Perceived Versus Actual Risk for Hypertension and Diabetes in the African American Community

COVID-19, Police Violence, and Educational Disruption: The Differential Experience of Anxiety for Racial and Ethnic Households

BACKGROUND

The threat of a deadly pandemic, racial tension, recessionary economic circumstances, and educational disruption likely contributed to the heightened anxiety felt by many Americans in 2020. This study examines the differential anxiety experienced by Black, White, and Hispanic households with and without children during 2020.

METHOD

Data from the Census Bureau's Household Pulse Survey detailing the frequency of anxiety among a nationally representative sample of adults from April 23 to December 21, 2020, was coupled with Centers for Disease Control and Prevention records of COVID-19 diagnoses and state-level police killings. Multinomial logistic regression assessed the relative contribution of COVID-19 deaths, police violence, unemployment, fear of unemployment, change in educational delivery, and geographic location to anxiety among racial/ethnic cohorts with and without children.

RESULTS

Anxiety frequency increased over the sample for all groups. However, White anxiety was highly responsive to state-level COVID-19 fatalities, while Black anxiety was highly correlated with police violence. Households with children showed higher levels of anxiety during nontraditional educational delivery, whereas both households with and without children experienced high levels of fear regarding employment uncertainty and poverty.

CONCLUSIONS

Experiences in 2020 impacted all groups differently, but each showed a high frequency of anxiety.

Risk of acute kidney injury requiring hemodialysis after contrast-enhanced imaging after traumatic injury: A National Trauma Databank analysis

BACKGROUND

Trauma patients undergo routine contrast administration for diagnostic and therapeutic purposes. The aim of this study is to investigate the incidence and predictors of contrast-induced nephropathy requiring acute hemodialysis in the trauma population.

METHODS

Adult patients (age ≥16) were identified from the National Trauma Databank (2017-2018) and were grouped based on contrast received. The defined groups included no contrast, computed tomography intravascular contrast only, and angiography contrast. Patient demographic and clinical variables collected included vital signs (systolic blood pressure, pulse rate) recorded upon arrival to the emergency room, injury severity score, shock index, Glasgow Coma Scale, and mechanism. Outcome measures included mortality, hospital discharge disposition, intensive care unit and hospital length of stay, and need for hemodialysis. We performed a Poisson regression to assess relative risk for undergoing hemodialysis during hospital admission.

RESULTS

In total, 1,850,460 patients were included in the analysis (no contrast: 1,189,209; computed tomography intravascular contrast only: 621,846; angiography: 39,405); 3,135 patients required hemodialysis during the admission. Patients with reduced Glasgow Coma Scale, higher injury severity score, higher shock index, and preexisting diabetes mellitus and hypertension were more likely to require hemodialysis. Poisson regression revealed the relative risk of requiring hemodialysis as 1.49 with computed tomography intravascular contrast only, 4.33 with angiography only, and 5.35 with consecutive computed tomography intravascular and angiography.

CONCLUSION

Intravascular contrast administration through computed tomography and or angiography is independently associated with increased risk of requiring hemodialysis after a traumatic injury. Trauma surgeons should consider the necessity of contrast for each clinical situation and understand the potential for contrast-induced nephropathy.

Perception of and risk factors for type 2 diabetes among students attending an upstate New York college: a pilot study

BACKGROUND

Detecting early type 2 diabetes (T2D) risk factors may reduce or prevent the development of the disease. We conducted a pilot study to generate preliminary data on the perception of T2D and further determined the prevalence of T2D risk factors among college students at an upstate New York campus.

METHODS

Metabolic profiles were available for 44 college students for cross-sectional analysis. The American Diabetes Association screening guidelines were used to determine risk factors, and perceived susceptibility, perceived seriousness, and self-efficacy were determined with the Health Belief Model's constructs. Sociodemographic and anthropometric data, nutrition knowledge, and metabolic profiles were obtained.

