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Alphonso SR, Andrews MR, Regan SD, Shishkov A, Cantor JH, Powell-Wiley TM, Tamura K. Geospatially clustered low COVID-19 vaccine rates among adolescents in socially vulnerable US counties. Prev Med Rep 2024; 37:102545. [PMID: 38186659 PMCID: PMC10767486 DOI: 10.1016/j.pmedr.2023.102545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
COVID-19 vaccinations are widely available across the United States (U.S.), yet little is known about the spatial clustering of COVID-19 vaccinations. This study aimed to test for geospatial clustering of COVID-19 vaccine rates among adolescents aged 12-17 across the U.S. counties and to compare these clustering patterns by sociodemographic characteristics. County-level data on COVID-19 vaccinations and sociodemographic characteristics were obtained from the COVID-19 Community Profile Report up to April 14, 2022. A total of 3,108 counties were included in the analysis. Global Moran's I statistic and Anselin Local Moran's analysis were used, and clustering patterns were compared to sociodemographic variables using t-tests. Counties with low COVID-19 vaccinated clusters were more likely, when compared to unclustered counties, to have higher numbers of individuals in poverty and uninsured individuals, and higher values of Social Vulnerability Index (SVI) and COVID-19 Community Vulnerability Index (CCVI). While high COVID-19 vaccinated clusters, compared to neighboring counties, had lower numbers of Black population, individuals in poverty, and uninsured individuals, and lower values of SVI and CCVI, but a higher number of Hispanic population. This study emphasizes the importance of addressing systemic barriers, such as poverty and lack of health insurance, which were found to be associated with low COVID-19 vaccination coverage.
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Affiliation(s)
- Sophie R. Alphonso
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Marcus R. Andrews
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Seann D. Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alyssa Shishkov
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | | | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Shishkov A, Andrews MR, Alphonso SR, Deng Y, Moniruzzaman M, Cantor JH, Tamura K. County-Level Sociodemographic Characteristics and Availability of COVID-19 Therapeutic Drugs. JAMA Netw Open 2023; 6:e2334763. [PMID: 37728929 PMCID: PMC10512099 DOI: 10.1001/jamanetworkopen.2023.34763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
This cross-sectional study examines access to COVID-19 treatments in US counties by race and ethnicity, poverty rate, uninsured rate, and other population and community characteristics.
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Affiliation(s)
- Alyssa Shishkov
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
| | - Marcus R. Andrews
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Sophie R. Alphonso
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
| | - Yangyang Deng
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
| | - Mohammad Moniruzzaman
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
| | | | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
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Andrews MR, Powell-Wiley TM. Abstract P267: Examining the Relationship Between Historic Redlining and Contemporary Coronary Heart Disease Prevalence. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background:
Coronary heart disease (CHD) is the leading cause of death in the United States (US). Evidence supports adverse neighborhood conditions as a contributor to CHD. However, the impact of discriminatory housing practices, including historic redlining, on CHD across US cities remains understudied.
Methods:
Data on CHD for US cities were downloaded from the 500 Cities Project. We merged this data with census tract historic redlining data from the Mapping Inequality Project and census tract level demographic data from the American Community Survey. We used linear regressions to examine relationships between historic redlining scores and CHD adjusting for census tract level covariates.
Results:
12 cities from the US were included in the analyses. After controlling for covariates, these relationships' strength and significance varied by city and region. In the Northeast/Mid-Atlantic region (Boston, Baltimore, and New York), increases in redlining scores were associated with increases in the proportion of people with CHD (Table). In the Midwest, increases in redlining scores were associated with increases in the proportion of people with CHD in Detroit and Cleveland; this relationship was significant in Detroit and marginally significant in Cleveland. There were no significant associations in Chicago. In the South, census tracts with higher redlining scores were associated with higher CHD prevalence in Miami. Paradoxical relationships were seen in Atlanta where higher redlining scores were associated with a lower proportion of people with CHD; there were no significant associations in Dallas. In the West, increases in redlining scores were associated with increases in the proportion of people with CHD in Los Angeles; relationships were not statistically significant in San Francisco or Seattle.
Discussion:
This is one of the first studies to suggest differential impact of historic redlining on CHD across US cities. Additional research is needed to examine potential mechanisms that explain these associations.
