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Wallace J, Williamson MM, Delfin D, Gray H, Zemke J, Pierce S, Jones E, Harriell K. A Roadmap for Sustainable Community-Engaged Partnerships in Athletic Training and Using a Traveling Athletic Training Camp as an Implementation Strategy. J Athl Train 2024; 59:438-446. [PMID: 38291793 PMCID: PMC11127670 DOI: 10.4085/1062-6050-0329.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Improving access to athletic trainers and increasing diversity in the profession have been major goals of the Strategic Alliance, with a particular interest in the secondary school setting. Within many marginalized communities, individuals are often faced with a lack of resources, high rates of poverty, and limited access to health care. This social and economic climate often extends to inequitable athletic training services and patterns of disparate health. Widely used and recognized strategies to cultivate diversity and address health inequities include community-engaged partnerships; however, these approaches are not well implemented across the athletic training discipline. Successful community-engaged partnerships link communities and universities, and they are rooted in intentionality to address intermediate and long-term health equity outcomes. Athletic training professionals and scholars frequently encounter gaps in resources and process-oriented methods to participate in community-engaged efforts that could include a roadmap or pathway to follow. To bridge this gap, our aims were 2-fold: (1) to disseminate a roadmap for building sustainable community-engaged partnerships in athletic training with the intent of promoting diversity, equity, inclusion, and social justice across athletic training education, research, and professional service and (2) to demonstrate how the roadmap can be implemented using a community-based athletic training education camp as an example. Implementation of the athletic training camp using the roadmap took place at secondary schools where community-engaged partnerships have been established throughout a geographic region known as the Alabama Black Belt, a region burdened with poor health outcomes, limited athletic trainer presence, and lower quality of life, exacerbated by racial and socioeconomic inequalities. Implementing this roadmap as a strategy to build sustainable community-engaged partnerships offers an innovative, interactive, and effective approach to addressing community needs by exposing secondary school students to the athletic training profession, advancing equitable athletic training research practices, and upholding and promoting the principles of diversity, equity, inclusion, and social justice in athletic training education.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa
| | | | - Danae Delfin
- School of Physical Therapy and Rehabilitation Sciences, Morsani College of Medicine, University of South Florida Health, Tampa
| | - Haleigh Gray
- College of Health Sciences, Charleston Southern University, SC
| | - Jeri Zemke
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa
| | | | - Emily Jones
- Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa
| | - Kysha Harriell
- Department of Kinesiology & Sport Sciences, School of Education and Human Development, University of Miami, Coral Gables, FL
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Satcher LA, Erving CL, Pitt RN. Are There Regional Differences in Mental Health among Black Americans? An Exploration of Explanatory Mechanisms. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01969-3. [PMID: 38468118 DOI: 10.1007/s40615-024-01969-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/13/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
Using data from the National Survey of American Life (NSAL) (2001-2003), we examine regional differences in past-year anxiety disorder and past-year major depressive episodes among a geographically diverse sample of Black Americans (N = 3,672). We find that Black Americans residing in the South experience a mental health advantage over Black Americans living in other parts of the country, experiencing lower rates of both anxiety disorder and past-year major depression. We also examine the extent to which stress exposure, religious involvement, and neighborhood contexts help explain any regional differences. We find that stress exposure helps to explain much of the differences observed across regions, while religious involvement and neighborhood contexts help explain observed regional differences to a lesser extent. These findings highlight the importance of considering regional contexts in understanding intra-racial differences in mental health.
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Affiliation(s)
- Lacee A Satcher
- Boston College, 140 Commonwealth Avenue, McGuinn Hall 420, 02467, Chestnut Hill, MA, USA.
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Safford MM, Cummings DM, Halladay J, Shikany JM, Richman J, Oparil S, Hollenberg J, Adams A, Anabtawi M, Andreae L, Baquero E, Bryan J, Clark D, Johnson E, Richman E, Soroka O, Tillman J, Cherrington AL. The design and rationale of a multicenter real-world trial: The Southeastern Collaboration to Improve Blood Pressure Control in the US Black Belt - Addressing the Triple Threat. Contemp Clin Trials 2023; 129:107183. [PMID: 37061162 PMCID: PMC10225352 DOI: 10.1016/j.cct.2023.107183] [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: 02/09/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Impoverished African Americans (AA) with hypertension face poor health outcomes. PURPOSE To conduct a cluster-randomized trial testing two interventions, alone and in combination, to improve blood pressure (BP) control in AA with persistently uncontrolled hypertension. METHODS We engaged primary care practices serving rural Alabama and North Carolina residents, and in each practice we recruited approximately 25 AA adults with persistently uncontrolled hypertension (mean systolic BP >140 mmHg over the year prior to enrollment plus enrollment day BP assessed by research assistants ≥140/90 mmHg). Practices were randomized to peer coaching (PC), practice facilitation (PF), both PC and PF (PC + PF), or enhanced usual care (EUC). Coaches met with participants from PC and PC + PF practices weekly for 8 weeks then monthly over one year, discussing lifestyle changes, medication adherence, home monitoring, and communication with the healthcare team. Facilitators met with PF and PC + PF practices monthly to implement ≥1 quality improvement intervention in each of four domains. Data were collected at 0, 6, and 12 months. RESULTS We recruited 69 practices and 1596 participants; 18 practices (408 participants) were randomized to EUC, 16 (384 participants) to PF, 19 (424 participants) to PC, and 16 (380 participants) to PC + PF. Participants had mean age 57 years, 61% were women, and 56% reported annual income <$20,000. LIMITATIONS The PF intervention acts at the practice level, possibly missing intervention effects in trial participants. Neither PC nor PF currently has established clinical reimbursement mechanisms. CONCLUSIONS This trial will fill evidence gaps regarding practice-level vs. patient-level interventions for rural impoverished AA with uncontrolled hypertension.
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Affiliation(s)
- Monika M Safford
- Department of Medicine, Weill Cornell Medical College of Cornell University, 1300 York Ave, New York, NY 10065, United States.
| | - Doyle M Cummings
- Department of Family Medicine, East Carolina University, E 5th St, Greenville, NC 27858, United States
| | - Jacqueline Halladay
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr., Chapel Hill, NC 27514, United States
| | - James M Shikany
- Department of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294, United States
| | - Joshua Richman
- Department of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294, United States
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294, United States
| | - James Hollenberg
- Department of Medicine, Weill Cornell Medical College of Cornell University, 1300 York Ave, New York, NY 10065, United States
| | - Alyssa Adams
- Department of Family Medicine, East Carolina University, E 5th St, Greenville, NC 27858, United States
| | - Muna Anabtawi
- Department of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294, United States
| | - Lynn Andreae
- Department of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294, United States
| | - Elizabeth Baquero
- Department of Medicine, Weill Cornell Medical College of Cornell University, 1300 York Ave, New York, NY 10065, United States
| | - Joanna Bryan
- Department of Medicine, Weill Cornell Medical College of Cornell University, 1300 York Ave, New York, NY 10065, United States
| | - Debra Clark
- Health & Wellness Education, 1121 N Washington St, Livingston, AL 35470, United States
| | - Ethel Johnson
- West Central Alabama Community Health Improvement League of Camden, PO Box 219 Camden, AL 36726-0219, United States
| | - Erica Richman
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Dr., Chapel Hill, NC 27514, United States
| | - Orysya Soroka
- Department of Medicine, Weill Cornell Medical College of Cornell University, 1300 York Ave, New York, NY 10065, United States
| | - James Tillman
- Open Water Coaching and Consulting, Cape Carteret, 300 Taylor Notion Rd, Cape Carteret, NC 28584, United States
| | - Andrea L Cherrington
- Department of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL 35294, United States
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Dowell S, Yun H, Curtis JR, Chen L, Xie F, Pedra-Nobre M, Wollaston D, Najmey S, Elliott CL, Ford TL, North H, Dore R, Dolatabadi S, Ramanujam T, Kennedy S, Ott S, Jileaeva I, Richardson A, Kaine J, Wright G, Kerr GS. Geographic Variation in Disease Burden and Mismatch in Care of Patients With Rheumatoid Arthritis in the United States. ACR Open Rheumatol 2023; 5:181-189. [PMID: 36811270 PMCID: PMC10100689 DOI: 10.1002/acr2.11532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/04/2023] [Accepted: 01/21/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Our objective was to evaluate the factors associated with regional variation of rheumatoid arthritis (RA) disease burden in the US. METHODS In a retrospective cohort analysis of Rheumatology Informatics System for Effectiveness (RISE) registry data, seropositivity, RA disease activity (Clinical Disease Activity Index [CDAI], Routine Assessment of Patient Index Data-version 3 [RAPID3]), socioeconomic status (SES), geographic region, health insurance type, and comorbidity burden were recorded. An Area Deprivation Index score of more than 80 defined low SES. Median travel distance to practice sites' zip codes was calculated. Linear regression was used to analyze associations between RA disease activity and comorbidity adjusting for age, sex, geographic region, race, and insurance type. RESULTS Enrollment data for 184,722 patients with RA from 182 RISE sites were analyzed. Disease activity was higher in African American patients, in those from Southern regions, and in those with Medicaid or Medicare coverage. Greater comorbidity was prevalent in patients in the South and those with Medicare or Medicaid coverage. There was moderate correlation between comorbidity and disease activity (Pearson coefficient: RAPID3 0.28, CDAI 0.15). High-deprivation areas were mainly in the South. Less than 10% of all participating practices cared for more than 50% of all Medicaid recipients. Patients living more than 200 miles away from specialist care were located mainly in Southern and Western regions. CONCLUSION A disproportionately large portion of socially deprived, high comorbidity, and Medicaid-covered patients with RA were cared for by a minority of rheumatology practices. Studies are needed in high-deprivation areas to establish more equitable distribution of specialty care for patients with RA.
