Understanding Barriers and Strategies to Accessing Healthy Food in Urban Agriculture for Community Residents in Predominantly Black Communities.

BACKGROUND: Some residents in predominantly Black communities face significant challenges in accessing healthy food. However, urban agriculture is a growing sector that aims to increase overall food production, access to affordable and nutritious produce, and potentially improve community food security. PURPOSE: This study aimed to provide insight into barriers and strategies that urban agriculture growers and advocates identified for accessing urban agriculture markets in their communities. RESEARCH DESIGN AND STUDY SAMPLE: We interviewed and conducted focus groups with 17 urban growers and local food advocates that work in predominantly Black communities in Chicago. DATA COLLECTION AND/OR ANALYSIS: Understanding the complexities of access to healthy food can be challenging; therefore, we used the concept of access - accessibility, availability, affordability, accommodation, and acceptability - to better understand these barriers. RESULTS: Key barriers were the lack of accessibility to traditional food retailers, high availability of processed foods, and cultural acceptability of urban-produced foods. CONCLUSION: Building urban agriculture networks to support growers, connect with consumers, and emphasize political engagement can help to diversify and grow urban agriculture.

COVID-19 Vaccine Decision-Making Among Black Pregnant and Postpartum Women.

INTRODUCTION: The history of biomedical research is marred by racially discriminatory and abusive practices that impacted Black/African Americans. Medical racism impacts the trust and utilization of new medical interventions, such as the COVID-19 vaccine. This study aimed to understand Black pregnant and postpartum women's perspectives and decision-making about the COVID-19 vaccine. METHODS: We used a qualitative descriptive design and recruited 23 pregnant and postpartum Black women aged 18 years and above. Data was collected using a semi-structured interview guide. Data were analyzed using content analysis. FINDINGS: The participants described factors influencing their decision to receive or not receive the COVID-19 vaccines. These factors included individual, cultural, ethnicity, religious, and family-related factors (individual-personal beliefs influenced decisions about the vaccine; ethnicity, culture, and religion influenced vaccine decision-making; group-family and friends played a role in decision-making), vaccine or vaccination-related issues (concerns about vaccination and pregnancy outcomes and mistrust in the vaccine information), and contextual influence (sources of vaccine information influenced decision-making and healthcare providers influenced decision-making). CONCLUSION: Understanding the vaccine decision-making process of underserved populations likely to decline vaccination due to pregnancy, postpartum, and breastfeeding status will help design tailored interventions to improve vaccine acceptance in minority communities, especially for pregnant and postpartum women.

Sleep Quality, Metabolic Function, Physical Activity, and Neurocognition Among Individuals with Resistant Hypertension.

BACKGROUND: Resistant hypertension (RH) is a major risk factor for stroke, cognitive decline, and dementia. Sleep quality is increasingly suggested to play an important role linking RH to cognitive outcomes, although the mechanisms linking sleep quality to poor cognitive function have yet to be fully delineated. OBJECTIVE: To delineate biobehavioral mechanisms linking sleep quality, metabolic function, and cognitive function among 140 overweight/obese adults with RH in the TRIUMPH clinical trial. METHODS: Sleep quality was indexed using actigraphy measures of sleep quality and sleep fragmentation, as well as self-reported sleep quality from the Pittsburgh Sleep Quality Index (PSQI). Cognitive function was assessed using a 45-minute battery assessing executive function, processing speed, and memory. Participants were randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA) for 4 months. RESULTS: Better sleep quality at baseline was associated with better executive function (B = 0.18 p = 0.027), as well as greater fitness (B = 0.27, p = 0.007) and lower HBA1c (B = -0.25, p = 0.010). Cross-sectional analyses revealed that the sleep quality executive function association was mediated by HBA1c (B = 0.71 [0.05, 2.05]). C-LIFE improved sleep quality (-1.1 [-1.5, -0.6] versus+-0.1 [-0.8, 0.7]) and actigraphy steps (+922 [529, 1316] versus+56 [-548, 661]), with actigraphy mediating improvements in executive function (B = 0.40 [0.02, 1.07]). CONCLUSION: Better metabolic function and improved physical activity patterns levels play important roles linking sleep quality and executive function in RH.