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Farmer N, Powell-Wiley TM, Middleton KR, Brooks AT, Mitchell V, Troncoso M, Ceasar J, Claudel SE, Andrews MR, Kazmi N, Johnson A, Wallen GR. Use of a focus group-based cognitive interview methodology to validate a cooking behavior survey among African-American adults. Front Nutr 2022; 9:1000258. [PMID: 36545469 PMCID: PMC9760831 DOI: 10.3389/fnut.2022.1000258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/21/2022] [Indexed: 12/08/2022] Open
Abstract
Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent's interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved African-American adults (n = 11) at risk for cardiovascular disease who were recruited from a community-based participatory research study in Washington, D.C., to participate in a focus group-based cognitive interview. Cognitive interview methodologies included the verbal think-aloud protocol and the use of retrospective probes. Thematic analysis and evaluation of verbalized cognitive processes were conducted using verbatim transcripts. Five thematic themes related to the survey were generated: (1) Clarity and relevancy of question items; (2) influence of participants' perspectives and gender roles; (3) participant social desirability response to questions; (4) concern regarding question intent. Eleven survey items were determined as difficult by participants. Cooking topics for these items were: cooking practices, cooking skills, cooking perception (how one defines cooking), food shopping skills, and socialization around cooking. Question comprehension and interpreting response selections were the most common problems identified. Cognitive interviews are useful for cooking research as they can evaluate survey questions to determine if the meaning of the question as intended by the researcher is communicated to the respondents-specific implications from the results that apply to cooking research include revising questions on cooking practice and skills. Focus-group-based cognitive interviews may provide a feasible method to develop culturally grounded survey instruments to help understand disparities in behavior for culturally relevant diet behaviors such as cooking.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States,*Correspondence: Nicole Farmer,
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States,Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD, United States
| | - Kimberly R. Middleton
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Alyssa T. Brooks
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Melissa Troncoso
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Joniqua Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Sophie E. Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marcus R. Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
| | - Allan Johnson
- Department of Nutritional Sciences, Division of Allied Health Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, United States
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, National Institutes of Health Clinical Center, Bethesda, MD, United States
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Andrews MR, Tamura K, Best JN, Ceasar JN, Batey KG, Kearse TA, Allen LV, Baumer Y, Collins BS, Mitchell VM, Powell-Wiley TM. Spatial Clustering of County-Level COVID-19 Rates in the U.S. Int J Environ Res Public Health 2021; 18:12170. [PMID: 34831926 PMCID: PMC8622138 DOI: 10.3390/ijerph182212170] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 12/18/2022]
Abstract
Despite the widespread prevalence of cases associated with the coronavirus disease 2019 (COVID-19) pandemic, little is known about the spatial clustering of COVID-19 in the United States. Data on COVID-19 cases were used to identify U.S. counties that have both high and low COVID-19 incident proportions and clusters. Our results suggest that there are a variety of sociodemographic variables that are associated with the severity of COVID-19 county-level incident proportions. As the pandemic evolved, communities of color were disproportionately impacted. Subsequently, it shifted from communities of color and metropolitan areas to rural areas in the U.S. Our final period showed limited differences in county characteristics, suggesting that COVID-19 infections were more widespread. The findings might address the systemic barriers and health disparities that may result in high incident proportions of COVID-19 clusters.
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Affiliation(s)
- Marcus R. Andrews
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1450 Washington Heights, Ann Arbor, MI 48109, USA; (M.R.A.); (J.N.B.)
| | - Kosuke Tamura
- Neighborhood Social and Geospatial Determinants of Health Disparities Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Janae N. Best
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1450 Washington Heights, Ann Arbor, MI 48109, USA; (M.R.A.); (J.N.B.)
| | - Joniqua N. Ceasar
- Department of Medicine, Internal Medicine-Pediatrics Residency, Johns Hopkins University, 251 Bayview Boulevard, Baltimore, MD 21224, USA;
| | - Kaylin G. Batey
- College of Medicine, University of Kentucky, 800 Rose Street MN 150, Lexington, KY 40506, USA;
| | - Troy A. Kearse
- Department of Psychology, Howard University, 525 Bryant Street, NW, Washington, DC 20059, USA;
| | - Lavell V. Allen
- Department of Public Health, University of New England, 11 Hills Beach Road, Biddeford, ME 04005, USA;
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (Y.B.); (B.S.C.); (V.M.M.)
| | - Billy S. Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (Y.B.); (B.S.C.); (V.M.M.)
| | - Valerie M. Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (Y.B.); (B.S.C.); (V.M.M.)
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (Y.B.); (B.S.C.); (V.M.M.)
- Adjunct Investigator, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD 20892, USA
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Andrews MR, Ceasar J, Tamura K, Langerman SD, Mitchell VM, Collins BS, Baumer Y, Gutierrez Huerta CA, Dey AK, Playford MP, Mehta NN, Powell-Wiley TM. Neighborhood environment perceptions associate with depression levels and cardiovascular risk among middle-aged and older adults: Data from the Washington, DC cardiovascular health and needs assessment. Aging Ment Health 2021; 25:2078-2089. [PMID: 32691611 PMCID: PMC7855489 DOI: 10.1080/13607863.2020.1793898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Little is understood about associations between neighborhood characteristics and depression, a cardiovascular disease (CVD) risk factor, in diverse populations. We examined relationships between perceived/objective neighborhood characteristics, depression, and CVD markers within the Washington, DC CV Health/Needs Assessment, an evaluation among predominantly African-American (AA) adults in resource-limited DC communities. METHOD Factor analysis of overall neighborhood environment perception (NEP) identified three NEP sub-scores:1) violence; 2) physical/social environment; 3) social cohesion (higher score = more favorable perception). Objective neighborhood characteristics were measured by geospatially-derived scores of walkability, transportation, and crime. Depression was defined by the revised Center for Epidemiologic Studies Depression Scale (CESD-R). We used linear-regression modeling to examine neighborhood measures and CESD-R associations. To investigate a subsequent connection with CVD risk, we examined relationships between CESD-R and CVD-associated cytokines in a population subset. RESULTS Participants (N = 99; mean age = 59.06; 99% AA) had a mean CESD-R score = 5.8(SD = 8.88). In adjusted models, CESD-R scores decreased by 0.20 units (p = 0.01) for every overall NEP unit-increase. Perceived physical/social environment (β = -0.34, p = 0.04) and social cohesion (β = -0.82, p = 0.01) were related to CESD-R while perceived violence was not (β = -0.28, p = 0.1). Of objective neighborhood environment measures (i.e. walk, transit, bike, personal crime, and property crime scores), only property crime score was associated with depression (β = 4.99, p < 0.03). In population subset (n = 42), higher CESD-R associated with higher IL-1β (β = 21.25, p < 0.01) and IL-18 (β = 0.006, p = 0.01). CONCLUSION Favorable neighborhood perceptions are related to lower depressive symptoms in a predominantly AA cohort from Washington, DC resource-limited communities. Neighborhood perceptions appear to be strongly associated with depressive symptoms compared to objective characteristics. Increasing CESD-R scores were related to higher pro-inflammatory markers. Improving neighborhood perceptions may be beneficial to psychological well-being and CV health for urban minority residents.
