Center for Urban Health Policy and Research

Philadelphia, PA, United States

Center for Urban Health Policy and Research

Philadelphia, PA, United States
SEARCH FILTERS
Time filter
Source Type

Kumanyika S.,University of Pennsylvania | Fassbender J.,University of Pennsylvania | Phipps E.,Center for Urban Health Policy and Research | Tan-Torres S.,Independence Blue Cross | And 9 more authors.
Contemporary Clinical Trials | Year: 2011

Primary care offices are critical access points for obesity treatment, but evidence for approaches that can be implemented within these settings is limited. The Think Health! (¡Vive Saludable!) Study was designed to assess the feasibility and effectiveness of a behavioral weight loss program, adapted from the Diabetes Prevention Program, for implementation in routine primary care. Recruitment of clinical sites targeted primary care practices serving African American and Hispanic adults. The randomized design compares (a) a moderate-intensity treatment consisting of primary care provider counseling plus additional counseling by an auxiliary staff member (i.e., lifestyle coach), with (b) a low-intensity, control treatment involving primary care provider counseling only. Treatment and follow up duration are 1 to 2years. The primary outcome is weight change from baseline at 1 and 2years post-randomization. Between November 2006 and January 2008, 14 primary care providers (13 physicians; 1 physician assistant) were recruited at five clinical sites. Patients were recruited between October 2007 and November 2008. A total of 412 patients were pre-screened, of whom 284 (68.9%) had baseline assessments and 261 were randomized, with the following characteristics: 65% African American; 16% Hispanic American; 84% female; mean (SD) age of 47.2 (11.7) years; mean (SD) BMI of 37.2(6.4) kg/m2; 43.7% with high blood pressure; and 18.4% with diabetes. This study will provide insights into the potential utility of moderate-intensity lifestyle counseling delivered by motivated primary care clinicians and their staff. The study will have particular relevance to African Americans and women. © 2010 Elsevier Inc.


Phipps E.J.,Center for Urban Health Policy and Research | Braitman L.E.,Office of Research and Technology | Stites S.D.,Center for Urban Health Policy and Research | Singletary S.B.,Center for Urban Health Policy and Research | And 5 more authors.
American Journal of Public Health | Year: 2015

Objectives: We assessed the impact of a rewards-based incentive program on fruit and vegetable purchases by low-income families. Methods: We conducted a 4-phase prospective cohort study with randomized intervention and wait-listed control groups in Philadelphia, Pennsylvania, in December 2010 through October 2011. The intervention provided a rebate of 50% of the dollar amount spent on fresh or frozen fruit and vegetables, reduced to 25% during a tapering phase, then eliminated. Primary outcome measures were number of servings of fruit and of vegetables purchased per week. Results: Households assigned to the intervention purchased an average of 8 (95% confidence interval [CI] = 1.5, 16.9) more servings of vegetables and 2.5 (95% CI = 0.3, 9.5) more servings of fruit per week than did control households. In longitudinal price-adjusted analyses, when the incentive was reduced and then discontinued, the amounts purchased were similar to baseline. Conclusions: Investigation of the financial costs and potential benefits of incentive programs to supermarkets, government agencies, and other stakeholders is needed to identify sustainable interventions.


Kumanyika S.K.,University of Pennsylvania | Fassbender J.E.,University of Pennsylvania | Fassbender J.E.,Children's Hospital of Philadelphia | Sarwer D.B.,University of Pennsylvania | And 15 more authors.
Obesity | Year: 2012

The Think Health study evaluated a behavioral weight loss program adapted from the Diabetes Prevention Program (DPP) lifestyle intervention to assist primary care providers (PCPs) and auxiliary staff acting as lifestyle coaches (LCs) in offering weight loss counseling to their patients. In a randomized trial conducted at five clinical sites, study participants were randomly assigned in a 1:1 ratio within each site to either Basic Plus (n = 137), which offered PCP counseling every 4 months plus monthly LC visits during the first year of treatment, or Basic (n = 124), which offered only PCP counseling every 4 months. Participants were primarily (84%) female, 65% African American, 16% Hispanic American, and 19% white. In the 72% of participants in each treatment group with a 12-month weight measurement, mean (95% CI) 1-year weight changes (kg) were 1.61 (2.68, 0.53) in Basic Plus and 0.62 (1.45, 0.20) in Basic (difference: 0.98 (0.36, 2.33); P = 0.15). Results were similar in model-based estimates using all available weight data for randomized participants, adjusting for potential confounders. More Basic Plus (22.5%) than Basic (10.2%) participants lost ≥5% of their baseline weight (P = 0.022). In a descriptive, nonrandomized analysis that also considered incomplete visit attendance, mean weight change was 3.3 kg in Basic Plus participants who attended ≥5 LC visits vs. 0.53 kg in those attending <5 LC visits. We conclude that the Basic Plus approach of moderate-intensity counseling by PCPs and their staff can facilitate modest weight loss, with clinically significant weight loss in high program attenders. © 2011 The Obesity Society.


