1
|
Nguyen AW, Bubu OM, Ding K, Lincoln KD. Chronic stress exposure, social support, and sleep quality among African Americans: findings from the National Survey of American Life-Reinterview. ETHNICITY & HEALTH 2024:1-25. [PMID: 38932587 DOI: 10.1080/13557858.2024.2367976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/06/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE The purpose of this study was to determine whether social support from extended family and church members moderate the association between chronic stress exposure and sleep quality in a nationally representative sample of African American adults. DESIGN Data from African American respondents aged 18 and older were drawn from the National Survey of American Life-Reinterview. The analytic sample for this study included 1,372 African American adults who attended religious services at least a few times a year, as the church-based relationship measures were only assessed for these individuals. Self-reported sleep quality was assessed by sleep satisfaction, trouble falling asleep, and restless sleep. Chronic stress exposure was measured by a nine-item index. OLS and logistic regression were used to estimate the relationship between chronic stress exposure, extended family and church relationships, and sleep quality. RESULTS The data indicated that chronic stress exposure was associated with decreased sleep satisfaction, increased likelihood of trouble falling asleep and restless sleep. Receiving emotional support from family and more frequent contact with church members were associated with decreased restless sleep. Emotional family support moderated the associations between chronic stress exposure and trouble falling asleep and restless sleep. The positive associations between chronic stress exposure and these two sleep quality measures were attenuated among respondents who received high levels of emotional support from their family. CONCLUSIONS Together, these findings underscore the detriment of chronic stress exposure to African Americans' sleep quality and suggest that extended family members are effective stress coping resources and play an important role in this population's sleep quality.
Collapse
Affiliation(s)
- Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Omonigho M Bubu
- Departments of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Kedong Ding
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Karen D Lincoln
- Program in Public Health, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, CA, USA
| |
Collapse
|
2
|
Bey GS, Pike JR, Palta P. Distinct moderating pathways for psychosocial risk and resilience in the association of neighborhood disadvantage with incident heart failure among Black persons. SSM Popul Health 2023; 24:101475. [PMID: 37736261 PMCID: PMC10509709 DOI: 10.1016/j.ssmph.2023.101475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 09/23/2023] Open
Abstract
Objective To assess whether psychosocial factors moderate the associations between neighborhood disadvantage and incident heart failure (HF). Methods Among 1448 Non-Hispanic (NH) Black persons dually enrolled in two community-based cohorts in Jackson, Mississippi who were free of HF as of January 1, 2000, 336 HF events classified by reviewer panel accrued through December 31, 2017. Multilevel, multivariable Cox regression models were used to examine whether optimism and negative affect moderated the associations of two measures of neighborhood characteristics (the national Area Deprivation Index (ADI) and perceived neighborhood problems) on incident hospitalized HF. Results Optimism moderated the association of the ADI with incident HF. Compared to participants reporting the lowest tertile of optimism, those in the highest tertile of optimism had a 29% lower rate of HF associated with increasing ADI in fully adjusted models. We found no evidence for a moderating effect of negative affect. Conclusions This study supports optimism as a source of resilience to the detrimental effects of neighborhood disadvantage on HF risk. Population-level strategies to promote sociocultural antecedents to optimism may serve as a viable method of reducing the disproportionate burden of HF among NH Black persons.
Collapse
Affiliation(s)
- Ganga S. Bey
- University of North Carolina at Chapel Hill, Department of Epidemiology, USA
| | - James R. Pike
- Johns Hopkins University Bloomberg School of Public Health, USA
| | - Priya Palta
- University of North Carolina School of Medicine, Department of Neurology, USA
| |
Collapse
|
3
|
Morris MC, Moradi H, Aslani M, Sims M, Schlundt D, Kouros CD, Goodin B, Lim C, Kinney K. Predicting incident cardiovascular disease among African-American adults: A deep learning approach to evaluate social determinants of health in the Jackson heart study. PLoS One 2023; 18:e0294050. [PMID: 37948388 PMCID: PMC10637695 DOI: 10.1371/journal.pone.0294050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
The present study sought to leverage machine learning approaches to determine whether social determinants of health improve prediction of incident cardiovascular disease (CVD). Participants in the Jackson Heart study with no history of CVD at baseline were followed over a 10-year period to determine first CVD events (i.e., coronary heart disease, stroke, heart failure). Three modeling algorithms (i.e., Deep Neural Network, Random Survival Forest, Penalized Cox Proportional Hazards) were used to evaluate three feature sets (i.e., demographics and standard/biobehavioral CVD risk factors [FS1], FS1 combined with psychosocial and socioeconomic CVD risk factors [FS2], and FS2 combined with environmental features [FS3]) as predictors of 10-year CVD risk. Contrary to hypothesis, overall predictive accuracy did not improve when adding social determinants of health. However, social determinants of health comprised eight of the top 15 predictors of first CVD events. The social determinates of health indicators included four socioeconomic factors (insurance status and types), one psychosocial factor (discrimination burden), and three environmental factors (density of outdoor physical activity resources, including instructional and water activities; modified retail food environment index excluding alcohol; and favorable food stores). Findings suggest that whereas understanding biological determinants may identify who is currently at risk for developing CVD and in need of secondary prevention, understanding upstream social determinants of CVD risk could guide primary prevention efforts by identifying where and how policy and community-level interventions could be targeted to facilitate changes in individual health behaviors.
Collapse
Affiliation(s)
- Matthew C. Morris
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
| | - Hamidreza Moradi
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, United States of America
- Department of Computer Science, University of North Carolina Agricultural and Technical State University, Greensboro, North Carolina, United States of America
| | - Maryam Aslani
- Department of Data Analytics, University of North Texas, Denton, Texas, United States of America
| | - Mario Sims
- Department of Social Medicine, Population, and Public Health, University of California, Riverside, California, United States of America
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Chrystyna D. Kouros
- Department of Psychology, Southern Methodist University, Dallas, Texas, United States of America
| | - Burel Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, Texas, United States of America
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Crystal Lim
- Department of Health Psychology, University of Missouri, Columbia, Missouri, Texas, United States of America
| | - Kerry Kinney
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, United States of America
| |
Collapse
|
4
|
Labaran RS, Johnson S, Johnson DA. The association of stress and work hours with sleep duration and insomnia symptoms among U.S.-born and Foreign-born Black adults. Sleep Health 2023; 9:56-63. [PMID: 36402727 PMCID: PMC9991989 DOI: 10.1016/j.sleh.2022.09.011] [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: 01/31/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine associations between stress and work hours with sleep duration and insomnia symptoms among U.S.-born and Foreign-born Black adults. DESIGN A cross-sectional analysis of the National Health Interview Survey. PARTICIPANTS Black adults (N = 16,315) with a mean age of 40 ± 0.1 years, mostly women (52.7%), college graduates (40.7%), and U.S.-born (82.5%). MEASUREMENTS Participants self-reported sleep duration, insomnia symptoms, frequent stress (yes/no), and work hours in the prior week (1-39 hours, 40 hours, ≥41 hours). Poisson regression with robust variance was used to test associations overall and by nativity. RESULTS Working ≥41 hours, frequent stress, and short sleep duration (<7 hours) were reported by 22%, 24.9%, and 43% of participants, respectively. U.S.-born and Foreign-born Black adults who reported frequent stress and working ≥41 hours vs. 40 hours had 60% and 19% higher prevalence of short sleep duration (adjusted prevalence ratio [aPR] = 1.60, 95% confidence interval [CI]: 1.47, 1.74 and aPR = 1.19, 95% CI: 1.12, 1.25, respectively). Foreign-born Black adults who worked 1-39 hours vs. 40 hours, had higher prevalence of short sleep duration, aPR = 1.18, 95% CI: 1.01, 1.37. U.S.-born Black adults who worked ≥41 hours vs. 40 hours had higher prevalence of insomnia symptoms (trouble falling asleep: aPR = 1.33 [95% CI: 1.13, 1.56], trouble staying asleep: aPR = 1.33 [95% CI: 1.16, 1.53]). CONCLUSION Frequent stress and working ≥41 hours are likely salient determinants of sleep health for U.S. and Foreign-born Black individuals. Further, less work hours (Foreign-born) while longer work hours (U.S.-born) were associated with short sleep duration. Stress and work hours may be factors for sleep health interventions among Black adults.
