCH METHODS AND PROCEDURES: We conducted bivariate and multivariate analyses of cross-sectional survey data from a representative sample of Los Angeles County adults. RESULTS: Women were more likely to perceive themselves to be overweight than men overall (73.2% of overweight/non-obese and 24.1% of average weight women vs. 44.5% of overweight/non-obese and 5.6% of average weight men) and within each ethnic group. African-Americans were least likely (41.3% of overweight/non-obese African-Americans self-identified as overweight) and whites were most likely to consider themselves overweight (60.6% of overweight/non-obese whites self-identified as overweight). Overweight (vs. average weight) self-perception was correlated with sedentariness among average weight adults (45.3% vs. 33.0%, p < 0.001), overweight adults (43.4% vs. 33.6%, p < 0.001), men (average and overweight: 38.4% vs. 27.8%, p < 0.001), overweight whites (41.9% vs. 29.7%, p = 0.0012), and African-Americans and Latinos (41.6% vs. 33.9%, p = 0.005). DISCUSSION: These data suggest that our society's emphasis on weight loss rather than lifestyle change may inadvertently discourage physical activity adoption/maintenance among non-obese individuals. However, further research is needed, particularly from prospective cohort and intervention studies, to elucidate the relationship between overweight self-perception and healthy lifestyle change.

Adult↗
PubMed2005

Growing the field of health impact assessment in the United States: an agenda for research and practice.

Health impact assessment (HIA) methods are used to evaluate the impact on health of policies and projects in community design, transportation planning, and other areas outside traditional public health concerns. At an October 2004 workshop, domestic and international experts explored issues associated with advancing the use of HIA methods by local health departments, planning commissions, and other decisionmakers in the United States. Workshop participants recommended conducting pilot tests of existing HIA tools, developing a database of health impacts of common projects and policies, developing resources for HIA use, building workforce capacity to conduct HIAs, and evaluating HIAs. HIA methods can influence decisionmakers to adjust policies and projects to maximize benefits and minimize harm to the public's health.

Community Health Planning↗
PubMed2005

Shortchanged? An assessment of chronic disease programming in major US city health departments.

A self-administered survey was distributed to members of The Big Cities Health Coalition, a group of Health Officers/Commissioners from 17 of the largest US metropolitan health departments. The survey asked participants about their chronic disease priorities, data sources, budgets, and funding sources as well as examples of successful chronic disease interventions. Members of the Coalition discussed the survey results in a scheduled conference call. Chronic diseases account for 70% of all deaths nationwide on average, yet the health departments surveyed allocated an average of 1.85% of their budgets to chronic disease. Average chronic disease spending per inhabitant was 2.33 dollars, with a median of 1.56 dollars. Among the group's top chronic disease priorities were asthma, diabetes, tobacco, cancer, and cardiovascular disease (CVD). Nearly half of the group's chronic disease spending was on tobacco. Chronic disease funding sources varied across localities, but direct federal funding was minimal. In 14 cities serving a combined 37 million people (13% of the US population), direct federal chronic disease funding totaled 8.7 million dollars, an average of 0.24 dollars per capita. The group described successful chronic disease interventions, particularly related to tobacco and asthma.

Budgets↗
PubMed2005

Methodologies for realizing the potential of health impact assessment.

Health impact assessment (HIA), a systematic assessment of potential health impacts of proposed public polices, programs, and projects, offers a means to advance population health by bringing public health research to bear on questions of public policy. The United States has been slow to adopt HIA, but considerable strides have been made in many other countries, and under the auspices of the World Health Organization and World Bank. Varied applications in these diverse milieu have given rise to diverse approaches to HIA-quantitative/analytic, participatory, and procedural-each with distinct disciplinary foundations, goals, and methodologies. Suitability of these approaches for different applications and their challenges are highlighted, along with areas in which methodologic work is most needed and most likely to advance the field from theory and infrequent application to more routine practice in the United States.

Community Health Planning↗
PubMed2005

Projected health impact of the Los Angeles City living wage ordinance.

