Report of Health Behavior Modification Among Latinos Diagnosed With Multiple Cardiovascular Risk Factors.

INTRODUCTION: Hypertension, hypercholesterolemia, and type II diabetes are leading cardiovascular risk factors in the United States, and Latinos are disproportionately burdened by these chronic health conditions. The extent to which Latinos overall and by language spoken at home report health behavior modification following diagnosis is poorly understood. METHODS: Our inclusion criteria included participants sampled in the 2011-2016 waves of the National Health and Nutrition Examination Survey who self-identified as Latinos, were 20 years of age or above, and reported a diagnosis of hypertension, hypercholesterolemia or diabetes (N=2027). We examined associations between the language spoken at home and report of adoption of 3 recommended health behaviors in the past year: weight loss, leisure-time physical activity (LTPA) and smoking cessation. Separate log-binomial models were fit to estimate prevalence ratios (PRs) for each health behavior. RESULTS: Approximately one third (28%) of study participants had been diagnosed with diabetes and more than half reported a diagnosis of hypercholesterolemia (65%) or hypertension (60%). Most Latinos met the highest levels of smoking cessation criteria (82%), whereas less than a third met LTPA recommendations (29%) or attempted weight loss (24%) in the past year. Fully adjusted outcome specific models showed that exclusively speaking English at home was associated with a higher probability of reporting weight loss attempt and LTPA compared with Spanish only speakers, although only LTPA was statistically significant [weight loss PR: 1.23, 95% confidence interval (CI): 0.92, 1.65; LTPA PR: 1.74; 95% CI: 1.37, 2.20; smoking cessation PR: 0.93, 95% CI: 0.86, 1.01]. CONCLUSIONS: Our findings provide new evidence on patterns of behavioral modification in a population-based sample of Latinos diagnosed with chronic health conditions. Findings suggest the need to promote language and culturally relevant initiatives to increase the adoption of health-enhancing behaviors and improve chronic disease management among Spanish-speaking Latinos.

Social and clinically-relevant cardiovascular risk factors in Asian Americans adults: NHANES 2011-2014.

Little evidence exists examining cardiovascular risk factors among Asian Americans and how social determinants such as nativity status and education pattern risk in the United States (U.S.) context. We used the National Health and Nutrition Examination Survey, which purposely oversampled Asian Americans from 2011 to 2014, and examined prevalence of Type II diabetes, smoking and obesity for Asian Americans (n=1363) and non-Latino Whites (n=4121). We classified Asian Americans as U.S. or foreign-born and by years in the U.S. Obesity status was based on standard body mass index (BMI) cut points of ≥30kg/m2 and Asian-specific cut points (BMI≥25kg/m2) that may be more clinically relevant for this population. We fit separate logistic regression models for each outcome using complex survey design methods and tested for the joint effect of race, nativity and education on each outcome. Diabetes and obesity prevalence (applying Asian-specific BMI cut points) were higher among Asian Americans when compared to non-Latino Whites but smoking prevalence was lower. These patterns remained in fully adjusted models and showed small increases with longer duration in the U.S. Joint effects models showed higher odds of prevalent Type II diabetes and obesity (Asian-specific) for foreign-born Asians, regardless of years in the U.S. and slightly higher risk for low education, when compared to non-Latino Whites with high education. Smoking models showed significant interaction effects between race and education for non-Latino Whites only. Our study supports the premise that social as well as clinical factors should be considered when developing health initiatives for Asian Americans.

Is there a relationship between accelerometer-assessed physical activity and sedentary behavior and cognitive function in US Hispanic/Latino adults? The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Normative changes in cognitive function are expected with increasing age. Research on the relationship between normative cognitive decline and moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SED) needs further investigation in Hispanic/Latinos adults. We assessed the cross-sectional association between accelerometer assessed MVPA and SED with cognitive function in 7,478 adults aged 45-74years from the Hispanic Community Health Study/Study of Latinos. At baseline, cognitive tests included two executive function tests (Digit Symbol Substitution Test (DSST), a test of language (Word Fluency), and a test of memory (Spanish English Verbal Learning Test). Multiple regression models were used to examine associations of time spent in MVPA and SED with cognitive function by age groups, adjusted for age, education, sex, acculturation, and field center. Mean time spent in sedentary behaviors was 12.3h/day in females and 11.9 h/day in males (75% and 77% of accelerometer wear time, respectively). Higher SED, but not MVPA, was associated with lower DSST raw scores (ß -0.03 with each 10-min increment in SED; P<0.05), indicating lower performance in executive function in all age groups. No associations were observed for MVPA and SED with tests of language or memory tests. Our findings suggest a distinct association of SED but not MVPA on executive functioning in middle-aged and older Latino adults. Longitudinal studies are needed to more conclusively determine causal links.

