Camille Velarde, MA1; Erica Landrau-Cribbs, PhD1; Mahtab Soleimani, BA1; Theresa H. Cruz, PhD1
Suggested citation for this article: Velarde C, Landrau-Cribbs E, Soleimani M, Cruz TH. Measuring Policy, Systems, and Environmental Changes at Elementary Schools Involved in SNAP-Ed New Mexico Programming, 2018–2022. Prev Chronic Dis 2024;21:230221. DOI: http://dx.doi.org/10.5888/pcd21.230221.
PEER REVIEWED
Summary
What is already known on this topic?
Robust evidence supports policy, systems, and environmental (PSE) strategies as effective approaches to combat obesity and chronic diseases. These strategies work by fostering healthier eating habits and increased physical activity within school environments. Implementing PSE strategies in low-income communities is particularly crucial for promoting health equity.
What is added by this report?
This report highlights that school-specific recommendations for PSE strategies led to a notable increase in nutrition-focused PSE implementations within participating elementary schools. These findings reflect the positive Snap New Mexico Changes 2024 aims to achieve through its programming.
What are the implications for public health practice?
The utilization of standardized PSE assessments, coupled with tailored, evidence-based recommendations and dedicated technical assistance, offers a promising pathway to enhance nutrition policies and environments within elementary schools located in low-income communities. This approach is key to driving meaningful SNAP New Mexico changes 2024 seeks to establish.
Abstract
Introduction
In 2018, the New Mexico Supplemental Nutrition Assistance Program–Education (SNAP-Ed NM) strategically integrated policy, systems, and environmental (PSE) strategies into its state plan. This integration was a proactive step to promote healthier eating habits and increase physical activity levels among New Mexico residents. While individual PSE strategies have been studied, research on the combined impact of multiple PSE strategies within elementary school settings remained limited. This study addresses that gap, examining the broader impact of SNAP New Mexico changes 2024 initiatives.
Methods
This study undertook comprehensive assessments of physical activity and nutrition environments across 11 elementary schools in New Mexico. These assessments were conducted both before and after the schools received tailored, school-specific PSE recommendations and technical support. Baseline data was meticulously gathered in 2018 using the School Physical Activity and Nutrition Environment Tool (SPAN-ET). SPAN-ET is designed to evaluate policy, situational, and physical environments within elementary schools. PSE scores were calculated to represent the proportion of criteria fulfilled within and across 27 key areas of interest. The implementation phase of evidence-based PSE interventions commenced in 2019. Unforeseen COVID-19 school closures caused delays in follow-up assessments, which were ultimately conducted in 2022. Descriptive data analysis was then employed to evaluate shifts in PSE scores over the study period, providing insights into the SNAP New Mexico changes 2024 initiatives fostered.
Results
The study revealed a significant overall increase in mean PSE scores, rising from 53.6% at baseline to 62.7% at follow-up. Notably, nutrition PSE scores demonstrated a substantial increase of 17.6 percentage points. Examining the different environmental domains, the policy environment exhibited the most significant improvement (+26.0 percentage points), followed by the situational environment (+13.8 percentage points), and the physical environment (+9.1 percentage points). In contrast, the study observed a non-significant increase in the overall average physical activity score (+2.7 percentage points). These results begin to quantify the SNAP New Mexico changes 2024 is bringing to school environments.
Conclusion
The application of a standardized instrument to assess PSE strategy implementation across multiple schools demonstrated a significant overall improvement in nutrition scores and non-significant gains in physical activity scores. The study suggests that delivering school-specific recommendations in conjunction with technical assistance can be an effective methodology for implementing evidence-based nutrition and physical activity PSE strategies. This approach aligns with the goals of SNAP New Mexico changes 2024 to create sustainable improvements in school health environments.
Introduction
The prevalence of obesity among US youth aged 2 to 19 years saw a concerning rise from 17.7% to 21.5% between 2011 and 2020 (1). Alarmingly, in 2022, obesity affected 28.0% of third-grade students in New Mexico. This issue disproportionately impacts certain populations, with American Indian (46.8%) and Hispanic (28.7%) third-graders experiencing significantly higher rates of obesity compared to their non-Hispanic White counterparts (15.9%) (2). Compounding this disparity, American Indian and Hispanic children are also more likely to experience poverty (3) and face limited access to nutritious food options (4) and safe spaces for physical activity (5) compared to non-Hispanic White children. These statistics underscore the urgent need for initiatives like SNAP New Mexico changes 2024 to address these disparities.
