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Greaney ML, Cohen SA, Xu F, Ward-Ritacco CL, Riebe D. Healthcare provider counselling for weight management behaviours among adults with overweight or obesity: a cross-sectional analysis of National Health and Nutrition Examination Survey, 2011-2018. BMJ Open 2020; 10:e039295. [PMID: 33234635 PMCID: PMC7684803 DOI: 10.1136/bmjopen-2020-039295] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To determine if adults with overweight or obesity received counselling from their healthcare providers (HCPs) to lose weight and/or adopt healthful behaviours associated with weight loss, and whether they took action on their HCPs' recommendations. DESIGN Cross-sectional analysis of 2011-2018 National Health and Nutrition Examination Survey (NHANES) data. SAMPLE NHANES respondents aged 18+ who were overweight/obese and had seen an HCP in the previous 12 months (n=13 158). METHODS Respondents reported if their HCPs recommended they control/lose weight, increase exercise/physical activity (PA) and/or reduce fat/calorie intake, and if they adopted the offered recommendation(s). Weighted logistic regression models examined receipt of HCP counselling by sex, age, race/ethnicity, and weight status accounting for demographic characteristics and complex sampling. Similar analyses examined reported adoption of HCPs' recommendations. RESULTS The sample was 53.1% women, 45.0% were overweight and 55.0% had obesity. In total, 40.4% received counselling to control/lose weight, 49.5% to increase exercise/PA and 38.9% to reduce fat/calorie intake. The following groups were less likely (p<0.001) to receive counselling: men; younger adults (aged 18-39) versus middle-aged (aged 40-64) and older adults (aged 65+); White versus Black and Hispanic respondents; overweight respondents versus respondents with obesity. Approximately half of those advised to make changes reported doing so (53.6% controlled/lost weight, 57.3% increased exercise/PA, 51.8% reduced fat/calorie intake). Differences in the adoption of recommendations were identified by sex, age group, race/ethnicity and weight status (all p<0.05); women, middle-aged and older adults, Black and Hispanic respondents and individuals with obesity were more likely to adopt one or more recommendations. CONCLUSION Most respondents did not receive HCP counselling, and approximately half of those who received counselling reported taking action. HCPs may need training to provide counselling and to offer recommendations tailored to the social contexts of populations less likely to adopt weight control related recommendations.
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Brown MJ, Cohen SA, DeShazo JP. Psychopathology and HIV diagnosis among older adults in the United States: disparities by age, sex, and race/ethnicity. Aging Ment Health 2020; 24:1746-1753. [PMID: 31274001 PMCID: PMC6942639 DOI: 10.1080/13607863.2019.1636201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 2016, 17% of new HIV infections in the US were among adults aged 50 and older. Differences by age, sex, and race/ethnicity exist among older people living with HIV. Co-morbid mental health and substance use disorders (SUD) are also major challenges for this population. This study examined the association between generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), SUD, depression, and HIV diagnosis among adults aged 50 and older, and the disparities by age, sex, and race/ethnicity. Data were obtained from Cerner Corporation's Health Facts® database. Multivariable logistic regression models were used to determine the associations between GAD, PTSD, SUD, and depression, and HIV diagnosis. Results were also stratified by age group, sex, and race/ethnicity. Overall, there were positive associations between SUD, depression, GAD, PTSD and HIV; and differences by age, sex and race/ethnicity existed in these associations. For example, after adjusting for age, race/ethnicity and marital status, men who were diagnosed with GAD were 10 times more likely (adjusted OR: 10.3; 95% CI: 8.75 - 12.1) to have an HIV diagnosis compared to men who were not diagnosed with GAD. Women who were diagnosed with GAD were five times more likely (adjusted OR: 5.01; 95% CI: 3.81 - 6.58) to have an HIV diagnosis compared to women who were not diagnosed with GAD. HIV prevention and intervention programs for older adults should address GAD, PTSD, SUD and depression and consider the age, sex and racial/ethnic disparities in the association between psychopathology and HIV.
