Systolic Blood Pressure and Survival to Very Old Age: Results From the Women's Health Initiative.

BACKGROUND: The relationship between systolic blood pressure (SBP) and longevity is not fully understood. We aimed to determine which SBP levels in women ≥65 years of age with or without blood pressure medication were associated with the highest probability of surviving to 90 years of age. METHODS: The study population consisted of 16 570 participants enrolled in the Women's Health Initiative who were eligible to survive to 90 years of age by February 28, 2020, without a history of cardiovascular disease, diabetes, or cancer. Blood pressure was measured at baseline (1993 through 1998) and then annually through 2005. The outcome was defined as survival to 90 years of age with follow-up. Absolute probabilities of surviving to 90 years of age were estimated for all combinations of SBP and age using generalized additive logistic regression modeling. The SBP that maximized survival was estimated for each age, and a 95% CI was generated. RESULTS: During a median follow-up of 19.8 years, 9723 of 16 570 women (59%) survived to 90 years of age. Women with an SBP between 110 and 130 mm Hg at attained ages of 65, 70, 75, and 80 years had a 38% (95% CI, 34%-48%), 54% (52%-56%), 66% (64%-67%), or 75% (73%-78%) absolute probability to survive to 90 years of age, respectively. The probability of surviving to 90 years of age was lower for greater SBP levels. Women at the attained age of 80 years with 0%, 20%, 40%, 60%, 80%, or 100% time in therapeutic range (defined as an SBP between 110 and 130 mm Hg) had a 66% (64%-69%), 68% (67%-70%), 71% (69%-72%), 73% (71%-74%), 75% (72%-77%), or 77% (74%-79%) absolute survival probability to 90 years of age. CONCLUSIONS: For women >65 years of age with low cardiovascular disease and other chronic disease risk, an SBP level <130 mm Hg was found to be associated with longevity. These findings reinforce current guidelines targeting an SBP target <130 mm Hg in older women.

Differences in Metabolomic Profiles Between Black and White Women and Risk of Coronary Heart Disease: an Observational Study of Women From Four US Cohorts.

BACKGROUND: Racial differences in metabolomic profiles may reflect underlying differences in social determinants of health by self-reported race and may be related to racial disparities in coronary heart disease (CHD) among women in the United States. However, the magnitude of differences in metabolomic profiles between Black and White women in the United States has not been well-described. It also remains unknown whether such differences are related to differences in CHD risk. METHODS: Plasma metabolomic profiles were analyzed using liquid chromatography-tandem mass spectrometry in the WHI-OS (Women's Health Initiative-Observational Study; 138 Black and 696 White women), WHI-HT trials (WHI-Hormone Therapy; 156 Black and 1138 White women), MESA (Multi-Ethnic Study of Atherosclerosis; 114 Black and 219 White women), JHS (Jackson Heart Study; 1465 Black women with 107 incident CHD cases), and NHS (Nurses' Health Study; 2506 White women with 136 incident CHD cases). First, linear regression models were used to estimate associations between self-reported race and 472 metabolites in WHI-OS (discovery); findings were replicated in WHI-HT and validated in MESA. Second, we used elastic net regression to construct a racial difference metabolomic pattern (RDMP) representing differences in the metabolomic patterns between Black and White women in the WHI-OS; the RDMP was validated in the WHI-HT and MESA. Third, using conditional logistic regressions in the WHI (717 CHD cases and 719 matched controls), we examined associations of metabolites with large differences in levels by race and the RDMP with risk of CHD, and the results were replicated in Black women from the JHS and White women from the NHS. RESULTS: Of the 472 tested metabolites, levels of 259 (54.9%) metabolites, mostly lipid metabolites and amino acids, significantly differed between Black and White women in both WHI-OS and WHI-HT after adjusting for baseline characteristics, socioeconomic status, lifestyle factors, baseline health conditions, and medication use (false discovery rate <0.05); similar trends were observed in MESA. The RDMP, composed of 152 metabolites, was identified in the WHI-OS and showed significantly different distributions between Black and White women in the WHI-HT and MESA. Higher RDMP quartiles were associated with an increased risk of incident CHD (odds ratio=1.51 [0.97-2.37] for the highest quartile comparing to the lowest; Ptrend=0.02), independent of self-reported race and known CHD risk factors. In race-stratified analyses, the RDMP-CHD associations were more pronounced in White women. Similar patterns were observed in Black women from the JHS and White women from the NHS. CONCLUSIONS: Metabolomic profiles significantly and substantially differ between Black and White women and may be associated with CHD risk and racial disparities in US women.

Experiences of cisgender youth with a transgender and/or nonbinary sibling.

