Publications, Department of Global and Community Health

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    Satisfaction with healthcare services in South Africa: results of the national 2010 General Household Survey
    (Pan African Medical Journal, 2014-06-22) Jacobsen, Kathryn H.; Hasumi, Takahiro
    Introduction The 1998 and 2003 Demographic and Health Surveys suggested increasing rates of dissatisfaction with health services in South Africa. The goal of this analysis was to examine national healthcare satisfaction rates in 2010. Methods We conducted weighted logistic regression analysis of data from 22,959 household representatives who participated in the nationally-representative 2010 General Household Survey (GHS). Results In total, 88.5% of participants were somewhat or very satisfied with their last visit to their usual healthcare provider, including 84.6% of those visiting a public provider and 97.3% of those consulting a private provider. Satisfaction rates were lower for black South Africans (87.0%) and low income households (86.3% of households with monthly incomes less than 2500 rands) than for white South Africans (96.0%) and high income households (94.0% of those with monthly incomes of at least 8000 rands) (p<0.001). However, after adjusting for provider type, there were few differences in satisfaction rates by race/ethnicity and income level. Conclusion The analysis suggests that differences in satisfaction with healthcare services in South Africa by racial/ethnic group and income level are due in large part to different rates of use of private providers.
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    Diabetes, obesity, and recommended fruit and vegetable consumption in relation to food environment sub-types: a cross-sectional analysis of Behavioral Risk Factor Surveillance System, United States Census, and food establishment data
    (BioMed Central, 2015-05-14) Frankenfeld, Cara L.; Leslie, Timothy F.; Makara, Matthew A.
    Background Social and spatial factors are an important part of individual and community health. The objectives were to identify food establishment sub-types and evaluate prevalence of diabetes, obesity, and recommended fruit and vegetable consumption in relation to these sub-types in the Washington DC metropolitan area. Methods A cross-sectional study design was used. A measure of retail food environment was calculated as the ratio of number of sources of unhealthier food options (fast food, convenience stores, and pharmacies) to healthier food options (grocery stores and specialty food stores). Two categories were created: ≤1.0 (healthier options) and >1.0 (unhealthier options). k-means clustering was used to identify clusters based on proportions of grocery stores, restaurants, specialty food, fast food, convenience stores, and pharmacies. Prevalence data for county-level diabetes, obesity, and consumption of five or more fruits or vegetables per day (FV5) was obtained from the Behavioral Risk Factor Surveillance System. Multiple imputation was used to predict block-group level health outcomes with US Census demographic and economic variables as the inputs. Results The healthier options category clustered into three sub-types: 1) specialty food, 2) grocery stores, and 3) restaurants. The unhealthier options category clustered into two sub-types: 1) convenience stores, and 2) restaurants and fast food. Within the healthier options category, diabetes prevalence in the sub-types with high restaurants (5.9 %, p = 0.002) and high specialty food (6.1 %, p = 0.002) was lower than the grocery stores sub-type (7.1 %). The high restaurants sub-type compared to the high grocery stores sub-type had significantly lower obesity prevalence (28.6 % vs. 31.2 %, p <0.001) and higher FV5 prevalence (25.2 % vs. 23.1 %, p <0.001). Within the larger unhealthier options category, there were no significant differences in diabetes, obesity, or higher FV5 prevalence across the two sub-types. However, restaurants (including fast food) sub-type was significantly associated with lower diabetes and obesity, and higher FV prevalence compared to grocery store sub-type. Conclusions These results suggest that there are sub-types within larger categories of food environments that are differentially associated with adverse health outcomes. These observations support the specific food establishment composition of an area may be an important component of the food establishment-health relationship.