First name
Senbagam
Last name
Virudachalam

Title

Association of Neighborhood Social Context and Perceived Stress Among Mothers of Young Children.

Year of Publication

2022

Number of Pages

1414-1421

Date Published

12/2022

ISSN Number

1876-2867

Abstract

BACKGROUND: Chronic parental stress may negatively impact health among both parents and children. Adverse neighborhood social conditions like crime may increase stress while a supportive neighborhood may buffer stress and promote well-being. Our objective was to examine associations between neighborhood social factors and stress among mothers of young children.

METHODS: We surveyed 300 mothers/female caregivers of Medicaid-enrolled 2 to 4-year-old children in Philadelphia. Maternal stress was measured via the 10-item Perceived Stress Scale (range 0-40). Mothers' perceived neighborhood safety and collective efficacy were assessed using validated scales. Addresses were geocoded to link census tract-level violent crime rates. We used multivariable linear regression to examine associations of neighborhood safety, collective efficacy, and crime with maternal stress, adjusted for demographics, household socioeconomic status, and neighborhood poverty.

RESULTS: Among mothers (mean age 31, 60% Black/African American), higher perceived neighborhood safety and collective efficacy were associated with lower stress scores after adjustment for covariates. Each 1-point increase (on a 5-point scale) in perceived neighborhood safety was associated with a 2.30-point decrease in maternal stress (95% CI: -3.07, -1.53). Similarly, each 1-point increase in perceived collective efficacy was associated with a 3.08-point decrease in maternal stress (95% CI: -4.13, -2.02). Police-recorded violent crime rates were not associated with maternal stress.

CONCLUSION: Mothers of young children who perceive their neighborhood social environment more favorably report less stress compared to those who feel their neighborhood environment is less safe and cohesive. Future work is warranted to investigate whether interventions that increase perceived neighborhood safety and collective efficacy reduce stress.

DOI

10.1016/j.acap.2022.03.013

Alternate Title

Acad Pediatr

PMID

35346861

Title

Experiences with Pandemic Food Access Among Clinic-Based Community Supported Agriculture Program Participants.

Year of Publication

2022

Number of Pages

1-10

Date Published

12/2022

ISSN Number

1573-6628

Abstract

OBJECTIVES: The COVID-19 pandemic intensified food insecurity (FI) across the country, and families with children were disproportionately affected. This study explores experiences with FI and social resources during the pandemic among families participating in a free, clinic-based community supported agriculture (CSA) program.

METHODS: Free weekly boxes of organic produce from local farms were distributed to pediatric caregivers for 12 weeks at two pediatric outpatient centers associated with a children's hospital in a low-income, urban area. Demographics and a two-question FI screen were collected. Caregivers were purposively selected to participate in semi-structured interviews about experiences with FI and community or federal nutrition programs during the pandemic. Interviews were recorded and transcribed. Content analysis with constant comparison was used to code interviews inductively and identify emerging themes.

RESULTS: The 31 interviewees were predominantly female; more than half were Black, FI, and SNAP beneficiaries. Study participants were more likely to have repeat participation in the CSA program. Interviews elucidated four major themes of barriers to food access during the pandemic: (1) fluctuations in price, availability, and quality of food; (2) financial strain; (3) faster consumption with all family members home; (4) shopping challenges: infection fears, store closures, childcare. SNAP, WIC, and school meal programs were generally facilitators to food access. Increased SNAP allotments were particularly useful, and delays of mailed WIC benefits were challenging.

CONCLUSIONS FOR PRACTICE: This qualitative study describes facilitators and barriers to food access among clinic-based CSA program participants during the pandemic. The findings highlight areas for further exploration and potential policy intervention.

DOI

10.1007/s10995-022-03580-6

Alternate Title

Matern Child Health J

PMID

36581733

Title

Experiences with Pandemic Food Access Among Clinic-Based Community Supported Agriculture Program Participants.

Year of Publication

2022

Number of Pages

1-10

Date Published

12/2022

ISSN Number

1573-6628

Abstract

OBJECTIVES: The COVID-19 pandemic intensified food insecurity (FI) across the country, and families with children were disproportionately affected. This study explores experiences with FI and social resources during the pandemic among families participating in a free, clinic-based community supported agriculture (CSA) program.

METHODS: Free weekly boxes of organic produce from local farms were distributed to pediatric caregivers for 12 weeks at two pediatric outpatient centers associated with a children's hospital in a low-income, urban area. Demographics and a two-question FI screen were collected. Caregivers were purposively selected to participate in semi-structured interviews about experiences with FI and community or federal nutrition programs during the pandemic. Interviews were recorded and transcribed. Content analysis with constant comparison was used to code interviews inductively and identify emerging themes.