While recent research has begun to address the effects of family support on transgender and/or nonbinary youth (TNY), almost no studies have directly examined how cisgender siblings in families with TNY navigate their sibling's gender disclosure and affirmation within both their families and their larger communities. We conducted an exploratory secondary analysis of in-person, semi-structured interviews with 15 adolescent and young adult siblings (age 13-24 years) of TNY from the northeastern United States from the baseline wave of the community-based, longitudinal, mixed methods Trans Teen and Family Narratives Project. Interview transcripts were analyzed using immersion/crystallization and template organizing approaches. Analyses yielded three main themes: gender-related beliefs and knowledge, peri- and post-disclosure family dynamics, and assessing responses to their sibling. Subthemes included anticipation of their sibling's TN identity, expectations post-disclosure, participants' level of involvement in gender-related family processes, perceptions of changes in family relationships, concern for their sibling (including a high degree of attunement to gender-affirming name and pronoun usage), and concern for themselves. Findings from this study suggest the need to engage directly with siblings of TNY to further elucidate their intrapersonal, intra-familial, and extra-familial experiences related to having a TN sibling and determine their unique support needs. Implications for families, clinicians, and communities are discussed.

Discrimination and Sleep: Differential Effects by Type and Coping Strategy.

BACKGROUND: Discrimination has been posited as a contributor of sleep disparities for Latinxs. The strategy used to cope with discrimination may reduce or exacerbate its effects on sleep. This study examined whether different types of discrimination (everyday and major lifetime discrimination) were associated with sleep indices (quality, disturbances, efficiency) and whether coping strategy used moderated associations. METHOD: Data of Latinx adults (N = 602; 51% women, 65% Dominican, Mage = 46.72 years) come from the Latino Health and Well-being Project, a community-based, cross-sectional study of Latinxs in Lawrence, MA. Multiple linear regressions were estimated separately for each sleep outcome. RESULTS: Everyday discrimination was significantly associated with poorer sleep quality and greater disturbances; major lifetime discrimination was significantly associated with worse sleep across the three sleep indices. Coping strategy moderated associations between discrimination and sleep. Compared with Latinxs who used passive coping, those who used passive-active coping strategies had poorer sleep quality the more they experienced everyday discrimination. Latinxs who used any active coping strategy, compared with passive coping, had greater sleep disturbances the more frequently they experienced major lifetime discrimination. CONCLUSIONS: Findings show that everyday discrimination and major lifetime discrimination are associated with different dimensions of sleep and suggest that coping with discrimination may require the use of different strategies depending on the type of discrimination experienced.

Experiencing discrimination can negatively affect sleep. But some coping strategies may reduce the negative impact of discrimination on sleep. This study investigated the link between multiple forms of discrimination (i.e., everyday and major lifetime) and various aspects of sleep, including quality, efficiency, and sleep disturbances. We also investigated whether the use of active coping (e.g., discussing discriminatory experiences) and passive coping (e.g., keeping discriminatory experiences to oneself) improved or worsened sleep outcomes. The study analyzed survey data from 602 Latinx adults. Individuals reported on their sleep, discrimination, and the coping strategies they used in response to discriminatory experiences. Everyday discrimination was related to poor sleep quality and more sleep disturbances. Lifetime discrimination was related to all sleep outcomes. Among those reporting more everyday discrimination, using both active and passive coping strategies was associated with poor sleep quality. Using any type of active coping was related to more sleep disturbances among individuals who reported more major lifetime discrimination. Selecting a coping strategy that is protective may depend on the frequency and type of discrimination.

Shift-and-persist strategies as a potential protective factor against symptoms of psychological distress among young adults in Puerto Rico.

