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Onigbogi O, Pratt R, Luo X, Everson-Rose SA, Cooney NL, Specker S, Okuyemi K. Association between psychosocial factors and co-morbid cigarette smoking and alcohol use in a population experiencing homelessness. Addict Behav Rep 2024; 19:100523. [PMID: 38155753 PMCID: PMC10753056 DOI: 10.1016/j.abrep.2023.100523] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6). Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.
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Affiliation(s)
- Olanrewaju Onigbogi
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414, USA
| | - Xianghua Luo
- Division of Biostatistics and Health Data Science, School of Public Health and Biostatistics Core, Masonic Cancer Center, University of Minnesota, 2221 University Ave SE, Suite 300, Minneapolis, MN 55414, USA
| | - Susan A. Everson-Rose
- Program in Health Disparities, School of Public Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN 55414, USA
- Department of Medicine, University of Minnesota, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Ned L. Cooney
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA
| | - Sheila Specker
- Department of Psychiatry and Behavioral Sciences, F282/2A West, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA
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Adam HS, Merkin SS, Anderson MD, Seeman T, Kershaw KN, Magnani JW, Everson-Rose SA, Lutsey PL. Personal Health Literacy and Life Simple 7: The Multi-Ethnic Study of Atherosclerosis. Am J Health Educ 2023; 54:451-462. [PMID: 38486878 PMCID: PMC10939068 DOI: 10.1080/19325037.2023.2254354] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/14/2023] [Indexed: 03/17/2024]
Abstract
Background Personal Health literacy (PHL) is essential in cardiovascular risk management. Hindrances in PHL can lead to poor cardiovascular outcomes. Purpose To investigate whether limited PHL is associated with lower likelihoods of i) overall cardiovascular health and ii) individual cardiovascular health components as defined by the American Heart Association's Life Simple (LS7). Methods Multi-Ethnic Study of Atherosclerosis participants (N=3719; median age[range]: 59[45-84]) completed a PHL questionnaire in 2016-2018. PHL was classified as limited (score ≥10) or adequate (score <10). LS7 components were measured in 2000-2002. Robust Poisson regression was employed to compute prevalence ratios and 95% confidence intervals (PR[95%CI]) of LS7 measures. Results 14.7% of participants had limited PHL. Limited PHL was associated with lower likelihoods of optimal LS7 (0.69[0.50, 0.95], p=0.02) and average LS7 (0.95[0.88, 1.02], p=0.15) after adjustment. Limited PHL was significantly associated with a 7% lower likelihood of ideal fasting blood glucose level after adjustment (0.93[0.89, 0.98], p<0.01). Discussion Limited PHL was modestly associated with suboptimal cardiovascular health and elevated blood glucose, independent of income and education. Translation to Health Education Practice Health educators and providers should equitably address PHL barriers to improve cardiovascular management and quality of care for patients and communities.
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El Khoudary SR, Chen X, Wang Z, Brooks MM, Orchard T, Crawford S, Janssen I, Everson-Rose SA, McConnell D, Matthews K. Low-density lipoprotein subclasses over the menopausal transition and risk of coronary calcification and carotid atherosclerosis: the SWAN Heart and HDL ancillary studies. Menopause 2023; 30:1006-1013. [PMID: 37738035 PMCID: PMC10539013 DOI: 10.1097/gme.0000000000002245] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Perimenopausal women experience a steep increase in low-density lipoprotein cholesterol (LDL-C) that is related to a higher risk of carotid plaque later in life. Low-density lipoprotein subclasses have been linked to cardiovascular diseases beyond LDL-C, promising a better risk stratification. We aim to characterize changes in LDL subclasses and assess their associations with presence of coronary artery calcium (CAC score ≥10) and carotid intima-media thickness (cIMT) over the menopausal transition (MT) and by menopause stage. METHODS Nuclear magnetic resonance spectroscopy LDL subclasses were measured for a maximum of five time points. Coronary artery calcification and cIMT were measured for a maximum of two time points. LOESS (locally weighted regression with scatter smoothing) plots, linear mixed-effects models, and generalized estimating equations were used for analyses. RESULTS The study included 471 women (baseline: age, 50.2 ± 2.7 years; 79.0% premenopausal/early perimenopausal), of whom 221 had data on CAC or cIMT. Low-density lipoprotein subclasses increased over the MT, whereas intermediate density-lipoprotein particles declined. In adjusted models, higher total LDL particles (LDL-P) and apolipoprotein B were associated with greater CAC prevalence and greater cIMT. Although none of the associations were modified by menopause stage, higher LDL-C, apolipoprotein B, and total LDL-P were associated with greater cIMT during the perimenopause or postmenopause stages, whereas higher LDL-C and small LDL-P were associated with greater CAC prevalence, mainly during perimenopause. CONCLUSIONS During the MT, women experience significant increases in LDL subclasses found to be related to greater cIMT levels and CAC prevalence. Whether these changes could better predict future risk of hard cardiovascular disease events beyond LDL-C remains a research question to address.
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Affiliation(s)
| | - Xirun Chen
- University of Pittsburgh, Pittsburgh, PA
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Adkins-Hempel M, Japuntich SJ, Chrastek M, Dunsiger S, Breault CE, Ayenew W, Everson-Rose SA, Nijjar PS, Bock BC, Wu WC, Miedema MD, Carlson BM, Busch AM. Integrated smoking cessation and mood management following acute coronary syndrome: Protocol for the post-acute cardiac event smoking (PACES) trial. Addict Sci Clin Pract 2023; 18:29. [PMID: 37173792 PMCID: PMC10175930 DOI: 10.1186/s13722-023-00388-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Approximately 400,000 people who smoke cigarettes survive Acute Coronary Syndrome (ACS; unstable angina, ST and non-ST elevation myocardial infarction) each year in the US. Continued smoking following ACS is an independent predictor of mortality. Depressed mood post-ACS is also predictive of mortality, and smokers with depressed mood are less likely to abstain from smoking following an ACS. A single, integrated treatment targeting depressed mood and smoking could be effective in reducing post-ACS mortality. METHOD/DESIGN The overall aim of the current study is to conduct a fully powered efficacy trial enrolling 324 smokers with ACS and randomizing them to 12 weeks of an integrated smoking cessation and mood management treatment [Behavioral Activation Treatment for Cardiac Smokers (BAT-CS)] or control (smoking cessation and general health education). Both groups will be offered 8 weeks of the nicotine patch if medically cleared. Counseling in both arms will be provided by tobacco treatment specialists. Follow-up assessments will be conducted at end-of-treatment (12-weeks) and 6, 9, and 12 months after hospital discharge. We will track major adverse cardiac events and all-cause mortality for 36 months post-discharge. Primary outcomes are depressed mood and biochemically validated 7-day point prevalence abstinence from smoking over 12 months. DISCUSSION Results of this study will inform smoking cessation treatments post-ACS and provide unique data on the impact of depressed mood on success of post-ACS health behavior change attempts. TRIAL REGISTRATION ClinicalTrials.gov, NCT03413423. Registered 29 January 2018. https://beta. CLINICALTRIALS gov/study/NCT03413423 .
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Affiliation(s)
- Melissa Adkins-Hempel
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
| | - Sandra J Japuntich
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, 900 S. 8th St., G5, Minneapolis, MN, 55415, USA
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA
| | - Michelle Chrastek
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
| | - Christopher E Breault
- Center for Behavioral and Preventative Medicine, Lifespan, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Woubeshet Ayenew
- Division of Cardiology, Department of Medicine, Hennepin Healthcare, 900 South 8th St., O5, Minneapolis, MN, 55415, USA
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Susan A Everson-Rose
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Beth C Bock
- Center for Behavioral and Preventative Medicine, Lifespan, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, 700 Butler Drive, Providence, RI, 02906, USA
| | - Wen-Chih Wu
- Department of Epidemiology, School of Public Health, Brown University, 121 South Main St., Providence, RI, 02903, USA
- Center of Innovation in Long Term Services and Support, Providence VA Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
- Cardiovascular Rehab Center, Lifespan, 208 Collyer St., Providence, RI, 02904, USA
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, 920 East 28th St., Suite 480, Minneapolis, MN, 55407, USA
| | - Brett M Carlson
- North Memorial Health Heart and Vascular Center, 3300 Oakdale Ave. N., Suite 200, Robbinsdale, MN, 55422, USA
| | - Andrew M Busch
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, 701 Park Ave. S9.104, Minneapolis, MN, 55415, USA.
- Division of Clinical Pharmacology, Department of Medicine, Hennepin Healthcare, 900 S. 8th St., G5, Minneapolis, MN, 55415, USA.
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, 401 East River Parkway, Suite 131, Minneapolis, MN, 55455, USA.
- Program in Health Disparities Research, University of Minnesota, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.
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Hadidi NN, Gorzycki E, Jones C, Everson-Rose SA, Taylor Z, Gurvich O. Sharing Perspectives in African American Communities to Reduce Stroke Risk Through Community Listening Circles. J Community Health Nurs 2023; 40:119-132. [PMID: 36920113 DOI: 10.1080/07370016.2022.2161306] [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] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
PURPOSE To build trust and explore community perception on stroke disparities as well as barriers and strengths to stroke prevention. DESIGN Mixed methods study. METHODS A convenience sample (n = 54) of African Americans responded to questionnaires and participated in focus groups. FINDINGS Although a majority of participants had some knowledge of stroke warning signs and risk factors, there were misconceptions identified through the Community Listening Circles (CLCs). Misconceptions about stroke were identified. Six key themes emerged. CONCLUSIONS Focus groups provided a better understanding of stroke perception. CLINICAL EVIDENCE Community health nurses may be able to use this information to provide care appropriately.
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Affiliation(s)
| | - Emily Gorzycki
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Clarence Jones
- community organization titled Hue-MAN Partnership, Hue-MAN Organization, Minneapolis, MN, USA
| | | | - Zachary Taylor
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Olga Gurvich
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
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Johnson AM, Teoh D, Jewett P, Darst BF, Mattson J, Hoffmann C, Brown K, Makaram A, Keller C, Blaes AH, Everson-Rose SA, Vogel RI. Genetic variants associated with post-traumatic stress symptoms in patients with gynecologic cancer. Gynecol Oncol 2023; 170:102-107. [PMID: 36681010 PMCID: PMC10023401 DOI: 10.1016/j.ygyno.2023.01.006] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/29/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Patients with cancer experience symptoms of post-traumatic stress disorder (PTSD) more commonly than the general population. The objective of this study was to identify single nucleotide polymorphisms (SNPs) associated with increased risk of post-traumatic stress disorder (PTSD) in patients with gynecologic cancer. METHODS A prospective cohort study recruited 181 gynecologic cancer survivors receiving care at the University of Minnesota between 2017 and 2020 who completed PTSD DSM-V surveys to self-report their symptoms of PTSD and provided saliva samples. DNA samples were genotyped for 11 SNPs in 9 genes involved in dopaminergic, serotonergic, and opioidergic systems previously associated with risk of PTSD in populations without cancer. RESULTS Most participants had either ovarian (42.5%) or endometrial (46.4%) cancer; fewer had cervical (7.7%) or vaginal/vulvar (3.3%) cancer. Two SNPS were identified as statistically significantly associated with higher PTSD scores: rs622337 in HTR2A and rs510769 in OPRM1. CONCLUSIONS Genetic variation likely plays a role in development of PTSD. HTR2A is involved in the serotonin pathway, and OPRM1 is involved in the opioid receptor pathway. This information can be used by oncologic providers to identify patients at greater risk of developing PTSD and may facilitate referral to appropriate consultants and resources early in their treatment.
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Affiliation(s)
- Andrea M Johnson
- University of Minnesota, Department of Obstetrics, Gynecology and Women's Health, Minneapolis, MN, United States of America
| | - Deanna Teoh
- University of Minnesota, Department of Obstetrics, Gynecology and Women's Health, Minneapolis, MN, United States of America
| | - Patricia Jewett
- University of Minnesota, Department of Obstetrics, Gynecology and Women's Health, Minneapolis, MN, United States of America; University of Minnesota, Division of Hematology and Oncology, Minneapolis, MN, United States of America
| | - Burcu F Darst
- Fred Hutchinson Cancer Center, Public Health Sciences, Seattle, WA, United States of America
| | - Jordan Mattson
- University of Minnesota, Department of Obstetrics, Gynecology and Women's Health, Minneapolis, MN, United States of America
| | - Cody Hoffmann
- University of Minnesota Genomics Center, University of Minnesota, Minneapolis, MN, United States of America
| | - Katherine Brown
- University of Minnesota, Department of Obstetrics, Gynecology and Women's Health, Minneapolis, MN, United States of America
| | - Aditi Makaram
- University of Minnesota, College of Biological Sciences, Minneapolis, MN, United States of America
| | - Ciana Keller
- University of Minnesota, Medical School, Minneapolis, MN, United States of America
| | - Anne H Blaes
- University of Minnesota, Division of Hematology and Oncology, Minneapolis, MN, United States of America
| | - Susan A Everson-Rose
- University of Minnesota, Division of Geriatrics, Palliative and Primary Care, Minneapolis, MN, United States of America
| | - Rachel I Vogel
- University of Minnesota, Department of Obstetrics, Gynecology and Women's Health, Minneapolis, MN, United States of America.