RESULTS

The most common T2D risk factors were lack of physical activity (61.4%), decreased high-density lipoprotein cholesterol (HDL-c, 56.8%), high fasting blood glucose (FBG, 45.5%), family history of T2D (43.2%), increased body mass index (BMI, 36.4%), and high blood pressure (15.9%). A high proportion (70%) of participants with detected impaired FBG perceived they were at low risk of developing T2D. Participants with a family history of T2D (mean rank = 24.2) perceived the seriousness of T2D at a similar level as those without family history (mean rank = 21.2), with no significant difference (U = 205, P = 0.430). Nearly 30% of students did not feel confident they could prevent the development of T2D. Pearson's correlations revealed direct relationships between perceived risk of T2D and BMI (r = 0.49, P = 0.001), fat mass percent (r = 0.51, P < 0.001), and waist circumference (r = 0.42, P = 0.005), and an inverse relationship was found with HDL-c (r = - 0.41, P = 0.005). The association of perceived risk of T2D with a family history of T2D revealed a trend toward significance (Chi-squared = 5.746, P = 0.057), and the association of perceived risk of T2D with physical activity was not significant (Chi-squared = 1.520, P = 0.468). The nutrition knowledge score was 74.32 ± 15.97 (recommended is > 75). However, knowledge scores regarding recommended intake of fruits, vegetables, high sodium foods, and whole grains to prevent T2D were only 36.36%, 34.09%, 47.73%, and 63.6%, respectively.

CONCLUSIONS

The discordance between college students' perceived risk and prevalence of T2D risk factors warrants strategies to address misperceptions of T2D risk and improve lifestyle behaviors among this study sample.

Perceived diabetes risk and related determinants in individuals with high actual diabetes risk: results from a nationwide population-based survey

Objective

The purpose of this study was first, to examine perceived diabetes risk compared with actual diabetes risk in the general population and second, to investigate which factors determine whether persons at increased actual risk also perceive themselves at elevated risk.

Research design and methods

The study comprised adults (aged 18-97 years) without known diabetes from a nationwide survey on diabetes-related knowledge and information needs in Germany in 2017. Actual diabetes risk was calculated by an established risk score estimating the 5-year probability of developing type 2 diabetes and was compared with perceived risk of getting diabetes over the next 5 years (response options: 'almost no risk', 'slight risk', 'moderate risk', 'high risk'; n = 2327). Among adults with an increased actual diabetes risk (n=639), determinants of perceived risk were investigated using multivariable logistic regression analysis.

Results

Across groups with a 'low' (<2%), 'still low' (2% to<5%), 'elevated' (5% to <10%), and 'high' (≥10%) actual diabetes risk, a proportion of 89.0%, 84.5%, 79.3%, and 78.9%, respectively, perceived their diabetes risk as almost absent or slight. Among those with an increased (elevated/high) actual risk, independent determinants of an increased (moderate/high) perceived risk included younger age (OR 0.92 (95% CI 0.88 to 0.96) per year), family history of diabetes (2.10 (1.06-4.16)), and being informed about an increased diabetes risk by a physician (3.27 (1.51-7.07)), but none of further diabetes risk factors, healthcare behaviors or beliefs about diabetes.

Conclusions

Across categories of actual diabetes risk, perceived diabetes risk was low, even if actual diabetes risk was high. For effective strategies of primary diabetes prevention, attention should be directed to risk communication at the population level as well as in primary care practice.

Diabetes Risk Factor Knowledge Varies Among Multiracial College Students

All racial/ethnic groups are at higher risk for type 2 diabetes compared to whites, but it is unknown if young adults recognize their risk. Risk knowledge and individual risk perception were examined in 1579 multiracial urban college students. Students have little knowledge of diabetes risk factors; identifying less than three of ten. Considerable variation exists in the understanding of risk; only .02 % of Asian, 14.0 % of Hispanic and 22.8 % of black students recognized that their race increased risk. Among those with ≥3 risk factors (n = 541) only 39 % perceived their risk. These under-estimators had lower knowledge scores (p = .03) than those who acknowledged their risk; indicating that the cause of under-estimating risk may be, at least, in part due to a lack of information. There is a pressing need to heighten understanding of type 2 diabetes risk among young adults to decrease the future burden of this disease.

Perceptions of risks for diabetes-related complications in Type 2 diabetes populations: a systematic review

AIM

In Type 2 diabetes, there is no clear understanding of how people perceive their risk of experiencing diabetes-related complications. To address this issue, we undertook an evidence-based synthesis of how people with Type 2 diabetes perceive their risk of complications.