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Affiliation(s)
- Sharon Dowell
- Howard University College of Medicine, Washington, DC
| | | | | | | | | | | | | | - Sawsan Najmey
- Ocean University Medical Center at Hackensack Meridian Health, CentraState Medical Center, Freehold, New Jersey
| | | | | | - Heather North
- UNC Health, Pardee Hospital, Hendersonville, North Carolina
| | - Robin Dore
- David Geffen School of Medicine at University of California, Los Angeles
| | - Soha Dolatabadi
- Assistant Professor at UCLA Geffen School of Medicine, Los Angeles, California
| | | | - Stacy Kennedy
- Novant Health Rowan Medical Center, Salisbury, North Carolina
| | - Stephanie Ott
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, and Fairfield Medical Center, Lancaster, Ohio
| | | | | | | | - Grace Wright
- Association of Women in Rheumatology, New York, New York
| | - Gail S Kerr
- Washington DC Veterans Affairs Medical Center, Georgetown University, and Howard University College of Medicine, Washington, DC
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He KY, Kelly TN, Wang H, Liang J, Zhu L, Cade BE, Assimes TL, Becker LC, Beitelshees AL, Bielak LF, Bress AP, Brody JA, Chang YPC, Chang YC, de Vries PS, Duggirala R, Fox ER, Franceschini N, Furniss AL, Gao Y, Guo X, Haessler J, Hung YJ, Hwang SJ, Irvin MR, Kalyani RR, Liu CT, Liu C, Martin LW, Montasser ME, Muntner PM, Mwasongwe S, Naseri T, Palmas W, Reupena MS, Rice KM, Sheu WHH, Shimbo D, Smith JA, Snively BM, Yanek LR, Zhao W, Blangero J, Boerwinkle E, Chen YDI, Correa A, Cupples LA, Curran JE, Fornage M, He J, Hou L, Kaplan RC, Kardia SLR, Kenny EE, Kooperberg C, Lloyd-Jones D, Loos RJF, Mathias RA, McGarvey ST, Mitchell BD, North KE, Peyser PA, Psaty BM, Raffield LM, Rao DC, Redline S, Reiner AP, Rich SS, Rotter JI, Taylor KD, Tracy R, Vasan RS, Morrison AC, Levy D, Chakravarti A, Arnett DK, Zhu X. Rare coding variants in RCN3 are associated with blood pressure. BMC Genomics 2022; 23:148. [PMID: 35183128 PMCID: PMC8858539 DOI: 10.1186/s12864-022-08356-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While large genome-wide association studies have identified nearly one thousand loci associated with variation in blood pressure, rare variant identification is still a challenge. In family-based cohorts, genome-wide linkage scans have been successful in identifying rare genetic variants for blood pressure. This study aims to identify low frequency and rare genetic variants within previously reported linkage regions on chromosomes 1 and 19 in African American families from the Trans-Omics for Precision Medicine (TOPMed) program. Genetic association analyses weighted by linkage evidence were completed with whole genome sequencing data within and across TOPMed ancestral groups consisting of 60,388 individuals of European, African, East Asian, Hispanic, and Samoan ancestries. RESULTS Associations of low frequency and rare variants in RCN3 and multiple other genes were observed for blood pressure traits in TOPMed samples. The association of low frequency and rare coding variants in RCN3 was further replicated in UK Biobank samples (N = 403,522), and reached genome-wide significance for diastolic blood pressure (p = 2.01 × 10- 7). CONCLUSIONS Low frequency and rare variants in RCN3 contributes blood pressure variation. This study demonstrates that focusing association analyses in linkage regions greatly reduces multiple-testing burden and improves power to identify novel rare variants associated with blood pressure traits.
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Affiliation(s)
- Karen Y He
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106, USA
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Heming Wang
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Jingjing Liang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106, USA
| | - Luke Zhu
- Center for Human Genetics & Genomics, New York University Grossman School of Medicine, New York, NY, USA
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Themistocles L Assimes
- Department of Medicine (Division of Cardiovascular Medicine), Stanford University, Palo Alto, CA, USA
| | - Lewis C Becker
- GeneSTAR Research Program, Department of Medicine, Divisions of Cardiology and General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amber L Beitelshees
- Division of Endocrinology, Diabetes, and Nutrition, Program for Personalized and Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Yen-Pei Christy Chang
- Division of Endocrinology, Diabetes, and Nutrition, Program for Personalized and Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Yi-Cheng Chang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei City, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Paul S de Vries
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ravindranath Duggirala
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
| | - Ervin R Fox
- Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Nora Franceschini
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Anna L Furniss
- Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yan Gao
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jeffrey Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yi-Jen Hung
- Institute of Preventive Medicine, National Defense Medical Center, New Taipei City, Taiwan
| | - Shih-Jen Hwang
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
- Framingham Heart Study, National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
| | - Marguerite Ryan Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AB, USA
| | - Rita R Kalyani
- GeneSTAR Research Program, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ching-Ti Liu
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
- Framingham Heart Study, National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
| | - Chunyu Liu
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
- Framingham Heart Study, National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
| | - Lisa Warsinger Martin
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC, USA
| | - May E Montasser
- Division of Endocrinology, Diabetes, and Nutrition, Program for Personalized and Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul M Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AB, USA
| | | | - Take Naseri
- Ministry of Health, Government of Samoa, Apia, Samoa
| | - Walter Palmas
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Kenneth M Rice
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Wayne H-H Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Daichi Shimbo
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Beverly M Snively
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lisa R Yanek
- GeneSTAR Research Program, Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - John Blangero
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Yii-Der Ida Chen
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
- Division of Genomic Outcomes, Department of Pediatrics, Harbor-UCLA Medical Center Professor of Pediatrics, UCLA, Torrance, CA, USA
| | - Adolfo Correa
- Jackson Heart Study, University of Mississippi Medical Center, Jackson, MS, USA
| | - L Adrienne Cupples
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
- Framingham Heart Study, National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
| | - Joanne E Curran
- Department of Human Genetics and South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, USA
| | - Myriam Fornage
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Lifang Hou
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University Chicago, Evanston, IL, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, USA
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Eimear E Kenny
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Donald Lloyd-Jones
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rasika A Mathias
- GeneSTAR Research Program, Department of Medicine, Divisions of Allergy and Clinical Immunology and General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen T McGarvey
- International Health Institute and Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Department of Anthropology, Brown University, Providence, RI, USA
| | - Braxton D Mitchell
- Division of Endocrinology, Diabetes, and Nutrition, Program for Personalized and Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Geriatrics Research and Education Clinical Center, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Kari E North
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patricia A Peyser
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D C Rao
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Alex P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Russell Tracy
- Department of Pathology & Laboratory Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - Ramachandran S Vasan
- Framingham Heart Study, National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Alanna C Morrison
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Daniel Levy
- Framingham Heart Study, National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Aravinda Chakravarti
- Center for Human Genetics & Genomics, New York University Grossman School of Medicine, New York, NY, USA
| | - Donna K Arnett
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Wolstein Research Building, 2103 Cornell Road, Cleveland, OH, 44106, USA.
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Burns SP, Lutz BJ, Magwood GS. 'Timing it Right': needs of African American adults with stroke and their caregivers across the care continuum. ETHNICITY & HEALTH 2022; 27:420-434. [PMID: 31752519 DOI: 10.1080/13557858.2019.1693512] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 11/02/2019] [Indexed: 06/10/2023]
Abstract
Objective: African Americans are disproportionately affected by stroke in the United States (US). The purpose of this study is to explore experiences, wants, and needs of African Americans with stroke and their family caregivers residing in the stroke belt across the care continuum using the 'Timing It Right' (TIR) framework as a conceptual guide.Design: We conducted a series of focus groups among 20 African Americans living with stroke and 19 family caregivers. Focus groups were audio-recorded and transcribed verbatim. For this secondary analysis, we coded qualitative data using the TIR framework.Results: Participants in this sample identified pre-stroke needs in addition to the TIR phases that span across the care continuum and into community living. We identified four important contextual factors and real-world conditions that operate in the background and influence the post-stroke needs of this specific population across the TIR framework: (1) religion, faith, and church, (2) healthcare delivery, (3) community, and (4) sentinel events.Conclusions: We propose a TIR model that expands upon the original TIR framework which includes factors important for consideration when developing and delivering community-based interventions among African Americans with stroke and family caregivers in the southeastern US.
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Affiliation(s)
- Suzanne Perea Burns
- School of Occupational Therapy, Texas Woman's University, Denton, TX, USA
- WISSDOM Center, Medical University of South Carolina, Charleston, SC, USA
| | - Barabara J Lutz
- College of Health and Human Sciences, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Gayenell S Magwood
- WISSDOM Center, Medical University of South Carolina, Charleston, SC, USA
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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7
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Stroke Disparities. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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8
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Linden T, De Jong J, Lu C, Kiri V, Haeffs K, Fröhlich H. An Explainable Multimodal Neural Network Architecture for Predicting Epilepsy Comorbidities Based on Administrative Claims Data. Front Artif Intell 2021; 4:610197. [PMID: 34095818 PMCID: PMC8176093 DOI: 10.3389/frai.2021.610197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/21/2021] [Indexed: 01/16/2023] Open
Abstract
Epilepsy is a complex brain disorder characterized by repetitive seizure events. Epilepsy patients often suffer from various and severe physical and psychological comorbidities (e.g., anxiety, migraine, and stroke). While general comorbidity prevalences and incidences can be estimated from epidemiological data, such an approach does not take into account that actual patient-specific risks can depend on various individual factors, including medication. This motivates to develop a machine learning approach for predicting risks of future comorbidities for individual epilepsy patients. In this work, we use inpatient and outpatient administrative health claims data of around 19,500 U.S. epilepsy patients. We suggest a dedicated multimodal neural network architecture (Deep personalized LOngitudinal convolutional RIsk model-DeepLORI) to predict the time-dependent risk of six common comorbidities of epilepsy patients. We demonstrate superior performance of DeepLORI in a comparison with several existing methods. Moreover, we show that DeepLORI-based predictions can be interpreted on the level of individual patients. Using a game theoretic approach, we identify relevant features in DeepLORI models and demonstrate that model predictions are explainable in light of existing knowledge about the disease. Finally, we validate the model on independent data from around 97,000 patients, showing good generalization and stable prediction performance over time.
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Affiliation(s)
- Thomas Linden
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, Sankt Augustin, Germany
- Bonn-Aachen International Center for Information Technology (B-IT), University of Bonn, Bonn, Germany
- UCB Biosciences GmbH, Monheim, Germany
| | | | - Chao Lu
- UCB Ltd., Raleigh, NC, United States
| | | | | | - Holger Fröhlich
- Department of Bioinformatics, Fraunhofer Institute for Algorithms and Scientific Computing (SCAI), Schloss Birlinghoven, Sankt Augustin, Germany
- Bonn-Aachen International Center for Information Technology (B-IT), University of Bonn, Bonn, Germany
- UCB Biosciences GmbH, Monheim, Germany
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9
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Davis Armstrong NM, Spragley KJ, Chen WM, Hsu FC, Brewer MS, Horn PJ, Williams SR, Sale MM, Worrall BB, Keene KL. Multi-omic analysis of stroke recurrence in African Americans from the Vitamin Intervention for Stroke Prevention (VISP) clinical trial. PLoS One 2021; 16:e0247257. [PMID: 33661917 PMCID: PMC7932724 DOI: 10.1371/journal.pone.0247257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022] Open
Abstract
African Americans endure a nearly two-fold greater risk of suffering a stroke and are 2–3 times more likely to die from stroke compared to those of European ancestry. African Americans also have a greater risk of recurrent stroke and vascular events, which are deadlier and more disabling than incident stroke. Stroke is a multifactorial disease with both heritable and environmental risk factors. We conducted an integrative, multi-omic study on 922 plasma metabolites, 473,864 DNA methylation loci, and 556 variants from 50 African American participants of the Vitamin Intervention for Stroke Prevention clinical trial to help elucidate biomarkers contributing to recurrent stroke rates in this high risk population. Sixteen metabolites, including cotinine, N-delta-acetylornithine, and sphingomyelin (d17:1/24:1) were identified in t-tests of recurrent stroke outcome or baseline smoking status. Serum tricosanoyl sphingomyelin (d18:1/23:0) levels were significantly associated with recurrent stroke after adjusting for covariates in Cox Proportional Hazards models. Weighted Gene Co-expression Network Analysis identified moderate correlations between sphingolipid markers and clinical traits including days to recurrent stroke. Integrative analyses between genetic variants in sphingolipid pathway genes identified 29 nominal associations with metabolite levels in a one-way analysis of variance, while epigenomic analyses identified xenobiotics, predominately smoking-associated metabolites and pharmaceutical drugs, associated with methylation profiles. Taken together, our results suggest that metabolites, specifically those associated with sphingolipid metabolism, are potential plasma biomarkers for stroke recurrence in African Americans. Furthermore, genetic variation and DNA methylation may play a role in the regulation of these metabolites.
