Suchergebnisse

Community-level interventions dominate contemporary public health responses to health inequalities as a lack of political will has discouraged action at a structural level. Health promoters commonly leverage community capacity to achieve programme goals, yet the health implications of low community capacity are unknown. In this study, we analyse perceptions of community capacity at the individual-level to explore how place-based understandings of identity and connectedness are associated with self-rated health. We examine associations between individual community capacity, self-rated health and income using a cross-sectional survey that was disseminated to 303 residents of four small (populations 1500–2000) New Zealand towns. Evidence indicating a relationship between individual community capacity and self-reported health was unconvincing once the effects of income were incorporated. That is, people who rated their community's capacity higher did not have better self-rated health. Much stronger evidence supported the relationship between income and both higher individual community capacity and higher self-rated health. We conclude that individual community capacity may mediate the positive association between income and health, however, overall we find no evidence suggesting that intervening to enhance individual community capacity is likely to improve health outcomes.

Abstract Background In September 2009, a folic acid fortification mandate (135 μg/100 g bread) was to be implemented in New Zealand. However, due to political and manufacturer objection, fortification was deferred until May 2012. Based on estimates of bread consumption derived from a 1997 nationally representative survey, this program was intended to deliver a mean additional intake of 140 μg folic acid/d to women of childbearing age. Little is known about current bread consumption patterns in this target group. The aim of this study was to assess bread consumption among women prior to and during pregnancy with the intent to estimate periconceptional folic acid intakes that would be derived from bread if mandatory fortification were implemented as currently proposed. Methods A retrospective survey of 723 postpartum women in hospitals and birthing centres across New Zealand was conducted using a self-administered questionnaire on bread intake prior to and during pregnancy and maternal socio-demographic and obstetric characteristics. Results Median bread intake before conception (2 slices/d) was below that of previous data upon which the current fortification proposal was modeled (3-4 slices/d). If mandatory fortification is implemented as proposed, only 31% (95% CI = 24%-37%) of childbearing-age women would attain an additional folic acid intake of ≥ 140 μg/d, with a mean of 119 μg/d (95% CI = 107 μg/d-130 μg/d). Based on these data, a fortification level of 160 μg/100 g bread is required to achieve the targeted mean of 140 μg folic acid/d. Nonetheless, under the current proposal additional folic acid intakes would be greatest among the least advantaged segments of the target population: Pacific and indigenous Māori ethnic groups; those with increased parity, lower income and education; younger and single mothers; and women with unplanned pregnancies. Subgroups predicted to derive less than adequate folic acid intakes from the proposed policy were women of Asian descent and those with a postgraduate education. Conclusions This study provides insight on the ability of a fortification policy to benefit the groups at highest risk of poor folate intakes in a population. However, bread consumption among the target group of childbearing women appears to have declined since the data used in previous dietary modeling were collected. Thus, it seems prudent to re-model dietary folic acid intakes based on more recent national survey data prior to the implementation of a mandatory folic acid fortification policy.

Purpose.Determine if a "nondieting" intervention focused on intensive training in eliciting the relaxation response enhances health outcomes compared with nondieting interventions without such training.Design.Randomized trial with follow-up at 10 weeks, 4 months, and 12 months.Setting.General community.Subjects.Total of 225 overweight and obese women with at least one other cardiovascular risk factor.Interventions.Three 10-week nondieting interventions: a group program (P1) focused on intensive training in techniques for eliciting the relaxation response (n = 60), a group program (P2) focused on healthy eating and physical activity (n = 61), and a self-guided, mail-delivered version of P2 (P3; n = 101).Measures.The Revised Symptom Checklist measured psychological distress, the Medical Symptoms Checklist measured the experience of medical symptoms, and the Health-Promoting Lifestyle Profile measured a range of lifestyle behaviors. Self-efficacy for low-fat eating, intuitive eating, and body mass index were also assessed.Analysis.An intention-to-treat analysis was used.Results.At 12 months, P1 produced statistically greater improvements in stress management behaviors and medical symptom discomfort and was the only program to significantly improve self-efficacy for low-fat eating. In P1, the effect sizes for reductions in depression (0.75) and interpersonal sensitivity (0.85) were large. At 12 months, mean weight was unchanged.Conclusion.Inclusion of intensive relaxation response training in a nondieting program for overweight women enhanced stress management and medical symptoms outcomes but not weight outcomes.