Infant Outcomes in Hypertensive Women: Are there Moderating Effects of Prenatal Care and Race/Ethnicity?

BACKGROUND: Hypertensive disorders of pregnancy is one of the leading causes of adverse infant outcomes. Black women are disproportionately affected by hypertensive disorders of pregnancy, and it associated adverse outcomes. Adequate prenatal care may improve adverse infant outcomes. However, the evidence on adequate prenatal care improving birth outcomes for women with hypertensive disorders of pregnancy especially for Blacks is limited. This study examined the role of adequate prenatal care and race/ethnicity as moderators of hypertensive disorders of pregnancy on infant outcomes. METHODS: The sample was obtained from the 2016-2019 Pregnancy Risk Assessment Monitoring Surveillance dataset from North Carolina. We compared adequate prenatal care among women with hypertensive disorders of pregnancy (n = 610) to women without(n = 2,827), and women with hypertensive disorders of pregnancy with adequate prenatal care to women hypertensive disorders of pregnancy with inadequate prenatal care. RESULTS: The weighted prevalence of hypertensive disorders of pregnancy was 14.1%. Adequate prenatal care was associated with better infant outcomes for low birth weight (AOR = 0.72; 95% CI = 0.58, 0.90) and preterm birth (AOR = 0.62; 95% CI = 0.46, 0.82). Although these effects were not moderated by Black race/ethnicity, Black women independently also had worse outcomes for preterm birth (AOR = 1.59; 95% CI = 1.11, 2.28) and low birth weight (AOR = 1.81; 95% CI = 1.42, 2.29). CONCLUSIONS: Moderation of hypertensive disorders of pregnancy effects on infant outcomes by prenatal care and race/ethnicity was not found. Women with hypertensive disorders of pregnancy who received inadequate prenatal care experienced worse adverse birth outcomes compared to women without hypertensive disorders of pregnancy. Strategies to improve prenatal care, particularly among underserved populations at risk for hypertensive disorders of pregnancy, need to be a public health priority.

Cardiovascular Disease-Related Emergency Department Visits and Hospitalization among Women with Hypertensive Disorders of Pregnancy.

INTRODUCTION: The risk of developing cardiovascular disease is higher for women who had hypertensive disorders of pregnancy than for women without a history of hypertensive disorders of pregnancy. However, it is unknown whether the emergency department visits and hospitalization differ between women with a history of hypertensive disorders of pregnancy and women without hypertensive disorders of pregnancy. The objective of this study was to characterize and compare cardiovascular disease-related emergency department visits, hospitalization rates, and diagnoses in women with a history of hypertensive disorders of pregnancy with those in women without. METHODS: This study included participants from the California Teachers Study (N=58,718) with a history of pregnancy and data from 1995 through 2020. Incidence of cardiovascular disease-related emergency department visits and hospitalizations based on linkages with hospital records were modeled using multivariable negative binomial regression. Data were analyzed in 2022. RESULTS: A total of 5% of the women had a history of hypertensive disorders of pregnancy (5.4%, 95% CI=5.2%, 5.6). A total of 31% of women had 1 or more cardiovascular disease-related emergency department visits (30.9%), and 30.1% had 1 or more hospitalizations. The incidence of cardiovascular disease-related emergency department visits (adjusted incident rate ratio=8.96, p<0.001) and hospitalizations (adjusted incident rate ratio=8.88, p<0.001) were significantly higher for women with hypertensive disorders of pregnancy than for those without, adjusting for other related characteristics of the women. CONCLUSIONS: History of hypertensive disorders of pregnancy is associated with higher cardiovascular disease-related emergency department visits and hospitalizations. These findings underscore the potential burden on women and the healthcare system of managing complications associated with hypertensive disorders of pregnancy. Evaluating and managing cardiovascular disease risk factors in women with a history of hypertensive disorders of pregnancy is necessary to avoid cardiovascular disease-related emergency department visits and hospitalizations in this group.

Inflammation moderates the effects of lifestyle modification on neurocognition among individuals with resistant hypertension.

