Impact of food allergy on food insecurity and health literacy in a tertiary care pediatric allergy population.

BACKGROUND: Food insecurity (FI), limited availability of or access to nutritional foods, is linked to poor child/caregiver health. We examined FI in food-allergic and non-food-allergic children to determine whether dietary limitations associated with food allergy increases risk of FI. METHODS: Food-allergic and non-food-allergic children (1-17 years) were recruited from Arkansas Children's Hospital allergy/asthma clinics. The USDA Food Security Survey, the Newest Vital Sign Health Literacy (HL) questionnaire, and the Food Allergy Impact Scale QOL survey were administered. Logistic regression and analysis of covariance models were utilized for data analysis. RESULTS: Subjects (n = 650) included 325 food-allergic and 325 non-food-allergic children. Overall rate of FI was 21.5% (food allergic 22.2% and non-food allergic 20.9%) with no significant difference in the prevalence of FI between groups (OR = 1.30; 95% CI 0.86-1.96; P = 0.21). FI was increased in households of children with both milk and egg allergy when compared to those without food allergy and those with single food allergy (OR = 2.5; 95% CI 1.4-4.6; P = 0.003). Mean HL rates were higher in the food-secure vs food-insecure groups (mean diff = 0.31; 95% CI 0.03-0.59; P = 0.03). Among food-allergic children, QOL was better in the food-secure vs food-insecure group (mean diff = 0.61; 95% CI 0.002-1.23; P = 0.049). CONCLUSION: Food allergy to milk and egg was associated with increased risk of household FI. Food-insecure participants had lower HL than their food-secure counterparts. Further work is needed to define risks associated with FI among food-allergic children to improve screening and management strategies.

Effects of allergen sensitization on response to therapy in children with eosinophilic esophagitis.

BACKGROUND: In children with eosinophilic esophagitis (EoE) foods are the most common disease triggers, but environmental allergens are also suspected culprits. OBJECTIVE: To determine the effects of environmental allergen sensitization on response to treatment in children with EoE in the southeastern United States. METHODS: Patients 2 to 18 years old who were referred to the Arkansas Children's Hospital Eosinophilic Gastrointestinal Disorders Clinic from January 2012 to January 2016 were enrolled in a prospective, longitudinal cohort study with collection of demographics, clinical symptoms, medical history, allergy sensitization profiles, and response to treatment over time. Comparisons were made between complete responders (peak esophageal eosinophil count <15 per high-power field [HPF]) and nonresponders (>25 eosinophils per HPF) after treatment with diet elimination alone, swallowed corticosteroids alone, or diet elimination and swallowed corticosteroids. Sensitization patterns to environmental allergens found in the southeastern United States were analyzed for the effect on treatment response. RESULTS: A total of 223 individuals were enrolled. Of these, 182 had environmental allergy profiling and at least one endoscopy while receiving proton pump inhibitor (PPI) therapy. Twenty-nine individuals had PPI-responsive EoE and were excluded from further analysis, leaving 123 individuals with non-PPI-responsive EoE who were further analyzed; 72 (58.5%) were complete responders and 33 (26.8%) were nonresponders. Seventeen individuals (13.8%) were partial responders (≥1 but ≤25 eosinophils per HPF) and excluded from further analysis. Nonresponders were more likely to be sensitized to perennial allergens (P = .02). There was no significant difference in response based on seasonal allergen sensitization. Individuals with mold or cockroach sensitization were more likely to fail combination diet and swallowed corticosteroid treatment (P = .02 and P = .002). CONCLUSION: Perennial allergen and mold sensitization may lead to nonresponse to EoE treatment in some patients. Additional studies are needed to further understand the effect of environmental allergens on EoE. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01779154.

Correlates of physical activity in urban Midwestern African-American women.

BACKGROUND: African-American women are at higher risk than white women of cardiovascular disease and stroke. In addition, fewer African-American women reap the cardiovascular benefits of exercise, because of low physical activity. The study goals were to identify personal, social environmental, and physical environmental correlates of physical activity of urban-dwelling, Midwestern, African-American women and to obtain their recommendations for increasing exercise in their communities. METHODS: A face-to-face interview (Women and Physical Activity Survey) covering personal, social environmental, and physical environmental correlates of physical activity was administered to 399 volunteer African-American women aged 20 to 50 years, living in Chicago. Physical activity was measured with questions on lifestyle and planned leisure-time activity (exercise) from the Behavioral Risk Factor Surveillance System. RESULTS: The women were from a wide socioeconomic spectrum of education and income. Forty-two percent of the women met current recommendations for moderate or vigorous physical activity; 48% were insufficiently active; and 9% were inactive. The following groups of women were more likely to be physically active: women with at least a high school education; women with perceived good health; women who knew people who exercise; and women who viewed the neighborhood as safe. These findings were statistically significant. CONCLUSIONS: Interventions that target urban African-American women must address the safety of the physical environment and personal and social environmental correlates of physical activity, and they should focus especially on inactive women who have less than a high school education or perceive themselves to be in poor health.

