Modifiable Factors and Incident Gout Across Ethnicity Within a Large Multiethnic Cohort of Older Adults.

OBJECTIVE: Gout disproportionately affects older Pacific Islander and Black populations relative to White populations. However, the ethnic-specific determinants remain understudied within these groups, as well as within other ethnicities. We examined gout incidence and associations with behavioral factors, including diet, alcohol, and smoking, within a large multiethnic population of older adults from the Multiethnic Cohort Study, which linked prospective cohort data to Medicare gout claims between 1999-2016. METHODS: Using samples of Black (n = 12,370), Native Hawaiian (n = 6459), Japanese (n = 29,830), Latino (n = 17,538), and White (n = 26,067) participants, we conducted multiple Cox regressions, producing hazard ratios (HRs) and 95% CIs. RESULTS: Relative to White individuals, Native Hawaiians had the highest risk of gout (HR 2.21, 95% CI 2.06-2.38), followed successively by Black and Japanese participants, whereas Latino individuals had a lower risk of gout (HR 0.78, 95% CI 0.73-0.83). Alcohol use was associated with an increased risk, with significantly greater effects observed among Japanese participants drinking ≥ 3 drinks per day (HR 1.46, 95% CI 1.27-1.66), or > 5 beers per week (HR 1.29, 95% CI 1.17-1.43), compared to White individuals (Pinteraction < 0.001). Former smokers with ≥ 20 pack-years had an increased risk (HR 1.14, 95% CI 1.06-1.22). Higher dietary quality was associated with a decreased gout risk, with the largest effect observed among White participants (HRQ5vsQ1 0.84, 95% CI 0.79-0.90), whereas vitamin C was weakly associated with a decreased risk of gout only among Japanese individuals (HR 0.91, 95% CI 0.85-0.98). CONCLUSION: Overall, notable ethnic differences were observed in both gout risk and associations with modifiable behavioral factors. Our findings offer crucial insights that may improve precision in preventing and managing gout.

Frailty syndrome and risk of cardiovascular disease: Analysis from the International Mobility in Aging Study.

OBJECTIVE: To investigate the association between frailty and a summary cardiovascular risk measure (Framingham Risk Score, FRS) in a sample of older adults from different epidemiologic contexts participating in the multicenter International Mobility in Aging Study (IMIAS). MATERIAL AND METHODS: This cross-sectional study used data from the IMIAS, which is composed of older adults from four different countries (Canada, Albania, Colombia and Brazil). A total of 1724 older adults aged 65-74 years were assessed. Frailty was defined as the presence of 3 or more of the following criteria: unintentional weight loss in the last year, exhaustion, muscle weakness, slowness in gait speed, and low levels of physical activity. The FRS was calculated to estimate the 10-year risk for cardiovascular disease (CVD), based on: sex, age, systolic blood pressure (SBP), and treatment for hypertension, total and high-density lipoprotein (HDL) cholesterol, diabetes mellitus status and smoking habits. Confounders included measures of childhood social and economic adversity, as well as mid-life and adult adversity. RESULTS: After adjustment for adversities which occurred during in early, adult or current life, frail individuals presented higher FRS values (ß = 3.81, 95 %CI: 0.97-6.65, p-value <0.001) when compared to robust participants. A statistically significant relationship was also observed in prefrail participants with FRS (ß = 1.61, 95 % CI: 0.72-3.02, p-value <0.05). CONCLUSION: Frailty and prefrailty were associated to FRS, independent of life course adversities. Screening cardiovascular risk factors should be a target, mainly in those who present frailty syndrome.

Self-Measured Blood Pressure Monitoring: Program Planning, Implementation, and Lessons Learned From 5 Federally Qualified Health Centers in Hawai'i.

Self-measured blood pressure monitoring programs (BPMPs) are effective at controlling hypertension. We examined implementation of self-measured BPMPs at 5 Hawai'i-based Federally Qualified Health Centers (FQHCs). In a process evaluation of these programs, we found that FQHCs developed protocols for self-measured BPMP recruitment and enrollment and provided additional supports to account for their patients' psychosocial needs to achieve blood pressure control, such as lifestyle change education and opportunities through referrals either to on-site or other programs (eg, on-site gym, tobacco cessation program). Common barriers across sites included insufficient material support for blood pressure monitors and data collection; funding, which affects program sustainability; and the lack of an "off-the-shelf" self-measured BPMP intervention. Policy makers and funding organizations should address these issues related to self-measured BPMPs to ensure implementation success.

Insights in Public Health: Development, Implementation, and Evaluation of the Prevent Diabetes, Hawai'i Campaign.