Collapse
Affiliation(s)
- Rukkayya S Labaran
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Sheroi Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
| |
Collapse
|
5
|
Langford AT, Butler M, Booth JN, Jin P, Bress AP, Tanner RM, Kalinowski J, Blanc J, Seixas A, Shimbo D, Sims M, Ogedegbe G, Spruill TM. Stress and Depression Are Associated With Life's Simple 7 Among African Americans With Hypertension: Findings From the Jackson Heart Study. Am J Hypertens 2021; 34:1311-1321. [PMID: 34272853 PMCID: PMC8643585 DOI: 10.1093/ajh/hpab116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The American Heart Association created the Life's Simple 7 (LS7) metrics to promote cardiovascular health (CVH) by achieving optimal levels of blood pressure, cholesterol, blood sugar, physical activity, diet, weight, and smoking status. The degree to which psychosocial factors such as stress and depression impact one's ability to achieve optimal CVH is unclear, particularly among hypertensive African Americans. METHODS Cross-sectional analyses included 1,819 African Americans with hypertension participating in the Jackson Heart Study (2000-2004). Outcomes were LS7 composite and individual component scores (defined as poor, intermediate, ideal). High perceived chronic stress was defined as the top quartile of Weekly Stress Inventory scores. High depressive symptoms were defined as Center for Epidemiologic Studies Depression scale scores of ≥16. We compared 4 groups: high stress alone; high depressive symptoms alone; high stress and high depressive symptoms; low stress and low depressive symptoms (reference) using linear regression for total LS7 scores and logistic regression for LS7 components. RESULTS Participants with both high stress and depressive symptoms had lower composite LS7 scores (B [95% confidence interval] = -0.34 [-0.65 to -0.02]) than those with low stress and depressive symptoms in unadjusted and age/sex-adjusted models. They also had poorer health status for smoking (odds ratio [95% confidence interval] = 0.52 [0.35-0.78]) and physical activity (odds ratio [95% confidence interval] = 0.71 [0.52-0.95]) after full covariate adjustment. CONCLUSIONS The combination of high stress and high depressive symptoms was associated with poorer LS7 metrics in hypertensive African Americans. Psychosocial interventions may increase the likelihood of engaging in behaviors that promote optimal CVH.
Collapse
Affiliation(s)
- Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Mark Butler
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - John N Booth
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Real-World Evidence and Late Phase, CTI Clinical Trials and Consulting Services, Inc., Covington, Kentucky, USA
| | - Peng Jin
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rikki M Tanner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jolaade Kalinowski
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Judite Blanc
- Department of Psychiatry & Behavioral Sciences, University of Miami, Miami, Florida, USA
| | - Azizi Seixas
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Gbenga Ogedegbe
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York, USA
| | - Tanya M Spruill
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
6
|
Forde AT, Sims M, Wang X, Barber S, Diez Roux AV. The role of perceived discrimination in predicting changes in health behaviours among African Americans in the Jackson Heart Study. J Epidemiol Community Health 2021; 75:1222-1231. [PMID: 34117112 PMCID: PMC8588298 DOI: 10.1136/jech-2020-215998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examined whether perceived discrimination was associated with health behaviours over time and whether associations of discrimination with behaviours varied by attribution of discrimination. METHODS Multinomial logistic regression was used to estimate ORs and CIs for the associations of discrimination (everyday, lifetime, stress from lifetime discrimination) with health behaviours (cigarette smoking, alcohol use) over time among 3050 African Americans in the Jackson Heart Study from visit 1 (2000-2004) to visit 3 (2009-2013). Smoking status was classified as persistent current, persistent former, persistent never, current to former and former/never to current smokers. Alcohol use status was classified as persistent heavy, persistent moderate/none, heavy to moderate/none and moderate/none to heavy alcohol users. RESULTS Higher everyday discrimination was associated with persistent current smoking (OR per SD higher discrimination 1.26, 95% CI 1.11,1.43) and with persistent former smoking (high vs low OR 1.32, 95% CI 1.02,1.70) relative to persistent never smoking. Similar findings were observed for lifetime discrimination and persistent current smoking (high vs low OR 1.85, 95% CI 1.15,2.95) and with persistent former smoking (high vs low OR 1.45, 95% CI 1.06,1.98). Participants reporting lifetime discrimination as very stressful compared with not stressful were more likely to be persistent former smokers (OR 1.44, 95% CI 1.04,1.99). Associations did not vary by discrimination attribution. CONCLUSION Discrimination did not predict changes in smoking status or alcohol use. Discrimination was associated with persistent current smoking status, which may provide a plausible mechanism through which discrimination impacts the health of African Americans.
Collapse
Affiliation(s)
- Allana T Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Xu Wang
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Sharrelle Barber
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Ana V Diez Roux
- The Urban Health Collaborative, and the Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Buis L, Jenkins S, Patten CA, Hayes SN, Jones C, Cooper LA, Brewer LC. Improvements in Diet and Physical Activity-Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study. JMIR Mhealth Uhealth 2021; 9:e28024. [PMID: 34766917 PMCID: PMC8663698 DOI: 10.2196/28024] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/27/2021] [Accepted: 09/01/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. OBJECTIVE This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. METHODS This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory-informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. RESULTS Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=-0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). CONCLUSIONS Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans.
