Qualitative study of knowledge, perception, behavior and barriers associated with cardiovascular disease risk among overweight and obese Hispanic taxi drivers of South Bronx, NYC

Assessing the Risk Perception and Knowledge Regarding Cardiovascular Diseases in Patients With Hypertension and Diabetes in Central India: A Mixed-Methods Study

Background Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide. The perceptions of patients can be important in health-related behaviors and disease prognosis. Thus, this study aimed to determine the risk perception and knowledge of hypertensive and diabetic patients. Methodology The study was conducted among 264 patients with diabetes and/or hypertension. A sequential exploratory mixed-methods design was used, which initially identified themes related to risk perception about CVDs among patients. Knowledge and risk perception about CVDs were quantified using a survey derived from predefined themes. CVD knowledge scores were categorized into low, intermediate, and high scores, and the trends of risk perception were studied across this spectrum of cardiovascular knowledge. Results The age of the participants ranged from 30 to 78 years. Overall, 57.19% of the participants were males, whereas 42.80% were females. The qualitative results revealed that the sources of knowledge about CVDs, physical activity, and maintaining a nutritious diet included family, friends, and media. On the other hand, doctors played a significant role in influencing perceptions related to medications. The observation of complications related to CVDs and the fear of mortality played a pivotal role in shaping the perception regarding the seriousness of the condition. Perceived susceptibility was low if there was unawareness of protection through medications and lifestyle changes, but it was high with stress or heredity. The analysis of CVD knowledge and risk perception survey data revealed the median CVD knowledge score to be 12 (interquartile range = 7.5-13), which showed a significant association with education and socioeconomic status (p < 0.05). The distribution of risk perception scores across the spectrum of CVD knowledge scores depicted that participants with higher scores agreed more with CVDs being serious and their susceptibility to them. Conclusions Despite having high knowledge scores regarding CVDs, the study population had average risk perception. Patient risk perceptions should be evaluated as it affects the health-seeking behavior and prognosis of the disease.

Assessment of Adverse Childhood Experiences in the South Bronx on the Risk of Developing Chronic Disease as Adults

Background Adverse childhood experiences (ACEs) have a negative impact on health outcomes. Using a cross-sectional study design, our objective was to identify the prevalence of ACEs among residents of South Bronx and the increased relationship between such childhood stressors and the prevalence of both chronic disease and modifiable high-risk behavior in adulthood. Methods We recruited patients from a hospital-based, adult primary care clinic in the metropolitan area of the South Bronx. A prospectively designed, observational study recruited patients in a consecutive fashion to conduct a cross-sectional survey between September 2017 and January 2018. The demographic representation comprises a low socioeconomic sector of urban New York City, with low education and immigrant population. A modified ACE questionnaire that included nine ACE categories (Physical Abuse, Sexual Abuse, Household Substance Abuse, Separation from Parents, Incarcerated Household Member, Parental Separation/Divorce, and Bullying) in addition to questions on demographics, high-risk behavior, and diagnosis of chronic disease. Our primary objective was to gather the incidence of ACEs organized by domains. Secondary objectives were to demonstrate any expected increase (as odds ratios (ORs)) in chronic disease or maladaptive social habits when compared to patients with no ACEs within the cohort. The OR for the associations was calculated with logistic regression. Individual logistic regression models for each chronic disease, high-risk behavior, and demographics were used to measure the exposure response of the nine ACE categories.  Results A total of 454 patients completed the survey. The average age was 53.1±14.2 years, and females were 49% of the sample. Hispanics were at 61% followed by Blacks at 34%. Participants reported high-risk behavior at 24%, had a high prevalence of chronic illness (82%), and had ACE events at 70%. We found a significant relationship between ACE events and having a chronic disease diagnosis and engagement in high-risk behavior with higher odds of reporting chronic illnesses among participants with exposure to childhood stressors (OR 1.26, 95% confidence interval 1.1-1.5, p=0.002). Of the nine ACE categories, many were independently associated with one or more chronic diseases in adulthood. Conclusion According to our survey data, ACE events in our patient population were more prevalent (30% with four or more exposures), higher than the proposed average of one out of six Americans with four or more exposures nationally according to national statistics. These childhood stressors appeared to have a strong association with the development of high-risk behavior and chronic illnesses.

Co-Design of an eHealth Intervention to Reduce Cardiovascular Disease Risk in Male Taxi Drivers: ManGuard

Taxi driving, a male-dominated occupation, is associated with an increased risk of cardiovascular disease (CVD). The increased risk is linked to a high prevalence of modifiable CVD risk factors including overweight/obesity, poor nutrition, smoking, excessive alcohol consumption and physical inactivity. Behaviour change interventions may prove advantageous, yet little research has been conducted to reduce CVD risk in this population. The purpose of this study was to co-design an eHealth intervention, 'ManGuard', to reduce CVD risk in male taxi drivers. The IDEAS framework was utilised to guide the development of the eHealth intervention, with the Behaviour Change Wheel (BCW) incorporated throughout to ensure the intervention was underpinned by behaviour change theory. Development and refinement of ManGuard was guided by current literature, input from a multidisciplinary team, an online survey, a systematic review and meta-analysis, and focus groups (n = 3) with male taxi drivers. Physical inactivity was identified as the prime behavior to change in order to reduce CVD risk in male taxi drivers. Male taxi drivers indicated a preference for an eHealth intervention to be delivered using smartphone technology, with a simple design, providing concise, straightforward, and relatable content, and with the ability to track and monitor progress.

Factors Affecting the Deterioration of the Physical Health Status of Taxi Drivers by Age Group

With the rapidly aging population, taxi drivers are aging at a fast pace, and competition in the taxi industry is intensifying due to the emergence of various transportation platforms. A descriptive secondary data study was conducted (on a total of 936 subjects) to determine the factors affecting the deterioration of taxi drivers’ physical health status (PHS) according to their age group. The increased incidence of chronic diseases and cognitive decline among taxi drivers aged 55−64 years had the greatest influence on the deterioration of their PHS. Driver obesity was more likely to be related to deterioration of the PHS in the drivers aged 55−64 years (OR: 2.459, <0.001) and 35−54 years (OR: 2.133, <0.001). Among the financial factors, a driver’s income and their number of dependent family members were correlated with the deterioration of the PHS for drivers aged 55 years or over. Therefore, chronic diseases, obesity and cognitive decline were related with deterioration of the physical health status. This suggests that attention should be paid to healthcare policies not only for the elderly aged over 65 years but also those aged 50 to 64 years, i.e., middle-aged people at the beginning of the transition to old age.