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Affiliation(s)
- Marcus R. Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joniqua Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven D. Langerman
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valerie M. Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Billy S. Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cristhian A. Gutierrez Huerta
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amit K. Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Martin P. Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Nehal N. Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, USA
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA;,Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Okeke CAV, Perry JD, Simmonds FC, Erskine AB, Shipman WD, Seltzer JA, Andrews MR, Saini AD, Cole TA, Perkins JA, Otado J, Kwagyan J, Collins CIF, Okoye GA, Byrd AS. Clinical Trials and Skin of Color: The Example of Hidradenitis Suppurativa. Dermatology 2021; 238:180-184. [PMID: 34107480 DOI: 10.1159/000516467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Chidubem A V Okeke
- Howard University College of Medicine, Washington, District of Columbia, USA,
| | - Jessica D Perry
- Howard University College of Medicine, Washington, District of Columbia, USA
| | | | | | | | - Janyla A Seltzer
- Howard University College of Medicine, Washington, District of Columbia, USA
| | - Marcus R Andrews
- Department of Health Behaviors and Health Education, University of Michigan, Ann Arbor, Michigan, USA
| | - Arjun D Saini
- Department of Dermatology, Howard University Hospital, Washington, District of Columbia, USA
| | - Taylor A Cole
- Charles R. Drew/UCLA Medical Education Program, Los Angeles, California, USA
| | | | - Jane Otado
- Howard University College of Medicine, Washington, District of Columbia, USA
| | - John Kwagyan
- Howard University College of Medicine, Washington, District of Columbia, USA
| | | | - Ginette A Okoye
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Angel S Byrd
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia, USA
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Claudel SE, Tamura K, Troendle J, Andrews MR, Ceasar JN, Mitchell VM, Vijayakumar N, Powell-Wiley TM. Comparing Methods to Identify Wear-Time Intervals for Physical Activity With the Fitbit Charge 2. J Aging Phys Act 2021; 29:529-535. [PMID: 33326935 PMCID: PMC8493649 DOI: 10.1123/japa.2020-0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/22/2020] [Accepted: 08/26/2020] [Indexed: 01/28/2023]
Abstract
There is no established method for processing data from commercially available physical activity trackers. This study aims to develop a standardized approach to defining valid wear time for use in future interventions and analyses. Sixteen African American women (mean age = 62.1 years and mean body mass index = 35.5 kg/m2) wore the Fitbit Charge 2 for 20 days. Method 1 defined a valid day as ≥10-hr wear time with heart rate data. Method 2 removed minutes without heart rate data, minutes with heart rate ≤ mean - 2 SDs below mean and ≤2 steps, and nighttime. Linear regression modeled steps per day per week change. Using Method 1 (n = 292 person-days), participants had 20.5 (SD = 4.3) hr wear time per day compared with 16.3 (SD = 2.2) hr using Method 2 (n = 282) (p < .0001). With Method 1, participants took 7,436 (SD = 3,543) steps per day compared with 7,298 (SD = 3,501) steps per day with Method 2 (p = .64). The proposed algorithm represents a novel approach to standardizing data generated by physical activity trackers. Future studies are needed to improve the accuracy of physical activity data sets.
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Powell-Wiley TM, Dey AK, Rivers JP, Chaturvedi A, Andrews MR, Ceasar JN, Claudel SE, Mitchell VM, Ayers C, Tamura K, Gutierrez-Huerta CA, Teague HL, Oeser SG, Goyal A, Joshi AA, Collins BS, Baumer Y, Chung ST, Sumner AE, Playford MP, Tawakol A, Mehta NN. Chronic Stress-Related Neural Activity Associates With Subclinical Cardiovascular Disease in a Community-Based Cohort: Data From the Washington, D.C. Cardiovascular Health and Needs Assessment. Front Cardiovasc Med 2021; 8:599341. [PMID: 33778019 PMCID: PMC7988194 DOI: 10.3389/fcvm.2021.599341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Psychosocial stress correlates with cardiovascular (CV) events; however, associations between physiologic measures of stressors and CVD remain incompletely understood, especially in racial/ethnic minority populations in resource-limited neighborhoods. We examined associations between chronic stress-related neural activity, measured by amygdalar 18Fluorodeoxyglucose (18FDG) uptake, and aortic vascular FDG uptake (arterial inflammation measure) in a community-based cohort. Methods: Forty participants from the Washington, DC CV Health and Needs Assessment (DC-CHNA), a study of a predominantly African-American population in resource-limited urban areas and 25 healthy volunteers underwent detailed phenotyping, including 18FDG PET/CT for assessing amygdalar activity (AmygA), vascular FDG uptake, and hematopoietic (leukopoietic) tissue activity. Mediation analysis was used to test whether the link between AmygA and vascular FDG uptake was mediated by hematopoietic activity. Results: AmygA (1.11 ± 0.09 vs. 1.05 ± 0.09, p = 0.004) and vascular FDG uptake (1.63 ± 0.22 vs. 1.55 ± 0.17, p = 0.05) were greater in the DC-CHNA cohort compared to volunteers. Within the DC-CHNA cohort, AmygA associated with vascular FDG uptake after adjustment for Framingham score and body mass index (β = 0.41, p = 0.015). The AmygA and aortic vascular FDG uptake relationship was in part mediated by splenic (20.2%) and bone marrow (11.8%) activity. Conclusions: AmygA, or chronic stress-related neural activity, associates with subclinical CVD risk in a community-based cohort. This may in part be mediated by the hematopoietic system. Our findings of this hypothesis-generating study are suggestive of a potential relationship between chronic stress-related neural activity and subclinical CVD in an African American community-based population. Taken together, these findings suggest a potential mechanism by which chronic psychosocial stress, such as stressors that can be experienced in adverse social conditions, promotes greater cardiovascular risk amongst resource-limited, community-based populations most impacted by cardiovascular health disparities. However, larger prospective studies examining these findings in other racially and ethnically diverse populations are necessary to confirm and extend these findings.