STUDY OBJECTIVE: To estimate the relative health effects of the income and health insurance provisions of the Los Angeles City living wage ordinance. SETTING AND PARTICIPANTS: About 10 000 employees of city contractors are subject to the Los Angeles City living wage ordinance, which establishes an annually adjusted minimum wage (7.99 US dollars per hour in July 2002) and requires employers to contribute 1.25 US dollars per hour worked towards employees' health insurance, or, if health insurance is not provided, to add this amount to wages. DESIGN: As part of a comprehensive health impact assessment (HIA), we used estimates of the effects of health insurance and income on mortality from the published literature to construct a model to estimate and compare potential reductions in mortality attributable to the increases in wage and changes in health insurance status among workers covered by the Los Angeles City living wage ordinance. RESULTS: The model predicts that the ordinance currently reduces mortality by 1.4 deaths per year per 10,000 workers at a cost of 27.5 million US dollars per death prevented. If the ordinance were modified so that all uninsured workers received health insurance, mortality would be reduced by eight deaths per year per 10,000 workers at a cost of 3.4 million US dollars per death prevented. CONCLUSIONS: The health insurance provisions of the ordinance have the potential to benefit the health of covered workers far more cost effectively than the wage provisions of the ordinance. This analytical model can be adapted and used in other health impact assessments of related policy actions that might affect either income or access to health insurance in the affected population.

Cost-Benefit Analysis↗
PubMed2005

Impact of restaurant hygiene grade cards on foodborne-disease hospitalizations in Los Angeles County.

Although health departments routinely inspect restaurants to assess compliance with established hygienic standards, few data are available on the effectiveness of these efforts in preventing foodborne disease. The study reported here assessed the impact on foodborne-disease hospitalizations in Los Angeles County of a restaurant hygiene grading system that utilized publicly posted grade cards. The grading systm was introduced in January 1998. Hospital discharge data on foodborne-disease hospitalizations were analyzed for Los Angeles County and, as a control, for the rest of California during the period 1993-2000. Ordinary least-squares regression analysis was done to measure the effect of the grading progam on these hospitalizations. After baseline temporal and geographic trends were adjusted for, the restaurant hygiene grading program was associated with a 13.1 percent decrease (p < .01) in the number of foodborne-disease hospitalizations in Los Angeles County in the year following implementation the program (1998). This decrease was sustained over the next two years (1999-2000). The results suggest that restaurant hygiene grading with public posting of results is an effective intervention for reducing the burden of foodborne disease.

Bacterial Infections↗
PubMed2004

Physical inactivity and overweight among Los Angeles County adults.

OBJECTIVES: The present study examines sociodemographic, health status, health behavioral, and health-related self-perception correlates of physical inactivity in a large, multiethnic urban population. METHODS: A random-digit-dialed telephone survey of a representative sample of 8353 Los Angeles County adults aged >/= 18 years was conducted between September 17, 1999 and December 31, 2000. Data were analyzed to assess the prevalence and identify independent correlates of physical inactivity, defined as <10 minutes of continuous physical activity weekly ("sedentary"). RESULTS: Overall, the prevalence of sedentary adults was 41%. Lower educational attainment, female gender, advancing age, non-U.S. birthplace, poorer self-perceived health status, self-perceived depression, smoking, leisure-time television watching/computer use, and receiving a diabetes diagnosis were significantly related to sedentariness in both bivariate and multivariate analyses. CONCLUSIONS: Mental and physical health status were prominent correlates of sedentariness. Lower socioeconomic class was also associated with sedentary behavior. Further research is needed to understand the relationship between self-perceived overweight and sedentary behavior.

Adult↗
PubMed2004

The Los Angeles Lift Off: a sociocultural environmental change intervention to integrate physical activity into the workplace.