OBJECTIVE: Residents of Puerto Rico are disproportionately exposed to social and environmental stressors (e.g., Hurricane María and the 2020 sequence of tremors) known to be associated with psychological distress. Shift-and-persist (SP), or the ability to adapt the self to stressors while preserving focus on the future, has been linked with lower psychological distress, but no study has evaluated this in Puerto Rico. This study examined the association between SP and psychological distress (including that from natural disasters) in a sample of young adults in Puerto Rico. METHODS: Data from the Puerto Rico-OUTLOOK study (18-29 y) were used. Participants (n = 1497) completed assessments between September 2020 and September 2022. SP was measured with the Chen scale and categorized into quartiles (SPQ1-SPQ4). Psychological distress included symptoms of depression (CESD-10), anxiety (STAI-10), post-traumatic stress disorder (Civilian Abbreviated Scale PTSD checklist), and ataque de nervios (an idiom of distress used by Latinx groups). Outcomes were dichotomized according to clinical cutoffs when available, otherwise used sample-based cutoffs. Two additional items assessed the perceived mental health impact of Hurricane María and the 2020 sequence of tremors (categorized as no/little impact vs. some/a lot). Adjusted prevalence ratios (PR) and their 95% confidence intervals (CI) were estimated. RESULTS: The most commonly reported psychological distress outcome was PTSD (77%). In adjusted models, compared to SP Q1, persons in SP Q2-Q4 were less likely to have elevated symptoms of depression (PR Q2 = 0.79, 95% CI = 0.72-0.85; PR Q3 = 0.65, 95% CI = 0.58-0.73; and PR Q4 = 0.41, 95% CI = 0.35-0.48), PTSD (PR Q2 = 0.92, 95% CI = 0.87-0.98; PR Q3 = 0.86, 95% CI = 0.80-0.93; and PR Q4 = 0.76, 95% CI = 0.70-0.83), anxiety (PR Q2 = 0.39, 95% CI = 0.31-0.48; PR Q3 = 0.27, 95% CI = 0.20-0.37; and PR Q4 = 0.11, 95% CI = 0.07-0.17) and experiences of ataque de nervios (PR Q2 = 0.85, 95% CI = 0.76-0.94; PR Q3 = 0.79, 95% CI = 0.70-0.90; and PR Q4 = 0.68, 95% CI = 0.60-0.78). Compared to persons in SP Q1, persons in SP Q3-Q4 were less likely to report adverse mental health impacts from Hurricane María (PR Q3 = 0.66, 95% CI = 0.55-0.79; and PR Q4 = 0.53, 95% CI = 0.44-0.65) and the 2020 sequence of tremors (PR Q3 = 0.77, 95% CI = 0.61-0.98; and PR Q4 = 0.74, 95% CI = 0.59-0.94). CONCLUSION: SP was associated with lower psychological distress. Studies are needed to confirm our findings and evaluate potential mechanisms of action.

Association between poor sleep quality and emotional eating in US Latinx adults and the mediating role of negative emotions.

INTRODUCTION: Poor sleep quality is associated with negative emotions and may modulate emotional eating (EE). However, this has not been studied among US Latinx adults, a group experiencing sleep disparities. OBJECTIVE: To examine the association between sleep quality and EE in Latinx adults and explore the mediating role of negative emotions. METHODS: This cross-sectional analysis used data from the Latino Health and Well-being Study. Sleep quality was measured with the Pittsburgh Sleep Quality Index. EE was measured with the EE subscale of the Three Factor Eating Questionnaire R18-V2 (categorized as no EE, low EE, and high EE). Negative emotions were measured via a composite score that included depression, anxiety, and perceived stress. Poisson regression models with robust variance errors estimated prevalence ratios (PR) and 95% confidence intervals (CI). Mediation was evaluated with the Karlsson-Holm-Breen method. RESULTS: More individuals with poor (vs. good) sleep quality experienced high EE (39.1% vs. 17.9%). Individuals with poor (vs. good) sleep quality were more likely to experience high EE vs. no EE (total effect = 1.74; 95% CI = 1.34, 2.26). Controlling for negative emotions, the effect of poor sleep on high EE was reduced to 1.23 (95% CI = 0.92, 1.65), leaving an indirect effect of 1.41 (95% CI = 1.25, 1.60); 62.6% of the effect was explained by negative emotions. CONCLUSION: Poor sleep quality was associated with high EE in US Latinx adults and negative emotions partially mediated this relationship. Longitudinal studies are needed. Interventions and clinical programs should concomitantly address sleep quality and negative emotions to help prevent dysfunctional eating behaviors.

Association Between Optimism and Negative Emotional Eating in Caribbean Latinx Adults in the Northeast US.

BACKGROUND: Negative emotional eating (EE) is associated with unfavorable behavioral and health outcomes. Understanding its association with positive factors, such as optimism, may shed light into novel interventions. We examined the association between optimism and negative EE in US Caribbean Latinx adults, a population disproportionately exposed to adversity. METHOD: This cross-sectional analysis used data from the Latino Health and Well-being Study (21-84 years; n = 579). Optimism was measured with the Life Orientation Test-Revised version. EE was measured with the Three-Factor Eating Questionnaire R18-V2. Adjusted Poisson models with robust error variance estimated prevalence ratios (PR). RESULTS: The proportion of individuals reporting high EE was greater in the low (39.0%) and moderate (36.8%) optimism groups than that in the high optimism group (24.8%; p = 0.011). Individuals with high optimism (vs. low) were less likely to report high EE over no EE (PR = 0.68; 95% CI = 0.53-0.88). CONCLUSION: High optimism was negatively associated with high EE. Future studies are needed to confirm our findings and test interventions promoting optimism for preventing negative EE in US Caribbean Latinx adults.

Empowering Youth Vaccine Ambassadors to Promote COVID-19 Vaccination in Local Communities: A 7-Step Approach.