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Logeais ME, Eckerstorfer M, Krohn KM, Everson-Rose SA, Termuhlen AM, Joseph AM. Gender Distribution of Authors of Evaluation Letters for Promotion at One Medical School. Acad Med 2022; 97:1816-1823. [PMID: 35794809 DOI: 10.1097/acm.0000000000004803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Women remain underrepresented in key leadership positions and advanced ranks in academic medicine. This study examines the numbers of men and women letter writers for promotion candidates during a 5-year period across departments, tracks, ranks, and candidate gender. METHOD A descriptive study characterized the gender of evaluation letter writers for candidates for promotion to associate or full professor at the University of Minnesota Medical School between 2015 and 2020. Letter writer and candidate gender were characterized by self-identified pronouns in the faculty biography or dossier. Letter writer gender was described by candidate department, promotion track, rank, terminal degree, and gender. RESULTS Among 299 candidates for promotion, 172 (58%) were men and 127 (42%) were women; dossiers included 3,995 evaluation letters. Across all years, men wrote more letters than women (external letters, range, 69% in 2019-2020 to 75% in 2015-2016; internal letters, range, 67% in 2018-2019 to 77% in 2015-2016). Candidates in the family medicine and pediatrics departments had the highest percentages of letters written by women (44% and 40%, respectively). No differences were found in the number of women letter writers by candidate promotion track; however, differences were found by candidate rank (associate professor, 30%; full professor, 23%) and terminal degree (MD/DO, 25%; PhD, 33%; MD-PhD, 20%). Regardless of candidate gender, most evaluation letters were written by men. Women candidates had 15% to 20% more letters authored by women than men candidates (34%-40% vs 18%-23%). CONCLUSIONS The gender pattern of letter writers may reflect implicit biases regarding gender and perceived leadership status, expertise, and success. Adopting policies that promote or require gender diversity among letter writers for promotion candidates may provide an opportunity to encourage faculty to seek diverse networks and recognize the achievements of women faculty.
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Affiliation(s)
- Mary E Logeais
- M.E. Logeais is assistant professor, Department of Medicine, and general internist, Division of Geriatrics, Palliative and Primary Care, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-6256-8721
| | - Margaret Eckerstorfer
- M. Eckerstorfer is mobile health initiative lead coordinator and past executive assistant for faculty affairs, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Kristina M Krohn
- K.M. Krohn is assistant professor and hospitalist, Department of Medicine and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0001-6116-7128
| | - Susan A Everson-Rose
- S.A. Everson-Rose is professor, Department of Medicine, associate director for research, Division of Geriatrics, Palliative and Primary Care, associate director, Program in Health Disparities Research, and director, Health Equity Leadership and Mentoring Program, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-9839-2537
| | - Amanda M Termuhlen
- A.M. Termuhlen is professor, Department of Pediatrics, and associate dean, Department of Faculty Affairs, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-4072-5546
| | - Anne M Joseph
- A.M. Joseph is Wexler Professor of Medicine and vice chair for faculty affairs and diversity, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. ORCID: https://orcid.org/0000-0002-3440-2679
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Bhattacharya M, Ojo-Fati O, Everson-Rose SA, Thomas JL, Miller JM, Ogedegbe G, Jean-Louis G, Joseph AM, Okuyemi KS. Smoking reduction among homeless smokers in a randomized controlled trial targeting cessation. Addict Behav 2022; 133:107373. [PMID: 35689905 DOI: 10.1016/j.addbeh.2022.107373] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Homeless populations have high rates of smoking and unique barriers to quitting. General cessation strategies have been unsuccessful in this population. Smoking reduction may be a good intermediate goal. We conducted a secondary analysis to identify predictors of smoking reduction in a cohort of homeless smokers enrolled in a 26-week randomized clinical trial (RCT) targeting smoking cessation. METHODS Data are from an RCT comparing motivational interviewing counseling plus nicotine replacement therapy (NRT) to brief advice to quit (standard care) plus NRT among homeless smokers. Using bivariate analyses and multinomial logistic regression, we compared demographics, health and psychosocial variables, tobacco use, substance use, and NRT adherence among those who reported: quitting; reducing smoking by 50-99%; and not reducing smoking by 50%. RESULTS Of 324 participants who completed 26-week follow-up, 18.8% and 63.9% self-reported quitting and reducing, respectively. Compared to those who did not reduce smoking, participants reporting reducing indicated higher baseline cigarette use (OR=1.08; CI:1.04-1.12) and menthol use (OR=2.24; CI:1.05-4.77). Compared to participants who reduced, participants reporting quitting were more likely to be male (OR=1.998; CI:1.00-3.98), experience more housing instability (OR=1.97; CI:1.08-3.59), indicate higher importance of quitting (OR=1.27; CI:1.041.55), have higher NRT adherence (OR=1.75; CI:1.00-3.06), and lower odds of reported illicit drug use (OR=0.48; CI:0.24-0.95). CONCLUSIONS Over half of participants reduced smoking by at least 50%, indicating reduction is feasible among homeless smokers. Further research is required to understand the impact of reduction on future cessation attempts in homeless smokers. This study shows that reduction is achievable and may be a valid intermediate goal.
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Affiliation(s)
- Manami Bhattacharya
- University of Minnesota, Department of Health Policy and Management, Minneapolis, MN 55455, USA.
| | - Olamide Ojo-Fati
- California Department of Public Health, Sacramento, CA, United States
| | | | - Janet L Thomas
- University of Minnesota, Department of Medicine, Minneapolis, MN, United States
| | - Jonathan M Miller
- University of Minnesota, Department of Health Policy and Management, Minneapolis, MN 55455, USA
| | - Gbenga Ogedegbe
- New York University, Department of Population Health, New York, NY, United States
| | - Girardin Jean-Louis
- New York University, Department of Population Health, New York, NY, United States
| | - Anne M Joseph
- University of Minnesota, Department of Medicine, Minneapolis, MN, United States
| | - Kolawole S Okuyemi
- University of Utah, Department of Family & Preventive Medicine, Salt Lake City, UT, United States.
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Jewett PI, Vogel RI, Galchutt P, Everson-Rose SA, Teoh D, Radomski M, Blaes AH. Associations between a sense of connection and existential and psychosocial outcomes in gynecologic and breast cancer survivors. Support Care Cancer 2022; 30:3329-3336. [PMID: 34985561 PMCID: PMC8727470 DOI: 10.1007/s00520-021-06784-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/12/2021] [Accepted: 12/22/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND A cancer diagnosis may lead to existential despair but potentially also to perceived inner growth. This growth may be fostered through meaningful connections with others. We sought to describe existential and related psychosocial outcomes and their association with a sense of connection with others in individuals with gynecological and breast cancers. METHODS We used cross-sectional data from two ongoing cohort studies of gynecologic (N = 236) and breast (N = 62) cancer survivors at the University of Minnesota. We summarized self-reported post-traumatic growth (PTG), sense of meaning, peace, spirituality, hopelessness, loneliness, and three exploratory measures of sense of connections with others, and used multivariate linear regression models to describe the associations between them. RESULTS Hope, sense of meaning, peace, and spirituality were generally high among participants, but PTG and loneliness scores varied more. Sense of connection with others was consistently associated with greater PTG and decreased loneliness with medium effect sizes: for example having positive interactions with most/all versus nobody on one's medical team, PTG (coefficient 10.49, 95% CI: 4.10, 16.87, Cohen's D 0.44); loneliness (coefficient - 0.85, 95% CI: - 1.36, - 0.34, Cohen's D 0.43). Those who knew someone in a similar life situation felt a strong sense of connection with such a person; however, 28% of participants had not met anyone in a similar situation. CONCLUSIONS There may be untapped opportunities to nurture beneficial existential outcomes in cancer survivors. Potential interventions include connecting survivors with one another and creating opportunities for more authentic patient-provider relationships, for example, within palliative care.
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Affiliation(s)
- Patricia I Jewett
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota Medical School, 420 Delaware Street SE MMC 480, Minneapolis, MN, 55455, USA.
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Paul Galchutt
- Spiritual Health Services, M Health Fairview, Minneapolis, MN, USA
| | - Susan A Everson-Rose
- Department of Medicine, Division of General Internal Medicine, and Program in Health Disparities Research, University of Minnesota, Minneapolis, MN, USA
| | - Deanna Teoh
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Mary Radomski
- Courage Kenny Research, Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN, USA
| | - Anne H Blaes
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota Medical School, 420 Delaware Street SE MMC 480, Minneapolis, MN, 55455, USA
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Anderson MD, Merkin SS, Everson-Rose SA, Widome R, Seeman T, Magnani JW, Rodriguez CJ, Lutsey PL. Health Literacy Within a Diverse Community-Based Cohort: The Multi-Ethnic Study of Atherosclerosis. J Immigr Minor Health 2021; 23:659-667. [PMID: 33206278 PMCID: PMC8128937 DOI: 10.1007/s10903-020-01123-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Health literacy has yet to be described in a non-clinical, racially diverse, community-based cohort. METHODS Four questions assessing health literacy were asked during annual phone encounters with Multi-Ethnic Study of Atherosclerosis (MESA) participants between 2016 and 2018 (n = 3629). We used prevalence ratios (PRs) with 95% confidence intervals (CIs) to characterize how demographic and acculturation factors related to limited health literacy. Models adjusted for age, sex, and race/ethnicity, and race/ethnicity-stratified models were also examined. RESULTS Limited health literacy was prevalent in 15.4% of the sample. Participants who were older, female, lower-income, or less acculturated were at greater risk for having limited health literacy. Chinese, Hispanic, and Black participants were more likely than White participants to have limited health literacy. Patterns were similar when stratified by race/ethnicity. DISCUSSION Within MESA limited health literacy was common, particularly among Chinese and Hispanic participants, with some of the variance explained by differences in acculturation.
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Affiliation(s)
- Madison D Anderson
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55455, USA.
| | - Sharon Stein Merkin
- Division of Geriatrics, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55455, USA
| | - Teresa Seeman
- Department of Epidemiology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carlos J Rodriguez
- Department of Cardiovascular Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55455, USA
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11
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Derby CA, Hutchins F, Greendale GA, Matthews KA, Sternfeld B, Everson-Rose SA, Kazlauskaite R, Whitmer RA, Brooks MM. Cardiovascular risk and midlife cognitive decline in the Study of Women's Health Across the Nation. Alzheimers Dement 2021; 17:1342-1352. [PMID: 33710770 DOI: 10.1002/alz.12300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/01/2020] [Accepted: 01/02/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Cardiovascular risk factors in midlife have been linked to late life risk for Alzheimer's disease and related dementias (ADRD). The relation of vascular risk factors on cognitive decline within midlife has been less studied. METHODS Using data from the Study of Women's Health Across the Nation, we examined associations of midlife hypertension, elevated lipid levels, diabetes, fasting glucose, central adiposity, and Framingham heart age with rates of cognitive decline in women who completed multiple cognitive assessments of processing speed, and working and verbal memory during midlife. RESULTS Diabetes, elevated fasting glucose, central obesity, and heart age greater than chronological age were associated with rate of decline in processing speed during midlife. Vascular risk factors were not related to rate of decline in working or verbal memory. DISCUSSION Midlife may be a critical period for intervening on cardiovascular risk factors to prevent or delay later life cognitive impairment and ADRD.
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Affiliation(s)
- Carol A Derby
- Saul R. Korey Department of Neurology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Franya Hutchins
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gail A Greendale
- Division of Geriatrics, University of California at Los Angeles, Los Angeles, California, USA
| | - Karen A Matthews
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rasa Kazlauskaite
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois, USA
| | - Rachel A Whitmer
- Division of Epidemiology, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, USA
| | - Maria M Brooks
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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12
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Lakshminarayan K, Murray TA, Westberg SM, Connett J, Overton V, Nyman JA, Culhane-Pera KA, Pergament SL, Drawz P, Vollbrecht E, Xiong T, Everson-Rose SA. Mobile Health Intervention to Close the Guidelines-To-Practice Gap in Hypertension Treatment: Protocol for the mGlide Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25424. [PMID: 33492231 PMCID: PMC7870345 DOI: 10.2196/25424] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/29/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022] Open
Abstract
Background Suboptimal treatment of hypertension remains a widespread problem, particularly among minorities and socioeconomically disadvantaged groups. We present a health system–based intervention with diverse patient populations using readily available smartphone technology. This intervention is designed to empower patients and create partnerships between patients and their provider team to promote hypertension control. Objective The mGlide randomized controlled trial is a National Institutes of Health–funded study, evaluating whether a mobile health (mHealth)-based intervention that is an active partnership between interprofessional health care teams and patients results in better hypertension control rates than a state-of-clinical care comparison. Methods We are recruiting 450 participants including stroke survivors and primary care patients with elevated cardiovascular disease risk from diverse health systems. These systems include an acute stroke service (n=100), an academic medical center (n=150), and community medical centers including Federally Qualified Health Centers serving low-income and minority (Latino, Hmong, African American, Somali) patients (n=200). The primary aim tests the clinical effectiveness of the 6-month mHealth intervention versus standard of care. Secondary aims evaluate sustained hypertension control rates at 12 months; describe provider experiences of system usability and satisfaction; examine patient experiences, including medication adherence and medication use self-efficacy, self-rated health and quality of life, and adverse event rates; and complete a cost-effectiveness analysis. Results To date, we have randomized 107 participants (54 intervention, 53 control). Conclusions This study will provide evidence for whether a readily available mHealth care model is better than state-of-clinical care for bridging the guideline-to-practice gap in hypertension treatment in health systems serving diverse patient populations. Trial Registration Clinicaltrials.gov NCT03612271; https://clinicaltrials.gov/ct2/show/NCT03612271 International Registered Report Identifier (IRRID) DERR1-10.2196/25424
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Affiliation(s)
- Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Thomas A Murray
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Sarah M Westberg
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - John Connett
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Val Overton
- Fairview Health Services, Minneapolis, MN, United States
| | - John A Nyman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kathleen A Culhane-Pera
- SoLaHmo Partnership for Health and Wellness, Minneapolis, MN, United States.,Minnesota Community Care, Saint Paul, MN, United States
| | | | - Paul Drawz
- Division of Renal Disease and Hypertension, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Emily Vollbrecht
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Txia Xiong
- SoLaHmo Partnership for Health and Wellness, Minneapolis, MN, United States
| | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, Medical School, University of Minnesota, Minneapolis, MN, United States
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13
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Messelt A, Thomaier L, Jewett PI, Lee H, Teoh D, Everson-Rose SA, Blaes AH, Vogel RI. Comparisons of emotional health by diagnosis among women with early stage gynecological cancers. Gynecol Oncol 2020; 160:805-810. [PMID: 33384163 DOI: 10.1016/j.ygyno.2020.12.019] [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] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess self-reported emotional health in a cohort of women with early stage gynecologic cancers and to explore differences based on primary cancer type. METHODS We analyzed survey data from a cohort study of gynecological cancer patients treated at an academic cancer center. Measures of emotional health included cancer-related quality of life, distress, depression, anxiety, posttraumatic stress disorder (PTSD), and posttraumatic growth. Univariate and multivariate linear regression models examined differences in emotional health measures by primary cancer site. Potential confounders considered for inclusion in the final models were age, stage, education, income, partner status, treatment status, and race. RESULTS 242 patients with early stage disease completed the survey. Patients with cervical and vaginal/vulvar cancers reported greater cancer-related distress, anxiety and PTSD symptoms. Patients with endometrial cancer reported the lowest posttraumatic growth scores, which remained statistically significant after adjustment for demographic and clinical differences. No significant differences in cancer-related quality of life were observed among individuals with different primary cancer sites CONCLUSIONS: These data suggest patients with early-stage gynecologic cancer face different psychosocial sequelae based on primary cancer site, though underlying clinical and sociodemographic factors may play a significant role in this observed relationship. Further research is needed to assess poorer emotional health among individuals with vaginal/vulvar cancers and the lower posttraumatic growth among patients with endometrial cancer as posttraumatic growth is considered a potentially beneficial psychosocial outcome of cancer.
