Implementation of Prevention Science to Eliminate Health Care Inequities in Achieving Cardiovascular Health: A Scientific Statement From the American Heart Association.

Prevention of cardiovascular and related diseases is foundational to attaining ideal cardiovascular health to improve the overall health and well-being of individuals and communities. Social determinants of health and health care inequities adversely affect ideal cardiovascular health and prevention of disease. Achieving optimal cardiovascular health in an effective and equitable manner requires a coordinated multidisciplinary and multilayered approach. In this scientific statement, we examine barriers to ideal cardiovascular health and its related conditions in the context of leveraging existing resources to reduce health care inequities and to optimize the delivery of preventive cardiovascular care. We systematically discuss (1) interventions across health care environments involving direct patient care, (2) leveraging health care technology, (3) optimizing multispecialty/multiprofession collaborations and interventions, (4) engaging local communities, and (5) improving the community environment through health-related government policies, all with a focus on making ideal cardiovascular health equitable for all individuals.

Acculturation, acculturative stress, and tobacco/nicotine use of Latin American immigrants.

OBJECTIVE: US Hispanics have several health disparities, greater tobacco/nicotine-related illnesses, lower access to smoking cessation, and lower rates of cessation. Understanding cultural constructs linked to tobacco/nicotine use may provide a greater understanding of future cultural adaptations of cessation interventions. This study used a multidimensional acculturation framework, with cultural practices, identity, and values, to test links between measures of acculturation stress, multidimensional acculturation (language-based enculturation and acculturation, cultural identity, familism), and tobacco/nicotine use, and interactions with gender. DESIGN: Participants were 391 adult Latin American immigrants (69% women); 12% self-reported tobacco/nicotine use in the past six months. RESULTS: Path analysis showed acculturative stress, ß = .16, and acculturation, ß = .20, were positively related to tobacco/nicotine use. Enculturation, familism, and Hispanic cultural identity were not related to tobacco/nicotine use. There were no significant acculturation by enculturation or gender interactions, but women were less likely to use tobacco/nicotine than men, ß = -.36. CONCLUSION: Findings suggest that tobacco/nicotine cessation interventions for Latino immigrants may be enhanced with an emphasis on the mitigation of acculturative stress, attention to the adoption of US cultural practices, and gender. Future research should examine specific sources of acculturative stress or social norms related to tobacco/nicotine use.

Building resilience in families experiencing homelessness through integration of health, parenting and child development programs.

Children who experience homelessness are vulnerable to mental health problems, developmental delays and lower academic achievement. Research suggests that parental health literacy, sensitive parenting behaviour and child self-regulation are modifiable mechanisms that might enhance children's resilience to adversities associated with homelessness, yet empirical evidence on implementing such interventions in shelter settings is limited. Through a coordinated academic-community partnership, this study aimed to examine the (1) feasibility of conducting an integrated health approach in shelter settings and (2) the effectiveness of separate interventions on child and parent outcomes. Results are discussed in terms of best practices in shelter settings and building resilience in families experiencing homelessness with young children.

Exploring Nursing Strategies to Engage Community in Cardiovascular Care.

PURPOSE OF REVIEW: This review aims to highlight some of the strategies nurses use to engage community members in cardiovascular care. We also elaborate on opportunities for improving community engagement. RECENT FINDINGS: Community engagement occurs across a continuum of progressive levels of community involvement, impact, trust, and flow of communication. Successful community engagement has been shown to improve both patient-centered care and intervention design, implementation, and dissemination. Nurse strategies used for engaging community in cardiovascular care included more examples of outreach, consult, and involvement than collaboration and shared leadership. More attention is needed toward strategies that embrace collaboration and enhance trusting relationships to advance to shared leadership. Nurses must intentionally work in partnership with communities to improve cardiovascular health for all. Furthermore, assessing meaningful community engagement is necessary to achieve the desired outcomes, including optimal cardiovascular health and thriving communities.

Maternal Mental Health, COVID-19-Related Distress, and Disruptions in Lifestyle Behaviors Among Postpartum Mothers With a Previous Hypertensive Disorder of Pregnancy.