Collapse
Affiliation(s)
| | - Sarah Jenkins
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | | | - Lisa A Cooper
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States.,Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
8
|
Bhavsar NA, Davenport CA, Yang LZ, Peskoe S, Scialla JJ, Hall RK, Tyson CC, Strigo T, Sims M, Pendergast J, Curtis LH, Boulware LE, Diamantidis CJ. Psychosocial determinants of cardiovascular events among black Americans with chronic kidney disease or associated risk factors in the Jackson heart study. BMC Nephrol 2021; 22:375. [PMID: 34763649 PMCID: PMC8582093 DOI: 10.1186/s12882-021-02594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with chronic kidney disease (CKD), hypertension (HTN), or diabetes mellitus (DM) are at increased risk for cardiovascular disease (CVD). The extent to which psychosocial factors are associated with increased CVD risk within these individuals is unclear. Black individuals experience a high degree of psychosocial stressors due to socioeconomic factors, environment, racism, and discrimination. We examined the association between psychosocial factors and risk of CVD events among Black men and women with CKD and CKD risk factors in the Jackson Heart Study. Methods and Results We identified 1919 participants with prevalent CKD or CKD risk factors at baseline. We used rotated principal component analysis - a form of unsupervised machine learning that may identify constructs not intuitively identified by a person - to describe five groups of psychosocial components (including negative moods, religiosity, discrimination, negative outlooks, and negative coping resources) based on a battery of questionnaires. Multiple imputation by chained equation (MICE) was used to impute missing covariate data. Cox models were used to quantify the association between psychosocial components and incident CVD, defined as a fatal coronary heart disease event, myocardial infarction, cardiac procedure (angiography or revascularization procedure), or stroke. Of the 929 participants in the analysis, 67% were female, 28% were current/former smokers with mean age of 56 years and mean BMI of 33 kg/m2. Over a median follow-up of 8 years, 6% had an incident CVD event. In multivariable models, each standard deviation (SD) increase in the religiosity component was associated with an increased hazard for CVD event (hazard ratio [HR] = 1.52, 95% CI: 1.09–2.13). Conclusions Religiosity was associated with CVD among participants with prevalent CKD or CKD risk factors. Studies to better understand the mechanisms of this relationship are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02594-6.
Collapse
Affiliation(s)
- Nrupen A Bhavsar
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St, 3rd Floor, NC, 27701, Durham, USA. .,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
| | - Clemontina A Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Lexie Zidanyue Yang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Sarah Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Julia J Scialla
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA.,Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rasheeda K Hall
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| | - Crystal C Tyson
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| | - Tara Strigo
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St, 3rd Floor, NC, 27701, Durham, USA
| | - Mario Sims
- University of Mississippi School of Medicine, Jackson, MS, USA
| | - Jane Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Lesley H Curtis
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St, 3rd Floor, NC, 27701, Durham, USA
| | - Clarissa J Diamantidis
- Division of General Internal Medicine, Duke University School of Medicine, 200 Morris St, 3rd Floor, NC, 27701, Durham, USA.,Division of Nephrology, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
9
|
Ko YA, Shen J, Kim JH, Topel M, Mujahid M, Taylor H, Quyyumi A, Sims M, Vaccarino V, Baltrus P, Lewis T. Identifying neighbourhood and individual resilience profiles for cardiovascular health: a cross-sectional study of blacks living in the Atlanta metropolitan area. BMJ Open 2021; 11:e041435. [PMID: 34330849 PMCID: PMC8327812 DOI: 10.1136/bmjopen-2020-041435] [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] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To simultaneously examine multiple individual-level neighbourhood perceptions and psychosocial characteristics and their relationships with cardiovascular health (CVH) among blacks. DESIGN Cross-sectional study. SETTING Subjects were recruited between 2016 and 2018 via convenience sampling. PARTICIPANTS 385 Black men and women, age 30-70 living in the Atlanta metropolitan area (Georgia, USA). PRIMARY OUTCOME MEASURE Individual's CVH was summarised as a composite score using American Heart Association's Life's Simple 7 (LS7) metrics. METHODS We implemented unsupervised learning (k-means) and supervised learning (Bayesian Dirichlet process clustering) to identify clusters based on 11 self-reported neighbourhood perception and psychosocial characteristics. We also performed principal component analysis to summarise neighbourhood perceptions and psychosocial variables and assess their associations with LS7 scores. RESULTS K-means and Bayesian clustering resulted in 4 and 5 clusters, respectively. Based on the posterior distributions, higher LS7 scores were associated with better neighbourhood perceptions and psychosocial characteristics, including neighbourhood safety, social cohesion, activities with neighbours, environmental mastery, purpose in life, resilient coping and no depression. Taken together, the first principal components of neighbourhood perceptions and psychosocial characteristics were associated with an increase of 0.07 (95% CI -0.17 to 0.31) and 0.31 (95% CI 0.06 to 0.55) in LS7 score, respectively, after accounting for age, sex, household income and education level. CONCLUSION Both neighbourhood perception and psychosocial domains were related to CVH, but individual psychosocial characteristics appeared to contribute to CVH most. Approaches that acknowledge the importance of factors in both domains may prove most beneficial for enhancing resilience and promoting CVH among black communities.
Collapse
Affiliation(s)
- Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Jenny Shen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeong Hwan Kim
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Topel
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mahasin Mujahid
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Herman Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Arshed Quyyumi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Viola Vaccarino
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tene Lewis
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| |
Collapse
|
10
|
Gibbons FX, Gerrard M, Fleischli ME, Simons RL, Kingsbury JH. Perceived racial discrimination and healthy behavior among African Americans. Health Psychol 2021; 40:155-165. [PMID: 33630637 DOI: 10.1037/hea0001056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Numerous studies have found evidence of a link between perceived discrimination and unhealthy behavior, especially substance use. Within this body of literature, however, several studies have found unexpected evidence of a positive relation between perceived racial discrimination among African Americans-mostly women-and certain types of healthy behavior, primarily exercise and healthy eating. The current study further examined this positive relation, including an anticipated moderator: optimism. It also examined the relation between perceived racial discrimination and a correlate of unhealthy behavior: BMI. METHOD Six waves of data were collected over 14 years in three related samples of African Americans from families participating in the Family and Community Health Study. Each family included an adolescent (Mage = 10.5 at Wave 1), the adolescent's primary caregiver (Mage = 37), and, in some cases, an older sibling of that adolescent (Mage = 13). Wave 1 Ns were 889, 889, and 295, respectively. Healthy behavior was defined as diet and exercise. RESULTS There was very little evidence of a long-term relation between perceived racial discrimination and BMI in any sample, and no evidence of a relation between discrimination and healthy behavior among the males. However, correlational analyses revealed a positive prospective relation between discrimination and healthy behavior among all three groups of females; structural equation modeling indicated that this relation was stronger among women who were high in optimism. CONCLUSIONS Perceived racial discrimination does not appear to be related to BMI among African Americans, but it is related to healthy behavior among Black females who are high in dispositional optimism. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Meg Gerrard
- Department of Psychological Sciences, University of Connecticut
| | - Mary E Fleischli
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut
| | | | | |
Collapse
|
11
|
Tamura K, Orstad SL, Cromley EK, Neally SJ, Claudel SE, Andrews MR, Ceasar J, Sims M, Powell-Wiley TM. The Mediating role of perceived discrimination and stress in the associations between neighborhood social environment and TV Viewing among Jackson Heart Study participants. SSM Popul Health 2021; 13:100760. [PMID: 33681448 PMCID: PMC7930346 DOI: 10.1016/j.ssmph.2021.100760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives The aim of this study was to test the mediating role of perceived discrimination and stress on associations between perceived neighborhood social environment (PNSE) and TV viewing. Methods Baseline data were used for 4716 participants (mean age = 55.1 y; 63.4% female) in the Jackson Heart Study (JHS), a large prospective cohort study of African Americans in Jackson, Mississippi. One binary TV viewing outcome was created: ≥4 h/day versus <4 h/day. PNSE variables included neighborhood violence, problems (higher value = more violence/problems), and social cohesion (higher value = more cohesion). Mediators included perceived lifetime discrimination, daily discrimination, and chronic stress (higher value = greater discrimination/stress). Multivariable regression was used with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation adjusting for demographics, health-related and psychosocial factors, and population density. Results Neighborhood violence, problems, and social cohesion were indirectly associated with TV viewing through lifetime discrimination (OR = 1.03, 95%BC CI = 1.00, 1.07; OR = 1.03, 95%BC CI = 0.99, 1.06 [marginal]; OR = 0.98, 95%BC CI = 0.94, 0.99, respectively) and chronic stress (OR = 0.95, 95%BC CI = 0.90, 0.99; OR = 0.96, 95%BC CI = 0.92, 0.99; OR = 1.05, 95%BC CI = 1.01, 1.10, respectively). Daily discrimination was neither directly nor indirectly associated with TV viewing. Conclusions Each PNSE variable was indirectly associated with TV viewing via lifetime discrimination and perceived stress, but not with daily discrimination among JHS participants. Unexpected directionality of mediating effects of lifetime discrimination and chronic stress should be replicated in future studies. Further research is also needed to pinpoint effective community efforts and physical environmental policies (e.g., installing bright street lights, community policing) to reduce adverse neighborhood conditions and psychosocial factors, and decrease TV viewing and subsequent cardiovascular disease risk.
