1
|
Gilchrist SC, Hall JL, Khandelwal A, Hidalgo B, Aggarwal B, Kinzy C, Mallya P, Conners K, Stevens LM, Alger HM, Mehta L, Wexler L, Mega JL, Hernandez A, Hayes SN, Mieres JH, Jessup M, Roger VL. Research Goes Red: Early Experience With a Participant-Centric Registry. Circ Res 2022; 130:343-351. [PMID: 35113661 PMCID: PMC10505520 DOI: 10.1161/circresaha.121.320403] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022]
Abstract
RATIONALE Cardiovascular disease remains the leading cause of death in women. To address its determinants including persisting cardiovascular risk factors amplified by sex and race inequities, novel personalized approaches are needed grounded in the engagement of participants in research and prevention. OBJECTIVE To report on a participant-centric and personalized dynamic registry designed to address persistent gaps in understanding and managing cardiovascular disease in women. METHODS AND RESULTS The American Heart Association and Verily launched the Research Goes Red registry (RGR) in 2019, as an online research platform available to consenting individuals over the age of 18 years in the United States. RGR aims to bring participants and researchers together to expand knowledge by collecting data and providing an open-source longitudinal dynamic registry for conducting research studies. As of July 2021, 15 350 individuals have engaged with RGR. Mean age of participants was 48.0 48.0±0.2 years with a majority identifying as female and either non-Hispanic White (75.7%) or Black (10.5%). In addition to 6 targeted health surveys, RGR has deployed 2 American Heart Association-sponsored prospective clinical studies based on participants' areas of interest. The first study focuses on perimenopausal weight gain, developed in response to a health concerns survey. The second study is designed to test the use of social media campaigns to increase awareness and participation in cardiovascular disease research among underrepresented millennial women. CONCLUSIONS RGR is a novel online participant-centric platform that has successfully engaged women and provided critical data on women's heart health to guide research. Priorities for the growth of RGR are centered on increasing reach and diversity of participants, and engaging researchers to work within their communities to leverage the platform to address knowledge gaps and improve women's health.
Collapse
Affiliation(s)
- Susan C Gilchrist
- Departments of Clinical Cancer Prevention and Cardiology, The University of Texas MD Anderson Cancer Center, Houston (S.C.G.)
| | - Jennifer L Hall
- American Heart Association, Dallas, TX (J.L.H., C.K., P.M., L.M.S., H.M.A., M.J.)
| | - Abha Khandelwal
- Division of Cardiology, Stanford University School of Medicine, Palo Alto, CA (A.K.)
| | - Bertha Hidalgo
- Division of Cardiology, Stanford University School of Medicine, Palo Alto, CA (A.K.)
| | - Brooke Aggarwal
- Division of Cardiology, Stanford University School of Medicine, Palo Alto, CA (A.K.)
| | - Claire Kinzy
- American Heart Association, Dallas, TX (J.L.H., C.K., P.M., L.M.S., H.M.A., M.J.)
| | - Pratheek Mallya
- American Heart Association, Dallas, TX (J.L.H., C.K., P.M., L.M.S., H.M.A., M.J.)
| | - Katie Conners
- Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (K.C., V.L.R.)
| | - Laura M Stevens
- American Heart Association, Dallas, TX (J.L.H., C.K., P.M., L.M.S., H.M.A., M.J.)
- University of Colorado Anschutz Medical Campus, Aurora (L.M.S.)
| | - Heather M Alger
- American Heart Association, Dallas, TX (J.L.H., C.K., P.M., L.M.S., H.M.A., M.J.)
| | - Laxmi Mehta
- Division of Cardiology, Ohio State University Wexner Medical Center, Columbus (L.M.)
| | - Laura Wexler
- Department of Internal Medicine, University of Cincinnati, OH (L.W.)
| | | | - Adrian Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.H.)