METHODS

We performed a systematic search of nine electronic databases for peer-reviewed articles published on or before 1 March 2016. Data from 18 studies reporting lay perceptions of risks for complications in Type 2 diabetes populations were included. Publication year ranged between 2002 and 2014.

RESULTS

Methods used to assess risk perceptions were heterogeneous, ranging from questionnaires measuring the accuracy of perceived risks to semi-structured and focus group interviews. We found evidence of low risk awareness in most dimensions of risk perceptions measured and the existence of optimistic bias.

CONCLUSIONS

Perceptions were generally biased and varied according to the dimension of risk measured, the subpopulation concerned and the type of complications considered. Future work is needed to identify the best practical ways of correcting for biased risk perceptions so as to encourage self-care behaviours and treatment adherence.

Can an educational application increase risk perception accuracy amongst patients attending a high-risk breast cancer clinic?

OBJECTIVES

To design, develop and test the effect of an educational initiative to improve risk perception amongst patients attending a high-risk breast cancer clinic. This was achieved through three objectives - 1. identifying an optimal method of presenting risk data, 2. designing and building a risk application, and 3. testing the ability of the application to successfully modify patients perceived risk of cancer.

MATERIALS AND METHODS

A mobile application was developed for this project using best practice methods for displaying risk information. Patients (n = 84) were randomly allocated into two groups - 'Control' or 'Treatment'. Both groups underwent standard risk counseling while the application was employed in the 'Treatment' group. The patients were surveyed before their session, immediately after and six weeks later.

RESULTS

Increases in accuracy were seen in both groups with larger increases demonstrated in the 'Treatment' group with 'Personal 10 Year Risk' statistically significant ('Control' group increase from 21% to 48% vs the 'Treatment' group increase from 33% to 71% - p = 0.003).

CONCLUSION

This project demonstrated trends towards improved risk perception, however mixed logistic regression was unable to show a 30% difference between groups. Numerical literacy and understanding of risk were identified as issues amongst the general population. Overestimating risk remains high amongst attendees. Using mobile applications to convey risk information to patients is a new and evolving area with a corresponding paucity of data. We have demonstrated its potential and emphasised the importance of designing how this information is communicated to patients in order to make it understandable and meaningful.

Understanding perceived risk of type 2 diabetes in healthy middle-aged adults: a cross-sectional study of associations with modelled risk, clinical risk factors, and psychological factors

AIMS

To determine the perceived risk of type 2 diabetes in a sample of healthy middle-aged adults and examine the association between perceived risk and modelled risk, clinical risk factors, and psychological factors theorised to be antecedents of behaviour change.

METHODS

An exploratory, cross-sectional analysis of perceived risk of type 2 diabetes (framed according to time and in comparison with peers) was conducted using baseline data collected from 569 participants of the Diabetes Risk Communication Trial (Cambridgeshire, UK). Type 2 diabetes risk factors were measured during a health assessment and the Framingham Offspring Diabetes Risk Score was used to model risk. Questionnaires assessed psychological factors including anxiety, diabetes-related worry, behavioural intentions, and other theory-based antecedents of behaviour change. Multivariable regression analyses were used to examine associations between perceived risk and potential correlates.

RESULTS

Participants with a high perceived risk were at higher risk according to the Framingham Offspring Diabetes Risk Score (p<0.001). Higher perceived risk was observed in those with a higher body fat percentage, lower self-rated health, higher diabetes-related worry, and lower self-efficacy for adhering to governmental recommendations for physical activity (all p<0.001). The framing of perceived risk according to time and in comparison with peers did not influence these results.

CONCLUSIONS

High perceived risk of type 2 diabetes is associated with higher risk of developing the disease, and a decreased likelihood of engagement in risk-reducing health behaviours. Risk communication interventions should target high-risk individuals with messages about the effectiveness of prevention strategies.

Risk perception is not associated with attendance at a preventive intervention for type 2 diabetes mellitus among South Asians at risk of diabetes

OBJECTIVE

To evaluate the association between risk perception and attendance in a diabetes prevention programme among South Asians with a high risk for diabetes.