Individuals with resistant hypertension (RH) have the greatest risk of cerebrovascular disease and cognitive impairment among individuals with hypertension. Elevated levels of pro-inflammatory cytokines may represent a critical yet unexamined factor influencing the impact of healthy lifestyle changes on cognitive function. We explored the influence of inflammation on changes in cognition following lifestyle modification among individuals with RH participating in the TRIUMPH clinical trial. One hundred forty participants with RH completed a battery of neurocognitive tests along with the inflammatory marker C-reactive protein (hsCRP) and were subsequently randomized to an intensive 4-month lifestyle modification intervention or to education and physician advice control. Results indicated that the effects of lifestyle modification on Executive Function and Learning were moderated by pre-intervention hsCRP levels (P = .049), with treatment efficacy increasing across levels of baseline inflammation levels (low: d = 0.12; mild: d = 0.43; moderate: d = 0.81). We conclude that inflammatory profiles may help identify individuals more likely to improve executive functioning resulting from lifestyle modification.

Exploring illness perceptions of multimorbidity among community-dwelling older adults: a mixed methods study.

Background: Illness perceptions are individual beliefs or experiences about the nature and treatment of their illness. Although extensive research exists about illness perceptions, little is known about illness perceptions of multimorbidity. Methods: The purpose of this parallel-convergent mixed-methods study was to comprehensively explore illness perception of multimorbidity among community dwelling older adults. Data was collected using one-on-one semi-structured interviews (n=17) and the Multimorbidity Illness Perception Scale (MULTIPleS) (n=116). Qualitative data were analyzed using content analysis while quantitative data were analyzed with descriptive and inferential statistics. Both qualitative and quantitative findings were integrated to identify differences in illness perceptions of multimorbidity by participant's socio-demographic and illness-related characteristics. Results: Overall, participants were mostly female (71%), self-reported as Hispanic (35%), Black (33%), White (27%), or Asian (5%). From the content analysis of the qualitative data, we described three themes pertaining to Illness perception of multimorbidity which were influenced by both participants' socio-demographic and illness-related characteristics: (1) inter-relationships between conditions (2) consequences and priorities and (3) impact of multimorbidity on wellbeing. While inferential analysis of quantitative data indicated statistically significant differences across only socio-demographic characteristics such as race/ethnicity (causal links, prioritization, summary scale) and educational attainment (prioritization subscale). Mixed analysis of qualitative and quantitative findings confirmed that illness perception of multimorbidity may not differ by the number of chronic conditions. Conclusions: Illness perception of multimorbidity may not differ by the number of chronic conditions the participants had. Rather, participants prioritized the impact of multimorbidity on their overall wellbeing, placing less importance on the number of their chronic conditions. Additional studies are needed to further characterize illness perceptions of multimorbidity and develop interventions that extend beyond disease-focused interventions to address holistic needs of older adults with multimorbidity.

Addressing challenges faced by underrepresented biomedical investigators and efforts to address them: An NHLBI-PRIDE perspective.

Junior investigators from groups underrepresented in the biomedical workforce confront challenges as they navigate the ranks of academic research careers. Biochemical research needs the participation of these researchers to adequately tackle critical research priorities such as cardiovascular health disparities and health inequities. We explore the inadequate representation of underrepresented minority investigators and the historical role of systemic racism in impacting their poor career progression. We highlight challenges these investigators face, and opportunities to address these barriers are identified. Ensuring adequate recruitment and promotion of underrepresented biomedical researchers fosters inclusive excellence and augments efforts to address health inequities. The Programs to Increase Diversity among Individuals Engaged in Health-Related Research (PRIDE), funded by the National Heart, Lung, and Blood Institute (NHLBI), is a pilot program by the National Institutes of Health (NIH) that aims to address these challenges yet, only a limited number of URM can be accepted to PRIDE programs. Hence the need for additional funding for more PRIDE or PRIDE-like programs. Here we aim to examine the challenges underrepresented minority biomedical investigators face and describe ongoing initiatives to increase URM in biomedical research using the NHLBI-PRIDE program as a focus point.

Lifestyle modification and cognitive function among individuals with resistant hypertension: cognitive outcomes from the TRIUMPH trial.