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Xu F, Earp JE, Greene GW, Cohen SA, Lofgren IE, Delmonico MJ, Greaney ML. Temporal Association between Abdominal Weight Status and Healthy Aging: Findings from the 2011-2018 National Health and Aging Trends Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165656. [PMID: 32764442 PMCID: PMC7459859 DOI: 10.3390/ijerph17165656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 11/21/2022]
Abstract
Background/objectives: The longitudinal effect of abdominal weight status (AWS) defined by waist circumference (WC) on healthy aging has not yet been comprehensively examined. Therefore, the purpose of the present study was to examine the temporal association between WC-defined AWS and a comprehensive assessment for healthy aging. Subjects/methods: This study utilized data from 5211 respondents aged 65+ who participated in the National Health and Aging Trends Study from 2011 to 2018. Mixed effects regression models were used to examine the association between baseline AWS and the annual change rate in healthy aging score (HAS) via interaction terms (AWS*round) adjusting for confounding effects. Further multiple mixed models examined the relationship of AWS and HAS over an 8-year period. Results: There were no annual change rate differences in HAS by baseline AWS, regardless of sex. However, males with abdominal obesity were more likely to have a lower HAS than males with normal AWS (β = −0.20, 95% CI: −0.30, −0.10, p < 0.001) but no difference in HAS was observed between males with overweight and normal AWS. A similar pattern was observed among females. Conclusions: Study results indicate that AWS was associated with HAS but it did not modify annual HAS change rate over time.
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Xu F, Cohen SA, Greaney ML, Earp JE, Delmonico MJ. Longitudinal
Sex‐Specific
Physical Function Trends by Age, Race/Ethnicity, and Weight Status. J Am Geriatr Soc 2020; 68:2270-2278. [DOI: 10.1111/jgs.16638] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 01/06/2023]
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Cohen SA, Broccoli JR, Greaney ML. Community-based social determinants of three measures of mortality in Rhode Island cities and towns. Arch Public Health 2020; 78:56. [PMID: 32549982 PMCID: PMC7296717 DOI: 10.1186/s13690-020-00438-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022] Open
Abstract
Background Efforts to understand and address the causes of place-based health disparities have focused primarily on understanding the social determinants of health on a large geographic level, such as the region, state, or county. However, there is a growing need to assess and understand how place-based characteristics at smaller geographic areas relate to of local place-based neighborhood characteristics on population health. Therefore, the objective of this study was to evaluate the magnitude of the associations between social determinants of health and life expectancy (LE) and related measures on the community level. Methods LE at birth (LE0), remaining LE at age 65 (LE65), and age-specific mortality rates (ASMR) were calculated from mortality data (2009–2011) collected by the Rhode Island Department of Health (RIDoH) using abridged life table methods for each RI city/town. The city/town-specific LE and ASMR were linked to data collected by the US Census, RIDoH, the Federal Bureau of Investigation, and other databases that include information about multiple social, environmental, and demographic determinants of health. Bivariate correlations between city/town-level LE0, LE65, and ASMR and social determinants: demographics, household composition, income and poverty, education, environment, food insecurity, crime, transportation, and rural-urban status were examined. Results LE0 (range: 75.9–83.3 years) was strongly associated with the percent of the population with a graduate/professional degree (r = 0.687, p < 0.001), violent crime rate (r = − 0.598, p < 0.001), and per capita income (r = 0.553, p < 0.001). Similar results were observed for ASMR: ASMR was associated with the percent of the population with a graduate/professional degree (r = − 0.596, p < 0.001), violent crime rate (r = 0.450, p = 0.005), and per capita income (r = − 0.533, p < 0.001). The associations between LE65 and social determinants were more attenuated. Of note, none of the measures (LE0, LE65, or ASMR) were associated with any of the race/ethnicity variables. Conclusions There are several important place-based characteristics associated with mortality (LE and ASMR) among RI cities/towns. Additionally, some communities had unexpectedly high LE and low ASMR, despite poor social indicators.
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Cohen SA, Sabik NJ, Cook SK, Azzoli AB, Mendez-Luck CA. Differences within Differences: Gender Inequalities in Caregiving Intensity Vary by Race and Ethnicity in Informal Caregivers. J Cross Cult Gerontol 2020; 34:245-263. [PMID: 31407137 DOI: 10.1007/s10823-019-09381-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Among the 50+ million informal caregivers in the US, substantial gender, racial/ethnic, and socioeconomic disparities in caregiving intensity are well-documented. However, those disparities may be more nuanced: gender disparities in caregiving intensity may vary by race/ethnicity (White, Black, and Hispanic) and socioeconomic status (SES). We used data from the 2011 National Study of Caregiving and applied generalized linear models to estimate associations between three measures of caregiver intensity (ADLs, IADLs, and hours caregiving/month) and the three sociodemographic factors with their interaction terms. Black female caregivers provided significantly higher levels of care than White females and males for both IADL caregiving and hours/month spent caregiving. Black caregivers spent an average of 28.5 more hours/month (95%CI 1.7-45.2) caregiving than White caregivers. These findings highlight the need to understand the complex disparities within population subgroups and how intersections between gender, race/ethnicity, and SES can be used to develop effective policies to reduce disparities and improve caregiver quality-of-life.