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Affiliation(s)
- Audrey Messelt
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Lauren Thomaier
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Patricia I Jewett
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Heewon Lee
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Deanna Teoh
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Susan A Everson-Rose
- Department of Medicine, Division of General Internal Medicine, and Program in Health Disparities Research, University of Minnesota, Minneapolis, MN, United States of America
| | - Anne H Blaes
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN, United States of America
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN, United States of America.
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14
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El Khoudary SR, Chen X, Nasr A, Shields K, Barinas-Mitchell E, Janssen I, Everson-Rose SA, Powell L, Matthews K. Greater Periaortic Fat Volume at Midlife Is Associated with Slower Gait Speed Later in Life in Women: The SWAN Cardiovascular Fat Ancillary Study. J Gerontol A Biol Sci Med Sci 2020; 74:1959-1964. [PMID: 30977813 DOI: 10.1093/gerona/glz095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Higher perivascular adipose tissue (PVAT) contributes to adverse physiologic alterations in the vascular wall, and thus could potentially limit normal physical function later in life. We hypothesize that higher PVAT volume at midlife is prospectively associated with slower gait speed later in life, independent of overall adiposity and other risk factors. METHODS Participants from the Study of Women's Health Across the Nation (SWAN) cardiovascular fat ancillary study were included. PVAT volume around the descending aorta was quantified using existing computed tomography scans at midlife, while gait speed was measured after an average of 10.4 ± 0.7 years. RESULTS Two hundred and seventy-six women (aged 51.3 ± 2.8 years at PVAT assessment) were included. Mean gait speed was 0.96 ± 0.21 m/s. Adjusting for study site, race, education level, menopausal status, and length of descending aorta at PVAT assessment, and age, body mass index, difficulty paying for basics, overall health and smoking status at gait speed assessment, a higher midlife PVAT volume was associated with a slower gait speed later in life (p = .03). With further adjustment for presence of any comorbid conditions by the time of gait speed assessment, the association persisted; every 1SD increase in log-PVAT was associated with 3.3% slower gait speed (95% confidence interval: 0.3-6.3%; p = .03). CONCLUSION Greater PVAT in midlife women may contribute to poorer physical function in older age supporting a potential role of midlife PVAT in multiple domains of healthy aging. Additional research is needed to fully elucidate the physiologic changes associated with PVAT that may underlie the observed associations.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Xirun Chen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Alexis Nasr
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Kelly Shields
- Enterprise Analytics, Highmark Health, Pittsburgh, Pennsylvania
| | - Emma Barinas-Mitchell
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois
| | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, University of Minnesota, Minneapolis
| | - Lynda Powell
- Department of Medicine and Program in Health Disparities Research, University of Minnesota, Minneapolis
| | - Karen Matthews
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
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15
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Jewett PI, Teoh D, Petzel S, Lee H, Messelt A, Kendall J, Hatsukami D, Everson-Rose SA, Blaes AH, Vogel RI. Cancer-Related Distress: Revisiting the Utility of the National Comprehensive Cancer Network Distress Thermometer Problem List in Women With Gynecologic Cancers. JCO Oncol Pract 2020; 16:e649-e659. [PMID: 32091952 DOI: 10.1200/jop.19.00471] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The Distress Thermometer (DT) includes a measure of cancer-related distress and a list of self-reported problems. This study evaluated the utility of the DT problem list in identifying concerns most associated with distress and poorer quality of life (QOL) in survivors of gynecologic cancer. METHODS Demographic, clinical, psychosocial functioning, and DT data were described among 355 women participating in a gynecologic cancer cohort. Problems from the DT list were ranked by prevalence, distress, and QOL. Logistic regression models explored factors associated with problems that were common (≥ 25% prevalence) and associated with distress and QOL. RESULTS The average age of participants was 59.9 years (standard deviation [SD], 10.8 years). Most participants were non-Hispanic white (97%) and had ovarian (44%) or uterine (42%) cancer. The mean DT score was 2.7 (SD, 2.7); participants reported a mean of 7.3 problems (SD, 5.9 problems). The most common problems were fatigue (53.6%), worry (49.9%), and tingling (46.3%); least common problems were childcare (2.1%), fevers (2.1%), and substance abuse (1.1%). Report of some common problems, including tingling, sleep, memory, skin issues, and appearance, was not associated with large differences in distress or QOL. In contrast, some rarer problems such as childcare, treatment decisions, eating, housing, nausea, and bathing/dressing were associated with worse distress or QOL. Younger age, lower income, and chemotherapy were risk factors across common problems that were associated with worse distress or QOL (fatigue, nervousness, sadness, fears, and pain). CONCLUSION The DT problem list did not easily identify concerns most associated with distress and low QOL in patients with gynecologic cancer. Adaptations that enable patients to report their most distressing concerns would enhance clinical utility of this commonly used tool.
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Affiliation(s)
- Patricia I Jewett
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN.,Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | - Deanna Teoh
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - Sue Petzel
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - Heewon Lee
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | - Audrey Messelt
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
| | | | | | - Susan A Everson-Rose
- Department of Medicine, Division of General Internal Medicine, and Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Anne H Blaes
- Department of Medicine, Division of Hematology and Oncology, University of Minnesota, Minneapolis, MN
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology, and Women's Health, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, MN
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16
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Nijjar PS, Connett JE, Lindquist R, Brown R, Burt M, Pergolski A, Wolfe A, Balaji P, Chandiramani N, Yu X, Kreitzer MJ, Everson-Rose SA. Randomized Trial of Mindfulness-Based Stress Reduction in Cardiac Patients Eligible for Cardiac Rehabilitation. Sci Rep 2019; 9:18415. [PMID: 31804580 PMCID: PMC6895078 DOI: 10.1038/s41598-019-54932-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/22/2019] [Accepted: 11/21/2019] [Indexed: 01/05/2023] Open
Abstract
Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR's potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.
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Affiliation(s)
- Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - John E Connett
- Biostatistics, Epidemiology and Research Design (BERD), University of Minnesota, Minneapolis, Minnesota, USA
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ruth Lindquist
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roland Brown
- Biostatistics, Epidemiology and Research Design (BERD), University of Minnesota, Minneapolis, Minnesota, USA
| | - Marsha Burt
- Cardiac Rehabilitation, Fairview Health Services, Minneapolis, Minnesota, USA
| | - Aaron Pergolski
- Cardiac Rehabilitation, Fairview Health Services, Minneapolis, Minnesota, USA
| | - Alexandra Wolfe
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Priya Balaji
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Nitya Chandiramani
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Xiaohui Yu
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mary Jo Kreitzer
- Earl E Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan A Everson-Rose
- Program in Health Disparities Research, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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17
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Hultman MT, Everson-Rose SA, Tracy MF, Lindquist R, Hadidi NN. Associations between characteristics of stroke survivors and caregiver depressive symptoms: a critical review. Top Stroke Rehabil 2019; 26:528-537. [PMID: 31303131 DOI: 10.1080/10749357.2019.1641010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Poststroke depression is common in stroke survivors. Evidence suggests that caregivers of stroke survivors also experience depression, at rates similar to survivors (30-40%). While much research has focused on developing better understanding of poststroke depression in stroke survivors, stroke caregiver depression has received less attention. Available research suggests that characteristics of the survivor such as age, gender, relation to caregiver, mental health, and physical or cognitive deficits correlate with and may be contributing factors for caregiver depression. Knowledge of risk factors for stroke caregiver depression could translate to better screening, management, and prevention, but further investigation is needed. Objectives: To examine the existing literature and synthesize evidence surrounding survivor characteristics and their association with poststroke depressive symptoms in caregivers. Methods: Medline, PsychInfo, and CINAHL databases were searched with variations of keywords: "stroke," "caregiver" and "depression." Studies analyzing associations between at least one stroke survivor characteristic and caregiver depressive symptoms were included. Results: Seventeen studies met eligibility criteria. They analyzed a wide range of survivor characteristics. Many survivor characteristics lacked convincing evidence of an association with caregiver depressive symptoms. However, a trend emerged supporting an association between survivor depressive symptoms and caregiver depressive symptoms. Conclusions: Health-care providers should be aware that depressive symptoms in one member of a stroke survivor-caregiver dyad may indicate risk for depressive symptoms in the other. Screening both individuals may lead to earlier detection and provide information to guide interventions. Knowing risk factors for stroke caregiver depression may improve prevention/management, but further investigation is needed.
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Affiliation(s)
| | | | - Mary Fran Tracy
- School of Nursing, University of Minnesota , Minneapolis , USA
| | - Ruth Lindquist
- School of Nursing, University of Minnesota , Minneapolis , USA
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18
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Everson-Rose SA, Mendes de Leon CF, Roetker NS, Lutsey PL, Alonso A. Subclinical Cardiovascular Disease and Changes in Self-Reported Mobility: Multi-Ethnic Study of Atherosclerosis. J Gerontol A Biol Sci Med Sci 2019; 73:218-224. [PMID: 28582505 DOI: 10.1093/gerona/glx103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 01/06/2023] Open
Abstract
Background We examined associations of three markers of subclinical cardiovascular disease (intimal-medial thickening, coronary artery calcification , and ankle-brachial index) with changes in self-reported walking over time. Methods Data were from 6,490 Multi-Ethnic Study of Atherosclerosis participants (aged 45-84 years), free of clinical cardiovascular disease at baseline. Outcomes, assessed four times over 11 years, included self-reported walking pace (none to striding pace; score, 0-4) and total walking time (minutes/week). Linear generalized estimating equation models estimated associations of baseline intimal-medial thickening (z-scored), coronary artery calcification (Agatston units), and ankle-brachial index (ratio of ankle-to-arm systolic blood pressure) with walking pace and walking time modeled continuously in separate analyses. Results Median follow-up was 9.2 years (maximum, 11.4). Walking pace (estimate, -0.042 points [95% CI; -0.048, -0.036], p < 0.0001) and walking time (estimate, -4.71 minutes [95% CI: -8.54, -0.88], p = 0.016) decreased yearly. Greater baseline intimal-medial thickening related to faster decline in walking pace in multivariable analyses: walking pace score decreased 0.004 points (95% CI: -0.008, -0.001) more per year for each 1-SD higher intimal-medial thickening z-score, equivalent to an additional 10% slower yearly walking. Greater coronary artery calcification was associated with slower walking but inconsistently related to decline in walking pace. Higher ankle-brachial index was associated with faster baseline walking pace (estimate, 0.043 points [95% CI: 0.027, 0.059] per 1-SD) but unrelated to changes in walking pace. Cardiovascular disease measures were unrelated to total walking time. Conclusions Greater subclinical cardiovascular disease is associated with prevalent slower self-reported walking pace in middle-aged and older adults but has limited impact on changes in walking over time.
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Affiliation(s)
| | | | - Nicholas S Roetker
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Pamela L Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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19
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Everson-Rose SA, Clark CJ, Wang Q, Guo H, Mancuso P, Kravitz HM, Bromberger JT. Depressive symptoms and adipokines in women: Study of women's health across the nation. Psychoneuroendocrinology 2018; 97:20-27. [PMID: 30005278 PMCID: PMC6300165 DOI: 10.1016/j.psyneuen.2018.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 01/10/2023]
Abstract
Small clinical studies suggest depression is associated with alterations in adiponectin and leptin, adipocyte-derived secretory proteins involved in metabolic regulation; however, longitudinal data on these association are lacking. This study examined cross-sectional and longitudinal associations of depressive symptoms and major depressive disorder (MDD) with adiponectin and leptin in healthy middle-aged women (mean (SD) age, 45.6 (2.5) years). Cross-sectional analyses included 575 women with baseline adipokine data; longitudinal analyses included 262 women with 2-4 adipokine measurements over 5 years. The 20-item Center for Epidemiologic Studies Depression scale (CES-D) was used to assess depressive symptoms; history of MDD was determined by the Structured Clinical Interview for DSM-IV. Adipokines were assayed from stored serum specimens; values were log-transformed for analyses. Linear and repeated measure random effects regression models evaluated associations of baseline CES-D scores with baseline adipokine concentrations and changes over time, respectively. Secondary analyses evaluated the relation of MDD history with adipokine concentrations. Mean (SD) baseline concentrations of adiponectin and leptin were 9.90 (4.92) μg/mL and 27.02 (20.06) ng/mL; both increased over time (p < .0001). CES-D scores were associated with lower adiponectin at baseline (per 1-SD: estimate=-0.04, SE=.02, p=.03) and over time (per 1-SD: estimate=-0.055, SE = .024, p=.02). Associations were unchanged in risk factor-adjusted models. Women with elevated CES-D scores (≥16) had 6.9% (95% CI: -1.1%, 14.3%; p = .089) lower median adiponectin at baseline and 11.5% (95% CI: 1.5%, 20.4%, p = .025) lower median adiponectin over time in adjusted models, compared to women with CES-D<16. Rate of change in adipokines did not vary by baseline depressive symptoms or MDD history. Depressive symptoms and MDD history were unrelated to leptin. In women at midlife, depressive symptoms are associated with lower adiponectin, a critical anti-inflammatory biomarker involved in metabolic and cardiovascular conditions.