Latino Immigrants, Acculturation, and Health: Promising New Directions in Research.

This article provides an analysis of novel topics emerging in recent years in research on Latino immigrants, acculturation, and health. In the past ten years, the number of studies assessing new ways to conceptualize and understand how acculturation-related processes may influence health has grown. These new frameworks draw from integrative approaches testing new ground to acknowledge the fundamental role of context and policy. We classify the emerging body of evidence according to themes that we identify as promising directions--intrapersonal, interpersonal, social environmental, community, political, and global contexts, cross-cutting themes in life course and developmental approaches, and segmented assimilation--and discuss the challenges and opportunities each theme presents. This body of work, which considers acculturation in context, points to the emergence of a new wave of research that holds great promise in driving forward the study of Latino immigrants, acculturation, and health. We provide suggestions to further advance the ideologic and methodologic rigor of this new wave.

Social engagement and chronic disease risk behaviors: the Multi-Ethnic Study of Atherosclerosis.

OBJECTIVE: Although engagement in social networks is important to health, multiple different dimensions exist. This study identifies which dimensions are associated with chronic disease risk behaviors. METHODS: Cross-sectional data on social support, loneliness, and neighborhood social cohesion from 5381 participants, aged 45-84 from the Multi-Ethnic Study of Atherosclerosis was used. RESULTS: After adjusting for individual characteristics and all social engagement variables, social support was associated with lower smoking prevalence (PR=0.88, 95% CI: 0.82, 0.94), higher probability of having quit (PR=1.03, 95% CI: 1.01, 1.06) and a slightly higher probability of achieving physical activity recommendations (PR=1.03, 95% CI: 1.01, 1.06). Neighborhood social cohesion was associated with very slightly higher probability of achieving recommended (PR=1.03, 95% CI: 1.01, 1.05) or any regular (PR=1.0, 95% CI: 1.01, 1.04) physical activity, and a higher probability of consuming at least five daily fruit and vegetable servings (PR=1.05, 95% CI: 1.01, 1.09). CONCLUSIONS: Both social support and neighborhood social cohesion, a less commonly considered aspect of social engagement, appear to be important for chronic disease prevention interventions and likely act via separate pathways.

How Neighborhood Poverty Structures Types and Levels of Social Integration.

Social integration is fundamental to health and well-being. However, few studies have explored how neighborhood contexts pattern types and levels of social integration that individuals experience. We examined how neighborhood poverty structures two dimensions of social integration: integration with neighbors and social integration more generally. Using data from the United States Third National Health and Nutrition Examination Survey, we linked study participants to percent poverty in their neighborhood of residence (N = 16,040). Social integration was assessed using a modified Social Network Index and neighborhood integration based on yearly visits with neighbors. We fit multivariate logistic regression models that accounted for the complex survey design. Living in high poverty neighborhoods was associated with lower social integration but higher visits with neighbors. Neighborhood poverty distinctly patterns social integration, demonstrating that contexts shape the extent and quality of social relationships.

Assessing the feasibility and sample quality of a national random-digit dialing cellular phone survey of young adults.

The majority of adults aged 18-34 years have only cellular phones, making random-digit dialing of landline telephones an obsolete methodology for surveillance of this population. However, 95% of this group has cellular phones. This article reports on the 2011 National Young Adult Health Survey (NYAHS), a pilot study conducted in the 50 US states and Washington, DC, that used random-digit dialing of cellular phones and benchmarked this methodology against that of the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Comparisons of the demographic distributions of subjects in the NYAHS and BRFSS (aged 18-34 years) with US Census data revealed adequate reach for all demographic subgroups. After adjustment for design factors, the mean absolute deviations across demographic groups were 3 percentage points for the NYAHS and 2.8 percentage points for the BRFSS, nationally, and were comparable for each census region. Two-sided z tests comparing cigarette smoking prevalence revealed no significant differences between NYAHS and BRFSS participants overall or by subgroups. The design effects of the sampling weight were 2.09 for the NYAHS and 3.26 for the BRFSS. Response rates for the NYAHS and BRFSS cellular phone sampling frames were comparable. Our assessment of the NYAHS methodology found that random-digit dialing of cellular phones is a feasible methodology for surveillance of young adults.

The clustering effects of current smoking status, overweight/obesity, and physical inactivity with all-cause and cause-specific mortality risks in U.S. adults.