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Bidlingmeyer BA, Cohen SA, Tarvin TL, Frost B. A New, Rapid, High-Sensitivity Analysis of Amino Acids in Food Type Samples. J AOAC Int 2020. [DOI: 10.1093/jaoac/70.2.241] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A new approach to the analysis of free amino acids and amino acids from hydrolyzed foods is described. The method is based on reaction of the free amino acids with phenylisothiocyanate to form stable derivatives which are subsequently separated by liquid chromatography. Sample preparation procedures are described and results are compared with conventional ion exchange results. Reproducibility of the new method has been determined on a typical food type sample.
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Cohen SA, Talamas AX, Sabik NJ. Disparities in social determinants of health outcomes and behaviours between older adults in Alaska and the contiguous US: evidence from a national survey. Int J Circumpolar Health 2019; 78:1557980. [PMID: 30672398 PMCID: PMC6327929 DOI: 10.1080/22423982.2018.1557980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/28/2018] [Accepted: 12/06/2018] [Indexed: 12/02/2022] Open
Abstract
Few studies have focused on understanding how sociodemographic factors impact healthy ageing in the rapidly growing population of Alaskan older adults. Therefore, the objectives of this study are to compare the health of Alaskan older adults to those in the contiguous US, and determine how the associations differ between older adults in Alaska and the contiguous US. We abstracted 165,295 respondents age 65+ from the 2016 Behavioral Risk Factor Surveillance System. We used generalised linear models to assess the associations between sociodemographic factors and six health outcomes accounting for confounders and complex sampling. In the contiguous US, females were less likely than males to be obese (OR 0.96, 95%CI 0.96-0.97), while in Alaska, females were more likely to be obese (OR 1.24, 95%CI 1.19-1.29). In the contiguous US, Alaska Natives/American Indians were more likely than respondents of other races to be smokers (OR 1.62, 95%CI 1.60-1.63), while in Alaska, the association between race and smoking was not significant (OR 1.00, 95%CI 0.94-1.06). These differences between Alaska and the contiguous US results suggest that programs designed to reduce disparities and promote healthy behaviours may need to be tailored to meet the unique needs and challenges of older adults living in Alaska.
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Xu F, Cohen SA, Greaney ML, Hatfield DL, Greene GW. Racial/Ethnic Disparities in US Adolescents' Dietary Quality and Its Modification by Weight-Related Factors and Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234803. [PMID: 31795448 PMCID: PMC6926511 DOI: 10.3390/ijerph16234803] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/31/2022]
Abstract
There are well-known disparities in the prevalence of obesity across racial-ethnic groups, although the behavioral and psychological factors driving these disparities are less well understood. Therefore, the objectives of this study were: (1) to examine differences in dietary quality by race/ethnicity and weight-related variables [body mass index (BMI), weight loss attempt, and weight dissatisfaction] and physical activity (PA) using the Health Eating Index-2015 (HEI-2015); and (2) to investigate the interactions and independent associations of race/ethnicity, weight-related variables and PA on dietary quality. Data for adolescents aged 12–19 years (n = 3373) were abstracted from the 2007–2014 National Health and Nutrition and Examination Survey and analyzed using multiple PROC SURVEYREG, adjusting for demographics and accounting for complex sampling. Analyses determined that Hispanic males had better overall HEI-2015 scores than non-Hispanic whites (48.4 ± 0.5 vs. 45.7 ± 0.6, p = 0.003) or blacks (48.4 ± 0.5 vs. 45.5 ± 0.5, p < 0.001). Hispanic females also had better dietary quality than non-Hispanic whites (50.2 ± 0.4 vs. 47.5 ± 0.5, p < 0.001) and blacks (50.2 ± 0.4 vs. 47.1 ± 0.5, p < 0.001). Meeting the PA recommendation modified racial/ethnic differences in dietary quality for females (p = 0.011) and this was primarily driven by the associations among non-Hispanic white females (ΔR2 = 2.6%, p = 0.0004). The study identified racial/ethnic and gender differences among adolescents in factors that may promote obesity. Results may be useful for obesity prevention efforts designed to reduce health disparities in adolescents.