BACKGROUND: Resistant hypertension is associated with increased risk of cognitive decline, stroke, and dementia. Lifestyle modification has been suggested to improve cognitive function through its salutary effects on vascular function. METHODS: Participants included 140 patients with resistant hypertension participating in the TRIUMPH trial. Participants were randomized to a cardiac rehabilitation-based lifestyle program (C-LIFE) or a standardized education and physician advice condition (SEPA). Participants completed a 45-min cognitive test battery consisting of tests of Executive Functioning and Learning, Memory, and Processing Speed. Biomarkers of vascular [flow mediated dilation of the brachial artery (FMD)], microvascular, and cerebrovascular function were also collected, in addition to weight, fitness, and ambulatory blood pressure. RESULTS: Participants averaged 63 years of age, 48% women, 59% black, and obese [mean BMI = 36 kg/m 2 (SD = 4)]. Cognitive performance improved across the entire cohort during the 4-month trial [ t -scores pretreatment = 48.9 (48, 50) vs. posttreatment = 50.0 (49, 51), P  < 0.001]. Postintervention Executive Function/Learning composite performance was higher for participants in C-LIFE compared to SEPA ( d  = 0.37, P  = 0.039). C-LIFE intervention effects on Memory and Processing Speed were moderated by sex and baseline stroke risk, respectively ( P  = 0.026 and P  = 0.043 for interactions), such that males and participants with greater stroke risk showed the greatest cognitive changes. FMD [C-LIFE: +0.3% (-0.3, 1.0) vs. SEPA: -1.4% (-2.5, -0.3), P  = 0.022], and microvascular function [C-LIFE: 97 (65, 130) vs. SEPA: 025 (-75, 23), P  < 0.001] were improved in C-LIFE compared with SEPA, whereas cerebrovascular reactivity was not [C-LIFE: -0.2 (-0.4, 0) vs. SEPA: 0.1 (-0.2, 0.4), P  = 0.197). Mediation analyses suggested that increased executive function/learning was associated with reduced ambulatory SBP levels secondary to weight loss [indirect effect: B  = 0.25 (0.03, 0.71)]. CONCLUSION: Lifestyle modification individuals with resistant hypertension improves cognition, which appeared to be associated with reduced ambulatory SBP changes through weight loss. Cognitive improvements were accompanied by parallel improvements in endothelial and microvascular function.

Hypertension and infant outcomes: North Carolina pregnancy risks assessment monitoring system data.

This study examined the risk factors that moderate the relationship between hypertension and infant outcomes or were independent risk factors in a large and diverse sample of pregnant women with and without hypertension before conception. The sample included 2,996 women, where 197 had hypertension. Black women comprised 35.5% of the hypertension group relative to 19.7% of non-hypertension. Women with hypertension were more likely to have more preterm births (17.7% vs. 7.4%; ARR = 1.91, p <.001) and have infants with low birth weights (16.8% vs. 6.7%; ARR = 2.26, p <.001), independent of other maternal risk factors in logistic modeling. Maternal Black race versus White also was independently associated with preterm birth (ARR = 1.42, p =.045) and low birth weight (ARR = 1.72, p <.001). Maternal age and race did not significantly moderate the effects of hypertension on infant outcomes, but both Black race and hypertension status were independently associated with adverse birth outcomes.

Cerebrovascular Function, Vascular Risk, and Lifestyle Patterns in Resistant Hypertension.

BACKGROUND: Impaired cerebrovascular reactivity (CVR) and blunted cerebral hemodynamic recruitment are thought to be important mechanisms linking hypertension to cerebrovascular and cognitive outcomes. Few studies have examined cardiovascular or dietary correlates of CVR among hypertensives. OBJECTIVE: To delineate associations between cardiometabolic risk, diet, and cerebrovascular functioning among individuals with resistant hypertension from the TRIUMPH trial (n = 140). METHODS: CVR was assessed by examining changes in tissue oxygenation (tissue oxygenation index [TOI] and oxygenated hemoglobin [HBO2]) using functional near-infrared spectroscopy (fNIRS) during a breath holding test, a standardized CVR assessment to elicit a hypercapnic response. Participants also underwent fNIRS during three cognitive challenge tasks. Vascular function was assessed by measurement of brachial artery flow-mediated dilation and hyperemic flow response. Cardiometabolic fitness was assessed from peak VO2 on an exercise treadmill test and body mass index. Dietary patterns were quantified using the DASH eating score. Cognitive function was assessed using a 45-minute test battery assessing Executive Function, Processing Speed, and Memory. RESULTS: Greater levels fitness (B = 0.30, p = 0.011), DASH compliance (B = 0.19, p = 0.045), and lower obesity (B = -0.30, p = 0.004), associated with greater changes in TOI, whereas greater flow-mediated dilation (B = 0.19, p = 0.031) and lower stroke risk (B = -0.19, p = 0.049) associated with greater HBO2. Similar associations were found for cerebral hemodynamic recruitment, and associations between CVR and cognition were moderated by duration of hypertension. CONCLUSION: Impaired CVR elevated cardiometabolic risk, obesity, vascular function, and fitness among hypertensives.

