1
|
Agudelo C, Ramos AR, Gardener H, Cheung K, Elkind MSV, Sacco RL, Rundek T. Sleep Duration Is Associated With Subclinical Carotid Plaque Burden. Stroke 2023; 54:2347-2355. [PMID: 37470161 PMCID: PMC10527503 DOI: 10.1161/strokeaha.122.041967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/06/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Sleep duration is associated with stroke risk and is 1 of 8 essential components of cardiovascular health according to the American Heart Association. As stroke disproportionately burdens Black and Hispanic populations in the United States, we hypothesized that long and short sleep duration would be associated with greater subclinical carotid atherosclerosis, a precursor of stroke, in the racially and ethnically diverse NOMAS (Northern Manhattan Study). METHODS NOMAS is a study of community-dwelling adults. Self-reported nightly sleep duration and daytime sleepiness were collected between 2006 and 2011. Carotid plaque presence, total plaque area, and intima-media thickness were measured by ultrasound between 1999 and 2008. Linear and logistic regression models examined the cross-sectional associations of sleep duration groups (primary exposure) or daytime sleepiness (secondary exposure) with measures of carotid atherosclerosis. Models adjusted for age, time between ultrasound and sleep data collection, sex, race and ethnicity, education, health insurance, smoking, alcohol use, physical activity, body mass index, hypertension, diabetes, hypercholesterolemia, and cardiac disease. RESULTS The sample (n=1553) had a mean age of 64.7±8.5 years and was 61.9% female, 64.8% Hispanic, and 18.2% non-Hispanic Black. Of the sample, 55.6% had carotid plaque, 22.3% reported nightly short sleep (<7 hours), 66.6% intermediate sleep (≥7 and <9 hours), and 11.1% had long sleep (≥9 hours). Compared with intermediate sleep, long sleep was associated with greater odds of carotid plaque presence relative to plaque absence (odds ratio, 1.6 [95% CI, 1.1-2.4]) and larger total plaque area (odds ratio, 1.4 [95% CI, 1.0-1.9]) after full covariate adjustment. Short sleep and daytime sleepiness were not significantly associated with any carotid measures. CONCLUSIONS The association between long sleep and subclinical carotid atherosclerosis may explain prior associations between long sleep and stroke.
Collapse
Affiliation(s)
- Christian Agudelo
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, US
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, US
| | - Alberto R. Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, US
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, US
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, US
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, US
| | - Ken Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, US
| | - Mitchell SV Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, US
| | - Ralph L. Sacco
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, US
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, US
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, US
- The Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, Florida, US
| |
Collapse
|
2
|
Guo J, Shan S, Ali Khan Y. What are the impetuses Behind E-health applications' self-management services' ongoing adoption by health community participants? Health Informatics J 2023; 29:14604582231152801. [PMID: 36648056 DOI: 10.1177/14604582231152801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Over the past 20 years, the identification of interventions related to healthcare management has been greatly facilitated by improvements in the well-being and health of the entire population. However, regardless of the positive developments in smart health applications and e-health research, there are two important gaps, (1) the role of gamification variables in the continued use of eHealth applications has not been adequately assessed, and (2) the extent to which people's perception of the continued use of e-health applications is encouraged through habit. Customers and companies can derive considerable value from exploring E-Health applications' health self-management services. Accordingly, estimating such services' ongoing adoption by customers is aimed for in this research, with habits, intrinsic and extrinsic variables incorporated into a study model which is then tested. This paper examined perceived autonomy, perceived competence, perceived relatedness has positively related to enjoyment and habit. Reward has positively related to perceived autonomy and continued to use. Enjoyment and Habit have positively associated with the decision to continue to use in e-Health Apps. 269 individuals who have used Chinese e-health applications comprised the data collection sample, being reached via an online questionnaire. Data analysis was undertaken using Partial Least Squares Structural Equation Modelling (PLS-SEM). It was found that the ongoing adoption of e-health self-management services was perpetuated to a greater extent by intrinsic variables; in terms of strategizing for companies' e-services, the results can inform this process.
Collapse
Affiliation(s)
- Jin Guo
- Department of Management, Lincoln International Business School, 4547University of Lincoln, UK
| | - Shan Shan
- Business Analytics and Decision Making, 2706Coventry University, UK
| | - Yousaf Ali Khan
- Department of Mathematics and Statistics, 66934Hazara University, Pakistan
| |
Collapse
|
3
|
Factors Associated with Physical Activity in a Diverse Older Population. Geriatrics (Basel) 2022; 7:geriatrics7050111. [PMID: 36286214 PMCID: PMC9601632 DOI: 10.3390/geriatrics7050111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
Physical activity is important for healthy aging, but few older adults achieve the goal of 150 min per week of moderate activity. The purpose of this study was to employ a robust statistical approach in the analysis of the factors related to physical activity in a diverse sample of older adults. A secondary analysis of factors associated with calculated MET-h/week was conducted in a sample of 601 African Americans, Afro-Caribbeans, European Americans, and Hispanic Americans age 59 to 96 living independently in the community. Age, education, social network, pain, and depression were the five variables that accounted for a statistically significant proportion of unique variance in the model. The strongest correlation to total MET-h/week was with depression. Directionality of the relationship between these variables and physical activity is complex: while pain and depression can reduce physical activity, activity may also help to reduce pain and depression. Additionally, of note is that many of these factors may be modified, calling for the design and testing of individual, group, and community level interventions to increase physical activity in the older population.
Collapse
|
4
|
Choi A, Blanco L, Hays RD. Race and Ethnicity Differences in Walking and Associations with Neighborhood Perceptions among Older Adults in California. J Appl Gerontol 2022; 41:2499-2510. [PMID: 35959781 DOI: 10.1177/07334648221118902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper estimates differences in walking and associations of walking with neighborhood perceptions among older adults in California. We analyzed the restricted-use California Health Interview Survey data merged with the American Community Survey data. Walking at least 10 minutes for leisure in the last 7 days and number of minutes walked were regressed on perceived neighborhood social cohesion scale (PNSCS) and neighborhood socioeconomic characteristics. We estimated ordinary least squares regression models. We found that positive neighborhood perceptions were significantly (p< 0.05) associated with walking among older Hispanic and Asian adults. Older Hispanic adults with above median PNSCS report that they walk 6.3 percentage points more than Non-Hispanic White adults. Older adults' perceptions of their neighbors and neighborhoods are positively correlated with walking. Policymakers can consider ways to improve neighborhood perceptions and relationships to help increase walking among minority older adults especially in low SES neighborhoods.
Collapse
Affiliation(s)
- Anna Choi
- Department of Public Administration, 35006Sejong University, Seoul, Korea
| | - Luisa Blanco
- School of Public Policy, 5262Pepperdine University, Malibu, CA, USA
| | - Ron D Hays
- Department of Medicine, 8783University of California, Los Angeles, CA, USA
| |
Collapse
|
5
|
Tibiriçá L, Jester DJ, Jeste DV. A systematic review of loneliness and social isolation among Hispanic/Latinx older adults in the United States. Psychiatry Res 2022; 313:114568. [PMID: 35643058 DOI: 10.1016/j.psychres.2022.114568] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/20/2022]
Abstract
Loneliness and social isolation are growing public health problems in older adults, associated with physical and mental comorbidity and increased mortality. In the United States, Hispanic/Latinx individuals constitute the largest racial/ethnic minority. Studies retrieved from PsycInfo, Embase, and PubMed were examined. The initial search yielded 1476 publications. Using the updated PRISMA Flow guidelines, a total of 17 studies met our review criteria. Eight studies assessed loneliness, six evaluated social isolation, and three investigated both. The reports varied in the details of methodology, preventing meta-analyses. Differences in the experience of loneliness and social isolation between Hispanic/Latinx and White adults are not consistent. Of the three studies of loneliness or social isolation among Hispanic/Latinx groups of different national origins, two reported significant differences. Loneliness was associated with greater overall comorbidity, but two studies found higher risk of metabolic and cardiovascular disorders in Hispanic/Latinx with loneliness. Social isolation was generally associated with worse physical health, being older, male, and unmarried, and having lower education and income, and more smoking, along with frailty and cognitive impairment. We make specific suggestions for future research on loneliness and social isolation in Hispanic/Latinx adults and offer guidelines for clinical management.
Collapse
Affiliation(s)
- Lize Tibiriçá
- Department of Psychiatry, University of California San Diego, Address: 9500 Gilman Drive 0664, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Dylan J Jester
- Department of Psychiatry, University of California San Diego, Address: 9500 Gilman Drive 0664, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, Address: 9500 Gilman Drive 0664, La Jolla, CA 92093, USA; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA; Department of Neurosciences, University of California San Diego, La Jolla, CA, USA.
| |
Collapse
|
6
|
Fatigue in Persons With Heart Failure: A Systematic Literature Review and Meta-Synthesis Using the Biopsychosocial Model of Health. J Card Fail 2022; 28:283-315. [PMID: 34329719 PMCID: PMC8795245 DOI: 10.1016/j.cardfail.2021.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fatigue is a common and distressing symptom of heart failure (HF) and has important implications for patient-reported and clinical outcomes. Despite being a common and bothersome symptom, fatigue has been understudied in HF. We sought to synthesize existing literature on fatigue in HF through a systematic literature review guided by the biopsychosocial model of health. METHODS AND RESULTS A systematic search of the literature was performed on March 18, 2020, using Pubmed, Embase, and CINAHL. Full-text, primary research articles, written in English, in which fatigue was a primary symptom of interest in adults with a diagnosis of HF, were included. The search yielded 1138 articles; 33 articles that met inclusion criteria were selected for extraction and synthesis. Biological and psychological factors associated with fatigue were New York Heart Association functional class, hemoglobin level, history of stroke, and depression. However, there are limited HF-specific factors linked to fatigue. Social factors related to fatigue included social roles, relationship strain, and loneliness and isolation. Few nonpharmacologic interventions have been tested by show some promise for alleviating fatigue in HF. Studies show conflicting evidence related to the prognostic implications of fatigue. CONCLUSIONS Important biological correlates of fatigue were identified; however, psychological and social variables were limited to qualitative description. There is need for expanded models to better understand the complex physiologic nature of fatigue in HF. Additionally, more research is needed to (1) define the relationships between fatigue and both psychological and social factors, (2) better describe the prognostic implications of fatigue, and (3) develop more therapeutic approaches to alleviate fatigue with the goal of improving overall quality of life.