PubMed | Arcadia University, University of Pennsylvania and Center for Urban Health Policy and Research
Type: | Journal: Preventing chronic disease | Year: 2014

The obesity epidemic has drawn attention to food marketing practices that may increase the likelihood of caloric overconsumption and weight gain. We explored the associations of discounted prices on supermarket purchases of selected high-calorie foods (HCF) and more healthful, low-calorie foods (LCF) by a demographic group at high risk of obesity.Our mixed methods design used electronic supermarket purchase data from 82 low-income (primarily African American female) shoppers for households with children and qualitative data from focus groups with demographically similar shoppers.In analyses of 6,493 food purchase transactions over 65 weeks, the odds of buying foods on sale versus at full price were higher for grain-based snacks, sweet snacks, and sugar-sweetened beverages (odds ratios: 6.6, 5.9, and 2.6, respectively; all P < .001) but not for savory snacks. The odds of buying foods on sale versus full price were not higher for any of any of the LCF (P .07). Without controlling for quantities purchased, we found that spending increased as percentage saved from the full price increased for all HCF and for fruits and vegetables (P .002). Focus group participants emphasized the lure of sale items and took advantage of sales to stock up.Strategies that shift supermarket sales promotions from price reductions for HCF to price reductions for LCF might help prevent obesity by decreasing purchases of HCF.


PubMed | Einstein Healthcare Network, Temple University and Center for Urban Health Policy and Research
Type: | Journal: Appetite | Year: 2015

The objective of this study was to evaluate an intervention that combined mindful eating and online pre-ordering to promote healthier lunch purchases at work. The study took place at an urban hospital with 26 employees who were overweight or obese. The design included a contemporaneous comparison with delayed-treatment control and a three-phase prospective study. A minimum 4-week baseline period preceded a 4-week full-intervention, in which participants received mindful eating training, pre-ordered their lunches, and received price discounts toward lunch purchases. In a 4-week reduced intervention phase, participants pre-ordered lunches without price discounts. Participant lunch purchases were tracked electronically at the point of purchase. The primary outcome measures were the amounts of kilocalories and fat grams in purchased lunches. In contemporaneous comparisons, the treatment group purchased lunches with an average of 144.6 fewer kilocalories (p=0.01) and 8.9 fewer grams of fat (p=0.005) compared to controls. In multivariable longitudinal analyses, participants decreased the average number of calories in their meals by 114.6kcal per lunch and the average grams of fat by 5.4 per lunch during the partial-intervention compared to the baseline (p<0.001). At the end of the study, a moderate increase was observed in participants overall mindful eating behaviors as compared to the beginning of the study (p<0.001). The majority of participants (92%) said they would use the pre-ordering system if offered in the future. Combined mindful eating training and online pre-ordering appears a feasible and useful worksite intervention to improve food choices by employees.


Phipps E.J.,Center for Urban Health Policy and Research | Stites S.D.,Center for Urban Health Policy and Research | Wallace S.L.,Center for Urban Health Policy and Research | Braitman L.E.,Albert Einstein Healthcare Network
Journal of Nutrition Education and Behavior | Year: 2013

Objective: To investigate the predictors of fresh fruit and vegetable purchases in a low-income population and identify subgroups in which interventions to increase such purchases might prove useful. Methods: Retrospective analysis of 209 shopping transactions from 30 households. Individual and household characteristics obtained from primary shopper. Data collected covered April 1-June 30, 2010. Primary outcome was number of servings of fresh produce purchased per week. Bivariate and multivariable analyses were conducted. Results: Controlling for household size, the average number of servings of fresh produce per week was higher in families with more children (P = .008) and in families with a wider age range of children (P = .04). Conclusions and Implications: Households with more children purchased more fresh produce. Purchase data combined with shopper household characteristics helped to distinguish relatively high from low purchasers of fresh produce among low-income families. © 2013.