Racial Disparities in Neighborhood and Household Socioeconomic Disadvantage Predict Postpartum Weight Retention.

Introduction: Structural racism leads to neighborhood-level socioeconomic disadvantage, which determines adverse birth outcomes. Individual socioeconomic disadvantage is associated with compromised healthy pregnancy outcomes. This study aimed to investigate the pathways by which race, neighborhood socioeconomic disadvantage, and household socioeconomic disadvantage predict subsequent maternal postpartum weight retention. Method: A total of 176 (N=176) racially diverse women were studied from the third trimester to 6 months after delivery. Neighborhood socioeconomic disadvantage was defined by information from the American Community Survey based on women's census tract and self-reports of neighborhood healthy food availability, safety, violence, and walking environment. Household socioeconomic disadvantage included food insecurity, income-to-needs ratio, and maternal education. Pregnancy health risk was operationalized using a summative index that included prepregnancy overweight/obesity, excessive gestational weight gain, and diagnosed hypertensive disorders during pregnancy. Postpartum weight retention was operationalized as a 6-month postpartum weight minus prepregnancy weight. Data were analyzed using structural equation modeling with bootstrapped CIs to estimate indirect effects. Results: One third of participants retained more than 22 lbs. of pregnancy weight gain 6 months after delivery. Increased household socioeconomic disadvantage (ß=0.64, p=0.039) and pregnancy health risk (ß=0.34, p=0.002) were directly associated with higher postpartum weight retention. Maternal race/ethnicity had an indirect impact on postpartum weight retention through neighborhood socioeconomic disadvantage and household socioeconomic disadvantage. Non-Hispanic Black women had greater neighborhood socioeconomic disadvantage than non-Hispanic White women (White vs Black ß= -0.62; p<0.001) and all other women (other vs Black ß= -0.22; p=0.013). In addition, Black women had greater household socioeconomic disadvantage than White women (White vs Black ß= -0.35; p=0.004), both of which in turn predicted higher postpartum weight retention. Conclusions: To prevent postpartum weight retention, education on behavior change to lose weight is essential, but it must be offered in the context of basic resources, at both the neighborhood and household levels.

A Systematic Review on Outcomes of Preterm Small for Gestational Infants Born to Women With Hypertensive Disorders in Pregnancy.

There is a lack of knowledge on the intersection between prematurity, small for gestational age, and hypertensive disorders of pregnancy (HDP). Therefore, the aim of this systematic review was to examine the outcomes of preterm infants who were small for gestational age born to women with HDP. Searches were conducted with no date restriction through the final search date of May 13, 2020, in the following databases: PubMed, Web of Science Core Collection, Cumulative Index of Nursing and Allied Health Literature Plus with Full Text (EBSCOhost), and Embase (Elsevier). A total of 6 studies were eligible for this review. The adjusted odds of mortality and necrotizing enterocolitis were significantly lower in the pregnancy-induced hypertension (PIH)/HDP group than in the non-PIH/HDP group. There was no significant difference in the odds of respiratory distress syndrome, bronchopulmonary dysplasia, and intraventricular hemorrhage between PIH/HDP and non-PIH/HDP groups. There was no significant difference between PIH/HDP and non-PIH/HDP groups in cystic periventricular leukomalacia, retinopathy of prematurity, late-onset sepsis, patent ductus arteriosus, length of hospital stays, duration of supplemental oxygen use, duration of mechanical ventilation, and continuous airway pressure. The studies included in this systematic review demonstrated that PIH/HDP is associated with lower infant mortality and necrotizing enterocolitis.

THE DUAL ROLE OF STUDENTS PURSUING A HIGHER DEGREE AND PROVIDING CARE TO THEIR CHILDREN AND FAMILY MEMBERS DURING THE COVID-19 PANDEMIC.