Collapse
Affiliation(s)
- Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Stephanie L Orstad
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, 550 Avenue, New York, NY, 10016, USA
| | - Ellen K Cromley
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269-1248, USA
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Sophie E Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Marcus R Andrews
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Joniqua Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA.,Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Bethesda, MD, 20892, USA
| |
Collapse
|
12
|
Stress-Induced Eating Among Racial/Ethnic Groups in the United States: a Systematic Review. J Racial Ethn Health Disparities 2020; 8:912-926. [PMID: 32839895 DOI: 10.1007/s40615-020-00849-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Racial/ethnic disparities in obesity may be due, in part, to minority groups consuming more energy-rich diets in response to greater stress exposure. The present study systematically reviewed the literature describing the effects of stress on food consumption among various racial/ethnic groups in the US. METHODS PubMed and PsycINFO databases were searched for studies reporting associations between stress and food consumption by different racial/ethnic groups, conducted between January 1, 1999 to November 25, 2019. The search included terms related to food consumption, stress, and race/ethnicity. After screening 3660 records, 30 studies were included for review. RESULTS The selected studies assessed diverse stressors and eating constructs; African-American and Hispanic/Latinx were the most commonly studied minority groups. Studies generally supported that diverse forms of stress exposure are associated with reduced healthy eating patterns and increased obesogenic eating patterns across racial/ethnic groups. However, studies that directly compared stress-eating associations among multiple racial/ethnic groups showed mixed results. CONCLUSION Members of diverse racial/ethnic groups are susceptible to stress-induced unhealthy eating patterns, though evidence is insufficient to conclude whether the degree of susceptibility differs among groups. Additional studies utilizing observational measures of food intake and culturally sensitive measures of stress are needed to identify the most influential stressors on dietary behaviors, to assess whether some stressors are more salient for given racial/ethnic groups, and to examine the extent to which stress-induced eating contributes to racial/ethnic disparities in obesity and obesity-related diseases.
Collapse
|
13
|
Tamura K, Langerman SD, Orstad SL, Neally SJ, Andrews MR, Ceasar JN, Sims M, Lee JE, Powell-Wiley TM. Physical activity-mediated associations between perceived neighborhood social environment and depressive symptoms among Jackson Heart Study participants. Int J Behav Nutr Phys Act 2020; 17:91. [PMID: 32650787 PMCID: PMC7350640 DOI: 10.1186/s12966-020-00991-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA. METHODS We used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multilevel modeling, controlling for census tract clustering effects, was used to estimate associations between each PNSE variable and CES-D score, adjusting for covariates, including demographic, health-related, and population density. Second, validated, self-reported total PA, based on active living, sport, and home indices, was tested as the mediator. Multivariable linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated to test for significant unstandardized indirect effects, controlling for all covariates. RESULTS Our participants were 64.2% female with a mean age of 52.6 (SD = 12.2) and a mean CES-D score of 10.8 (SD = 8.1). In the fully-adjusted model, neighborhood violence and problems were positively related to depressive symptoms (B = 3.59, 95%CI = 0.93, 6.26, and B = 3.06, 95%CI = 1.19, 4.93, respectively). Neighborhood violence and problems were also indirectly related to depressive symptoms via total PA (B = 0.26, 95%BC CI = 0.05, 0.55; and B = 0.15, 95%BC CI = 0.02, 0.34, respectively). Social cohesion was neither directly nor indirectly related to depressive symptoms. CONCLUSIONS We found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms. These associations may be explained in part by lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate PA increases in conjunction with community efforts to reduce neighborhood violence and problems.
Collapse
Affiliation(s)
- Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA.
| | | | - Stephanie L Orstad
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Marcus R Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Joniqua N Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jae E Lee
- Research Centers in Minority Institutions Translational Research Network Data Coordinating Center, Jackson State University, Jackson, MS, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
14
|
Glover LM, Cain‐Shields LR, Spruill TM, O'Brien EC, Barber S, Loehr L, Sims M. Goal-Striving Stress and Incident Cardiovascular Disease in Blacks: The Jackson Heart Study. J Am Heart Assoc 2020; 9:e015707. [PMID: 32342735 PMCID: PMC7428553 DOI: 10.1161/jaha.119.015707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/04/2020] [Indexed: 12/12/2022]
Abstract
Background Goal-striving stress (GSS), the stress from striving for goals, is associated with poor health. Less is known about its association with cardiovascular disease (CVD). Methods and Results We used data from the JHS (Jackson Heart Study), a study of CVD among blacks (21-95 years old) from 2000 to 2015. Participants free of CVD at baseline (2000-2004) were included in this analysis (n=4648). GSS was examined in categories (low, moderate, high) and in SD units. Incident CVD was defined as fatal or nonfatal stroke, coronary heart disease (CHD), and/or heart failure. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident CVD by levels of GSS, adjusting for demographics, socioeconomic status, health behaviors, risk factors, and perceived stress. The distribution of GSS categories was as follows: 40.77% low, 33.97% moderate, and 25.26% high. Over an average of 12 years, there were 140 incident stroke events, 164 CHD events, and 194 heart failure events. After full adjustment, high (versus low) GSS was associated with a lower risk of stroke (HR, 0.38; 95% CI, 0.17-0.83) and a higher risk of CHD (HR, 1.91; 95% CI, 1.10-3.33) among women. A 1-standard deviation unit increase in GSS was associated with a 31% increased risk of CHD (HR, 1.31; 95% CI, 1.10-1.56) among women. Conclusions Higher GSS may be a risk factor for developing CHD among women; however, it appears to be protective of stroke among women. These analyses should be replicated in other samples of black individuals.
