Understanding Determinants of Cardiovascular Health in a Mexican American Community.

Cardiovascular disease (CVD) is the leading cause of death in Hispanic Americans. Social and physical determinants of health unique to this community must be understood before interventions can be designed and implemented. This article describes a CVD risk assessment conducted in a primarily Mexican American community, using Healthy People 2020 as a model. Social (language, culture, awareness of CVD, and socio-economic status) and physical (presence and use of recreation areas, presence of grocery stores, public transportation, and environmental pollution) determinants of health as well as access to health services were assessed. Fifteen community leaders were interviewed using guided interviews. Database searches and direct observations were conducted. Using these methods provided comprehensive assessment of social and physical determinants of health, and access issues that were unique to the community studied. Findings demonstrated greater awareness of diabetes than CVD as a health problem, with little knowledge of CVD risk factors. Lack of access to health services (lack of insurance, lack of a medical home) and presence of cultural and socioeconomic barriers such as language, unemployment, low income, and lack of insurance were identified. The physical determinants such as environment presented fewer barriers, with adequate access to fruits and vegetables, transportation, and parks. Results revealed target areas for intervention.

Does knowledge of coronary artery calcium affect cardiovascular risk perception, likelihood of taking action, and health-promoting behavior change?

BACKGROUND: Evidence indicates that a healthy lifestyle can reduce cardiovascular disease risk, yet many people engage in unhealthy behaviors. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Knowledge of an abnormal finding could provide the "teachable moment" to enhance motivation for change. OBJECTIVE: The aim of this study was to examine how knowledge of CAC score affects risk perception, likelihood of taking action, and health-promoting behavior change in persons at high risk for cardiovascular disease. METHODS: This study used a descriptive prospective design with 174 high-risk adults (≥3 major risk factors) recruited at a radiology center offering CAC scans. Baseline self-report surveys using the Perception of Risk of Heart Disease Scale, the Benefits and Barriers Scale, the Quality of Life Index, and the Health-Promoting Lifestyle Profile II were completed immediately after a screening CAC scan but before results were known. Follow-up occurred 3 months later using mailed packets. RESULTS: Participants' mean age was 58 years; 62% were men, 89% were white, and most were well educated. There was no significant change in risk perception scores over time or between groups, except for a positive interaction in the moderate-risk group (CAC scores of 101-400) (P = .004). Quality of life remained unchanged. Health-promoting behavior changes increased in all groups over time (P < .001). McNemar χ² analysis indicated that risk reduction medication use increased in all groups, with a significant increase in statin (P < .001) and aspirin (P < .001) intake. Predictors of behavior change were perceived barriers (ß = -.41; P < .001) and quality of life (ß = .44; P < .001). CONCLUSIONS: Knowledge of CAC score does impact risk perception for some at-risk groups. This knowledge does enhance motivation for behavior change. Knowledge of CAC score does not impact quality of life. It is hoped that through improved understanding of the effect of CAC scoring on behavior change, nurses can better assist patients to modify behaviors during teachable moments.

Cardiovascular risk factors and lifestyle habits among preventive cardiovascular nurses.

UNLABELLED: The cornerstone of cardiovascular disease prevention is the promotion of a healthy lifestyle and the identification and reduction of cardiovascular risk factors. Cardiology nurses play a major role in counseling patients about lifestyle and cardiovascular risk factors. We used an e-mail survey to elicit self-reported prevalence of cardiovascular risk factors and healthy lifestyles among the Preventive Cardiovascular Nurses Association (PCNA) members and compared their risk profiles with published data for American cardiologists, the Nurses' Health Study 2, and the Behavioral Risk Factor Surveillance Survey data for women. RESULTS: A total of 1,345 complete surveys were collected. The respondents were mostly women (96%), with mean (SD) age of 47.4 (8.7) years. More than 95% were not cigarette smokers, more than 50% had a healthy body mass index (<25), and more than 56% achieved the recommended levels of physical activity. Nevertheless, obesity (body mass index ≥ 30) was a health risk in one-fifth of PCNA respondents. The rates of hypertension (17%) and dyslipidemia (15%) were lower than rates reported in other national samples; however, the rate for family history of premature heart disease (20%) was similar to those reported in national samples. Since family history of premature heart disease may be a more significant risk factor in women, PCNA respondents with such a family history may require targeted interventions to further reduce their risk and improve their lifestyle behaviors. CONCLUSION: PCNA nurses have more favorable lifestyle profiles compared with national samples. It can be expected that nurses who know their risk factors and who follow healthy lifestyle behaviors will be more effective in these counseling roles.

The relationships among self-esteem, stress, coping, eating behavior, and depressive mood in adolescents.

The prevalence of adolescent overweight is significant, almost 25% in some minorities, and often is associated with depressive symptoms. Psychological and psychosocial factors as well as poor coping skills have been correlated with unhealthy eating and obesity. The purpose of this study was to examine relationships among self-esteem, stress, social support, and coping; and to test a model of their effects on eating behavior and depressive mood in a sample of 102 high school students (87% minority). Results indicate that (a) stress and low self-esteem were related to avoidant coping and depressive mood, and that (b) low self-esteem and avoidant coping were related to unhealthy eating behavior. Results suggest that teaching adolescents skills to reduce stress, build self-esteem, and use more positive approaches to coping may prevent unhealthy eating and subsequent obesity, and lower risk of depressive symptoms.