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Cohen SA, Xu F, Meucci MR, Woodham S, Greaney ML. IDENTIFYING UNMET NEED IN INFORMAL CAREGIVING: DISPARITIES BY GENDER, EMPLOYMENT STATUS, AND RACE-ETHNICITY. Innov Aging 2019. [PMCID: PMC6845417 DOI: 10.1093/geroni/igz038.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Older adults, including those with dementia and other types of cognitive decline, often report a desire to remain in their homes. Over 50 million informal caregivers in the US provide needed in-home assistance to those in need, and there are well-documented disparities in informal caregiving responsibilities by sociodemographic factors , yet little is known about “unmet need” in informal caregiving. Therefore, the study’s objective is to examine discrepancies in unmet caregiving-related need by race/ethnicity, gender, and employment status. We abstracted data about caregivers from the 2017 National Study of Caregiving and linked these data to participants in the National Health and Aging Trends Study on caregivers of older adults (n=993). Generalized linear models were used to model the discrepancies between the number of activities of daily living for which the care recipient required assistance and the number of tasks caregivers provide, by race/ethnicity, gender, and employment status, accounting for confounders and complex sampling. Care recipients whose primary informal caregivers were employed were 69% more likely than those whose informal caregivers were not employed to experience unmet caregiving need (OR 1.69, 95%CI 1.19-2.41). A similar association between employment and unmet caregiving was observed among White caregivers (OR=1.79, 95% CI 1.16-2.69), while the association was not significant among Black caregivers (p=0.228). These findings suggest potentially addressable disparities in informal caregiving duties between Black and White caregivers, and can be used to inform and develop of policies and programs designed to improve caregiver health and reduce undue strain on caregiver health and wellbeing.
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Cohen SA, Broccoli J, O’Neill H, Greaney ML. SOCIAL DETERMINANTS OF HEALTH COMMUNITY-LEVEL SOCIAL DETERMINANTS OF MORTALITY IN OLDER ADULTS: AN ASSESSMENT OF RHODE ISLAND CITIES AND TOWNS. Innov Aging 2019. [PMCID: PMC6846230 DOI: 10.1093/geroni/igz038.2882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Addressing the causes of place-based health disparities among older adults have focused on understanding social determinants of health on a large geographic level, such as region, state, or county. However, there is a growing realization for the need to understand how place-based characteristics at smaller geographic areas relate to population health and contribute to successful aging. The purpose of this study was to assess the magnitude of the associations between place-based social determinants and life expectancy (LE) among older adults and related measures. Methods: LE at age 50 (LE50) and age 65 (LE65), and the age-specific mortality rate (ASMR) for ages 65+ (ASMR65) were calculated from mortality data (2009-2011) from the Rhode Island (RI) Department of Health (RIDoH) using abridged life table methods for each RI city/town. City/town-specific LE and ASMR were linked to the US Census, RIDoH, and other databases that include social determinants: demographics, household composition, wealth, education, environment, food insecurity, crime, transportation, and rural-urban status. Bivariate and partial correlations were examined between city/town-level LE50, LE65, and ASMR65. Results: LE50, (range: 29.3-34.0 years) was most strongly associated with the percent of the population with at least a bachelor’s degree (r=0.652, p<0.001), per capita income (r=-0.632, p < 0.001), and percent multigenerational households (r=-0.489, p=0.003). The associations between both LE65 and ASMR65 and examined social determinants were more attenuated, however. Discussion: These results highlight substantial place-based disparities in mortality and potentially addressable social determinants that could improve population health for older adults and reduce place-based disparities among neighboring communities.
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Broccoli J, Cohen SA, Greaney ML. GRANDPARENTAL CAREGIVING AND CO-RESIDENCE, SOCIOECONOMIC STATUS, AND MORTALITY IN RHODE ISLAND CITIES AND TOWNS. Innov Aging 2019. [PMCID: PMC6840622 DOI: 10.1093/geroni/igz038.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Grandparents co-residing with their grandchildren is becoming increasingly more common, with over 1.5 million grandchildren living with their grandchildren in the U.S. Furthermore, the number of grandparents who are primary caregivers for their grandchildren has also increased, which can negatively effects the grandparents’ physical and mental health, and increase social isolation and financial burden. However, the associations between grandparental caregiving and health outcomes are not well understood on a population level. Therefore, the purpose of this study was to assess associations between grandparental caregiving, socioeconomic status, and population health outcomes. Using mortality data (2009-2011) from the Rhode Island (RI) Department of Health and life table methods for each RI city/town, life expectancy at age 65 (LE65) and age-standardized mortality rates (ASMR) were calculated and linked to data from the American Community Survey on grandparental caregiving responsibilities, grandparental living arrangements (co-residence), poverty status, and demographics. Correlations and multivariable linear regression modeling were used to evaluate associations among LE65, ASMR, grandparental caregiving and co-residence, demographics, and poverty. Both LE65 (rho=-0.382, p=0.016) and ASMR (rho=0.327, p=0.042) were associated with the percent of grandparents living with grandchildren. The percent of grandparents as primary caregivers to their grandchildren was not significantly associated with LE65 or ASMR. ASMR was associated with the percent of grandparents living in poverty (rho=0.401, p=0.013) and overall poverty (rho=0.363, p=0.023). These results highlight conditions of community-based living and role of primary caregivers at an older age that should be further explored to improve the health of grandparents, particularly in multi-generational homes.
