Obesity rates in the U.S. are associated with area-level, food-related characteristics. Studies have previously examined the role of structural racism (policies/practices that advantaged White Americans and deprived other racial/ethnic minority groups), but racial inequalities in socioeconomic status (SES) is a novel indicator. The aim of this study is to determine the associations between racial inequalities in SES with obesity and obesogenic environments. Data from 2007–2014 County Health Rankings and 2012–2016 County Business Patterns were combined to assess the associations between relative SES comparing Blacks to Whites with obesity, and number of grocery stores and fast food restaurants in U.S. counties. Random effects linear and Poisson regressions were used and stratified by county racial composition. Racial inequality in poverty, unemployment, and homeownership were associated with higher obesity rates. Racial inequality in median income, college graduates, and unemployment were associated with fewer grocery stores and more fast food restaurants. Associations varied by county racial composition. The results demonstrate that a novel indicator of structural racism on the county-level is associated with obesity and obesogenic environments. Associations vary by SES measure and county racial composition, suggesting the ability for targeted interventions to improve obesogenic environments and policies to eliminate racial inequalities in SES.
T he US population has become increasingly diverse; during 1965-2015, the proportion of non-Hispanic whites decreased from 84% to 62%, concurrent with a population increase among Hispanics and Asians. According to the US Census Bureau, in 2017, 50% of children younger than 5 years belonged to racial or ethnic minority groups; by 2044, minority groups-that is, African Americans, Asians and Pacific Islanders, Hispanic/Latinos, American Indians, and Alaskan natives, and individuals who are 2 or more races-are estimated to constitute 50% of the US population. 1 Although health indicators, including life expectancy and infant mortality, have improved for most Americans, disparities in health and health care exist, with minority groups being at disproportionate risk of experiencing worse health outcomes from preventable and treatable conditions. 2 A diverse public health workforce is better equipped to address public health disparities than a nondiverse workforce and therefore to implement population-based approaches aimed to improve health in communities. 3 However, the public health workforce is not representative of the population it serves. Overall, only 42% of the governmental public health workforce is people of color. 1,4
Objective The aim of the present study was to describe the research activities being undertaken by health service employees within one Australian health service and explore their experiences with undertaking research. Methods The present mixed-methods study was conducted across one health service in Queensland, Australia, and included a cross-sectional online survey and interviews with healthcare service employees. The anonymous survey was a self-administered online questionnaire, distributed to all 6121 employees at the health service via email, asking about research activity and engagement. Willing participants were also interviewed on their perceptions and experiences with research and capacity building. Results In all, 151 participants responded to the survey and 22 participated in interviews. Three-quarters of respondents reported actively participating in research over the past 6 years and several research outputs, such as publications, conference presentations and competitive grant funding, were displayed. Four concepts emerged from interview findings, namely collaborative partnerships, skilled mentorship, embedding research and organisational support, which represented the overall theme 'opportunities for a research-infused health service'. Conclusion Employees of the health service recognised the importance of research and had a range of research skills, knowledge and experience. They also identified several opportunities for building research capacity in this service. What is known about the topic? Building research capacity among healthcare professionals is important for enabling the conduct of high-quality research in healthcare institutions. However, building research capacity is complex and influenced by the uniqueness of organisational context. In order to successfully build research capacity among employees at any health service, current research activity, skills and experience, as well as staff perceptions around building research capacity in that setting, should first be explored. What does this paper add? Healthcare services should incorporate teaching and research with clinical care to optimise outcomes for consumers. Support for research can be diminished in favour of clinical care and reduced emphasis on the importance of research can negatively influence research activity and expansion of clinician-led research. Highlighting the perceptions and experience of clinicians with enabling research and capacity building is a context-specific but necessary process to ensure that strategies, processes and resources are targeted to maintain support for research activity while overcoming barriers. What are the implications for practitioners? Participants in this study identified several ways to build research capacity in their health service, many of which may be applicable to other settings and contexts. Building research collaborations and academic partnerships are important to enable and drive research. Structural processes, such as organisational support and opportunities for skilled mentorship, m...
In the United States, the American Indian and Alaska Native (AI/AN) population has the highest motor vehicle death rate, which is significantly greater than that of any other race or ethnic group. To better understand why this significant disparity exists and how to eliminate it, the authors conducted a systematic review of the published scientific literature. Included studies were published between January 1, 1990, and January 31, 2011, and identified risk factors, or implemented and tested interventions, targeting motor vehicle deaths among the AI/AN population. Only 14 papers met the study's inclusion criteria. Most of the epidemiologic studies explored alcohol use as a risk factor for deaths of both motor vehicle occupants and pedestrians; few studies addressed risk factors specifically for pedestrians. All of the intervention studies focused on mitigating risks for motor vehicle occupants. On the basis of the authors' review, injury prevention interventions that are multifaceted and involve partnerships to change policy, the environment, and individual behavior can effectively mitigate motor-vehicle-related deaths among AI/ANs. Priority should be given to implementing interventions that address pedestrian safety and to sound investment in the states with the highest AI/AN motor vehicle death rates because reducing their burden can dramatically reduce the overall disparity.
We have presented empirical findings on criteria used in state health agency budgetary decision-making. These criteria suggested a focus and interest on core public health and the largest public health problems with the most serious ramifications.
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