Mental health, substance use, and a composite of sleep health in adults, 2018 Ohio behavioral risk factor surveillance system.

OBJECTIVES: Various factors impact sleep health including mental health and substance use. Mental health issues and substance use continue to rise in the United States. Yet, the association between mental health, substance use and sleep health in adults remains unclear. METHODS: We used multivariable linear regression models to examine the associations between mental health (poor mental health days in the past 30 days) and substance use (marijuana, tobacco, alcohol) with sleep health (individual dimensions of sleep: alertness, sleep efficiency, duration, and sleep health composite score) in 4333 participants from the 2018 Ohio Behavioral Risk Factor Surveillance System Survey. RESULTS: Better mental health was associated with higher alertness, higher sleep efficiency, longer sleep duration and a higher sleep health composite score even after controlling for covariates (individual: sex at birth, age, body mass index, race, education, sleep disordered breathing, and area-level: socioeconomic deprivation) (all p < .001). Higher marijuana and tobacco use were associated with lower individual sleep health dimensions (marijuana with sleep efficiency and duration and tobacco use with lower efficiency) and a lower sleep health composite score even after controlling for covariates for tobacco use (p < .001). Contrary to the hypothesis, higher alcohol use was associated with higher alertness and a higher sleep health composite score (p < .001), however after adjusting for covariates these associations were no longer significant. CONCLUSIONS: The implications of these trends on sleep health are important to address as mental health and substance use are modifiable targets to consider when addressing sleep health.

Brief Report: Relationship Between Adiposity and Biomarkers of Aging and Frailty Among Adults Aging With HIV.

BACKGROUND: This study examined the relationships among adiposity, handgrip, physical function, inflammation (ie, senescence-associated secretory phenotype chemokines as biomarkers of aging and frailty), and sex hormones in aging people with HIV. METHODS: This cross-sectional exploratory study included 150 people with HIV aged ≥40 years (67.3% of participants were male). Our measures included (1) body mass index and waist circumference as measures of adiposity; (2) handgrip as a measure of muscle strength; (3) short physical performance battery as a measure of physical function; (4) interleukin-6, tumor necrosis factor alpha receptor II, high sensitivity C-reactive protein, C-X-C motif chemokine 10, and C-X3-C motif chemokine ligand 1 also known as fractalkine as senescence-associated secretory phenotype chemokines; and (5) free testosterone, estradiol, sex hormone-binding globulin, and dehydroepiandrosterone as sex hormones. Quantile regression analyses were used to identify relationships among inflammatory markers and hormones with age, adiposity, handgrip, and physical function. RESULTS: Overall, 74% (n = 111) of participants were classified as overweight or obese and 53.3% (n = 80) presented with abdominal obesity. After controlling for age and sex, body mass index was positively associated with estradiol (ß = 0.043, P < 0.01), and waist circumference was positively associated with high sensitivity C-reactive protein (ß = 2.151, P < 0.01). After controlling for sex, age was positively associated with C-X-C motif chemokine 10 (ß = 0.024, P = 0.03) and tumor necrosis factor alpha receptor II (ß = 2.205, P = 0.01). After controlling for age and sex, short physical performance battery was negatively associated with dehydroepiandrosterone (ß = -0.004, P = 0.01); no statistically significant associations were observed for handgrip. CONCLUSION: Adiposity levels and aging were associated with inflammation (ie, C-X-C motif chemokine 10, tumor necrosis factor alpha receptor II, and high sensitivity C-reactive protein) among people with HIV aged 40 years and older.

Impact of Perceived Cardiovascular Risk on Cardiovascular Disease Prevention Behaviors in People With and Without HIV Infection.

BACKGROUND: People living with HIV (PLHIV) are at elevated risk of developing atherosclerotic cardiovascular disease (ASCVD). PLHIV do not engage in recommended levels of ASCVD prevention behaviors, perhaps due to a reduced perception of risk for ASCVD. We examined how HIV status influences knowledge, beliefs, and perception of risk for ASCVD and ASCVD prevention behaviors. METHODS AND RESULTS: We conducted a mixed-methods study of 191 PLHIV and demographically similar HIV-uninfected adults. Participants completed self-reported surveys on CVD risk perceptions, adherence to CVD medication (aspirin, antihypertensives, and lipid-lowering medication) and 3 dietary intake interviews. All wore an accelerometer to measure physical activity. A subset of PLHIV (n = 38) also completed qualitative focus groups to further examine the influence of HIV on knowledge, perception of risk for ASCVD, and behavior. PARTICIPANTS: They were approximately 54 (±10) years, mostly men (n = 111; 58%), and African American (n = 151, 83%) with an average 10-year risk of an ASCVD event of 10.4 (±8.2)%. PLHIV were less likely to engage in physical activity (44% vs 65%, P < 0.05), and HIV status was associated with 43 fewer minutes of physical activity per week (P = 0.004). Adherence to ASCVD medications was better among PLHIV (P < 0.001). Diet composition was similar between groups (P > 0.05). HIV status did not influence ASCVD risk perceptions (P > 0.05) and modestly influenced physical activity and smoking. CONCLUSIONS: Although perceptions of ASCVD risk modestly influence some behaviors, additional barriers and insufficient cues to action result in suboptimal physical activity, dietary intake, and smoking rates. However, PLHIV have high adherence to ASCVD medications, which can be harnessed to reduce their high burden of ASCVD.

Randomized Controlled Trial of the SystemCHANGE Intervention on Behaviors Related to Cardiovascular Risk in HIV+ Adults.

OBJECTIVE: To examine the effect of a lifestyle behavior intervention (SystemCHANGE) on physical activity and diet quality among sedentary people living with HIV (PLHIV). All participants expressed a desire to improve lifestyle health behaviors. METHODS: One hundred and seven HIV+ adults were randomized to either the intervention (6, in-person, standardized group sessions focusing on improving lifestyle behaviors) or a control condition (general advice on AHA diet and exercise guidelines). All participants wore an ActiGraph accelerometer and completed 24-hour dietary recalls at baseline, 3, and 6 months. Generalized estimating equations were used to examine intervention effects. The primary activity outcome was time spent in moderate-to-vigorous physical activity, and the primary dietary outcome was Healthy Eating Index. RESULTS: Mean age was 53 years, 65% were male, and 86% African American. Approximately 90% attended at least half of the sessions and 60% attended 5 or more sessions. The intervention did not significantly improve our primary lifestyle behavior endpoints (P ≥ 0.05); however, intervention participants consumed fewer carbohydrates-primarily sugar-sweetened beverages-per day and lost 0.732 kg body weight compared with a 0.153 weight gain in the control group (P = 0.03). CONCLUSIONS: Among sedentary PLHIV at high risk of cardiovascular disease, the SystemCHANGE intervention reduced daily carbohydrate intake and body weight, but did not increase physical activity or improve overall diet quality. Future work should identify fundamental personal, interpersonal, and contextual factors that will increase physical activity and improve overall diet quality among this population, and integrate these factors into tailored, lifestyle interventions for aging PLHIV.