Article Database

Innovative Strategies to Improve Diabetes Outcomes in Disadvantaged Populations

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Diabetes disproportionately affects disadvantaged populations. Eighty percent of deaths directly caused by diabetes occurred in low‐ and middle‐income countries. In high‐income countries, there are marked disparities in diabetes control among racial/ethnic minorities and those with low socio‐economic status. Innovative, effective and cost‐effective strategies are needed to improve diabetes outcomes in these populations. Technological advances, peer educators and community health workers have expanded methodologies to reach, educate and monitor individuals with diabetes. In the present manuscript we review the outcomes of these strategies, and describe the barriers to and facilitators of these approaches for improving diabetes outcomes.

Understanding Pregnancy and Postpartum Health Using Ecological Momentary Assessment and Mobile Technology: Protocol for the Postpartum Mothers Mobile Study

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Background: There are significant racial disparities in pregnancy and postpartum health outcomes, including postpartum weight retention and cardiometabolic risk. These racial disparities are a result of a complex interplay between contextual, environmental, behavioral, and psychosocial factors.

Objective: This protocol provides a description of the development and infrastructure for the Postpartum Mothers Mobile Study (PMOMS), designed to better capture women’s daily experiences and exposures from late pregnancy through 1 year postpartum. The primary aims of PMOMS are to understand the contextual, psychosocial, and behavioral factors contributing to racial disparities in postpartum weight and cardiometabolic health, with a focus on the daily experiences of stress and racism, as well as contextual forms of stress (eg, neighborhood stress and structural racism).

Methods: PMOMS is a longitudinal observation study that is ancillary to an existing randomized control trial, GDM² (Comparison of Two Screening Strategies for Gestational Diabetes). PMOMS uses an efficient and cost-effective approach for recruitment by leveraging the infrastructure of GDM², facilitating enrollment of participants while consolidating staff support from both studies. The primary data collection method is ecological momentary assessment (EMA) and through smart technology (ie, smartphones and scales). The development of the study includes: (1) the pilot phase and development of the smartphone app; (2) feedback and further development of the app including selection of key measures; and (3) implementation, recruitment, and retention.

Results: PMOMS aims to recruit 350 participants during pregnancy, to be followed through the first year after delivery. Recruitment and data collection started in December 2017 and are expected to continue through September 2020. Initial results are expected in December 2020. As of early May 2019, PMOMS recruited a total of 305 participants. Key strengths and features of PMOMS have included data collection via smartphone technology to reduce the burden of multiple on-site visits, low attrition rate because of participation in an ongoing trial in which women are already motivated and enrolled, high EMA survey completion and the use of EMA as a unique data collection method to understand daily experiences, and shorter than expected timeframe for enrollment because of the infrastructure of the GDM² trial.

Conclusions: This protocol outlines the development of the PMOMS, one of the first published studies to use an ongoing EMA and mobile technology protocol during pregnancy and throughout 1 year postpartum to understand the health of childbearing populations and enduring racial disparities in postpartum weight and cardiometabolic health. Our findings will contribute to the improvement of data collection methods, particularly the role of EMA in capturing multiple exposures and knowledge in real time. Furthermore, the results of the study will inform future studies investigating weight and cardiometabolic health during pregnancy and the postpartum period, including how social determinants produce population disparities in these outcomes.

International registered report identifier (irrid): DERR1-10.2196/13569.

Evaluation of a Mobile Farmer’s Market Aimed at Increasing Fruit and Vegetable Consumption in Food Deserts: A Pilot Study to Determine Evaluation Feasibility

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Purpose: In November 2015, Greater Pittsburgh Community Food Bank implemented a pilot phase of the Green Grocer mobile market, a program aimed at improving access to locally sourced fresh foods in low-resource neighborhoods. We conducted an evaluation of this pilot phase. Methods: We conducted baseline surveys of residents in six neighborhoods that received Green Grocer in the pilot phase to understand the food environment, including perceptions of fresh food availability, and another survey of Green Grocer consumers to evaluate their experiences and satisfaction. We measured respondent intake of fruit and vegetable in the terms of days per week and servings per day. We used Poisson regression with cluster-robust standard errors to model the average change in produce consumption pre-post intervention. Results: Residents of select communities observed meaningful improvements in intake. After covariate adjustment, Homewood residents observed an average 13% increase in vegetable intake (days/week) rates post-Green Grocer (p=0.04). Clairton residents also showed marked increases, with an average 20% increase in vegetable intake (servings/day) (p=0.049). After 6 months, declines in produce purchase from discount stores and supercenters were observed alongside increases in procurement from Green Grocer, farmer’s markets, gardens, and other sources. Conclusion: Our preliminary work provides support that this mobile market serving under-resourced areas was valued by consumers and showed increases in vegetable consumption in several neighborhoods. When scaled-up, this program had the potential to reduce geographically-based food and health disparities.

Experiences of Community Doulas Working with Low-Income, African American Mothers

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Purpose: The aim of this study was to learn from doulas the components of their services that might best serve low-income, African American (AA) women and to show the significance of doulas in helping these women have healthy, positive, birth experiences. Methods: Ten doulas were recruited from a local community doula program and through word-of-mouth referrals from participants and completed in-depth interviews. Interviews were transcribed verbatim and analyzed using Atlas.ti software to identify emerging themes. Thematic saturation was achieved in interviews. Results: Several themes emerged from the interviews including: (1) The influence of similarities of race, culture, and lived experience on doula care; (2) How doulas often provide birthing persons with support and resources beyond birth; and (3) How doulas recognize the institutional biases that exist in the health care system and try to mediate their effect on birthing persons. Conclusions: These themes highlight how doulas can support birthing persons to mitigate the negative effects of social determinants of health, specifically racism and classism, and highlight potential avenues for doulas to consider when working with birthing persons who have low income and are AA.

The Cities Left Behind

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The future of the suburbs cannot be considered in isolation from the future of the central cities, many of whose problems — economic decline, poverty and racial segregation — stem from the very process of suburbanization itself.

The Impact of Corporate Tourism on Gullah Blacks: Notes on Issues of Employment

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K. 2001 Focus Groups in Social Research

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Model Cities Revisited: Issues of Race and Empowerment

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Social Equity in Redevelopment and Housing: United States and Korea

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Although the two countries of the United States and South Korea are different in many ways, they have had some parallel experiences with urban redevelopment. Both have created policies designed to re-form previous problems in such areas as forced relocation and lack of provision of low-income housing. This article reviews the parallel history of each concerning urban redevelopment, describing several key programs. The authors suggest that in four areas—lack of oppressive practices, just compensation, decision making, and “fairness”—each nation still has many challenges, since reforms have had limited effectiveness.

Targeting Strategies of Three Detroit CDCs

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