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Applying the socio-ecological model to understand factors associated with sugar-sweetened beverage behaviours among rural Appalachian adolescents
- Brittany A McCormick, Kathleen J Porter, Wen You, Maryam Yuhas, Annie L Reid, Esther J Thatcher, Jamie M Zoellner
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- Journal:
- Public Health Nutrition / Volume 24 / Issue 11 / August 2021
- Published online by Cambridge University Press:
- 11 January 2021, pp. 3242-3252
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Objective:
The objective of the current study was to identify factors across the socio-ecological model (SEM) associated with adolescents’ sugar-sweetened beverage (SSB) intake.
Design:This cross-sectional study surveyed adolescents using previously validated instruments. Analyses included descriptive statistics, ANOVA tests and stepwise nonlinear regression models (i.e., two-part models) adjusted to be cluster robust. Guided by SEM, a four-step model was used to identify factors associated with adolescent SSB intake – step 1: demographics (i.e., age, gender), step 2: intrapersonal (i.e., theory of planned behaviour (attitudes, subjective norms, perceived behavioural control, behavioural intentions), health literacy, media literacy, public health literacy), step 3: interpersonal (i.e., caregiver’s SSB behaviours, caregiver’s SSB rules) and step 4: environmental (i.e., home SSB availability) level variables.
Setting:Eight middle schools across four rural southwest Virginia counties in Appalachia.
Participants:Seven hundred ninety seventh grade students (55·4 % female, 44·6 % males, mean age 12 (sd 0·5) years).
Results:Mean SSB intake was 36·3 (sd 42·5) fluid ounces or 433·4 (sd 493·6) calories per day. In the final step of the regression model, seven variables significantly explained adolescent’s SSB consumption: behavioural intention (P < 0·05), affective attitude (P < 0·05), perceived behavioural control (P < 0·05), health literacy (P < 0·001), caregiver behaviours (P < 0·05), caregiver rules (P < 0·05) and home availability (P < 0·001).
Conclusions:SSB intake among adolescents in rural Appalachia was nearly three times above national mean. Home environment was the strongest predictor of adolescent SSB intake, followed by caregiver rules, caregiver behaviours and health literacy. Future interventions targeting these factors may provide the greatest opportunity to improve adolescent SSB intake.
Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study
- Linda H. Banks, Lisa A. Davenport, Meghan H. Hayes, Moriah A. McArthur, Stacey N. Toro, Cameron E. King, Hazel M. Vazirani
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 6 / December 2016
- Published online by Cambridge University Press:
- 19 September 2016, pp. 583-592
- Print publication:
- December 2016
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Introduction
In the foothills of the Cumberland Mountains, in central Appalachia (a region that spans 13 states in the US), sits an economically distressed and rural community of the United States. Once a thriving coal-mining area, this region now is reported as one of the hardest places to live in the US. Southeastern Kentucky, located in a remote, rocky, mountainous area surrounded by rivers and valleys and prone to flooding, experienced a major flood in Spring 2013 causing significant damage to homes and critical infrastructure.
PurposeAims of the study were to: (1) identify and better understand the contextual variables compounding the impact of a disaster event that occurred in Spring 2013; (2) identify ways participants managed antecedent circumstances, risk, and protective factors to cope with disaster up to 12 months post-event; and (3) further determine implications for community-focused interventions that may enhance recovery for vulnerable populations to promote greater outcomes of adaptation, wellness, and readiness.
MethodsUsing an ethnographic mixed-methods approach, an inter-collaborative team conducted face-to-face interviews with (N=12) Appalachian residents about their disaster experience, documented observations and visual assessment of need on an observation tool, and used photography depicting structural and environmental conditions. A Health and Emergency Preparedness Assessment Survey Tool was used to collect demographic, health, housing, environment, and disaster readiness assessment data. Community stakeholders facilitated purposeful sampling through coordination of scheduled home visits.
ResultsTriangulation of all data sources provided evidence that the community had unique coping strategies related to faith and spirituality, cultural values and heritage, and social support to manage antecedent circumstances, risk, and protective factors during times of adversity that, in turn, enhanced resilience up to 12 months post-disaster. The community was found to have an innate capacity to persevere and utilize resources to manage and transcend adversity and restore equilibrium, which reflected components of resilience that deserve greater recognition and appreciation.
ConclusionResilience is a foundational concept for disaster science. A model of resilience for the rural Appalachia community was developed to visually depict the encompassing element of community-based interventions that may enhance coping strategies, mitigate risk factors, integrate protective factors, and strengthen access. Community-based interventions are recommended to strengthen resilience, yielding improved outcomes of adaptation, health and wellness, and disaster readiness.
,Banks LH ,Davenport LA ,Hayes MH ,McArthur MA ,Toro SN ,King CE .Vazirani HM Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study . Prehosp Disaster Med.2016 ;31 (6 ):583 –592 .