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Greaney ML, Cohen SA, Blissmer BJ, Earp JE, Xu F. Age-specific trends in health-related quality of life among US adults: findings from National Health and Nutrition Examination Survey, 2001–2016. Qual Life Res 2019; 28:3249-3257. [DOI: 10.1007/s11136-019-02280-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 12/15/2022]
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Xu F, Cohen SA, Lofgren IE, Greene GW, Delmonico MJ, Greaney ML. The Association between Physical Activity and Metabolic Syndrome in Older Adults with Obesity. J Frailty Aging 2019; 8:27-32. [PMID: 30734828 DOI: 10.14283/jfa.2018.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Physical activity reduces the likelihood of developing metabolic syndrome (MetS). However, the association between different physical activity levels and MetS remains unclear in older adults with obesity. METHODS This cross-sectional study used four waves of data (2007-2008, 2009-2010, 2011-2012, 2013-2014) from two datasets: The National Health and Nutrition Examination Survey and United Sates Department of Agriculture's Food Patterns Equivalents Database. The sample included adults 60+ years of age (n= 613) with obesity who had physical activity and MetS data. Physical activity was assessed using the Global Physical Activity Questionnaire and categorized into three physical activity levels (low, medium, and high); and medium or high physical activity levels are aligned with or exceed current physical activity recommendations. Participants were classified as having MetS using a commonly agreed upon definition. Multiple logistic regression models examined the association between the three physical activity levels and MetS risk factors and MetS. All analyses adjusted for potential confounding variables and accounted for complex sampling. RESULTS Of 613 respondents, 72.1% (n=431) were classified as having MetS, and 44.3% (n = 263) had not met physical activity recommendations. Participants with high levels of physical activity had a lower risk of MetS (OR = 0.31, 95%CI: 0.13, 0.72) and more healthful levels of high-density lipoprotein cholesterol (OR = 0.39, 95%CI: 0.18, 0.84), blood pressure (OR = 0.39, 95%CI: 0.20, 0.77), fasting glucose (OR = 0.34, 95%CI: 0.15, 0.78) than participants categorized as having low physical activity. CONCLUSIONS Physical activity is associated with lower risk of MetS only for participants with the highest level of physical activity, which suggests that physical activity dosage is important to reduce MetS risk in older adults with obesity.
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Greaney ML, Cohen SA, Ward-Ritacco CL, Riebe D. Rural-Urban Variation in Weight Loss Recommendations Among US Older Adults with Arthritis and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060946. [PMID: 30884784 PMCID: PMC6466170 DOI: 10.3390/ijerph16060946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022]
Abstract
Purpose: Weight loss is advantageous for individuals with obesity and arthritis. Therefore, this study was conducted to determine if there are differences by rural-urban status among older adults with these conditions who reported being advised by a health care provider to lose weight for arthritis or to ameliorate arthritis symptoms. Methods: A cross-sectional analysis of 2011 Behavioral Risk Factor Surveillance System (BRFSS) data. Respondents reported if they had been diagnosed with arthritis and if they received a provider weight loss recommendation (WLR). The analytic sample was limited to older adults aged 60⁻79 living in the five states that administered the examined BRFSS arthritis module who had body mass index ≥ 30 kg/m² and reported having arthritis (n = 2920). The respondent's county of residence was linked to the corresponding county-level population density from the US Decennial Census to determine rural-urban status. A generalized linear model examined the association between receipt of a WLR and population density, controlling for demographics. Results: The sample was 83.6% white, 57.8% female, and 63.2% received a WLR. Respondents from more urban counties were more likely to receive a WLR (p value for trend <0.001). Additionally, older respondents, men, individuals with less than a high school education, and whites had a decreased likelihood of receiving a WLR. Conclusions: The analysis identified notable rural-urban differences with respondents in more urban counties being more likely to receive a WLR. Furthermore, there were differences in those who received a WLR by age, sex, and education. Reasons for these differences should be explored.