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Affiliation(s)
- Susan A. Everson-Rose
- Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN
| | - Cari J. Clark
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Qi Wang
- Biostatistical Design & Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Hongfei Guo
- Division of Biostatistics, School of Public Health, and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Peter Mancuso
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI
| | - Howard M. Kravitz
- Department of Psychiatry and Department of Preventive Medicine, Rush Medical College, Rush University Medical Center, Chicago, IL
| | - Joyce T. Bromberger
- Departments of Epidemiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA
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Khan ZA, Janssen I, Mazzarelli JK, Powell LH, Dumasius A, Everson-Rose SA, Barinas-Mitchell E, Matthews K, El Khoudary SR, Weinstock PJ, Hollenberg SM. Serial Studies in Subclinical Atherosclerosis During Menopausal Transition (from the Study of Women's Health Across the Nation). Am J Cardiol 2018; 122:1161-1168. [PMID: 30077316 DOI: 10.1016/j.amjcard.2018.06.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 01/18/2023]
Abstract
Cardiovascular disease risk increases in women after the menopausal transition; why this inflection point occurs remains uncertain. We aimed to characterize the influence of menopause on vascular aging by prospective assessment of change in indexes of subclinical atherosclerosis across the menopausal transition. We evaluated 411 healthy women from SWAN Heart, an ancillary study of SWAN (Study of Women's Health Across the Nation), for subclinical atherosclerosis at baseline and again after an average of 2.3 years. Carotid intima-media thickness and aortic pulse wave velocity were measured by ultrasound. Coronary artery calcium scores were obtained by computed tomography. Women were grouped by menopausal status as premenopausal, postmenopausal, or having undergone the transition during follow-up. Analyses of changes were adjusted for age at baseline and time between scans. Mean age at baseline was 51 ± 3 years; 93 (23%) subjects transitioned to menopause (Pre-Post), 147 (36%) remained premenopausal (Pre-Pre), while 171 (41%) were postmenopausal at baseline (Post-Post). Blood pressure readings did not differ between groups with similar increase noted in carotid intima-media thickness and log coronary artery calcium + 1 from baseline to follow-up. Change in aortic pulse wave velocity from baseline to follow-up was higher in Pre-Post (121 ± 23 cm/s) compared with Pre-Pre (38 ± 250 cm/s, p = 0.029) and Post-Post (41 ± 228 cm/s, p = 0.045). In conclusion, changes in aortic stiffness were more sensitive measures of perimenopausal vascular aging than morphologic indexes of subclinical atherosclerosis in women undergoing the menopausal transition. Serial assessment of such changes could potentially elucidate mechanisms of disease and identify women to target for aggressive lifestyle risk factor modification.
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21
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Stewart AL, Kathawalla UK, Wolfe AG, Everson-Rose SA. Women's heart health at mid-life: what is the role of psychosocial stress? Womens Midlife Health 2018; 4:11. [PMID: 30766721 PMCID: PMC6297972 DOI: 10.1186/s40695-018-0041-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/12/2018] [Accepted: 07/02/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women in mid-life experience unique stressors, including transitions within their family roles, informal caregiving, job stress, and perceived discrimination. The impact of these stressors on cardiovascular health in women during mid-life is of growing interest in both the popular and scientific literature. The objective of this review is to summarize the recent literature on stress and cardiovascular health in mid-life women. We focus on stressors that are relevant to mid-life women, including social stress and discrimination, and long-term risk of CVD events and subclinical CVD measures. METHODS We systematically reviewed the literature published between January 2012 and April 2018 for studies examining stress in mid-life and either CVD endpoints or subclinical CVD outcomes. Eligible studies included at least one psychosocial stress exposure, a CVD or subclinical CVD outcome, and either included only female participants, reported sex-stratified analyses or tested for a sex*stress interaction. RESULTS We identified 37 studies published since 2012 that met our criteria and included women between the ages of 40 and 65, including 3 case-control studies, 15 cross-sectional studies, and 19 prospective cohort studies. Because clinical CVD events typically occur after age 65 in women, only 22 studies were available that evaluated stress and hard CVD events in samples with mid-life women. Results from these studies suggested an increased and significant risk of CVD due to stress. Of the 15 studies that included subclinical CVD outcomes, the majority showed that mid-life women experiencing greater levels of stress had more subclinical CVD, as indicated by carotid intima-media thickness, flow-mediated dilation and arterial stiffness; however, several studies reported null associations. CONCLUSIONS General life stress, including perceived stress and life events, in mid-life was significantly related to later-life CVD risk and mid-life subclinical CVD in the majority of studies published in the past six years. Job stress was inconsistently related to CVD risk in women, and fewer studies examined characteristics of other social roles, such as marriage, motherhood or caregiving. Perceived discrimination also was associated with CVD events and subclinical CVD in some samples of mid-life women. Further investigation into specific stressors relevant to women in mid-life, including caregiving and marital stress, are needed to understand the full extent to which life stress impacts CVD risk in mid-life women.
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Affiliation(s)
- Andrea L. Stewart
- Department of Epidemiology, University of Pittsburgh, 4420 Bayard Street, Suite 600, Pittsburgh, PA 15260 USA
| | - Ummul-Kiram Kathawalla
- Department of Psychology, University of Minnesota, 75 E River Parkway, Minneapolis, MN 55414 USA
| | - Alexandra G. Wolfe
- Department of Medicine, University of Minnesota, 717 Delaware St SE, Suite 166, Minneapolis, MN 55414 USA
| | - Susan A. Everson-Rose
- Department of Medicine, University of Minnesota, 717 Delaware St SE, Suite 166, Minneapolis, MN 55414 USA
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22
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Loftus J, Allen EM, Call KT, Everson-Rose SA. Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans. J Rural Health 2018; 34 Suppl 1:s48-s55. [PMID: 28295584 PMCID: PMC6069955 DOI: 10.1111/jrh.12235] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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] [Received: 09/23/2016] [Revised: 12/20/2016] [Accepted: 01/30/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota. METHODS This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities. RESULTS Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees. CONCLUSIONS Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence.
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Affiliation(s)
- John Loftus
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Elizabeth M Allen
- Department of Public Health, St. Catherine University, St. Paul, Minnesota
| | - Kathleen Thiede Call
- School of Public Health, Division of Health Policy & Management, and SHADAC, University of Minnesota, Minneapolis, Minnesota
| | - Susan A Everson-Rose
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Medicine, and Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota
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23
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Rajan KB, Aggarwal NT, Schneider JA, Wilson RS, Everson-Rose SA, Evans DA. Role of APOE ε4 Allele and Incident Stroke on Cognitive Decline and Mortality. Alzheimer Dis Assoc Disord 2017; 30:318-323. [PMID: 27849638 DOI: 10.1097/wad.0000000000000173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The apolipoprotein E (APOE) ε4 allele and stroke increase the risk of cognitive decline. However, the association of the APOE ε4 allele before and after stroke is not well understood. METHODS Using a prospective sample of 3444 (66% African Americans, 61% females, mean age=71.9 y) participants, we examined cognitive decline relative to stroke among those with and without the APOE ε4 allele. RESULTS In our sample, 505 (15%) had incident stroke. Among participants without stroke, the ε4 allele was associated with increased cognitive decline compared to noncarriers (0.080 vs. 0.036 units/year; P<0.0001). Among participants without the ε4 allele, cognitive decline increased significantly after stroke compared to before stroke (0.115 vs. 0.039 units/year; P<0.0001). Interestingly, cognitive decline before and after stroke was not significantly different among those with the ε4 allele (0.091 vs. 0.102 units/year; P=0.32). Poor cognitive function was associated with higher risk of stroke (hazard ratio=1.41, 95% confidence interval, 1.25-1.58), but the APOE ε4 allele was not (P=0.66). The APOE ε4 allele, cognitive function, and incident stroke were associated with mortality. CONCLUSIONS The association of stroke with cognitive decline appears to differ by the presence of the APOE ε4 allele, but no such interaction was observed for mortality.
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Affiliation(s)
- Kumar B Rajan
- Departments of *Internal Medicine, Rush Institute for Healthy Aging ‡Neurological Sciences §Behavioral Sciences †Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago IL ∥Department of Medicine, University of Minnesota, Minneapolis, MN
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24
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Whitaker KM, Everson-Rose SA, Pankow JS, Rodriguez CJ, Lewis TT, Kershaw KN, Diez Roux AV, Lutsey PL. Experiences of Discrimination and Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Epidemiol 2017; 186:445-455. [PMID: 28407040 DOI: 10.1093/aje/kwx047] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 04/19/2016] [Accepted: 10/07/2017] [Indexed: 01/14/2023] Open
Abstract
Experiences of discrimination are associated with increased risk of adverse health outcomes; however, it is unknown whether discrimination is related to incident type 2 diabetes mellitus (diabetes). We investigated the associations of major experiences of discrimination (unfair treatment in 6 situations) and everyday discrimination (frequency of day-to-day experiences of unfair treatment) with incident diabetes among 5,310 participants from the Multi-Ethnic Study of Atherosclerosis, enrolled in 2000-2002. Using Cox proportional hazards models, we estimated hazard ratios and confidence intervals, adjusting for demographic factors, depressive symptoms, stress, smoking, alcohol, physical activity, diet, waist circumference, and body mass index. Over a median follow-up of 9.4 years, 654 diabetes cases were accrued. Major experiences of discrimination were associated with greater risk of incident diabetes when modeled continuously (for each additional experience of discrimination, hazard ratio = 1.09, 95% confidence interval: 1.01, 1.17) or categorically (for ≥2 experiences vs. 0, hazard ratio = 1.34, 95% confidence interval: 1.08, 1.66). Similar patterns were observed when evaluating discrimination attributed to race/ethnicity or to a combination of other sources. Everyday discrimination was not associated with incident diabetes. In conclusion, major experiences of discrimination were associated with increased risk of incident diabetes, independent of obesity or behavioral and psychosocial factors. Future research is needed to explore the mechanisms of the discrimination-diabetes relationship.
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25
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Ojo-Fati O, Joseph AM, Ig-Izevbekhai J, Thomas JL, Everson-Rose SA, Pratt R, Raymond N, Cooney NL, Luo X, Okuyemi KS. Practical issues regarding implementing a randomized clinical trial in a homeless population: strategies and lessons learned. Trials 2017; 18:305. [PMID: 28679430 PMCID: PMC5498931 DOI: 10.1186/s13063-017-2046-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/17/2016] [Accepted: 06/14/2017] [Indexed: 12/03/2022] Open
Abstract
Abstract There is a critical need for objective data to guide effective health promotion and care for homeless populations. However, many investigators exclude homeless populations from clinical trials due to practical concerns about conducting research with this population. This report is based on our experience and lessons learned while conducting two large NIH-funded randomized controlled trials targeting smoking cessation among persons who are homeless. The current report also addresses challenges when conducting clinical trials among homeless populations and offers potential solutions. Homeless individuals face several challenges including the need to negotiate daily access to food, clothing, and shelter. Some of the critical issues investigators encounter include recruitment and retention obstacles; cognitive impairment, mental health and substance abuse disorders; transportation and scheduling challenges; issues pertaining to adequate study compensation; the need for safety protocols for study staff; and issues related to protecting the wellbeing of these potentially vulnerable adults. Anticipating realistic conditions in which to conduct studies with participants who are homeless will help investigators to design efficient protocols and may improve the feasibility of conducting clinical trials involving homeless populations and the quality of the data collected by the researchers. Trial registration ClinicalTrials.gov, ID: NCT00786149. Registered on 5 November 2008; ClinicalTrials.gov, ID: NCT01932996. Registered on 20 November 2014.
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Affiliation(s)
- Olamide Ojo-Fati
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA. .,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Anne M Joseph
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Medicine, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Jed Ig-Izevbekhai
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Janet L Thomas
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Medicine, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Susan A Everson-Rose
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Medicine, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA
| | - Nancy Raymond
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Ave., F282/2AW, Minneapolis, MN, 55454, USA
| | - Ned L Cooney
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Xianghua Luo
- Division of Biostatistics, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.,Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Kolawole S Okuyemi
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware St. SE, Suite 166, Minneapolis, MN, 55414, USA.,Department of Family & Preventive Medicine, University of Utah, 375 Chipeta, Suite A, Salt Lake, UT, 84108, USA
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26
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El Khoudary SR, Shields KJ, Janssen I, Budoff MJ, Everson-Rose SA, Powell LH, Matthews KA. Postmenopausal Women With Greater Paracardial Fat Have More Coronary Artery Calcification Than Premenopausal Women: The Study of Women's Health Across the Nation (SWAN) Cardiovascular Fat Ancillary Study. J Am Heart Assoc 2017; 6:JAHA.116.004545. [PMID: 28137715 PMCID: PMC5523758 DOI: 10.1161/jaha.116.004545] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 12/29/2022]
Abstract
Background Volumes of paracardial adipose tissue (PAT) and epicardial adipose tissue (EAT) are greater after menopause. Interestingly, PAT but not EAT is associated with estradiol decline, suggesting a potential role of menopause in PAT accumulation. We assessed whether volumes of heart fat depot (EAT and PAT) were associated with coronary artery calcification (CAC) in women at midlife and whether these associations were modified by menopausal status and estradiol levels. Methods and Results EAT and PAT volumes and CAC were measured using electron beam computed tomography scans. CAC was evaluated as (1) the presence of CAC (CAC Agatston score ≥10) and (2) the extent of any CAC (log CAC Agatston score >0). The study included 478 women aged 50.9 years (58% pre‐ or early perimenopausal, 10% late perimenopausal, and 32% postmenopausal). EAT was significantly associated with CAC measures, and these associations were not modified by menopausal status or estradiol. In contrast, associations between PAT and CAC measures were modified by menopausal status (interaction‐P≤0.01). Independent of study covariates including other adiposity measures, each 1‐SD unit increase in log PAT was associated with 102% higher risk of CAC presence (P=0.04) and an 80% increase in CAC extent (P=0.008) in postmenopausal women compared with pre‐ or early perimenopausal women. Additional adjustment for estradiol and hormone therapy attenuated these differences. Moreover, the association between PAT and CAC extent was stronger in women with lower estradiol levels (interaction P=0.004). Conclusions The findings suggest that PAT is a potential menopause‐specific coronary artery disease risk marker, supporting the need to monitor and target this fat depot for intervention in women at midlife.