Childhood obesity is a serious health concern, elevating the risk of chronic diseases (6), mental health issues (7), and obesity in adulthood (8). Policy, systems, and environmental (PSE) approaches offer a broader reach and greater impact than health behavior curricula alone (9). Schools are pivotal in health promotion and disease prevention (10). Implementing PSE interventions within schools is a strategic approach to improve health outcomes, reduce health disparities, and promote health equity (10), aligning with the core objectives of SNAP New Mexico changes 2024.
In 2018, SNAP-Ed NM integrated PSE interventions into its state plan to enhance healthy eating and physical activity. While the effectiveness of individual PSE interventions is documented (e.g., nutrition standards for school meals, water access, playground redesigns) (11,12), comprehensive data on implementing multiple PSE strategies across numerous elementary schools remained lacking. To bridge this gap, the SNAP-Ed NM evaluation team developed a 3-year plan to assess PSE efforts in a sample of elementary schools. This study aimed to evaluate the effectiveness of evidence-based PSE interventions implemented by SNAP-Ed agencies in partnership with schools in real-world settings. The findings are crucial for informing future school-based PSE initiatives aiming to improve healthy eating and physical activity in low-income communities, reflecting the ongoing commitment of SNAP New Mexico changes 2024.
Methods
This study adopted a quasi-experimental design, purposefully selecting a sample of schools to collaborate with SNAP-Ed implementing agencies. The goal was to evaluate the implementation of PSE interventions. Baseline measurements were taken in 2018, followed by follow-up measurements in 2022, assessing the impact of SNAP New Mexico changes 2024 initiatives over time. Baseline data collection preceded PSE intervention implementation, serving to inform potential PSE strategies and provide a benchmark for evaluation. The intended follow-up assessment was initially scheduled for 2021. The 3-year timeframe was chosen to allow sufficient time for changes to school policies and environments to take effect, recognizing that such transformations often require considerable time. The unforeseen COVID-19 pandemic, with its associated school closures and restrictions, caused a delay, pushing the follow-up assessment to 2022.
Population
SNAP-Ed NM implementing agencies have established long-term partnerships with elementary schools across New Mexico, delivering nutrition education for over a decade. Schools are generally eligible for SNAP-Ed programming if they meet the Community Eligibility Provision. This provision requires schools to be located in high-poverty areas where at least 40% of students were eligible for free and reduced-price meals under the National School Lunch Program in the preceding year (13). Annually, SNAP-Ed NM implementing agencies extend their programming to over 150 schools, contributing significantly to the landscape of SNAP New Mexico changes 2024.
In 2018, five SNAP-Ed implementing agencies reached out to principals and staff at partner schools to discuss participation in a new initiative focused on implementing and evaluating PSE strategies. This initiative aimed to increase opportunities for physical activity and healthy eating within these schools. Schools were deemed eligible and ready to participate if they were already receiving SNAP-Ed NM programming in 2018, demonstrated leadership interest, and had identified at least one evidence-based PSE strategy they were prepared to implement in the upcoming academic year. Nineteen schools met these criteria and were assessed at baseline, with 14 schools completing the follow-up assessment (a 73.7% retention rate). The five schools lost to follow-up became inaccessible due to COVID-19 pandemic-related policy changes restricting school campus access. The schools participating at both time points included 11 elementary, 1 middle, and 2 high schools. Middle and high schools were excluded from the final analysis because the assessment tool was not validated for these settings, focusing the study on the elementary school level where SNAP New Mexico changes 2024 efforts are primarily targeted. The final sample consisted of 11 elementary schools.
Intervention
Following the baseline PSE assessment, results were shared with SNAP-Ed implementing agencies and school leadership. These results were accompanied by school-specific recommendations for PSE changes tailored to each school’s unique context. It’s important to note that no single, uniform evidence-based PSE strategy was mandated across all schools. Recommendations were school-dependent and encompassed various evidence-based strategies. Examples include strengthening written wellness policies, establishing school gardens, integrating nutrition education across all grade levels, forming active wellness committees, and increasing the availability of portable equipment (e.g., balls, jump ropes, hula hoops) to encourage active play. Schools were granted autonomy to select and implement strategies at their own pace, with technical assistance provided by SNAP-Ed implementing agencies. Funding for strategies with associated costs (e.g., school gardens, shade structures) was often secured with the support of SNAP-Ed agencies, drawing from diverse sources, including federal funding, foundations, and community donations. The unexpected COVID-19 pandemic and subsequent school closures and restrictions during the 2019–2020 and 2020–2021 academic years significantly disrupted implementation. This disruption impacted both the ongoing and planned PSE strategy selection and implementation, adding complexity to the SNAP New Mexico changes 2024 initiative rollout.