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.N.H.)
| | - Jennifer H Mieres
- Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY (J.H.M.)
| | - Mariell Jessup
- American Heart Association, Dallas, TX (J.L.H., C.K., P.M., L.M.S., H.M.A., M.J.)
| | - Veronique L Roger
- Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (K.C., V.L.R.)
| |
Collapse
|
2
|
Schneider EC, Chin MH, Graham GN, Lopez L, Obuobi S, Sequist TD, McGlynn EA. Increasing Equity While Improving the Quality of Care: JACC Focus Seminar 9/9. J Am Coll Cardiol 2021; 78:2599-2611. [PMID: 34887146 PMCID: PMC9172264 DOI: 10.1016/j.jacc.2021.06.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/02/2021] [Indexed: 01/14/2023]
Abstract
This review summarizes racial and ethnic disparities in the quality of cardiovascular care-a challenge given the fragmented nature of the health care delivery system and measurement. Health equity for all racial and ethnic groups will not be achieved without a substantially different approach to quality measurement and improvement. The authors adapt a tool frequently used in quality improvement work-the driver diagram-to chart likely areas for diagnosing root causes of disparities and developing and testing interventions. This approach prioritizes equity in quality improvement. The authors demonstrate how this approach can be used to create interventions that reduce systemic racism within the institutions and professions that deliver health care; attends more aggressively to social factors related to race and ethnicity that affect health outcomes; and examines how hospitals, health systems, and insurers can generate effective partnerships with the communities they serve to achieve equitable cardiovascular outcomes.
Collapse
Affiliation(s)
| | - Marshall H Chin
- University of Chicago, Section of General Internal Medicine, Chicago, Illinois, USA
| | - Garth N Graham
- Healthcare and Public Health, Google, Palo Alto, California, USA
| | - Lenny Lopez
- Division of Hospital Medicine, San Francisco VA Medical Center, University of California-San Francisco, Department of Medicine, San Francisco, California, USA
| | - Shirlene Obuobi
- Internal Medicine, University of Chicago, Section of Cardiology, Chicago, Illinois, USA
| | - Thomas D Sequist
- Division of General Medicine, Brigham and Women's Hospital, Department of Health Care Policy, Harvard Medical School, Department of Quality and Patient Experience, Mass General Brigham, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth A McGlynn
- Kaiser Permanente, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
| |
Collapse
|
3
|
Valero-Elizondo J, Aneni EC, Osondu CU, Grandhi GR, Virani SS, Nasir K. Gaps in provider lifestyle counseling and its adherence among obese adults with prediabetes and diabetes in the United States. Prev Med 2019; 129:105815. [PMID: 31454663 DOI: 10.1016/j.ypmed.2019.105815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
Abstract
Obesity is an epidemic affecting about 40% of the US adult population. Tracking with the obesity epidemic is an increase in the prevalence of diabetes and pre-diabetes. Both pre-diabetes and diabetes are often coexistent with obesity and contribute to an increased total and cardiovascular disease related morbidity and mortality. Lifestyle modification is usually the first step in management among individuals with obesity and/or pre-diabetes or diabetes, but remains an unfulfilled potential by healthcare providers to promote healthier lifestyles in obese patients. We aimed to describe the current patterns of lifestyle counseling (diet, physical activity, and weight loss) and their adherence by patients with obesity in the US using the National Health Interview Survey, 2016-2017. We analyzed these patterns among individuals with pre-diabetes and diabetes. We found that, regardless of pre-diabetes or diabetes status, almost 1 in 3 individuals with mild obesity (BMI ≥ 30 & < 35) and 1 in 4 with severe obesity (BMI ≥ 35) reported lack of lifestyle counseling from healthcare providers regarding diet or physical activity, and 2 in 3 individuals with any level of obesity reported lack of referral/counsel concerning weight loss programs. Lifestyle counseling and its compliance among obese adults from a contemporary dataset in the US is still suboptimal. This study highlights the gaps in the implementation of the AHA/ACC 2013 guidelines on management of obesity among adults particularly among those with metabolic disease, who would derive the greatest benefit.
Collapse
Affiliation(s)
- Javier Valero-Elizondo
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America. https://twitter.com/jvaleromd
| | - Ehimen C Aneni
- Yale University School of Medicine, Division of Cardiovascular Medicine, New Haven, CT, United States of America.