Despite the availability of COVID-19 vaccines for youth since 2021, vaccine hesitancy has resulted in suboptimal uptake. Public health campaigns that empower local youth ambassadors as trusted messengers who share their personal narratives related to getting vaccinated hold promise for promoting COVID-19 vaccination. We used a seven-step approach to develop, implement, and evaluate a youth-led ambassador campaign to promote COVID-19 vaccine uptake in communities experiencing COVID-19 disparities in Worcester, MA. The seven steps included (1) engaging with key partners; (2) determining a community of focus; (3) identifying trusted sources; (4) determining campaign components; (5) training the vaccine ambassadors; (6) disseminating the campaign; and (7) evaluating the campaign. We trained nine youth as vaccine ambassadors. Ambassadors were guided through self-reflection of motivations for COVID-19 vaccination and the resulting personal narratives became the campaign messaging. English/Spanish vaccine messages developed by youth ambassadors were disseminated through social media platforms (n = 3), radio (n = 2), local TV (n = 2), flyers (n = 2,086), posters (n = 386), billboards (n = 10), and local bus ads (n = 40). Qualitative youth feedback indicate participation in the campaign was a positive and empowering experience which reinforces the importance of engaging youth in public health messaging. Youth empowerment through personal narratives (and storytelling) holds promise for future public health campaigns.

Adherence to the American Cancer Society Guidelines on nutrition and physical activity for cancer prevention and obesity-related cancer risk and mortality in Black and Latina Women's Health Initiative participants.

BACKGROUND: Although adherence to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention associates with lower risk of obesity-related cancer (ORC) incidence and mortality, evidence in Black and Latina women is limited. This association was examined in Black and Latina participants in the Women's Health Initiative (WHI). METHODS: Semi-Markov multistate model examined the association between ACS guideline adherence and ORC incidence and mortality in the presence of competing events, combined and separately, for 9301 Black and 4221 Latina postmenopausal women. Additionally, ACS guideline adherence was examined in a subset of less common ORCs and potential effect modification by neighborhood socioeconomic status and smoking. RESULTS: Over a median of 11.1, 12.5, and 3.7 years of follow-up for incidence, nonconditional mortality, and conditional mortality, respectively, 1191 ORCs (Black/Latina women: 841/269), 1970 all-cause deaths (Black/Latina women: 1576/394), and 341 ORC-related deaths (Black/Latina women: 259/82) were observed. Higher ACS guideline adherence was associated with lower ORC incidence for both Black (cause-specific hazard ratio [CSHR]highvs.low : 0.72; 95% CI, 0.55-0.94) and Latina (CSHRhighvs.low : 0.58, 95% CI, 0.36-0.93) women; but not conditional all-cause mortality (Black hazard ratio [HR]highvs.low : 0.86; 95% CI, 0.53-1.39; Latina HRhighvs.low : 0.81; 95% CI, 0.32-2.06). Higher adherence was associated with lower incidence of less common ORC (Ptrend  = .025), but conditional mortality events were limited. Adherence and ORC-specific deaths were not associated and there was no evidence of effect modification. CONCLUSIONS: Adherence to the ACS guidelines was associated with lower risk of ORCs and less common ORCs but was not for conditional ORC-related mortality. LAY SUMMARY: Evidence on the association between the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and cancer remains scarce for women of color. Adherence to the guidelines and risk of developing one of 13 obesity-related cancers among Black and Latina women in the Women's Health Initiative was examined. Women who followed the lifestyle guidelines had 28% to 42% lower risk of obesity-related cancer. These findings support public health interventions to reduce growing racial/ethnic disparities in obesity-related cancers.

Examination of the Allostatic Load Construct and Its Longitudinal Association With Health Outcomes in the Boston Puerto Rican Health Study.

OBJECTIVE: Despite evidence on allostatic load (AL) as a model explaining associations between stress and disease, there is no consensus on its operationalization. This study aimed to contrast various AL constructs and their longitudinal associations with disease and disability. METHODS: Baseline and 5-year follow-up data from 738 adults participating in the Boston Puerto Rican Health Study were used. Five AL scores were created by summing the presence of 21 dysregulated multisystem physiological parameters using the following: a) z scores, b) population-based quartile cutoffs, c) clinical-based cutoffs, d) 10 preselected clinical-based cutoffs (AL-reduced), and e) 12 clinical-based cutoffs selected a posteriori based on association with disease (AL-select). Adjusted logistic regression models examined associations between each AL score at baseline and 5-year incident type 2 diabetes (T2D), cardiovascular disease (CVD), activities (or instrumental activities) of daily living (ADL; IADL) for physical impairment, and cognitive impairment. RESULTS: AL-quartile was associated with greater odds of T2D (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 1.07-1.35) and CVD (OR = 1.14; 95% CI = 1.06-1.22). AL-reduced was associated with higher odds of IADL (OR = 1.21; 95% CI = 1.07-1.37) and AL-clinical with CVD (OR = 1.14; 95% CI = 1.07-1.21), IADL (OR = 1.11; 95% CI = 1.04-1.19), and ADL (OR = 1.15; 95% CI = 1.04-1.26). AL-select showed associations with T2D (OR = 1.35; 95% CI = 1.14-1.61), CVD (OR = 1.21; 95% CI = 1.11-1.32), IADL (OR = 1.15; 95% CI = 1.04-1.26), and ADL (OR = 1.24; 95% CI = 1.08-1.41). No associations were found with AL z-score. CONCLUSIONS: AL scores computed with clinical-based cutoffs performed robustly in our sample of mainland Puerto Ricans, whereas z scores did not predict disease and disability. AL-select was the most consistent predictor, supporting its use as a disease-predicting model. Future assessment of AL-select in other populations may help operationalize AL.

