Television Viewing Time, Physical Activity, and Mortality Among African Americans

Background

Prolonged television viewing time, a marker of sedentary activity, is independently associated with increased all-cause mortality; however, this association has rarely been studied in African Americans. The objective of our study was to examine the association between television viewing time and mortality among African Americans by using data from the Jackson Heart Study (JHS).

Methods

We studied 5,289 participants from the JHS study who reported television viewing time (h/day) in the JHS baseline questionnaire from 2000 through 2004. Using multivariable Cox regression models adjusted for age, sex, smoking, alcohol use, physical activity, nutrition, prevalent coronary heart disease, chronic kidney disease, diabetes, and hypertension, we computed hazard ratios to examine the association between television viewing time (≤2 h/day, 2–4 h/day, and ≥4 h/day) and mortality.

Results

Participants had a mean age of 55 years, and 64% were women. After a median follow-up of 9.9 years (interquartile range, 9.0–10.7), 615 deaths occurred (data analysis conducted in 2017). Hazard ratios for mortality were 1.08 (0.86–1.37) for television time of 2 to 4 hours per day and 1.48 (95% CI: 1.19–1.83) for television time of greater than or equal to 4 hours per day when compared with those who watched television less than 2 hours per day (P trend = .002). When we restricted analyses to those who performed leisure-time activities, the hazard ratios for mortality were 1.10 (95% CI, 0.84–1.45) for television viewing of 2 to 4 hours per day and 1.45 (95% CI, 1.13–1.86) for more than 4 hours per day compared with the less than 2 hours per day.

Conclusion

Our findings suggest that greater television viewing time, even among those who perform leisure-time physical activities, is associated with increased all-cause mortality among African Americans. Thus, it may serve as an indicator of a sedentary lifestyle with potential for intervention.

Factors associated with maintenance of body mass index in the Jackson Heart Study: A prospective cohort study secondary analysis

The purpose of this study was to compare the relationship of diet quality, physical activity, and environmental factors with body mass index (BMI) maintenance in African American adults. We analyzed data from 4041 participants in the Jackson Heart Study, a prospective cohort study based in Jackson, Mississippi. Exposures were baseline American Heart Association diet quality score, American Heart Association physical activity categories, the built environment, the food environment, and neighborhood safety. The outcome was weight maintenance or loss (no BMI increase ≥1.0kg/m²) versus weight gain (BMI increased ≥1.0kg/m²) over a mean of 5.0years. We found that 63% of participants maintained or lost weight and 37% gained weight. In multivariable analyses, ideal diet quality was associated with a 6% greater likelihood of BMI maintenance (incidence rate ratio [IRR] 1.06, 95% confidence interval [CI]: 1.03, 1.10). Living in an unsafe neighborhood was associated with a 2% lower likelihood of BMI maintenance (IRR 0.98, 95% CI: 0.96, 0.99), as was poor built environment (IRR 0.98, 95% CI: 0.97, 0.998). Physical activity and poor food environment were not associated with BMI maintenance. In conclusion, among African American adults in Jackson, Mississippi, high quality diet was the strongest factor associated with BMI maintenance.

Tai Chi for Posttraumatic Stress Disorder and Chronic Musculoskeletal Pain: A Pilot Study

PURPOSE

Explore the feasibility of a Tai Chi intervention to improve musculoskeletal pain, emotion, cognition, and physical function in individuals with posttraumatic stress disorder.

DESIGN

Two-phase, one-arm quasi-experimental design.

METHOD

Phase 1: 11 participants completed one Tai Chi session, feasibility questionnaire, and were offered participation in Phase 2, a 12-week Tai Chi intervention. Ten participants participated in Phase 2. Pain intensity, interference, physical function scales, an emotional battery, and cognition tests were used for pre- and postintervention outcome measures. Paired t tests and thematic analysis were used for analysis.

FINDINGS

In Phase 1, most felt Tai Chi would benefit health (90.9%) and expressed interest in continuing Tai Chi (6.73 out of 7). Phase 2 results showed improvement in fear-affect (raw t = -2.64, p = .03; age adjusted t = -2.90, p = .02), fear-somatic arousal (raw t = -2.53, p = .035), List Sorting Working Memory (raw t = 2.62, p = .031; age adjusted t = 2.96, p = .018), 6-Minute Walk Test ( t = 3.541, p = .008), and current level of Pain Intensity ( t = -4.00, p = .004).