| | - Chukwuemeka U Osondu
- Baptist Health South Florida, Miami, FL, United States of America. https://twitter.com/droz09
| | - Gowtham R Grandhi
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America. https://twitter.com/gowthyharsha
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Baylor College of Medicine, Houston, TX, United States of America. https://twitter.com/virani_md
| | - Khurram Nasir
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America; Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States of America. https://twitter.com/khurramn1
| |
Collapse
|
4
|
Goldberg DM, Cho BY, Lin HC. Factors influencing U.S. physicians' decision to provide behavioral counseling. Prev Med 2019; 119:70-76. [PMID: 30593794 DOI: 10.1016/j.ypmed.2018.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/13/2018] [Accepted: 12/24/2018] [Indexed: 01/03/2023]
Abstract
Prevention and treatment of non-communicable diseases is critical due to high costs of healthcare and increasing prevalence. Historical trends suggest physicians underperform in behavioral counseling (including exercise, diet/nutrition, or weight management). This study investigated physicians' decision-making by examining non-clinical sociological factors that influence ordering and provision of behavioral counseling. This was a retrospective multi-year cross-sectional study. Using the Eisenberg model of physician-decision making, we analyzed data from the 2005-2015 National Ambulatory Medical Care Surveys (unweighted N = 177,599). Four weighted logistic regressions were performed to examine sociological factors associated with physician prescribing or ordering of behavioral counseling. Behavioral counseling was provided at suboptimal rates. Patient age, race/ethnicity, body weight status, and reasons for a medical visit were associated with physicians' decision to provide or order behavioral counseling. There was in general a decreasing trend of odds of provision of behavior counseling from 2005 to 2015. Patients who had been seen before were more likely to receive diet/nutrition and exercise counseling. This study concluded that ordering and provision of behavioral counseling was less than optimal. Policy makers and educators can consider factors that influence physicians' decisions for behavioral counseling to improve training and site policies. Future research examining effective behavioral counseling training and strategies to promote its provision, in particular to patients of different races/ethnicities and with different medical conditions, may increase effectiveness. Integrated care with behavioral health professionals could improve rates and/or delivery of counseling. Physicians can consider providing behavioral counseling when patients present with new problems and to newly seen patients.
Collapse
Affiliation(s)
- Daniel M Goldberg
- Department of Counseling and Educational Psychology, School of Education, Indiana University Bloomington, 201 N. Rose Ave., Bloomington, IN 47405, USA.
| | - Beom-Young Cho
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, 1025 E. 7th Street, Bloomington, IN 47405, USA.
| |
Collapse
|
5
|
Abstract
AIM There is a need to develop sound healthcare practices where patients and providers are able to succeed in meeting weight management goals. The aim of this analysis is to develop a better understanding the concept of weight management. BACKGROUND Obesity is a rapidly growing healthcare issue, reaching epidemic levels around the world. According to the World Health Organization, the current incident rate of obesity makes it the leading risk for death across the globe. DESIGN Walker and Avant's model for concept analysis. DATA SOURCE A literature search was accomplished using Cumulative Index to Nursing and Allied Health, Health Source: Nursing Academic Edition, Medline, and ProQuest Health and Medical Complete. REVIEW METHODS Keywords included weight management, weight control, weight loss, obesity, weight, and management. RESULTS Weight management is complex concept. Strategies to develop successful weight management programs need to be multifaceted to have impact on this healthcare crisis. CONCLUSION The critical attributes for weight management are dietary measures, physical activity, behavior modification, motivation, education, and lifelong changes. Unsuccessful weight management results in metabolic disorders and increased risk of mortality. Successful weight management practices include the prevention of weight gain, weight loss, and maintenance of ideal body weight.
Collapse
Affiliation(s)
- Connie L Winik
- Student, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
| | - C Elizabeth Bonham
- Student, College of Nursing and Health Professions, University of Southern Indiana, Evansville, IN
| |
Collapse
|
6
|
Heintzman JD, Bailey SR, Muench J, Killerby M, Cowburn S, Marino M. Lack of Lipid Screening Disparities in Obese Latino Adults at Health Centers. Am J Prev Med 2017; 52:805-809. [PMID: 28190691 PMCID: PMC5438764 DOI: 10.1016/j.amepre.2016.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/17/2016] [Accepted: 12/16/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In cross-sectional survey studies, obese Latinos are less likely to be screened for elevated serum cholesterol, despite their higher risk for hyperlipidemia and coronary artery disease. This study evaluated insurance and racial/ethnic disparities in lipid screening receipt between obese Latino and non-Hispanic white patients in Oregon community health centers (CHCs) over 5 years, using electronic health record data. METHODS This retrospective cohort study evaluated obese (BMI ≥30), low-income, adult patients (aged 21-79 years) with at least one visit at an Oregon CHC during 2009-2013 (n=11,095). Odds of lipid screening in the study period (clinical data collected in 2009-2013) were measured, adjusting for age, sex, primary clinic, and comorbidities, stratified by utilization in the study period. Analysis was done in 2016. RESULTS Sixty percent of the study population received at least one lipid screening in 2009-2013. There were no significant differences in screening between insured Latinos and insured non-Hispanic whites, except those with more than five visits over 5 years (OR=0.75, 95% CI=0.60, 0.94). Uninsured Latinos had higher odds of screening versus insured non-Hispanic whites among the low visit strata (OR=1.65, 95% CI=1.18, 2.30). Among Latinos, Spanish preference resulted in higher screening odds versus English preference in the two- to five-visit stratum (OR=1.63, 95% CI=1.12, 2.35). CONCLUSIONS Obese, low-income patients at CHCs underutilize cholesterol screening. However, screening differences by race/ethnicity and preferred language are minimal. Further research is necessary to understand how care delivered by CHCs may mitigate previously reported disparities in lipid screening.