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Affiliation(s)
- Samar R El Khoudary
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Kelly J Shields
- Lupus Center of Excellence, Autoimmunity Institute, Department of Medicine, Allegheny Health Network, PA, USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute, Torrance, CA
| | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN
| | - Lynda H Powell
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Karen A Matthews
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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27
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Janssen I, Powell LH, Matthews KA, Jasielec MS, Hollenberg SM, Bromberger JT, Sutton-Tyrrell K, Everson-Rose SA. Relation of Persistent Depressive Symptoms to Coronary Artery Calcification in Women Aged 46 to 59 Years. Am J Cardiol 2016; 117:1884-9. [PMID: 27138181 DOI: 10.1016/j.amjcard.2016.03.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
Abstract
Depressive disorders have been associated with cardiovascular disease (CVD), but the impact of depression on early atherogenesis has not been well described, particularly in women and minorities. The relation between repeated episodes of high depressive symptoms and coronary calcium (CAC) is unknown in women at midlife when depression is common. Participants in the Study of Women's Health Across the Nation Heart study were assessed annually for depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D scale]) over 5 years before CAC assessment and classified as high (CES-D ≥16) or not. CAC, measured by computed tomography, was analyzed as a categorical variable using cumulative logit partial proportional odds models. In these middle-aged women free of CVD and diabetes (194 black, 334 white), high depressive symptoms over 5 years were common; 19% had 1, 9% had 2, and 11% experienced ≥3 episodes. CAC was low; 54% had no CAC, 25% had scores from 0 to 10, and 21% had CAC ≥10 Agatston score. After adjusting for CVD risk factors, women with ≥3 episodes were twice as likely to have significant CAC (≥10 Agatston units) than women with no depressive episodes (odds ratio 2.20, 95% confidence interval 1.13 to 4.28, p = 0.020) with no difference by race. Women with 1 or 2 episodes did not differ from women with no episodes. In conclusion, in healthy women aged 46 to 59 years without clinical CVD or diabetes, persistent depressive symptoms were significantly associated with elevated CAC scores, suggesting that they are more likely to have pathophysiological and behavioral effects on the development of subclinical CVD than does a single episode of elevated depressive symptoms.
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28
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Ogilvie RP, Everson-Rose SA, Longstreth WT, Rodriguez CJ, Diez-Roux AV, Lutsey PL. Psychosocial Factors and Risk of Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Circ Heart Fail 2015; 9:e002243. [PMID: 26699386 DOI: 10.1161/circheartfailure.115.002243] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 03/07/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a major source of morbidity and mortality in the United States. Psychosocial factors have frequently been studied as risk factors for coronary heart disease but not for HF. METHODS AND RESULTS We examined the relationship between psychological status and incident HF among 6782 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Anger, anxiety, chronic stress, depressive symptoms, and hostility were measured using validated scales, and physician reviewers adjudicated incident HF events. Cox proportional hazards models were used to adjust for relevant demographic, behavioral, and physiological covariates. Interactions by age, race, sex, and self-reported health were examined in exploratory analyses. During a mean follow-up of 9.3 years, 242 participants developed incident HF. There was no association between psychosocial factors and HF hazard ratios (95% confidence interval) for the highest versus lowest quartile: anger=1.14 (0.81-1.60), anxiety=0.74 (0.51-1.07), chronic stress=1.25 (0.90-1.72), depressive symptoms=1.19 (0.76-1.85), and hostility=0.95 (0.62-1.42). In exploratory analysis, among the participants reporting fair/poor health at baseline, those reporting high versus low levels of anxiety, chronic stress, and depressive symptoms had 2-fold higher risk of incident HF, but there was no association for those with good/very good/excellent self-reported health. CONCLUSIONS Overall, these psychosocial factors were not significantly associated with incident HF. However, for participants reporting poor health at baseline, there was evidence that anxiety, chronic stress, and depressive symptoms were associated with increased risk of HF. Future research with greater statistical power is necessary to replicate these findings and seek explanations.
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Affiliation(s)
- Rachel P Ogilvie
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
| | - Susan A Everson-Rose
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - W T Longstreth
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Carlos J Rodriguez
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Ana V Diez-Roux
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Pamela L Lutsey
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
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Rajan KB, Schneider JA, Aggarwal NT, Wilson RS, Everson-Rose SA, Evans DA. Racial Differences in Cognitive Function and Risk of Incident Stroke. J Stroke Cerebrovasc Dis 2015; 24:2854-9. [PMID: 26387044 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Received: 03/16/2015] [Accepted: 08/16/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Cognitive impairment is associated with increased risk of stroke; however, it is not known whether this association varies by race. Our objective was to examine the association between cognitive function and the risk of stroke among non-Hispanic blacks and whites with no history of stroke. METHODS Participants were from a population-based cohort study of 7205 older adults (61% black and 59% female) from Chicago's South Side. A standardized composite cognitive function score based on 3 components--global cognition (Mini-Mental State Examination), executive function (Symbol Digits Modalities test), and episodic memory (Delayed and Immediate Story Recall tests)--was used to predict risk of stroke (from Medicare hospitalization data) using a Cox model. RESULTS During 72,868 person-years of follow-up, 16% (N = 1185) developed stroke. After adjusting for vascular risk factors, 1 standard deviation lower composite cognitive function score was associated with increased risk of stroke in blacks (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.66-1.88), which was twofold higher than whites (HR = 1.38; 95% CI, 1.26-1.55) (Pdifference = .002). Lower global cognition and executive function were associated with a similarly increased risk of stroke in blacks and whites. Lower episodic memory (composite of recall tests) was associated with increased risk of stroke that was twofold higher in blacks (HR = 1.12; 95% CI, 1.10-1.14) than in whites (HR = 1.06; 95% CI, 1.04-1.09). CONCLUSIONS Lower cognitive function was associated with increased risk of stroke and this association was stronger among blacks than whites. Future studies are needed to determine factors that can explain this finding.
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Affiliation(s)
- Kumar B Rajan
- Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL.
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Neelum T Aggarwal
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | | | - Denis A Evans
- Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL
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Kelley-Moore JA, Cagney KA, Skarupski KA, Everson-Rose SA, Mendes de Leon CF. Do Local Social Hierarchies Matter for Mental Health? A Study of Neighborhood Social Status and Depressive Symptoms in Older Adults. J Gerontol B Psychol Sci Soc Sci 2015; 71:369-77. [PMID: 26333821 DOI: 10.1093/geronb/gbv047] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/19/2014] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Despite a well-established association between relative social position and health, stratification at smaller levels of social organization has received scant attention. Neighborhood is a localized context that has increasing relevance for adults as they age, thus one's relative position within this type of mesolevel group may have an effect on mental health, independent of absolute level of social and economic resources. We examine the relationship between an older adult's relative rank within their neighborhoods on two criteria and depressive symptoms. METHOD Using data from the Chicago Health and Aging Project, neighborhood relative social position was ascertained for two social domains: income and social reputation (number of neighbors one knows well enough to visit). Using multilevel models, we estimated the effect of relative position within the neighborhood on depressive symptoms, net of absolute level for each domain and average neighborhood level. RESULTS Higher neighborhood relative rankings on both income and visiting neighbors were associated with fewer depressive symptoms. Although both were modest in effect, the gradient in depressive symptoms was three times steeper for the relative rank of visiting neighbors than for income. Men had steeper gradients than women in both domains, but no race differences were observed. DISCUSSION These findings suggest that an older adult's relative position in a local social hierarchy is associated with his/her mental health, net of absolute position.
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Affiliation(s)
| | | | | | | | - Carlos F Mendes de Leon
- Department of Epidemiology, Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor
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Khan ZA, Janssen I, Mazzarelli JK, Powell LH, Dumasius A, Everson-Rose SA, Barinas-Mitchell E, Weinstock PJ, Hollenberg SM. Abstract P137: Accelerated Arterial Stiffness During the Menopausal Transition - Results from Study of Women’s Health Across the Nation. Hypertension 2015. [DOI: 10.1161/hyp.66.suppl_1.p137] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Arterial stiffness is an independent marker of cardiovascular disease (CVD). We hypothesized that arterial stiffness would increase in women undergoing menopausal (MP) transition.
Methods:
349 healthy, peri-MP participants from SWAN-Heart, an ancillary study of SWAN (Study of Women’s Health Across the Nation) were evaluated for subclinical atherosclerosis at baseline and again at 2 years. Subjects using hormone replacement (15) or vasodilators (38) were excluded. Radial tonometry waveforms were digitized and a transfer function was utilized to calculate Aortic Augmentation index, adjusted for heart rate of 75bpm (AIx@75). Pulse wave velocity (PWV) was recorded as carotid-to-femoral arterial pulse propagation time. Carotid intima-media thickness (cIMT) was measured by ultrasound. Women were grouped into pre/early-MP (PMP) and late peri/post-MP (LMP). Kruskal-Wallis test was utilized to compare differences among groups.
Results:
Mean duration of follow up was 2.4 years with a retention rate of 69% (203/296). Age at baseline was (mean±SD) 51±3, BMI 29±6; 46 subjects transitioned from PMP to LMP, 82 remained at PMP and 75 at LMP. Peripheral blood pressure (BP) readings did not differ among groups at baseline or follow up (mean, 120/77 mmHg at both). Augmentation index ([[Unable to Display Character: ∆]]AIx@75) changed from 35±6 to 40±6%, for a difference of 5±8, for women transitioning from PMP to LMP vs 34±8 to 34±6% in women staying in PMP and 36±8 to 38±9% in women staying at LMP, p=.04. The trend for [[Unable to Display Character: ∆]]PWV was similar in PMP to LMP, changing from 6.9 to 8.4 m/s ([[Unable to Display Character: ∆]] = 1.5±2.1) compared to PMP, from 7.4 to 8.3 m/s ([[Unable to Display Character: ∆]] = 0.9±1.9) and LMP, from 8 to 8.4 m/s ([[Unable to Display Character: ∆]] = 0.4±2.5), p=.19. There was no difference in cIMT change between all groups; from 0.67 to 0.7 mm ([[Unable to Display Character: ∆]] = 0.03±0.05) in PMP to LMP, from 0.64 to 0.68 mm ([[Unable to Display Character: ∆]] = 0.04±0.05) in PMP and from 0.64 to 0.68 mm ([[Unable to Display Character: ∆]] = 0.04±0.07) in LMP.
Conclusion:
Augmentation index, a physiologic measure of arterial stiffness, increased through the menopausal transition. There was no significant difference in cIMT change, showing that physiological changes occur before detectable morphologic changes in arterial vasculature in this setting. Changes in arterial stiffness occur first and may mediate the increased CVD risk in women undergoing menopause.
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El Khoudary SR, Shields KJ, Janssen I, Hanley C, Budoff MJ, Barinas-Mitchell E, Everson-Rose SA, Powell LH, Matthews KA. Cardiovascular Fat, Menopause, and Sex Hormones in Women: The SWAN Cardiovascular Fat Ancillary Study. J Clin Endocrinol Metab 2015; 100:3304-12. [PMID: 26176800 PMCID: PMC4570161 DOI: 10.1210/jc.2015-2110] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Cardiovascular risk increases in women after menopause. Mounting evidence demonstrates a role of cardiovascular fat (CF) in the pathogenesis of coronary heart disease, but no research has examined CF in relation to sex hormones or menopausal status in women. OBJECTIVE The objective was to determine the relationship between CF depots, menopausal status, and endogenous sex hormones. DESIGN Cross-sectional and longitudinal study designs were used. SETTING The setting included the Study of Women's Health Across the Nation (SWAN) Heart and Cardiovascular Fat Ancillary Study. PARTICIPANTS A total of 456 women (mean age, 50.75 y); 62% premenopausal/early perimenopausal, and 38% late peri-/postmenopausal. INTERVENTION Menopausal status, endogenous sex hormones measured simultaneously with CF volumes, and circulating estradiol available 4.80 years (median) before CF measures. MAIN OUTCOME MEASURES Volumes of CF (epicardial adipose tissue [EAT], paracardial adipose tissue [PAT], total heart adipose tissue [TAT = EAT + PAT], and aortic perivascular adipose tissue [PVAT]). RESULTS In final models, late peri-/postmenopausal women had 9.88% more EAT, 20.72% more PAT, and 11.69% more TAT volumes than pre-/early perimenopausal women (P < .05). PVAT was not associated with menopausal status. In final models, lower estradiol concentrations were associated with greater volumes of PAT and TAT (P < .05). Women with the greatest reduction in estradiol since baseline had greater volumes of PAT compared to women with the least reduction (P = .02). CONCLUSIONS Late peri-/postmenopausal women have greater volumes of heart fat compared with pre-/early perimenopausal women independent of age, obesity, and other covariates. Endogenous sex hormones are associated with CF. Perhaps CF plays a role in the higher risk of coronary heart disease reported in women after menopause.