High Prevalence and Lack of Parental Awareness of Pediatric Hypertension Among a Low-income Sample in Worcester, MA.

OBJECTIVES: To identify frequency and correlates of hypertension in a low income, ethnically diverse, sample of children as well as to assess parental awareness of hypertension. METHODS: This cross-sectional study included parent-child dyads (n = 228), from which physical measurements of the child, and parent reported survey measures were collected. Child's blood pressure percentile was determined via 2017 American Academy of Pediatrics (AAP) clinical practice guidelines and categorized as normal (< 90th percentile), elevated (≥ 90th percentile to < 95th percentile), or hypertensive (≥ 95th percentile). Bivariate multinomial logistic regression models assessed the relative risk ratio for potential correlates of blood pressure categorization and frequency distribution of parental awareness of blood pressure status was examined. RESULTS: Median child age was 8.1 years (IQR 6.5-9.9). Half were female, 61.8% were Latino and 15.8% were Non-Latino Black. Median body mass index (BMI) percentile was 83.6 (IQR 58.4-97.1) and 31.6% exceeded the 95th percentile. AAP criteria for hypertension and elevated blood pressure were met by 30.7% and 14.3% of children respectively. After full adjustment, the relative risk of categorization as hypertensive versus normal increased by a factor of 1.16 (95% CI 1.02-1.3) per 10-unit increase in BMI percentile, and 0.86 (95% CI 0.74-1.0) per one-year increase in age. Less than five parents (redacted due to low sample size) reported their child having a history of high blood pressure. CONCLUSIONS: In this low income, racially/ethnically diverse sample, we observed levels of hypertension and elevated blood pressure considerably higher than national estimates. However, in contrast, extremely low parental awareness was observed.

Factors Associated with Risk of Perinatal Depressive Symptoms Among Puerto Rican Women with Hyperglycemia.

OBJECTIVES: Rates of perinatal depression and pregnancy hyperglycemia are higher in Hispanic women as compared to non-Hispanic white women. In turn, depressive symptoms may reduce a woman's ability to engage in lifestyle changes that could reduce their subsequent diabetes risk. METHODS: We conducted a secondary analysis using data from Estudio Parto to evaluate sociodemographic, behavioral, psychosocial, and medical factors associated with perinatal depressive symptoms. Estudio Parto was a randomized controlled trial conducted in Western Massachusetts from 2013 to 17. Eligible participants had pregnancy hyperglycemia. The Edinburgh Postnatal Depression Scale (EPDS) was administered at 24-28 weeks gestation and at 6 weeks, 6 months, and 12 months postpartum. An EPDS cutpoint of 10 or greater defined the presence of depressive symptoms. RESULTS: In this sample of Puerto Rican women with pregnancy hyperglycemia, 32% and 27% showed prenatal and postpartum depressive symptoms, respectively. Among participants, 35.5% were diagnosed with GDM, 44.3% with isolated hyperglycemia, and 20.2% with impaired glucose tolerance. In multivariable models, being unmarried (OR 3.87; 95% CI 1.51-9.94), prenatal substance use (smoking or alcohol consumption; OR 2.96; 95% CI 1.41-6.18), and maternal age (1.11 for each year; 95% CI 1.04-1.18) were associated with higher odds of prenatal depressive symptoms. None of the risk factors were associated with subsequent postpartum depression in adjusted analyses. CONCLUSIONS: Identifying factors associated with prenatal and postpartum depression in Puerto Rican women with pregnancy hyperglycemia can inform targeted lifestyle interventions in this at-risk group, increase the likely adoption of healthy lifestyle behaviors, and thereby work to address health disparities. CLINICALTRIALS: gov NCT01679210; date of registration 08/07/2012.

The Impact of a Randomized Controlled Trial of a Lifestyle Intervention on Sleep Among Latina Postpartum Women.