BACKGROUND: Many perinatal people experienced pandemic-related distress and changes in health behaviors at the onset of the COVID-19 pandemic, but less is known about how the pandemic continued to impact their health. OBJECTIVE: The authors of this study examined the influence of pandemic-related distress and maternal mental health on postpartum lifestyle behaviors of mothers with a previous hypertensive disorder of pregnancy. METHODS: Between September 2021 and March 2022, 82 postpartum (19.2 ± 5.5 months) mothers with a hypertensive disorder of pregnancy completed measures of pandemic-related distress and pandemic-related disruption in lifestyle behaviors from the Coronavirus Perinatal Experiences Impact Survey. A Patient Health Questionnaire-9 score ≥ 10 and a score ≥ 3 on the Breslau scale indicated significant depressive and posttraumatic stress disorder (PTSD) symptoms, respectively. RESULTS: Twenty-two (27.2%) and 30 (36.6%) participants had significant depressive or PTSD symptoms, respectively. In models adjusted for education, income, parity, delivery prepandemic or peripandemic, intervention group, and prepregnancy mental health history, both PTSD symptoms (B = 0.229, P = .029) and pandemic-related distress (B = 0.492, P < .001) associated with greater disruption in health behaviors. Depressive symptoms did not associate with greater disruption in health behaviors (B = 0.169, P = .135). CONCLUSION: Monitoring PTSD symptoms may be vital in supporting mothers with hypertensive disorders of pregnancy in making lifestyle changes to prevent cardiovascular disease.

Cognitive behavioural therapy and medication for treatment of adolescent depression: a network meta-analysis.

BACKGROUND: Cognitive behavioural therapy (CBT) and medication are widely accepted and useful interventions for individuals with depression. However, a gap remains in our current understanding of how CBT directly benefits adolescents with depression. AIMS: The purpose of this study was to examine the short- and long-term effectiveness of CBT only, CBT+Medication, or Medication alone in reducing the duration of major depressive episodes, lessening internalizing and externalizing symptoms and improving global functioning. METHODS: Data were extracted from 14 unique studies with a total of 35 comparisons. Network meta-analysis was conducted and p-scores, a measure of the extent of certainty that one treatment is better than another, were used to rank treatments. RESULTS: There was no significant difference between any two treatments for depression, nor internalizing or externalizing symptoms. For global functioning, CBT had significantly greater effect at the longest follow-up than CBT+Medication. CBT+Medication had the highest p-score for depression, short- and long-term effects, and internalizing and externalizing symptoms long-term effects. No indication of publication bias was found. CONCLUSIONS: Neither modality, CBT nor medication, is superior for treating adolescent depression. However, CBT was superior in improving global functioning, which is essential for meeting developmental goals.

Equity in Genomics: A Brief Report on Cardiovascular Health Disparities in African American Adults.

BACKGROUND: African Americans are more likely to die from cardiovascular disease (CVD) than all other populations in the United States. Although technological advances have supported rapid growth in applying genetics/genomics to address CVD, most research has been conducted among European Americans. The lack of African American representation in genomic samples has limited progress in equitably applying precision medicine tools, which will widen CVD disparities if not remedied. PURPOSE: This report summarizes the genetic/genomic advances that inform precision health and the implications for cardiovascular disparities in African American adults. We provide nurse scientists recommendations for becoming leaders in developing precision health tools that promote population health equity. CONCLUSIONS: Genomics will continue to drive advances in CVD prevention and management, and equitable progress is imperative. Nursing should leverage the public's trust and its widespread presence in clinical and community settings to prevent the worsening of CVD disparities among African Americans.

Understanding Social Determinants of Cardiometabolic Disease Risk in Rural Women.

Women living in rural America experience significant disparities in cardiometabolic diseases warranting research to aid in understanding the contextual factors that underlie the rural and urban disparity and in planning effective primary prevention interventions. While research has established a general understanding of cardiometabolic risks individually, the combination or bundling of these risk behaviors is not clearly understood. The purpose of this study is to explore the association of social determinants of health on obesity and adiposity related cardiometabolic disease risk among rural women. Data were from the multi-state Rural Families Speak about Health Study. A total of 399 women were included in the analyses. Data were collected using a self-administered questionnaire on women's demographics, economic stability, education, and health and healthcare. Food insecurity, education, healthcare access and comprehension health literacy were associated with higher obesity and adiposity-related cardiometabolic risk. Health behaviors, tobacco use and physical activity were not associated with higher cardiometabolic risk in this sample of rural women. This is one of the first studies to focus on multiple social determinants of health and cardiometabolic risk in rural American women. Understanding combinations of risk behaviors can assist health care providers and community health professionals in tailoring multiple health behavior change interventions to prevent cardiometabolic disease among rural women. The findings support a focus on community and societal level factors may be more beneficial for improving the cardiometabolic health of rural women.

Measuring the social impact of nursing research: An insight into altmetrics.