Objective: To estimate the associations of smoking, weight status and physical inactivity with all-cause and cause-specific deaths, and the advanced rate period (RAP) to determine how early death was advanced among United States (U.S.) adults aged 18 years or older. Methods: We used data from the third National Health and Nutrition Examination Survey (NHANES III) and the 2019 Linked Mortality File (LMF) with a follow-up period of 21.6 years (n = 16,612, including 7,278 deaths). Smoking, weight status, and physical inactivity were obtained from NHANES III and mortality outcomes from the 2019 LMF. Cox regression was used to estimate hazard ratios, RAPs and their corresponding confidence intervals. Results: For adults who currently smoke, were obese and physically inactive, the rate of dying from all-cause, CVD, and cancer was at least 231 % greater than for those who never smoked, were normal weight and physically active. The RAPs associated with the clustering of these risk factors for all cause, CVD- and cancer-specific cause of deaths were 13.0, 12.1 and 18.9 years older, respectively. Conclusions: Our findings underscore the need to focus on modifiable risk factors for illness prevention and health promotion and call attention to the increasing clustering of unhealthy risk factors in the U.S. population.

Food allergy among low birthweight children in a national survey.

The aim of this paper was to investigate the association between birthweight and prevalence of food allergies using a national sample of US children. Adult report of birthweight and child food allergies were obtained for years 2005-2009 from the National Health Interview Survey (NHIS), a cross-sectional household survey of the US population. A total of 51,748 children aged 0-17 years were included in the analyses representing over 73 million children. Multivariable logistic regression analyses examined associations between birthweight categories and food allergies stratified by age and gender; accounting for the complex design of NHIS. Children aged 6-12 years who were born very low birthweight (500-1,499 g) were more likely to have reported food allergy compared to referent (3,000-3,499 g), OR = 1.72; 95% CI: 1.02-2.91. However, there was no clear trend of an association between birthweight and food allergy with increasing or decreasing birthweight across all ages. Estimates were generally stronger in younger male children as compared to estimates in females of the same age group. Marginal associations for respiratory allergy (OR = 1.52; 95% CI: 1.02-2.29) and hay fever (OR = 1.54; 95% CI: 0.93-2.54) were observed among very low birthweight children aged 0-5 years. There was limited evidence for a clear association between birthweight and food allergy. Marginal associations observed in children weighing 500-1,499 g at birth support efforts to minimize preterm births and very low birthweight given the increase in pediatric food allergies and the large number of children born low birthweight each year in the US.

Fear of Job Loss and Hypertension Prevalence Among Working Latino Adults.

Evidence indicates that stress increases cardiovascular disease risk. Latinos are disproportionately employed in precarious work conditions that can trigger hypertension risk. We examined if fear of job loss, a work stressor, was associated with hypertension among U.S. Latinos. We utilized 2015 National Health Interview Survey data from working Latino adults (n = 2683). In multivariate logistic regression models, we examined if fear of job loss was associated with hypertension, adjusting for age, sex, education, household income, and health insurance, and whether nativity status modified this relationship. Fear of job loss was significantly associated with increased probability of reporting hypertension among Latino workers in fully adjusted models (PR 1.55, 95% CI 1.18-2.03), compared with no fear of job loss. This relationship varied by nativity. These findings suggest that work-related conditions may contribute to cardiovascular disease risk among Latinos and public health initiatives should promote behavioral interventions in work settings.

The use of Latinx in public health research when referencing Hispanic or Latino populations.

We provide a brief description of the demographics of the Hispanic or Latino population in the United States; point out the origin of the term Hispanic or Latino as standardized terminology in general including public health research; discuss the use of Latinx among the Hispanic or Latino population; and suggest recommendations for the use of Latinx in research including Hispanic or Latino populations. The Hispanic or Latino population is a heterogenous population familiar with name and/or labeling controversies since the introduction of the ethnicity category in the 1980 U.S. Census. Latinx, a term aiming to be gender-expansive, inclusive, and/or neutral, is being used to refer to the Hispanic or Latino population overall. However, only a small proportion of this population has heard or use the term. For research purposes, we recommend that 1) the population is referred to using the labels used during data collection for existing data; 2) when using Latinx, participants are explained the meaning of the term and other choices be provided; and 3) investigations using Latinx should interpret the results within the current context of the term and acknowledge the group (s) to which the findings apply. The latter will lead to accurately represent the Hispanic or Latino population. This correct identification is important to document and address health inequities across race and ethnicity in the U.S.

Latina Women in Academia: Challenges and Opportunities.