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Cohen SA, Greaney ML, Sabik NJ. Assessment of dietary patterns, physical activity and obesity from a national survey: Rural-urban health disparities in older adults. PLoS One 2018; 13:e0208268. [PMID: 30517166 PMCID: PMC6281245 DOI: 10.1371/journal.pone.0208268] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Obesity is a critical public health issue, affecting over one-third of all Americans, and is an underlying cause of numerous health issues across the lifespan. For older adults, obesity is linked to premature declines in physical and mental health and cognitive functioning. The occurrence of obesity and related health behaviors and chronic diseases are higher in rural areas than in urban areas. Furthermore, rural areas of the United States have a higher proportion of older adults than urban areas. Few studies, to date, have explored rural-urban differences in the relationships between dietary patterns and obesity among older adults. Therefore, the purpose of this study is to assess rural-urban differences in obesity rates in older adults, and the potential for the associations between obesity and physical activity and dietary patterns to vary by rural-urban status. METHODS Data were abstracted from respondents aged 65 and above from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) database linked to Census-based county-level information on rural-urban status and socioeconomic status. Generalized linear models were utilized to assess rural-urban disparities in obesity, and the potential for associations between obesity and known risk factors (fruit consumption, green vegetable consumption and physical activity) to vary by rural-urban status, accounting for complex sampling and confounders. RESULTS Obesity rates were highest and fruit consumption was lowest in the most rural areas. However, for older adults in the most urban areas, there was a significant negative association between obesity and fruit and green vegetable consumption. This association was not observed in more rural older adults. CONCLUSION These findings underscore the need to take into account place-based factors such as rural-urban status, when designing and implementing policies and interventions designed to reduce obesity through risk factor mitigation in older adults. To reduce rural-urban disparities in older adults, all policies, programs, and interventions should address the unique barriers and needs specific to rural and urban older adults.
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Xu F, Cohen SA, Greaney ML, Greene GW. The Association between US Adolescents' Weight Status, Weight Perception, Weight Satisfaction, and Their Physical Activity and Dietary Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091931. [PMID: 30189607 PMCID: PMC6163799 DOI: 10.3390/ijerph15091931] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/02/2018] [Accepted: 09/02/2018] [Indexed: 11/16/2022]
Abstract
Background: It remain unclear that the association between weight status, weight perception, weight satisfaction and the clustering of physical activity (PA) and dietary behaviors in adolescents. Method: A cross-sectional analysis of National Health and Nutrition Examination Survey and the US Department of Agriculture's Food Patterns Equivalents 2007⁻2014 data from adolescents aged 12⁻17 years (n = 2965) was conducted. Multivariable logistic regression models adjusted for demographic characteristics examined the association between weight status, weight perception, weight satisfaction, and the four created lifestyle groups (healthier behaviors, healthier diet only, physically active only, unhealthier behaviors). Results: Males with obesity were more likely to be in the healthier diet only group than males with a normal weight (OR = 1.90, 95% CI: 1.02, 3.52). Similar patterns were found in males who perceived themselves as being overweight or having obesity (OR = 2.09, 95% CI: 1.09, 3.99) and males with obesity who perceived their weight status accurately (OR = 2.33, 95% CI: 1.12, 4.88). Female respondents who were satisfied with their weight were 59% less likely to be in the healthier diet only group than healthier behaviors group compared with females who were weight dissatisfied (OR = 0.41, 95% CI: 0.23, 0.75). This pattern was not observed in males. Conclusions: Clustering PA and dietary behaviors were associated with weight status and weight perception for males but not females. Weight satisfaction was associated with clustered PA and dietary behaviors for females. These findings are important for obesity prevention policies and programs to better address adolescents' obesity and reduce health disparities in this population.
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Cook SK, Cohen SA. Sociodemographic Disparities in Adult Child Informal Caregiving Intensity in the United States: Results from the New National Study of Caregiving. J Gerontol Nurs 2018; 44:15-20. [DOI: 10.3928/00989134-20180808-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/19/2018] [Indexed: 11/20/2022]
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Bareis N, Sando TA, Mezuk B, Cohen SA. Association Between Psychotropic Medication Polypharmacy and an Objective Measure of Balance Impairment Among Middle-Aged Adults: Results from the US National Health and Nutrition Examination Survey. CNS Drugs 2018; 32:863-871. [PMID: 30014315 PMCID: PMC6146074 DOI: 10.1007/s40263-018-0542-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Psychotropic medications (e.g., antidepressants, anxiolytics, and neuroleptics) are increasingly prescribed with two or more taken concurrently (polypharmacy), and have been associated with an increased risk of falling. The aim of this study was to examine the association between psychotropic medication use and balance impairment using an objective balance measure. METHODS We derived data from participants aged 40 years and older in the US National Health and Nutrition Examination Survey (1999/00-2003/04) who completed the Modified Clinical Trial of Sensory Interaction and Balance and indicated current medications (n = 3090). Balance impairment was defined as failing the Modified Clinical Trial of Sensory Interaction and Balance condition 4 (standing on foam surface, eyes closed). Medication use included specific psychotropic classes, a count of psychotropic medications, and a count of non-psychotropic medications taken concurrently. Nested multiple logistic regression assessed relationships between medication use and balance impairment, adjusting for covariates and complex sampling. RESULTS One third of participants had balance impairment. After accounting for medical comorbidities, there was no relationship between individual classes of psychotropic medications and balance impairment. After adjusting for all covariates, there was a dose-response relationship between the number of psychotropic medications taken and balance impairment, with every additional medication associated with a 35% higher odds (odds ratio = 1.35; 95% confidence interval 1.07-1.70). In comparison, there was no increase in the odds of balance impairment associated with each additional medication taken for participants only taking non-psychotropic medications. CONCLUSIONS Psychotropic medication polypharmacy is associated with an increased odds of balance impairment. Clinicians should exercise caution when prescribing combinations of psychotropic medications, and refer to physical therapy for assessment and treatment if balance impairment is detected.