Instrument
The School Physical Activity and Nutrition Environment Tool (SPAN-ET) (14), a validated instrument, was utilized to assess PSE interventions in participating schools. Effectiveness was measured by tracking the increase in SPAN-ET PSE scores over time within these schools. SPAN-ET is recognized as a reliable tool for evaluating physical activity and nutrition environments in elementary schools (15). It provides comprehensive data to consistently assess the school environment and pinpoint areas influencing obesity-preventing behaviors among students. SPAN-ET comprises 27 areas of interest (AOIs) that evaluate the physical, situational, and policy environments related to physical activity and nutrition (Figure). Each AOI is assessed through multiple criteria, with each criterion scored as 0 (not met) or 1 (met). These scores are summed and then divided by the total number of criteria to calculate scores. Scores are presented as the proportion of criteria met within each AOI, domain, and category, expressed as percentages ranging from 0% to 100%. Two SPAN-ET AOIs were enhanced with added criteria: 1) assessing sustainability resources for existing garden spaces or greenhouses (AOI 18: nutrition–garden features) and 2) documenting social marketing materials and nutrition education areas and equipment (AOI 20: nutrition–food and beverage habits). These additions were made to ensure a more comprehensive assessment, aligning with the specific PSE strategies and goals of the implementing agencies and schools. While the SPAN-ET underwent some modifications by its developer between 2018 and 2022, this study focused solely on items consistently included in both assessment years to maintain data comparability and accurately reflect SNAP New Mexico changes 2024 impact using consistent metrics.
Figure. The categories, domains, areas of interest (AOIs), and number of criteria per AOI in the School Physical Activity and Nutrition Environment Tool (SPAN-ET). [A text version of this figure is available.]
SPAN-ET is structured around 3 key domains: physical environment, situational environment, and policy environment.
Physical environment. This domain encompasses built environment features within and around the school that influence physical activity or nutrition. Eight AOIs assessed the physical activity physical environment, including gymnasiums, outdoor play areas, shade structures, natural features, school gardens, and neighborhood features. Two AOIs focused on the nutrition physical environment: the cafeteria and school gardens, both crucial elements in understanding SNAP New Mexico changes 2024 within school infrastructure.
Situational environment. The situational environment domain examines the utilization of the physical environment. This includes the appearance and atmosphere of spaces and the promotion of actions or activities within them. Five AOIs evaluated the situational environment for physical activity: portable equipment, spaces stimulating senses, features promoting physical activity, opportunities for activity in before- and after-school programs, and landscape/garden spaces fostering physical activity. Six AOIs assessed the situational environment for nutrition, including school meals, food habits and practices, water availability, cafeteria atmosphere, and extracurricular activities, all contributing to the broader picture of SNAP New Mexico changes 2024 in daily school life.
Policy environment. The policy environment domain focuses on wellness policies, wellness committees and objectives, and policies regarding trained staff. Three AOIs assessed the policy environment for physical activity: physical activity wellness policy, a wellness committee, and structured physical education policies. Three AOIs evaluated the policy environment for nutrition, including nutrition wellness policy, wellness committee, and health and nutrition education, representing the foundational policy shifts driving SNAP New Mexico changes 2024.
Data collection
Data collection followed SPAN-ET protocol, incorporating document reviews (e.g., school wellness policies, meal menus, parent handbooks), on-site observations of facilities (e.g., cafeteria, gymnasium, playground, physical education classes), and interviews with school administrators and staff regarding AOIs. Interview topics included school staffing, curricula, and policies. Prior to each data collection period (2018 and 2022), the data collection team, comprising research team members and SNAP-Ed implementing agencies, underwent rigorous training on the instrument and methods. This training began with a 6-hour class led by the tool’s developer. Following classroom training, the research team engaged in internal reviews and training sessions and conducted a practice assessment at a school not involved in the study to gain practical experience with the tool, ensuring robust data collection for evaluating SNAP New Mexico changes 2024.