Collapse
Affiliation(s)
| | | | - Tanya M. Spruill
- Department of Population HealthNYU Grossman School of MedicineNew YorkNY
| | | | - Sharrelle Barber
- Epidemiology and BiostatisticsDornsife School of Public HealthDrexel UniversityPhiladelphiaPA
| | - Laura Loehr
- Department of EpidemiologyUniversity of North Carolina at Chapel HillNC
| | - Mario Sims
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| |
Collapse
|
15
|
Sims M, Glover LSM, Gebreab SY, Spruill TM. Cumulative psychosocial factors are associated with cardiovascular disease risk factors and management among African Americans in the Jackson Heart Study. BMC Public Health 2020; 20:566. [PMID: 32345300 PMCID: PMC7189712 DOI: 10.1186/s12889-020-08573-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 03/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Racial disparities in cardiovascular disease (CVD) have been attributed in part to negative psychosocial factors. Prior studies have demonstrated associations between individual psychosocial factors and CVD risk factors, but little is known about their cumulative effects. METHODS Using the Jackson Heart Study, we examined the cross-sectional associations of cumulative psychosocial factors with CVD risk factors among 5306 African Americans. We utilized multivariable Poisson regression to estimate sex-stratified prevalence ratios (PR 95% confidence interval-CI) of obesity, hypertension and diabetes prevalence and hypertension and diabetes control with negative affect (cynicism, anger-in, anger-out, depressive symptoms and cumulative negative affect) and stress (global stress, weekly stress, major life events-MLEs and cumulative stress), adjusting for demographics, socioeconomic status, and behaviors. RESULTS After full adjustment, high (vs. low) cumulative negative affect was associated with prevalent obesity among men (PR 1.36 95% CI 1.16-1.60), while high (vs. low) cumulative stress was similarly associated with obesity among men and women (PR 1.24 95% CI 1.01-1.52 and PR 1.13 95% CI 1.03-1.23, respectively). Psychosocial factors were more strongly associated with prevalent hypertension and diabetes among men than women. For example, men who reported high cynicism had a 12% increased prevalence of hypertension (PR 1.12, 95% CI 1.03-1.23). Psychosocial factors were more strongly associated with lower hypertension and diabetes control for women than men. Women who reported high (vs. low) cynicism had a 38% lower prevalence of hypertension control (PR 0.62, 95% CI 0.46-0.84). CONCLUSIONS Cumulative psychosocial factors were associated with CVD risk factors and disease management among African Americans. The joint accumulation of psychosocial factors was more associated with risk factors for men than women.
Collapse
Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, 350 W. Woodrow Wilson Avenue, Jackson, MS 39213, USA
| | - Lá Shauntá M. Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Tanya M. Spruill
- Department of Population Health, NYU School of Medicine, New York, USA
| |
Collapse
|
16
|
Thomas K, Nilsson E, Festin K, Henriksson P, Lowén M, Löf M, Kristenson M. Associations of Psychosocial Factors with Multiple Health Behaviors: A Population-Based Study of Middle-Aged Men and Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041239. [PMID: 32075162 PMCID: PMC7068361 DOI: 10.3390/ijerph17041239] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
Background: The health behaviors smoking, risky alcohol consumption, insufficient physical activity, and poor diet constitute the main contributors to non-communicable diseases. Clustering of risk behaviors is common and increases the risk of these diseases. Despite health benefits, it is difficult to change health behaviors. Psychosocial factors could play a role in health behavior change, with research showing relationships between unfavorable psychosocial factors and health risk behaviors. However, many studies only investigated one or two health behaviors at a time. The present study, therefore, aimed to investigate associations between a broad range of psychosocial factors and multiple health risk behaviors in a general middle-aged population in Sweden. Methods: A cross-sectional design was used to investigate a random sample from the general population in Sweden (n = 1007, 45–69 years, 50% women). Questionnaire data on health behaviors (smoking, alcohol consumption, physical activity, and fruit/vegetable intake) and psychosocial factors, with both psychological and social resources (social integration, emotional support, perceived control, self-esteem, sense of coherence and trust) and psychological risk factors (cynicism, vital exhaustion, hopelessness and depressiveness), were analyzed. Logistic and ordinal logistic regression were used to analyze associations between psychosocial factors and multiple (0–1, 2 or 3–4) health risk behaviors. Results: A total of 50% of the sample had two health risk behaviors and 18% had three health risk behaviors. After adjusting for age, sex, education, employment status, and immigrant status, eight out of 10 psychosocial factors (exceptions: social integration and self-esteem) showed significant odds ratios (ORs) in the expected directions; low levels of psychosocial resources and high levels of psychosocial risk factors were associated with multiple risk behaviors. The strongest associations with multiple risk behaviors were seen for vital exhaustion (adjusted (adj.) OR 1.28; confidence interval (CI) 1.11–1.46), depressiveness (adj. OR 1.32, CI 1.14–1.52), and trust (adj. OR 0.80, CI 0.70–0.91). When controlling for all psychosocial factors in the same model, only the association with trust remained statistically significant (adj. OR 0.89, CI 0.73–1.00, p = 0.050). Associations with individual health behaviors were fewer and scattered, with no psychosocial factor being related to all four behaviors. Conclusions: Examining associations between a broad range of psychosocial factors and multiple health risk behaviors revealed consistent and significant associations for almost all psychosocial factors. These associations were stronger compared to associations to single health risk behaviors. Our findings support the relevance of considering psychosocial aspects in interventions aimed at health behavior change, especially for people with multiple health risk behaviors.
Collapse
Affiliation(s)
- Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health, Linköping University, SE-581 83 Linköping, Sweden; (E.N.); (K.F.); (P.H.); (M.L); (M.K.)
- Correspondence: ; Tel.: +46-1328-2546
| | - Evalill Nilsson
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health, Linköping University, SE-581 83 Linköping, Sweden; (E.N.); (K.F.); (P.H.); (M.L); (M.K.)
| | - Karin Festin
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health, Linköping University, SE-581 83 Linköping, Sweden; (E.N.); (K.F.); (P.H.); (M.L); (M.K.)
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health, Linköping University, SE-581 83 Linköping, Sweden; (E.N.); (K.F.); (P.H.); (M.L); (M.K.)
- Department of Biosciences and Nutrition, Karolinska Institute, 141 83 Huddinge, Sweden
| | - Mats Lowén
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health, Linköping University, SE-581 83 Linköping, Sweden; (E.N.); (K.F.); (P.H.); (M.L); (M.K.)
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health, Linköping University, SE-581 83 Linköping, Sweden; (E.N.); (K.F.); (P.H.); (M.L); (M.K.)