Collapse
|
7
|
Ruchman SG, Delong AK, Kamano JH, Bloomfield GS, Chrysanthopoulou SA, Fuster V, Horowitz CR, Kiptoo P, Matelong W, Mugo R, Naanyu V, Orango V, Pastakia SD, Valente TW, Hogan JW, Vedanthan R. Egocentric social network characteristics and cardiovascular risk among patients with hypertension or diabetes in western Kenya: a cross-sectional analysis from the BIGPIC trial. BMJ Open 2021; 11:e049610. [PMID: 34475172 PMCID: PMC8413931 DOI: 10.1136/bmjopen-2021-049610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Management of cardiovascular disease (CVD) is an urgent challenge in low-income and middle-income countries, and interventions may require appraisal of patients' social networks to guide implementation. The purpose of this study is to determine whether egocentric social network characteristics (SNCs) of patients with chronic disease in western Kenya are associated with overall CVD risk and individual CVD risk factors. DESIGN Cross-sectional analysis of enrollment data (2017-2018) from the Bridging Income Generation with GrouP Integrated Care trial. Non-overlapping trust-only, health advice-only and multiplex (trust and health advice) egocentric social networks were elicited for each participant, and SNCs representing social cohesion were calculated. SETTING 24 communities across four counties in western Kenya. PARTICIPANTS Participants (n=2890) were ≥35 years old with diabetes (fasting glucose ≥7 mmol/L) or hypertension. PRIMARY AND SECONDARY OUTCOMES We hypothesised that SNCs would be associated with CVD risk status (QRISK3 score). Secondary outcomes were individual CVD risk factors. RESULTS Among the 2890 participants, 2020 (70%) were women, and mean (SD) age was 60.7 (12.1) years. Forty-four per cent of participants had elevated QRISK3 score (≥10%). No relationship was observed between QRISK3 level and SNCs. In unadjusted comparisons, participants with any individuals in their trust network were more likely to report a good than a poor diet (41% vs 21%). SNCs for the trust and multiplex networks accounted for a substantial fraction of variation in measures of dietary quality and physical activity (statistically significant via likelihood ratio test, adjusted for false discovery rate). CONCLUSION SNCs indicative of social cohesion appear to be associated with individual behavioural CVD risk factors, although not with overall CVD risk score. Understanding how SNCs of patients with chronic diseases relate to modifiable CVD risk factors could help inform network-based interventions. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier: NCT02501746; https://clinicaltrials.gov/ct2/show/NCT02501746.
Collapse
Affiliation(s)
- Samuel G Ruchman
- Department of Medicine, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Allison K Delong
- Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jemima H Kamano
- Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | | | | | - Valentin Fuster
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Carol R Horowitz
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Winnie Matelong
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Richard Mugo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Violet Naanyu
- Department of Sociology, Psychology and Anthropology, School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Sonak D Pastakia
- Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
| | - Thomas W Valente
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Joseph W Hogan
- Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| |
Collapse
|
8
|
Fontán-Vela M, Rivera-Navarro J, Gullón P, Díez J, Anguelovski I, Franco M. Active use and perceptions of parks as urban assets for physical activity: A mixed-methods study. Health Place 2021; 71:102660. [PMID: 34454253 DOI: 10.1016/j.healthplace.2021.102660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
Parks are potential key urban assets for improved population health; however, their use is not equal among all social groups. Individual and contextual factors could influence residents' perceptions of parks and how they interact with and, eventually, benefit from them. The use of complementary methodologies provides a deeper understanding of the relationship between park use, physical activity (PA), and residents' perceptions. Thus, we designed a mixed-methods study to analyze differences in park use and PA, and the perceptions of parks as urban assets for PA. We selected six parks from three neighborhoods in Madrid (Spain) with different neighborhood socioeconomic status (NSES) for systematic social observation. We registered park users by age, PA level (low, medium, and high), gender, and NSES using the System for Observing Play and Recreation in Communities (SOPARC) audit tool adapted for iOS software (iSOPARC). We also conducted 37 semi-structured interviews and 29 focus groups to analyze residents' perceptions of parks as urban assets for PA in the same neighborhoods. We adopted a convergent-parallel design to analyze both quantitative and qualitative data, and to describe the convergence and divergence areas between them. Parks within the high-NSES were more visited, showing a higher proportion of people performing high PA (11.9%) as compared to residents of the middle (9.3%) and low-NSES (3.2%). Female visitors showed lower PA levels compared to men, especially for parks within high-NSES. The following issues were reported as influence urban park use and perceptions: park maintenance and area perception, works constraints, insecurity and crime, differential perceptions by age, and the availability of organized activities in the parks. Residents from high-NSES reported fewer barriers to park use compared to residents from the other areas, who reported limitations such as less leisure time due to job constrains or perceived insecurity in parks. Senior participants reported that having parks with organized activities and a design oriented towards different age-groups are valuable. Our study shows consistency between the fewer and less intense use of parks registered in the middle and low-NSES neighborhoods, and the more barriers for PA reported in this areas during the qualitative analysis. Mixed-methods provided an insight of the potential causes leading to the differences in park use and PA within cities, which is essential in terms of environmental justice and health equity. Thus, a mixed-methods comprehensive approach to public health problems can help designing public policies addressing relevant factors related to urban health inequities.
Collapse
Affiliation(s)
- Mario Fontán-Vela
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Preventive Medicine Department, Infanta Leonor University Hospital, 28031, Madrid, Spain
| | - Jesús Rivera-Navarro
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Department of Sociology and Communication, University of Salamanca, 37007, Salamanca, Spain
| | - Pedro Gullón
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; School of Global, Urban and Social Studies, RMIT University, Melbourne, Australia.
| | - Julia Díez
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain
| | - Isabelle Anguelovski
- Catalan Institution for Research and Advanced Studies (ICREA), Universitat Autònoma de Barcelona (UAB), Institute for Environmental Sciences and Technology (ICTA), Barcelona Laboratory for Urban Environmental Justice and Sustainability, Medical Research Institute Hospital Del Mar (IMIM), 08003, Barcelona, Spain
| | - Manuel Franco
- Universidad de Alcalá, Facultad de Medicina y Ciencias de La Salud, Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Alcalá de Henares, Madrid, Spain; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| |
Collapse
|
9
|
Delerue Matos A, Barbosa F, Cunha C, Voss G, Correia F. Social isolation, physical inactivity and inadequate diet among European middle-aged and older adults. BMC Public Health 2021; 21:924. [PMID: 33992074 PMCID: PMC8122541 DOI: 10.1186/s12889-021-10956-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Social isolation is a growing public health concern for older adults, as it has been associated with poor health and premature mortality. On the other hand, physical inactivity and an inadequate diet are important health risk behaviours associated with physical and mental health problems. Considering that there is no research examining the possible relationship between social isolation and the above mentioned health risk behaviours of European middle-aged and older adults, this cross-sectional study aims to contribute to filling this gap. METHODS We used data from the SHARE project (Survey of Health, Ageing and Retirement in Europe), wave 6 (2015), release 7.0.0 (N = 67,173 individuals from 17 European countries plus Israel). Statistical tests for a two-group comparison were carried out to assess the differences between highly socially isolated individuals and low/intermediate socially isolated ones. Logistic regressions by country were performed to examine whether social isolation is associated with physical inactivity and an inadequate diet in the population aged 50 + . RESULTS Our results point out that, for the majority of the countries analysed, highly socially isolated individuals are more likely than low/intermediate isolated ones to be physically inactive and to consume less fruit or vegetables on a daily basis. In 9 European countries (Austria, Germany, Sweden, Denmark, Greece, Belgium, Poland, Luxembourg and Estonia) highly socially isolated individuals are more likely to be physically inactive. On the other hand, in 14 European countries (Austria, Germany, Sweden, Italy, France, Denmark, Greece, Switzerland, Belgium, Czech Republic, Luxembourg, Slovenia, Estonia and Croatia), high social isolation increases the likelihood of having an inadequate diet. CONCLUSION Highly socially isolated European middle-aged and older adults are more prone to be physically inactive and to have an inadequate diet in terms of daily consumption of fruit and vegetables. The reduced social integration, social support and companionship of the highly socially isolated individuals may explain this association. Our results reinforce the importance of social and health policies targeting highly socially isolated European individuals aged 50 + .
Collapse
Affiliation(s)
- Alice Delerue Matos
- Department of Sociology, Institute of Social Sciences, University of Minho, Braga, Portugal.
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal.
| | - Fátima Barbosa
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal
| | - Cláudia Cunha
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal
| | - Gina Voss
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal
| | - Filipa Correia
- Communication and Society Research Centre, Institute of Social Sciences, University of Minho, Braga, Portugal
| |
Collapse
|
10
|
Seet V, Abdin E, Asharani PV, Lee YY, Roystonn K, Wang P, Devi F, Cetty L, Teh WL, Verma S, Mok YM, Subramaniam M. Physical activity, sedentary behaviour and smoking status among psychiatric patients in Singapore - a cross-sectional study. BMC Psychiatry 2021; 21:110. [PMID: 33602151 PMCID: PMC7893878 DOI: 10.1186/s12888-021-03103-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/27/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Unhealthy behaviours such as physical inactivity, sedentary behaviour and smoking have been found to be more prevalent in people with psychiatric disorders than in the general population, leading to increased mortality risk. The present study seeks to identify correlates of physical activity and sedentary behaviour among psychiatric patients in Singapore, as well as investigate differences in their physical activity patterns by smoking status. METHODS Participants (n = 380) were recruited from a tertiary psychiatric hospital in Singapore as part of a study on the prevalence and correlates of smoking among psychiatric patients. Physical activity levels and sedentary behaviour were measured using the Global Physical Activity Questionnaire (GPAQ) and analysed based on GPAQ guidelines. Chi-square analyses were conducted to examine differences in physical activity by smoking status, and logistic regression analyses to yield sociodemographic correlates of meeting physical activity guidelines (as recommended by the World Health Organization) and sedentary behaviour. RESULTS Education was found to be significantly associated with meeting recommended physical activity levels, while age and marital status were significantly associated with excessive sedentary behaviour. Additionally, while no significant differences were found among current, former and non-smokers across all types of physical activity engagement levels, there was a high prevalence of inadequate physical activity (43.2%) and excessive sedentary behaviour (38.8%) among participants. CONCLUSION Given the high prevalence of inadequate physical activity and excessive sedentary behaviour among current, former and non-smokers with psychiatric disorders, programmes aimed at increasing physical activity and lowering sedentary behaviour levels should be integrated into targeted treatment plans to improve clinical outcomes.
Collapse
Affiliation(s)
- Vanessa Seet
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Edimansyah Abdin
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - P. V. Asharani
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ying Ying Lee
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Kumarasan Roystonn
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Peizhi Wang
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Fiona Devi
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Laxman Cetty
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Wen Lin Teh
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Swapna Verma
- grid.414752.10000 0004 0469 9592Early Psychosis Intervention Programme, Institute of Mental health, Singapore, Singapore
| | - Yee Ming Mok
- grid.414752.10000 0004 0469 9592Department of Mood and Anxiety, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| |
Collapse
|
11
|
The Positive Impact and Associated Mechanisms of Physical Activity on Mental Health in Underprivileged Children and Adolescents: An Integrative Review. Behav Sci (Basel) 2020; 10:bs10110171. [PMID: 33171632 PMCID: PMC7695200 DOI: 10.3390/bs10110171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 02/01/2023] Open
Abstract
(1) Background: Review-based studies are required to consider the different designs and data that describe the association between physical activity and mental health for underprivileged children and adolescents. There is a particular need to identify mechanisms which could explain the association, and factors which influence the association in this population group. (2) Methods: An integrative review with a systematic search was conducted in three stages: (i) a systematic literature search on four databases from inception until May 2020. Studies were eligible if they examined underprivileged children, involved moderate to vigorous physical activity (MVPA) and had a focus on at least one outcome measure related to mental health. (ii) Two critical appraisal tools were used to assess quality across different study designs. (iii) Synthesis was undertaken in four stages, examining social, internal and physical outcomes and mechanisms. (3) Results: A total of 16 studies were included (2 qualitative; 12 quantitative and 2 mixed methods). Fifteen (15/16; 93.8%) showed an association between MVPA and a significant improvement in at least one mental health outcome. The most studied outcomes included: internal aspects (n = 14), significant effects were identified in 12/14 studies; social aspects (n = 6), significant effects were identified across all studies and finally physical aspects (n = 5), significant effects were found in 3/5 studies. Autonomy support was identified as a mechanism to explain the change, whilst age and gender influenced the strength of the association. (4) Conclusions: The findings provide confirmation of the link between MVPA and the improved mental health and wellbeing of disadvantaged children and adolescents. Future research must consider the long-term effect through longitudinal studies, along with determining whether any specific types of PA are more impactful than others.