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Affiliation(s)
- Samar R El Khoudary
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Kelly J Shields
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Imke Janssen
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Carrie Hanley
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Matthew J Budoff
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Emma Barinas-Mitchell
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Susan A Everson-Rose
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Lynda H Powell
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
| | - Karen A Matthews
- University of Pittsburgh Graduate School of Public Health (S.R.E.K., C.H., E.B.-M., K.A.M.), Department of Epidemiology, Pittsburgh, Pennsylvania 15261; Lupus Center of Excellence (K.J.S.), Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania 15212; Rush University Medical Center (I.J., L.H.P.), Department of Preventive Medicine, Chicago, Illinois 60612; Los Angeles Biomedical Research Institute (M.J.B.), Division of Cardiology, Torrance, California 90502; Department of Medicine, Program in Health Disparities Research and Center for Health Equity (S.A.E.-R.), University of Minnesota, Minneapolis, Minnesota 55414; and University of Pittsburgh School of Medicine (K.A.M.), Department of Psychiatry, Pittsburgh, Pennsylvania 15213
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Ojo-Fati O, John F, Thomas J, Joseph AM, Raymond NC, Cooney NL, Pratt R, Rogers CR, Everson-Rose SA, Luo X, Okuyemi KS. Integrating smoking cessation and alcohol use treatment in homeless populations: study protocol for a randomized controlled trial. Trials 2015; 16:385. [PMID: 26320081 PMCID: PMC4552980 DOI: 10.1186/s13063-015-0858-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/10/2015] [Indexed: 12/02/2022] Open
Abstract
Background Despite progress in reducing cigarette smoking in the general U.S. population, smoking rates, cancer morbidity and related heart disease remain strikingly high among the poor and underserved. Homeless individuals’ cigarette smoking rate remains an alarming 70 % or greater, and this population is generally untreated with smoking cessation interventions. Furthermore, the majority of homeless smokers also abuse alcohol and other drugs, which makes quitting more difficult and magnifies the health consequences of tobacco use. Methods/Design Participants will be randomized to one of three groups, including (1) an integrated intensive smoking plus alcohol intervention using cognitive behavioral therapy (CBT), (2) intensive smoking intervention using CBT or (3) usual care (i.e., brief smoking cessation and brief alcohol counseling). All participants will receive 12-week treatment with a nicotine patch plus nicotine gum or lozenge. Counseling will include weekly individual sessions for 3 months, followed by monthly booster group sessions for 3 months. The primary smoking outcome is cotinine-verified 7-day smoking abstinence at follow-up week 52, and the primary alcohol outcome will be breathalyzer-verified 90-day alcohol abstinence at week 52. Discussion This study protocol describes the design of the first community-based controlled trial (n = 645) designed to examine the efficacy of integrating alcohol abuse treatment with smoking cessation among homeless smokers. To further address the gap in effectiveness of evidence-based smoking cessation interventions in the homeless population, we are conducting a renewed smoking cessation clinical trial called Power to Quit among smokers experiencing homelessness. Trial registration ClinicalTrials.gov Identifier: NCT01932996. Date of registration: 20 November 2014.
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Affiliation(s)
- Olamide Ojo-Fati
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Florence John
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Janet Thomas
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Department of Medicine, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Anne M Joseph
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Department of Medicine, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Nancy C Raymond
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Department of Psychiatry, University of Minnesota Medical School, Medical School, Academic Affairs, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Ned L Cooney
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Charles R Rogers
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Susan A Everson-Rose
- Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Department of Medicine, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Xianghua Luo
- Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building, MMC 303, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Kolawole S Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA. .,Program in Health Disparities Research, University of Minnesota Medical School, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
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Everson-Rose SA, Lutsey PL, Roetker NS, Lewis TT, Kershaw KN, Alonso A, Diez Roux AV. Perceived Discrimination and Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2015; 182:225-34. [PMID: 26085044 DOI: 10.1093/aje/kwv035] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [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: 06/10/2014] [Accepted: 01/29/2015] [Indexed: 11/14/2022] Open
Abstract
Perceived discrimination is positively related to cardiovascular disease (CVD) risk factors; its relationship with incident CVD is unknown. Using data from the Multi-Ethnic Study of Atherosclerosis, a population-based multiethnic cohort study of 6,508 adults aged 45-84 years who were initially free of clinical CVD, we examined lifetime discrimination (experiences of unfair treatment in 6 life domains) and everyday discrimination (frequency of day-to-day occurrences of perceived unfair treatment) in relation to incident CVD. During a median 10.1 years of follow-up (2000-2011), 604 incident events occurred. Persons reporting lifetime discrimination in ≥2 domains (versus none) had increased CVD risk, after adjustment for race/ethnicity and sociodemographic factors, behaviors, and traditional CVD risk factors (hazard ratio (HR) = 1.36, 95% confidence interval (CI): 1.09, 1.70) and after control for chronic stress and depressive symptoms (HR = 1.28, 95% CI: 1.01, 1.60). Reported discrimination in 1 domain was unrelated to CVD (HR = 1.05, 95% CI: 0.86, 1.30). There were no differences by race/ethnicity, age, or sex. In contrast, everyday discrimination interacted with sex (P = 0.03). Stratified models showed increased risk only among men (for each 1-standard deviation increase in score, adjusted HR = 1.14, 95% CI: 1.03, 1.27); controlling for chronic stress and depressive symptoms slightly reduced this association (HR = 1.11, 95% CI: 0.99, 1.25). This study suggests that perceived discrimination is adversely related to CVD risk in middle-aged and older adults.
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Derby CA, Whitmer RA, Sternfeld B, Everson-Rose SA, Lasley B, Karlamangla A, Greendale G. P1‐269: Vascular risk factors and cognitive function in midlife women: The study of women's health across the nation (SWAN). Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.470] [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] [Indexed: 10/22/2022]
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Clark CJ, Borowsky IW, Salisbury J, Usher J, Spencer RA, Przedworski JM, Renner LM, Fisher C, Everson-Rose SA. Disparities in long-term cardiovascular disease risk by sexual identity: The National Longitudinal Study of Adolescent to Adult Health. Prev Med 2015; 76:26-30. [PMID: 25849883 PMCID: PMC4559408 DOI: 10.1016/j.ypmed.2015.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine long-term cardiovascular disease (CVD) risk disparities by sexual identity using a nationally representative sample of young adults in the United States. METHODS Data include participants in wave 4 (2008/09; ages 24-34years) of the National Longitudinal Study of Adolescent to Adult Health (7087 females; 6340 males). Sexual identity was self-reported (heterosexual, mostly heterosexual, bisexual, mostly homosexual, homosexual) and a Framingham-based prediction model was used to estimate participants' risk of a CVD event over 30years. Differences in CVD risk by sexual identity, relative to heterosexuals, were calculated with linear regression models adjusted for age, race/ethnicity, education, and financial distress. RESULTS Average 30-year CVD risk was 17.2% (95% CI: 16.7, 17.7) in males and 9.0% (95% CI: 8.6, 9.3) in females. Compared to heterosexual females, mostly heterosexual (0.8%; 95% CI: 0.2, 1.4) and mostly homosexual females (2.8%; 95% CI: 0.8, 4.9) had higher CVD risk. Bisexual and homosexual females had higher but not statistically significant CVD risk compared to heterosexuals. Among males, differences in CVD risk by sexual identity were not statistically significant. CONCLUSION Sexual identity was associated with CVD risk in sexual minority subgroups. Population- and clinic-based prevention strategies are needed to minimize disparities in subsequent disease.
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Affiliation(s)
- Cari Jo Clark
- Department of Medicine, Division of Epidemiology and Community Health, Program in Health Disparities Research, University of Minnesota, 717 Delaware Street, SE, Ste 166, Minneapolis, MN 55414, United States.
| | - Iris W Borowsky
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St., SE, Ste. 353, Minneapolis, MN 55414, United States.
| | - John Salisbury
- Rainbow Health Initiative, 2021 E Hennepin Ave #220, Minneapolis, MN 55413, United States.
| | - Joann Usher
- Rainbow Health Initiative, 2021 E Hennepin Ave #220, Minneapolis, MN 55413, United States.
| | - Rachael A Spencer
- Independent Researcher, Ponce de Leon Avenue, Atlanta, GA 30308, United States.
| | - Julia M Przedworski
- Division of Health Policy & Management, 420 Delaware St. S.E., MMC 729, Minneapolis, MN 55455, United States.
| | - Lynette M Renner
- School of Social Work, University of Minnesota, 105 Peters Hall, 1404 Gortner Avenue, Saint Paul, MN 55108, United States.
| | - Colleen Fisher
- School of Social Work, University of Minnesota, 105 Peters Hall, 1404 Gortner Avenue, Saint Paul, MN 55108, United States.
| | - Susan A Everson-Rose
- Department of Medicine, Program in Health Disparities Research, 717 Delaware St SE, #166, Minneapolis, MN 55414, United States.
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Sewali B, Harcourt N, Everson-Rose SA, Leduc RE, Osman S, Allen ML, Okuyemi KS. Prevalence of cardiovascular risk factors across six African Immigrant Groups in Minnesota. BMC Public Health 2015; 15:411. [PMID: 25895917 PMCID: PMC4409770 DOI: 10.1186/s12889-015-1740-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 07/21/2014] [Accepted: 04/08/2015] [Indexed: 11/17/2022] Open
Abstract
Background Although African immigrants represent a large and growing segment of the U.S. population, there are little or no data available on the prevalence of cardiovascular disease (CVD) risk factors among this diverse population. This study compared the prevalence of self-reported CVD risk factors and health behaviors and examined the associations between immigration related characteristics and CVD risk factors and health behaviors across six African immigrants groups. Methods Data were from 996 African immigrants in the U.S., (37.9% Somalis; 26.8% Ethiopians; 14% Liberians; 8.5% Sudanese; 5.1% Kenyans and 7.8% others group) from a cross-sectional survey conducted in the Twin cities of Minnesota. Logistic regression models estimated the associations of demographic characteristics, and immigration-related factors (length of stay in the United states, English proficiency, income and health insurance) with prevalence of CVD risk factors (overweight/obese; hypertension and diabetes mellitus) and self-reported health behaviors (cigarette smoking, physical inactivity, conscious effort to exercise and eating a healthy diet). Results We found a relatively low self-reported prevalence of diabetes, hypertension, and smoking. However, significant differences were noted by country of origin. Using Somalis as our referent country of origin group, we found that Liberians and Kenyans were more likely to report having diabetes or hypertension. On all measures of health behaviors, Liberians were more likely to engage in more health protective behaviors than other individuals. Conclusions Although African immigrants have different prevalence rates for CVD risk factors and health behaviors, there is a need to further explore the differences observed by country of emigration.
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Affiliation(s)
- Barrett Sewali
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN, 55414, USA. .,Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE. Ste. 166, Minneapolis, MN, 55414, USA.
| | - Nonyelum Harcourt
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN, 55414, USA. .,Department of Medicine, Cardiology Division, University of Minnesota, Minneapolis, MN, 55414, USA.
| | - Susan A Everson-Rose
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN, 55414, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, 55414, USA.
| | - Robert E Leduc
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, 55414, USA.
| | - Sirad Osman
- New American Community Services, Minneapolis, MN, 55104, USA.
| | - Michele L Allen
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN, 55414, USA. .,Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE. Ste. 166, Minneapolis, MN, 55414, USA.
| | - Kolawole S Okuyemi
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN, 55414, USA. .,Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St. SE. Ste. 166, Minneapolis, MN, 55414, USA. .,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, 55414, USA.
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Avis NE, Crawford SL, Greendale G, Bromberger JT, Everson-Rose SA, Gold EB, Hess R, Joffe H, Kravitz HM, Tepper PG, Thurston RC. Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med 2015; 175:531-9. [PMID: 25686030 PMCID: PMC4433164 DOI: 10.1001/jamainternmed.2014.8063] [Citation(s) in RCA: 474] [Impact Index Per Article: 52.7] [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: 12/29/2022]
Abstract
IMPORTANCE The expected duration of menopausal vasomotor symptoms (VMS) is important to women making decisions about possible treatments. OBJECTIVES To determine total duration of frequent VMS (≥ 6 days in the previous 2 weeks) (hereafter total VMS duration) during the menopausal transition, to quantify how long frequent VMS persist after the final menstrual period (FMP) (hereafter post-FMP persistence), and to identify risk factors for longer total VMS duration and longer post-FMP persistence. DESIGN, SETTING, AND PARTICIPANTS The Study of Women's Health Across the Nation (SWAN) is a multiracial/multiethnic observational study of the menopausal transition among 3302 women enrolled at 7 US sites. From February 1996 through April 2013, women completed a median of 13 visits. Analyses included 1449 women with frequent VMS. MAIN OUTCOMES AND MEASURES Total VMS duration (in years) (hot flashes or night sweats) and post-FMP persistence (in years) into postmenopause. RESULTS The median total VMS duration was 7.4 years. Among 881 women who experienced an observable FMP, the median post-FMP persistence was 4.5 years. Women who were premenopausal or early perimenopausal when they first reported frequent VMS had the longest total VMS duration (median, >11.8 years) and post-FMP persistence (median, 9.4 years). Women who were postmenopausal at the onset of VMS had the shortest total VMS duration (median, 3.4 years). Compared with women of other racial/ethnic groups, African American women reported the longest total VMS duration (median, 10.1 years). Additional factors related to longer duration of VMS (total VMS duration or post-FMP persistence) were younger age, lower educational level, greater perceived stress and symptom sensitivity, and higher depressive symptoms and anxiety at first report of VMS. CONCLUSIONS AND RELEVANCE Frequent VMS lasted more than 7 years during the menopausal transition for more than half of the women and persisted for 4.5 years after the FMP. Individual characteristics (eg, being premenopausal and having greater negative affective factors when first experiencing VMS) were related to longer-lasting VMS. Health care professionals should counsel women to expect that frequent VMS could last more than 7 years, and they may last longer for African American women.