DESIGN

An observational study. We measured risk perception during the baseline interview with causal beliefs, perceived susceptibility and perceived controllability. We used logistic regression to examine the relationship between risk perception and attendance. We adjusted for relevant sociodemographic factors, screening results and psychosocial factors.

SETTING

The Hague, the Netherlands.

SUBJECTS

Five hundred and thirty-five Hindustani Surinamese (South Asians) aged 18-60 years from a lifestyle-versus-control intervention for the prevention of diabetes.

RESULTS

In total, 68·2% attended the lifestyle or control intervention. Participants perceived lifestyle and heredity to increase the risk of diabetes and perceived increasing physical activity to decrease it. Only 44·2% of the participants perceived themselves as susceptible to diabetes and only those who perceived a family history of diabetes as a cause of diabetes appeared to be more inclined to attend. However, after adjustment for confounding, the association was not statistically significant.

CONCLUSIONS

Risk perception was not significantly associated with attendance. The results suggest that increasing the risk perception alone in this South Asian population is unlikely to increase the attendance at a diabetes prevention programme.

Pacific Islanders' perceived risk of cardiovascular disease and diabetes

PURPOSE

To explore literature on Pacific Islanders' perceived risk of cardiovascular disease (CVD) and diabetes.

METHOD

A search of literature databases for English-language perceived risk research published from 2000 to 2008.

RESULTS

Few studies targeting perceived risk of CVD (n = 6) and diabetes (n = 4) included minority participants. No studies targeted Pacific Islanders exclusively. Overall, Pacific Islanders and other minority groups inaccurately perceive their risk of these conditions. No studies explored cultural relevancy or measurement of perceived risk.

IMPLICATIONS

Perceived risk, an integral part of health behavior change theories, is greatly understudied in Pacific Islanders. Perceived risk research for CVD and diabetes is sparse for any minority group. More research is needed to develop socioculturally appropriate interventions that promote accurate risk perceptions for both diseases and facilitate adoption of health behaviors. Ultimately, these behaviors will reduce the onset and devastating consequences of CVD and diabetes in Pacific Islanders and other minority populations.

Factorial structure of the perception of risk factors for type 2 diabetes scale: exploratory and confirmatory factor analyses

RATIONALE, AIMS AND OBJECTIVES

The extent to which individuals' perceptions of risk for type 2 diabetes are related to their actual risks and health-promoting behaviours is not well known. Yet perception of risk for type 2 diabetes may influence the likelihood that individual would engage in preventive behaviours. The purpose of this study was to evaluate the psychometric properties of the perception of risk factors for type 2 diabetes (PRF-T2DM).

METHODS

A descriptive, correlational, methodological design was used to conduct this study. The sample consisted of 629 adults from 42 states of the United States. A demographic questionnaire, the PRF-T2DM, the health-promoting lifestyle profile II and the depressive cognition scale were used to collect the data. Data analyses consisted of descriptive statistics, scale and item analyses, Pearson's correlation analysis, and exploratory and confirmatory factor analyses.

RESULTS

The PRF-T2DM has a Cronbach's alpha of 0.81. Both extracted factors had Cronbach's alphas of 0.74 and 0.80, respectively. Most inter-item and item-to-total correlation coefficients for factor 1 and factor 2 met the recommended criteria of r=0.30 to r=0.70. The PRF-T2DM achieved all minimum recommended criteria for model fit (χ(2) /d.f.=2.33, goodness of fit index=0.95, adjusted goodness of fit index=0.93, comparative fit index=0.94, root mean square error of approximation=0.05, root mean residual=0.05 and the P value for test of close fit=0.33).

CONCLUSIONS

All statistical estimates and measures of model fit were above the standard recommended criteria. The scale has potential uses in research and clinical practice. Further development and psychometric evaluation of the PRF-T2DM is warranted.

Perception of weight and threat to health

OBJECTIVES

To examine African American women's perception of their risk for obesity-related comorbid illnesses compared to their weight category.

METHODS

Participants were recruited from urban health centers in Atlanta, Georgia. Anthropometric measurements and self-reported demographics, medical conditions, and health beliefs about obesity and its related comorbid diseases were recorded.