The Prevent Diabetes, Hawai'i campaign aimed to increase awareness of prediabetes by encouraging adults to take a Diabetes Risk Test and share the results with their doctors or healthcare providers. The campaign was developed based on social marketing principles, and focus groups were used to inform the marketing mix. Television, radio, digital, and print advertisements featured local actor and comedian Frank De Lima, and a website with an online Diabetes Risk Test and resources for patients and providers were promoted in all advertisements. From March 2017 to November 2019, more than 55,000 Hawai'i residents visited the campaign website. Campaign outcomes were assessed through state-added questions to the 2017 Behavioral Risk Factor Surveillance System. Overall, 35.0% of adults said that they remembered seeing or hearing an advertisement featuring Frank De Lima and/or the Prevent Diabetes, Hawai'i message. Five percent of respondents reported taking an online or paper version of the Diabetes Risk Test in the past 12 months, and an additional 19.7% said that they planned to take it. Among those who reported taking the Diabetes Risk Test, 60.2% said they had already spoken to their doctor or other healthcare provider about the test results or risk for type 2 diabetes. The State Department of Health will continue efforts to increase awareness of type 2 diabetes and prediabetes, reach priority populations most at risk, and expand availability of evidence-based lifestyle change programs.

The Healthy Hawai'i Initiative: insights from two decades of building a culture of health in a multicultural state.

BACKGROUND: The Healthy Hawai'i Initiative was created in 2000 with tobacco settlement funds as a theory-based statewide effort to promote health-supporting environments through systems and policy change. Still active today, it is imbedded explicitly in a multi-sectoral, social ecological approach, effectively striving to build a culture of health before this was the name for such an ambitious effort. METHODS: From interviews with key informants, we analyze two decades of the Healthy Hawai'i Initiative (HHI) in the context of the Robert Wood Johnson Foundation (RWJF) Culture of Health Action Framework (CHAF). We list HHI accomplishments and examine how the Initiative achieved notable policy and environmental changes supportive of population health. RESULTS: The Healthy Hawai'i Initiative started with an elaborate concept-mapping process that resulted in a common vision about making "the healthy choice the easiest choice." Early on, the Initiative recognized that making health a shared value beyond the initial stakeholders required coalition and capacity building across a broad range of governmental and nonprofit actors. HHI coalitions were designed to promote grassroots mobilization and to link community leaders across sectors, and at their height, included over 500 members across all main islands of the state. Coalitions were particularly important for mobilizing rural communities. Additionally, the Initiative emphasized accessibility to public health data, published research, and evaluation reports, which strengthened the engagement to meet the shared vision and goals between diverse sector partners and HHI. Over the past two decades, HHI has capitalized on relationship building, data sharing, and storytelling to encourage a shared value of health among lawmakers, efforts which are believed to have led to the development of health policy champions. All of these factors combined, which centered on developing health as a shared value, have been fundamental to the success of the other three action areas of the CHAF over time. CONCLUSIONS: This evidence can provide critical insights for other communities at earlier stages of implementing broad, diverse, multifaceted system change and fills a key evidence gap around building a culture of health from a mature program in a notably multicultural state.

Age at natural menopause and physical functioning in postmenopausal women: the Canadian Longitudinal Study on Aging.

OBJECTIVE: The aim of this study was to evaluate the association between categories of age at natural menopause (ANM) and gait speed (slowness) and grip strength (weakness), common measures of physical functioning in older women. METHODS: We analyzed data from the Canadian Longitudinal Study on Aging, which included participants from seven cities across Canada collected in 2012. The sample was restricted to women who reported to have entered menopause (N = 9,920). Women who had a hysterectomy before menopause were excluded since the age at which this surgical procedure was performed was not available. ANM was categorized into five groups: less than 40 (premature), 40 to 44 (early), 45 to 49, 50 to 54, and more than 54. We conducted linear regressions to assess the association between ANM and gait speed (m/s) and grip strength (kg) adjusting for participant age, education, body mass index, smoking, use of hormone therapy, height, and province of residence. RESULTS: Mean ANM was 49.8 (95% confidence interval [CI]: 49.7-50.0), with 3.8% of women having a premature menopause; the average gait speed was 0.98 m/s (standard deviation: 0.22), the average grip strength was 26.6 kg (standard deviation: 6.39). Compared to women with ANM of 50 to 54, women with premature menopause had 0.054 m/s (95% CI -0.083, -0.026) lower gait speed when adjusting for age and study site. In the fully adjusted model, the association was attenuated, 0.032 m/s (95% CI -0.060, -0.004). ANM was not associated with grip strength. CONCLUSION: Our study suggests that premature menopause (<40 years) may be associated with lower gait speed (slowness) among Canadian women. No association was observed between ANM and grip strength. Future studies should include a life course approach to evaluate whether social and biological pathways modify the association between age at menopause and physical function in populations from different contexts.