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Affiliation(s)
- Nancy E Avis
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sybil L Crawford
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester
| | - Gail Greendale
- Division of Geriatric Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Joyce T Bromberger
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | | | - Ellen B Gold
- Division of Epidemiology, Department of Public Health Sciences, UC Davis School of Medicine, University of California, Davis
| | - Rachel Hess
- Department of Medicine, University of Utah Schools of the Health Sciences, Salt Lake City
| | - Hadine Joffe
- Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
| | - Howard M Kravitz
- Departments of Psychiatry and Preventive Medicine, Rush University Medical Center, Chicago, Illinois
| | - Ping G Tepper
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Rebecca C Thurston
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Clark CJ, Alonso A, Spencer RA, Pencina M, Williams K, Everson-Rose SA. Predicted long-term cardiovascular risk among young adults in the national longitudinal study of adolescent health. Am J Public Health 2014; 104:e108-15. [PMID: 25322295 PMCID: PMC4232148 DOI: 10.2105/ajph.2014.302148] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We estimated the distribution of predicted long-term cardiovascular disease (CVD) risk among young adults in the United States. METHODS Our data were derived from National Longitudinal Study of Adolescent Health participants (n = 14 333; average age: 28.9 years). We used a Framingham-derived risk prediction function to calculate 30-year risks of "hard" and "general" CVD by gender and race/ethnicity. RESULTS Average 30-year risks for hard and general CVD were 10.4% (95% confidence interval [CI] = 10.1%, 10.7%) and 17.3% (95% CI = 17.0%, 17.7%) among men and 4.4% (95% CI = 4.3%, 4.6%) and 9.2% (95% CI = 8.9%, 9.5%) among women. Average age-adjusted risks of hard and general CVD were higher among Blacks and American Indians than among Whites and lower among Asian/Pacific Islander women than White women. American Indian men continued to have a higher risk of general CVD after adjustment for socioeconomic status. Four percent of women (95% CI = 3.6%, 5.0%) and 26.2% of men (95% CI = 24.7%, 27.8%) had a 20% or higher risk of general CVD. Racial differences were detected but were not significant after adjustment for socioeconomic status. CONCLUSIONS Average CVD risk among young adults is high. Population-based prevention strategies and improved detection and treatment of high-risk individuals are needed to reduce the future burden of CVD.
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Affiliation(s)
- Cari Jo Clark
- Cari Jo Clark is with the Department of Medicine and the Division of Epidemiology and Community Health, School of Public Health, Program in Health Disparities Research, University of Minnesota, Minneapolis. Alvaro Alonso is with the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota. Rachael A. Spencer is an independent researcher in Atlanta, GA. Michael Pencina is with the Clinical Research Unit and the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC. Ken Williams is with KenAnCo Biostatistics, San Antonio, TX. Susan A. Everson-Rose is with the Department of Medicine and the Program in Health Disparities Research, University of Minnesota
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Clark CJ, Spencer RA, Everson-Rose SA, Brady SS, Mason SM, Connett JE, Henderson KM, To M, Suglia SF. Dating violence, childhood maltreatment, and BMI from adolescence to young adulthood. Pediatrics 2014; 134:678-85. [PMID: 25201793 PMCID: PMC4179102 DOI: 10.1542/peds.2014-1179] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study tested whether dating violence (DV) victimization is associated with increases in BMI across the transition from adolescence to young adulthood and whether gender and previous exposure to child maltreatment modify such increases. METHODS Data were from participants (N = 9295; 49.9% female) in the National Longitudinal Study of Adolescent Health. BMI was calculated from measured height and weight at waves 2, 3, and 4 of the study. DV victimization was measured at waves 2, 3, and 4 by using items from the revised Conflict Tactics Scales. Linear regression by using generalized estimating equations with robust SEs was used to test the association. Models were stratified according to gender and history of child maltreatment. RESULTS From baseline to wave 4, BMI increased on average 6.5 units (95% confidence interval [CI]: 6.2-6.7) and 6.8 units (95% CI: 6.5-7.1) among men and women, respectively, and nearly one-half (45.5% of men; 43.9% of women) reported DV at some point. In stratified models, DV victimization (β: 0.3 [95% CI: 0.0-0.6]) independently predicted BMI increase over time in women. Exposure to childhood sexual abuse magnified the increase in BMI associated with DV victimization (β: 1.3 [95% CI: 0.3-2.3]). No other types of childhood maltreatment were significant modifiers of the DV-BMI association. Violence victimization was not associated with BMI among men. CONCLUSIONS Screening and support for DV victims, especially women who have also experienced childhood maltreatment, may be warranted to reduce the likelihood of health consequences associated with victimization.
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Affiliation(s)
| | | | | | | | | | | | | | - Michelle To
- College of Liberal Arts, University of Minnesota, Minneapolis, Minnesota
| | - Shakira F. Suglia
- Columbia University Mailman School of Public Health, New York, New York
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Kershaw KN, Diez Roux AV, Bertoni A, Carnethon MR, Everson-Rose SA, Liu K. Associations of chronic individual-level and neighbourhood-level stressors with incident coronary heart disease: the Multi-Ethnic Study of Atherosclerosis. J Epidemiol Community Health 2014; 69:136-41. [PMID: 25271247 DOI: 10.1136/jech-2014-204217] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Several individual-level stressors have been linked to incident coronary heart disease (CHD), but less attention has focused on the influence of neighbourhood-level sources of stress. In this study we examined prospective associations of individual-level and neighbourhood-level stressors with incident CHD. METHODS Multi-Ethnic Study of Atherosclerosis participants aged 45-84 years at baseline (2000-2002) with complete data were included in the analyses (n=6678 for individual-level and n=6105 for neighbourhood-level stressors). CHD was defined as non-fatal myocardial infarction, resuscitated cardiac arrest or CHD death. Median follow-up was 10.2 years. Multivariable Cox proportional hazards models were fitted to estimate associations of individual-level and neighbourhood-level stressors (categorised into approximate tertiles) with incident CHD. RESULTS Higher reported individual-level stressors were associated with higher incident CHD. Participants in the high individual-level stressor category had 65% higher risk of incident CHD (95% CI 1.23 to 2.22) than those in the low category after adjusting for sociodemographics (P for trend=0.002). This association weakened but remained significant with further adjustment for behavioural and biological risk factors. There was a non-linear relationship between neighbourhood-level stressors and incident CHD (P for quadratic term=0.01). Participants in the medium category had 49% higher CHD risk (95% CI 1.06 to 2.10) compared with those in the low category; those in the high category had only 27% higher CHD risk (95% CI 0.83 to 1.95). These associations persisted with adjustment for risk factors and individual-level stressors. CONCLUSIONS Individual-level and neighbourhood-level stressors were independently associated with incident CHD, though the nature of the relationships differed.
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Affiliation(s)
- Kiarri N Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Alain Bertoni
- Division of Public Health Sciences, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Johnson PJ, Ghildayal N, Rockwood T, Everson-Rose SA. Differences in diabetes self-care activities by race/ethnicity and insulin use. Diabetes Educ 2014; 40:767-77. [PMID: 25253625 DOI: 10.1177/0145721714552501] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to examine differences in diabetes self-care activities by race/ethnicity and insulin use. METHODS Data were from the 2011 Behavioral Risk Factor Surveillance System for adults with diabetes. Outcomes included 5 diabetes self-care activities (blood glucose monitoring, foot checks, nonsmoking, physical activity, healthy eating) and 3 levels of diabetes self-care (high, moderate, low). Logistic regression models stratified by insulin use were used to estimate the odds of each self-care activity by race/ethnicity. RESULTS Only 20% of adults had high levels of diabetes self-care, while 64% had moderate and 16% had low self-care. Racial/ethnic differences were apparent for every self-care activity among non-insulin users but only for glucose monitoring and foot checks among insulin users. Overall, American Indian / Alaska Natives had higher odds of glucose monitoring; blacks had higher odds of foot checks; and Hispanics had higher odds of not smoking compared with non-Hispanic Whites. Non-insulin-using American Indian / Alaska Natives had higher odds of foot checks, and non-insulin-using Hispanics had higher odds of fruit/vegetable consumption. CONCLUSIONS Participation in specific diabetes self-care behaviors differs by race/ethnicity and by insulin use. Yet, few adults with diabetes of any race/ethnicity engage in high levels of self-care. Findings suggest that culturally tailored messages about diabetes self-care may be needed, in addition to more effective population promotion of healthy lifestyles and risk reduction behaviors to improve diabetes control and overall health. Diabetes educators can be a catalyst for adopting a population approach to diabetes management, which requires addressing both prevention and management of diabetes for all patients.
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Affiliation(s)
- Pamela Jo Johnson
- Medica Research Institute, Minnetonka, MN, USA (Dr Johnson, Ms Ghildayal),Center for Spirituality and Healing and the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA (Dr Johnson)
| | - Neha Ghildayal
- Medica Research Institute, Minnetonka, MN, USA (Dr Johnson, Ms Ghildayal),Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA (Ms Ghildayal, Dr Rockwood)
| | - Todd Rockwood
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA (Ms Ghildayal, Dr Rockwood)
| | - Susan A Everson-Rose
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA (Dr Everson-Rose)
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Misialek JR, Rose KM, Everson-Rose SA, Soliman EZ, Clark CJ, Lopez FL, Alonso A. Socioeconomic status and the incidence of atrial fibrillation in whites and blacks: the Atherosclerosis Risk in Communities (ARIC) study. J Am Heart Assoc 2014; 3:jah3654. [PMID: 25142059 PMCID: PMC4310413 DOI: 10.1161/jaha.114.001159] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND No previous studies have examined the interplay among socioeconomic status, sex, and race with the risk of atrial fibrillation (AF). METHODS AND RESULTS We prospectively followed 14 352 persons (25% black, 75% white, 55% women, mean age 54 years) who were free of AF and participating in the Atherosclerosis Risk in Communities (ARIC) study. Socioeconomic status was assessed at baseline (1987-1989) through educational level and total family income. Incident AF through 2009 was ascertained from electrocardiograms, hospitalizations, and death certificates. Cox regression was used to estimate hazard ratios and 95% CIs of AF for education and family income. Interactions were tested between socioeconomic status and age, race, or sex. Over a median follow-up of 20.6 years, 1794 AF cases occurred. Lower family income was associated with higher AF risk (hazard ratio 1.45, 95% CI 1.27 to 1.67 in those with income less than $25 000 per year compared with those with $50 000 or more per year). The association between education and AF risk varied by sex (P=0.01), with the lowest education group associated with higher AF risk in women (hazard ratio 1.88, 95% CI 1.55 to 2.28) but not in men (hazard ratio 1.15, 95% CI 0.97 to 1.36) compared with the highest education group. Adjustment for cardiovascular risk factors attenuated the associations. There were no interactions with race or age. Blacks had lower AF risk than whites in all income and education groups. CONCLUSIONS Lower family income was associated with a higher AF risk overall, whereas the impact of education on AF risk was present only in women. Differences in socioeconomic status do not explain the lower risk of AF in blacks compared with whites.
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Affiliation(s)
- Jeffrey R Misialek
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (J.R.M., F.L.L., A.A.)
| | - Kathryn M Rose
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (K.M.R.) Social and Scientific Systems, Durham, NC (K.M.R.)
| | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, University of Minnesota, Minneapolis, MN (S.A.E.R., C.J.C.) Center for Health Equity, University of Minnesota, Minneapolis, MN (S.A.E.R.)
| | - Elsayed Z Soliman
- Department of Epidemiology and Prevention and Internal Medicine (Cardiology Section), Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.)
| | - Cari J Clark
- Department of Medicine and Program in Health Disparities Research, University of Minnesota, Minneapolis, MN (S.A.E.R., C.J.C.)
| | - Faye L Lopez
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (J.R.M., F.L.L., A.A.)
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (J.R.M., F.L.L., A.A.)
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Nagayoshi M, Everson-Rose SA, Iso H, Mosley TH, Rose KM, Lutsey PL. Social network, social support, and risk of incident stroke: Atherosclerosis Risk in Communities study. Stroke 2014; 45:2868-73. [PMID: 25139878 DOI: 10.1161/strokeaha.114.005815] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Having a small social network and lack of social support have been associated with incident coronary heart disease; however, epidemiological evidence for incident stroke is limited. We assessed the longitudinal association of a small social network and lack of social support with risk of incident stroke and evaluated whether the association was partly mediated by vital exhaustion and inflammation. METHODS The Atherosclerosis Risk in Communities study measured social network and social support in 13 686 men and women (mean, 57 years; 56% women; 24% black; 76% white) without a history of stroke. Social network was assessed by the 10-item Lubben Social Network Scale and social support by a 16-item Interpersonal Support Evaluation List-Short Form. RESULTS During a median follow-up of 18.6 years, 905 incident strokes occurred. Relative to participants with a large social network, those with a small social network had a higher risk of stroke (hazard ratio [95% confidence interval], 1.44 [1.02-2.04]) after adjustment for demographics, socioeconomic variables, marital status, behavioral risk factors, and major stroke risk factors. Vital exhaustion, but not inflammation, partly mediated the association between a small social network and incident stroke. Social support was unrelated to incident stroke. CONCLUSIONS In this sample of US community-dwelling men and women, having a small social network was associated with excess risk of incident stroke. As with other cardiovascular conditions, having a small social network may be associated with a modestly increased risk of incident stroke.
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Affiliation(s)
- Mako Nagayoshi
- From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.).
| | - Susan A Everson-Rose
- From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.)
| | - Hiroyasu Iso
- From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.)
| | - Thomas H Mosley
- From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.)
| | - Kathryn M Rose
- From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.)
| | - Pamela L Lutsey
- From the Division of Epidemiology and Community Health (M.N., P.L.L.) and Department of Medicine (S.A.E.-R.), University of Minnesota, Minneapolis; Department of Community Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan (M.N.); Department of Medicine, Osaka University, Suita, Japan (H.I.); Departments of Geriatrics/Gerontology and Neurology, University of Mississippi Medical Center, Jackson, MS (T.H.M.); and Department of Epidemiology, University of North Carolina at Chapel Hill (K.M.R.)