Correlates of physical activity in urban Midwestern Latinas.

BACKGROUND: Latinas (Latino women) are at higher risk than non-Latina white women of cardiovascular disease and stroke, primarily because of higher rates of obesity and type-2 diabetes mellitus. Increases in physical activity help control these cardiovascular risk factors, but a higher percentage of Latinas than white women are inactive. The study goals were to identify personal, social environmental, and physical environmental correlates of physical activity of urban-dwelling, Midwestern Latinas and to obtain their recommendations for increasing exercise in their communities. METHODS: A face-to-face interview (Women and Physical Activity Survey) that covered personal, social environmental, and physical environmental correlates of physical activity was performed with 300 volunteer Latinas (242 in Spanish, 58 in English), aged 20 to 50 years, living in Chicago. Physical activity was measured with questions on lifestyle and planned leisure activity (exercise) from the Behavioral Risk Factor Surveillance System survey. RESULTS: The sample consisted of urban-dwelling Latinas who were primarily from Mexico and who spoke predominantly Spanish. The breakdown was as follows: 36% met current recommendations for moderate or vigorous physical activity, 52.3% were insufficiently active, and 11.7% were inactive. Physical activity was higher among younger women, married women, and women with the following characteristics: had some confidence about becoming more active, saw people exercising in the neighborhood, attended religious services, or lived in areas with heavy traffic. CONCLUSIONS: Interventions need to focus on encouraging Latinas, especially those who are older, to reach the level of physical activity recommended to benefit health. The church may be a suitable community setting for initiating programs that provide women with the knowledge, skills, and motivation to become more active so that they can bring back to the larger Latina community.

Demographic characteristics, menopausal status, and depression in midlife immigrant women.

The purpose of this cross-sectional analysis is to examine symptoms of depressed mood in relation to age, menopausal status, and length of residence in the United States in midlife women who are recent immigrants from the former Soviet Union. Data for this analysis are from a longitudinal study of the impact of acculturation on postimmigration health status and psychological well-being. The mean score for the Center for Epidemiological Studies-Depression (CES-D) scale was 23.56, with 77.3% of the women obtaining a score greater than the usual screening cutoff score for referral. Women taking antidepressant medications had a mean score of 30.52. CES-D scores varied significantly by age group. The lowest CES-D scores were reported by women aged 40-50, and women aged 55-60 had significantly higher scores than younger women and those over 65 years old. Total CES-D scores did not vary significantly by length of residence in United States or use of hormone therapy. Regression analysis indicated that even when use of antidepressant medication was held constant, age and residence in the United States were significant independent contributors to CES-D score: women who were older, had lived fewer years in the United States, and those who took antidepressants had higher CES-D scores. Cultural and immigration-related explanations for high scores on the depression scale are suggested.

Acculturation and cardiovascular disease risk in midlife immigrant women from the former Soviet Union.

This study examines relationships among acculturation, depression, and cardiovascular risk factors in midlife women from the former Soviet Union and identifies factors predicting Framingham Risk Scores. Data were collected at baseline and 1 year later from 218 participants in a longitudinal study of postimmigration health. The leading risk factors were obesity, dyslipidemia, and depression. Older women had lower American Behavioral Acculturation subscale scores, higher Russian Behavioral Acculturation subscale scores, and higher depression scores. Length of residence was significantly correlated with American behavioral acculturation but not Russian behavioral acculturation. Baseline body mass index, both acculturation scores, and depression scores predicted Framingham Risk Scores after 1 year, but serum glucose did not. The results suggest that contrary to findings in other immigrant groups, women from the former Soviet Union may decrease their risk for coronary heart disease as they assume a more American lifestyle. Nursing interventions to address the high cardiovascular disease risk in this population are suggested.

Midlife women's adherence to home-based walking during maintenance.

BACKGROUND: Despite the many known benefits of physical activity, some women (27%) report no leisure-time physical activity in the prior month. Of those women who began an exercise program, the dropout rate was as high as 50% in the first 3-6 months. The challenge for researchers and clinicians is to identify those factors that influence not only adoption, but also maintenance, of physical activity. OBJECTIVE: The purpose of this study was (a) to describe midlife women's maintenance of walking following the intervention phase of a 24-week, home-based walking program, and (b) to identify the effects of background characteristics, self-efficacy for overcoming barriers to exercise, and adherence to walking during the intervention phase on retention and adherence to walking. METHODS: There were Black and White women participants (N = 90) aged 40-65 years who completed a 24-week, home-based walking program. Self-efficacy for overcoming barriers to exercise, maximal aerobic fitness, and percentage of body fat were measured at baseline, 24 weeks, and 48 weeks. Adherence was measured with heart-rate monitors and an exercise log. RESULTS: Retention was 80% during maintenance. On average, the women who reported walking during maintenance adhered to 64% of the expected walks during that phase. Examination of the total number of walks and the number and sequence of weeks without a walk revealed dynamic patterns. The multiple regression model explained 40% of the variance in adherence during the maintenance phase. DISCUSSION: These results suggest that both self-efficacy for overcoming barriers and adherence during the intervention phase play a role in women's walking adherence. The findings reflect dynamic patterns of adopting and maintaining new behavior.