CONCLUSIONS

Tai Chi is an acceptable, holistic treatment to individuals with musculoskeletal pain and posttraumatic stress disorder. It may reduce pain, improve emotion, memory, and physical function.

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement

CONTEXT

The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings.

OBJECTIVES

To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker.

METHODS

Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record.

RESULTS

Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences.

CONCLUSIONS

Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers.

Leveraging Spousal Support to Improve Health Promotion in Serious Mental Illness

Although the majority of Veterans are overweight or obese, and many have comorbid mental health disorders, little is known about the most effective way to intervene in this complex population. This case describes a telephone-based cognitive-behavioral treatment for depression and weight management with an obese Veteran with bipolar disorder. His wife joined sessions to leverage spousal support. The Veteran evidenced variable levels of physical activity and mood fluctuations during treatment; although he reported some degree of positive behavior change and improved social support, he did not lose weight. He continued to endorse moderate levels of depressive symptomatology at the end of the nine-session intervention. This case illustrates the complexity of treating those with chronic serious mental illness and multimorbidities. Further research is needed to inform interventions that concurrently improve mental health symptomatology and weight-related outcomes in chronic, complex cases.

Perceived discrimination is associated with health behaviours among African-Americans in the Jackson Heart Study

BACKGROUND

Using Jackson Heart Study data, we examined associations of multiple measures of perceived discrimination with health behaviours among African-Americans (AA).

METHODS

The cross-sectional associations of everyday, lifetime and burden of discrimination with odds of smoking and mean differences in physical activity, dietary fat and sleep were examined among 4925 participants aged 35-84 years after adjustment for age and socioeconomic status (SES).

RESULTS

Men reported slightly higher levels of everyday and lifetime discrimination than women and similar levels of burden of discrimination as women. After adjustment for age and SES, everyday discrimination was associated with more smoking and a greater percentage of dietary fat in men and women (OR for smoking: 1.13, 95% CI 1.00 to 1.28 and 1.19, 95% CI 1.05 to 1.34; mean difference in dietary fat: 0.37, p<0.05 and 0.43, p<0.01, in men and women, respectively). Everyday and lifetime discrimination were associated with fewer hours of sleep in men and women (mean difference for everyday discrimination: -0.08, p<0.05 and -0.18, p<0.001, respectively; and mean difference for lifetime discrimination: -0.08, p<0.05 and -0.24, p<0.001, respectively). Burden of discrimination was associated with more smoking and fewer hours of sleep in women only.

CONCLUSIONS

Higher levels of perceived discrimination were associated with select health behaviours among men and women. Health behaviours offer a potential mechanism through which perceived discrimination affects health in AA.

The role of gender in moderating treatment outcome in collaborative care for anxiety

OBJECTIVE

The aim of this study was to test whether gender moderates intervention effects in the Coordinated Anxiety Learning and Management (CALM) intervention, a 12-month, randomized controlled trial of a collaborative care intervention for anxiety disorders (panic disorder, generalized anxiety disorder, posttraumatic stress disorder, and social anxiety disorder) in 17 primary care clinics in California, Washington, and Arkansas.

METHODS

Participants (N=1,004) completed measures of symptoms (Brief Symptom Inventory [BSI]) and functioning (mental and physical health components of the 12-Item Short Form [MCS and PCS] and Healthy Days, Restricted Activity Days Scale) at baseline, six, 12, and 18 months. Data on dose, engagement, and beliefs about psychotherapy were collected for patients in the collaborative care group.

RESULTS

Gender moderated the relationship between treatment and its outcome on the BSI, MCS, and Healthy Days measures but not on the PCS. Women who received collaborative care showed clinical improvements on the BSI, MHC, and Healthy Days that were significantly different from outcomes for women in usual care. There were no differences for men in collaborative care compared with usual care on any measures. In the intervention group, women compared with men attended more sessions of psychotherapy, completed more modules of therapy, expressed more commitment, and viewed psychotherapy as more helpful.

CONCLUSIONS

These findings contribute to the broader literature on treatment heterogeneity, in particular the influence of gender, and may inform personalized care for people seeking anxiety treatment in primary care settings.