BACKGROUND: Poor sleep is associated with adverse outcomes among postpartum women. Exercise may improve sleep, but this has not been well examined in the postpartum period. PURPOSE: To examine the impact of a culturally modified, individually tailored lifestyle intervention on sleep outcomes among postpartum Latina women. METHODS: Estudio PARTO was a randomized controlled trial aimed at reducing Type 2 diabetes among Latina women with abnormal glucose tolerance in pregnancy. Participants were randomized to a lifestyle (i.e., diet and exercise; n = 70) or a health and wellness control intervention (n = 78) in late pregnancy (baseline). The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality (PSQI score), onset latency (minutes per night), duration (hours per night), efficiency (percentage of the time in bed asleep), and daytime dysfunction at baseline, 6 weeks, 6 months, and 12 months postpartum. RESULTS: Mean PSQI score (6.56 ± 3.87), sleep duration (6.84 ± 1.75 hr/night), and sleep efficiency (79.70% ± 18.10%) did not differ between the arms at baseline. Mixed-effects models indicated a greater decrease of 1.29 in PSQI score (i.e., improved sleep quality) in the lifestyle versus health and wellness arm (95% confidence interval [CI] = -2.50 to -0.08, p = .04) over follow-up. There was the suggestion of a smaller decrease in sleep duration (mean = 0.48 hr/night, 95% CI = -0.10 to 1.06, p = .10) in the lifestyle versus health and wellness arm. There were no statistically significant differences in other sleep outcomes between arms. CONCLUSIONS: Findings suggest that lifestyle interventions improve sleep quality but not sleep duration, sleep onset latency, sleep efficiency, or daytime dysfunction in postpartum Latina women and, therefore, may hold promise for improving subsequent mental and physical health in this population. CLINICAL TRIALS REGISTRATION: NCT01679210.

A youth empowerment intervention to prevent childhood obesity: design and methods for a cluster randomized trial of the H2GO! program.

BACKGROUND: Reducing sugar-sweetened beverage (SSB) consumption is a promising dietary target for childhood obesity prevention. This paper describes the design and methods of a cluster randomized trial of H2GO!, a youth empowerment intervention to prevent childhood obesity through reducing SSB consumption among a low-income, ethnically diverse sample of youth. METHODS: This cluster randomized controlled trial is an academic-community partnership with the Massachusetts Alliance of Boys and Girls Clubs (BGC). Ten BGC sites will be randomly assigned to the H2GO! intervention or a wait-list, usual care control. Eligible study participants will be N = 450 parent-child pairs (youth ages 9-12 years and their parents/caregivers) recruited from participating BGCs. The 6-week in-person H2GO! intervention consists of 12 group-based sessions delivered by BGC staff and youth-led activities. An innovative feature of the intervention is the development of youth-produced narratives as a strategy to facilitate youth empowerment and parental engagement. Child outcomes include measured body mass index z scores (zBMI), beverage intake, and youth empowerment. Parent outcomes include beverage intake and availability of SSBs at home. Outcomes will be measured at baseline and at 2, 6, and 12 months. With a 75% retention rate, the study is powered to detect a minimum group difference of 0.1 zBMI units over 12 months. DISCUSSION: Empowering youth may be a promising intervention approach to prevent childhood obesity through reducing SSB consumption. This intervention was designed to be delivered through BGCs and is hypothesized to be efficacious, relevant, and acceptable for the target population of low-income and ethnically diverse youth. TRIAL REGISTRATION: ClinicalTrials.gov NCT04265794 . Registered 11 February 2020.

Healthy Eating Policy Strategies in Community Health Improvement Plans: A Cross-Sectional Survey of US Local Health Departments.

CONTEXT: Policies (eg, regulations, taxes, and zoning ordinances) can increase opportunities for healthy eating. Community Health Improvement Plans (CHIP) may foster collaboration and local health department (LHD) engagement in policy decision making to improve local food environments. Limited research describes what policies supportive of healthy food environments are included in CHIPs nationally and relationships between LHD characteristics and participation in plans including such policies. OBJECTIVES: To determine the proportion of US LHDs who participated in development of a CHIP containing healthy eating policy strategies and assess the association between LHD characteristics and inclusion of any healthy eating policy strategy in a CHIP. DESIGN: A cross-sectional national probability survey. PARTICIPANTS: Of the 209 US LHDs (serving populations <500 000) (response rate: 30.2%), 176 LHDs with complete data on CHIP status, outcomes, and covariates were eligible for analysis. MAIN OUTCOME MEASURES: Thirteen healthy eating policy strategies were organized into 3 categories: increasing availability/identification of healthy foods, reducing access to unhealthy foods, and improving school food environments. Strategies and categories were identified from literature and public health recommendations. RESULTS: In total, 32.2% of LHDs reported inclusion of 1 or more healthy eating policy strategies in a CHIP. The proportion of departments reporting specific strategies ranged from 20.8% for school district policies to 1.1% for sugar-sweetened beverage taxes. Local health departments serving 25 000 to 49 999 residents (odds ratio [OR]: 5.00; 95% confidence interval [CI]: 1.71-14.63), 100 000 to 499 999 residents (OR: 3.66; 95% CI: 1.12-11.95), pursuing national accreditation (OR: 4.46; 95% CI: 1.83-10.83), or accredited (OR: 3.22; 95% CI: 1.08-9.63) were more likely to include 1 or more healthy eating policy strategies in a CHIP than smaller LHDs (<25 000) and LHDs not seeking accreditation, respectively, after adjusting for covariates. CONCLUSIONS: Few LHDs serving less than 500 000 residents reported CHIPs that included a policy-based approach to improve food environments, indicating room for improvement. Population size served and accreditation may affect LHD policy engagement to enhance local food environments.