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Affiliation(s)
- Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States.,Intramural Research Program, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, MD, United States
| | - Amit K Dey
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Joshua P Rivers
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States.,Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Abhishek Chaturvedi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Marcus R Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Joniqua N Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Sophie E Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Valerie M Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Colby Ayers
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Cristhian A Gutierrez-Huerta
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Heather L Teague
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Steffen G Oeser
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Aditya Goyal
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Aditya A Joshi
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Billy S Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Stephanie T Chung
- Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, United States
| | - Anne E Sumner
- Intramural Research Program, National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health, Bethesda, MD, United States.,Section on Ethnicity and Health, Diabetes Endocrinology and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, United States
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
| | - Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.,Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Bethesda, MD, United States
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10
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Tamura K, Orstad SL, Cromley EK, Neally SJ, Claudel SE, Andrews MR, Ceasar J, Sims M, Powell-Wiley TM. The Mediating role of perceived discrimination and stress in the associations between neighborhood social environment and TV Viewing among Jackson Heart Study participants. SSM Popul Health 2021; 13:100760. [PMID: 33681448 PMCID: PMC7930346 DOI: 10.1016/j.ssmph.2021.100760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives The aim of this study was to test the mediating role of perceived discrimination and stress on associations between perceived neighborhood social environment (PNSE) and TV viewing. Methods Baseline data were used for 4716 participants (mean age = 55.1 y; 63.4% female) in the Jackson Heart Study (JHS), a large prospective cohort study of African Americans in Jackson, Mississippi. One binary TV viewing outcome was created: ≥4 h/day versus <4 h/day. PNSE variables included neighborhood violence, problems (higher value = more violence/problems), and social cohesion (higher value = more cohesion). Mediators included perceived lifetime discrimination, daily discrimination, and chronic stress (higher value = greater discrimination/stress). Multivariable regression was used with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) to test for mediation adjusting for demographics, health-related and psychosocial factors, and population density. Results Neighborhood violence, problems, and social cohesion were indirectly associated with TV viewing through lifetime discrimination (OR = 1.03, 95%BC CI = 1.00, 1.07; OR = 1.03, 95%BC CI = 0.99, 1.06 [marginal]; OR = 0.98, 95%BC CI = 0.94, 0.99, respectively) and chronic stress (OR = 0.95, 95%BC CI = 0.90, 0.99; OR = 0.96, 95%BC CI = 0.92, 0.99; OR = 1.05, 95%BC CI = 1.01, 1.10, respectively). Daily discrimination was neither directly nor indirectly associated with TV viewing. Conclusions Each PNSE variable was indirectly associated with TV viewing via lifetime discrimination and perceived stress, but not with daily discrimination among JHS participants. Unexpected directionality of mediating effects of lifetime discrimination and chronic stress should be replicated in future studies. Further research is also needed to pinpoint effective community efforts and physical environmental policies (e.g., installing bright street lights, community policing) to reduce adverse neighborhood conditions and psychosocial factors, and decrease TV viewing and subsequent cardiovascular disease risk.
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Affiliation(s)
- Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Stephanie L Orstad
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, 550 Avenue, New York, NY, 10016, USA
| | - Ellen K Cromley
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT, 06269-1248, USA
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Sophie E Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Marcus R Andrews
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Joniqua Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA.,Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Bethesda, MD, 20892, USA
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11
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Tamura K, Vijayakumar NP, Troendle JF, Curlin K, Neally SJ, Mitchell VM, Collins BS, Baumer Y, Gutierrez-Huerta CA, Islam R, Turner BS, Andrews MR, Ceasar JN, Claudel SE, Tippey KG, Giuliano S, McCoy R, Zahurak J, Lambert S, Moore PJ, Douglas-Brown M, Wallen GR, Dodge T, Powell-Wiley TM. Multilevel mobile health approach to improve cardiovascular health in resource-limited communities with Step It Up: a randomised controlled trial protocol targeting physical activity. BMJ Open 2020; 10:e040702. [PMID: 33371027 PMCID: PMC7754642 DOI: 10.1136/bmjopen-2020-040702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Although physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women. METHODS AND ANALYSIS An mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named 'tailored-to-place') to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervention for 3 months, at which point the intervention strategy will adapt based on individuals' PA levels. Those who do not meet the PA goal will be rerandomised to more intensive treatment. Participants will be followed for another 3 months to determine the contribution of each mHealth intervention to PA level. This protocol will use novel statistical approaches to account for the adaptive strategy. Finally, effects of PA changes on CVD risk biomarkers will be characterised. ETHICS AND DISSEMINATION This protocol has been developed in partnership with a Washington, DC-area community advisory board to ensure feasibility and acceptability to community members. The National Institutes of Health Intramural IRB approved this research and the National Heart, Lung, and Blood Institute provided funding. Once published, results of this work will be disseminated to community members through presentations at community advisory board meetings and our quarterly newsletter. TRIAL REGISTRATION NUMBER NCT03288207.