A pilot study evaluating a minimal contact telephone and mail weight management intervention for primary care patients

OBJECTIVE

This study examined an 8-week telephone and mail weight management intervention for Veterans who are unable to attend frequent clinical visits.

METHODS

A mail and phone based intervention was compared to a "usual care" intervention in a Hospital clinic. 26 participants (80% male; mean wt=246.2 lbs, BMI=34.7) completed the study. All participants received weight management counseling at weeks 1 and 8. Participants in the intervention group received phone calls and mailings during weeks 2-7.

RESULTS

The intervention group lost more weight, although it was not statistically significant. Multivariate analyses showed stage of change was associated with weight loss and attendance. Treatment group and role limitations due to emotional problems were related to weight loss. The intervention group significantly increased their intake of fruits and vegetables.

CONCLUSION

This pilot study suggests that minimal interventions may be a method to reach populations that do not have access to more intensive treatments for weight management.

Prevention and Treatment of Hypertension Study (PATHS): effects of an alcohol treatment program on blood pressure

OBJECTIVE

To determine whether blood pressure is reduced for at least 6 months with an intervention to lower alcohol intake in moderate to heavy drinkers with above optimal to slightly elevated diastolic blood pressure, and whether reduction of alcohol intake can be maintained for 2 years.

DESIGN

A randomized controlled trial.

METHODS

Six hundred forty-one outpatient veterans with an average intake of 3 or more alcoholic drinks per day in the 6 months before entry into the study and with diastolic blood pressure 80 to 99 mm Hg were randomly assigned to a cognitive-behavioral alcohol reduction intervention program or a control observation group for 15 to 24 months. The goal of the intervention was the lower of 2 or fewer drinks daily or a 50% reduction in intake. A subgroup with hypertension was defined as having a diastolic blood pressure of 90 to 99 mm Hg, or 80 to 99 mm Hg if recently taking medication for hypertension.

RESULTS

Reduction in average weekly self-reported alcohol intake was significantly greater (P<.001) at every assessment from 3 to 24 months in the intervention group vs the control group: levels declined from 432 g/wk at baseline by 202 g/wk in the intervention group and from 445 g/wk by 78 g/wk in the control group in the first 6 months, with similar reductions after 24 months. The intervention group had a 1.2/0.7-mm Hg greater reduction in blood pressure than the control group (for each, P = .17 and P = .18) for the 6-month primary end point; for the hypertensive stratum the difference was 0.9/0.7 mm Hg (for each, P = .58 and P = .44).

CONCLUSIONS

The 1.3 drinks per day average difference between changes in self-reported alcohol intake observed in this trial produced only small nonsignificant effects on blood pressure. The results from the Prevention and Treatment of Hypertension Study (PATHS) do not provide strong support for reducing alcohol consumption in nondependent moderate drinkers as a sole method for the prevention or treatment of hypertension.

Prevention and Treatment of Hypertension Study (PATHS). Rationale and design

Alcohol consumption has been recognized as an important correlate of blood pressure in many epidemiologic studies, but few interventional studies have been conducted to examine the effect of a reduction in alcohol intake on blood pressure. Because these studies have usually included few subjects and been of short duration, the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Veterans Affairs (VA) Cooperative Studies Program have initiated a randomized, controlled, multicenter trial to determine whether blood pressure and left ventricular mass are lowered over 6 months of alcohol moderation in non-dependent moderate to heavy drinkers (three or more drinks per day average but not alcohol dependent) with above-average normal (80 to 89 mm Hg) and mildly hypertensive (90 to 99 mm Hg) levels of diastolic blood pressure, and whether a reduction in alcohol intake can be maintained for 2 years. Eligible veterans are randomized to either an alcohol reduction intervention or a control observation group at seven clinical sites. The projected sample size is 580 participants. Alcohol intake is assessed by self-report using a retrospective diary (Chronological Drinking Record) and by various biochemical markers, including apolipoproteins, HDL cholesterol (and subfractions), and carbohydrate deficient transferrin, analyzed at a central laboratory. The alcohol intervention technique is a cognitive-behavioral program, the intensive phase of which consists of six counseling sessions over 3 months. Echocardiograms are obtained at baseline and 6 months after randomization. This trial has important implications for both the prevention and treatment of hypertension.