RESULTS: The 31 interviewees were predominantly female; more than half were Black, FI, and SNAP beneficiaries. Study participants were more likely to have repeat participation in the CSA program. Interviews elucidated four major themes of barriers to food access during the pandemic: (1) fluctuations in price, availability, and quality of food; (2) financial strain; (3) faster consumption with all family members home; (4) shopping challenges: infection fears, store closures, childcare. SNAP, WIC, and school meal programs were generally facilitators to food access. Increased SNAP allotments were particularly useful, and delays of mailed WIC benefits were challenging.

CONCLUSIONS FOR PRACTICE: This qualitative study describes facilitators and barriers to food access among clinic-based CSA program participants during the pandemic. The findings highlight areas for further exploration and potential policy intervention.

DOI

10.1007/s10995-022-03580-6

Alternate Title

Matern Child Health J

PMID

36581733

Title

Association of Neighborhood Social Context and Perceived Stress Among Mothers of Young Children.

Year of Publication

2022

Number of Pages

1414-1421

Date Published

12/2022

ISSN Number

1876-2867

Abstract

BACKGROUND: Chronic parental stress may negatively impact health among both parents and children. Adverse neighborhood social conditions like crime may increase stress while a supportive neighborhood may buffer stress and promote well-being. Our objective was to examine associations between neighborhood social factors and stress among mothers of young children.

METHODS: We surveyed 300 mothers/female caregivers of Medicaid-enrolled 2 to 4-year-old children in Philadelphia. Maternal stress was measured via the 10-item Perceived Stress Scale (range 0-40). Mothers' perceived neighborhood safety and collective efficacy were assessed using validated scales. Addresses were geocoded to link census tract-level violent crime rates. We used multivariable linear regression to examine associations of neighborhood safety, collective efficacy, and crime with maternal stress, adjusted for demographics, household socioeconomic status, and neighborhood poverty.

RESULTS: Among mothers (mean age 31, 60% Black/African American), higher perceived neighborhood safety and collective efficacy were associated with lower stress scores after adjustment for covariates. Each 1-point increase (on a 5-point scale) in perceived neighborhood safety was associated with a 2.30-point decrease in maternal stress (95% CI: -3.07, -1.53). Similarly, each 1-point increase in perceived collective efficacy was associated with a 3.08-point decrease in maternal stress (95% CI: -4.13, -2.02). Police-recorded violent crime rates were not associated with maternal stress.

CONCLUSION: Mothers of young children who perceive their neighborhood social environment more favorably report less stress compared to those who feel their neighborhood environment is less safe and cohesive. Future work is warranted to investigate whether interventions that increase perceived neighborhood safety and collective efficacy reduce stress.

DOI

10.1016/j.acap.2022.03.013

Alternate Title

Acad Pediatr

PMID

35346861
Gruver, R. S., Virudachalam, S., Gerdes, M., Shults, J., Suh, A., Bishop, C. T., et al. (2014). Early Childhood Obesity Prevention: Comparing Mothers’ and Clinicians’ Priorities. Pediatric Academic Societies Meeting. Presented at the. (Original work published 05/2014 C.E.)

Title

Association of Neighborhood Social Context and Perceived Stress among Mothers of Young Children.

Year of Publication

2022

Date Published

2022 Mar 25

ISSN Number

1876-2867

Abstract

<p><strong>BACKGROUND: </strong>Chronic parental stress may negatively impact health among both parents and children. Adverse neighborhood social conditions like crime may increase stress while a supportive neighborhood may buffer stress and promote well-being. Our objective was to examine associations between neighborhood social factors and stress among mothers of young children.</p>

<p><strong>METHODS: </strong>We surveyed 300 mothers/female caregivers of Medicaid-enrolled 2-4-year-old children in Philadelphia. Maternal stress was measured via the 10-item Perceived Stress Scale (range 0-40). Mothers' perceived neighborhood safety and collective efficacy were assessed using validated scales. Addresses were geocoded to link census tract-level violent crime rates. We used multivariable linear regression to examine associations of neighborhood safety, collective efficacy, and crime with maternal stress, adjusted for demographics, household socioeconomic status, and neighborhood poverty.</p>