Collapse
|
12
|
Gardener H, Sacco RL, Rundek T, Battistella V, Cheung YK, Elkind MSV. Race and Ethnic Disparities in Stroke Incidence in the Northern Manhattan Study. Stroke 2020; 51:1064-1069. [PMID: 32078475 PMCID: PMC7093213 DOI: 10.1161/strokeaha.119.028806] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/28/2020] [Indexed: 01/01/2023]
Abstract
Background and Purpose- An excess incidence of strokes among blacks versus whites has been shown, but data on disparities related to Hispanic ethnicity remain limited. This study examines race/ethnic differences in stroke incidence in the multiethnic, largely Caribbean Hispanic, NOMAS (Northern Manhattan Study), and whether disparities vary by age. Methods- The study population included participants in the prospective population-based NOMAS, followed for a mean of 14±7 years. Multivariable-adjusted Cox proportional hazards models were constructed to estimate the association between race/ethnicity and incident stroke of any subtype and ischemic stroke, stratified by age. Results- Among 3298 participants (mean baseline age 69±10 years, 37% men, 24% black, 21% white, 52% Hispanic), 460 incident strokes accrued (400 ischemic, 43 intracerebral hemorrhage, 9 subarachnoid hemorrhage). The most common ischemic subtype was cardioembolic, followed by lacunar infarcts, then cryptogenic. The greatest incidence rate was observed in blacks (13/1000 person-years), followed by Hispanics (10/1000 person-years), and lowest in whites (9/1000 person-years), and this order was observed for crude incidence rates until age 75. By age 85, the greatest incidence rate was in Hispanics. Blacks had an increased risk of stroke versus whites overall in multivariable models that included sociodemographics (hazard ratio, 1.51 [95% CI, 1.13-2.02]), and stratified analyses showed that this disparity was driven by women of age ≥70. The increased rate of stroke among Hispanics (age/sex-adjusted hazard ratio, 1.48 [95% CI, 1.13-1.93]) was largely explained by education and insurance status (a proxy for socieoeconomic status; hazard ratio after further adjusting for these variables, 1.17 [95% CI, 0.85-1.62]) but remained significant for women age ≥70. Conclusions- This study provides novel data regarding the increased stroke risk among Caribbean Hispanics in this elderly population. Results highlight the need to create culturally tailored campaigns to reach black and Hispanic populations to reduce race/ethnic stroke disparities and support the important role of low socioeconomic status in driving an elevated risk among Caribbean Hispanics.
Collapse
Affiliation(s)
- Hannah Gardener
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ralph L Sacco
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Ying Kuen Cheung
- Department of Biostatistics, Mailman Public School of Health, Columbia University, New York, NY, USA
| | - Mitchell SV Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
13
|
The effect of aerobic exercise on various symptoms of depression: the mediating role of quality of life. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
The Association Between Family Social Network Size and Healthy Lifestyle Factors: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Behav Med 2019; 43:198-208. [PMID: 31350713 DOI: 10.1007/s10865-019-00082-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 07/16/2019] [Indexed: 12/25/2022]
Abstract
We examined associations of central family (i.e., children, parents, in-laws) social network size with healthy lifestyle factors (i.e., favorable body mass index, physical activity, diet, alcohol use, smoking). Using data on 15,511 Hispanics/Latinos 18-74 years old from the Hispanic Community Health Study/Study of Latinos, multivariable adjusted survey logistic regression was used to compute associations of social network size with healthy lifestyle factors. A one-unit higher total of central family size was associated with lower odds of healthy body mass index (OR 0.90; 95% CI 0.86-0.93) and having all five healthy lifestyle factors (OR 0.90; 95% CI 0.85-0.96). Findings suggest familial structural social support may contribute to healthy lifestyle factors and differ based on the type of relationship among Hispanics/Latinos.
Collapse
|
15
|
Oikawa SY, Holloway TM, Phillips SM. The Impact of Step Reduction on Muscle Health in Aging: Protein and Exercise as Countermeasures. Front Nutr 2019; 6:75. [PMID: 31179284 PMCID: PMC6543894 DOI: 10.3389/fnut.2019.00075] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022] Open
Abstract
Declines in strength and muscle function with age—sarcopenia—contribute to a variety of negative outcomes including an increased risk of: falls, fractures, hospitalization, and reduced mobility in older persons. Population-based estimates of the loss of muscle after age 60 show a loss of ~1% per year while strength loss is more rapid at ~3% per year. These rates are not, however, linear as periodic bouts of reduced physical activity and muscle disuse transiently accelerate loss of muscle and declines in muscle strength and power. Episodic complete muscle disuse can be due to sickness-related bed rest or local muscle disuse as a result of limb immobilization/surgery. Alternatively, relative muscle disuse occurs during inactivity due to illness and the associated convalescence resulting in marked reductions in daily steps, often referred to as step reduction (SR). While it is a “milder” form of disuse, it can have a similar adverse impact on skeletal muscle health. The physiological consequences of even short-term inactivity, modeled by SR, show losses in muscle mass and strength, as well as impaired insulin sensitivity and an increase in systemic inflammation. Though seemingly benign in comparison to bed rest, periodic inactivity likely occurs, we posit, more frequently with advancing age due to illness, declining mental health and declining mobility. Given that recovery from inactivity in older adults is slow or possibly incomplete we hypothesize that accumulated periods of inactivity contribute to sarcopenia. Periodic activity, even in small quantities, and protein supplementation may serve as effective strategies to offset the loss of muscle mass with aging, specifically during periods of inactivity. The aim of this review is to examine the recent literature encompassing SR, as a model of inactivity, and to explore the capacity of nutrition and exercise interventions to mitigate adverse physiological changes as a result of SR.
Collapse
Affiliation(s)
- Sara Y Oikawa
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Tanya M Holloway
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Stuart M Phillips
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
16
|
Dhamoon MS, Cheung YK, Moon YP, Wright CB, Sacco RL, Elkind MSV. Interleukin-6 and lipoprotein-associated phospholipase A2 are associated with functional trajectories. PLoS One 2019; 14:e0214784. [PMID: 30934019 PMCID: PMC6443177 DOI: 10.1371/journal.pone.0214784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/20/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES Inflammatory biomarkers have been associated with stroke and mortality, but inflammation may also have detrimental effects beyond acute events. We hypothesized that serum concentrations of interleukin-6 (IL6) and lipoprotein-associated phospholipase A2 (LpPLA2) were inversely associated with long-term functional decline independently of vascular risk factors, stroke and myocardial infarction (MI) occurring during follow-up. DESIGN Prospective population based cohort study. SETTING The Northern Manhattan Study. PARTICIPANTS (INCLUDING THE SAMPLE SIZE) Race/ethnically diverse stroke-free individuals in northern Manhattan aged ≥40 years (n = 3298). INTERVENTION None. MEASUREMENTS Annual functional assessments with the Barthel index (BI), for a median of 13 years. BI was analyzed as a continuous variable (range 0-100). Baseline demographics, risk factors, and laboratory studies were collected, including IL6 (n = 1679), LpPLA2 mass (n = 1912) and activity (n = 1937). Separate mixed models estimated standardized associations between each biomarker and baseline functional status and change over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up. RESULTS Mean age was 69 (SD 10) years, 35% were male, 53% Hispanic, 74% hypertensive, and 16-24% diabetic. LogIL6 was associated with decline in BI over time (-0.13 points per year, 95% CI -0.24, -0.02) and marginally with baseline BI (-0.20, 95% CI -0.40, 0.01). LpPLA2 activity levels were associated with baseline BI (-0.36, 95% CI -0.68, -0.04) but not change over time, and LpPLA2 mass levels were not associated with either. CONCLUSION In this large population-based study, higher serum inflammatory biomarker levels were associated with disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up.
Collapse
Affiliation(s)
- Mandip S. Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Ying-Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Yeseon P. Moon
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Clinton B. Wright
- National Institutes of Health, Bethesda, MD, United States of America
| | - Ralph L. Sacco
- McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Departments of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, United States of America
- Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Mitchell S. V. Elkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| |
Collapse
|
17
|
Jacobson LT, Hade EM, Collins TC, Margolis KL, Waring ME, Van Horn LV, Silver B, Sattari M, Bird CE, Kimminau K, Wambach K, Stefanick ML. Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative. J Am Heart Assoc 2018; 7:e008739. [PMID: 30371157 PMCID: PMC6201437 DOI: 10.1161/jaha.118.008739] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/20/2018] [Indexed: 11/16/2022]
Abstract
Background Stroke is the third leading cause of death among US Hispanic and non-Hispanic black women aged 65 and older. One factor that may protect against stroke is breastfeeding. Few studies have assessed the association between breastfeeding and stroke and whether this association differs by race and ethnicity. Methods and Results Data were taken from the Women's Health Initiative Observational Study with follow-up through 2010; adjusted hazard ratios for stroke subsequent to childbirth were estimated with Cox regression models accounting for left and right censoring, overall and stratified by race/ethnicity. Of the 80 191 parous women in the Women's Health Initiative Observational Study, 2699 (3.4%) had experienced a stroke within a follow-up period of 12.6 years. The average age was 63.7 years at baseline. Fifty-eight percent (n=46 699) reported ever breastfeeding; 83% were non-Hispanic white, 8% were non-Hispanic black, 4% were Hispanic, and 5% were of other race/ethnicity. After adjustment for nonmodifiable potential confounders, compared with women who had never breastfed, women who reported ever breastfeeding had a 23% lower risk of stroke (adjusted hazard ratio=0.77; 95% confidence interval 0.70-0.83). This association was strongest for non-Hispanic black women (adjusted hazard ratio=0.52; 95% confidence interval 0.37-0.71). Further, breastfeeding for a relatively short duration (1-6 months) was associated with a 19% lower risk of stroke (adjusted hazard ratios=0.81; 95% confidence interval 0.74-0.89). This association appeared stronger with longer breastfeeding duration and among non-Hispanic white and non-Hispanic black women (test for trend P<0.01). Conclusions Study results show an association and dose-response relationship between breastfeeding and lower risk of stroke among postmenopausal women after adjustment for multiple stroke risk factors and lifestyle variables. Further investigation is warranted.