- Department of Biosciences and Nutrition, Karolinska Institute, 141 83 Huddinge, Sweden
| | - Margareta Kristenson
- Department of Health, Medicine and Caring Sciences, Faculty of Medicine and Health, Linköping University, SE-581 83 Linköping, Sweden; (E.N.); (K.F.); (P.H.); (M.L); (M.K.)
| |
Collapse
|
17
|
Cain-Shields LR, Johnson DA, Glover L, Sims M. The association of goal-striving stress with sleep duration and sleep quality among African Americans in the Jackson Heart Study. Sleep Health 2020; 6:117-123. [PMID: 31734287 PMCID: PMC6995417 DOI: 10.1016/j.sleh.2019.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND African Americans (AAs) report a higher frequency of certain stressors over their lifetime which may impact biological processes that can impair sleep. For this reason, goal-striving stress (GSS), the difference between aspiration and achievement, weighted by disappointment, may contribute to poor sleep quality and suboptimal sleep duration among AAs. METHODS We completed a cross-sectional analysis using exam 1 data (2000-2004) from the Jackson Heart Study (JHS) (n=4943). GSS was self-reported and categorized in tertiles of low, moderate, and high. Participants self-reported the number of hours they slept each night and rated their sleep quality as (1) very poor to (5) excellent. Sleep duration categories included the following: short sleep (≤6 hours), normal sleep (7-8 hours) and long sleep (≥ 9 hours). Sleep quality was categorized as high (good/very good/excellent) and low (fair/poor). Relative risk ratios (RRRs 95% confidence intervals-CI) were estimated for sleep duration and sleep quality categories by GSS using logistic regression. RESULTS After full adjustment, there were no significant associations between GSS and sleep duration categories. However, participants who reported high (versus low) GSS had a 20% greater risk (1.20 95% CI: 1.01, 1.43) of low (versus high) sleep quality in the fully adjusted model. CONCLUSION The stress due to the deficit between goal aspiration and achievement was associated with poor sleep quality. Future investigations should examine the association of changes in GSS with changes in sleep duration and sleep quality.
Collapse
Affiliation(s)
- Loretta R Cain-Shields
- Department of Data Science, John D Bower School of Population Health, University of Mississippi Medical Center, 2500 North State St., Jackson, MS, 39216, USA.
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - LáShauntá Glover
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill NC, 27516, USA
| | - Mario Sims
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| |
Collapse
|
18
|
Sims M, Glover LM, Norwood AF, Jordan C, Min YI, Brewer LC, Kubzansky LD. Optimism and cardiovascular health among African Americans in the Jackson Heart Study. Prev Med 2019; 129:105826. [PMID: 31473218 PMCID: PMC6985922 DOI: 10.1016/j.ypmed.2019.105826] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 01/05/2023]
Abstract
Little research has examined associations of positive psychosocial factors with the American Heart Association Life's Simple 7™ (LS7) among African Americans. This study examined the associations between positive optimistic orientation and LS7 among African Americans. Using exam 1 data (2000-2004) from the Jackson Heart Study, we examined cross-sectional associations of optimism (in tertiles) with LS7 components [smoking, physical activity, diet, body mass index, blood pressure, cholesterol, glucose] and a composite LS7 score (classified as poor, intermediate, ideal) among 4734 African Americans free of cardiovascular disease. Multivariable prevalence regression was used to estimate prevalence ratios (PR, 95% confidence interval-CI) of intermediate and ideal (vs. poor) individual LS7 components and composite LS7 score by optimism levels, adjusting for demographics, socioeconomic status, and depressive symptoms. For LS7 components with low prevalence, we estimated odds ratios. A greater percentage of participants with high vs. low optimism were younger, female, high SES, and not depressed. After full covariate adjustment, the prevalence ratio of ideal (vs. poor) composite LS7 score was 1.24 for participants who reported high (vs. low) optimism (95% CI 1.09-1.42) at exam 1. Higher levels of optimism were also associated with greater prevalence of ideal (vs. poor) physical activity and smoking. Promoting positive optimistic orientation may be an important step toward increasing the likelihood of achieving optimal cardiovascular health among African Americans.
Collapse
Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
| | - LáShauntá M Glover
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Arnita F Norwood
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Christina Jordan
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
19
|
Alexander AC, Nollen NL, Ahluwalia JS, Hébert ET, Businelle MS, Kendzor DE. Darker skin color is associated with a lower likelihood of smoking cessation among males but not females. Soc Sci Med 2019; 240:112562. [PMID: 31586778 PMCID: PMC6921999 DOI: 10.1016/j.socscimed.2019.112562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/24/2019] [Accepted: 09/19/2019] [Indexed: 11/21/2022]
Abstract
Darker skin color is associated with discrimination and unfair treatment and may contribute to persisting health disparities. This study examined whether darker skin color was associated with smoking cessation and whether this association was moderated by sex and race. This study also explored whether biological and psychosocial factors, including nicotine and cotinine concentrations, discrimination, distrust, and neuroticism, mediated this association. The data for this study came from a prospective smoking cessation intervention that included 224 Black and 225 White adults from Kansas City, Missouri. Skin color was assessed using a DermaSpectrometer to measure melanin contained within the skin. Point prevalence smoking abstinence was biochemically-verified and assessed at weeks 4 and 26. Hierarchical logistic regression analyses were conducted to evaluate hypothesized relations between skin color and smoking cessation. Interactions between race and sex with skin color were also evaluated. While skin color was not associated with smoking cessation in the overall sample or among Blacks only, results indicated that sex moderated the effect of skin color on smoking cessation after adjusting for race and other covariates. Among males, darker skin color was associated with lower odds of achieving smoking abstinence at weeks 4 (OR = 0.60 [95% CI = 0.36, 0.99]) and 26 (OR = 0.52 [95% CI = 0.29, 0.91]). Skin color did not predict smoking cessation among females. Skin color was positively correlated with discrimination (r = 0.15, p = 0.02), cynicism/distrust (r = 0.14, p = 0.03) and neuroticism (r = 0.24, p < 0.01) among males only. However, these factors did not mediate the association between skin color and smoking cessation. Skin color may contribute to cessation-related health disparities among Black males, but more research is needed to understand the psychosocial and biological mechanisms through which skin color influences tobacco cessation.
Collapse
Affiliation(s)
- Adam C Alexander
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Nicole L Nollen
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael S Businelle
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Darla E Kendzor
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
20
|
Topel ML, Kim JH, Mujahid MS, Ko YA, Vaccarino V, Mubasher M, Liu C, Dunbar S, Sims M, Taylor HA, Quyyumi AA, Baltrus P, Lewis TT. Individual Characteristics of Resilience are Associated With Lower-Than-Expected Neighborhood Rates of Cardiovascular Disease in Blacks: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. J Am Heart Assoc 2019; 8:e011633. [PMID: 31203713 PMCID: PMC6645651 DOI: 10.1161/jaha.118.011633] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Factors promoting cardiovascular health in the face of high risk, ie, resilience, are unknown and may identify novel areas of intervention for reducing racial health disparities. We examined neighborhood perceptions and psychological attributes of blacks living in high and low cardiovascular–risk neighborhoods, as potential characteristics of resilience promoting cardiovascular health. Methods and Results We identified 1433 blacks residing in census tracts of Atlanta, GA, with higher‐than‐expected (“high” risk) or lower‐than‐expected (“low” risk) rates of cardiovascular mortality, hospitalizations, and emergency department visits during 2010–2014. Domains of psychosocial well‐being and neighborhood quality were assessed via telephone survey between August 2016 and October 2016. Using multilevel logistic regression, odds of reporting better resilient characteristics were compared between individuals living in low‐ versus high‐risk neighborhoods. Those from low‐risk (versus high‐risk) neighborhoods reported better neighborhood aesthetic quality (odds ratio [OR], 1.84), healthy food access (OR, 1.69), and absence of violence (OR, 0.67). Individuals from low‐risk neighborhoods reported greater optimism (OR, 1.38), purpose in life (OR, 1.42), and fewer depressive symptoms (OR, 0.69). After full adjustment, these associations remained significant for neighborhood factors (aesthetic quality, healthy food access, violence) and psychosocial well‐being (purpose in life). We found no evidence of differences in self‐reported cardiovascular risk factors or disease history between low‐ versus high‐risk neighborhoods. Conclusions Positive neighborhood environments and psychological characteristics are associated with low cardiovascular–risk neighborhoods, despite similar prevalence of cardiovascular risk factors, in the census tracts studied. These factors may confer cardiovascular resilience among blacks.