<p><strong>RESULTS: </strong>Among mothers (mean age 31, 60% Black/African American), higher perceived neighborhood safety and collective efficacy were associated with lower stress scores after adjustment for covariates. Each 1-point increase (on a 5-point scale) in perceived neighborhood safety was associated with a 2.30-point decrease in maternal stress (95% CI: -3.07, -1.53). Similarly, each 1-point increase in perceived collective efficacy was associated with a 3.08-point decrease in maternal stress (95% CI: -4.13, -2.02). Police-recorded violent crime rates were not associated with maternal stress.</p>

<p><strong>CONCLUSION: </strong>Mothers of young children who perceive their neighborhood social environment more favorably report less stress compared to those who feel their neighborhood environment is less safe and cohesive. Future work is warranted to investigate whether interventions that increase perceived neighborhood safety and collective efficacy reduce stress.</p>

DOI

10.1016/j.acap.2022.03.013

Alternate Title

Acad Pediatr

PMID

35346861

Title

Association of a Sweetened Beverage Tax With Soda Consumption in High School Students.

Year of Publication

2021

Date Published

2021 Oct 18

ISSN Number

2168-6211

Abstract

<p><strong>Importance: </strong>Sweetened beverage taxes are one policy approach to reduce intake of added sugars. Soda is the leading source of added sugars in the US diet, but few studies have examined how such taxes influence sweetened beverage intake in youth.</p>

<p><strong>Objective: </strong>To estimate the association between the Philadelphia, Pennsylvania, beverage tax and adolescent soda intake.</p>

<p><strong>Design, Setting, and Participants: </strong>This economic evaluation of school district-level Youth Risk Behavior Surveillance System data from September 2013 to December 2019 compared weekly soda intake in high school students in Philadelphia, a city with a sweetened beverage tax, with that in 7 comparison cities without beverage taxes. Difference-in-differences regression modeling was used to estimate change in soda intake in Philadelphia compared with control cities. Secondary analyses compared 100% juice and milk intake to explore potential substitution associations. Subgroup analyses evaluated differences by race and ethnicity and weight status (obesity and overweight or obesity). Analyses were performed between August 20 and October 20, 2020. School districts that had weighted data and a survey question on weekly soda intake from 2013 to 2019 were included. The study included high school students, grades 9 to 12, in school districts participating in the Youth Risk Behavior Surveillance System from 2013 to 2019.</p>

<p><strong>Exposures: </strong>Implementation of a sweetened beverage tax in Philadelphia, Pennsylvania, in January 2017.</p>

<p><strong>Main Outcomes and Measures: </strong>Reported weekly servings of soda, 100% juice, and milk.</p>

<p><strong>Results: </strong>A total of 86 928 participants (weighted mean [SD] age, 15.8 [1.3] years; 49% female) from 8 US cities (including Philadelphia) were included. Before the tax, adolescents in the 7 comparison cities had a mean intake of 4 servings of soda per week compared with 5.4 servings per week in Philadelphia. Philadelphia's tax was associated with a reduction of 0.81 servings of soda per week (95% CI, -1.48 to -0.14 servings; P = .02) 2 years after tax implementation. There was no significant difference in 100% juice or milk intake, although Philadelphia adolescents consumed more juice than those in nontaxed cities. In subgroup analyses, the tax was associated with a reduction of 1.13 servings per week in Hispanic/Latinx adolescents (95% CI, -2.04 to -0.23 servings; P = .01) and 1.2 servings per week in adolescents with obesity (95% CI, -2.33 to -0.13 servings; P = .03).</p>

<p><strong>Conclusions and Relevance: </strong>This economic evaluation found that a sweetened beverage tax was associated with a reduction in soda intake among adolescents, providing evidence that such taxes can improve dietary behaviors.</p>

DOI

10.1001/jamapediatrics.2021.3991

Alternate Title

JAMA Pediatr

PMID

34661612

Title

Associations of Neighborhood Safety and Collective Efficacy with Dietary Intake among Preschool-Aged Children and Mothers.