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Affiliation(s)
- Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nithya P Vijayakumar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James F Troendle
- Office of Biostatistics Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kaveri Curlin
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Valerie M Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Billy S Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cristhian A Gutierrez-Huerta
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rafique Islam
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Briana S Turner
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marcus R Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joniqua N Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sophie E Claudel
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathryn G Tippey
- University of North Carolina, Nutrition Obesity Research Center, Lineberger Comprehensive Cancer Center, Connected Health Applications and Interventions (CHAI) Core, Chapel Hill, North Carolina, USA
| | - Shayne Giuliano
- University of North Carolina, Nutrition Obesity Research Center, Lineberger Comprehensive Cancer Center, Connected Health Applications and Interventions (CHAI) Core, Chapel Hill, North Carolina, USA
| | - Regina McCoy
- University of North Carolina, Nutrition Obesity Research Center, Lineberger Comprehensive Cancer Center, Connected Health Applications and Interventions (CHAI) Core, Chapel Hill, North Carolina, USA
| | - Jessica Zahurak
- University of North Carolina, Nutrition Obesity Research Center, Lineberger Comprehensive Cancer Center, Connected Health Applications and Interventions (CHAI) Core, Chapel Hill, North Carolina, USA
| | - Sharon Lambert
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Philip J Moore
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | | | - Gwenyth R Wallen
- National Institutes of Health Clinical Center, Nursing Department, Bethesda, Maryland, USA
| | - Tonya Dodge
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
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12
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Claudel SE, Ceasar JN, Andrews MR, El-Toukhy S, Farmer N, Middleton KR, Sabado-Liwag M, Mitchell VM, Tamura K, Brooks AT, Wallen GR, Powell-Wiley TM. Time to listen: a mixed-method study examining community-based views of mobile technology for interventions to promote physical activity. BMJ Health Care Inform 2020; 27:e100140. [PMID: 32830106 PMCID: PMC7445338 DOI: 10.1136/bmjhci-2020-100140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION A mixed-method, co-design approach to studying the adoption of mobile health (mHealth) technology among African-American (AA) women has not been fully explored. Qualitative data may contextualise existing knowledge surrounding perceptions of mHealth among AA women as part of formative work for designing a physical activity application (app). METHODS A convenience sample of 16 AA women completed an informatics survey prior to participating in focus groups exploring their use of mobile technology and health apps. Survey responses provided frequency data, while iterative transcript analysis of focus groups identified themes. RESULTS The majority of participants (mean age=62.1 years, SD=6.6) felt comfortable using a tablet/smartphone (75.0%). Most (68.8%) reported using health-related apps, primarily focused on physical activity and nutrition. Focus groups revealed four overarching concepts, including (1) user attachment, (2) technology adoption, (3) potential facilitators and (4) potential barriers. Important features which may serve as facilitators or barriers to future adoption of a mobile app for an mHealth intervention include individual app tailoring and software concerns, respectively. DISCUSSION Thematic analysis revealed high user attachment to smartphones and described participants' process for adopting new mHealth technology. CONCLUSION Early engagement of target end users as a part of a broader co-design and community-based participatory research process for developing mHealth technologies may be useful for sustained adoption of these tools in future mHealth behavioural interventions.
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Affiliation(s)
| | | | | | - Sherine El-Toukhy
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
| | | | | | - Melanie Sabado-Liwag
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
- Public Health Department, California State University Los Angeles, Los Angeles, California, USA
| | | | - Kosuke Tamura
- Cardiovascular Branch, NHLBI, Bethesda, Maryland, USA
| | | | | | - Tiffany M Powell-Wiley
- Cardiovascular Branch, NHLBI, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
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13
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Tamura K, Langerman SD, Orstad SL, Neally SJ, Andrews MR, Ceasar JN, Sims M, Lee JE, Powell-Wiley TM. Physical activity-mediated associations between perceived neighborhood social environment and depressive symptoms among Jackson Heart Study participants. Int J Behav Nutr Phys Act 2020; 17:91. [PMID: 32650787 PMCID: PMC7350640 DOI: 10.1186/s12966-020-00991-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA. METHODS We used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multilevel modeling, controlling for census tract clustering effects, was used to estimate associations between each PNSE variable and CES-D score, adjusting for covariates, including demographic, health-related, and population density. Second, validated, self-reported total PA, based on active living, sport, and home indices, was tested as the mediator. Multivariable linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated to test for significant unstandardized indirect effects, controlling for all covariates. RESULTS Our participants were 64.2% female with a mean age of 52.6 (SD = 12.2) and a mean CES-D score of 10.8 (SD = 8.1). In the fully-adjusted model, neighborhood violence and problems were positively related to depressive symptoms (B = 3.59, 95%CI = 0.93, 6.26, and B = 3.06, 95%CI = 1.19, 4.93, respectively). Neighborhood violence and problems were also indirectly related to depressive symptoms via total PA (B = 0.26, 95%BC CI = 0.05, 0.55; and B = 0.15, 95%BC CI = 0.02, 0.34, respectively). Social cohesion was neither directly nor indirectly related to depressive symptoms. CONCLUSIONS We found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms. These associations may be explained in part by lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate PA increases in conjunction with community efforts to reduce neighborhood violence and problems.