The research team then systematically analyzed policies and other written materials, utilizing standardized scoring criteria within SPAN-ET. In both 2018 and 2022, document review was followed by a day-long visit to each school for observations and structured interviews, with criteria scored according to SPAN-ET protocols. All assessments were independently scored by two data collectors, who then met to reconcile scores until consensus was reached. Any scoring discrepancies were resolved by re-examining original data (e.g., observational photographs and notes, policy documents, interview transcripts). If further clarification was needed for 100% agreement, data collectors revisited the site or re-contacted school personnel. This rigorous process, incorporating thorough training, on-site practice, quality improvement checks, observational photographs, and reconciliation meetings, ensured strong interrater reliability, enhancing the credibility of findings related to SNAP New Mexico changes 2024.
Data analysis
For each school in both 2018 and 2022, data was collected on student enrollment, percentage of students eligible for free or reduced-price lunch through the National School Lunch Program, percentage of Hispanic students, and percentage of American Indian students. These data were sourced from the New Mexico Public Education Department (16) and the National Center for Education Statistics (17).
The proportion of met criteria was calculated for each AOI, and scores were averaged across schools within each domain. The overall proportion of met criteria was calculated for physical activity and nutrition domains. Mean scores were calculated for each AOI across schools and converted into percentages representing the proportion of schools meeting criteria. Within schools, the proportion of met AOIs in physical activity and nutrition categories was calculated, resulting in an overall score for each school, with a maximum possible score of 100%. Paired-samples t tests were used to assess differences between mean baseline and follow-up scores for each domain and category, statistically analyzing the SNAP New Mexico changes 2024 impacts.
Results
At baseline, student populations in 10 of the 11 participating schools were majority Hispanic, and all students in 8 of 11 schools were eligible for free or reduced-price lunch through the National School Lunch Program (Table 1). Student enrollment at baseline ranged from 75 to 616, highlighting the diverse school sizes involved in the SNAP New Mexico changes 2024 initiative.
Change in proportion of criteria met among all schools
The study found no significant differences in mean overall physical activity scores from baseline to follow-up across the three physical activity domains for all schools (Table 2). However, significant increases were observed in two nutrition scores from baseline to follow-up: nutrition–situational environment, rising from 60.9% to 74.7% (+13.8 percentage points; P = .005), and nutrition–policy environment, increasing from 28.9% to 54.9% (+26.0 percentage points; P < .001). These increases indicate positive SNAP New Mexico changes 2024 in school nutrition environments. The nutrition–physical environment score also showed a non-significant increase (+7.1 percentage points; P = .10).
Among AOIs across all schools, the highest average increase in mean scores (+30.3 percentage points) from baseline to follow-up was in the physical activity–physical environment domain, specifically AOI 3, which focuses on shelter and shade structures (Table 3). Conversely, the highest average decrease (−5.5 percentage points) in this domain was observed for AOI 1, addressing gymnasiums and dedicated multipurpose spaces for physical activity. In the physical activity–situational environment domain, AOI 13, gardening activity spaces and programs, showed the highest average increase (+12.1 percentage points). The largest average decrease (−12.7 percentage points) in this domain was for AOI 9, portable equipment. Within the physical activity–policy environment domain, AOI 15, addressing physical activity and wellness committees, showed the highest average increase (+56.4 percentage points). The highest average decrease (−44.4 percentage points) in this domain was for AOI 16, structured physical education. In the nutrition–physical environment domain, AOI 18, school garden features, exhibited the highest average increase (+13.6 percentage points), with no decreases observed in this domain. The nutrition–situational environment domain saw the highest average increase (+22.1 percentage points) in AOI 20, promoting healthy food and beverage habits, and similarly, no decreases were observed in this domain. Finally, the nutrition–policy environment domain demonstrated the highest average increase (+78.2 percentage points) in AOI 26, which addresses nutrition and wellness committees. The largest average decrease (−6.8 percentage points) in this domain was for AOI 27, nutrition education. These detailed AOI changes offer a nuanced view of the SNAP New Mexico changes 2024 impacts.
Change in mean school scores from baseline to follow-up
A significant increase (+9.1 percentage points) in overall scores from baseline to follow-up was observed, rising from 53.6% at baseline to 62.7% at follow-up (P = .02) (Table 4). Average nutrition scores showed a significant increase (+17.6 percentage points) from baseline to follow-up, increasing from 50.8% to 68.5% (P < .001). In contrast, no significant differences in physical activity scores were found between baseline and follow-up (P = .44). These summary scores further illustrate the positive SNAP New Mexico changes 2024 effect, particularly in nutrition.