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Cook SK, Snellings L, Cohen SA. Socioeconomic and demographic factors modify observed relationship between caregiving intensity and three dimensions of quality of life in informal adult children caregivers. Health Qual Life Outcomes 2018; 16:169. [PMID: 30157852 PMCID: PMC6116379 DOI: 10.1186/s12955-018-0996-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/12/2018] [Indexed: 12/17/2022] Open
Abstract
Background The relationship between informal caregiving intensity and caregiver health is well-established, though research suggests this may vary by caregiver demographics. The aim of this exploratory study is to assess the association between caregiving intensity and three dimensions of quality of life outcomes, and determine how caregiver sociodemographics change the nature of this relationship among informal adult children caregivers. Methods Using the 2011 National Study of Caregiving, associations between caregiving intensity and quality of life were examined in caregivers providing care to an aging parent (n = 1014). Logistic regression was used to model caregiver quality of life on caregiving intensity using an ordinal composite measure of caregiving activities, including Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), hours per month, and length of caregiving, stratified by race/ethnicity, gender, age, and family income. Odds ratios and corresponding 95% confidence intervals were calculated. Results Associations between caregiving intensity and quality of life varied substantially by race/ethnicity, gender, age, and annual family income. White caregivers were significantly more likely to experience negative emotional burden when providing high intensity care (ADL: 1.92, Hours: 3.23). Black caregivers were more likely to experience positive emotions of caregiving (ADL: 2.68, Hours: 2.60) as well as younger caregivers (Hours: 8.49). Older caregivers were more likely to experience social burden when providing high ADL, IADL, and monthly hours of care. Conclusions These findings demonstrate the complex and multi-dimensional nature of caregiving, and emphasize the need to develop approaches that are tailored to the specific health needs of subpopulations of informal caregivers.
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Xu F, Greaney ML, Cohen SA, Riebe D, Greene GW. The Association between Adolescent's Weight Perception and Health Behaviors: Analysis of National Health and Nutrition Examination Survey Data, 2011-2014. J Obes 2018; 2018:3547856. [PMID: 29850231 PMCID: PMC5937432 DOI: 10.1155/2018/3547856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/21/2018] [Accepted: 04/02/2018] [Indexed: 11/18/2022] Open
Abstract
The association between adolescents' weight perception and their physical activity (PA) and sedentary behaviors remains unclear. Therefore, these associations were explored using data from 2438 adolescents aged 12-19 years who participated in the National Health and Nutrition Examination 2011-2014 Survey. Respondents reported weight perception, and their weight perception accuracy was determined by examining whether the measured weight and perceived weight were concordant. Respondents also reported sedentary time (sitting time and screen time), PA, and intention to lose weight. Linear and logistic regression models were conducted to determine whether adolescents' PA, sedentary behaviors, and weight loss intention differed by weight perception and weight perception accuracy adjusted for demographic variables accounting for complex sampling. About one-quarter (21.4%) of the respondents had obesity. For respondents who perceived themselves as being overweight/fat, despite greater weight loss intention, males reported more sitting time (512.7 ± 16.3 versus 474.1 ± 10.2 minutes/day, p < 0.05) and females reported less PA (48.7 ± 5.0 versus 64.6 ± 3.3 minutes/day, p < 0.05) than respondents who perceived themselves as being normal weight. Similar patterns were observed for weight perception accuracy among individuals with obesity. Study results show that perceiving oneself as being overweight/fat regardless of accuracy was associated with more sedentary time for males or less PA for females despite higher weight loss intention.