Collapse
Affiliation(s)
- John D Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - John Muench
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Marie Killerby
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
7
|
Xing S, Sharp LK, Touchette DR. Weight loss drugs and lifestyle modification: Perceptions among a diverse adult sample. PATIENT EDUCATION AND COUNSELING 2017; 100:592-597. [PMID: 27847132 DOI: 10.1016/j.pec.2016.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 09/26/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Explore how adults from diverse racial and socioeconomic backgrounds perceive the use of weight loss drugs (prescription, over-the counter, herbals and supplements) and lifestyle modification. METHODS Individual, face-to-face, semi-structured interviews were conducted with persons presenting to an academic hospital-affiliated outpatient pharmacy serving ethnic minorities and low income individuals. RESULTS Fifty persons were interviewed, including 21 African Americans, 11 Hispanics and 17 low-income individuals (annual income <$20,000), of whom 33 self-reported as overweight or obese. Ever-users (14/50) and nonusers (36/50) of weight loss drugs expressed a belief in the importance of diet and exercise, but were not necessarily doing so themselves. Fear of side effects and skepticism towards efficacy of drugs deterred use. Some expressed concern over herbal product safety; others perceived herbals as natural and safe. Drugs were often viewed as a short-cut and not a long-term weight management solution. CONCLUSION A range of concerns related to the safety and efficacy of weight loss drugs were expressed by this lower income, ethnically diverse population of underweight to obese adults. PRACTICE IMPLICATIONS There is need and opportunity for healthcare providers to provide weight loss advice and accurate information regarding the safety and efficacy of various types of weight loss approaches.
Collapse
Affiliation(s)
- S Xing
- University of Illinois at Chicago Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, 833 South Wood St (MC 871), 60612-7230, USA.
| | - L K Sharp
- University of Illinois at Chicago Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, 833 South Wood St (MC 871), 60612-7230, USA.
| | - D R Touchette
- University of Illinois at Chicago Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, 833 South Wood St (MC 871), 60612-7230, USA.
| |
Collapse
|
8
|
Lulebo AM, Mapatano MA, Kayembe PK, Mafuta EM, Mutombo PB, Coppieters Y. Assessment of hypertension management in primary health care settings in Kinshasa, Democratic Republic of Congo. BMC Health Serv Res 2015; 15:573. [PMID: 26704087 PMCID: PMC4690396 DOI: 10.1186/s12913-015-1236-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/11/2015] [Indexed: 12/03/2022] Open
Abstract
Background Hypertension-related complications have become more diagnosed at secondary and tertiary care levels, in the Democratic Republic of the Congo (DRC), probably indicative of poor management of hypertensive patients at primary health care level. This study aimed to assess the management of hypertension in primary health care settings by using guidelines of the International Forum for Prevention and Control of HTN in Africa (IFHA). Methods A multi-center cross-sectional study was carried out in primary health care settings. A total of 102 nurses were surveyed using a structured interview. Mean and proportion comparisons were performed using the t Student test and the Chi-square test respectively. The Kinshasa Primary Health Care network facilities were compared with non-Kinshasa Primary Health Care network facilities. Results From the 102 nurses surveyed; 52.9 % were female with a mean age of 41.1, (SD = 10) years, merely 9.5 % benefited from in-job training on cardiovascular diseases or their risk factors, and 51.7 % had guidelines on the management of hypertension. Less than a quarter of the nurses knew the cut-off values of hypertension, diabetes and obesity. Merely 14.7 % knew the therapeutic goals for uncomplicated hypertension. Several of the indicators for immediate referral recommended by IFHA were unmentioned. The content of patient education was lacking, avoiding stress being the best advice provided to hypertensive patients. The antihypertensive most used were unlikely to be recommended by the IFHA. Conclusions This study showed a considerable gap of knowledge and practices in the management of hypertensive patients at primary health care facilities in Kinshasa pertaining to the IFHA guidelines. We think that task-shifting for management of hypertension is feasible if appropriate guidelines are provided and nurses trained. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1236-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Aimée M Lulebo
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo. .,Department of Epidemiology and Bio-statistics, Kinshasa School of Public Health, University of Kinshasa, P.O. Box 11850, Kinshasa, Democratic Republic of Congo.