The objective of this qualitative study was to explore the psychological well-being of college students during the COVID-19 pandemic and highlight their experience as caregivers. A total of 1444 college students responded to the questionnaire on the impact of COVID-19 on their lives. Qualitative responses from 25 female and 7 male college students who serve as caregivers were analyzed. Data were assessed using thematic analyses. The analysis revealed that college students' caregiving experiences impacted every aspect of their lives, including psychological health, academic performance, and career. Students who served as caregivers indicated that the mandated "Stay-at-Home" order resulted in homeschooling children, working from home, and attending school via online at home, limiting space for work, school, childcare, and homeschool. This led to increased stress, difficulty finding childcare, a drop in GPA for some, fear of delayed graduation, and financial distress. Conclusion: University students serving as caregivers were negatively affected during the pandemic. These individuals play a significant role in the workforce; therefore, rethinking resources and policies promoting their success as they serve their loved ones is in society's best interest.

Neurocognition in treatment-resistant hypertension: profile and associations with cardiovascular biomarkers.

BACKGROUND: Hypertension in midlife has been associated with increased risk of stroke and neurocognitive decline. Few studies, however, have examined neurocognition among individuals with treatment-resistant hypertension or potential mechanisms by which treatment-resistant hypertension may impair neurocognition. METHODS: We examined the pattern of neurocognitive impairment and potential mechanisms in a sample of 96 overweight adults with treatment-resistant hypertension, aged 41-81 years. Neurocognitive function was assessed using a 45-min test battery consisting of executive function and memory. Vascular and metabolic mechanisms examined included cerebrovascular risk factors (CVRFs: Framingham Stroke Risk Profile), insulin sensitivity (homeostatic model assessment of insulin resistance), waist-to-hip ratio, microvascular function (hyperemic response), and peak oxygen consumption from an exercise treadmill test. Simple path analyses were used to assess the association between potential vascular and metabolic mechanisms and neurocognition. RESULTS: Neurocognitive impairments were common, with 70% of the sample exhibiting impaired performance on at least one executive function subtest and 38% on at least one measure of memory. Higher levels of aerobic fitness, greater insulin sensitivity, and better microvascular function, as well as lower CVRFs and waist-to-hip ratio were associated with better neurocognition. In path analyses, aerobic fitness, microvascular function, and CVRFs all were independently associated with neurocognitive performance. Insulin resistance associated with worse executive function but better memory performance among older participants. CONCLUSION: Neurocognitive impairments are common in adults with treatment-resistant hypertension, particularly on tests of executive function. Better neurocognition is independently associated with aerobic fitness, microvascular function, and CVRFs.

Health, Physical Growth, and Neurodevelopmental Outcomes in Preterm Infants of Women With Hypertensive Disorders of Pregnancy.

OBJECTIVE: To compare the health, physical growth, and developmental outcomes in preterm infants of women with and without hypertensive disorders of pregnancy (HDP). DESIGN: Cross-sectional analysis of health outcomes; physical growth (head circumference, height, and weight) collected at birth and 2 months, corrected for prematurity; and cognitive, language, and motor skills of preterm infants of women with and without HDP. SETTING: Four NICUs in the United States. PARTICIPANTS: Women (n = 221) and their preterm infants who weighed less than 1,750 g were enrolled in a multicenter, randomized trial of two interventions administered by each infant's mother when the infant was no longer critically ill. METHODS: Women and their preterm infants were categorized into groups with (n = 80) and without (control, n = 141) HDP. Data were extracted from infants' medical records, and the women completed questionnaires. RESULTS: The infants of women with HDP were more likely to be small for gestational age than the infants of women without HDP (31.7% vs. 10.6%, p < .002). The proportion of infants with greater neurologic risk, patent ductus arteriosus, intraventricular hemorrhage, and days on a ventilator did not differ between the groups. Although mean infant height at 2 months was less in the HDP group than the control group, other growth and neurodevelopmental outcomes did not differ between the groups. CONCLUSION: Among preterm infants admitted to NICUs, those born to women with HDP were more likely to be small for gestational age than those born to normotensive women. Additional research is needed to optimize care for infants born to women with HDP.