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Affiliation(s)
- Nicole M. Davis Armstrong
- Department of Biology, East Carolina University, Greenville, North Carolina, United States of America
| | - Kelsey J. Spragley
- Department of Biology, East Carolina University, Greenville, North Carolina, United States of America
| | - Wei-Min Chen
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Fang-Chi Hsu
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Michael S. Brewer
- Department of Biology, East Carolina University, Greenville, North Carolina, United States of America
| | - Patrick J. Horn
- Department of Biology, East Carolina University, Greenville, North Carolina, United States of America
| | - Stephen R. Williams
- Department of Neurology, University of Virginia, Charlottesville, Virginia, United States of America
| | - Michèle M. Sale
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Bradford B. Worrall
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Neurology, University of Virginia, Charlottesville, Virginia, United States of America
| | - Keith L. Keene
- Department of Biology, East Carolina University, Greenville, North Carolina, United States of America
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, North Carolina, United States of America
- * E-mail:
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10
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Lamar M, Lerner AJ, James BD, Yu L, Glover CM, Wilson RS, Barnes LL. Relationship of Early-Life Residence and Educational Experience to Level and Change in Cognitive Functioning: Results of the Minority Aging Research Study. J Gerontol B Psychol Sci Soc Sci 2021; 75:e81-e92. [PMID: 30882155 PMCID: PMC7424266 DOI: 10.1093/geronb/gbz031] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Investigate associations of early-life residence and school segregation with cognitive change in the Minority Aging Research Study. METHODS Four hundred ninety-eight blacks (age ~ 73.5; 75% = women) without dementia at baseline self-reported State of birth, residence at age 12, and school segregation status. Census Bureau definitions of South and Northeast/Midwest were used to categorize early-life residence. We evaluated global cognition and five cognitive domains at baseline and annually for ~7.5 years. Linear mixed effects models examined the associations of region of birth and residence at age 12 with baseline level and longitudinal change in cognition. Additional models examined school segregation experience. RESULTS ~65% of Southern-born participants still lived in the South at age 12. Southern birth was associated with lower baseline global cognition and all cognitive domains (p-values ≤ .02) compared to Northern birth, but not cognitive change. A similar profile was seen for Southern residence at age 12. Segregation experience significantly modified associations of residence at age 12 on levels of cognition. Participants residing in the South attending a legally desegregated school demonstrated lower baseline levels of cognition (global, semantic, and working memory) than their Northeast/Midwest counterparts attending a legally desegregated or segregated school as well as their Southern counterparts attending a legally segregated school. This profile for participants attending a desegregated school in the South held for processing speed and visuospatial ability in comparisons to Northeast/Midwest counterparts, particularly those attending a legally desegregated school. CONCLUSION Baseline cognition was poorer in individuals born and residing in the South, particularly those attending desegregated schools at age 12.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Alan J Lerner
- Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio.,Department of Neurology, Case Western Reserve University, Cleveland, Ohio
| | - Bryan D James
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.,Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
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11
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Lin C, Arevalo YA, Nanavati HD, Lin DM. Racial differences and an increased systemic inflammatory response are seen in patients with COVID-19 and ischemic stroke. Brain Behav Immun Health 2020; 8:100137. [PMID: 32904928 PMCID: PMC7462566 DOI: 10.1016/j.bbih.2020.100137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To describe the difference in clinical presentation, including race, of ischemic stroke between patients with and without novel coronavirus disease 2019 (COVID-19), and the association of inflammatory response with stroke severity. METHODS This is a retrospective, observational, cross-sectional study of patients (n = 60) admitted with ischemic stroke between late March and early May 2020. All patients were tested for COVID-19 during admission. Demographic, clinical, and laboratory data was collected through electronic medical record review. Descriptive statistics was performed to observe the differences between stroke patients with and without COVID-19. RESULTS 60 hospitalized patients with acute ischemic stroke were included in the analysis. Nine were positive for COVID-19. African-Americans comprised of 55.6% of those that had COVID-19 and stroke and 37.7% of those with only stroke. Stroke patients with COVID-19 had a significantly higher NIHSS [18.4 (8.8)] and neutrophil-to-lymphocyte ratio (NLR) [7.3 (4.2) vs 3.8 (2.8); P = 0.0137] than those without. Those with COVID-19 also had a significantly higher mortality rate (44.4% vs. 7.6%; p < 0.001). CONCLUSION We observed a cohort of patients, including a large proportion of African-Americans, who developed ischemic stroke with or without COVID-19. An exaggerated inflammatory response, as indicated by NLR, likely plays a role in stroke severity among COVID-19 patients that concurrently develop ischemic stroke.
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Affiliation(s)
- Chen Lin
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Yurany A. Arevalo
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Hely D. Nanavati
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Diana M. Lin
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, 35294, USA
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12
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Regional variations in cardiovascular risk factors and access to care among US veterans with cardiovascular disease. Coron Artery Dis 2020; 31:733-738. [PMID: 32404592 DOI: 10.1097/mca.0000000000000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It remains unclear whether cardiovascular risk factors and access to healthcare for veterans with cardiovascular disease (CVD) vary among US regions. This study sought to determine the extent of regional variations in cardiovascular risk factors and access to medical care in a cohort of veterans with CVD in the USA. METHODS The 2016 Centers for Disease Control Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of veteran patients with CVD. Participants were classified based on four US regions: (1) Northeast, (2) Midwest, (3) South, and (4) West. We compared demographic data, medical history, and access to care for veterans of each US region. The outcomes of interest included financial barriers to medical care and annual medical checkup. RESULTS Among the 13 835 veterans, 18.3% were from the Northeast, while 23.5, 37.1, and 21.1% were from the Midwest, South, and West, respectively. Veterans of each region differed significantly with respect to demographic characteristics, prior medical history, and access to care. Rates of financial barriers to medical care were similar across the four regions (7.3 vs. 7.1 vs. 8.0 vs. 6.9%, P = 0.203). Veterans from the West had the lowest rates of medical checkup within the past year (91.7 vs. 89.5 vs. 91.4 vs. 86.6%). On multivariate analysis, the Midwest [odds ratio (OR) 0.69; 95% CI, 0.53-0.89] and West (OR 0.53; 95% CI 0.41-0.68) regions were independently associated with lower rates of medical checkup within the past year compared to the Northeast. CONCLUSIONS In this observational study involving US veterans with CVD, cardiovascular risk factors and frequency of annual medical checkup differed amongst each US region. Further large-scale studies examining the prevalence of impaired access to care and quality of care in US veterans with CVD are warranted.
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13
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Affiliation(s)
- George Howard
- From the Department of Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham
| | - Virginia J. Howard
- Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham
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14
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Samuel-Hodge CD, Gizlice Z, Allgood SD, Bunton AJ, Erskine A, Leeman J, Cykert S. Strengthening community-clinical linkages to reduce cardiovascular disease risk in rural NC: feasibility phase of the CHANGE study. BMC Public Health 2020; 20:264. [PMID: 32085707 PMCID: PMC7035725 DOI: 10.1186/s12889-020-8223-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 01/15/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Community Health Workers (CHW) are recommended for delivery of interventions to prevent cardiovascular disease, but there is insufficient evidence to guide implementation of CHW interventions in rural, medically underserved areas. METHODS Using a hybrid implementation-effectiveness design, we evaluated the implementation and effectiveness of an adapted, evidence-based cardiovascular disease risk reduction intervention among rural high-risk adults. CHWs at a community health center and local health department recruited, enrolled and counseled participants during 4 monthly home visits and 3 brief phone contacts. Participant data collection included pre- and post-intervention measurements of blood pressure, weight, and dietary and physical activity behaviors. We evaluated implementation with measures of intervention reach and delivery fidelity. Statistical analyses included descriptive statistics and paired t-tests. RESULTS Study participants (n = 105) had a mean age of 62 years and included 88% Non-Hispanic Blacks and 82% females. Recruitment strategies resulted in the enrollment of 38% of interested and eligible participants who received 80% of the planned intervention visits and phone contacts. Mean differences in pre-/post-intervention measures showed significant mean reductions in blood pressure (- 5.4 mmHg systolic, p = .006; - 2.3 mmHg diastolic, p = .04) and body weight (- 3.8 lb., p = .02). Self-reported dietary and physical activity behaviors also improved significantly. CONCLUSION This feasibility study demonstrated preliminary implementation and program effectiveness of a CHW-delivered intervention to reduce cardiovascular disease risk factors. Additionally, it identified areas for future refinements to strategies that strengthen community-clinical linkages with an integrated role of CHWs in rural health care delivery. If results from this feasibility study can be enhanced in a larger sample, there would be significant potential to positively impact the excess burden of chronic diseases that adversely impact rural, low-income, and medically underserved populations. TRIAL REGISTRATION ClinicalTrials.gov: NCT03582696.
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Affiliation(s)
- Carmen D. Samuel-Hodge
- Gillings School of Global Public Health, Department of Nutrition, Center for Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin Luther King Jr. Blvd., Room 216, CB #7426, Chapel Hill, NC 27599-7426 USA
| | - Ziya Gizlice
- Center for Health Promotion & Disease Prevention, 1700 Martin Luther King Jr. Blvd. CB# 7426, Chapel Hill, NC 27599-7426 USA
| | - Sallie D. Allgood
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB # 7460, Chapel Hill, NC 27599-7460 USA
| | - Audrina J. Bunton
- Cecil G Sheps Center for Health Services Research, 725 Martin Luther King Jr. Blvd. CB# 7590, Chapel Hill, NC 27599-7590 USA
| | - Amber Erskine
- Center for Health Promotion & Disease Prevention, 1700 Martin Luther King Jr. Blvd. CB# 7426, Chapel Hill, NC 27599-7426 USA
| | - Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB # 7460, Chapel Hill, NC 27599-7460 USA
| | - Samuel Cykert
- School of Medicine, Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill, 145 N Medical Drive, CB# 7165, Chapel Hill, NC 27599-7165 USA
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15
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Sterling SR, Bowen SA. The Potential for Plant-Based Diets to Promote Health Among Blacks Living in the United States. Nutrients 2019; 11:E2915. [PMID: 31810250 PMCID: PMC6949922 DOI: 10.3390/nu11122915] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023] Open
Abstract
Plant-based diets are associated with reduced risks of various chronic diseases in the general population. However, it is unclear how these benefits translate to Blacks living in the United States, who are disproportionately burdened with heart disease, cancer, diabetes, obesity, and chronic kidney disease. The objectives of this study were to: (1) review the general evidence of plant-based diets and health outcomes; (2) discuss how this evidence translates to Blacks following a plant-based diet; and (3) provide recommendations and considerations for future studies in this area. Interestingly, although the evidence supporting plant-based diets in the general population is robust, little research has been done on Blacks specifically. However, the available data suggests that following a plant-based diet may reduce the risk of heart disease and possibly cancer in this population. More research is needed on cardiovascular disease risk factors, cancer subtypes, and other chronic diseases. Further, attention must be given to the unique individual, familial, communal, and environmental needs that Blacks who follow plant-based diets may have. Interventions must be culturally appropriate in order to achieve long-term success, and providing low-cost, flavorful, and nutritious options will be important.