Collapse
Affiliation(s)
- Lisette T. Jacobson
- Department of Preventive Medicine and Public HealthSchool of Medicine‐WichitaUniversity of KansasWichitaKS
| | - Erinn M. Hade
- Center for BiostatisticsDepartment of Biomedical InformaticsThe Ohio State UniversityColumbusOH
| | - Tracie C. Collins
- Department of Preventive Medicine and Public HealthSchool of Medicine‐WichitaUniversity of KansasWichitaKS
| | | | | | | | - Brian Silver
- Department of NeurologyUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Maryam Sattari
- Department of MedicineUniversity of Florida College of MedicineGainesvilleFL
| | | | - Kim Kimminau
- Department of Family MedicineUniversity of Kansas Medical CenterKansas CityKS
| | - Karen Wambach
- School of NursingUniversity of Kansas Medical CenterKansas CityKS
| | | |
Collapse
|
18
|
Willey JZ, Moon YP, Dhamoon MS, Kulick ER, Bagci A, Alperin N, Cheung YK, Wright CB, Sacco RL, Elkind MSV. Regional Subclinical Cerebrovascular Disease Is Associated with Balance in an Elderly Multi-Ethnic Population. Neuroepidemiology 2018; 51:57-63. [PMID: 29953989 DOI: 10.1159/000490351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 05/22/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION White matter hyperintensity volume (WMHV) and subclinical brain infarcts (SBI) are associated with impaired mobility, but less is known about the association of WMHV in specific brain regions. We hypothesized that anterior WMHV would be associated with lower scores on the Short Physical Performance Battery (SPPB), a well-validated mobility scale. METHODS The SPPB was measured a median of 5 years after enrollment into the Northern Manhattan MRI sub study. Volumetric distributions for WMHV in 14 brain regions as a proportion of total cranial volume were determined. Multi-variable linear regression was performed to examine the association of SBI and regional log-WMHV with the SPPB score. RESULTS Among 668 participants with SPPB measurements (mean 74 ± 9 years, 37% male and 70% Hispanic), the mean SPPB score was 8.2 ± 2.9. Total (beta = -0.3 per SD, p = 0.001), anterior periventricular (beta = -0.4 per SD, p = 0.001), parietal (beta = -0.2 per SD, p = 0.02) and frontal (beta = -0.3 per SD, p = 0.002) WMHVs were associated with SPPB; other WMHV and SBI were not associated with the SPPB. CONCLUSIONS WMHV, especially in the anterior -cerebral regions, is associated with a lower SPPB. Prevention of subclinical cerebrovascular disease is a potential target to prevent physical decline in the elderly.
Collapse
Affiliation(s)
- Joshua Z Willey
- Department of Neurology, Columbia University, New York, New York, USA
| | - Yeseon P Moon
- Department of Neurology, Columbia University, New York, New York, USA
| | - Mandip S Dhamoon
- Department of Neurology, Mount Sinai School of Medicine, New York, New York, USA
| | - Erin R Kulick
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - Ahmet Bagci
- Evelyn McKnight Brain Institute, University of Miami, Miami, Florida, USA
| | - Noam Alperin
- Evelyn McKnight Brain Institute, University of Miami, Miami, Florida, USA
| | - Ying Kuen Cheung
- Department of Biostatistics, Columbia University, New York, New York, USA
| | | | - Ralph L Sacco
- Evelyn McKnight Brain Institute, University of Miami, Miami, Florida, USA.,Department of Neurology, University of Miami, Miami, Florida, USA
| | - Mitchell S V Elkind
- Department of Neurology, Columbia University, New York, New York, USA.,Department of Epidemiology, Columbia University, New York, New York, USA
| |
Collapse
|
19
|
Marquez B, Norman G, Fowler J, Gans K, Marcus B. Egocentric networks and physical activity outcomes in Latinas. PLoS One 2018; 13:e0199139. [PMID: 29912935 PMCID: PMC6005572 DOI: 10.1371/journal.pone.0199139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/03/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Despite data linking the social environment to physical inactivity in Latinas, research on social network predictors of physical activity (PA) is limited. This study examined social network predictors of PA change in Latinas. METHODS Egocentric network data were collected from 102 adult Latinas (egos) participating in a randomized controlled PA intervention trial for underactive women. Moderate-to-vigorous PA (MVPA) was measured in minutes per week using the 7-Day PA Recall Interview and accelerometers at baseline and 12 months. Analyses characterized social network structure, composition, tie strength, homogeneity, and support for PA and determined the relationship between network characteristics and PA outcomes. RESULTS Networks had an average of four social ties (alters). Networks were high in density and transitivity and low in components, indicating high cohesion. Networks were primarily composed of females, Latinos, Spanish-speakers, and family members. Relationship ties were strong as evidenced by close living proximity, in-person contact, high emotional closeness, and long relationship duration. There was high homogeneity in demographics and PA behaviors. Multivariate analyses revealed that network size, familial ties, contact frequency, and ego-alter dissimilarities in age and running but similarities in walking, were associated with increased MVPA. Networks high in support for PA in the form of complimenting ego on exercise, taking over chores to allow ego to exercise, and co-participating with ego in exercise were also associated with greater MVPA. CONCLUSION These findings contribute to better understanding interpersonal processes that may influence behavior change in a group with especially low levels of PA.
Collapse
Affiliation(s)
- Becky Marquez
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Greg Norman
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, United States of America
| | - James Fowler
- School of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Kim Gans
- Department of Human Development and Family Studies, Storrs, Connecticut, United States of America
| | - Bess Marcus
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, United States of America
| |
Collapse
|
20
|
Child S, Kaczynski AT, Moore S. Meeting Physical Activity Guidelines: The Role of Personal Networks Among Residents of Low-Income Communities. Am J Prev Med 2017; 53:385-391. [PMID: 28601404 DOI: 10.1016/j.amepre.2017.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 03/21/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Despite known benefits of regular physical activity (PA), residents of low-income communities have disproportionately high rates of physical inactivity. Mounting evidence suggests that social network characteristics may be associated with health behaviors, including PA. The purpose of the current study was to examine associations between egocentric network characteristics and meeting PA guidelines among residents of low-income and predominantly African-American communities. METHODS Data from the Greenville Healthy Neighborhoods Project (2014), a cross-sectional study, examined social network characteristics, including the PA behavior of social ties, and whether participants met PA guidelines (150 minutes per week of aerobic exercise). Respondent-driven sampling (non-random) was utilized to recruit participants (n=430) within eight low-income communities. Logistic regression analyses, performed in 2016, included robust sandwich estimation to account for clustering (non-independence) of observations. RESULTS Participants were predominantly older (M=54.4 years, SD=15.1 years), African American (88.0%), and female (70.7%). More than one third of participants had an annual household income <$15,000 (41.6%) or reported meeting the current aerobic PA guidelines (45.8%). Controlling for sociodemographic characteristics, greater network extensity (based on the occupation of ego's network ties; OR=1.11, 95% CI=1.03, 1.20, p=0.02) and a higher percentage of physically active network members (OR=1.97, 95% CI=1.02, 3.82, p=0.04) were associated with higher odds of meeting PA guidelines. CONCLUSIONS Social network characteristics are associated with individual PA behavior among residents of low-income communities. Interventions to increase PA among low-income and predominantly African-American communities should leverage personal networks, including the implementation of walking groups or buddy systems.
Collapse
Affiliation(s)
- Stephanie Child
- Department of Sociology, University of California, Berkeley, Berkeley, California.
| | - Andrew T Kaczynski
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Prevention Research Center, University of South Carolina, Columbia, South Carolina
| | - Spencer Moore
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
21
|
Dhamoon MS, Cheung YK, Moon YP, Wright CB, Willey JZ, Sacco RL, Elkind MSV. Association Between Serum Tumor Necrosis Factor Receptor 1 and Trajectories of Functional Status: The Northern Manhattan Study. Am J Epidemiol 2017; 186:11-20. [PMID: 28453789 DOI: 10.1093/aje/kwx035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 07/19/2016] [Indexed: 12/25/2022] Open
Abstract
We hypothesized that tumor necrosis factor receptor 1 (TNFR1) levels are associated with long-term trajectories of functional status independently of vascular risk factors and the occurrence of stroke and myocardial infarction (MI) during follow-up. In the Northern Manhattan Study, stroke-free persons aged ≥40 years in northern Manhattan (New York, New York) had annual assessments with the Barthel index (BI) for a median of 13 years (1993-2015). Assessment of baseline demographic factors, risk factors, and laboratory studies included measurement of TNFR1 (n = 1,863). Generalized estimating equations models were used to estimate standardized associations between TNFR1 and 1) baseline functional status and 2) change in function over time, adjusting for demographic factors, vascular risk factors, social variables, cognition, and depression, as well as stroke and MI occurrence during follow-up. The mean age of participants was 70 (standard deviation (SD), 10) years; 66% were women, and 55% were Hispanic. The mean TNFR1 level was 2.57 mg/L. TNFR1 was associated with baseline BI (-0.93 BI points per SD increment in TNFR1; 95% confidence interval: -1.59, -0.26) and change over time (-0.36 BI points per year per SD increment in TNFR1; 95% confidence interval: -0.69, -0.03). In this large population-based study, higher TNFR1 levels were associated with greater baseline disability and disability over time, even with adjustment for baseline covariates and stroke and MI occurrence during follow-up.
Collapse
|
22
|
Abstract
This study identified factors associated with unhealthy lifestyle behaviors in people with metabolic syndrome in South Korea. The sample consisted of 1,207 subjects with metabolic syndrome from the Sixth Korea National Health and Nutrition Examination Survey conducted in 2014. High-risk alcohol consumption, smoking, aerobic physical activity, leisure physical activity, excessive carbohydrate intake, and fat intake were measured. A secondary data analysis was performed using chi-square tests and logistic regression. Gender was associated with all unhealthy behaviors. The number of metabolic syndrome components, a poor perceived health status, and attempts to control weight were associated with physical inactivity. Those findings may be helpful to develop a tailored lifestyle modification programs for people with metabolic syndrome.