AIMS: The objectives of this study were to (a) identify nursing journal articles that provoked the most online activity and discussion and (b) assess the association between these articles' altmetric scores and publication characteristics, citation counts; and publishing journals metrics. BACKGROUND: Altmetrics, or alternative metrics, have recently emerged as a complementary way of measuring the societal impact of research by assessing the public engagement with research output. To date, no studies have yet investigated the online attention about scientific papers published in the nursing field. DESIGN: Integration of quantitative and qualitative synthesized evidence. DATA SOURCES AND REVIEW METHODS: InCites Journal Citation Report was used to identify a list of nursing journals indexed in the Web of Science Core Collection. Altmetric Explorer was selected as an altmetrics harvesting tool. The search in Altmetric Explorer yielded 66,608 research outputs from 118 nursing journals. The articles with the top 100 altmetric attention score (AAS) were identified and a new search, limited to only those 100 articles, was run to produce aggregate metrics specific to those articles. The articles were also exported for thematic analysis. RESULTS: The median AAS for the 100 articles was 248, ranging from 138 - 649. The articles were mostly discussed on Twitter, followed by news outlets and Mendeley. Articles indexed in the nursing journals category attracted low online attention compared with articles published in other health journal categories. Twitter remained the dominant source of attention over the years 2012-2018, followed distantly by news outlets. Most online attention came from the USA and the UK. Of the top 100 articles included in the study, the Journal of Advanced Nursing published the highest number of articles (N = 26; Median AAS = 179). The AAS was not significantly different between articles published in Q1 journals and those published in Q2 and Q3 journals. There was a significant relationship between articles' AASs and their citation counts on Scopus and Web of Science. Publication date was significantly related to citation counts on Scopus and Web of Science but not with AASs. CONCLUSION: Altmetrics will likely continue to evolve alongside the rapidly expanding use of social media and online platforms. As nursing continues to strive to have our research and scholarship inform policy, translated into practice and recognized for its scientific merit, we have to remain vigilant about the best ways to disseminate the important work we are doing. Research, such as this study, will allow nursing scholars to benchmark our progress as we adapt to the changing environment for measuring impact and quality in the digital age.

Neighborhood Deprivation, Perceived Stress, and Pregnancy-Related Hypertension Phenotypes a Decade Following Pregnancy.

BACKGROUND: Hypertensive disorders in pregnancy and other adverse pregnancy outcomes (APOs) increase the risk of developing chronic hypertension and cardiovascular disease. Perceptions of stress and neighborhood context also influence blood pressure (BP) fluctuations. We examined if APOs, higher perceived stress, and neighborhood deprivation were associated with hypertension phenotypes a decade after pregnancy in untreated individuals. METHODS: Participants were 360 individuals who gave birth between 2008 and 2009 and participated in a research study 8-10 years following pregnancy. Standardized office and home BP readings were obtained, and we applied the AHA/ACC 2017 guidelines to identify sustained, white coat, and masked hypertension phenotypes. We measured personal stress with the perceived stress scale and neighborhood deprivation with the CDC Social Vulnerability Index. RESULTS: Of the 38.3% (138/360) with any hypertension, 26.1% (36/138) reported a diagnosis of hypertension but were currently untreated. Sustained hypertension was the most common (17.8%), followed by masked and white coat hypertension, both 10.3%. Hypertensive disorders in pregnancy were associated with sustained (odds ratio [OR] 5.54 [95% confidence interval, CI 2.46, 12.46] and white coat phenotypes (OR 4.20 [1.66, 10.60], but not masked hypertension (OR 1.74 [0.62, 4.90]). Giving birth to a small for gestational age infant was also associated with sustained hypertension. In covariate adjusted models, perceived stress, but not neighborhood deprivation, was significantly associated with masked hypertension. CONCLUSIONS: A decade after delivery, APOs were associated with sustained and white coat hypertension, but not masked hypertension. Exploration of the mechanisms underlying, and clinical implications of, these associations is warranted.

Using a Structural Intersectionality Approach to Understand Drivers of Health Inequities.

Clinical nurses and nurse scientists should consider how societal systems of inequality interact, affect the health of individuals, and exacerbate health inequities, especially for Black women. In this short review, we examine a recent study that introduces an innovative approach to measuring intersectional systems of inequality at the state level and their impact on health referred to as structural intersectionality. Implications for nursing practice and nursing science are discussed.

The wear and tear of racism: Self-silencing from the perspective of young Black women.