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16
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Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. Semin Arthritis Rheum 2018; 48:840-846. [PMID: 30205982 DOI: 10.1016/j.semarthrit.2018.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/30/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE), which is associated with increased stroke risk, is more prevalent and often more severe among Blacks, Asians, and Hispanics than Whites. We examined racial/ethnic variation in stroke rates and risks, overall and by hemorrhagic versus ischemic subtype, among SLE patients. METHODS Within Medicaid (2000-2010), we identified patients aged 18-65 with SLE (≥ 3 ICD-9 710.0 codes, ≥ 30days apart) and ≥12 months of continuous enrollment. Subjects were followed from index date to first stroke event, death, disenrollment, or end of follow-up. Race/ethnicity-specific annual event rates were calculated for stroke overall and by subtypes (hemorrhagic vs. ischemic). We used Cox proportional hazard models to estimate hazard ratios (HR) of stroke by race/ethnicity, adjusting for comorbidities and the competing risk of death. RESULTS Of 65,788 SLE patients, 93.1% were female. Racial/ethnic breakdown was 42% Black, 38% White, 16% Hispanic, 3% Asian, and 1% American Indian/Alaska Natives. Mean follow-up was 3.7 ± 3.0years. After multivariable adjustment, Blacks were at increased risk of overall stroke (HR 1.34 [95%CI 1.18-1.53), hemorrhagic stroke (HR 1.42 [1.00-2.01]), and ischemic stroke (HR 1.33 [1.15-1.52]) compared to Whites. Hispanics were at increased risk of overall stroke (HR 1.25 [1.06-1.47)] and hemorrhagic stroke (HR 1.79 [95% CI 1.22-2.61]), but not ischemic stroke, compared to Whites. CONCLUSION Among SLE patients enrolled in Medicaid, we observed elevated stroke risk (overall and by subtype) among Blacks and Hispanics compared to Whites, suggesting the importance of early recognition and screening for stroke risk factors among Blacks and Hispanics.
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Calancie L, Keyserling TC, Taillie LS, Robasky K, Patterson C, Ammerman AS, Schisler JC. TAS2R38 Predisposition to Bitter Taste Associated with Differential Changes in Vegetable Intake in Response to a Community-Based Dietary Intervention. G3 (BETHESDA, MD.) 2018; 8:2107-2119. [PMID: 29686110 PMCID: PMC5982837 DOI: 10.1534/g3.118.300547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/19/2018] [Indexed: 12/05/2022]
Abstract
Although vegetable consumption associates with decreased risk for a variety of diseases, few Americans meet dietary recommendations for vegetable intake. TAS2R38 encodes a taste receptor that confers bitter taste sensing from chemicals found in some vegetables. Common polymorphisms in TAS2R38 lead to coding substitutions that alter receptor function and result in the loss of bitter taste perception. Our study examined whether bitter taste perception TAS2R38 diplotypes associated with vegetable consumption in participants enrolled in either an enhanced or a minimal nutrition counseling intervention. DNA was isolated from the peripheral blood cells of study participants (N = 497) and analyzed for polymorphisms. Vegetable consumption was determined using the Block Fruit and Vegetable screener. We tested for differences in the frequency of vegetable consumption between intervention and genotype groups over time using mixed effects models. Baseline vegetable consumption frequency did not associate with bitter taste diplotypes (P = 0.937), however after six months of the intervention, we observed an interaction between bitter taste diplotypes and time (P = 0.046). Participants in the enhanced intervention increased their vegetable consumption frequency (P = 0.020) and within this intervention group, the bitter non-tasters and intermediate-bitter tasters had the largest increase in vegetable consumption. In contrast, in the minimal intervention group, the bitter tasting participants reported a decrease in vegetable consumption. Bitter-non tasters and intermediate-bitter tasters increased vegetable consumption in either intervention more than those who perceive bitterness. Future precision medicine applications could consider genetic variation in bitter taste perception genes when designing dietary interventions.
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Affiliation(s)
| | - Thomas C Keyserling
- Center for Health Promotion and Disease Prevention
- Division of General Medicine and Clinical Epidemiology
| | | | | | - Cam Patterson
- Presbyterian Hospital/Weill-Cornell Medical Center, New York, NY 10065
| | - Alice S Ammerman
- Center for Health Promotion and Disease Prevention
- Department of Nutrition, Gillings School of Global Public Health
| | - Jonathan C Schisler
- McAllister Heart Institute, Department of Pharmacology, and Department of Pathology and Lab Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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18
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Min YI, Anugu P, Butler KR, Hartley TA, Mwasongwe S, Norwood AF, Sims M, Wang W, Winters KP, Correa A. Cardiovascular Disease Burden and Socioeconomic Correlates: Findings From the Jackson Heart Study. J Am Heart Assoc 2017; 6:JAHA.116.004416. [PMID: 28778943 PMCID: PMC5586401 DOI: 10.1161/jaha.116.004416] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Black persons have an excess burden of cardiovascular disease (CVD) compared with white persons. This burden persists after adjustment for socioeconomic status and other known CVD risk factors. This study evaluated the CVD burden and the socioeconomic gradient of CVD among black participants in the JHS (Jackson Heart Study). METHODS AND RESULTS CVD burden was evaluated by comparing the observed prevalence of myocardial infarction, stroke, and hypertension in the JHS at baseline (2000-2004) with the expected prevalence according to US national surveys during a similar time period. The socioeconomic gradient of CVD was evaluated using logistic regression models. Compared with the national data, the JHS age- and sex-standardized prevalence ratios for myocardial infarction, stroke, and hypertension were 1.07 (95% CI, 0.90-1.27), 1.46 (95% CI, 1.18-1.78), and 1.51 (95% CI, 1.42-1.60), respectively, in men and 1.50 (95% CI, 1.27-1.76), 1.33 (95% CI, 1.12-1.57), and 1.43 (95% CI, 1.37-1.50), respectively, in women. A significant and inverse relationship was observed between socioeconomic status and CVD within the JHS cohort. The strongest and most consistent socioeconomic correlate after adjusting for age and sex was income for myocardial infarction (odds ratio: 3.53; 95% CI, 2.31-5.40) and stroke (odds ratio: 3.73; 95% CI, 2.32-5.97), comparing the poor and affluent income categories. CONCLUSIONS Except for myocardial infarction in men, CVD burden in the JHS cohort was higher than expected. A strong inverse socioeconomic gradient of CVD was also observed within the JHS cohort.
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Affiliation(s)
- Yuan-I Min
- University of Mississippi Medical Center, Jackson, MS
| | - Pramod Anugu
- University of Mississippi Medical Center, Jackson, MS
| | | | - Tara A Hartley
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
| | | | | | - Mario Sims
- University of Mississippi Medical Center, Jackson, MS
| | - Wei Wang
- University of Mississippi Medical Center, Jackson, MS
| | | | - Adolfo Correa
- University of Mississippi Medical Center, Jackson, MS
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Wirth LS, Tobo BB, Hinyard L, Vaughn MG. Foreign-born blacks no different from whites for odds of stroke. J Epidemiol Community Health 2017; 71:786-793. [DOI: 10.1136/jech-2016-208125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 03/29/2017] [Accepted: 05/11/2017] [Indexed: 12/22/2022]
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20
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Rumalla K, Kumar AS, Mittal MK. Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes in a U.S. Nationwide Analysis of 3,998,667 Hospitalizations. J Stroke Cerebrovasc Dis 2017; 26:2093-2101. [PMID: 28527586 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/21/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The prognosis from acute ischemic stroke (AIS) is worsened by poststroke medical complications. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS are not known. METHODS We queried the Nationwide Inpatient Sample (2002-2011) to identify all patients with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariable analysis was utilized to identify risk factors for GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes. RESULTS We identified 16,987 patients with GIBO (.43%) among 3,988,667 AIS hospitalizations and 4.2% of these patients underwent surgery. In multivariable analysis, patients with 75+ years of age were two times as likely to suffer GIBO compared to younger patients (P < .0001). African Americans were 42% more likely to have GIBO compared to Whites (P < .0001). Stroke patients with pre-existing comorbidities (coagulopathy, cancer, blood loss anemia, and fluid/electrolyte disorder) were more likely to experience GIBO (all P < .0001). AIS patients with GIBO were 184% and 39% times more likely to face moderate-to-severe disability and in-hospital death, respectively (P < .0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (P < .0001). CONCLUSION GIBO is a rare but burdensome complication of AIS, associated with complications, disability, and mortality. The risk factors identified in this study aim to encourage the monitoring of patients at highest risk for GIBO. The predominant form of stroke-related GIBO is nonmechanical obstruction, although the causative relationship remains unknown.
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Affiliation(s)
- Kavelin Rumalla
- School of Medicine, University of Missouri-Kansas City, Kansas City, Kansas
| | - Ashwath S Kumar
- School of Medicine, University of Missouri-Kansas City, Kansas City, Kansas
| | - Manoj K Mittal
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas.
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Embree GGR, Samuel-Hodge CD, Johnston LF, Garcia BA, Gizlice Z, Evenson KR, DeWalt DA, Ammerman AS, Keyserling TC. Successful long-term weight loss among participants with diabetes receiving an intervention promoting an adapted Mediterranean-style dietary pattern: the Heart Healthy Lenoir Project. BMJ Open Diabetes Res Care 2017; 5:e000339. [PMID: 28405344 PMCID: PMC5372065 DOI: 10.1136/bmjdrc-2016-000339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/02/2017] [Accepted: 02/20/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To examine weight change by diabetes status among participants receiving a Mediterranean-style diet, physical activity, and weight loss intervention adapted for delivery in the southeastern USA, where rates of cardiovascular disease (CVD) are disproportionately high. RESEARCH DESIGN AND METHODS The intervention included: Phase I (months 1-6), an individually tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI≥25 kg/m2 offered as 16 weekly group sessions or 5 group sessions and 10 phone calls, or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance intervention for those losing ≥8 pounds with all others receiving a lifestyle maintenance intervention. Weight change was assessed at 6, 12, and 24-month follow-up. RESULTS Baseline characteristics (n=339): mean age 56, 77% female, 65% African-American, 124 (37%) with diabetes; mean weight 103 kg for those with diabetes and 95 kg for those without. Among participants with diabetes, average weight change was -1.2 kg (95% CI -2.1 to -0.4) at 6 months (n=92), -1.5 kg (95% CI -2.9 to -0.2) at 12 months (n=96), and -3.7 kg (95% CI -5.2 to -2.1) at 24 months (n=93). Among those without diabetes, weight change was -0.4 kg (95% CI -1.4 to 0.6) at 24 months (n=154). CONCLUSIONS Participants with diabetes experienced sustained weight loss at 24-month follow-up. High-risk US populations with diabetes may experience clinically important weight loss from this type of lifestyle intervention. TRIAL REGISTRATION NUMBER NCT01433484.