| | - Mala A Mapatano
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
| | - Patrick K Kayembe
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
| | - Eric M Mafuta
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
| | - Paulin B Mutombo
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo.
| | - Yves Coppieters
- School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| |
Collapse
|
9
|
Hill LL, Nichols J, Wing D, Waalen J, Friedman E. Training on Exercise is Medicine® Within an Integrative Medicine Curriculum. Am J Prev Med 2015; 49:S278-84. [PMID: 26477904 DOI: 10.1016/j.amepre.2015.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/17/2015] [Accepted: 08/27/2015] [Indexed: 10/22/2022]
Abstract
Physicians are increasingly approached by individuals seeking integrative approaches to health care and well-being. Many integrative modalities include a physical activity component. Patients seek guidance from primary and specialty care providers on the safe and effective incorporation of these modalities into their lifestyle. Physicians and other health professionals receive very limited training in the clinical applications of exercise science. This paper reports on a curriculum designed to teach health professionals key exercise constructs for application to clinical practice for prevention and management of lifestyle-related disease, and incorporating the curriculum into a preventive medicine residency training program. The course was developed in 2012-2013, data collected in 2013-2015, and analysis was done in 2015. Six modules were developed as part of a 24-hour course. Each module included didactic, laboratory, and case examples. The modules included energetics, exercise and cardiorespiratory health, bone health, obesity and sarcopenia, balance and fall prevention, and behavior change and the use of technologies. The delivery was found feasible for all three components, delivered in 2-4-hour segments. The incorporation into the residency curriculum was feasible, efficacious, well received, and easily incorporated into the existing curriculum. This comprehensive curriculum has the potential to close the gap in medical school, residency, graduate, nursing, and integrative curricula on this important topic. Current practitioners would benefit in primary care and geriatric settings. This curriculum would also be useful for cross-disciplinary researchers, including public health, health behaviors, and integrative medicine practitioners.
Collapse
Affiliation(s)
- Linda L Hill
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
| | - Jeanne Nichols
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - David Wing
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Jill Waalen
- The Scripps Research Institute, La Jolla, California
| | - Elizabeth Friedman
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| |
Collapse
|
10
|
Neighborhood-level socioeconomic deprivation predicts weight gain in a multi-ethnic population: longitudinal data from the Dallas Heart Study. Prev Med 2014; 66:22-7. [PMID: 24875231 PMCID: PMC4127483 DOI: 10.1016/j.ypmed.2014.05.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/13/2014] [Accepted: 05/18/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study is to examine a relationship between neighborhood-level socioeconomic deprivation and weight change in a multi-ethnic cohort from Dallas County, Texas and whether behavioral/psychosocial factors attenuate the relationship. METHODS Non-movers (those in the same neighborhood throughout the study period) aged 18-65 (N=939) in Dallas Heart Study (DHS) underwent weight measurements between 2000 and 2009 (median 7-year follow-up). Geocoded home addresses defined block groups; a neighborhood deprivation index (NDI) was created (higher NDI=greater deprivation). Multi-level modeling determined weight change relative to NDI. Model fit improvement was examined with adding physical activity and neighborhood environment perceptions (higher score=more unfavorable perceptions) as covariates. A significant interaction between residence length and NDI was found (p-interaction=0.04); results were stratified by median residence length (11 years). RESULTS Adjusting for age, sex, race/ethnicity, smoking, and education/income, those who lived in neighborhood >11 years gained 1.0 kg per one-unit increment of NDI (p=0.03), or 6 kg for those in highest NDI tertile compared with those in the lowest tertile. Physical activity improved model fit; NDI remained associated with weight gain after adjustment for physical activity and neighborhood environment perceptions. There was no significant relationship between NDI and weight change for those in their neighborhood ≤11 years. CONCLUSIONS Living in more socioeconomically deprived neighborhoods over a longer time period was associated with weight gain in DHS.