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Affiliation(s)
- Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA.
| | | | - Stephanie L Orstad
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY, USA
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Marcus R Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Joniqua N Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jae E Lee
- Research Centers in Minority Institutions Translational Research Network Data Coordinating Center, Jackson State University, Jackson, MS, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD, 20892, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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14
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Ceasar JN, Ayers C, Andrews MR, Claudel SE, Tamura K, Das S, de Lemos J, Neeland IJ, Powell-Wiley TM. Unfavorable perceived neighborhood environment associates with less routine healthcare utilization: Data from the Dallas Heart Study. PLoS One 2020; 15:e0230041. [PMID: 32163470 PMCID: PMC7067436 DOI: 10.1371/journal.pone.0230041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Neighborhood environment perception (NEP) has been associated with health outcomes. However, little is known about how NEP relates to routine healthcare utilization. This study investigated the relationship between NEP and independent subfactors with healthcare utilization behavior, as measured by self-reported (1) usual source of healthcare and (2) time since last routine healthcare check-up. We used cross-sectional data from the Dallas Heart Study, which features a diverse, probability-based sample of Dallas County residents ages 18 to 65. We used logistic regression modeling to examine the association of self-reported NEP and routine healthcare utilization. NEP was assessed via a questionnaire exploring residents' neighborhood perceptions, including violence, the physical environment, and social cohesion. Routine healthcare utilization was assessed via self-reported responses regarding usual source of care and time since last routine healthcare check-up. The analytic sample (N = 1706) was 58% black, 27% white, 15% Hispanic, 42% male, and had a mean age of 51 (SD = 10.3). Analysis of NEP by tertile demonstrated that younger age, lower income, and lower education were associated with unfavorable overall NEP (p trend <0.05 for each). After adjustment for potential confounders, including neighborhood deprivation, health insurance, disease burden and psychosocial factors, we found that individuals with more unfavorable perception of their physical environment were more likely to report lack of a usual source of care (p = 0.013). Individuals with more unfavorable perception of the neighborhood physical environment or greater neighborhood violence reported longer time periods since last routine visit (p = 0.001, p = 0.034 respectively). There was no relationship between perceived social cohesion and healthcare utilization. Using a multi-ethnic cohort, we found that NEP significantly associates with report of a usual source of care and time since last routine check-up. Our findings suggest that public health professionals should prioritize improving NEP since it may act as barrier to routine preventive healthcare and ideal health outcomes.
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Affiliation(s)
- Joniqua N. Ceasar
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Colby Ayers
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Marcus R. Andrews
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sophie E. Claudel
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Kosuke Tamura
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sandeep Das
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - James de Lemos
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Ian J. Neeland
- University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Tiffany M. Powell-Wiley
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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15
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Jackson CL, Powell-Wiley TM, Gaston SA, Andrews MR, Tamura K, Ramos A. Racial/Ethnic Disparities in Sleep Health and Potential Interventions Among Women in the United States. J Womens Health (Larchmt) 2020; 29:435-442. [PMID: 32096683 PMCID: PMC7097680 DOI: 10.1089/jwh.2020.8329] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
While essential for health and wellness, the various dimensions of sleep health are generally not equitably distributed across the population, and reasons for racial/ethnic sleep disparities are not fully understood. In this review, we describe racial/ethnic sleep disparities and subsequent implications for health from prior and recently conducted epidemiological and clinical studies as well as the potential sleep interventions presented at the 2018 Research Conference on Sleep and the Health of Women at the National Institutes of Health. Given the clear connection between sleep and poor health outcomes such as cardiovascular disease, we concluded that future studies are needed to focus on sleep health in general, sleep disorders such as insomnia and obstructive sleep apnea in particular, and disparities in both sleep health and sleep disorders among women using an intersectional framework. Future research should also integrate sleep into interventional research focused on women's health as these results could address health disparities by informing, for example, future mobile health (mHealth) interventions prioritizing women beyond the clinical setting.
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Affiliation(s)
- Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Sciences, Research Triangle Park, North Carolina
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Sciences, Bethesda, Maryland
| | - Tiffany M. Powell-Wiley
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Sciences, Bethesda, Maryland
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Symielle A. Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Sciences, Research Triangle Park, North Carolina
| | - Marcus R. Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Alberto Ramos
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, Florida
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16
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Baumer Y, Gutierrez-Huerta CA, Saxena A, Dagur PK, Langerman SD, Tamura K, Ceasar JN, Andrews MR, Mitchell V, Collins BS, Yu Q, Teague HL, Playford MP, Bleck CKE, Mehta NN, McCoy JP, Powell-Wiley TM. Immune cell phenotyping in low blood volumes for assessment of cardiovascular disease risk, development, and progression: a pilot study. J Transl Med 2020; 18:29. [PMID: 31952533 PMCID: PMC6966880 DOI: 10.1186/s12967-020-02207-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/02/2020] [Indexed: 12/28/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in the world. Given the role of immune cells in atherosclerosis development and progression, effective methods for characterizing immune cell populations are needed, particularly among populations disproportionately at risk for CVD. Results By using a variety of antibodies combined in one staining protocol, we were able to identify granulocyte, lymphocyte, and monocyte sub-populations by CD-antigen expression from 500 µl of whole blood, enabling a more extensive comparison than what is possible with a complete blood count and differential (CBC). The flow cytometry panel was established and tested in a total of 29 healthy men and women. As a proof of principle, these 29 samples were split by their race/ethnicity: African-Americans (AA) (N = 14) and Caucasians (N = 15). We found in accordance with the literature that AA had fewer granulocytes and more lymphocytes when compared to Caucasians, though the proportion of total monocytes was similar in both groups. Several new differences between AA and Caucasians were noted that had not been previously described. For example, AA had a greater proportion of platelet adhesion on non-classical monocytes when compared to Caucasians, a cell-to-cell interaction described as crucially important in CVD. We also examined our flow panel in a clinical population of AA women with known CVD risk factors (N = 20). Several of the flow cytometry parameters that cannot be measured with the CBC displayed correlations with clinical CVD risk markers. For instance, Framingham Risk Score (FRS) calculated for each participant correlated with immune cell platelet aggregates (PA) (e.g. T cell PA β = 0.59, p = 0.03 or non-classical monocyte PA β = 0.54, p = 0.02) after adjustment for body mass index (BMI). Conclusion A flow cytometry panel identified differences in granulocytes, monocytes, and lymphocytes between AA and Caucasians which may contribute to increased CVD risk in AA. Moreover, this flow panel identifies immune cell sub-populations and platelet aggregates associated with CVD risk. This flow cytometry panel may serve as an effective method for phenotyping immune cell populations involved in the development and progression of CVD.