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Affiliation(s)
- Genevieve G R Embree
- Ambulatory Care Physician, Durham VA Medical Center, Durham, North Carolina, USA
| | - Carmen D Samuel-Hodge
- Department of Nutrition, Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Larry F Johnston
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Beverly A Garcia
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Kelly R Evenson
- Department of Epidemiology , Gillings School of Global Public Health, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Darren A DeWalt
- Division of General Medicine and Clinical Epidemiology , School of Medicine, University of North Carolina , Chapel Hill, North Carolina , USA
| | - Alice S Ammerman
- Department of Nutrition, Center for Health Promotion and Disease Prevention, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Thomas C Keyserling
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA; Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Thayer LM, Pimentel DC, Smith JC, Garcia BA, Lee Sylvester L, Kelly T, Johnston LF, Ammerman AS, Keyserling TC. Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items. AMERICAN JOURNAL OF HEALTH EDUCATION 2016; 48:11-21. [PMID: 28947925 PMCID: PMC5609464 DOI: 10.1080/19325037.2016.1250688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As Americans commonly consume restaurant foods with poor dietary quality, effective interventions are needed to improve food choices at restaurants. PURPOSE To design and evaluate a restaurant-based intervention to help customers select and restaurants promote heart healthy menu items with healthful fats and high quality carbohydrates. METHODS The intervention included table tents outlining 10 heart healthy eating tips, coupons promoting healthy menu items, an information brochure, and link to study website. Pre and post intervention surveys were completed by restaurant managers and customers completed a brief "intercept" survey. RESULTS Managers (n = 10) reported the table tents and coupons were well received, and several noted improved personal nutrition knowledge. Overall, 4214 coupons were distributed with 1244 (30%) redeemed. Of 300 customers surveyed, 126 (42%) noticed the table tents and of these, 115 (91%) considered the nutrition information helpful, 42 (33%) indicated the information influenced menu items purchased, and 91 (72%) reported the information will influence what they order in the future. DISCUSSION The intervention was well-received by restaurant managers and positively influenced menu item selection by many customers. TRANSLATION TO HEALTH EDUCATION PRACTICE Further research is needed to assess effective strategies for scaling up and sustaining this intervention approach.
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Affiliation(s)
- Linden M. Thayer
- Duke University – Center for Advanced Hindsight; 334 Blackwell Street, Suite 320, Durham, NC 27701-3971
| | - Daniela C. Pimentel
- University of North Carolina – Chapel Hill, Department of Nutrition; 135 Dauer Drive 2200 McGavran-Greenberg Hall, CB #7461, Chapel Hill, NC 27599-7461
| | - Janice C. Smith
- University of North Carolina – Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Beverly A. Garcia
- University of North Carolina – Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Laura Lee Sylvester
- Lenoir County Cooperative Extension; 1791 NC Highway 11 55, Kinston, NC 28504
| | - Tammy Kelly
- Kinston-Lenoir Chamber of Commerce; 301 N. Queen St, Kinston, NC 28501
| | - Larry F. Johnston
- University of North Carolina – Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Alice S. Ammerman
- University of North Carolina – Chapel Hill, Department of Nutrition; 135 Dauer Drive 2200 McGavran-Greenberg Hall, CB #7461, Chapel Hill, NC 27599-7461
- University of North Carolina – Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Thomas C. Keyserling
- University of North Carolina – Chapel Hill, Department of Medicine; 125 MacNider Hall, CB #7005 Chapel Hill NC 27599-7005
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Labarthe DR, Howard G, Safford MM, Howard VJ, Judd SE, Cushman M, Kissela BM. Incidence and Case Fatality at the County Level as Contributors to Geographic Disparities in Stroke Mortality. Neuroepidemiology 2016; 47:96-102. [PMID: 27626792 PMCID: PMC5121010 DOI: 10.1159/000449102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Is the high stroke mortality in the Southeastern parts of the United States driven by differences in stroke incidence or case-fatality? This question remains unanswered. Differences in incidence would underscore the need for stroke prevention, while differences in case fatality would call for improved stroke care. METHODS Quartiles of US counties were defined by stroke mortality, and this gradient was related with stroke incidence and stroke case fatality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, where 1,317 incident stroke events (of which 242 were fatal) occurred among 29,650 participants. RESULTS There was a significant (p = 0.0025) gradient of fatal stroke events in REGARDS (quartile 4 vs. quartile 1 (Q4/Q1) hazard ratio 1.95, 95% CI 1.35-2.81), demonstrating the consistency of REGARDS with national mortality data. The gradient for incident stroke (fatal + nonfatal) was also significant (p = 0.0023; Q4/Q1 hazard ratio 1.29, 95% CI 1.10-1.52). The gradient for stroke case-fatality was marginally significant (p = 0.058), though the OR for Q4/Q1 (1.71, 95% CI 1.13-2.25) was large. CONCLUSIONS Both stroke incidence and case-fatality in REGARDS appear to be contributing, underscoring the need for strengthening both stroke prevention and acute stroke care in order to reduce the disparity.
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Affiliation(s)
- Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
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Keyserling TC, Samuel-Hodge CD, Pitts SJ, Garcia BA, Johnston LF, Gizlice Z, Miller CL, Braxton DF, Evenson KR, Smith JC, Davis GB, Quenum EL, Elliott NTM, Gross MD, Donahue KE, Halladay JR, Ammerman AS. A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health 2016; 16:732. [PMID: 27495295 PMCID: PMC4975883 DOI: 10.1186/s12889-016-3370-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/23/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population. METHODS The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1-6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7-12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m(2) offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13-24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up. RESULTS Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m(2). In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (-6.4 mmHg [-8.7 to -4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: -3.1 kg (-4.9 to -1.3) for group (N = 50) and -2.1 kg (-3.2 to -1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was -2.1 kg (-4.3 to 0.0) for group (N = 51) and -1.1 kg (-2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar. CONCLUSIONS The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01433484.
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Affiliation(s)
- Thomas C. Keyserling
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, School of Medicine, CB 7110, University of North Carolina, 5039 Old Clinic Building, Chapel Hill, NC 27599 USA
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Carmen D. Samuel-Hodge
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Stephanie Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Lakeside Annex 8, 600 Moye Blvd, MS 660, Greenville, NC 27834 USA
| | - Beverly A. Garcia
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Larry F. Johnston
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Ziya Gizlice
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Cassandra L. Miller
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Danielle F. Braxton
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, CB 8050, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Janice C. Smith
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Gwen B. Davis
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Emmanuelle L. Quenum
- Greene County Health Department, 225 Kingold Blvd, Suite B, Snow Hill, North Carolina 28580 USA
| | - Nadya T. Majette Elliott
- Student Health Services, East Carolina University, 1000 East 5th St, MS 408, Greenville, NC 27858 USA
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55455 USA
| | - Katrina E. Donahue
- Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Jacqueline R. Halladay
- Department of Family Medicine, School of Medicine, CB 7595, University of North Carolina, Chapel Hill, NC 27599 USA
- Cecil G. Sheps Center for Health Services Research, School of Medicine, CB 7590, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Alice S. Ammerman
- Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), CB 7426, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Nutrition, Gillings School of Global Public Health, CB 7461, University of North Carolina, Chapel Hill, NC 27599 USA
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Howard G, Howard VJ. Stroke Disparities. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kowitt S, Woods-Jaeger B, Lomas J, Taggart T, Thayer L, Sutton S, Lightfoot AF. Using Photovoice to Understand Barriers to and Facilitators of Cardiovascular Health Among African American Adults and Adolescents, North Carolina, 2011-2012. Prev Chronic Dis 2015; 12:E164. [PMID: 26425868 PMCID: PMC4591620 DOI: 10.5888/pcd12.150062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Cardiovascular disease is the leading cause of death in the United States, and mortality rates are higher among African Americans than among people of other races/ethnicities. We aimed to understand how African American adults and adolescents conceptualize cardiovascular health and perceive related barriers and facilitators. METHODS This qualitative study was conducted as formative research for a larger study, Heart Healthy Lenoir, which aimed to reduce cardiovascular disease disparities among African Americans in eastern North Carolina, part of the widely-known "stroke belt" that runs through the southeastern United States. Using photovoice, a community-based participatory research method, we conducted eight 90-minute photovoice sessions with 6 adults and 9 adolescents in Lenoir County, North Carolina. Topics for each discussion were selected by participants and reflected themes related to cardiovascular health promotion. All sessions were transcribed and coded using a data-driven, inductive approach. RESULTS Participants conceptualized cardiovascular health to have mental, spiritual, and social health dimensions. Given these broad domains, participants acknowledged many ecological barriers to cardiovascular health; however, they also emphasized the importance of personal responsibility. Facilitators for cardiovascular health included using social health (eg, family/community relationships) and spiritual health dimensions (eg, understanding one's body and purpose) to improve health behaviors. CONCLUSION The perspectives of African American adults and adolescents elicited through this formative research provided a strong foundation for Heart Healthy Lenoir's ongoing engagement of community members in Lenoir County and development and implementation of its intervention to prevent cardiovascular disease.
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Affiliation(s)
- Sarah Kowitt
- Department of Health Behavior, Rosenau Hall, CB no. 7440, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7440.
| | - Briana Woods-Jaeger
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Jesse Lomas
- Wake Forest University, Winston-Salem, North Carolina
| | - Tamara Taggart
- University of North Carolina at Chapel Hill, North Carolina
| | - Linden Thayer
- University of North Carolina at Chapel Hill, North Carolina
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McGuirt JT, Pitts SBJ, Ammerman A, Prelip M, Hillstrom K, Garcia RE, McCarthy WJ. A Mixed Methods Comparison of Urban and Rural Retail Corner Stores. AIMS Public Health 2015; 2:554-582. [PMID: 29546125 PMCID: PMC5690250 DOI: 10.3934/publichealth.2015.3.554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Indexed: 11/18/2022] Open
Abstract
Efforts to transform corner stores to better meet community dietary needs have mostly occurred in urban areas but are also needed in rural areas. Given important contextual differences between urban and rural areas, it is important to increase our understanding of the elements that might translate successfully to similar interventions involving stores in more rural areas. Thus, an in-depth examination and comparison of corner stores in each setting is needed. A mixed methods approach, including windshield tours, spatial visualization with analysis of frequency distribution, and spatial regression techniques were used to compare a rural North Carolina and large urban (Los Angeles) food environment. Important similarities and differences were seen between the two settings in regards to food environment context, spatial distribution of stores, food products available, and the factors predicting corner store density. Urban stores were more likely to have fresh fruits (Pearson chi2 = 27.0423; p < 0.001) and vegetables (Pearson chi2 = 27.0423; p < 0.001). In the urban setting, corner stores in high income areas were more likely to have fresh fruit (Pearson chi2 = 6.00; p = 0.014), while in the rural setting, there was no difference between high and low income area in terms of fresh fruit availability. For the urban area, total population, no vehicle and Hispanic population were significantly positively associated (p < 0.05), and median household income (p < 0.001) and Percent Minority (p < 0.05) were significantly negatively associated with corner store count. For the rural area, total population (p < 0.05) and supermarket count were positively associated (p < 0.001), and median household income negatively associated (P < 0.001), with corner store count. Translational efforts should be informed by these findings, which might influence the success of future interventions and policies in both rural and urban contexts.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, Gillings School of Global Public Health, UNC Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, 2200 McGavran-Greenberg Hall, Chapel Hill NC
| | | | - Alice Ammerman
- Department of Nutrition, Gillings School of Global Public Health, UNC Center for Health Promotion and Disease Prevention, University of North Carolina-Chapel Hill, 2200 McGavran-Greenberg Hall, Chapel Hill NC
| | - Michael Prelip
- UCLA Fielding School of Public Health, University of California, Los Angeles, CA
| | - Kathryn Hillstrom
- Department of Kinesiology & Nutritional Science, California State University, Los Angeles, CA
| | - Rosa Elena Garcia
- UCLA Fielding School of Public Health, University of California, Los Angeles, CA
| | - William J McCarthy
- UCLA Fielding School of Public Health, University of California, Los Angeles, CA
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Bhatt H, Safford M, Stephen G. Coronary heart disease risk factors and outcomes in the twenty-first century: findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Curr Hypertens Rep 2015; 17:541. [PMID: 25794955 PMCID: PMC4443695 DOI: 10.1007/s11906-015-0541-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal study supported by the National Institutes of Health to determine the disparities in stroke-related mortality across USA. REGARDS has published a body of work designed to understand the disparities in prevalence, awareness, treatment, and control of coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS has focused on racial and geographical disparities in the quality and access to health care, the influence of lack of medical insurance, and has attempted to contrast current guidelines in lipid lowering for secondary prevention in a nationwide cohort. It has described CHD risk from nontraditional risk factors such as chronic kidney disease, atrial fibrillation, and inflammation (i.e., high-sensitivity C-reactive protein) and has also assessed the role of depression, psychosocial, environmental, and lifestyle factors in CHD risk with emphasis on risk factor modification and ideal lifestyle factors. REGARDS has examined the utility of various methodologies, e.g., the process of medical record adjudication, proxy-based cause of death, and use of claim-based algorithms to determine CHD risk. Some valuable insight into less well-studied concepts such as the reliability of current troponin assays to identify "microsize infarcts," caregiving stress, and CHD, heart failure, and cognitive decline have also emerged. In this review, we discuss some of the most important findings from REGARDS in the context of the existing literature in an effort to identify gaps and directions for further research.