PURPOSE: To present the development and feasibility testing of a sociocultural environmental change intervention strategy aimed at integrating physical activity into workplace routine. DESIGN: Randomized, controlled, post-test only, intervention trial. Setting. Los Angeles County Department of Health Services' worksites. PARTICIPANTS: Four hundred forty-nine employees, predominantly sedentary, overweight, middle-aged women of color, distributed across 26 meetings. INTERVENTION: A single 10-min exercise break during work time involving moderate intensity, low-impact aerobic dance and calisthenic movements to music. MEASURES: Primary-level of participation, particularly among sedentary staff; secondary-self-perceived health status, satisfaction with current fitness level, and mood/affective state. RESULTS: More than 90% of meeting attendees participated in the exercises. Among completely sedentary individuals, intervention participants' self-perceived health status ratings were significantly lower than controls' (OR = 0.17; 95% CI = 0.05, 0.60; P = 0.0003). Among all respondents not regularly physically active, intervention participants' levels of satisfaction with fitness were more highly correlated with self-ranked physical activity stage of change (r = 0.588) than the control participants' (r = 0.376, z = -2.32, p = 0.02). Among the completely sedentary, control participants reported significantly higher levels of energy than did intervention participants (P < 0.01). CONCLUSIONS: Captive audiences may be engaged in brief bouts of exercise as a part of the workday, regardless of physical activity level or stage of change. This experience may also appropriately erode sedentary individuals' self-perception of good health and fitness, providing motivation for adoption of more active lifestyles.

Adolescent↗
PubMed2004

Developing and using the Guide to Community Preventive Services: lessons learned about evidence-based public health.

The Guide to Community Preventive Services (Community Guide) is being developed under the leadership of the independent, nonfederal Task Force on Community Preventive Services. The Task Force makes recommendations for the use of public health programs and policies based on scientific evidence about what practices have worked to improve health. The Community Guide thoroughly searches scientific literature for topic-relevant studies, evaluates their quality according to established criteria, and makes recommendations based on the overall strength of the body of evidence and the size and variability of reported effects. In addition, the Community Guide identifies promising interventions that have not been adequately researched, thus helping to inform the public health research agenda. The continuously updated and expanded body of recommendations and research agenda formulated by this rigorous process have been published on the Internet and in various publications since 1999 and constitute a highly valued and objective evidence-based resource for guiding current and future public health activities. More remains to be learned, however, on how best to disseminate Community Guide findings to key target audiences and encourage their use to inform practice, policy, and additional research.

Centers for Disease Control and Prevention, U.S.↗
PubMed2004

Prospects for health impact assessment in the United States: new and improved environmental impact assessment or something different?

Health impact assessment (HIA) has been advanced as a means of bringing potential health impacts to the attention of policy makers, particularly in sectors where health impacts may not otherwise be considered. This article examines lessons for HIA in the United States from the related and relatively well-developed field of environmental impact assessment (EIA). We reviewed the EIA literature and conducted twenty phone interviews with EIA professionals. Successes of EIA cited by respondents included integration of environmental goals into decision making, improved planning, and greater transparency and public involvement. Reported shortcomings included the length and complexity of EIA documents, limited and adversarial public participation, and an emphasis on procedure over substance. Presently, EIAs consider few, if any, health outcomes. Respondents differed on the prospects for HIA. Most agreed that HIA could contribute to EIA in several areas, including assessment of cumulative impacts and impacts to environmental justice. Reasons given for not incorporating HIA into EIA were uncertainties about interpreting estimated health impacts, that EIA documents would become even longer and more complicated, and that HIA would gain little from the procedural and legal emphasis in EIA. We conclude that for HIA to advance, whether as part of or separate from EIA, well-formulated methodologies need to be developed and tested in real-world situations. When possible, HIA should build on the methods that have been utilized successfully in EIA. The most fruitful avenue is demonstration projects that test, refine, and demonstrate different methods and models to maximize their utility and acceptance.

California↗
PubMed2003

Population-based interventions engaging communities of color in healthy eating and active living: a review.