PubMed | Center for Urban Health Policy and Research
Type: Journal Article | Journal: Journal of nutrition education and behavior | Year: 2013

To investigate the predictors of fresh fruit and vegetable purchases in a low-income population and identify subgroups in which interventions to increase such purchases might prove useful.Retrospective analysis of 209 shopping transactions from 30 households. Individual and household characteristics obtained from primary shopper. Data collected covered April 1-June 30, 2010. Primary outcome was number of servings of fresh produce purchased per week. Bivariate and multivariable analyses were conducted.Controlling for household size, the average number of servings of fresh produce per week washigher in families with more children (P = .008) and in families with a wider age range of children (P = .04).Households with more children purchased more fresh produce. Purchase data combined with shopper household characteristics helped to distinguish relatively high from low purchasers of fresh produce among low-income families.


PubMed | Center for Urban Health Policy and Research
Type: Journal Article | Journal: Public health nutrition | Year: 2013

To report the design and baseline results of a rewards-based incentive to promote purchase of fruit and vegetables by lower-income households.A four-phase randomized trial with wait-listed controls. In a pilot study, despite inadequate study coupon use, purchases of fresh fruit (but not vegetables) increased, but with little maintenance. In the present study, credits on the study store gift card replace paper coupons and a tapering phase is added. The primary outcome is the number of servings of fresh and frozen fruit and vegetables purchased per week.A large full-service supermarket located in a predominantly minority community in Philadelphia, Pennsylvania, USA.Fifty-eight households, with at least one child living in the home.During the baseline period, households purchased an average of 37 servings of fresh vegetables and an average of less than 1 serving of frozen vegetables per week. Households purchased an average of 19 servings of fresh fruit per week, with little to no frozen fruit purchases. Overall, the range of fresh and frozen produce purchased during this pre-intervention period was limited.At baseline, produce purchases were small and of limited variety. The study will contribute to understanding the impact of financial incentives on increasing the purchases of healthier foods by lower-income populations.


PubMed | Center for Urban Health Policy and Research
Type: Journal Article | Journal: Journal of health care for the poor and underserved | Year: 2013

Identifying effective strategies to promote healthier eating in underserved populations is a public health priority. In this pilot study, we examined the use of financial incentives to increase fresh fruit and vegetable purchases in low-income households (N=29). Participants received pre-paid coupons to buy fresh produce at the study store during the intervention period. Purchases were compared among the three study phases (baseline, intervention, and follow-up). A financial incentive provided by study coupons increased the average weekly purchase of fresh fruit but was less successful with fresh vegetables. These findings underscore the need for specific targeting of vegetable selection and preparation to exploit this strategy more fully.


PubMed | Center for Urban Health Policy and Research
Type: Journal Article | Journal: Joint Commission journal on quality and patient safety | Year: 2012

Accurate patient identification (PT ID) is a key component in hospital patient safety practices and was addressed by one of the first six Joint Commission National Patient Safety Goals, which were introduced in 2003. Although the literature on patient safety practices is replete with discussion of strategies for improvement, less is known about frontline providers subjective views. A qualitative study was conducted to examine the subjective views and experiences of nurses and residents regarding PT ID at an urban teaching hospital.Some 15 registered nurses and 15 residents were interviewed between August 2009 and June 2010. Transcripts were analyzed using qualitative methodologies.Although residents and nurses viewed PT ID as crucial to patient safety, they cited time pressures; confidence in their ability to informally identify patients; and a desire to deliver personal, humanistic care as reasons for not consistently verifying patient identification. Nurses expressed concern about annoying, offending, and/or alienating patients by repeatedly checking wristbands and asking date of birth, in the belief that excessive patient identification practices could undermine trust. Residents relied on nurses to check ID and preferred to greet the patient by name, a practice that they viewed as more consistent with their professional identity. Referring to patients by their room number and location was cited as a commonly used practice of PT ID and a contributor to errors in identification.Nurses and residents are aware of the importance and requirements to verify PT ID, but their adherence is mitigated by a variety of factors, including assessment of necessity or risk, impact on their relationship with the patient, and practices in place in the hospital environment that protect patient privacy.

Loading Center for Urban Health Policy and Research collaborators
Loading Center for Urban Health Policy and Research collaborators