Collapse
Affiliation(s)
- Matthew L Topel
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jeong Hwan Kim
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Mahasin S Mujahid
- 2 Division of Epidemiology School of Public Health University of California, Berkeley Berkeley CA
| | - Yi-An Ko
- 3 Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Viola Vaccarino
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Mohamed Mubasher
- 5 Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA
| | - Chang Liu
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Sandra Dunbar
- 6 Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Mario Sims
- 7 Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Herman A Taylor
- 8 Department of Medicine Morehouse School of Medicine Atlanta GA
| | - Arshed A Quyyumi
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Peter Baltrus
- 5 Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA.,9 National Center for Primary Care Morehouse School of Medicine Atlanta GA
| | - Tené T Lewis
- 4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| |
Collapse
|
21
|
Schoenthaler A, Fei K, Ramos MA, Richardson LD, Ogedegbe G, Horowitz CR. Comprehensive examination of the multilevel adverse risk and protective factors for cardiovascular disease among hypertensive African Americans. J Clin Hypertens (Greenwich) 2019; 21:794-803. [PMID: 31125186 DOI: 10.1111/jch.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 12/25/2022]
Abstract
This paper describes the multilevel factors that contribute to hypertension disparities in 2052 hypertensive African Americans (mean age 52.9 ± 9.9 years; 66.3% female) who participated in a clinical trial. At the family level, participants reported average levels of life chaos and high social support. However, at the individual level, participants exhibited several adverse clinical and behavioral factors including poor blood pressure control (45% of population), obesity (61%), medication non-adherence (48%), smoking (32%), physical inactivity (45%), and poor diet (71%). While participants rated their provider as trustworthy, they reported high levels of discrimination in the health care system. Finally, community-level data indicate that participants reside in areas characterized by poor socio-economic and neighborhood conditions (eg, segregation). In the context of our trial, hypertensive African Americans exhibited several adverse risks and protective factors at multiple levels of influence. Future research should evaluate the impact of these factors on cardiovascular outcomes using a longitudinal design.
Collapse
Affiliation(s)
- Antoinette Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Kezhen Fei
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle A Ramos
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lynne D Richardson
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Carol R Horowitz
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Health Equity and Community Engaged Research, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
22
|
Glover LM, Ma JZ, Kesh A, Tompkins LK, Hart JL, Mattingly DT, Walker K, Robertson RM, Payne T, Sims M. The social patterning of electronic nicotine delivery system use among US adults. Prev Med 2018; 116:27-31. [PMID: 30171967 PMCID: PMC9186153 DOI: 10.1016/j.ypmed.2018.08.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
There is little research examining the social patterning of electronic nicotine delivery system (ENDS) use. This study investigated the association between socioeconomic status (SES) (education, income, and employment status) and current and former ENDS use. Data were collected from 2561 participants from the American Heart Association Tobacco Regulatory and Addiction Center (A-TRAC) online survey. Participants were 18-64 years old and reported demographic, SES, and ENDS use. Poisson regression was used to estimate prevalence ratios (PR 95% confidence interval-CI) of participants' current and former (vs. never) ENDS use. Models were adjusted for age, sex, sexual orientation, race/ethnicity, marital status, and reasons for ENDS use. In the unadjusted analysis, ENDS use was primarily patterned by education and employment status. College educated persons (vs. those with less than a high school diploma) had a 37% greater prevalence of current ENDS use (PR 1.37, 95% CI 1.20-1.55), and a 16% greater prevalence of former ENDS use (PR 1.16, 95% CI 1.06-1.28) in the fully-adjusted model. Persons with household incomes above $90 K (vs. less than $20,000) had a greater prevalence of current (PR 1.30, 95% CI 1.19-1.41) and former (PR 1.17, 95% CI 1.05-1.30) ENDS use. Those who were employed (vs. not employed) had a 13% greater prevalence of current ENDS use (PR 1.13, 95% CI 1.07-1.19) after full adjustment. Higher SES (vs. lower SES) persons were more likely to use ENDS.
Collapse
Affiliation(s)
- LáShauntá M Glover
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Jennie Z Ma
- School of Medicine, University of Virginia, Charlottesville, VA 22904, USA
| | - Anshula Kesh
- American Heart Association, American Stroke Association, Dallas, TX 75231, USA
| | - Lindsay K Tompkins
- Department of Epidemiology and Population Health, University of Louisville, KY- 40292, USA
| | - Joy L Hart
- Department of Communication, University of Louisville, KY 40292, USA
| | | | - Kandi Walker
- Department of Communication, University of Louisville, KY 40292, USA
| | | | - Tom Payne
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| |
Collapse
|
23
|
Lin Y, Williams N, Wang D, Coetzee W, Zhou B, Eng LS, Um SY, Bao R, Devinsky O, McDonald TV, Sampson BA, Tang Y. Applying High-Resolution Variant Classification to Cardiac Arrhythmogenic Gene Testing in a Demographically Diverse Cohort of Sudden Unexplained Deaths. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001839. [PMID: 29247119 DOI: 10.1161/circgenetics.117.001839] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Genetic variant interpretation contributes to testing yield differences reported for sudden unexplained death. Adapting a high-resolution variant interpretation framework, which considers disease prevalence, reduced penetrance, genetic heterogeneity, and allelic contribution to determine the maximum tolerated allele count in gnomAD, we report an evaluation of cardiac channelopathy and cardiomyopathy genes in a large, demographically diverse sudden unexplained death cohort that underwent thorough investigation in the United States' largest medical examiner's office. METHODS AND RESULTS The cohort has 296 decedents: 147 Blacks, 64 Hispanics, 49 Whites, 22 Asians, and 14 mixed ethnicities; 142 infants (1 to 11 months), 39 children (1 to 17 years), 74 young adults (18 to 34 years), and 41 adults (35 to 55 years). Eighty-nine cardiac disease genes were evaluated. Using a high-resolution variant interpretation workflow, we classified 17 variants as pathogenic or likely pathogenic (2 of which were incidental findings and excluded in testing yield analysis), 46 novel variants of uncertain significance, and 130 variants of uncertain significance. Nine pathogenic or likely pathogenic variants in ClinVar were reclassified to likely benign and excluded in testing yield analysis. The yields of positive cases by ethnicity and age were 21.4% in mixed ethnicities, 10.2% Whites, 4.5% Asians, 3.1% Hispanics, and 2% Blacks; 7.7% children, 7.3% in adults, 5.4% young adults, and 2.8% infants. The percentages of uncertain cases with variants of uncertain significance by ethnicity were 45.5% in Asians, 45.3% Hispanics, 44.20% Blacks, 36.7% Whites, and 14.3% in mixed ethnicities. CONCLUSIONS High-resolution variant interpretation provides diagnostic accuracy and healthcare efficiency. Under-represented populations warrant greater inclusion in future studies.