Context: Historically, Black women strategically employed silence to endure enslavement to the U.S., and other forms of racial violence. The current study aimed to understand contemporary perspectives on self-silencing. Objective: To explore young adult Black women's experiences of self-silencing and its potential impact on their physical and mental well-being. Methods: Data are from 16 semi-structured interviews with Black women ages 18 to 39 in southwest Pennsylvania conducted between October 2021 - May 2022. We analyzed the interviews using inductive thematic analysis. Results: We identified four themes: "Self-silencing is Inherited," "Silencing Here and Now," "Wear and Tear," and "The Flip Side." The first theme represents the overwhelming consensus that limiting self-expression has a generational component rooted in racism. Most participants identified self-silencing in school and employment settings. Participants described the wear and tear of self-silencing as negatively impacting health behaviors (e.g., diet) and mental health both when deciding whether to self-silence and later ruminations on the decision. "The Flip Side" represents counter perspectives that not self-silencing liberates and improves health. Conclusions: The findings highlight that many Black women may use or resist self-silencing as a vigilance-based coping strategy to preserve their mental and physical well-being. We present measurement considerations for research on health impacts of racism and other forms of oppression.

Epigenomic Links Between Social Determinants of Health and Symptoms: A Scoping Review.

Social determinants of health (SDoH) impact health and wellness. The link between SDoH and adverse health outcomes, including symptom occurrence and severity, may be explained by an individual's physiologic response to one or more SDoH. One potential mechanism underlying this physiologic response linking SDoH and symptoms is the dynamic epigenome. The purpose of this scoping review of the literature was to examine differential susceptibility for symptoms by identifying and summarizing research linking SDoH and symptoms through epigenomic mechanisms. PubMed was searched to identify empirical research where at least one SDoH was an independent or dependent variable, at least one symptom was investigated, and the investigation included an epigenomic measure. Of the 484 articles initially retrieved, after thorough vetting, 41 articles met eligibility. The most studied symptom was depressive symptoms followed by anxiety, cognitive function, sleep dysfunction, and pain. The most frequently studied SDoH were: 1) stress, particularly early life stress and acculturative stress; and 2) trauma, predominantly childhood trauma. DNA methylation and telomere length were the most studied epigenomic measures. Four genes (SLC6A4, BDNF, NR3C1, OXTR) had evidence from multiple studies and across methodological approaches linking SDoH to symptoms. This review supports the inclusion of epigenomic approaches to better understand the link between SDoH and symptoms and provides evidence that SDoH impact telomere length and the methylation of genes involved in neurotransmitter signaling, neuronal survival, behavior, inflammation and stress response.

Learner Response to an Activity Introducing Adverse Childhood Experiences as a Social Determinant of Health.

BACKGROUND: Threading content on the social determinants of health into the nursing curricula is a best practice recommended by certifying bodies; however, introducing content on social determinants of health can overwhelm learners, who may have difficulty relating the information to their nursing practice. METHOD: A learning strategy was developed that used film and an experiential activity to introduce content on adverse childhood experiences, a social determinant of health, and resilience into nursing course-work. A total of 130 first-semester nursing students viewed a film in class and participated in a focused debriefing and subsequent clinical exercise. RESULTS: The majority of participants (97%) believed the film appropriately introduced the content. Learners reported the debriefing was helpful in relieving distress, and 95% found the content relevant to their future nursing practice. CONCLUSION: Early introduction of key concepts related to adverse childhood experiences may assist prelicensure nursing students in developing a trauma-informed professional practice. [J Nurs Educ. 2022;61(11):650-653.].

Adverse Childhood Experiences and Cardiovascular Health: An Exploration of Protective Social Determinants Among Young Adult Black Women.

This study sought to advance the literature on Black women's cardiovascular health (CVH) by examining maternal relationship, religion and spirituality, and social connections as potential protective social determinants that buffer the stress of adverse childhood experiences (ACEs). The outcome was the American Heart Association's ideal CVH score. Neither maternal relationship nor religion/spirituality was able to buffer the stress of ACEs on ideal CVH. Findings are discussed in terms of cultural aspects of potential protective factors that are critical for future research. Identifying protective factors that may buffer the influence of ACEs on CVH remains a priority to promote health equity.

Addressing health inequities re-illuminated by the COVID-19 pandemic: How can nursing respond?

The coronavirus disease 2019 mortality rate among Black adults in the U.S. is double that of other racial and ethnic groups. The current pandemic is re-illuminating health inequities that are pervasive in our society and reflected in our health system. This creative controversy describes critical conversations needed within nursing to acknowledge the contribution of structural racism to health equity. We recommend implementing structural competency into nursing education and prioritizing nursing research and policies focused on health equity and community-based interventions.

Adverse Childhood Experiences and Blood Pressure in Women in the United States: A Systematic Review.