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Abstract
BACKGROUND AND PURPOSE Stroke increases the risk of dementia; however, bidirectional association of incident stroke and cognitive decline below dementia threshold is not well established. Also, both cognitive decline and stroke increase mortality risk. METHODS A longitudinal population-based cohort of 7217 older adults without a history of stroke from a biracial community was interviewed at 3-year intervals. Cognitive function was assessed using a standardized global cognitive score. Stroke was determined by linkage with Medicare claims, and mortality was ascertained via the National Death Index. We used a Cox model to assess the risk of incident stroke, a joint model with a piecewise linear mixed model with incident stroke as a change point for cognitive decline process, and a time-dependent relative risk regression model for mortality risk. RESULTS During follow-up, 1187 (16%) subjects had incident stroke. After adjusting for known confounders, lower baseline cognitive function was associated with a higher risk of incident stroke (hazard ratio, 1.61; 95% confidence interval, 1.46-1.77). Cognitive function declined by 0.064 U per year before incident stroke occurrence and 0.122 U per year after stroke, a nearly 1.9-fold increase in cognitive decline (95% confidence interval, 1.78-2.03). Both stroke (hazard ratio, 1.17; 95% confidence interval, 1.08-1.26) and cognitive decline (hazard ratio, 1.90; 95% confidence interval, 1.81-1.98) increased mortality risk. CONCLUSIONS Baseline cognitive function was associated with incident stroke. Cognitive decline increased significantly after stroke relative to before stroke. Cognitive decline increased mortality risk independent of the risk attributable to stroke and should be followed as a marker for both stroke and mortality.
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Affiliation(s)
- Kumar B Rajan
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.).
| | - Neelum T Aggarwal
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.)
| | - Robert S Wilson
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.)
| | - Susan A Everson-Rose
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.)
| | - Denis A Evans
- From the Rush Institute for Healthy Aging, Department of Internal Medicine (K.B.R., D.A.E.), Rush Alzheimer's Disease Center (N.T.A., R.S.W.), Department of Neurological Sciences (N.T.A., R.S.W.), and Department of Behavioral Sciences (R.S.W.), Rush University Medical Center, Chicago, IL; and Department of Medicine, University of Minnesota, Minneapolis (S.A.E.-R.)
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Everson-Rose SA, Roetker NS, Lutsey PL, Kershaw KN, Longstreth WT, Sacco RL, Diez Roux AV, Alonso A. Chronic stress, depressive symptoms, anger, hostility, and risk of stroke and transient ischemic attack in the multi-ethnic study of atherosclerosis. Stroke 2014; 45:2318-23. [PMID: 25013018 PMCID: PMC4131200 DOI: 10.1161/strokeaha.114.004815] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [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] [Received: 01/13/2014] [Accepted: 05/22/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE This study investigated chronic stress, depressive symptoms, anger, and hostility in relation to incident stroke and transient ischemic attacks in middle-aged and older adults. METHODS Data were from the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort study of 6749 adults, aged 45 to 84 years and free of clinical cardiovascular disease at baseline, conducted at 6 US sites. Chronic stress, depressive symptoms, trait anger, and hostility were assessed with standard questionnaires. The primary outcome was clinically adjudicated incident stroke or transient ischemic attacks during a median follow-up of 8.5 years. RESULTS One hundred ninety-five incident events (147 strokes; 48 transient ischemic attacks) occurred during follow-up. A gradient of increasing risk was observed for depressive symptoms, chronic stress, and hostility (all P for trend ≤0.02) but not for trait anger (P>0.10). Hazard ratios (HRs) and 95% confidence intervals indicated significantly elevated risk for the highest-scoring relative to the lowest-scoring group for depressive symptoms (HR, 1.86; 95% confidence interval, 1.16-2.96), chronic stress (HR, 1.59; 95% confidence interval, 1.11-2.27), and hostility (HR, 2.22; 95% confidence interval, 1.29-3.81) adjusting for age, demographics, and site. HRs were attenuated but remained significant in risk factor-adjusted models. Associations were similar in models limited to stroke and in secondary analyses using time-varying variables. CONCLUSIONS Higher levels of stress, hostility, and depressive symptoms are associated with significantly increased risk of incident stroke or transient ischemic attacks in middle-aged and older adults. Associations are not explained by known stroke risk factors.
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Affiliation(s)
- Susan A Everson-Rose
- From the Departments of Medicine (S.A.E.-R.) and Epidemiology and Community Health (N.S.R., P.L.L., A.A.), School of Public Health, University of Minnesota, Minneapolis; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Departments of Neurology, Public Health Sciences, Neurosurgery, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (A.V.D.R.).
| | - Nicholas S Roetker
- From the Departments of Medicine (S.A.E.-R.) and Epidemiology and Community Health (N.S.R., P.L.L., A.A.), School of Public Health, University of Minnesota, Minneapolis; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Departments of Neurology, Public Health Sciences, Neurosurgery, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (A.V.D.R.)
| | - Pamela L Lutsey
- From the Departments of Medicine (S.A.E.-R.) and Epidemiology and Community Health (N.S.R., P.L.L., A.A.), School of Public Health, University of Minnesota, Minneapolis; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Departments of Neurology, Public Health Sciences, Neurosurgery, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (A.V.D.R.)
| | - Kiarri N Kershaw
- From the Departments of Medicine (S.A.E.-R.) and Epidemiology and Community Health (N.S.R., P.L.L., A.A.), School of Public Health, University of Minnesota, Minneapolis; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Departments of Neurology, Public Health Sciences, Neurosurgery, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (A.V.D.R.)
| | - W T Longstreth
- From the Departments of Medicine (S.A.E.-R.) and Epidemiology and Community Health (N.S.R., P.L.L., A.A.), School of Public Health, University of Minnesota, Minneapolis; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Departments of Neurology, Public Health Sciences, Neurosurgery, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (A.V.D.R.)
| | - Ralph L Sacco
- From the Departments of Medicine (S.A.E.-R.) and Epidemiology and Community Health (N.S.R., P.L.L., A.A.), School of Public Health, University of Minnesota, Minneapolis; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Departments of Neurology, Public Health Sciences, Neurosurgery, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (A.V.D.R.)
| | - Ana V Diez Roux
- From the Departments of Medicine (S.A.E.-R.) and Epidemiology and Community Health (N.S.R., P.L.L., A.A.), School of Public Health, University of Minnesota, Minneapolis; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Departments of Neurology, Public Health Sciences, Neurosurgery, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (A.V.D.R.)
| | - Alvaro Alonso
- From the Departments of Medicine (S.A.E.-R.) and Epidemiology and Community Health (N.S.R., P.L.L., A.A.), School of Public Health, University of Minnesota, Minneapolis; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (K.N.K.); Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Departments of Neurology, Public Health Sciences, Neurosurgery, and Human Genetics, Miller School of Medicine, University of Miami, FL (R.L.S.); and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (A.V.D.R.)
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Clark CJ, Everson-Rose SA, Alonso A, Spencer RA, Brady SS, Resnick MD, Borowsky IW, Connett JE, Krueger RF, Suglia SF. Effect of partner violence in adolescence and young adulthood on blood pressure and incident hypertension. PLoS One 2014; 9:e92204. [PMID: 24658452 PMCID: PMC3962399 DOI: 10.1371/journal.pone.0092204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 11/06/2013] [Accepted: 02/16/2014] [Indexed: 12/30/2022] Open
Abstract
Intimate partner violence has adverse health consequences, but little is known about its association with hypertension. This study investigates sex differences in the relationship between intimate partner violence and blood pressure outcomes. Data included 9,699 participants from waves 3 (2001-02) and 4 (2008-09) of the National Longitudinal Study of Adolescent Health (51% female). Systolic (SBP) and diastolic (DBP) blood pressure and incident hypertension (SBP≥140 mmHg, DBP≥90 mmHg, or taking antihypertensive medication) were ascertained at wave 4. Intimate partner violence was measured at wave 3 with 8 items from the revised Conflict Tactics Scales. Separate victimization and perpetration scores were calculated. Sex-specific indicators of severe victimization and perpetration were created using the 66th percentile among those exposed as a cut point. Sex-specific, linear and logistic regression models were developed adjusting for age, race, financial stress, and education. Thirty-three percent of men and 47% of women reported any intimate partner violence exposure; participants were categorized as having: no exposure, moderate victimization and / or perpetration only, severe victimization, severe perpetration, and severe victimization and perpetration. Men experiencing severe perpetration and victimization had a 2.66 mmHg (95% CI: 0.05, 5.28) higher SBP and a 59% increased odds (OR: 1.59, 95% CI: 1.07, 2.37) of incident hypertension compared to men not exposed to intimate partner violence. No other category of violence was associated with blood pressure outcomes in men. Intimate partner violence was not associated with blood pressure outcomes in women. Intimate partner violence may have long-term consequences for men's hemodynamic health. Screening men for victimization and perpetration may assist clinicians to identify individuals at increased risk of hypertension.
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Affiliation(s)
- Cari Jo Clark
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Program in Health Disparities Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Susan A. Everson-Rose
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Program in Health Disparities Research, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | | | - Sonya S. Brady
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Michael D. Resnick
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Iris W. Borowsky
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - John E. Connett
- Division of Biostatistics, Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Robert F. Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Shakira F. Suglia
- Department of Epidemiology, Columbia University, New York, New York, United States of America
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48
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Jacobs EA, Rathouz PJ, Karavolos K, Everson-Rose SA, Janssen I, Kravitz HM, Lewis TT, Powell LH. Perceived discrimination is associated with reduced breast and cervical cancer screening: the Study of Women's Health Across the Nation (SWAN). J Womens Health (Larchmt) 2013; 23:138-45. [PMID: 24261647 DOI: 10.1089/jwh.2013.4328] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Racial disparities in breast and cervical cancer screening have been documented in African American, Hispanic, and Asian populations. Perceived discrimination may contribute to this disparity. The aim of this study was to understand the relationship between perceived everyday racial/ethnic and other discrimination and receipt of breast and cervical cancer screening in a multiethnic population of women. METHODS We analyzed data from 3,258 women participating in the Study of Women's Health Across the Nation (SWAN), a multiethnic/racial, longitudinal cohort study of the natural history of the menopausal transition conducted at seven U.S. sites. Participants completed a validated measure of perceived discrimination and reasons for believing that they were treated differently, along with Pap smears, clinical breast exams (CBE), and mammography at each follow-up period. We used multiple logistic regression for the binary outcomes of having a Pap smear, CBE, or mammogram in each of the two follow-up years, using self-reported "race discrimination" and "other discrimination" at baseline as the main predictors. RESULTS African American women reported the highest percentage of racial discrimination (35%), followed by Chinese (20%), Hispanic (12%), Japanese (11%), and non-Hispanic white women (3%). Non-Hispanic white women reported the highest percentage of "other" discrimination (40%), followed by Chinese (33%), African American (24%), Japanese (23%), and Hispanic women (16%). Perceived racial discrimination was not associated with reduced receipt of preventive screening, except in one fully adjusted model. Reported discrimination owing to "other" reasons, such as age or gender, was associated with reduced receipt of Pap smear (odds ratio [OR] 0.85; 95% confidence interval [CI] 0.74-0.99), CBE (OR 0.78; 95% CI 0.67-0.91), and mammography (OR 0.80; 95% CI 0.69-0.92) regardless of patient race. CONCLUSIONS Perceived discrimination is an important issue across racial/ethnic groups and is negatively associated with receipt of breast and cervical cancer screening. This is an important issue that needs to be further explored and addressed in efforts to improve the delivery of healthcare to all groups.
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Affiliation(s)
- Elizabeth A Jacobs
- 1 Departments of Medicine and Population Health Sciences, University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin
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Janssen I, Powell LH, Jasielec MS, Matthews KA, Hollenberg SM, Sutton-Tyrrell K, Everson-Rose SA. Progression of coronary artery calcification in black and white women: do the stresses and rewards of multiple roles matter? Ann Behav Med 2013; 43:39-49. [PMID: 21901270 DOI: 10.1007/s12160-011-9307-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Black women experience higher rates of cardiovascular disease (CVD) than white women, though evidence for racial differences in subclinical CVD is mixed. Few studies have examined multiple roles (number, perceived stress, and/or reward) in relation to subclinical CVD, or whether those effects differ by race. PURPOSE The aim of this study was to investigate the effects of multiple roles on 2-year progression of coronary artery calcium. METHODS Subjects were 104 black and 232 white women (mean age 50.8 years). Stress and reward from four roles (spouse, parent, employee, caregiver) were assessed on five-point scales. Coronary artery calcium progression was defined as an increase of ≥10 Agatston units. RESULTS White women reported higher rewards from their multiple roles than black women, yet black women showed cardiovascular benefits from role rewards. Among black women only, higher role rewards were related significantly to lower progression of coronary artery calcium, adjusting for body mass index, blood pressure, and other known CVD risk factors. Blacks reported fewer roles but similar role stress as whites; role number and stress were unrelated to coronary artery calcium progression. CONCLUSION Rewarding roles may be a novel protective psychosocial factor for progression of coronary calcium among black women.
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Affiliation(s)
- Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
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Goldade K, Des Jarlais D, Everson-Rose SA, Guo H, Thomas J, Gelberg L, Joseph AM, Okuyemi KS. Knowing quitters predicts smoking cessation in a homeless population. Am J Health Behav 2013; 37:517-24. [PMID: 23985232 DOI: 10.5993/ajhb.37.4.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the impact of knowing quitters on cessation among homeless smokers. METHODS Secondary analysis of data derived from a community-based randomized controlled trial of 430 homeless smokers. We conducted multivariable logistic regression analysis to determine whether knowing quitters impacted the likelihood of cessation (salivary cotinine ≤ 20 ng/ml) at 26-week follow-up. RESULTS Multivariable logistic regression showed cessation was more likely for smokers who knew ≥ 5 quitters compared with those who knew no quitters (Odds Ratio = 3.79, CI = 1.17, 12.27, p = .008), adjusting for age, education, income, and time to first cigarette in morning. CONCLUSIONS Knowing former smokers was associated with increased likelihood of achieving smoking abstinence among homeless smokers.
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Affiliation(s)
- Kathryn Goldade
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
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