RESULTS

More than 80% of the women (N=323) were either overweight or obese. Among overweight women, 44% reported being a normal weight. Seventy-two percent of the obese women reported being overweight, and 13.6% reported that they were obese. All women reported that each disease was "very serious;" however, overweight women reported having the same risk for each disease as normal weight women. Obese women reported having a higher risk of each disease (p < .05 for all diseases).

CONCLUSION

Overweight and obese women underestimate their weight categories. Overweight, but not obese, women reported the same perceived susceptibility for obesity-related comorbid diseases as normal-weight women. An increase in the perceived threat to health may motivate women to increase prevention efforts in the early stage of overweight to prevent or delay morbidity or mortality.

Risks for hypertension among undiagnosed African American mothers and daughters

INTRODUCTION

This study examines risks for high blood pressure (BP) among undiagnosed African American mothers and daughters, because African American children are at risk for hypertension due to familial influences.

METHOD

This study was cross-sectional in design and included 70 African American mother and daughter participants from the Detroit metropolitan area.

RESULTS

BP readings clinically diagnostic of hypertension were found for mothers (25.7%) and daughters (54.3%), although they were undiagnosed. Many participants with BP readings in pre-hypertension or hypertension categories were overweight or obese (mothers, 90.9%; daughters, 50.2%). Fewer underweight or normal-weight mothers (25.0%) and daughters (64.3%) had BP readings indicative of hypertension. Lower diastolic BP was associated with higher body mass index (BMI) among mothers (r = -.34, P = .045). Higher systolic BP was positively related to potassium consumption among daughters and total African Americans (r = .55, P = .005 and r = .41, P = .003, respectively).

DISCUSSION

Early screening for hypertension is needed to improve health among African Americans. Health providers should use American Academy of Pediatrics guidelines for determining hypertension in children. Research on familial and environment influences on BP among children is recommended to determine early risk for the development of hypertension.

Engaging student health organizations in reducing health disparities in underserved communities through volunteerism: developing a student health corps

One underutilized method for reducing health disparities and training culturally competent health care workers is the engagement of undergraduate student health organizations in conducting health screenings, promotion, and health education outreach activities in in underserved racial/ethnic communities. We conducted a needs assessment of 14 predominantly racial/ethnic minority undergraduate student-run health organizations. The 14 organizations annually served approximately 12,425 people (67% Hispanic, 25% African American, 6.33% Asian Pacific Islander), predominantly at health fairs within Los Angeles County (averaging 138 attendees). Student organizations provided screenings on general health conditions and diseases, with less emphasis on behavioral risk factors (e.g., drinking, smoking). Organizations indicated a need for increased and affordable training in preventive health screenings and help in understanding target populations' needs. Universities are in an excellent position to train, supervise, and organize volunteer health corps in order to engage students in reducing health disparities and to train culturally competent health care providers.

Advancing the Prevention and Control of Hypertension

Hypertension is on a worrisome public health trajectory. This review discusses some key contributing dynamics as well as considerations for progress toward the prevention and control of hypertension and its comorbidities.

Family history and parents' beliefs about consequences of childhood overweight and their influence on children's health behaviors

OBJECTIVES

The aims of this study were to examine factors related to 1) parental perception of health risks for overweight children and 2) parents' self-efficacy for influencing their children's dietary and physical activity behaviors, especially in relation to family history (FH) of diabetes and cardiovascular disease (CVD).

METHODS

A consecutive sample of parents was surveyed at 7 primary care practices about FH, perceptions of childhood obesity-related health risks, health beliefs, and perceptions. Generalized estimated equation models clustering on practice were developed to examine associations with perceptions and self-efficacy.

RESULTS

Analyses included 386 parents of children aged 2 to 17 years. Sixty-seven percent had FH of CVD and 33% had FH of diabetes. Children were 57% white, 23% Hispanic, 12% African American, and 8% other race/ethnicity; 17% were overweight and 18% were obese. Parents whose child had FH of diabetes more often perceived higher risk of diabetes for overweight children than those with neither FH risk (adjusted odds ratio [OR] 1.4, 95% confidence interval [95% CI], 1.2-1.7), as did those with FH of CVD (adjusted OR 2.0, 95% CI, 1.6-2.5) and those with an obese child. Parents with less than college education or having African American and female children perceived risk less often. Parents had high self-efficacy for influencing their child if they had a strong belief in parental modeling and their child was aged <12 years.