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Affiliation(s)
- Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Cristhian A Gutierrez-Huerta
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Ankit Saxena
- Flow Cytometry Core, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Pradeep K Dagur
- Flow Cytometry Core, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven D Langerman
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Kosuke Tamura
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Joniqua N Ceasar
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Marcus R Andrews
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Billy S Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Quan Yu
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA
| | - Heather L Teague
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Martin P Playford
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christopher K E Bleck
- Electron Microscopy Core Facility, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Nehal N Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J Philip McCoy
- Flow Cytometry Core, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, Bethesda, MD, 20892, USA. .,Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
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Andrews MR, Tamura K, Claudel SE, Xu S, Ceasar JN, Collins BS, Langerman S, Mitchell VM, Baumer Y, Powell-Wiley TM. Geospatial Analysis of Neighborhood Deprivation Index (NDI) for the United States by County. J Maps 2020; 16:101-112. [PMID: 32855653 PMCID: PMC7447192 DOI: 10.1080/17445647.2020.1750066] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 01/12/2020] [Accepted: 02/29/2020] [Indexed: 05/21/2023]
Abstract
Little is known about the spatial clustering of neighborhood deprivation across the United States (U.S.). Using data from the 2010 U.S. Census Bureau, we created a neighborhood deprivation index (NDI: higher NDI indicates higher deprivation/ lower neighborhood socioeconomic status) for each county within the U.S. County level scores were loaded into ArcGIS 10.5.1 where they were mapped and analyzed using Moran's I and Anselin Local Moran's I. Ultimately, NDI varies spatially across the US. The highest NDI scores were found in the Southeastern and Southwestern U.S. states, and inland regions of Southern California. This information is critical for public health initiative development as planners may need to tailor the scale of their efforts based on the higher NDI neighborhoods of the county or geographic region with potentially greater chronic disease burden.
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Affiliation(s)
- Marcus R Andrews
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sophie E Claudel
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samantha Xu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joniqua N Ceasar
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Billy S Collins
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven Langerman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valerie M Mitchell
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yvonne Baumer
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany M Powell-Wiley
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Powell-Wiley TM, Gebreab SY, Claudel SE, Ayers C, Andrews MR, Adu-Brimpong J, Berrigan D, Davis SK. The relationship between neighborhood socioeconomic deprivation and telomere length: The 1999-2002 National Health and Nutrition Examination Survey. SSM Popul Health 2019; 10:100517. [PMID: 31872036 PMCID: PMC6909179 DOI: 10.1016/j.ssmph.2019.100517] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/29/2022] Open
Abstract
Socioeconomically disadvantaged neighborhoods have been associated with poor health outcomes. Little is known about the biological mechanism by which deprived neighborhood conditions exert negative influences on health. Data from the 1999–2002 National Health and Nutrition Examination Surveys (NHANES) were used to assess the relationship between neighborhood deprivation index (NDI) and log-transformed leukocyte telomere length (LTL) via multilevel modeling to control for census tract level clustering. Models were constructed using tertiles of NDI (ref = low NDI). NDI was calculated using census tract level socioeconomic indicators from the 2000 U.S. Census. The sample (n = 5,106 adults) was 49.8% female and consisted of 82.9% non-Hispanic whites, 9.4% non-Hispanic blacks, and 7.6% Mexican Americans. Mean age was 45.8 years. Residents of neighborhoods with high NDI were younger, non-white, had lower educational attainment, and had a lower poverty to income ratio (all p < 0.0001). Neighborhood deprivation was inversely associated with LTL among individuals living in neighborhoods with medium NDI (β = −0.043, SE = 0.012, p = 0.0005) and high NDI (β = −0.039, SE = 0.013, p = 0.003). Among men, both medium (β = −0.042, SE = 0.015, p = 0.006) and high (β = −0.047, SE = 0.015, p = 0.001) NDI were associated with shorter LTL. Among women, only medium NDI (β = −0.020, SE = 0.016, p = 0.009) was associated with shorter LTL. After controlling for individual characteristics, including individual-level socioeconomic status, increasing neighborhood socioeconomic deprivation is associated with shorter LTL among a nationally representative sample of US adults. This suggests that telomere shortening may be a mechanism through which neighborhood deprivation results in poor health outcomes. Neighborhood deprivation is inversely related to telomere length. This persists after adjusting for behavior and individual socioeconomic status. Telomere shortening in high deprivation represented 7.5 years of accelerated aging. Telomere shortening may be a mechanism linking neighborhoods and health.