Collapse
Affiliation(s)
- Seongmi Moon
- a Department of Nursing , College of Medicine, University of Ulsan , Ulsan , South Korea
| |
Collapse
|
23
|
Holliday KM, Lin DY, Chakladar S, Castañeda SF, Daviglus ML, Evenson KR, Marquez DX, Qi Q, Shay CM, Sotres-Alvarez D, Vidot DC, Zeng D, Avery CL. Targeting physical activity interventions for adults: When should intervention occur? Prev Med 2017; 97:13-18. [PMID: 28024863 PMCID: PMC5337155 DOI: 10.1016/j.ypmed.2016.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/29/2016] [Accepted: 12/21/2016] [Indexed: 11/25/2022]
Abstract
Understanding demographic differences in transitions across physical activity (PA) levels is important for informing PA-promoting interventions, yet few studies have examined these transitions in contemporary multi-ethnic adult populations. We estimated age-, race/ethnicity-, and sex-specific 1-year net transition probabilities (NTPs) for National Health and Nutrition Examination Survey (2007-2012, n=11,556) and Hispanic Community Health Study/Study of Latinos (2008-2011, n=15,585) adult participants using novel Markov-type state transition models developed for cross-sectional data. Among populations with ideal PA (≥150min/week; ranging from 56% (non-Hispanic black females) to 88% (non-Hispanic white males) at age 20), NTPs to intermediate PA (>0-<149min/week) generally increased with age, particularly for non-Hispanic black females for whom a net 0.0% (95% confidence interval (CI): 0.0, 0.2) transitioned from ideal to intermediate PA at age 20; by age 70, the NTP rose to 3.6% (95% CI: 2.3, 4.8). Heterogeneity in intermediate to poor (0min/week) PA NTPs also was observed, with NTPs peaking at age 20 for Hispanic/Latino males and females [age 20 NTP=3.7% (95% CI: 2.0, 5.5) for females and 5.0% (1.2, 8.7) for males], but increasing throughout adulthood for non-Hispanic blacks and whites [e.g. age 70 NTP=7.8% (95% CI: 6.1, 9.6%) for black females and 8.1% (4.7, 11.6) for black males]. Demographic differences in PA net transitions across adulthood justify further development of tailored interventions. However, innovative efforts may be required for populations in which large proportions have already transitioned from ideal PA by early adulthood.
Collapse
Affiliation(s)
- Katelyn M Holliday
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 137 E. Franklin Street Suite 306, Chapel Hill, NC 27514, USA.
| | - Dan Yu Lin
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenburg Hall, Chapel Hill, NC 27514, USA.
| | - Sujatro Chakladar
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenburg Hall, Chapel Hill, NC 27514, USA.
| | - Sheila F Castañeda
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182, USA.
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, 1819 W. Polk Street, Suite 246, Chicago, IL 60612, USA.
| | - Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 137 E. Franklin Street Suite 306, Chapel Hill, NC 27514, USA.
| | - David X Marquez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor Street, Room 625, MC 994, Chicago, IL 60612, USA.
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer 1306A, Bronx, NY 10461, USA.
| | - Christina M Shay
- Department of Nutrition, University of North Carolina at Chapel Hill, 2201 McGavran- Greenberg Hall, Chapel Hill, NC 27599, USA.
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, 137 E. Franklin Street, Suite 203, Chapel Hill, NC 27514, USA.
| | - Denise C Vidot
- University of Miami, Miller School of Medicine, Clinical Research Building, 1120 NW 14th Street, Suite 1515, Miami, FL 33136, USA.
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 3101 McGavran-Greenburg Hall, Chapel Hill, NC 27514, USA.
| | - Christy L Avery
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 137 E. Franklin Street Suite 306, Chapel Hill, NC 27514, USA.
| |
Collapse
|
24
|
Quality of life independently predicts long-term mortality but not vascular events: the Northern Manhattan Study. Qual Life Res 2017; 26:2219-2228. [PMID: 28357682 DOI: 10.1007/s11136-017-1567-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE Cardiovascular disease is a major contributor to morbidity and mortality, and prevention relies on accurate identification of those at risk. Studies of the association between quality of life (QOL) and mortality and vascular events incompletely accounted for depression, cognitive status, social support, and functional status, all of which have an impact on vascular outcomes. We hypothesized that baseline QOL is independently associated with long-term mortality in a large, multi-ethnic urban cohort. METHODS In the prospective, population-based Northern Manhattan Study, Spitzer QOL index (SQI, range 0-10, with ten signifying the highest QOL) was assessed at baseline. Participants were followed over a median 11 years for stroke, myocardial infarction (MI), and vascular and non-vascular death. Multivariable Cox proportional hazards regression estimated hazard ratio and 95% confidence interval (HR, 95% CI) for each outcome, with SQI as the main predictor, dichotomized at 10, adjusting for baseline demographics, vascular risk factors, history of cancer, social support, cognitive status, depression, and functional status. RESULTS Among 3298 participants, mean age was 69.7 + 10.3 years; 1795 (54.5%) had SQI of 10. In fully adjusted models, SQI of 10 (compared to SQI <10) was associated with reduced risk of all-cause mortality (HR 0.80, 95% CI 0.72-0.90), vascular death (0.81, 0.69-0.97), non-vascular death (0.78, 0.67-0.91), and stroke or MI or death (0.82, 0.74-0.91). In fully adjusted competing risk models, there was no association with stroke (0.93, 0.74-1.17), MI (0.98, 0.75-1.28), and stroke or MI (1.03, 0.86-1.24). Results were consistent when SQI was analyzed continuously. CONCLUSION In this large population-based cohort, highest QOL was inversely associated with long-term mortality, vascular and non-vascular, independently of baseline primary vascular risk factors, social support, cognition, depression, and functional status. QOL was not associated with non-fatal vascular events.
Collapse
|
25
|
Kim M, Paik MC, Jang J, Cheung YK, Willey J, Elkind MSV, Sacco RL. Cox proportional hazards models with left truncation and time-varying coefficient: Application of age at event as outcome in cohort studies. Biom J 2017; 59:405-419. [PMID: 28160312 DOI: 10.1002/bimj.201600003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 11/22/2016] [Accepted: 11/29/2016] [Indexed: 11/11/2022]
Abstract
When analyzing time-to-event cohort data, two different ways of choosing a time scale have been discussed in the literature: time-on-study or age at onset of disease. One advantage of choosing the latter is interpretability of the hazard ratio as a function of age. To handle the analysis of age at onset in a principled manner, we present an analysis of the Cox Proportional Hazards model with time-varying coefficient for left-truncated and right-censored data. In the analysis of Northern Manhattan Study (NOMAS) with age at onset of stroke as outcome, we demonstrate that well-established risk factors may be important only around a certain age span and less established risk factors can have a strong effect in a certain age span.
Collapse
Affiliation(s)
- Minjin Kim
- Department of Statistics, Seoul National University, Seoul, 151-747, Korea
| | - Myunghee Cho Paik
- Department of Statistics, Seoul National University, Seoul, 151-747, Korea
| | - Jiyeong Jang
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ying K Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Joshua Willey
- Department of Neurology, Neurological Institute, Columbia University, New York, NY 10032, USA
| | - Mitchell S V Elkind
- Department of Neurology, Neurological Institute, Columbia University, New York, NY 10032, USA
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| |
Collapse
|
26
|
Dhamoon MS, Cheung YK, Moon YP, Wright CB, Willey JZ, Sacco R, Elkind MS. C-reactive protein is associated with disability independently of vascular events: the Northern Manhattan Study. Age Ageing 2017; 46:77-83. [PMID: 28181636 DOI: 10.1093/ageing/afw179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/14/2016] [Indexed: 12/26/2022] Open
Abstract
Background High-sensitivity C-reactive protein (CRP) has been associated with cardiovascular events and mortality, but the association of CRP with functional status is not well defined. We hypothesised that serum levels of high-sensitivity CRP are associated with long-term trajectories of functional status independently of vascular risk factors and stroke and myocardial infarction (MI) occurring during follow-up. Design Prospective, population-based. Setting Northern Manhattan Study. Participants Stroke-free participants aged ≥40 years. Measurements Annual assessments of disability with the Barthel index (BI) for a median of 13 years. BI was analysed as a continuous variable (range 0–100). Baseline demographics, risk factors and laboratory studies were collected, including CRP (n = 2,240). Separate generalised estimating equation models estimated standardised associations between CRP and (i) baseline functional status and (ii) change in function over time, adjusting for demographics, vascular risk factors, social variables, cognition, and depression measured at baseline, and stroke and MI occurring during follow-up. Results Mean age was 69 (SD 10) years, 36% were male, 55% Hispanic, 75% hypertensive and 21% diabetic; 337 MIs and 369 first strokes occurred during follow-up. Mean CRP level was 5.24 mg/l (SD 8.86). logCRP was associated with baseline BI (−0.34 BI points per unit logCRP, 95% confidence interval −0.62, −0.06) but not with change over time. Conclusions In this large population-based study, higher serum CRP levels were associated with higher baseline disability, even when adjusting for baseline covariates and stroke and MI occurring during follow-up. Systemic inflammation may contribute to disability independently of clinical vascular events.
Collapse
Affiliation(s)
- Mandip S Dhamoon
- Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | | | - Yeseon P Moon
- Biostatistics, Columbia University, New York, NY, USA
| | | | | | - Ralph Sacco
- Medicine, University of Miami, Miami, FL, USA
| | | |
Collapse
|
27
|
Marquez B, Dunsiger SI, Pekmezi D, Larsen BA, Marcus BH. Social support and physical activity change in Latinas: Results from the Seamos Saludables trial. Health Psychol 2016; 35:1392-1401. [PMID: 27669178 DOI: 10.1037/hea0000421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Family responsibilities and poor social support are barriers to physical activity among Latinas. This study evaluated the effects of a home- and print-based intervention on social support, moderating effects of familial ties on support and moderate-to-vigorous physical activity (MVPA), and mediating effects of support on MVPA. METHOD Participants were randomized to receive through the mail either individually tailored physical activity intervention or general wellness print materials. Familial ties and social support were assessed by marital and child status and the social support for physical activity measure, respectively. MVPA was measured using the 7-day Physical Activity Recall Interview and accelerometer. Assessments were conducted at baseline, 6 months posttreatment, and 12 months follow-up. RESULTS Participants (n = 266; 40.6 ± 9.9 years old) were mostly immigrant and Spanish-speaking Latinas. The intervention group achieved greater increases in family and friend support compared to the wellness control group from baseline to posttreatment and follow-up (p < .05). Intervention changes in support did not depend on marital or child status. The intervention also increased minutes per week of MVPA more than the wellness control (p < .05) and the effect did not depend on marital or child status. There were significant indirect effects of treatment, indicating the intervention achieved greater increases in MVPA by increasing family (ab = 5.21, SE = 2.94, 95% confidence interval [CI] = 0.91-14.11) and friend (ab = 6.83, SE = 5.15, 95% CI = 0.16-20.56) support. CONCLUSIONS The intervention improved and sustained support from family and friends and MVPA irrespective of familial ties. Social support mediated increases in MVPA. (PsycINFO Database Record
Collapse
Affiliation(s)
| | - Shira I Dunsiger
- of Psychiatry & Human Behavior, Miriam Hospital, Brown University
| | - Dori Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama
| | | | | |
Collapse
|
28
|
Marquez B, Gonzalez P, Gallo L, Ji M. Latino Civic Group Participation, Social Networks, and Physical Activity. Am J Health Behav 2016; 40:437-45. [PMID: 27338990 DOI: 10.5993/ajhb.40.4.5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We examined whether social networks and resource awareness for physical activity may mediate the relationship between civic group participation and physical activity. METHODS This is a cross-sectional study of a randomly selected sample of 335 Latinos (mean age 42.1 ± 16.4 years) participating in the San Diego Prevention Research Center's 2009 Household Community Survey. Serial multiple mediation analysis tested the hypothesis that civic group participation is associated with meeting physical activity recommendations through an indirect mechanism of larger social networks followed by greater knowledge of physical activity community resources. RESULTS The indirect effects of level of civic group participation as well as religious, health, neighborhood, or arts group participation on meeting national physical activity recommendations were significant in models testing pathways through social network size and physical activity resource awareness. The direct effect was only significant for health group indicating that participating in a health group predicted physical activity independent of social network size and awareness of physical activity resources. CONCLUSION Belonging to civic groups may promote physical activity engagement through social network diffusion of information on community physical activity resources which has implications for health.