Collapse
|
11
|
Persky S, de Heer HD, McBride CM, Reid RJ. The role of weight, race, and health care experiences in care use among young men and women. Obesity (Silver Spring) 2014; 22:1194-200. [PMID: 24318861 PMCID: PMC3968189 DOI: 10.1002/oby.20677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Increases in overweight and obesity (O/O)-related morbidities and health care costs raise questions about how weight influences patients' health care use and care experiences. Past research has been inconsistent; however, prior study designs and samples have limited exploration of how this association might be influenced by gender, race, and the joint impact of these factors. METHODS This analysis of 1,036 young, relatively healthy, ethnically diverse, insured adults assessed the influence of O/O, gender, and race on, and the role of health care experiences in primary and preventive care use over a 12-month period. RESULTS The association of weight status with care use differed by gender. O/O men used more primary care visits; O/O women used fewer preventive care visits than their healthy weight counterparts. O/O men had poorer health care experiences than healthy weight men. African-American women reported poorer experiences, but those who were O/O reported greater trust in their provider. Care experience ratings did not explain the associations between BMI and care use. CONCLUSIONS Gender, race, and visit type together provide a context for O/O patient's care that may not be explained by care experiences. This context must be considered in efforts to encourage appropriate use of services.
Collapse
Affiliation(s)
- Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
| | | | | | | |
Collapse
|
12
|
Agyemang P, Powell-Wiley TM. Obesity and Black Women: Special Considerations Related to Genesis and Therapeutic Approaches. CURRENT CARDIOVASCULAR RISK REPORTS 2013; 7:378-386. [PMID: 24159367 PMCID: PMC3804270 DOI: 10.1007/s12170-013-0328-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Black women in the United States are disproportionately affected by obesity, with almost two-thirds considered obese based on body mass index. Obesity has been directly linked to cardiovascular morbidity and mortality in black women. Therefore, understanding contributors to the genesis of obesity in black women is imperative. While biologic differences likely result in varying obesity prevalence across racial/ethnic groups, behaviors such as post-partum weight retention and limited leisure-time physical activity, may especially contribute to obesity in black women. Black women also appear to be particularly susceptible to cultural, psychosocial, and environmental factors that can promote weight gain. Therapeutic interventions are being tailored to specifically address these social determinants of health and to foster lifestyle modification; however, more work is needed to understand barriers to behavior change for black women. Knowledge gaps also remain in identifying mechanisms by which pharmacologic and surgical treatments for obesity modify cardiovascular risk in black women.
Collapse
Affiliation(s)
- Priscilla Agyemang
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Drive, MSC 1454. Building 10 CRC - Room 5E3340, Bethesda, MD 20892; Phone: (301) 594 – 3735; Fax: (301) 402 – 0888
| | - Tiffany M. Powell-Wiley
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Drive, MSC 1454. Building 10 CRC - Room 5E3340, Bethesda, MD 20892; Phone: (301) 594 – 3735; Fax: (301) 402 – 0888
| |
Collapse
|
13
|
Rippe JM, Waite MA. Implementing Heart Healthy Dietary Guidelines. Am J Lifestyle Med 2012. [DOI: 10.1177/1559827611428744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over recent decades, abundant scientific evidence has led to authoritative dietary guidelines and recommendations for heart healthy eating and lifestyle behaviors. But most children and adults do not regularly achieve these goals. Consequently, our focus must now be on helping individual patients and our communities implement these guidelines in everyday life. This article reviews current evidence for insights and practical techniques that can help individuals move from ideal goals to real practice of heart healthy nutrition and lifestyle behaviors.
Collapse
Affiliation(s)
- James M. Rippe
- Rippe Lifestyle Institute, Shrewsbury, Massachusetts (JMR)
- Center for Lifestyle Medicine, University of Central Florida, Orlando, Florida (JMR)
- Tufts University School of Medicine, Boston, Massachusetts (JMR)
- Atlanta, Georgia (MAW)
| | - Mary Abbott Waite
- Rippe Lifestyle Institute, Shrewsbury, Massachusetts (JMR)
- Center for Lifestyle Medicine, University of Central Florida, Orlando, Florida (JMR)
- Tufts University School of Medicine, Boston, Massachusetts (JMR)
- Atlanta, Georgia (MAW)
| |
Collapse
|