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Affiliation(s)
- Hemal Bhatt
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Monika Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Glasser Stephen
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
- 1717 11th Avenue South, MT 634, Birmingham, AL 35205, USA
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Karcher R, Berman AE, Gross H, Hess DC, Jauch EC, Viser PE, Solenski NJ, Wolf AMD. Addressing Disparities in Stroke Prevention for Atrial Fibrillation: Educational Opportunities. Am J Med Qual 2015; 31:337-48. [PMID: 25788477 DOI: 10.1177/1062860615577971] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disparities in atrial fibrillation (AF)-related stroke and mortality persist, especially racial disparities, within the US "Stroke Belt." This study identified barriers to optimal stroke prevention to develop a framework for clinician education. A comprehensive educational needs assessment was developed focusing on clinicians within the Stroke Belt. The mixed qualitative-quantitative approach included regional surveys and one-on-one clinician interviews. Identified contributors to disparities included implicit racial biases, lack of awareness of racial disparities in AF stroke risk, and lack of effective multicultural awareness and training. Additional barriers affecting disparities included patient medical mistrust and clinician-patient communication challenges. General barriers included lack of consistency in assessing stroke and anticoagulant-related bleeding risk, underuse of standardized risk assessment tools, discomfort with novel anticoagulants, and patient education deficiencies. Effective cultural competency training is one strategy to reduce disparities in AF-related stroke and mortality by improving implicit clinician bias, addressing medical mistrust, and improving clinician-patient communication.
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Affiliation(s)
| | - Adam E Berman
- Medical College of Georgia at Georgia Regents University, Augusta, GA
| | - Hartmut Gross
- Medical College of Georgia at Georgia Regents University, Augusta, GA
| | - David C Hess
- Medical College of Georgia at Georgia Regents University, Augusta, GA
| | | | | | - Nina J Solenski
- University of Virginia School of Medicine, Charlottesville, VA
| | - Andrew M D Wolf
- University of Virginia School of Medicine, Charlottesville, VA
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Addressing rural health disparities through policy change in the stroke belt. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 19:503-10. [PMID: 23446877 DOI: 10.1097/phh.0b013e3182893bbb] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Obesity-prevention policies are needed, particularly in low-income rural areas of the southern United States, where obesity and chronic disease prevalence are high. In 2009, the Centers for Disease Control and Prevention issued the "Common Community Measures for Obesity Prevention" (COCOMO), a set of 24 recommended community-level obesity-prevention strategies. OBJECTIVE A variety of stakeholders in Lenoir County, North Carolina, were surveyed and interviewed, ranking the winnability, defined as feasibility and acceptability, of each of the 24 COCOMO-recommended strategies based on local culture, infrastructure, funding, and community support. DESIGN Mixed-methods. SETTING This study was part of the Heart Healthy Lenoir project, a community-based project to reduce cardiovascular disease risk and disparities in risk in Lenoir County, North Carolina. PARTICIPANTS COCOMO assessments were conducted with 19 Community Advisory Council members and in-depth interviews were conducted with 11 community stakeholders. Heart Healthy Lenoir lifestyle intervention participants (n = 366) completed surveys wherein they ranked their support for 7 obesity-prevention strategies (based on the COCOMO strategies). MAIN OUTCOME MEASURES Ranking of obesity-prevention strategies. RESULTS Policies to improve physical activity opportunities were deemed the most winnable, whereas policies that would limit advertisement of unhealthy food and beverages were deemed the least winnable. The most winnable food-related strategy was improving mechanisms to procure food from local farms. Stakeholders perceived the public as unfavorably disposed toward government mandates, taxes, and incentives. Among Heart Healthy Lenoir participants, males indicated lower levels of support for COCOMO-related strategies than females, and African Americans indicated higher levels of support than white participants. CONCLUSION The formative work presented here provides insight into the winnability of proposed obesity-prevention policy change strategies in Lenoir County, North Carolina.
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Gutiérrez OM, Muntner P, Rizk DV, McClellan WM, Warnock DG, Newby PK, Judd SE. Dietary patterns and risk of death and progression to ESRD in individuals with CKD: a cohort study. Am J Kidney Dis 2014; 64:204-13. [PMID: 24679894 PMCID: PMC4111976 DOI: 10.1053/j.ajkd.2014.02.013] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/04/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nutrition is linked strongly with health outcomes in chronic kidney disease (CKD). However, few studies have examined relationships between dietary patterns and health outcomes in persons with CKD. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 3,972 participants with CKD (defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or albumin-creatinine ratio ≥ 30 mg/g at baseline) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, a prospective cohort study of 30,239 black and white adults at least 45 years of age. PREDICTORS 5 empirically derived dietary patterns identified by factor analysis: "convenience" (Chinese and Mexican foods, pizza, and other mixed dishes), "plant-based" (fruits and vegetables), "sweets/fats" (sugary foods), "Southern" (fried foods, organ meats, and sweetened beverages), and "alcohol/salads" (alcohol, green-leafy vegetables, and salad dressing). OUTCOMES All-cause mortality and end-stage renal disease (ESRD). RESULTS 816 deaths and 141 ESRD events were observed over approximately 6 years of follow-up. There were no statistically significant associations of convenience, sweets/fats, or alcohol/salads pattern scores with all-cause mortality after multivariable adjustment. In Cox regression models adjusted for sociodemographic factors, energy intake, comorbid conditions, and baseline kidney function, higher plant-based pattern scores (indicating greater consistency with the pattern) were associated with lower risk of mortality (HR comparing fourth to first quartile, 0.77; 95% CI, 0.61-0.97), whereas higher Southern pattern scores were associated with greater risk of mortality (HR comparing fourth to first quartile, 1.51; 95% CI, 1.19-1.92). There were no associations of dietary patterns with incident ESRD in multivariable-adjusted models. LIMITATIONS Missing dietary pattern data, potential residual confounding from lifestyle factors. CONCLUSIONS A Southern dietary pattern rich in processed and fried foods was associated independently with mortality in persons with CKD. In contrast, a diet rich in fruits and vegetables appeared to be protective.
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Affiliation(s)
- Orlando M Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
| | - Paul Muntner
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Dana V Rizk
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - William M McClellan
- Department of Epidemiology, Emory University, Atlanta, GA; Department of Medicine, Emory University, Atlanta, GA
| | - David G Warnock
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - P K Newby
- Department of Pediatrics, Boston University School of Medicine, Boston, MA; Program in Graduate Medical Nutrition Sciences, Boston University School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA; Program in Gastronomy, Culinary Arts, and Wine Studies, Boston University Metropolitan College, Boston, MA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
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Rangaraju S, Liggins JT, Aghaebrahim A, Streib C, Sun CH, Gupta R, Nogueira R, Frankel M, Mlynash M, Lansberg M, Albers G, Jadhav A, Jovin TG. Pittsburgh Outcomes After Stroke Thrombectomy Score Predicts Outcomes After Endovascular Therapy for Anterior Circulation Large Vessel Occlusions. Stroke 2014; 45:2298-304. [DOI: 10.1161/strokeaha.114.005595] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Srikant Rangaraju
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - John T.P. Liggins
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Amin Aghaebrahim
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Christopher Streib
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Chung-Huan Sun
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Rishi Gupta
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Raul Nogueira
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Michael Frankel
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Michael Mlynash
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Maarten Lansberg
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Gregory Albers
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Ashutosh Jadhav
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
| | - Tudor G. Jovin
- From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.)
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Vaid I, Ahmed K, May D, Manheim D. The WISEWOMAN program: smoking prevalence and key approaches to smoking cessation among participants, July 2008-June 2013. J Womens Health (Larchmt) 2014; 23:288-95. [PMID: 24552434 PMCID: PMC5290425 DOI: 10.1089/jwh.2013.4712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tobacco use is a major risk factor for cardiovascular disease (CVD) and is the leading preventable cause of death, disease, and disability in the United States. The CDC's Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program addresses the heart health of low-income under- or uninsured women between the ages of 40 and 64 years. This article discusses WISEWOMAN's key approaches to smoking cessation and their impact on WISEWOMAN participants' cardiovascular health. METHODS A longitudinal retrospective analysis was conducted using data from 21 funded CDC programs from July 2008 to June 2013. Data were collected on 149,767 women to assess CVD risk, smoking status, and utilization of programs related to tobacco cessation. RESULTS The overall prevalence of smoking among the WISEWOMAN population during this period was 28%. Increases in referrals to tobacco quitlines, tobacco-cessation counseling, lifestyle interventions, and other community-based tobacco-cessation programs contributed to a 15% smoking-cessation rate among smokers who returned for a rescreening assessment over the 5-year program period. CONCLUSION The WISEWOMAN program has observed a smoking-cessation rate of 15% over the 5-year program period. WISEWOMAN's key approaches include continuous technical assistance that highlights quitline referrals, motivational interviewing done by program staff, and professional-development strategies for WISEWOMAN healthcare providers. WISEWOMAN will continue its programmatic emphasis on smoking cessation by partnering with state tobacco-cessation programs to work toward a lower smoking-prevalence rate among program participants.