Collapse
Affiliation(s)
- Becky Marquez
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA.
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Linda Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
29
|
Waterman MR, Wiecha JM, Manne J, Tringale SM, Costa E, Wiecha JL. Utilization of a free fitness center-based exercise referral program among women with chronic disease risk factors. J Community Health 2016; 39:1179-85. [PMID: 24752958 DOI: 10.1007/s10900-014-9874-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Physical activity (PA) reduces the risk for a number of chronic diseases including heart disease, hypertension, hyperlipidemia, and diabetes mellitus type 2. However, most Americans do not meet expert recommendations for exercise, and minorities and low-income persons are the most inactive. Community-based approaches to promoting PA include primary care exercise referral programs. This study examines patient characteristics associated with utilization of a community health center-based exercise referral program. Adult female patients of a community health center with an affiliated fitness center, in Boston, MA, were included in the study if they received a referral to the fitness center from their primary care provider. Demographic and medical information was abstracted from the medical chart, and fitness records were abstracted to measure activation of a fitness center membership (creation of an account denoting at least an initial visit) and utilization over time. Overall, 503 (40%) of the 1,254 referred women in the study sample activated their membership. Black women were almost 60% more likely to activate their membership (adjusted OR 1.6, 95% CI 1.2-2.2), and women with higher co-morbidity counts were almost 45% more likely to activate (adjusted OR 1.4, 95% CI 1.0-2.0). Once activated, a minority of women participated at levels likely to improve cardiometabolic fitness. Of the 503 activations, 96 (19%) had no participation, 359 (71%) had low participation, and only 48 (10%) had high participation. No independent predictors of participation were identified. These findings suggest that program design may benefit from developing activation, initial participation, and retention strategies that address population-specific barriers.
Collapse
Affiliation(s)
- Megan R Waterman
- Department of Family Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | | | | |
Collapse
|
30
|
Hernández D. Affording Housing at the Expense of Health: Exploring the Housing and Neighborhood Strategies of Poor Families. JOURNAL OF FAMILY ISSUES 2016; 37:921-946. [PMID: 27057078 PMCID: PMC4819250 DOI: 10.1177/0192513x14530970] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Low-income families often simultaneously encounter housing and neighborhood problems pertaining to safety, affordability, and quality issues that necessitate strategies to maximize limited budgets and ensure safety. Such constrained decisions regarding inadequate housing and poor neighborhood conditions, however, may themselves create or exacerbate health risks. Building on the survival strategies literature, this article offers rich and detailed accounts of coping and management strategies on the part of vulnerable families facing housing and neighborhood hardships. The findings are based on in-depth interviews with 72 respondents and ethnographic observations in an urban community. The results illustrate how low-income women avoid neighborhood danger by relegating family life to the home environment, thereby increasing exposure to health risks such as stress, depression, and asthma. The discussion focuses on public health literature linking housing and health and proposes the use of legal strategies and community engagement as resources to complement current approaches to housing and neighborhood problems.
Collapse
|
31
|
Santos SJD, Hardman CM, Barros SSH, Santos da Franca C, Barros MVGD. Association between physical activity, participation in Physical Education classes, and social isolation in adolescents. J Pediatr (Rio J) 2015; 91:543-50. [PMID: 26113429 DOI: 10.1016/j.jped.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/31/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze the association between physical activity, participation in Physical Education classes, and indicators of social isolation among adolescents. METHODS This was an epidemiological study based on secondary analysis of data from a representative sample of students (14-19 years) from public high schools (n=4,207). Data were collected through the questionnaire Global School-based Student Health Survey. The independent variables were the level of physical activity and enrollment in Physical Education classes, while the dependent variables were two indicators of social isolation (feeling of loneliness and having few friends). Descriptive and inferential procedures were used in the statistical analysis. RESULTS Most of the adolescents were classified as insufficiently active (65.1%) and reported not attending Physical Education classes (64.9%). Approximately two in each ten participants reported feeling of loneliness (15.8%) and, in addition, about one in each five adolescents reported have only one friend (19.5%). In the bivariate analysis, a significantly lower proportion of individuals reporting social isolation was observed among adolescents who referred higher enrollment in Physical Education classes. After adjustment for confounding variables, binary logistic regression showed that attending Physical Education classes was identified as a protective factor in relation to the indicator of social isolation 'having few friends,' but only for girls. CONCLUSIONS It was concluded that participation in Physical Education classes is associated with reduced social isolation among female adolescents.
Collapse
Affiliation(s)
- Simone José dos Santos
- Post-graduate Program in Hebiatria, Universidade de Pernambuco (UPE), Camaragibe, PE, Brazil.
| | - Carla Menêses Hardman
- Post-graduation Program in Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Department of Physical Education, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Simone Storino Honda Barros
- Post-graduation Program in Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Post-graduation Program in Physical Education, Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | | | - Mauro Virgilio Gomes de Barros
- Post-graduate Program in Hebiatria, Universidade de Pernambuco (UPE), Camaragibe, PE, Brazil; Post-graduation Program in Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Post-graduation Program in Physical Education, Universidade de Pernambuco (UPE), Recife, PE, Brazil
| |
Collapse
|
32
|
Santos SJD, Hardman CM, Barros SSH, Barros MVGD. Association between physical activity, participation in Physical Education classes, and social isolation in adolescents. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
33
|
Monteith TS, Gardener H, Rundek T, Elkind MSV, Sacco RL. Migraine and risk of stroke in older adults: Northern Manhattan Study. Neurology 2015. [PMID: 26203088 DOI: 10.1212/wnl.0000000000001854] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the association between migraine and stroke/vascular outcomes in a racially/ethnically diverse, older cohort. METHODS Participants from the Northern Manhattan Study, a population-based cohort study of stroke incidence, were assessed for migraine symptoms using a self-report questionnaire based on criteria from the International Classification of Headache Disorders, second edition. We estimated the association between migraine and combined vascular events including stroke and stroke only over a mean follow-up of 11 years, using Cox models adjusted for sociodemographic and vascular risk factors. RESULTS Of 1,292 participants (mean age 68 ± 9 years) with migraine data followed prospectively for vascular events, 262 patients (20%) had migraine and 75 (6%) had migraine with aura. No association was found between migraine (with or without aura) and risk of either stroke or combined cardiovascular events. There was an interaction between migraine and current smoking (p = 0.02 in relation to stroke and p = 0.03 for combined vascular events), such that those with migraine and smoking were at an increased risk. The hazard ratio of stroke for migraine among current smokers was 3.17 (95% confidence interval [CI] 1.13-8.85) and among current nonsmokers was 0.77 (95% CI 0.44-1.35). In relation to combined vascular events, the hazard ratio for migraine vs no migraine among current smokers was 1.83 (95% CI 0.89-3.75) and among current nonsmokers was 0.63 (95% CI 0.43-0.94). CONCLUSION In our racially/ethnically diverse population-based cohort, migraine was associated with an increased risk of stroke among active smokers but not among nonsmokers.
Collapse
Affiliation(s)
- Teshamae S Monteith
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - Hannah Gardener
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Tatjana Rundek
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Mitchell S V Elkind
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Ralph L Sacco
- From the Department of Neurology (T.S.M., H.G., T.R., R.L.S.), University of Miami School of Medicine, FL; and Department of Neurology (M.S.V.E.), College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| |
Collapse
|
34
|
Willey JZ, Moon YP, Sherzai A, Cheung YK, Sacco RL, Elkind MSV. Leisure-time physical activity and mortality in a multiethnic prospective cohort study: the Northern Manhattan Study. Ann Epidemiol 2015; 25:475-479.e2. [PMID: 25982960 PMCID: PMC4457561 DOI: 10.1016/j.annepidem.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE To examine whether the survival benefit of exercise is modified by obesity. METHODS In the Northern Manhattan Study, we collected baseline sociodemographics and cardiovascular disease risk factors. The primary exposure was leisure-time physical activity (LTPA) and the outcomes were total, vascular, and nonvascular deaths (non-VaD). LTPA was defined as any versus none and metabolic equivalent score category (total activity weighted by intensity). We used Cox models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS A total of 3298 participants (mean age 69 years, 52% Hispanic, 63% women) were followed over a mean of 11.8 years with 1589 total deaths (641 vascular, 819 nonvascular). Any activity (adjusted HR: 0.84, 95% CI: 0.75-0.94) was associated with reduced risk of all-cause mortality and non-VaD, but not VaD. We found an interaction (P < .05) of LTPA with body mass index (BMI) less than 30 for all-cause and vascular mortality. Any LTPA was associated with reduced all-cause mortality (adjusted HR: 0.77, 95% CI: 0.68-0.87) and VaD (adjusted HR: 0.79, 95% CI: 0.65-0.97) only among those with BMI less than 30. CONCLUSIONS We found no evidence of an independent survival benefit of LTPA among those with BMI more than 30. The health benefits of exercise should be considered in the context of obesity.
Collapse
Affiliation(s)
| | | | - Ayesha Sherzai
- Department of Neurology, Columbia University, New York, NY
| | | | - Ralph L Sacco
- Department of Neurology, University of Miami, Miami, FL
| | | |
Collapse
|
35
|
Effects of music aerobic exercise on depression and brain-derived neurotrophic factor levels in community dwelling women. BIOMED RESEARCH INTERNATIONAL 2015; 2015:135893. [PMID: 26075212 PMCID: PMC4446469 DOI: 10.1155/2015/135893] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/17/2022]
Abstract
A randomized clinical trial was utilized to compare the improvement of depression and brain-derived neurotrophic factor (BDNF) levels between community women with and without music aerobic exercise (MAE) for 12 weeks. The MAE group involved 47 eligible participants, whereas the comparison group had 59 participants. No significant differences were recorded in the demographic characteristics between the participants in the MAE group and the comparison group. Forty-one participants in the MAE group and 26 in the comparison group completed a pre- and posttest. The MAE group displayed significant improvement in depression scores (p = 0.016), decreased depression symptoms in crying (p = 0.03), appetite (p = 0.006), and fatigue (p = 0.011). The BDNF levels of the participants significantly increased after the 12-week MAE (p = 0.042). The parallel comparison group revealed no significant changes in depression scores or BDNF levels. In summary, the 12-week MAE had a significant impact on the enhancement of BDNF levels and improvement of depression symptoms. Middle-aged community women are encouraged to exercise moderately to improve their depression symptoms and BDNF levels.
