Increasing use of systems science in cardiovascular disease prevention to understand how to address geographic health disparities in communities with a disproportionate burden of risk

The CAMPUS Study: A Systems Approach to Alcohol-Involved Sexual Violence on College Campuses

OBJECTIVE

Developing a better mechanistic and multilevel understanding of sexual violence on college campuses can help us evaluate and implement existing interventions, as well as develop new ones. We brought together scientists, practitioners, and college students to collaboratively characterize the systems surrounding alcohol-involved sexual violence on college campuses. Using collaborative model-building, they created models that highlight interconnected and multilevel influences and consequences of sexual violence.

METHOD

Collaborative model-building activities involved two collaborator groups (12 students and 8 practitioners) and a core modeling team (7 scientists). Each collaborator group met for four 2-hour sessions to develop systems models of alcohol use and sexual violence on college campuses. The core modeling team facilitated each session and worked between sessions to ensure the successful development of the model. Specific activities included identifying and prioritizing the causes and consequences of alcohol-involved sexual violence, characterizing the causal relationships between these factors, and developing and modifying causal loop diagrams to illustrate these relationships.

RESULTS

Both students and practitioners identified key causes and consequences, including both individual-level (e.g., drinking to intoxication) and campus-level (e.g., institutional support for survivors) constructs. Both groups identified the causal relationships between these variables and identified salient, modifiable mechanisms for reducing alcohol-involved sexual violence.

CONCLUSIONS

The collaborative model-building process successfully included diverse collaborator voices, integrating influential factors across multiple social-ecological levels. This iterative and capability-building approach can bridge intensive modeling efforts with the implementation and development of more effective sexual violence interventions.

Gestational Diabetes and Subsequent Metabolic Dysfunction: An National Health and Nutrition Examination Survey Analysis (2011-2018)

Background: Gestational diabetes mellitus (GDM) complicates ∼10% of pregnancies, with the highest rates among Asian women. Evidence suggests that GDM is associated with an increased risk for future chronic health conditions, yet data for Asian women are sparse. We explored the association between prior GDM and metabolic dysfunction with nationally representative data to obtain Asian-specific estimates. Methods: For this cross-sectional study, data were drawn from the National Health and Nutrition Examination Survey for 7195 women with a prior pregnancy. GDM (yes/no) was defined using the question "During pregnancy, were you ever told by a doctor or other health professional that you had diabetes, sugar diabetes, or gestational diabetes?." Current metabolic dysfunction (yes/no) was based on having at least one of four indicators: systolic blood pressure (SBP, ≥130 mmHg), waist circumference (≥88 cm), high-density lipoprotein (HDL) cholesterol (<50 mg/dL), and glycosylated hemoglobin (HbA1c) (≥6.5%). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between prior GDM and metabolic outcomes, overall and by race. Models included sampling weights and demographic and behavioral factors. Results: Overall, women with prior GDM had 46% greater odds of high waist circumference (OR: 1.5; 95% CI: 1.1-2.0) and 200% greater odds (OR: 3.0; 95% CI: 2.1-4.2) of high HbA1c. Prior GDM was not associated with high blood pressure or low HDL cholesterol. In race-specific analyses, prior GDM was associated with increased risk of elevated HbA1c among Asian (OR: 6.6; 95% CI: 2.5-17.2), Mexican American (OR: 3.0; 95% CI: 1.5-5.8), Black (OR: 3.0; 95% CI: 1.7-5.5), and White (OR: 2.6; 95% CI: 1.5-4.6) women. Prior GDM was associated with elevated SBP among Mexican American women and low HDL among Black women. Discussion: Prior GDM is associated with elevated HbA1c among all women, yet is a stronger predictor of elevated HbA1c among Asian women than other women. Race-specific associations between prior GDM and metabolic dysfunction were observed among Mexican American and Black women. Further research is warranted to understand the observed race/ethnic-specific associations.