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Affiliation(s)
- Isam Vaid
- WISEWOMAN Program, Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia . *
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Wetmore JB, Phadnis MA, Mahnken JD, Ellerbeck EF, Rigler SK, Zhou X, Shireman TI. Race, ethnicity, and state-by-state geographic variation in hemorrhagic stroke in dialysis patients. Clin J Am Soc Nephrol 2014; 9:756-63. [PMID: 24458073 DOI: 10.2215/cjn.06980713] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Geographic variation in stroke rates is well established in the general population, with higher rates in the South than in other areas of the United States. A similar pattern of geographic variation in ischemic strokes has also recently been reported in patients undergoing long-term dialysis, but whether this is also the case for hemorrhagic stroke is unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Medicare claims from 2000 to 2005 were used to ascertain hemorrhagic stroke events in a large cohort of incident dialysis patients. A Poisson generalized linear mixed model was generated to determine factors associated with stroke and to ascertain state-by-state geographic variability in stroke rates by generating observed-to-expected (O/E) adjusted rate ratios (ARRs) for stroke. RESULTS A total of 265,685 Medicare-eligible incident dialysis patients were studied. During a median follow-up of 15.5 months, 2397 (0.9%) patients sustained a hemorrhagic stroke. African Americans (ARR, 1.43; 95% confidence interval [CI], 1.30 to 1.57), Hispanics (ARR, 1.78; 95% CI, 1.57 to 2.03), and individuals of other races (ARR, 1.51; 95% CI, 1.26 to 1.80) had a significantly higher risk for hemorrhagic stroke compared with whites. In models adjusted for age and sex, four states had O/E ARRs for hemorrhagic stroke that were significantly greater than 1.0 (California, 1.15; Maryland, 1.25; North Carolina, 1.25; Texas, 1.19), while only 1 had an ARR less than 1.0 (Wisconsin, 0.79). However, after adjustment for race and ethnicity, no states had ARRs that varied significantly from 1.0. CONCLUSION Race and ethnicity, or other factors that covary with these, appear to explain a substantial portion of state-by-state geographic variation in hemorrhagic stroke. This finding suggests that the factors underlying the high rate of hemorrhagic strokes in dialysis patients are likely to be system-wide and that further investigations into regional variations in clinical practices are unlikely to identify large opportunities for preventive interventions for this disorder.
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Affiliation(s)
- James B Wetmore
- Department of Medicine, Division of Nephrology and Hypertension,, †The Kidney Institute,, ‡Department of Biostatistics,, §Department of Preventive Medicine and Public Health,, ‖Department of Medicine, and, ¶The Landon Center on Aging, University of Kansas School of Medicine, Kansas City, Kansas
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Judd SE, Gutiérrez OM, Newby PK, Howard G, Howard VJ, Locher JL, Kissela BM, Shikany JM. Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in black Americans. Stroke 2013; 44:3305-11. [PMID: 24159061 PMCID: PMC3898713 DOI: 10.1161/strokeaha.113.002636] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 09/18/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Black Americans and residents of the Southeastern United States are at increased risk of stroke. Diet is one of many potential factors proposed that might explain these racial and regional disparities. METHODS Between 2003 and 2007, the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study enrolled 30 239 black and white Americans aged≥45 years. Dietary patterns were derived using factor analysis and foods from food frequency data. Incident strokes were adjudicated using medical records by a team of physicians. Cox-proportional hazards models were used to examine risk of stroke. RESULTS During 5.7 years, 490 incident strokes were observed. In a multivariable-adjusted analysis, greater adherence to the plant-based pattern was associated with lower stroke risk (hazard ratio, 0.71; 95% confidence interval, 0.56-0.91; Ptrend=0.005). This association was attenuated after addition of income, education, total energy intake, smoking, and sedentary behavior. Participants with a higher adherence to the Southern pattern experienced a 39% increased risk of stroke (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84), with a significant (P=0.009) trend across quartiles. Including Southern pattern in the model mediated the black-white risk of stroke by 63%. CONCLUSIONS These data suggest that adherence to a Southern style diet may increase the risk of stroke, whereas adherence to a more plant-based diet may reduce stroke risk. Given the consistency of finding a dietary effect on stroke risk across studies, discussing nutrition patterns during risk screening may be an important step in reducing stroke.
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Affiliation(s)
- Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Orlando M. Gutiérrez
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - PK Newby
- Program in Gastronomy, Culinary Arts, and Wine Studies, Boston University
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Julie L Locher
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL
| | - Brett M Kissela
- Department of Neurology, School of Medicine, University of Cincinnati, Cincinnati, OH
| | - James M Shikany
- Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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Wetmore JB, Ellerbeck EF, Mahnken JD, Phadnis MA, Rigler SK, Spertus JA, Zhou X, Mukhopadhyay P, Shireman TI. Stroke and the "stroke belt" in dialysis: contribution of patient characteristics to ischemic stroke rate and its geographic variation. J Am Soc Nephrol 2013; 24:2053-61. [PMID: 23990675 DOI: 10.1681/asn.2012111077] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Geographic variation in stroke rates is well established in the general population, with higher rates in the South than in other areas of the United States. ESRD is a potent risk factor for stroke, but whether regional variations in stroke risk exist among dialysis patients is unknown. Medicare claims from 2000 to 2005 were used to ascertain ischemic stroke events in a large cohort of 265,685 incident dialysis patients. A Poisson generalized linear mixed model was generated to determine factors associated with stroke and to ascertain state-by-state geographic variability in stroke rates by generating observed-to-expected (O/E) adjusted rate ratios for stroke. Older age, female sex, African American race and Hispanic ethnicity, unemployed status, diabetes, hypertension, history of stroke, and permanent atrial fibrillation were positively associated with ischemic stroke, whereas body mass index >30 kg/m(2) was inversely associated with stroke (P<0.001 for each). After full multivariable adjustment, the three states with O/E rate ratios >1.0 were all in the South: North Carolina, Mississippi, and Oklahoma. Regional efforts to increase primary prevention in the "stroke belt" or to better educate dialysis patients on the signs of stroke so that they may promptly seek care may improve stroke care and outcomes in dialysis patients.
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Affiliation(s)
- James B Wetmore
- Department of Medicine, Division of Nephrology and Hypertension
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Howard VJ, McClure LA, Glymour MM, Cunningham SA, Kleindorfer DO, Crowe M, Wadley VG, Peace F, Howard G, Lackland DT. Effect of duration and age at exposure to the Stroke Belt on incident stroke in adulthood. Neurology 2013; 80:1655-61. [PMID: 23616168 PMCID: PMC3716470 DOI: 10.1212/wnl.0b013e3182904d59] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 12/19/2012] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess whether there are differences in the strength of association with incident stroke for specific periods of life in the Stroke Belt (SB). METHODS The risk of stroke was studied in 24,544 black and white stroke-free participants, aged 45+, in the Reasons for Geographic and Racial Differences in Stroke study, a national population-based cohort enrolled 2003-2007. Incident stroke was defined as first occurrence of stroke over an average 5.8 years of follow-up. Residential histories (city/state) were obtained by questionnaire. SB exposure was quantified by combinations of SB birthplace and current residence and proportion of years in SB during discrete age categories (0-12, 13-18, 19-30, 31-45, last 20 years) and entire life. Proportional hazards models were used to establish association of incident stroke with indices of exposure to SB, adjusted for demographic, socioeconomic (SES), and stroke risk factors. RESULTS In the demographic and SES models, risk of stroke was significantly associated with proportion of life in the SB and with all other exposure periods except birth, ages 31-45, and current residence. The strongest association was for the proportion of the entire life in SB. After adjustment for risk factors, the risk of stroke remained significantly associated only with proportion of residence in SB in adolescence (hazard ratio 1.17, 95% confidence interval 1.00-1.37). CONCLUSIONS Childhood emerged as the most important period of vulnerability to SB residence as a predictor of future stroke. Improvement in childhood health circumstances should be considered as part of long-term health improvement strategies in the SB.
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Affiliation(s)
- Virginia J Howard
- Departments of Epidemiology, School of Medicine, University of Alabama at Birmingham, USA.
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Jilcott Pitts SB, Vu MB, Garcia BA, McGuirt JT, Braxton D, Hengel CE, Huff JV, Keyserling TC, Ammerman AS. A community assessment to inform a multilevel intervention to reduce cardiovascular disease risk and risk disparities in a rural community. FAMILY & COMMUNITY HEALTH 2013; 36:135-146. [PMID: 23455684 PMCID: PMC4155752 DOI: 10.1097/fch.0b013e31828212be] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To complete a formative evaluation to identify community-level assets and barriers to healthy lifestyle choices, we conducted qualitative interviews, community audits, and secondary data analyses. We solicited local leaders' perspectives regarding winnability of obesity prevention policy options. Participants noted that many resources were available, yet a barrier was high cost. There were more parks per capita in low-income areas, but they were of lower quality. The most winnable obesity prevention policy was incentives for use of food from local farms. Results are being used to inform an intervention to reduce cardiovascular disease risk in rural eastern North Carolina.
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Affiliation(s)
- Stephanie B. Jilcott Pitts
- East Carolina University, Department of Public Health, 600 Moye Blvd, MS 660, Greenville, 27834, ; Telephone: (252) 744-5572; Fax: (252) 744-4008
| | - Maihan B. Vu
- University of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention, 1700 Martin Luther King Jr Blvd, Campus Box 7426, Chapel Hill, NC 27599-7426, ; Telephone: 919-966-9793; Fax: 919-966-8564
| | - Beverly A. Garcia
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426, ; Telephone: 919-966-6088; Fax: 919-966-6264
| | - Jared T. McGuirt
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426;
| | - Danielle Braxton
- UNC Center for Health Promotion and Disease Prevention, CB# 7426, 1700 MLK Jr. Blvd., Chapel Hill, NC 27599-7426;
| | - Constance E. Hengel
- Community Programming and Development, Lenoir Memorial Hospital, 100 Airport Road, Kinston, NC 28501, ; Telephone: (252) 522-7028
| | - Joey V. Huff
- Lenoir County Health Department, ; Telephone: (252) 526-4299
| | - Thomas C. Keyserling
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, ; Telephone: 919-966-2276; Fax: 919-966-2274
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health Director, Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, CB# 7426, Chapel Hill, NC 27599-7426, ; Telephone: 919 966-6082, FAX 919 966-3374
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Limited Access to Safe Drinking Water and Sanitation in Alabama’s Black Belt: A Cross-Sectional Case Study. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s12403-013-0088-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hannon L, Sawyer P, Allman RM. Housing, the Neighborhood Environment, and Physical Activity among Older African Americans. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2012; 5:27-41. [PMID: 23745172 PMCID: PMC3672407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study examines the association of neighborhood environment, as measured by housing factors, with physical activity among older African Americans. Context is provided on the effects of structural inequality as an inhibitor of health enhancing neighborhood environments. The study population included African Americans participating in the UAB Study of Aging (n=433). Participants demonstrated the ability to walk during a baseline in-home assessment. The strength and independence of housing factors were assessed using neighborhood walking for exercise as the outcome variable. Sociodemographic data, co-morbid medical conditions, and rural/urban residence were included as independent control factors. Homeownership, occupancy, and length of residency maintained positive associations with neighborhood walking independent of control factors. Housing factors appear to be predictive of resident engagement in neighborhood walking. Housing factors, specifically high rates of homeownership, reflect functional and positive neighborhood environments conducive for physical activity. Future interventions seeking to promote health-enhancing behavior should focus on developing housing and built-environment assets within the neighborhood environment.