CONCLUSIONS

Family history of diabetes and CVD and other factors are associated with parents' perceptions of health risks for overweight children. Strategies to use FH to motivate families with overweight children toward behavior change are needed.

Perceptions of risk in adults with a low or high risk profile of developing type 2 diabetes; a cross-sectional population-based study

OBJECTIVE

To compare the perceived seriousness and risk of type 2 diabetes among low risk with high risk profile non-diabetic subjects and examine the relationship of perceived risk with multiple self-reported risk indicators.

METHODS

A cross-sectional population-based study among 4435 low risk profile and 2607 high risk profile non-diabetic residents of the Hoorn region, participating in a stepwise type 2 diabetes screening study. Main outcome measures were perceived seriousness and risk of diabetes in subjects categorized (low vs. high risk profile) using the Symptom Risk Questionnaire.

RESULTS

85.0% of the low risk and 81.2% of the high risk profile subjects perceived diabetes as a moderate to very serious disease. About half (43.0%) of all 7042 subjects reported that they do not know their risk of having diabetes. The mean perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects (difference = 2.8%; 95% confidence interval [CI] = 1.8% to 3.8%; P < 0.001). This difference was mostly explained by having a parent or sibling with diabetes, frequent thirst and claudication (difference = 0.6%; 95% CI = -0.7% to 1.9%). Interestingly, perceived risk decreased with increasing age within both groups (P for trend < 0.001).

CONCLUSIONS

Both low risk and high risk profile subjects perceive diabetes as a serious disease. Even among those at high risk profile for type 2 diabetes, almost half appeared not to know their risk. Perceived risk of having diabetes was slightly lower for the low risk compared with the high risk profile subjects. Furthermore, perceived risk decreases with increasing age.

PRACTICE IMPLICATIONS

This study points to a greater need to effectively address people's (mis)perceptions, and how to raise the awareness and understanding of type 2 diabetes and its risk factors in the general population in order to influence early detection and healthy lifestyle changes.

Attitudes and behaviors of African Americans regarding early detection of kidney disease

BACKGROUND

Chronic kidney disease (CKD) is an African American public health crisis. To inform interventions, the National Kidney Disease Education Program surveyed African Americans about their attitudes and behaviors regarding early detection of kidney disease and screening.

STUDY DESIGN

Cross-sectional study.

SETTING & PARTICIPANTS

2,017 African Americans from 7 states (Georgia, Maryland, Ohio, Mississippi, Louisiana, Missouri, and Tennessee) selected by using a random-digit dialing telephone survey (response rate, 42.4%).

PREDICTORS

Demographic, risk, knowledge, and behavior variables.

OUTCOMES & MEASUREMENTS

Perception of CKD as a top health concern, perceived risk of getting kidney disease, and accurate knowledge about CKD and its prevention.

RESULTS

Only 23.5% of African Americans were screened for kidney disease in the last year. Although almost half (43.7%) of African Americans had a CKD risk factor, only 2.8% reported that CKD was a top health concern. Almost half knew the correct definition of kidney disease (48.6%), but few knew a test to diagnose CKD (23.7%) or that African Americans were at greater risk of developing CKD (18.1%). African Americans who had diabetes (odds ratio [OR], 3.22; 95% confidence interval [CI], 2.17 to 4.76), hypertension (OR, 1.78; 95% CI, 1.28 to 2.44), at least a bachelor's degree (OR, 1.77; 95% CI, 1.17 to 2.66), who had spoken with a medical professional (OR, 1.85; 95% CI, 1.19 to 2.85) or their family (OR, 1.61; 95% CI, 1.11 to 2.38) about kidney disease, who knew that a family history of kidney disease is a risk factor (OR, 2.32; 95% CI, 1.08 to 5.0), and who had been tested for CKD in the last year (OR, 1.45; 95% CI, 1.03 to 2.0) were more likely to correctly perceive themselves at increased risk.

LIMITATIONS

Respondents were primarily African American women from urban areas.

CONCLUSIONS

Most African Americans have poor knowledge about CKD, do not perceive it as an important health problem, and are not getting screened. To increase early detection of kidney disease through screenings, educational efforts linking kidney disease prevention to other diseases that are health priorities for African Americans are necessary.