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Xu F, Cohen SA, Lofgren IE, Greene GW, Delmonico MJ, Greaney ML. Relationship between Diet Quality, Physical Activity and Health-Related Quality of Life in Older Adults: Findings from 2007-2014 National Health and Nutrition Examination Survey. J Nutr Health Aging 2018; 22:1072-1079. [PMID: 30379305 DOI: 10.1007/s12603-018-1050-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND A growing body of research shows that diet quality and physical activity (PA) are associated with health-related quality of life (HRQOL). However, no study to date has assessed this association using the Healthy Eating Index-2015 as a measure of diet quality. Furthermore, few studies have examined the association between PA dose and HRQOL among a nationally representative sample of older adults. OBJECTIVES To investigate the relationship between diet quality, physical activity, and HRQOL. DESIGN A cross-sectional analysis was conducted using data obtained from 5,311 adults aged 60+ years who took part in the National Health and Nutrition Examination Survey between 2007 and 2014. MEASUREMENTS HRQOL was assessed by general health status, and number of physically unhealthy days, mentally unhealthy days, and inactive days in past 30 days. Diet quality was assessed by the Healthy Eating Index-2015 using data generated by two 24-hour dietary recalls. PA was measured by the Global Physical Activity Questionnaire. Multivariate logistic/or linear regression models were used to examine the association between diet quality, PA and HRQOL controlling for confounders and accounting for complex sampling. RESULTS Approximately half of the participants (55.2%) were women, 45.1% met current PA recommendations, 65% had less healthful diets according to the Healthy Eating Index-2015. Diet quality was associated with HROQL. For every 1-point diet quality score increase, the likelihood of respondents rating their general health as being excellent/good increased by 3% (OR=1.03, 95%CI: 1.02, 1.04), and number of inactive days (β =-0.03, 95%CI: -0.05, 0.00) and mental unhealthy days (β =-0.03, 95%CI: -0.05, -0.01) declined by 0.03 days. PA was associated with all HROQL measures and respondents with high PA levels reported better general health (OR=3.53, 95%CI: 2.69, 4.63), fewer inactive days (β =-1.53, 95%CI: -2.11, -0.95), fewer physical unhealthy days (β =-1.88, 95%CI: -2.74, -1.02) than individuals with low PA levels but not fewer mentally unhealthy days. CONCLUSIONS Among older adults in this study, eating a healthier diet and being physically active were associated with better general health and reporting fewer physical unhealthy days and inactive days. Study results provide valuable information that could inform policies, programs and interventions designed to improve HRQOL in older adults and reduce potentially preventable health disparities.
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Cohen SA, Cook SK, Sando TA, Sabik NJ. What Aspects of Rural Life Contribute to Rural-Urban Health Disparities in Older Adults? Evidence From a National Survey. J Rural Health 2017; 34:293-303. [DOI: 10.1111/jrh.12287] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/30/2017] [Accepted: 10/19/2017] [Indexed: 12/27/2022]
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Cohen SA, Cook SK, Sando TA, Brown MJ, Longo DR. Socioeconomic and Demographic Disparities in Caregiving Intensity and Quality of Life in Informal Caregivers: A First Look at the National Study of Caregiving. J Gerontol Nurs 2017; 43:17-24. [DOI: 10.3928/00989134-20170224-01] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 01/23/2017] [Indexed: 11/20/2022]
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Brown MJ, Masho SW, Perera RA, Mezuk B, Pugsley RA, Cohen SA. Sex Disparities in Adverse Childhood Experiences and HIV/STIs: Mediation of Psychopathology and Sexual Behaviors. AIDS Behav 2017; 21:1550-1566. [PMID: 27688144 PMCID: PMC5896316 DOI: 10.1007/s10461-016-1553-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
HIV and other sexually transmitted infections (STIs) are important public health challenges in the US. Adverse childhood experiences (ACEs), including abuse (emotional, physical or sexual), witnessing violence among household members, may have an effect on sexual behaviors, which increase the risk of HIV/STIs. The aim of this study was to examine the sex differences in the role of posttraumatic stress disorder (PTSD), major depression (MD), substance use disorders (SUDs), early sexual debut, and intimate partner violence (IPV) perpetration as mediators in the association between ACEs and HIV/STIs. Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Structural equation modeling was used to determine the role of PTSD, MD, SUDs, early sexual debut, and IPV perpetration as mediators in the relationships between ACEs and HIV/STIs. Differences and similarities existed in the mediational roles of psychopathology and sexual behaviors. For example, among men, MD fully mediated physical/psychological abuse (β = 0.0002; p = 0.012) and sexual abuse (β = 0.0002; p = 0.006), and HIV/STIs while among women, MD fully mediated physical/psychological abuse (β = 0.0005; p < 0.001) and parental violence (β = -0.0002; p = 0.012). Among men, IPV perpetration fully mediated sexual abuse (β = -0.0005; p = 0.012) and HIV/STIs while among women, IPV perpetration was not a statistically significant mediator. HIV/STI prevention and intervention programs should use a life course approach by addressing adverse childhood events among men and women and consider the sex differences in the roles of psychopathology and sexual behaviors.
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