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Affiliation(s)
- Tiffany M. Powell-Wiley
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
- Corresponding author. Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, DIR, NHLBI, Building 10-CRC, Room 5-5332, MSC 1454 10 Center Drive, Bethesda, MD, 20892, USA.
| | - Samson Y. Gebreab
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sophie E. Claudel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Colby Ayers
- Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marcus R. Andrews
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Adu-Brimpong
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - David Berrigan
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sharon K. Davis
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Ceasar JN, Claudel SE, Andrews MR, Tamura K, Mitchell V, Brooks AT, Dodge T, El-Toukhy S, Farmer N, Middleton K, Sabado-Liwag M, Troncoso M, Wallen GR, Powell-Wiley TM. Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study. JMIR Form Res 2019; 3:e10944. [PMID: 30684422 PMCID: PMC6682281 DOI: 10.2196/10944] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. OBJECTIVE This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. METHODS We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants' experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. RESULTS In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). CONCLUSIONS Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population.
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Affiliation(s)
- Joniqua Nashae Ceasar
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Sophie Elizabeth Claudel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marcus R Andrews
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Kosuke Tamura
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Valerie Mitchell
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alyssa T Brooks
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Tonya Dodge
- Department of Psychology, George Washington University, Washington, DC, United States
| | - Sherine El-Toukhy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Nicole Farmer
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Kimberly Middleton
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Melanie Sabado-Liwag
- Department of Public Health, California State University, Los Angeles, CA, United States
| | - Melissa Troncoso
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Gwenyth R Wallen
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Tiffany M Powell-Wiley
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Abstract
Wireless communications are a fundamental part of modern information infrastructure. But wireless bandwidth is costly, prompting a close examination of the data channels available using electromagnetic waves. Classically, radio communications have relied on one channel per frequency, although it is well understood that the two polarization states of planar waves allow two distinct information channels; techniques such as 'polarization diversity' already take advantage of this. Recent work has shown that environments with scattering, such as urban areas or indoors, also possess independent spatial channels that can be used to enhance capacity greatly. In either case, the relevant signal processing techniques come under the heading of 'multiple-input/multiple-output' communications, because multiple antennae are required to access the polarization or spatial channels. Here we show that, in a scattering environment, an extra factor of three in channel capacity can be obtained, relative to the conventional limit using dual-polarized radio signals. The extra capacity arises because there are six distinguishable electric and magnetic states of polarization at a given point, rather than two as is usually assumed.
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Affiliation(s)
- M R Andrews
- Bell Labs, Lucent Technologies, Murray Hill, New Jersey 07974, USA.
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Abstract
The formation of a Bose-Einstein condensate of a dilute atomic gas has been studied in situ with a nondestructive, time-resolved imaging technique. Sodium atoms were evaporatively cooled close to the onset of Bose-Einstein condensation and then suddenly quenched to below the transition temperature. The subsequent equilibration and condensate formation showed a slow onset distinctly different from simple relaxation. This behavior provided evidence for the process of bosonic stimulation, or coherent matter-wave amplification, crucial to the concept of an atom laser.
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Affiliation(s)
- H Miesner
- Department of Physics and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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22
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Abstract
Interference between two freely expanding Bose-Einstein condensates has been observed. Two condensates separated by approximately 40 micrometers were created by evaporatively cooling sodium atoms in a double-well potential formed by magnetic and optical forces. High-contrast matter-wave interference fringes with a period of approximately 15 micrometers were observed after switching off the potential and letting the condensates expand for 40 milliseconds and overlap. This demonstrates that Bose condensed atoms are "laser-like"; that is, they are coherent and show long-range correlations. These results have direct implications for the atom laser and the Josephson effect for atoms.
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Affiliation(s)
- MR Andrews
- The authors are in the Department of Physics and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Mewes M, Andrews MR, Kurn DM, Durfee DS, Townsend CG, Ketterle W. Collective Excitations of a Bose-Einstein Condensate in a Magnetic Trap. Phys Rev Lett 1996; 77:988-991. [PMID: 10062962 DOI: 10.1103/physrevlett.77.988] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Mewes M, Andrews MR, Kurn DM, Durfee DS, Ketterle W. Bose-Einstein Condensation in a Tightly Confining dc Magnetic Trap. Phys Rev Lett 1996; 77:416-419. [PMID: 10062807 DOI: 10.1103/physrevlett.77.416] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
The spatial observation of a Bose condensate is reported. Dispersive light scattering was used to observe the separation between the condensed and normal components of the Bose gas inside a magnetic trap. This technique is nondestructive, and about a hundred images of the same condensate can be taken. The width of the angular distribution of scattered light increased suddenly at the phase transition.
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Affiliation(s)
- MR Andrews
- Department of Physics and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Davis KB, Mewes M, Andrews MR, Durfee DS, Kurn DM, Ketterle W. Bose-Einstein condensation in a gas of sodium atoms. Phys Rev Lett 1995; 75:3969-3973. [PMID: 10059782 DOI: 10.1103/physrevlett.75.3969] [Citation(s) in RCA: 655] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
Recent discussion about the care of the terminally ill patient has focused on the appropriateness of withholding and withdrawing food and fluid and on the discomfort of the dehydrated state. Evidence is mounting that suggests that dehydration in this group of people is not painful, but rather may be more comfortable than hydration by means of IV fluids or enteral and parenteral feedings. This study examines the relationship between the experience of hospice nurses in observing terminal dehydration and their perception of this state. The scores for the degree of positive perception of dehydration are compared for the experienced and nonexperienced groups of nurses. This study suggests that those hospice nurses who have observed terminal dehydration have a more positive perception of this state than those who have not.
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Walker JS, Rundquist JD, Taylor R, Wilson BL, Andrews MR, Barck J, Hogge AL, Huxsoll DL, Hildebrandt PK, Nims RM. Clinical and clinicopathologic findings in tropical canine pancytopenia. J Am Vet Med Assoc 1970; 157:43-55. [PMID: 5463394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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