Discussion
This study sought to evaluate the effectiveness of efforts to improve nutrition and physical activity policies, systems, and environments across multiple elementary schools in a real-world setting. The results demonstrate a significant improvement in elementary school nutrition policies and environments over the 4-year intervention period, as measured by a standardized PSE assessment. This research is innovative in its examination of SPAN-ET PSE score changes across 11 schools implementing self-selected, evidence-based strategies, guided by school-specific recommendations and technical assistance from SNAP-Ed implementing agencies. The findings align with existing research indicating that identifying gaps, providing recommendations, and offering technical assistance can effectively promote the adoption of new policies or practices within school environments (18), highlighting the successful approach of SNAP New Mexico changes 2024.
Among the 11 participating elementary schools, a significant 17.6 percentage point increase in the overall nutrition score was observed. This improvement was largely driven by the establishment of active wellness councils and nutrition policies, improved access to healthier foods outside of school meals, and an increase in the number of school gardens. Wellness councils and nutrition policies are known to enhance the healthfulness of foods consumed by students within the school environment (19). Furthermore, school gardens can improve student health behaviors and outcomes, particularly among students facing economic disadvantages (20), thereby promoting health equity, a key goal of SNAP New Mexico changes 2024. Beyond PSE strategy recommendations and technical assistance, the participating schools’ decisions to implement new nutrition policies and enhance nutrition environments may have been influenced by heightened awareness of student food insecurity during the COVID-19 pandemic (21).
In this study, none of the physical activity domains showed significant increases in PSE scores. However, substantial score increases were noted in certain AOIs. For instance, improvements to the outdoor environment were evident, including enhancements to playground areas, development of school gardens, and the addition of shade structures. Research indicates that gardening, combined with food preparation, nutrition education, and physical activity instruction, can improve children’s vegetable intake and physical activity levels (22). Additionally, providing shade in outdoor areas significantly promotes the use of play areas, reduces sun exposure, and prevents heat-related injuries (23). The COVID-19 pandemic unexpectedly created an opportunity as funding for shade structure construction became available to support outdoor learning environments. These structures continue to offer safe, comfortable spaces for outdoor active play for students, representing an unexpected positive outcome of SNAP New Mexico changes 2024 related initiatives.
Significant declines were observed in both nutrition and physical activity categories related to the teaching of nutrition and physical education. Research suggests that health education on healthy lifestyles improves student nutrition and physical activity (24). However, consistent with national trends (25), participating schools reported challenges in retaining qualified staff, including health and nutrition educators and trained physical education teachers (26), during the COVID-19 pandemic. Additionally, schools restricted access to non-school personnel during the pandemic, limiting access for SNAP-Ed nutrition educators. The observed declines in PSE scores in these areas may be temporary, potentially rebounding as schools work to recruit qualified physical education and health staff and resume external nutrition education programming access, suggesting a future area for SNAP New Mexico changes 2024 to address.
Furthermore, the study results indicated an unexpected decline in PSE supports for physical activity from baseline to follow-up in two areas: access to gymnasiums for physical activity and active play, and the availability of portable play equipment. Research demonstrates that access to portable equipment increases moderate to vigorous physical activity among students, particularly girls (27). The declines in these areas may be attributed to the COVID-19 pandemic, which led some schools to close gymnasiums in favor of outdoor play and others to limit portable play equipment use due to increased cleaning demands. These pandemic-related shifts highlight the complex factors influencing SNAP New Mexico changes 2024 outcomes.
This research also demonstrated the successful implementation of evidence-based PSE strategies in schools serving disproportionately high populations of Hispanic and American Indian students, where nearly all students qualified for the National School Lunch Program. In the US, individuals with low socioeconomic status and those identifying as Hispanic or American Indian experience higher rates of obesity and other chronic health conditions (28,29). SNAP-Ed NM strategically focuses its programming, including PSE intervention efforts, on schools in low-income communities, which in New Mexico predominantly serve Hispanic and American Indian students. Effective PSE efforts in these schools can improve physical activity and nutrition, reduce obesity-related health disparities, and enhance health equity (12), directly contributing to the broader goals of SNAP New Mexico changes 2024.