Supports for Maternal Communication About Peer Pressure to Have Sex Among Puerto Rican Families.

This research tests the independent contribution of social capital and the use of the internet to obtain health information to support maternal-child communication about peer pressure to have sex among Puerto Rican families. A sample of 413 Puerto Rican households in Springfield, MA provides the data to independently test these hypotheses. The results of a logistic regression model suggest that Puerto Rican mothers with increased social capital and who accessed the internet for health information are more likely to communicate with their adolescent children about peer pressure to have sex. The combination of these two mechanisms provide opportunities to convey culturally generated resources to Puerto Rican mothers to assist them in helping their children develop healthy sexual behaviors.

A Systems-Level Approach to Improving Medication Adherence in Hypertensive Latinos: a Randomized Control Trial.

BACKGROUND: Despite numerous interventions targeting medication adherence in patients with uncontrolled hypertension, practice-based trials in Latino patients are scant. OBJECTIVE: To evaluate the effect of a systems-level adherence intervention, delivered by medical assistants (MAs), versus a comparison condition on medication adherence and blood pressure (BP) in 119 hypertensive Latino patients who were initially non-adherent to their antihypertensive medications. STUDY DESIGN: Randomized control trial. PARTICIPANTS: Patients (50% women; mean age, 61 years) were recruited from April 2013 to August 2015 in a community-based practice in New York. INTERVENTION: Systems-level approach that included an office system component built into the electronic health record and a provider support component consisting of nine MA-delivered health coaching sessions for improving medication adherence. The comparison group received the standard health coaching procedures followed at the clinic. MAIN OUTCOME MEASURES: The primary outcome was rate of medication adherence measured by an electronic monitoring device (EMD) across 6 months. The secondary outcomes were self-reported medication adherence measured by the eight-item Morisky Medication Adherence Scale (MMAS-8) and BP reduction from baseline to 6 months. KEY RESULTS: Adherence as measure by EMD worsened for both groups (p = 0.04) with no between-group difference (- 9.6% intervention and - 6.6% control, p = 0.66). While systolic BP improved in both groups, the difference between groups was not significant (- 6 mmHg in intervention vs. - 2.7 mmHg in control, p = 0.34). In contrast, the intervention group had a greater improvement in self-reported adherence (mean change 1.98 vs. 1.26, p = 0.03) when measured using the MMAS-8. CONCLUSIONS: Among Latinos with poorly controlled BP who were non-adherent to their antihypertensive medications, a systems-level intervention did not improve adherence as measured by EMD nor blood pressure. However, many patients reported challenges to using the EMD. Improvements in self-reported adherence suggest that this measure captures different aspects of adherence behavior than EMD. CLINICAL TRIAL REGISTRATION: NCT03560596.

Changes in Glycemic Load Are Positively Associated with Small Changes in Primary Stress Markers of Allostatic Load in Puerto Rican Women.

BACKGROUND: Puerto Ricans experience a high prevalence of type 2 diabetes. Dietary glycemic load (GL) and allostatic load (AL) have been linked with diabetes. AL, the wear and tear on the body from chronic stress, starts with secretion of primary stress markers from activation of the hypothalamic-pituitary-adrenal (HPA) axis, sympathetic nervous system (SNS), and immune system. GL can act as a physiological stressor, contributing to the primary AL response. OBJECTIVE: We examined the relation between GL and a composite score of primary stress markers of AL in Puerto Rican adults. METHODS: Data were from the Boston Puerto Rican Health Study, a cohort study of Puerto Ricans, aged 45-75 y, including 262 men and 697 women with complete data at baseline and 2-y follow-up. GL was calculated from dietary intake obtained with an FFQ. Sex-specific composite primary AL scores included markers of the HPA axis (cortisol and dehydroepiandrosterone sulfate), SNS (epinephrine and norepinephrine), and immune system (C-reactive protein). Linear regression models were stratified by sex and adjusted for covariates. RESULTS: Mean ± SD baseline GL score was 155 ± 28 for men and 135 ± 34 for women. Mean primary stress AL score was 1.25 ± 1.14 for men and 1.25 ± 1.06 for women. GL was not associated with AL score in men. In women, increasing GL from baseline to 2 y was significantly associated with increasing AL, after adjusting for sociodemographics, physical activity, smoking, BMI, menopause, and baseline AL score (ß = 0.03; P = 0.049). Results became marginally significant after further adjustment for chronic diseases (P = 0.06) and intake of fats (P values: saturated fats = 0.08; trans fats = 0.06; unsaturated fats = 0.07), but the magnitude of the association remained unchanged. CONCLUSIONS: Increasing GL over 2 y was positively associated with increasing composite score of primary markers of AL in Puerto Rican women. More studies are needed to confirm our findings.