Latina women and other ethnic and racial groups continue to be underrepresented in science, technology, engineering, and mathematics (STEM) fields, including public health. This underrepresentation of people from diverse backgrounds and lived experiences in academic public health and other scientific disciplines is a form of epistemic oppression, exclusion that hinders contribution to knowledge production and advancement. Our analysis of 2021 data from the Association of Schools and Programs of Public Health indicates that Latinos/as represented only 6.0% of all instructional faculty and 6.1% of all tenured faculty at schools and programs of public health. We discuss the ways in which sociopolitical contexts, family-level dynamics and gendered norms, and institutional contexts hamper Latinas' full participation in academia. We propose solutions such as redefining metrics for success, leadership accountability, equity analyses, cluster hiring initiatives, and instituting structured mentoring and leadership programs. Bold actions are needed if we are to advance the scientific enterprise and address the diversity and equity problem in public health.

Nativity Status and Poly Tobacco Use among Young Adults in the United States.

Introduction: Young adults are the second largest segment of the immigrant population in the United States (US). Given recent trends in later age of initiation of tobacco use, we examined variation in use of tobacco products by nativity status for this population group. Methods: Our study included young adults 18-30 years of age sampled in the National Health Interview Survey (2015-2019), a nationally representative sample of the US population. We calculated prevalence of use of any and two or more tobacco products (cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco) for foreign-born (n = 3096) and US-born (n = 6811) young adults. Logistic regression models were adjusted for age, sex, race-ethnicity, education, and poverty, while accounting for the complex survey design. Results: Foreign-born young adults were significantly less likely to use any tobacco product (Cigarette = 7.3% vs. 10.7%; Cigar = 1.8% vs. 4.8%; E-cigarette = 2.3% vs. 4.5%, respectively; p < 0.01) or poly tobacco use (1.9% vs. 4.2%; p < 0.01) than US-born young adults. Adjusted regression models showed lower odds of poly tobacco use among the foreign-born than their US-born counterparts (Odds Ratio = 0.41, (95% Confidence Interval: 0.26-0.63)). Conclusions: The findings highlight the importance of targeted interventions by nativity status and further tobacco prevention efforts needed for the US-born.

Educational Attainment and Prevalence of Cardiovascular Health (Life's Simple 7) in Asian Americans.

Asian Americans have a high burden of cardiovascular disease, yet little is known about the social patterning of cardiovascular health (CVH) in this population. We examined if education (10+ years, and 15.9% for the U.S.-born. All models showed that low education compared to high education was associated with lower odds of having ideal CVH. This pattern remained in adjusted models but became non-significant when controlling for nativity (odds ratio = 0.34, 95% confidence interval: 0.10, 1.13). Models stratified by time in the U.S. were less consistent but showed similar education gradients in CVH. Low education is a risk factor for attaining ideal cardiovascular health among Asian Americans, regardless of time in the U.S.

Intergenerational differences in dietary acculturation among Ghanaian immigrants living in New York City: a qualitative study.

Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youth n 13, Age (Mean ± sd) 20 y ± 5⋅4, Parents (n 6) and Grandparents (n 6) age 58⋅7 ± 9⋅7) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US.

Incorporating Health Equity and Community Perspectives During COVID-19: Commonalities with Cardiovascular Health Equity Research.

The COVID-19 pandemic is revealing the deeply entrenched structural inequities in health that exist in the United States. We draw parallels between the COVID-19 pandemic and our cardiovascular health equity research focused on physical activity and diabetes to highlight three common needs: 1) access to timely and disaggregated data; 2) how to integrate community-engaged approaches in telehealth; and 3) policy initiatives that explicitly integrate health equity and social justice principles and action. We suggest that a similar sense of urgency regarding COVID-19 should be applied to slow the burgeoning costs and suffering associated with cardiovascular disease overall and in marginalized communities specifically. We remain hopeful that the current crisis can serve as a guide for aligning our principles as a just and democratic society with a health agenda that explicitly recognizes that social inequities in health for some impacts all members of society.

Household Food Insecurity, Breastfeeding, and Related Feeding Practices in US Infants and Toddlers: Results From NHANES 2009-2014.