Year of Publication

2021

Date Published

2021 Oct 05

ISSN Number

2153-2176

Abstract

<p>Positive neighborhood environments may promote healthier behaviors, yet few studies have examined associations between neighborhood social environment and diet. We examined associations of neighborhood perceived safety, collective efficacy, and violent crime with dietary intake among preschool-aged children and their mothers. We administered a cross-sectional survey to 300 mothers/female caregivers of Medicaid-enrolled 2- to 4-year-old children in Philadelphia. Mothers reported their own and their child's dietary intake using the validated Dietary Screener Questionnaire. Mixed-effects linear regression models assessed associations of perceived neighborhood safety, collective efficacy, and census tract-level violent crime with parent and child dietary intake, adjusted for individual, family, and neighborhood covariates. Among mothers, higher perceived neighborhood safety and collective efficacy were associated with higher daily intake of fruits/vegetables (β = 0.35 cups, 95% CI: 0.12-0.58 and β = 0.30 cups, 95% CI: 0.08-0.52, comparing the highest with lowest tertile). Higher neighborhood-perceived safety was also associated with higher whole-grain intake among mothers (β = 0.14 ounces, 95% CI: 0.02-0.27) and children (β = 0.07 ounces, 95% CI: 0.01-0.13, comparing the highest with lowest tertile). Neighborhood social exposures were not associated with intake of added sugars or sugar-sweetened beverages for mothers or children, nor were lower levels of violent crime associated with any outcome. More favorable perceptions of neighborhood safety and collective efficacy were associated with a slightly higher consumption of some healthy foods among mothers and their young children. Future prospective research is needed to confirm these findings, explore potential mechanisms, and determine whether intervening on the social environment improves diet.</p>

DOI

10.1089/chi.2021.0144

Alternate Title

Child Obes

PMID

34613834

Title

Neighborhood environments and sleep among children and adolescents: A systematic review.

Year of Publication

2021

Number of Pages

101465

Date Published

2021 Mar 17

ISSN Number

1532-2955

Abstract

<p>Understanding salient environmental determinants of pediatric sleep is essential for informing interventions and public health initiatives. Emerging evidence suggests that the neighborhood environment can impact pediatric sleep, but this evidence has not yet been systematically reviewed. We conducted a systematic review of the scientific literature on associations between neighborhood environments and sleep in young children (0-5 y), school-aged children (6-12 y) and adolescents (13-18 y). We reviewed 85 articles published between 2003 and 2020. The most commonly examined neighborhood exposure was low socioeconomic status (40 studies), which was associated with sleep outcomes in 58% of studies (primarily shorter sleep duration, later sleep timing, or obstructive sleep apnea). Evidence was stronger for neighborhood safety/crime/violence (21 studies), with 86% of studies reporting associations with sleep outcomes (primarily self- or caregiver-reported sleep problems). Fewer studies examined associations of neighborhood physical environment exposures, including noise (15 studies), the built environment (seven studies), and air pollution (six studies). Limitations of the current body of evidence include 1) limited examination of neighborhood exposures other than socioeconomic status or safety, 2) use of primarily cross-sectional observational study designs, 3) lack of objective sleep outcome assessment, and 4) limits of current exposure assessment methods.</p>

DOI

10.1016/j.smrv.2021.101465

Alternate Title

Sleep Med Rev

PMID

33827031

Title

A Culinary Medicine Elective for Clinically Experienced Medical Students: A Pilot Study.

Year of Publication

2020

Date Published

2020 Jun 12

ISSN Number

1557-7708

Abstract

<p>Culinary medicine, a combination of nutrition science and the culinary arts, is an emerging approach for teaching nutrition to medical students and improving their competence in counseling patients with diet-associated diseases. Data are, however, lacking on the impact of culinary medicine courses directed at clinically experienced students. This study reports initial outcomes of a pilot nutrition and culinary medicine course targeting 4th-year medical students. An elective course on culinary medicine was offered to 4th-year medical students at the Perelman School of Medicine, comprising seven disease-focused sessions, with a final capstone session. Students read primary literature for each session. Individual sessions consisted of culinary literacy, cooking, and a case discussion led by physicians and registered dietitians. In addition, students participated in a nutrition education initiative in a local high school. Students completed pre-and postcourse surveys that evaluated perceived nutrition knowledge and counseling skills and personal dietary choices, and included free-text options for qualitative comments. Thirty-one 4th-year medical students participated in three offerings of the course in 2018 and 2019. There was strong student enthusiasm for the course as (1) all the available slots for each course offering were filled within 2 h of an e-mail announcement to the students; (2) student attendance was consistently very high; and (3) student feedback about the course was uniformly positive. Students reported significant increases in their confidence regarding (1) knowledge of pertinent nutrition information; (2) discussing nutrition with patients; and (3) ability to impact patient behavior through counseling ( &lt; 0.001). Qualitative comments suggested that students were contemplating or implementing changes in their dietary habits and food choices. A culinary medicine course for clinically experienced medical students may improve perceived nutrition knowledge and increases confidence in counseling patients with diet-associated diseases.</p>

DOI

10.1089/acm.2020.0063

Alternate Title

J Altern Complement Med

PMID

32543207

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