Urinary sodium and potassium profile of blacks and whites in relation to education in two different geographic urban areas. TOMHS Research Group. Treatment of Mild Hypertension Study

Historical Differences in School Term Length and Measured Blood Pressure: Contributions to Persistent Racial Disparities among US-Born Adults

INTRODUCTION

Legally mandated segregation policies dictated significant differences in the educational experiences of black and white Americans through the first half of the 20th century, with markedly lower quality in schools attended by black children. We determined whether school term length, a common marker of school quality, was associated with blood pressure and hypertension among a cohort of older Americans who attended school during the de jure segregation era.

METHODS

National Health and Nutrition Examination Survey I and II data were linked to state level historical information on school term length. We used race and gender-stratified linear regression models adjusted for age, state and year of birth to estimate effects of term length on systolic and diastolic blood pressure (SBP and DBP) and hypertension for US-born adults. We also tested whether correcting years of schooling for term length differences attenuated estimated racial disparities.

RESULTS

Among black women, 10% longer school term was associated with lower SBP, DBP and hypertension prevalence (2.1 mmHg, 1.0 mmHg, and 5.0 percentage points respectively). Associations for whites and for black men were not statistically significant. Adjustment for education incorporating corrections for differences in school term length slightly attenuated estimated racial disparities.

CONCLUSIONS

Longer school term length predicted better BP outcomes among black women, but not black men or whites.

Contextual poverty, nutrition, and chronic kidney disease

Nutrition plays an important role in CKD outcomes. One of the strongest factors that affects nutrition is socioeconomic status as evidenced by the large body of epidemiologic data showing that income and education are directly associated with diet quality. Apart from individual-level markers of socioeconomic status such as income and education, contextual factors such as availability of and transportation to food outlets that provide healthy food options and the density of fast-food restaurants within particular regions markedly affect the ability of individuals to comply with nutrition recommendations. This is particularly true for nutrition guidelines most specific to individuals with CKD such as the consumption of protein, saturated fat, sodium, and phosphorus, all of which have been shown to affect CKD health and are influenced by the availability of healthy food options within individual neighborhood food environments. Because of the strong association of contextual poverty with the diet quality, any serious attempt to improve the diet of CKD patients must include a discussion of the environmental barriers that each individual faces in trying to access healthy foods, and health care providers should take account of these barriers when tailoring specific recommendations.

Metabolic syndrome in African Americans: views on making lifestyle changes

This study explores African American adults' understanding of metabolic syndrome (MetS) and their motivations for making lifestyle changes. African Americans have a greater risk for components of MetS, such as hypertension. Three focus groups were conducted with African American adults (n = 11) with MetS. Content analysis revealed five themes: Threat of Poor Health, Building Trust With Providers, Gaining Social Support, Seeking Culturally Acceptable Alternatives, and Getting on Track and Staying on Track. Lifestyle interventions for African Americans with MetS need to focus on building trust, developing self-monitoring skills, social support, and identifying low-cost/convenient opportunities for physical activity.

Socioeconomic status, blood pressure progression, and incident hypertension in a prospective cohort of female health professionals

AIMS

The aim of this study was to examine the association between socioeconomic status, blood pressure (BP) progression, and incident hypertension.

METHODS AND RESULTS

We included 27 207 female health professionals free of hypertension and cardiovascular disease at baseline. Participants were classified into five education and six income categories. The main outcome variables were BP progression at 48 months of follow-up and incident hypertension during the entire study period. At 48 months, 48.1% of women had BP progression. The multivariable adjusted relative risks [95% confidence intervals (CIs)] for BP progression were 1.0 (referent), 0.96 (0.92-1.00), 0.92 (0.88-0.96), 0.90 (0.85-0.94), and 0.84 (0.78-0.91) (P for trend <0.0001) across increasing education categories and 1.0 (referent), 1.01 (0.94-1.08), 0.99 (0.93-1.06), 0.97 (0.91-1.04), 0.96 (0.90-1.03), and 0.89 (0.83-0.96) across increasing income categories (P for trend = 0.0001). During a median follow-up of 9.8 years, 8248 cases of incident hypertension occurred. Multivariable adjusted hazard ratios (95% CI) were 1.0 (referent), 0.92 (0.86-0.99), 0.85 (0.79-0.92), 0.87 (0.80-0.94), and 0.74 (0.65-0.84) (P for trend <0.0001) across increasing education categories and 1.0 (referent), 1.07 (0.95-1.21), 1.07 (0.95-1.20), 1.06 (0.94-1.18), 1.04 (0.93-1.16), and 0.93 (0.82-1.06) (P for trend 0.08) across increasing income categories. In joint analyses, education but not income remained associated with BP progression and incident hypertension.

CONCLUSION

Socioeconomic status, as determined by education but not by income, is a strong independent predictor of BP progression and incident hypertension in women.

High-Sodium Food Choices by Southern, Urban African Americans With Heart Failure

BACKGROUND

Sodium restriction is important in the management of heart failure (HF). Although many low-sodium educational resources are available, few are directed specifically at urban African Americans.

METHODS AND RESULTS

A registered dietitian prospectively interviewed 50 African-American and 25 white patients in an urban public hospital (derivation cohort) in Dallas, TX, using a food-frequency instrument that listed 146 food choices. Foods >300 mg sodium/serving consumed at least weekly by 50% of an ethnic group were classified as being a high-sodium core food for that group. Classification of foods (core or not core) was validated in a second African-American cohort (n = 144). Five high-sodium food choices were classified as core food in both the derivation and validation African-American cohorts (salt in cooking, canned vegetables, cheese, processed meats, and cold cereal) and another 3 when the derivation and validation cohorts were combined (fast food, fried chicken, and corn bread). Four of these 8 foods were not classified as core foods in whites.

CONCLUSION

Eight high-sodium foods were frequently consumed by southern, urban African Americans with heart failure. Several of these foods were not commonly consumed by whites, emphasizing the need to be sensitive to ethnic differences in dietary habits when educating patients about sodium intake.