Collapse
|
36
|
Moderating Effects of Health Literacy on Change in Physical Activity Among Latinas in a Randomized Trial. J Racial Ethn Health Disparities 2015; 2:351-7. [PMID: 26863464 DOI: 10.1007/s40615-014-0080-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/30/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Latinas report low rates of physical activity (PA) and are at risk for poor health outcomes. Language and literacy barriers impede access and utilization of PA-related resources. This study examined health literacy as a moderator on changes in moderate-to-vigorous physical activity (MVPA) in 196 Latinas enrolled in Seamos Saludables, a randomized-controlled trial of a 6-month culturally and linguistically adapted PA print intervention METHODS Secondary analyses were conducted on demographics, acculturation and generation status, and health literacy (Newest Vital Sign). MVPA was determined by 7 day physical activity recall, assessed at baseline and 6 months. General linear models examined interaction effects between health literacy (HL), experimental condition (treatment vs. control), and generation status. RESULTS Health literacy moderated change in MVPA from baseline to 6 months. The intervention effect was greater among first-generation Latinas with limited health literacy. DISCUSSION Differences in health literacy level appear to influence MVPA outcomes. Formative research is recommended to ensure that materials are appropriate when developing print-based PA interventions, particularly among first-generation Latinas who are more likely to have limited health literacy.
Collapse
|
37
|
Halbert CH, Bellamy S, Briggs V, Bowman M, Delmoor E, Kumanyika S, Rogers R, Purnell J, Weathers B, Johnson JC. Collective efficacy and obesity-related health behaviors in a community sample of African Americans. J Community Health 2014; 39:124-31. [PMID: 24026302 DOI: 10.1007/s10900-013-9748-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The social environment is important to body mass index and obesity. However, it is unknown if perceptions of the social environment are associated with obesity-related behaviors in populations at greatest risk for being overweight or obese. We evaluated the relationship between collective efficacy and diet and physical activity in a community-based sample of African American adults who were residents in an urban area. Data were collected as part of an academic-community partnership from November 2009 to 2011. We evaluated whether participants met the recommended guidelines for diet and physical activity based on collective efficacy and their sociodemographic background, health care variables, and self-efficacy in a community-based sample of African American adults (n = 338) who were residents in the Philadelphia, PA metropolitan area. Overall, many participants did not meet the recommended guidelines for fruit and vegetable intake or physical activity. The likelihood of meeting the recommended guidelines for fruit intake increased with greater levels of collective efficacy (OR 1.56, 95 % CI 1.18, 2.07, p = 0.002) and self-efficacy for diet (OR 1.56, 95 % CI 1.19, 2.04, p = 0.001). Collective efficacy was not associated with physical activity and the positive association between collective efficacy and vegetable intake was not statistically significant (OR 1.25, 95 % CI 0.94, 1.65, p = 0.12). It is important to determine the most effective methods and settings for improving diet and physical activity behaviors in urban African Americans. Enhancing collective efficacy may be important to improving adherence to recommended guidelines for obesity-related health behaviors.
Collapse
Affiliation(s)
- Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center, Medical University of South Carolina, 68 President Street, Suite BE103, Charleston, SC, 29425, USA,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Marquez B, Elder JP, Arredondo EM, Madanat H, Ji M, Ayala GX. Social network characteristics associated with health promoting behaviors among Latinos. Health Psychol 2014; 33:544-53. [PMID: 24884908 PMCID: PMC10005843 DOI: 10.1037/hea0000092] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study examined the relationship between social network characteristics and health promoting behaviors (having a routine medical check-up, consuming no alcohol, consuming no fast food, and meeting recommendations for leisure-time physical activity and sleep duration) among Latinos to identify potential targets for behavioral interventions. METHOD Personal network characteristics and health behavior data were collected from a community sample of 393 adult Latinos (73% women) in San Diego County, California. Network characteristics consisted of size and composition. Network size was calculated by the number of alters listed on a name generator questionnaire eliciting people with whom respondents discussed personal issues. Network composition variables were the proportion of Latinos, Spanish-speakers, females, family, and friends listed in the name generator. Additional network composition variables included marital status and the number of adults or children in the household. RESULTS Network members were predominately Latinos (95%), Spanish-speakers (80%), females (64%), and family (55%). In multivariate logistic regression analyses, gender moderated the relationship between network composition, but not size, and a health behavior. Married women were more likely to have had a routine medical check-up than married men. For both men and women, having a larger network was associated with meeting the recommendation for leisure-time physical activity. CONCLUSION Few social network characteristics were significantly associated with health promoting behaviors, suggesting a need to examine other aspects of social relationships that may influence health behaviors.
Collapse
Affiliation(s)
- Becky Marquez
- Department of Family & Preventive Medicine, University of California-San Diego
| | - John P Elder
- Graduate School of Public Health, San Diego State University, San Diego Prevention Research Center
| | - Elva M Arredondo
- Graduate School of Public Health, San Diego State University, San Diego Prevention Research Center
| | - Hala Madanat
- Graduate School of Public Health, San Diego State University, San Diego Prevention Research Center
| | - Ming Ji
- Graduate School of Public Health, San Diego State University, San Diego Prevention Research Center
| | - Guadalupe X Ayala
- Graduate School of Public Health, San Diego State University, San Diego Prevention Research Center
| |
Collapse
|
39
|
Mateen FJ, Geer JP, Frick K, Carone M. Neurologic disorders in Medicaid vs privately insured children and working-age adults. Neurol Clin Pract 2014; 4:136-145. [PMID: 24790798 DOI: 10.1212/cpj.0000000000000011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This retrospective, observational study reports health utilization and access patterns of Medicaid recipients for neurologic diseases compared to privately insured individuals seen in 2 hospitals at a single institution in the same time period. We reviewed records of patients and compared demographic characteristics, visit types, neurologic diagnoses, and all-cause mortality, by age group, when seen with Medicaid vs private insurance. Adults insured by Medicaid were more likely to present as inpatients and with life-threatening neurologic disease compared to privately insured patients. Moreover, adult patients presenting with neurologic disease on Medicaid had a higher all-cause mortality rate than privately insured patients. Similar disparities in neurologic disease were not observed in children. The relationship of these findings to patient educational status, household income, comorbidities, and the reasons prompting Medicaid eligibility require additional study.
Collapse
Affiliation(s)
- Farrah J Mateen
- Department of Neurology (FJM), Massachusetts General Hospital, Boston; Departments of International Health (FJM) and Health Policy and Management (KF), The Bloomberg School of Public Health, The Johns Hopkins University, Baltimore; Department of Neurology (JPG), Johns Hopkins Hospital, Baltimore, MD; and Department of Biostatistics (MC), School of Public Health, University of Washington, Seattle, WA
| | - Joseph P Geer
- Department of Neurology (FJM), Massachusetts General Hospital, Boston; Departments of International Health (FJM) and Health Policy and Management (KF), The Bloomberg School of Public Health, The Johns Hopkins University, Baltimore; Department of Neurology (JPG), Johns Hopkins Hospital, Baltimore, MD; and Department of Biostatistics (MC), School of Public Health, University of Washington, Seattle, WA
| | - Kevin Frick
- Department of Neurology (FJM), Massachusetts General Hospital, Boston; Departments of International Health (FJM) and Health Policy and Management (KF), The Bloomberg School of Public Health, The Johns Hopkins University, Baltimore; Department of Neurology (JPG), Johns Hopkins Hospital, Baltimore, MD; and Department of Biostatistics (MC), School of Public Health, University of Washington, Seattle, WA
| | - Marco Carone
- Department of Neurology (FJM), Massachusetts General Hospital, Boston; Departments of International Health (FJM) and Health Policy and Management (KF), The Bloomberg School of Public Health, The Johns Hopkins University, Baltimore; Department of Neurology (JPG), Johns Hopkins Hospital, Baltimore, MD; and Department of Biostatistics (MC), School of Public Health, University of Washington, Seattle, WA
| |
Collapse
|
40
|
Kaur J, Kaur G, Ho BK, Yao WK, Salleh M, Lim KH. Predictors of physical inactivity among elderly malaysians: recommendations for policy planning. Asia Pac J Public Health 2014; 27:314-22. [PMID: 24425796 DOI: 10.1177/1010539513517257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physical inactivity is the fourth leading risk factor for global mortality. Regular moderate-intensity physical activity has significant benefits for health. To determine the socioeconomic predictors of physical inactivity among elderly Malaysian population. A nationwide community-based survey was conducted among 4831 respondents aged ≥60 years with a face-to-face questionnaire. The prevalence of physical inactivity among the elderly was 88.0%, highest in respondents aged older than 80 years (95.4%), females (90.1%), other Bumiputra (92.2%), earning household income less than RM1000 (87.9%), and residing in urban locality (88.4%). In the multivariate model, the predictors of physical inactivity were only sex, ethnicity, locality, and age group (adjusted odds ratio = 1.3-3.6). The predictors of physical inactivity can identify the risk factors to develop policies that will reduce the public health burden of noncommunicable diseases.
Collapse
Affiliation(s)
- Jasvindar Kaur
- Institute for Public Health, Ministry of Health, Bangsar, Malaysia
| | - Gurpreet Kaur
- Institute for Public Health, Ministry of Health, Bangsar, Malaysia
| | | | | | | | - Kuang Hock Lim
- Institute for Public Health, Ministry of Health, Bangsar, Malaysia
| |
Collapse
|
41
|
Dhamoon MS, Moon YP, Paik MC, Sacco RL, Elkind MSV. Diabetes predicts long-term disability in an elderly urban cohort: the Northern Manhattan Study. Ann Epidemiol 2014; 24:362-368.e1. [PMID: 24485410 DOI: 10.1016/j.annepidem.2013.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 12/11/2013] [Accepted: 12/24/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE There are limited data on vascular predictors of long-term disability in Hispanics. We hypothesized that (1) functional status declines over time and (2) vascular risk factors predict functional decline. METHODS The Northern Manhattan Study contains a population-based study of 3298 stroke-free individuals aged 40 years or older, followed for median 11 years. The Barthel Index (BI) was assessed annually. Generalized estimating equations and Cox models were adjusted for demographic, medical, and social risk factors. Stroke and myocardial infarction occurring during follow-up were censored in sensitivity analysis. Secondarily, motor and nonmotor domains of the BI were analyzed. RESULTS Mean age (standard deviation) of the cohort (n = 3298) was 69.2 (10) years, 37% were male, 52% Hispanic, 22% diabetic, and 74% hypertensive. There was a mean annual decline of 1.02 BI points (P < .0001). Predictors of decline in BI included age, female sex, diabetes, depression, and normocholesterolemia. Results did not change with censoring. We found similar predictors of BI for motor and nonmotor domains. CONCLUSION In this large, population-based, multiethnic study with long-term follow-up, we found a 1% mean decline in function per year that did not change when vascular events were censored. Diabetes predicted functional decline in the absence of clinical vascular events.