This study was designed in 2018, with interventions starting in 2019. The COVID-19 pandemic’s disruptions were unforeseen and significantly impacted the study, altering PSE strategy timing and implementation, ultimately affecting scores and effectiveness. Some scores were positively influenced (e.g., shade structures), while others were negatively impacted (e.g., physical education teacher recruitment and retention). The pandemic also introduced additional factors, such as staff and student mental health, workforce changes, and resource limitations, potentially influencing engagement in PSE implementation. Despite the pandemic’s challenges, improvements in most nutrition and physical activity PSEs were observed over time, demonstrating the resilience and potential of SNAP New Mexico changes 2024 initiatives.
Strengths and limitations
Study strengths include the use of a standardized instrument to assess school-level nutrition and physical activity PSEs, enabling the identification of gaps for strategic intervention. Furthermore, utilizing SPAN-ET to evaluate SNAP-Ed programming across multiple schools provided a standardized method to measure and assess PSE implementation statewide. This tool and standardized protocol allowed for tracking changes over time, offering insights into the effectiveness of evidence-based strategy implementation. The incorporation of a rigorous training protocol and reconciliation process enhanced reliability. The study also leveraged existing partnerships between nutrition educators and schools and allowed schools flexibility to identify PSE strategies relevant and feasible within their context. Providing school leadership with detailed score breakdowns and school-specific PSE strategy recommendations further informed their choices, strengthening the practical relevance of SNAP New Mexico changes 2024 research.
The study has several limitations. It lacked a uniform intervention across sites; each school chose PSE strategies deemed important and feasible. However, this approach aligns with community-engaged research and implementation science principles. Additionally, the absence of a comparison or control group makes it challenging to establish causality or isolate the effects of implementation efforts from other factors, including the COVID-19 pandemic. Future research could address some limitations by examining implementation in the post-pandemic period, incorporating a control group, and measuring the dissemination and implementation of specific strategies over time. Furthermore, COVID-19 pandemic-related school district policies prevented data collection from all 19 original sites. These additional data points might have altered findings if schools not participating in the follow-up assessment differed in PSE strategy implementation, highlighting areas for refinement in future SNAP New Mexico changes 2024 evaluations.
Implications
Standardized PSE assessments, combined with tailored, evidence-based recommendations and technical assistance, are effective in improving nutrition policies and environments in elementary schools in low-income communities. Additionally, SPAN-ET can effectively evaluate changes in nutrition and physical activity PSEs across multiple schools over time. Its standardized and reliable nature allows for comparisons across different studies, strengthening the broader evidence base for SNAP New Mexico changes 2024 and similar initiatives.
Conclusion
The use of SPAN-ET to identify potential PSE strategies and evaluate SNAP-Ed programming across multiple New Mexico schools revealed significant overall improvement in nutrition scores and non-significant increases in physical activity scores. Substantial variation was observed in pre-post score changes among AOIs, ranging from a 44.4 percentage point decrease for having a physical education program coordinated by a trained physical educator to a 78.2 percentage point increase for having an active wellness committee with nutrition objectives. Providing school-specific recommendations combined with technical assistance appears to be an effective approach for implementing evidence-based nutrition and physical activity PSE strategies in real-world contexts. However, the COVID-19 pandemic significantly impacted the types of strategies implemented, implementation timing, and data collection timing for evaluation. Future research could incorporate a comparison group to assess the interventions’ causal effect. However, some evidence suggests that baseline data collection itself influenced school staff intentions to implement PSE changes. Dissemination and implementation studies would also be valuable to investigate the characteristics of schools or school leadership that adopt different strategies, the fidelity of intervention implementation, and the sustainability of interventions over time and with new school leadership, informing the long-term impact of SNAP New Mexico changes 2024 and future iterations of the program.
Acknowledgments
The authors express their gratitude to the implementing agencies, participating schools, and the New Mexico Human Services Department (NM HSD) for their invaluable contributions to this research. We also extend our appreciation for the funding provided by the NM HSD through an award from the US Department of Agriculture (USDA) Food and Nutrition Service (FNS). The opinions, results, and conclusions presented in this article are solely those of the authors and do not necessarily reflect the views of the USDA, FNS, or the NM HSD. The authors declared no potential conflicts of interest regarding the research, authorship, or publication of this article. SPAN-ET materials and instrument training were provided by its creator, Deborah John, PhD, MS.