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McClure LA, Murphy HL, Roseman J, Howard G, Malarcher A. Regional and racial differences in smoking and exposure to secondhand smoke: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Prev Chronic Dis 2011; 8:A108. [PMID: 21843411 PMCID: PMC3181181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Stroke mortality rates differ by race and region, and smoking and exposure to secondhand smoke are associated with stroke. We evaluated regional and racial differences in current smoking and secondhand smoke exposure among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. METHODS African American and white adults (n = 26,373) aged 45 years or older were recruited during 2003 through 2007. Logistic regression was used to examine the likelihood of current smoking and secondhand smoke exposure by race (African American vs white) and region. We compared the buckle of the stroke belt (the coastal plain region of North Carolina, South Carolina, and Georgia) with the stroke belt (the remainder of North Carolina, South Carolina, and Georgia, plus Alabama, Mississippi, Tennessee, Arkansas, and Louisiana) and compared each of these regions with the remaining contiguous states. RESULTS Among whites, no regional differences in current smoking were seen, but among African Americans, the odds of current smoking were 5% lower in the stroke belt, and 24% lower in the stroke buckle than those in the nonbelt region. Similarly, among whites no regional differences in exposure to secondhand smoke were found, whereas among African Americans, the odds of being exposed to secondhand smoke were 14% lower in the stroke buckle than for nonbelt residents. CONCLUSION These data suggest that rates of current smoking and secondhand smoke exposure are not higher in regions that have higher stroke mortality and therefore cannot contribute to geographic disparities; nevertheless, given that 15% of our participants reported current smoking and 16% reported secondhand smoke exposure, continued implementation of tobacco control policies is needed.
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Affiliation(s)
| | | | | | - George Howard
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Ann Malarcher
- Centers for Disease Control and Prevention, Atlanta, Georgia
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WISEWOMAN: Addressing the Needs of Women at High Risk for Cardiovascular Disease. J Womens Health (Larchmt) 2011; 20:977-82. [DOI: 10.1089/jwh.2011.2850] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Anderson RT, Camacho F, Iaconi AI, Tegeler CH, Balkrishnan R. Enhancing the Effectiveness of Community Stroke Risk Screening: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2011; 20:330-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 01/22/2010] [Accepted: 02/05/2010] [Indexed: 10/19/2022] Open
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Glymour MM, Yen JJ, Kosheleva A, Moon JR, Capistrant BD, Patton KK. Elevated depressive symptoms and incident stroke in Hispanic, African-American, and White older Americans. J Behav Med 2011; 35:211-20. [PMID: 21656258 PMCID: PMC3305882 DOI: 10.1007/s10865-011-9356-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 05/24/2011] [Indexed: 11/28/2022]
Abstract
Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N = 18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27%) and Hispanics (33%) than whites/others (18%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR = 1.53; 95% CI: 1.36-1.73) and among blacks (HR = 1.31; 95% CI: 1.05-1.65). The HR was similar but only marginally statistically significant among Hispanics (HR = 1.33; 95% CI: 0.92-1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3% for whites/others, 7.8% for blacks, and 10.3% for Hispanics.
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Affiliation(s)
- M Maria Glymour
- Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 617, Boston, MA 02115, USA.
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Wadley VG, Unverzagt FW, McGuire LC, Moy CS, Go R, Kissela B, McClure LA, Crowe M, Howard VJ, Howard G. Incident cognitive impairment is elevated in the stroke belt: the REGARDS study. Ann Neurol 2011; 70:229-36. [PMID: 21618586 DOI: 10.1002/ana.22432] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 03/16/2011] [Accepted: 03/18/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether incidence of impaired cognitive screening status is higher in the southern Stroke Belt region of the United States than in the remaining United States. METHODS A national cohort of adults age ≥45 years was recruited by the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study from 2003 to 2007. Participants' global cognitive status was assessed annually by telephone with the Six-Item Screener (SIS) and every 2 years with fluency and recall tasks. Participants who reported no stroke history and who were cognitively intact at enrollment (SIS >4 of 6) were included (N = 23,913, including 56% women; 38% African Americans and 62% European Americans; 56% Stroke Belt residents and 44% from the remaining contiguous United States and the District of Columbia). Regional differences in incident cognitive impairment (SIS score ≤4) were adjusted for age, sex, race, education, and time between first and last assessments. RESULTS A total of 1,937 participants (8.1%) declined to an SIS score ≤4 at their most recent assessment, over a mean of 4.1 (±1.6) years. Residents of the Stroke Belt had greater adjusted odds of incident cognitive impairment than non-Belt residents (odds ratio, 1.18; 95% confidence interval, 1.07-1.30). All demographic factors and time independently predicted impairment. INTERPRETATION Regional disparities in cognitive decline mirror regional disparities in stroke mortality, suggesting shared risk factors for these adverse outcomes. Efforts to promote cerebrovascular and cognitive health should be directed to the Stroke Belt.
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Affiliation(s)
- Virginia G Wadley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-2041, USA.
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Newby PK, Noel SE, Grant R, Judd S, Shikany JM, Ard J. Race and region are associated with nutrient intakes among black and white men in the United States. J Nutr 2011; 141:296-303. [PMID: 21178088 PMCID: PMC3021449 DOI: 10.3945/jn.110.130583] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Stroke mortality rates and prevalence of several chronic diseases are higher in Southern populations and blacks in the US. This study examined the relationships of race (black, white) and region (Stroke Belt, Stroke Buckle, other) with selected nutrient intakes among black and white American men (n = 9229). The Block 98 FFQ assessed dietary intakes and multivariable linear regression analysis was used to examine whether race and region were associated with intakes of fiber, saturated fat, trans fat, sodium, potassium, magnesium, calcium, and cholesterol. Race and region were significant predictors of most nutrient intakes. Black men consumed 1.00% lower energy from saturated fat compared with white men [multivariable-adjusted β: 1.00% (95% CI = -0.88, -1.13)]. A significant interaction between race and region was detected for trans fat (P < 0.0001), where intake was significantly lower among black men compared with white men only in the Stroke Belt [multivariable-adjusted β: -0.21 (95% CI = -0.11, -0.31)]. Among black men, intakes of sodium, potassium, magnesium, and calcium were lower, whereas cholesterol was higher, compared with white men (P < 0.05 for all). Comparing regions, men in the Stroke Buckle had the lowest intakes of fiber, potassium, magnesium, and calcium compared with those in the Stroke Belt and other regions; men in both the Stroke Buckle and Stroke Belt had higher intakes of cholesterol compared with those in other regions (P < 0.005 for all). Given these observed differences in dietary intakes, more research is needed to understand if and how they play a role in the health disparities and chronic disease risks observed among racial groups and regions in the US.
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Affiliation(s)
- P. K. Newby
- Department of Pediatrics, School of Medicine, Boston University, Boston, MA 02118,Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118,To whom correspondence should be addressed. E-mail:
| | - Sabrina E. Noel
- Department of Pediatrics, School of Medicine, Boston University, Boston, MA 02118
| | - Rachael Grant
- Department of Pediatrics, School of Medicine, Boston University, Boston, MA 02118
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama, Birmingham, AL 35294
| | - James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama, Birmingham, AL 35294
| | - Jamy Ard
- Department of Nutritional Sciences, School of Medicine, University of Alabama, Birmingham, AL 35294
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Wei P, Milbauer LC, Enenstein J, Nguyen J, Pan W, Hebbel RP. Differential endothelial cell gene expression by African Americans versus Caucasian Americans: a possible contribution to health disparity in vascular disease and cancer. BMC Med 2011; 9:2. [PMID: 21223544 PMCID: PMC3029215 DOI: 10.1186/1741-7015-9-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 01/11/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health disparities and the high prevalence of cardiovascular disease continue to be perplexing worldwide health challenges. This study addresses the possibility that genetic differences affecting the biology of the vascular endothelium could be a factor contributing to the increased burden of cardiovascular disease and cancer among African Americans (AA) compared to Caucasian Americans (CA). METHODS From self-identified, healthy, 20 to 29-year-old AA (n = 21) and CA (n = 17), we established cultures of blood outgrowth endothelial cells (BOEC) and applied microarray profiling. BOEC have never been exposed to in vivo influences, and their gene expression reflects culture conditions (meticulously controlled) and donor genetics. Significance Analysis of Microarray identified differential expression of single genes. Gene Set Enrichment Analysis examined expression of pre-determined gene sets that survey nine biological systems relevant to endothelial biology. RESULTS At the highly stringent threshold of False Discovery Rate (FDR) = 0, 31 single genes were differentially expressed in AA. PSPH exhibited the greatest fold-change (AA > CA), but this was entirely accounted for by a homolog (PSPHL) hidden within the PSPH probe set. Among other significantly different genes were: for AA > CA, SOS1, AMFR, FGFR3; and for AA < CA, ARVCF, BIN3, EIF4B. Many more (221 transcripts for 204 genes) were differentially expressed at the less stringent threshold of FDR <.05. Using the biological systems approach, we identified shear response biology as being significantly different for AA versus CA, showing an apparent tonic increase of expression (AA > CA) for 46/157 genes within that system. CONCLUSIONS Many of the genes implicated here have substantial roles in endothelial biology. Shear stress response, a critical regulator of endothelial function and vascular homeostasis, may be different between AA and CA. These results potentially have direct implications for the role of endothelial cells in vascular disease (hypertension, stroke) and cancer (via angiogenesis). Also, they are consistent with our over-arching hypothesis that genetic influences stemming from ancestral continent-of-origin could impact upon endothelial cell biology and thereby contribute to disparity of vascular-related disease burden among AA. The method used here could be productively employed to bridge the gap between information from structural genomics (for example, disease association) and cell function and pathophysiology.
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Affiliation(s)
- P Wei
- Vascular Biology Center, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
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Shuaib F, Foushee HR, Ehiri J, Bagchi S, Baumann A, Kohler C. Smoking, sociodemographic determinants, and stress in the Alabama Black Belt. J Rural Health 2010; 27:50-9. [PMID: 21204972 DOI: 10.1111/j.1748-0361.2010.00317.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE In the Alabama Black Belt, poverty is high, and the educational level is low. Studies have found increased tobacco use among individuals exposed to high levels of stress. Few studies have been conducted in this region to measure smoking status, its sociodemographic determinants, and how smoking status relates to stressful environmental conditions. METHODS A cross-sectional questionnaire survey of 1,387 individuals. FINDINGS Approximately 25% of the respondents currently smoked cigarettes. Females were less likely to smoke compared to males (OR, 0.29; 95% CI, 0.23-0.38). Blacks were less likely to smoke cigarettes compared to whites (OR, 0.64; 95% CI, 0.43-0.95). Compared to individuals who were employed, participants who were unemployed or retired had increased odds of smoking (OR, 1.68; 95% CI, 1.15-2.20). The odds of being a current smoker were increased in the presence of moderate level stress (OR, 2.06; 95% CI, 1.38-3.07) or when there was a high level of stress (OR, 2.21; 95% CI, 1.47-3.31). Smoking was associated with increased odds of having a moderate level (OR, 2.06; 95% CI, 1.38-3.08) and a high level of stress (OR, 2.21; 95% CI, 1.47-3.32). Females who reported moderate to high levels of stress had increased odds of being smokers compared to males. Interaction between gender and stress showed deviation from additivity. CONCLUSION Our findings suggest a high rate of cigarette use in the area. Increased stress levels appear to predispose females more than males to cigarette smoking. The implications of this association may guide interventions targeted at reducing smoking and its complications.
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Affiliation(s)
- Faisal Shuaib
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama 35294-0022, USA
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