INTRODUCTION: The U.S. obesity epidemic is escalating, particularly among communities of color. Obesity control efforts have shifted away from individual-level approaches toward population-based approaches that address socio-cultural, political, economic, and physical environmental factors. Few data exist for ethnic minority groups. This article reviews studies of population-based interventions targeting communities of color or including sufficient samples to permit ethnic-specific analyses. METHODS: Inclusion criteria were established, an electronic database search conducted, and non-electronically catalogued studies retrieved. Findings were aggregated for earlier (early 1970s to early 1990s) and later (mid-1990s to present) interventions. RESULTS: The search yielded 23 ethnically inclusive intervention studies published between January 1970 and May 2003. Several characteristics of inclusive interventions were consistent with characteristics of community-level interventions among predominantly white European-American samples: use of non-interpersonal channels for information dissemination directed at broad spheres of influence (e.g., mass media), promotion of physical activity, and incorporation of social marketing principles. Ethnically inclusive studies, however, also placed greater emphasis on involving communities and building coalitions from study inception; targeting captive audiences; mobilizing social networks; and tailoring culturally specific messages and messengers. Inclusive studies also focused more on community than individual norms. Later studies used "upstream" approaches more than earlier studies. Fewer than half of the inclusive studies presented outcome evaluation data. Statistically significant effects were few and modest, but several studies demonstrated better outcomes among ethnic minority than white participants sampled. CONCLUSION: The best data available speak more about how to engage and retain people of color in these interventions than about how to create and sustain weight loss, regular engagement in physical activity, or improved diet. Advocacy should be directed at increasing the visibility and budget priority of interventions, particularly at the state and local levels.

Diet↗
PubMed2003

Methods for conducting systematic reviews of the evidence of effectiveness and economic efficiency of interventions to promote healthy social environments.

The social and physical surroundings in which people live affect their health. Knowing what basic conditions and opportunities in communities advance or impede improvement of community health can inform public health practice and policy. This article describes the methods for conducting systematic literature reviews of three community interventions to promote healthy social environments: early childhood development programs, programs to promote affordable family housing in safe neighborhoods, and interventions to increase the cultural and linguistic competence of healthcare systems. Existing methods, established for conducting systematic reviews for the Guide to Community Preventive Services, were applied to these interventions to promote healthy social environments.

Evidence-Based Medicine↗
PubMed2003

The effectiveness of early childhood development programs. A systematic review.

Early childhood development is influenced by characteristics of the child, the family, and the broader social environment. Physical health, cognition, language, and social and emotional development underpin school readiness. Publicly funded, center-based, comprehensive early childhood development programs are a community resource that promotes the well-being of young children. Programs such as Head Start are designed to close the gap in readiness to learn between poor children and their more economically advantaged peers. Systematic reviews of the scientific literature demonstrate effectiveness of these programs in preventing developmental delay, as assessed by reductions in retention in grade and placement in special education.

Child↗
PubMed2003

Providing affordable family housing and reducing residential segregation by income. A systematic review.

The inadequate supply of affordable housing for low-income families and the increasing spatial segregation of some households by income, race, ethnicity, or social class into unsafe neighborhoods are among the most prevalent community health concerns related to family housing. When affordable housing is not available to low-income households, family resources needed for food, medical or dental care, and other necessities are diverted to housing costs. Two housing programs intended to provide affordable housing and, concurrently, reduce the residential segregation of low-income families into unsafe neighborhoods of concentrated poverty, are reviewed: the creation of mixed-income housing developments and the Department of Housing and Urban Development (HUD) Section 8 Rental Voucher Program. The effectiveness of mixed-income housing developments could not be ascertained by this systematic review because of a lack of comparative research. Scientific evidence was sufficient to conclude that rental voucher programs improve household safety as measured by reduced exposure to crimes against person and property and decreased neighborhood social disorder. Effectiveness of rental voucher programs on youth health risk behaviors, mental health status, and physical health status could not be determined because too few studies of adequate design and execution reported these outcomes.

Family↗
PubMed2003

Culturally competent healthcare systems. A systematic review.

Culturally competent healthcare systems-those that provide culturally and linguistically appropriate services-have the potential to reduce racial and ethnic health disparities. When clients do not understand what their healthcare providers are telling them, and providers either do not speak the client's language or are insensitive to cultural differences, the quality of health care can be compromised. We reviewed five interventions to improve cultural competence in healthcare systems-programs to recruit and retain staff members who reflect the cultural diversity of the community served, use of interpreter services or bilingual providers for clients with limited English proficiency, cultural competency training for healthcare providers, use of linguistically and culturally appropriate health education materials, and culturally specific healthcare settings. We could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment.

Communication Barriers↗