Insights in Public Health: Formative Factors for a Statewide Tobacco Control Advocacy Infrastructure: Insights from Hawai'i.

Hawai'i has comprehensive statewide tobacco control policies and was the first US state to raise the minimum age of sale, purchase, and possession of tobacco products to age 21 ("Tobacco 21") in a policy including not just cigarettes, but also electronic smoking devices and other tobacco products. This insights article provides strategic thinking about tobacco control advocacy planning. Specifically, we identify formative factors critical to building and sustaining our cross-sector, statewide advocacy infrastructure that has been able to address many ongoing challenges of tobacco-use prevention and control over time. This can provide new insights for other large-scale tobacco-control advocacy efforts.

Model-based recursive partitioning to identify risk clusters for metabolic syndrome and its components: findings from the International Mobility in Aging Study.

OBJECTIVE: Conceptual models underpinning much epidemiological research on ageing acknowledge that environmental, social and biological systems interact to influence health outcomes. Recursive partitioning is a data-driven approach that allows for concurrent exploration of distinct mixtures, or clusters, of individuals that have a particular outcome. Our aim is to use recursive partitioning to examine risk clusters for metabolic syndrome (MetS) and its components, in order to identify vulnerable populations. STUDY DESIGN: Cross-sectional analysis of baseline data from a prospective longitudinal cohort called the International Mobility in Aging Study (IMIAS). SETTING: IMIAS includes sites from three middle-income countries-Tirana (Albania), Natal (Brazil) and Manizales (Colombia)-and two from Canada-Kingston (Ontario) and Saint-Hyacinthe (Quebec). PARTICIPANTS: Community-dwelling male and female adults, aged 64-75 years (n=2002). PRIMARY AND SECONDARY OUTCOME MEASURES: We apply recursive partitioning to investigate social and behavioural risk factors for MetS and its components. Model-based recursive partitioning (MOB) was used to cluster participants into age-adjusted risk groups based on variabilities in: study site, sex, education, living arrangements, childhood adversities, adult occupation, current employment status, income, perceived income sufficiency, smoking status and weekly minutes of physical activity. RESULTS: 43% of participants had MetS. Using MOB, the primary partitioning variable was participant sex. Among women from middle-incomes sites, the predicted proportion with MetS ranged from 58% to 68%. Canadian women with limited physical activity had elevated predicted proportions of MetS (49%, 95% CI 39% to 58%). Among men, MetS ranged from 26% to 41% depending on childhood social adversity and education. Clustering for MetS components differed from the syndrome and across components. Study site was a primary partitioning variable for all components except HDL cholesterol. Sex was important for most components. CONCLUSION: MOB is a promising technique for identifying disease risk clusters (eg, vulnerable populations) in modestly sized samples.

Early maternal age at first birth is associated with chronic diseases and poor physical performance in older age: cross-sectional analysis from the International Mobility in Aging Study.

BACKGROUND: Early maternal age at first birth and elevated parity may have long-term consequences for the health of women as they age. Both are known risk factors for obstetrical complications with lifelong associated morbidities. They may also be related to diabetes and cardiovascular disease development. METHODS: We examine the relationship between early maternal age at first birth, defined as ≤18 years of age, multiparity (>2 births), and poor physical performance (Short Physical Performance Battery≤8) in community samples of women between 65 and 74 years of age from Canada, Albania, Colombia, and Brazil (N=1040). Data were collected in 2012 to provide a baseline assessment for a longitudinal cohort called the International Mobility in Aging Study. We used logistic regression and general linear models to analyse the data. RESULTS: Early maternal age at first birth is significantly associated with diabetes, chronic lung disease, high blood pressure, and poor physical performance in women at older ages. Parity was not independently associated with chronic conditions and physical performance in older age. After adjustment for study site, age, education, childhood economic adversity and lifetime births, women who gave birth at a young age had 1.75 (95% CI: 1.17-2.64) the odds of poor SPPB compared to women who gave birth>18 years of age. Adjustment for chronic diseases attenuated the association between early first birth and physical performance. Results were weaker in Colombia and Brazil, than Canada and Albania. CONCLUSIONS: This study provides evidence that adolescent childbirth may increase the risk of developing chronic diseases and physical limitations in older age. Results likely reflect both the biological and social consequences of early childbearing and if the observed relationship is causal, it reinforces the importance of providing contraception and sex education to young women, as the consequences of early pregnancy may be life-long.