Home Visit Intervention Promotes Lifestyle Changes: Results of an RCT in Mexican Americans.

INTRODUCTION: Hispanic populations are less likely that other ethnicities to meet physical activity guidelines. Community health worker (CHW) outreach is an effective delivery method for behavior change messages owing to shared culture, language, and life experience. This study examined the efficacy of a CHW-delivered intervention, Tu Salud ¡Si Cuenta! (Your Health Matters!) at Home Intervention, to promote physical activity among Mexican Americans. STUDY DESIGN: RCT. SETTING AND PARTICIPANTS: Mexican Americans living along the Texas-Mexico border from June 2010 to April 2013. INTERVENTION: Eligible adults were randomized into intervention (n=250) or standard care (n=250). Intervention participants received 6 monthly CHW visits that included education, motivation, and support for lifestyle changes. Standard care was potentially exposed to a community-wide health promotion campaign. Data were collected at baseline and 6- and 12-month follow-ups. MAIN OUTCOME MEASURES: Meeting physical activity guidelines was defined as ≥600 MET-adjusted minutes of moderate and vigorous exercise. RESULTS: Intervention participants were more likely to meet physical activity guidelines at 6 months (AOR=2.02, 95% CI=1.25, 3.26) than standard care, but the significance was not maintained at 12 months (AOR=1.53, 95% CI=0.92, 2.53). The results were similar in the as-treated and obesity-stratified analyses. The secondary analysis corroborated the primary results. CONCLUSIONS: This study shows increases in physical activity among those exposed to a CHW intervention, including participants with obesity. It also indicates that the removal of CHW contact tapers the effect at 12 months. TRIAL REGISTRATION: NCT01168765.

Cardiovascular health and dementia incidence among older adults in Latin America: Results from the 10/66 study.

OBJECTIVES: Growing evidence shows that cardiovascular health (CVH) is associated with brain health. Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising. This study aimed to assess the longitudinal association between CVH and dementia in six Latin American countries. METHODS: We analyzed longitudinal data from the 10/66 study that included nondementia residents at baseline aged 65+ in six Latin American countries (n = 6447) and were followed up for 3 years. An index of modifiable CVH factors (ranging from 0 to 14) was calculated. Incident dementia was modeled using competing risk regression to adjust for risk of death. RESULTS: The sample included 6.2% participants with poor (0-5), 81.0% with moderate (6-10), and 12.8% with ideal CVH (11-14). At follow-up, 9.4% had developed dementia and 13.1% had died. Compared with those with poor CVH, participants with moderate and ideal levels of CVH had a significantly lower risk of dementia in both the unadjusted (subhazard ratio for moderate, 0.77; ideal, 0.59) and adjusted models (moderate, 0.73; ideal, 0.66). CONCLUSION: Moderate and ideal levels of CVH in old age may protect against dementia incidence. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries.

Weight loss and weight gain among participants in a community-based weight loss Challenge.

BACKGROUND: To describe the characteristics of participants who registered for multiple annual offerings of a community-based weight loss program called The Challenge, and to determine participant characteristics associated with weight change over multiple offerings of The Challenge occurring during the years 2010-2016. METHODS: Multivariable linear mixed effects analyses were conducted to describe percent weight change within and between offerings of The Challenge by participant characteristics. RESULTS: There were 669 and 575 participants included in the within and between analyses, respectively, for offerings of The Challenge. Among the 434 participants who lost weight in their first attempt at The Challenge and completed the initial weigh-in for a subsequent offering of The Challenge, 22.4% maintained their weight loss or had greater weight loss by the next Challenge, 40.3% gained back some weight, and 37.3% gained back all or more of the weight they lost during their first Challenge. Men had a significantly greater percent weight loss compared to women in their first and second Challenge and men were more likely to gain weight between Challenges. Participants who returned to more Challenges had a greater accumulated percent weight loss compared to those who returned to fewer Challenges. CONCLUSIONS: The current weight loss Challenge appears to contribute to helping a percentage of participants lose weight and maintain some or all of the weight loss.

Relationship between Homocysteine and Muscle Strength Decline: The Baltimore Longitudinal Study of Aging.

Background: Decreased muscle strength is strongly associated with future mobility limitations in older adults. Homocysteine is a risk factor for vascular disease and may exacerbate muscle strength decline. The present study aimed to examine the association between homocysteine levels and muscle strength in adults aged 50 years or older. Methods: Data were from 1,101 participants of The Baltimore Longitudinal Study of Aging between December 2004 and March 2015. Muscle strength was measured using grip strength. Mixed effects linear regression was used to estimate the association between homocysteine and muscle strength in men and women, separately. Results: Total mean follow-up time was 4.7 ± 3.1 years, range from 0 to 10.1 years. Baseline mean grip strength was 39.9 kg for men and 25.5 kg for women. Grip strength declined over the follow-up time for both men and women. Among women, there was a significant inverse relationship between homocysteine and grip strength, where grip strength declined as a function of increasing homocysteine over time (ß = -0.05, p = .031). Among men, an increase of 1 µmol/L in homocysteine was associated with -0.10 kg decrease in grip strength, though not significantly. Conclusions: In this study of healthy older adults aged 50 years or older, higher homocysteine was related to lower muscle strength in women. This is the first study to characterize the relationship over a long follow-up period. Future research should focus on assessing homocysteine as a marker of physical function decline and translating the relationship into clinical and public health practice.

A Community-Based Study of Staphylococcus aureus Nasal Colonization and Molecular Characterization Among Men Who Have Sex with Men.

PURPOSE: The aims of this cross-sectional study were to determine the prevalence of Staphylococcus aureus nasal colonization, evaluate community-related behavioral risk factors, and utilize staphylococcal protein A (spa) typing for epidemiological surveillance among community-based men who have sex with men from the National HIV Behavioral Surveillance System in Houston, Texas. METHODS: Descriptive methods and logistic analyses were used to determine associations with nasal colonization. RESULTS: The prevalence of S. aureus colonization was 29.7%; of these, 3.0% were colonized with methicillin-resistant S. aureus. Logistic analyses revealed that anal intercourse practices were associated with colonization (P < 0.05). A diverse population of 38 spa types was identified. CONCLUSION: Our findings suggest that an association among preferential sex practices, condom use, and S. aureus colonization exists and should be investigated further.