Collapse
Affiliation(s)
- Mandip S Dhamoon
- Department of Neurology, Mount Sinai School of Medicine, New York, NY.
| | - Yeseon Park Moon
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Myunghee C Paik
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Ralph L Sacco
- Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL; Department of Public Health Sciences and Human Genetics, Miller School of Medicine, University of Miami, FL; Department of Human Genetics, Miller School of Medicine, University of Miami, FL
| | - Mitchell S V Elkind
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY
| |
Collapse
|
42
|
Goodman D, Park HL, Stefanick M, LeBlanc E, Bea J, Qi L, Kapphahn K, Lamonte M, Manini T, Desai M, Anton-Culver H. Relation between self-recalled childhood physical activity and adult physical activity: The women's health initiative. OPEN JOURNAL OF EPIDEMIOLOGY 2013; 3:224-231. [PMID: 26877895 PMCID: PMC4749265 DOI: 10.4236/ojepi.2013.34033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Evidence suggests that childhood physical activity may play a role in the etiology and prevention of adult chronic diseases. Because researchers must often depend on self-recalled physical activity data many years after the exposure, it is important to understand factors which may influence adult recall of childhood physical activity. This study evaluated the influence of adult characteristics on reported childhood physical activity and the association between adult physical activity and self-recalled childhood physical activity. METHODS 48,066 post-menopausal women from the Women's Health Initiative Observational Study reported their physical activity level during ages 5 - 9, 10 - 14, and 15 - 19. RESULTS In this cohort, over 65% of the population reported the same category of physical activity over the three childhood age groups. While higher levels of childhood physical activity were significantly associated with higher adult physical activity, this association varied by race/ethnicity, education, smoking, body mass index, history of diabetes or cardiovascular disease, social support and physical functional status. Women who were consistently highly active reported adult physical activity levels that were 2.82 MET-hr/week (95% C.I. = 2.43, 3.20) higher compared to women who were always physically inactive during childhood. CONCLUSIONS It is important for researchers to understand the influence of adult characteristics on reported childhood physical activity.
Collapse
Affiliation(s)
- Deborah Goodman
- Department of Epidemiology, University of California, Irvine, USA
| | - Hannah L. Park
- Department of Epidemiology, University of California, Irvine, USA
| | - Marcia Stefanick
- S Stanford Prevention Research Center, Stanford University, Palo Alto, USA
| | - Erin LeBlanc
- Center for Health Research, Kaiser Permanente, Portland, USA
| | - Jennifer Bea
- Cancer Center, University of Arizona, Tuscon, Arizona, USA
| | - Lihong Qi
- Department of Public Health, University of California Davis, Sacramento, USA
| | | | - Michael Lamonte
- Department of Social and Preventive Medicine, University at Buffalo, Buffalo, USA
| | - Tood Manini
- Institute on Aging, University of Florida, Gainesville, USA
| | - Manisha Desai
- S Stanford Prevention Research Center, Stanford University, Palo Alto, USA
| | | |
Collapse
|
43
|
Zahuranec DB, Wing JJ, Edwards DF, Menon RS, Fernandez SJ, Burgess RE, Sobotka IA, German L, Trouth AJ, Shara NM, Gibbons MC, Boden-Albala B, Kidwell CS. Poor long-term blood pressure control after intracerebral hemorrhage. Stroke 2012; 43:2580-5. [PMID: 22903494 DOI: 10.1161/strokeaha.112.663047] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hypertension is the most important risk factor associated with intracerebral hemorrhage. We explored racial differences in blood pressure (BP) control after intracerebral hemorrhage and assessed predictors of BP control at presentation, 30 days, and 1 year in a prospective cohort study. METHODS Subjects with spontaneous intracerebral hemorrhage were identified from the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) Project. BP was compared by race at each time point. Multivariable linear regression was used to determine predictors of presenting mean arterial pressure, and longitudinal linear regression was used to assess predictors of mean arterial pressure at follow-up. RESULTS A total of 162 patients were included (mean age, 59 years; 53% male; 77% black). Mean arterial pressure at presentation was 9.6 mm Hg higher in blacks than whites despite adjustment for confounders (P=0.065). Fewer than 20% of patients had normal BP (<120/80 mm Hg) at 30 days or 1 year. Although there was no difference at 30 days (P=0.331), blacks were more likely than whites to have Stage I/II hypertension at 1 year (P=0.036). Factors associated with lower mean arterial pressure at follow-up in multivariable analysis were being married at baseline (P=0.032) and living in a facility (versus personal residence) at the time of BP measurement (P=0.023). CONCLUSIONS Long-term BP control is inadequate in patients after intracerebral hemorrhage, particularly in blacks. Further studies are needed to understand the role of social support and barriers to control to identify optimal approaches to improve BP in this high-risk population.
Collapse
Affiliation(s)
- Darin B Zahuranec
- Department of Neurology, Stroke Program, School of Public Health, University of Michigan Cardiovascular Center, Ann Arbor, MI 48109-5855, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Gardener H, Rundek T, Wright CB, Elkind MSV, Sacco RL. Dietary sodium and risk of stroke in the Northern Manhattan study. Stroke 2012; 43:1200-5. [PMID: 22499576 DOI: 10.1161/strokeaha.111.641043] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The American Heart Association recommends limiting sodium intake to ≤ 1500 mg/day for ideal cardiovascular health. Although sodium intake has been linked to vascular disease by direct relationship with hypertension, few studies have supported an association with stroke risk. METHODS Participants were from the Northern Manhattan Study (mean age 69 ± 10 years, 64% women, 21% white, 53% Hispanic, 24% black), a population-based cohort study of stroke incidence. Sodium intake was assessed with a food frequency questionnaire at baseline and evaluated continuously and categorically: ≤ 1500 mg/day (12%), 1501 to 2300 mg/day (24%), 2301 to 3999 mg/day (43%), and ≥ 4000 mg/day (21%). Over a mean follow-up of 10 years, we examined the association between sodium consumption and 235 strokes using Cox models adjusting for sociodemographics, diet, behavioral/lifestyle, and vascular risk factors. RESULTS Of 2657 participants with dietary data, the mean sodium intake was 3031 ± 1470 mg/day (median, 2787; interquartile range, 1966-3815 mg/day). Participants who consumed ≥ 4000 mg/day sodium had an increased risk of stroke (hazard ratio, 2.59; 95% CI, 1.27-5.28) versus those who consumed ≤ 1500 mg/day with a 17% increased risk of stroke for each 500-mg/day increase (95% CI, 1.07-1.27). CONCLUSIONS High sodium intake was prevalent and associated with an increased risk of stroke independent of vascular risk factors. The new American Heart Association dietary sodium goals will help reduce stroke risk.
Collapse
Affiliation(s)
- Hannah Gardener
- Department of Neurology, University of Miami, Miami, FL, USA.
| | | | | | | | | |
Collapse
|
45
|
Khuwaja AK, Khawaja S, Motwani K, Khoja AA, Azam IS, Fatmi Z, Ali BS, Kadir MM. Preventable lifestyle risk factors for non-communicable diseases in the Pakistan Adolescents Schools Study 1 (PASS-1). J Prev Med Public Health 2012; 44:210-7. [PMID: 22020186 PMCID: PMC3249258 DOI: 10.3961/jpmph.2011.44.5.210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. Methods In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. Results Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had ≥2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). Conclusions Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.
Collapse
Affiliation(s)
- Ali Khan Khuwaja
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan.
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Taking on the challenge of noncommunicable diseases: We all hold a piece of the puzzle. Int J Gynaecol Obstet 2011; 115 Suppl 1:S52-4. [DOI: 10.1016/s0020-7292(11)60016-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
47
|
Rambod M, Porszasz J, Make BJ, Crapo JD, Casaburi R. Six-minute walk distance predictors, including CT scan measures, in the COPDGene cohort. Chest 2011; 141:867-875. [PMID: 21960696 DOI: 10.1378/chest.11-0870] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Exercise tolerance in COPD is only moderately well predicted by airflow obstruction assessed by FEV(1). We determined whether other phenotypic characteristics, including CT scan measures, are independent predictors of 6-min walk distance (6MWD) in the COPDGene cohort. METHODS COPDGene recruits non-Hispanic Caucasian and African American current and ex-smokers. Phenotyping measures include postbronchodilator FEV(1) % predicted and inspiratory and expiratory CT lung scans. We defined % emphysema as the percentage of lung voxels < -950 Hounsfield units on the inspiratory scan and % gas trapping as the percentage of lung voxels < -856 Hounsfield units on the expiratory scan. RESULTS Data of the first 2,500 participants of the COPDGene cohort were analyzed. Participant age was 61 ± 9 years; 51% were men; 76% were non-Hispanic Caucasians, and 24% were African Americans. Fifty-six percent had spirometrically defined COPD, with 9.3%, 23.4%, 15.0%, and 8.3% in GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I to IV, respectively. Higher % emphysema and % gas trapping predicted lower 6MWD (P < .001). However, in a given spirometric group, after adjustment for age, sex, race, and BMI, neither % emphysema nor % gas trapping, or their interactions with FEV(1) % predicted, remained a significant 6MWD predictor. In a given spirometric group, only 16% to 27% of the variance in 6MWD could be explained by age, male sex, Caucasian race, and lower BMI as significant predictors of higher 6MWD. CONCLUSIONS In this large cohort of smokers in a given spirometric stage, phenotypic characteristics were only modestly predictive of 6MWD. CT scan measures of emphysema and gas trapping were not predictive of 6MWD after adjustment for other phenotypic characteristics.
Collapse
Affiliation(s)
- Mehdi Rambod
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Janos Porszasz
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | | | | | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA.
| | | |
Collapse
|
48
|
Willey JZ, Moon YP, Paik MC, Yoshita M, Decarli C, Sacco RL, Elkind MSV, Wright CB. Lower prevalence of silent brain infarcts in the physically active: the Northern Manhattan Study. Neurology 2011; 76:2112-8. [PMID: 21653889 DOI: 10.1212/wnl.0b013e31821f4472] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the independent association between physical activity and subclinical cerebrovascular disease as measured by silent brain infarcts (SBI) and white matter hyperintensity volume (WMHV). METHODS The Northern Manhattan Study (NOMAS) is a population-based prospective cohort examining risk factors for incident vascular disease, and a subsample underwent brain MRI. Our primary outcomes were SBI and WMHV. Baseline measures of leisure-time physical activity were collected in person. Physical activity was categorized by quartiles of the metabolic equivalent (MET) score. We used logistic regression models to examine the associations between physical activity and SBI, and linear regression to examine the association with WMHV. RESULTS There were 1,238 clinically stroke-free participants (mean age 70 ± 9 years) of whom 60% were women, 65% were Hispanic, and 43% reported no physical activity. A total of 197 (16%) participants had SBI. In fully adjusted models, compared to those who did not engage in physical activity, those in the upper quartile of MET scores were almost half as likely to have SBI (adjusted odds ratio 0.6, 95% confidence interval 0.4-0.9). Physical activity was not associated with WMHV. CONCLUSIONS Increased levels of physical activity were associated with a lower risk of SBI but not WMHV. Engaging in moderate to heavy physical activities may be an important component of prevention strategies aimed at reducing subclinical brain infarcts.
Collapse
Affiliation(s)
- J Z Willey
- Departments of Neurology, Columbia University, New York, NY 10032, USA
| | | | | | | | | | | | | | | |
Collapse
|