Association between food insecurity and emotional eating in Latinos and the mediating role of perceived stress.

OBJECTIVE: To examine the association between food insecurity and emotional eating (EE) in US Latinxs and explore the mediating role of perceived stress. DESIGN: Cross-sectional analysis. Food insecurity was measured with the six-item US Department of Agriculture Household Food Security Scale; EE with the Three-Factor Eating Questionnaire R18-V2; and perceived stress with Cohen's Perceived Stress Scale-10. Covariates included age, sex, education, marital status, household size and country of birth. Mediation was tested using the Baron and Kenny method and the mediated proportion was calculated. Analyses included multivariable linear regression and multinomial logistic regression. SETTING: A largely Latinx city in Massachusetts, USA. Participants were recruited from a community health centre serving a large portion of this Latinx community. PARTICIPANTS: Latinx individuals (n 580), aged 21-84 years. RESULTS: Overall, 34·4 % were food insecure and 33·8 % experienced High EE. Food insecurity was associated (adjusted OR; 95 % CI) with higher odds of High EE (1·96; 1·28, 3·02) but not Low EE (1·27; 0·82, 1·99). Food insecurity was associated (ß; 95 % CI) with higher perceived stress (5·69; 4·20, 7·19). Perceived stress was associated (adjusted OR; 95 % CI) with High EE (1·09; 1·06, 1·12) but not Low EE (1·00; CI 0·97, 1·02). When perceived stress was added in the main effects model, food insecurity was no longer associated (OR; 95 % CI) with High EE (1·31; 0·83, 2·07) and explained 69·9 % of the association between food insecurity and High EE. CONCLUSIONS: The association between food insecurity and high EE among Latinxs may be largely mediated by perceived stress. Longitudinal studies are needed.

Reducing sugary drink intake through youth empowerment: results from a pilot-site randomized study.

BACKGROUND: Efficacious strategies to reduce sugar-sweetened beverage (SSB) consumption among youth are needed. This pilot study assessed the feasibility and preliminary efficacy of a community-based youth empowerment intervention to reduce SSB consumption and obesity risk among a low-income, ethnically diverse sample of youth. METHODS: The H2GO! intervention was pilot-tested in an afterschool setting (Boys and Girls Clubs (BGC)) in Massachusetts, USA. One site was randomized to receive the intervention; the other site received standard programming. Youth ages 9-12 years and their parents/caregivers were eligible to participate. A total of N = 110 parent-child pairs (N = 55 parent-child pairs per site) were recruited. The 6-week intervention consisted of group-based weekly sessions delivered by trained BGC staff and youth-led activities that engaged parents. Child outcomes included self-reported SSB and water intake and measured body mass index z scores (zBMI). Parent outcomes included self-reported SSB and water intake, SSB purchasing, and availability of SSBs at home. Outcomes were measured at baseline, 2 months, and 6 months. Generalized linear and logistic regression models were used to estimate intervention effects over time. RESULTS: The final analytic study sample consisted of 100 child participants (38% Black, 20% Hispanic, 13% White, 12% Multiracial, 11% Asian) and 87 parent participants (78.2% female; 78.2% reporting eligibility for the free-or-reduced price lunch program). 6-month retention rates were ≥ 82%. Intervention attendance rates among intervention child participants (N = 51) averaged 78.1% (SD = 10.3). Over half (56.0%) of child participants were overweight or obese at baseline. Relative to the comparison site, intervention site child participants had decreased SSB intake (ß = - 1.64; 95% CI: 2.52, - 0.76), increased water intake (ß = 1.31; 95% CI: 0.38, 2.23), and decreased zBMI (- 0.23 units; 95% CI: - 0.31, - 0.14) over 6 months (p < 0.001). Intervention parent participants also reported decreased SSB intake (ß = - 1.76; 95% CI: - 2.56, - 0.96) and increased water intake (ß = 1.75; 95% CI: 1.11, 2.40) than comparison parent participants at 6 months (p < 0.001). CONCLUSIONS: Findings demonstrate the potential of a youth empowerment intervention on reducing SSB intake and zBMI among a diverse sample. Findings will guide a larger cluster-randomized controlled trial to test intervention efficacy on preventing childhood obesity, as well as inform future interventions that aim to target additional diet and physical activity behaviors through youth empowerment. TRIAL REGISTRATION: ClinicalTrials.gov NCT02890056 . Registered 31 August 2016.