Author Information
Corresponding Author: Camille Velarde, MA, University of New Mexico Prevention Research Center, 2703 Frontier Ave NE, Ste 120, Albuquerque, NM 87131 ([email protected]).
Author Affiliations: 1University of New Mexico Prevention Research Center, Albuquerque.
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Table
Table. Variables and definitions for Study of Cancer Disparities and Associated Risk Factors, United States, 2004–2018
| Variablea | Definitionb | Sources |
|—|—|—|
| Total cancer mortality rate | The number of deaths, with all types of cancer as the underlying cause of death, occurring in a specified population during a time frame. | CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) (12) |
| Demographic characteristics |
| Age | Age of respondent, grouped as ≥65 or | American Community Survey (15) |
| Race and ethnicity |
| Non-Hispanic American Indian or Alaska Native | A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. | American Community Survey (15) |
| Non-Hispanic Asian | A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. | American Community Survey (15) |
| Non-Hispanic Black or African American | A person having origins in any of the Black racial groups of Africa. | American Community Survey (15) |
| Hispanic | A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. | American Community Survey (15) |
| Non-Hispanic Native Hawaiian and Other Pacific Islander | A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. This includes people who reported detailed Pacific Islander responses such as Native Hawaiian or Other Pacific Islander; Fijian; Chamorro; Marshallese; Native Hawaiian; Other Micronesian; Other Pacific Islander; not Specified; Other Polynesian; Samoan; and Tonga. | American Community Survey (15) |
| Non-Hispanic White | A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. | American Community Survey (15) |
| Sex | Respondents mark either male or female to indicate their biological sex. | American Community Survey (15) |
| Health behaviors |
| Smoking | Percentage of adults that reported currently smoking. | Behavioral Risk Factor Surveillance System (14) |
| Obesity | Percentage of adults that report having a body mass index ≥30. | Behavioral Risk Factor Surveillance System (14) |
| Physical inactivity | Percentage of adults that report no leisure-time physical activity. | County Health Rankings & Roadmaps (16) |
| Drinking | Percentage of adults that report excessive drinking. | Behavioral Risk Factor Surveillance System (14) |
| Access to care, health literacy, health conditions |
| Lacks health insurance | Respondents who do not have health insurance coverage as from private health insurance or public coverage | County Health Rankings & Roadmaps (16) |
| High school education | Respondents who received at least a regular high school diploma and did not attend college were instructed to report “regular high school diploma.” | County Health Rankings & Roadmaps (16) |
| Unemployment | Respondents aged ≥16 years who were neither “at work” nor “with a job but not at work” during the reference week and were actively looking for work during the last 4 weeks, and were available to start a job. | County Health Rankings & Roadmaps (16) |
| Mammography screening | Percentage of female Medicare enrollees having ≥1 mammogram in 2 years. | County Health Rankings & Roadmaps (16) |
| Preventable hospital stay | Discharges for ambulatory care sensitive conditions per 1,000 Medicare enrollees. | County Health Rankings & Roadmaps (16) |
| Primary care physicians | Primary care physicians per 100,000 population. | County Health Rankings & Roadmaps (16) |
| Poor health | Percentage of adults that report fair or poor health. | County Health Rankings & Roadmaps (16) |
| Poor health days | Average number of reported physically unhealthy days per month. | County Health Rankings & Roadmaps (16) |
| Poor mental health days | Average number of reported mentally unhealthy days per month. | County Health Rankings & Roadmaps (16) |
| Mental health providers | Mental health providers per 100,000 population. | County Health Rankings & Roadmaps (16) |
| Economic stability |
| Housing problem | Percentage of households with at least 1 of 4 housing problems: overcrowding, high housing costs, lack of kitchen, lack of plumbing facilities. | County Health Rankings & Roadmaps (16) |
| Household without vehicle | Percentage of households that do not own ≥1 vehicle. | County Health Rankings & Roadmaps (16) |
| Median household income | A measure that divides the selected monthly owner costs as a percentage of household income distribution into 2 equal parts: one-half of the cases falling below the median selected monthly owner costs as a percentage of household income and one-half above the median | County Health Rankings & Roadmaps (16) |
| Transportation | Percentage of housing units with no vehicle available. | County Health Rankings & Roadmaps (16) |
a Total cancer death rate is the dependent variable; all others are independent variables. b Definitions are from original data sources.
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