Upper-body progressive resistance training improves strength and household physical activity performance in women attending cardiac rehabilitation.

PURPOSE: The purpose of this study was to examine the impact of moderate-intensity, progressive, upper-body resistance training (RT) on muscle strength and perceived performance of household physical activities (HPA) among women in cardiac rehabilitation. METHODS: The 10-week, pretest-posttest, experiment randomized women to either usual care (UC) aerobic exercise or RT. Muscle strength for 5 upper-body RT exercises (chest press, shoulder press, biceps curl, lateral row, and triceps extension) was measured using the 1-Repetition Maximum Assessment. The RT group progressively increased weight lifted using 40%, 50%, and 60% of obtained 1-Repetition Maximum Assessment at 3-week intervals. Perceived performance of HPA was measured with the Kimble Household Activities Scale. RESULTS: The RT group (n = 16, mean age 64 +/- 11) significantly increased muscle strength in all 5 exercises in comparison with the UC group (n = 14, mean age 65 +/- 10) (chest press, 18% vs 11%; shoulder press, 24% vs 14%; biceps curl, 21% vs 12%; lateral row, 32% vs 9%; and triceps extension, 28% vs 20%, respectively). By study end, Household Activities Scale scores significantly increased (F = 13.878, P = .001) in the RT group (8.75 +/- 3.19 vs 11.25 +/- 2.14), whereas scores in the UC group decreased (8.60 +/- 3.11 vs 6.86 +/- 4.13). CONCLUSION: Progressive upper-body RT in women shows promise as an effective tool to increase muscle strength and improve the ability to perform HPA after a cardiac event. Beginning RT early after a cardiac event in a monitored cardiac rehabilitation environment can maximize the strengthening benefit.

Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism.

Prescribed and supervised resistance training (RT) enhances muscular strength and endurance, functional capacity and independence, and quality of life while reducing disability in persons with and without cardiovascular disease. These benefits have made RT an accepted component of programs for health and fitness. The American Heart Association recommendations describing the rationale for participation in and considerations for prescribing RT were published in 2000. This update provides current information regarding the (1) health benefits of RT, (2) impact of RT on the cardiovascular system structure and function, (3) role of RT in modifying cardiovascular disease risk factors, (4) benefits in selected populations, (5) process of medical evaluation for participation in RT, and (6) prescriptive methods. The purpose of this update is to provide clinicians with recommendations to facilitate the use of this valuable modality.

Physical activity and exercise for elders with cardiovascular disease.

Elders participate in limited exercise, leading to reduced fitness and deconditioning. Regular moderate-intensity exercise/activity provides significant health benefits. As elders become more physically active, the health care burden on society will decrease. Because nurses often counsel patients on lifestyle changes, such as exercise, for improving cardiovascular health, it is important for them to be knowledgeable about the specific program modalities and benefits/risks of exercise for older patients with cardiovascular disease.

Using motivational interviewing to reduce diabetes risk.

With the growing prevalence of diabetes worldwide, controlling modifiable risk factors for diabetes is essential to preventing complications and disease progression. Recent research strongly supports targeting at-risk prediabetes clients through therapeutic lifestyle change. Many behavior change techniques and strategies are known to be successful, yet are seldom implemented in today's health care arena. Nurses are in an excellent position to serve as change agents to assist at-risk prediabetes clients in making necessary lifestyle changes. Motivational interviewing has been shown to be effective in counseling clients toward behavior change. The major principles of motivational interviewing will be described and motivational interviewing techniques will be demonstrated using a scenario with a prediabetes client.

Risk factors for type 2 diabetes mellitus.

Genetic, environmental, and metabolic risk factors are interrelated and contribute to the development of type 2 diabetes mellitus. A strong family history of diabetes mellitus, age, obesity, and physical inactivity identify those individuals at highest risk. Minority populations are also at higher risk, not only because of family history and genetics, but also because of adaptation to American environmental influences of poor dietary and exercise habits. Women with a history of gestational diabetes as well as their children are at greater risk for progressing to type 2 diabetes mellitus. Insulin resistance increases a person's risk for developing impaired glucose tolerance and type 2 diabetes. Individuals who have insulin resistance share many of the same risk factors as those with type 2 diabetes. These include hyperinsulinemia, atherogenic dyslipidemia, glucose intolerance, hypertension, prothrombic state, hyperuricemia, and polycystic ovary syndrome. Current interventions for the prevention and retardation of type 2 diabetes mellitus are those targeted towards modifying environmental risk factors such as reducing obesity and promoting physical activity. Awareness of risk factors for developing type 2 diabetes will promote screening, early detection, and treatment in high-risk populations with the goal of decreasing both microvascular and macrovascular complications.