OBJECTIVE: To examine the relationships among food insecurity, breastfeeding, and other related feeding practices by race/ethnicity among US infants and toddlers. DESIGN: National Health and Nutrition Examination Surveys 2009-2014, a nationally representative cross-sectional survey. PARTICIPANTS: Infants and toddlers aged 0-24 months with complete data on household food security status (n = 2,069). MAIN OUTCOME MEASURES: Initiation of breastfeeding (yes or no), duration of breastfeeding, and age of introduction to foods/drinks. ANALYSIS: Differences in feeding practices by food security status were tested in survey-weighted, stratified multiple regression models. RESULTS: Breastfeeding initiation rates among non-Hispanic whites, Hispanics, and non-Hispanic blacks were estimated at 80.0%, 77.5%, and 57.4%, respectively (P < .001). A total of 43% of infants and toddlers were introduced to foods/drinks before 4 months. After adjusting for household income, education, and other covariates, food insecurity was not a significant predictor of poor feeding behaviors. CONCLUSIONS AND IMPLICATIONS: Racial/ethnic disparities existed, with non-Hispanic black infants at the highest risk for never being breastfed, nor to continue through the recommended period of breastfeeding. Food insecurity was not shown to affect breastfeeding and other infant feeding practices directly. Further investigation is needed to understand whether food insecurity, through stress and other sociostructural pathways, mediates poor infant feeding practices.

Police Interactions and the Mental Health of Black Americans: a Systematic Review.

Black Americans comprise 13% of the US population, yet data suggests that they represent 23% of those fatally shot by police officers. Data on non-lethal encounters with police in the Black community is less available but can understandably result in emotional trauma, stress responses, and depressive symptoms. The aim of this systematic literature review is to assess if interactions with the police are associated with mental health outcomes among Black Americans. Following pre-defined inclusion criteria, 11 articles were reviewed. Using a quality assessment tool, eight studies received a fair quality rating, two studies a poor rating, and one study received a good rating. The types of police interaction reported among study participants included police use of force during arrest, police stops, police searches, exposure to police killings, and interactions with police in the court system and varied mental health outcomes. Most of the studies (6 of 11) reviewed found statistically significant associations between police interactions and mental health (psychotic experiences, psychological distress, depression, PTSD, anxiety, suicidal ideation and attempts), indicating a nearly twofold higher prevalence of poor mental health among those reporting a prior police interaction compared to those with no interaction. Although better quality studies are needed, findings suggest an association between police interactions and negative mental health outcomes. Changes in law enforcement policy, development and implementation of a validated instrument for police experiences, improved community outreach, a federally mandated review of policy and practice in police departments, and expanded police training initiatives could reduce the potential negative mental health impact of police interactions on Black Americans.

Health Equity and Implementation Science in Heart, Lung, Blood, and Sleep-Related Research: Emerging Themes From the 2018 Saunders-Watkins Leadership Workshop.

Disparities in health outcomes for heart, lung, blood, and sleep-related health conditions are pervasive in the United States, with an unequal burden experienced among structurally disadvantaged populations. One reason for this disparity is that despite the existence of effective interventions that promote health equity, few have been translated and implemented consistently in the healthcare system. To achieve health equity, there is a dire need to implement and disseminate effective evidence-based interventions that account for the complex and multilayered social determinants of health among marginalized groups across healthcare settings. To that end, the National Heart, Lung, and Blood Institute's Center for Translation Research and Implementation Science invited early stage investigators to participate in the inaugural Saunders-Watkins Leadership Workshop in May of 2018 at the National Institutes of Health. The goals of the workshop were to: (1) present an overview of health equity research, including areas which require ongoing investigation; (2) review how the fields of health equity and implementation science are related; (3) demonstrate how implementation science could be utilized to advance health equity; and (4) foster early stage investigator career success in heart, lung, blood, and sleep-related research. Herein, we highlight key themes from the 2-day workshop and offer recommendations for the future direction of health equity and implementation science research in the context of heart, lung, blood, and sleep-related health conditions.

Foreign-Born Blacks Experience Lower Odds of Obesity but Higher Odds of Diabetes than US-Born Blacks in New York City.

Research is limited on the health of foreign-born Blacks (FBBs), who are often grouped with African Americans. This study compared obesity and diabetes odds in FBBs and US-born Blacks (USBBs) in NYC. Analyzing the 2009-2013 NYC Community Health Survey (3701 FBBs and 6297 USBBs), weighted multivariate logistic regression examined odds of obesity and diabetes, adjusting for age, gender, education, income, marital status, children < 18, BMI (for diabetes only) and duration of residence. FBBs had lower odds of obesity [OR  0.62 (95% CI 0.54, 0.72)] and greater odds of diabetes [OR 1.24 (95% CI 1.01, 1.52)] compared to USBBs. FBBs had 1.4 times the odds of diabetes at overweight status, compared to USBBs [OR  1.40 (95% CI 1.01, 1.95)]. Living in the US ≥ 10 years was not associated with odds of obesity and diabetes. Future research should seek to uncover unique risk profiles of sub-ethnic groups in the African diaspora.