Acculturation, resilience, and depression in midlife women from the former Soviet Union.

BACKGROUND: A growing body of literature has demonstrated that demographic factors and acculturative stress contribute to depression in recent immigrants from many countries. Few studies examine potentially protective personality factors, such as resilience, for dealing with the challenges related to the early postmigration transition period. OBJECTIVES: The purpose of this analysis is to examine relationships among demographic characteristics, acculturation, psychological resilience, and symptoms of depression in midlife women from the former Soviet Union who recently immigrated to the United States. METHOD: Data for this analysis are from a larger cross-sectional study that explored the impact of immigration during midlife on women's health. The volunteer sample included 200 women from the former Soviet Union, 45-65 years old, who had lived in the U.S. fewer than 6 years. This analysis involves measures of acculturation, demands of immigration, resilience, and depressed mood. RESULTS: Findings include very high scores on the depression scale compared to U.S. norms. Older women, and those reporting greater demands of immigration, had higher scores on the depression scale. However, lower depression scores were found for women reporting greater English usage and resilience. DISCUSSION: The results corroborate previous studies that suggest high levels of depression in immigrant women, but additional validation is suggested to differentiate symptoms of depressed mood from clinical depression in this culture. Findings also suggest that interventions that encourage use of English language and enhance resilience may help decrease symptoms of depression in midlife women who are recent immigrants from the former Soviet Union.

Determinants of physical activity and adherence to a 24-week home-based walking program in African American and Caucasian women.

The purposes of this study were to: (a) identify which determinants of physical activity among African American and Caucasian women predict adherence to a 24-week home-based walking program; and (b) explore differences between African American and Caucasian women. Participants were 153 working women who were sedentary at leisure. The program included an exercise prescription, instructions, and support. Background determinants included demographics, previous exercise experience, and social role influences. Intrapersonal determinants (self-efficacy, self-determinism) were measured at baseline and 24 weeks. Adherence was measured with heart rate monitors and logs. Adherence was significantly higher in Caucasians, those with less previous exercise experience, and those with higher self-efficacy. Findings suggest that adherence to a walking program is influenced by multiple factors including background and intrapersonal determinants of physical activity.

Environmental, policy, and cultural factors related to physical activity in urban, African American women.

This study was part of a multi-site project carried out with seven universities throughout the United States to identify cultural, environmental, and policy determinants of physical activity in ethnic minority women aged 20 to 50 years. Following an extensive literature review, nine core research questions were created to examine potential barriers to physical activity as well as enabling factors. Methods and findings presented are from six focus groups of low-income, urban African American women. These focus groups were held at each of two health centers serving communities in Chicago, Illinois, that are predominantly African American and low income and have households usually headed by women. Forty-eight women participated, with 5 to 11 in each group. Most (85%) were unmarried, 40% had less than a high school education, and 33% were neither employed nor attending school. Findings reflected the influence of a culture of poverty and the importance of environmental safety and community support. The findings will be used to inform the development of community-based exercise interventions and policies that are culturally and socially sensitive to the needs of low-income, urban African American women.

Cardiovascular disease risk factors and menopausal status in midlife women from the former Soviet Union.

The purpose of this cross-sectional analysis is to examine modifiable CVD risk factors in relation to menopausal status, age, and length of residence in the U.S. of midlife women from the former Soviet Union. The analysis includes baseline data for 193 women, aged 40-70, who lived in the U.S. fewer than 8 years and were enrolled in an ongoing four-year study of post-immigration health and behavior change. Data collection was conducted in women's homes or other community locations. The presence of seven health risk indicators (obesity, dyslipidemia, high blood pressure, diabetes mellitus, sedentary lifestyle, smoking, and excessive alcohol use) was assessed. In addition, Framingham 10 year risk scores for heart disease, and the presence of metabolic syndrome, were calculated using recent National Cholesterol Education Program (ATP-III) guidelines. Consistent with the age distribution, 60% of the women were postmenopausal. Four risk indicators (obesity, dyslipidemia, high blood pressure, and sedentary lifestyle) were identified as significant areas of concern. Although the Framingham risk scores did not seem excessively high, almost 25% of the women had metabolic syndrome. Older and postmenopausal women had significantly higher scores on all risk estimates. When age and menopausal status were held constant, menopausal status remained an independent contributor for the number of CVD risk indicators. Issues specific to this group of women because of their pre- and post-migration lifestyles are discussed in relation to their CVD risk status.