Collapse
Affiliation(s)
- Ying Lin
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Nori Williams
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Dawei Wang
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - William Coetzee
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Bo Zhou
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Lucy S Eng
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Sung Yon Um
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Ruijun Bao
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Orrin Devinsky
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Thomas V McDonald
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Barbara A Sampson
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.)
| | - Yingying Tang
- From the Laboratory Division, Molecular Genetics Laboratory, New York City Office of Chief Medical Examiner (Y.L., N.W., D.W., B.Z., L.S.E., S.Y.U., R.B., B.A.S., Y.T.); Departments of Pediatrics, Biochemistry and Molecular Pharmacology, and Physiology and Neuroscience, NYU School of Medicine (W.C.); Department of Neurology, NYU Langone Medical Center (O.D.); and Departments of Medicine (Cardiology) and Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY (T.V.M.).
| |
Collapse
|
24
|
Subjective social class and distrust among Chinese college students: The mediating roles of relative deprivation and belief in a just world. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-9908-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
25
|
Brewer LC, Redmond N, Slusser JP, Scott CG, Chamberlain AM, Djousse L, Patten CA, Roger VL, Sims M. Stress and Achievement of Cardiovascular Health Metrics: The American Heart Association Life's Simple 7 in Blacks of the Jackson Heart Study. J Am Heart Assoc 2018; 7:JAHA.118.008855. [PMID: 29871857 PMCID: PMC6015384 DOI: 10.1161/jaha.118.008855] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Ideal cardiovascular health metrics (defined by the American Heart Association Life's Simple 7 [LS7]) are suboptimal among blacks, which results in high risk of cardiovascular disease. We examined the association of multiple stressors with LS7 components among blacks. Methods and Results Using a community‐based cohort of blacks (N=4383), we examined associations of chronic stress, minor stressors, major life events, and a cumulative stress score with LS7 components (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting plasma glucose) and an LS7 composite score. Multivariable logistic regression assessed the odds of achieving intermediate/ideal levels of cardiovascular health adjusted for demographic, socioeconomic, behavioral, and biomedical factors. The LS7 components with the lowest percentages of intermediate/ideal cardiovascular health levels were diet (39%), body mass index (47%), and physical activity (51%). Higher chronic, minor, and cumulative stress scores were associated with decreased odds (odds ratio [OR]) of achieving intermediate/ideal levels for smoking (OR [95% confidence interval], 0.80 [0.73–0.88], 0.84 [0.75–0.94], and 0.81 [0.74–0.90], respectively). Participants with more major life events had decreased odds of achieving intermediate/ideal levels for smoking (OR, 0.84; 95% confidence interval, 0.76–0.92) and fasting plasma glucose (OR, 0.90; 95% confidence interval, 0.82–0.98). Those with higher scores for minor stressors and major life events were less likely to achieve intermediate or ideal LS7 composite scores (OR [95% confidence interval], 0.89 [0.81–0.97] and 0.91 [0.84–0.98], respectively). Conclusions Blacks with higher levels of multiple stress measures are less likely to achieve intermediate or ideal levels of overall cardiovascular health (LS7 composite score), specific behaviors (smoking), and biological factors (fasting plasma glucose).
Collapse
Affiliation(s)
| | - Nicole Redmond
- National Heart, Lung, and Blood Institute/National Institutes of Health, Bethesda, MD
| | - Joshua P Slusser
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Luc Djousse
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Veronique L Roger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| |
Collapse
|
26
|
Chamik T, Viswanathan B, Gedeon J, Bovet P. Associations between psychological stress and smoking, drinking, obesity, and high blood pressure in an upper middle-income country in the African region. Stress Health 2018; 34:93-101. [PMID: 28586134 DOI: 10.1002/smi.2766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/17/2017] [Accepted: 05/14/2017] [Indexed: 11/06/2022]
Abstract
The direction and magnitude of the associations between cardiovascular risk factors (CVRFs) and psychological stress continue to be debated, and no data are available from surveys in the African region. In this study, we examine the associations between CVRFs and psychological stress in the Seychelles, a rapidly developing small island state in the African region. A survey was conducted in 1,240 adults aged 25-64 years representative of the Seychelles. Participants were asked to rank psychological stress that they had experienced during the past 12 months in four domains: work, social life, financial situation, and environment around home. CVRFs (high blood pressure, tobacco use, alcohol drinking, and obesity) were assessed using standard procedures. Psychological stress was associated with age, sex, and socioeconomic status. Overall, there were only few consistent associations between psychological stress and CVRFs, adjusting for age, sex, and socioeconomic status. Social stress was associated with smoking, drinking, and obesity, and there were marginal associations between stress at work and drinking, and between financial stress, and smoking and drinking. Psychological stress was not associated with high blood pressure. These findings suggest that psychological stress should be considered in cardiovascular disease prevention and control strategies.
Collapse
Affiliation(s)
- Tanja Chamik
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| |
Collapse
|
27
|
Kronenberg G, Schöner J, Nolte C, Heinz A, Endres M, Gertz K. Charting the perfect storm: emerging biological interfaces between stress and stroke. Eur Arch Psychiatry Clin Neurosci 2017; 267:487-494. [PMID: 28393267 PMCID: PMC5561158 DOI: 10.1007/s00406-017-0794-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/25/2017] [Indexed: 12/20/2022]
Abstract
A growing body of evidence demonstrates that psychosocial stress is an important and often underestimated risk factor for cardiovascular disease such as myocardial infarction and stroke. In this article, we map out major biological interfaces between stress, stress-related psychiatric disorders, and stroke, placing special emphasis on the fact that stress and psychiatric disorders may be both cause and consequence of cardiovascular disease. Apart from high-risk lifestyle habits such as smoking and lack of exercise, neuroendocrine dysregulation, alterations of the hemostatic system, increased oxidative stress, and inflammatory changes have been implicated in stress-related endothelial dysfunction. Heart rate provides another useful and easily available measure that reflects the complex interplay of vascular morbidity and psychological distress. Importantly, heart rate is emerging as a valuable predictor of stroke outcome and, possibly, even a target for therapeutic intervention. Furthermore, we review recent findings highlighting the role of FK506-binding protein 51 (FKBP5), a co-chaperone of the glucocorticoid receptor, and of perturbations in telomere maintenance, as potential mediators between stress and vascular morbidity. Finally, psychiatric sequelae of cardiovascular events such as post-stroke depression or posttraumatic stress disorder are highly prevalent and may, in turn, exert far-reaching effects on recovery and outcome, quality of life, recurrent ischemic events, medication adherence, and mortality.
Collapse
Affiliation(s)
- G. Kronenberg
- 0000 0000 9737 0454grid.413108.fKlinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Rostock, Rostock, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J. Schöner
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany ,0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C. Nolte
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A. Heinz
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - M. Endres
- 0000 0001 2218 4662grid.6363.0Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany ,0000 0001 2218 4662grid.6363.0Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany ,0000 0004 0438 0426grid.424247.3German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany ,grid.452396.fGerman Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Karen Gertz
- Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|