INTRODUCTION: Elevated blood pressure is a leading contributor to adverse cardiovascular outcomes. Some studies suggest there is an association between adverse childhood experiences (ACEs) and subsequent elevated blood pressure in adulthood. The literature specific to ACEs and blood pressure in women has not been synthesized; thus the purpose of this systematic review was to examine what is known about the association between ACEs and blood pressure in women living in the United States. METHODS: In collaboration with a medical librarian, a systematic search of the literature published between January 1998 and December 2019 was conducted. Original, peer-reviewed publications were identified from PubMed, CINAHL, and PsycINFO databases. Studies were excluded if they (1) were conducted outside the United States, (2) measured acute stress or adult stressors, or (3) measured childhood- or pregnancy-related outcomes. RESULTS: Of 1740 articles, 12 publications met criteria for inclusion in this study, 8 of which were from cohort studies. Racial and ethnic diversity was limited, with half of the articles in this review consisting of samples that were majority white. Of the studies that used a self-reported history of hypertension, 60% obtained significant associations with ACEs, compared with only 30% of the studies that had objective blood pressure data. ACEs were associated with lower blood pressure in 3 studies. DISCUSSION: More research is needed to elucidate the relationship between ACEs and elevated blood pressure. Inconsistencies in the findings may be related to the measurement of blood pressure, assessment of ACEs, and population characteristics. Future studies should incorporate diverse population-representative samples with consideration for sex- or race-specific stressors such as pregnancy or racism and their potential influence on blood pressure. Health care providers may consider the history of ACEs as part of screening for cardiovascular risk factors among female patients, especially younger women presenting with elevated blood pressure.

Racism as Public Health Crisis: Assessment and Review of Municipal Declarations and Resolutions Across the United States.

Racism in the United States has been cited as a key driver of racial health inequities. Racism as a public health crisis has been in the forefront, particularly with respect to state and municipal governments that have developed legislation, resolutions, and declarations. This policy brief includes a review of resolutions and declarations across the US related to Racism as a Public Health Crisis through the end of September 2020. There were 125 resolutions reviewed for content related to the history of racism, reference to racial health equity data, content related to action steps or implementation, and any accompanying funding or resources. We found that the majority of policies name racism as critical in addressing racial inequities in health with limited details about specific actions, funding, or resources.

Social Adversity, Sleep Characteristics, and Elevated Blood Pressure Among Young Adult Black Females.

Purpose: We examined whether sleep characteristics and adverse social exposures were associated with elevated blood pressure (BP) in young adult black women. Methods: This is a cross-sectional analysis of existing data from 581 black females who participated in the National Longitudinal Study of Adolescent to Adult Health (Add Health). Adverse social exposures included child abuse, discrimination, perceived stress, social isolation, and subjective social status. Self-reported sleep characteristics were measures of duration, latency, continuity, and snoring. Logistic regression was used to evaluate the influence of social exposures and sleep characteristics on BP. Results: Among the women (mean age=29.1 years), 32.4% had elevated BP (≥130 systolic or ≥80 diastolic). In adjusted analysis, poor sleep continuity (adjusted odds ratio [aOR]=1.70, 95% confidence interval [CI]=1.07-2.70) and discrimination (aOR=1.61, 95% CI=1.00-2.58) were associated with higher odds of elevated BP, while more social isolation (aOR=0.69, 95% CI=0.48-0.99) was associated with lower odds of elevated BP. Conclusion: Poor sleep continuity and experiencing discrimination may represent key risk factors for hypertension in young black females. Unexpectedly, being more isolated was associated with lower BP. Future research should examine how to adapt current paradigms and measures of social connectedness, isolation, and stress to better elucidate the impact of these factors on the long-term health of young black females.

Do beliefs about depression etiologies influence the type and severity of depression stigma? The case of Arab adolescents.

PURPOSE: Research has documented that holding certain etiological beliefs about depression can determine the level of stigma experienced by individuals with depression. To date, no studies have yet examined this relationship among adolescents. Using a sample of Arab adolescents, the purpose of this study was to describe adolescents' beliefs about the etiology of depression, and examine whether these beliefs influence the type and severity of depression stigma. METHODS: A nationwide school survey was conducted in a representative sample of Jordanian public and private schools located in Jordan, a Middle-Eastern Arab country. A total of 2,349 adolescents aged 12-17 (59% female) completed and returned an anonymous survey that included measures on adolescents' sociodemographic and health characteristics, depression symptoms, depression stigma, and depression etiological beliefs. An exploratory factor analysis with principal components analysis (PCA) was used to examine the factor structure of the Depression Etiological Beliefs Scale. The stability of the PCA findings was tested using a cross-validation method. Regression analyses were performed to examine whether depression etiological beliefs, depression severity, or their interaction are associated with depression stigma. RESULTS: Adolescents endorsed multiple etiological beliefs about depression. The beliefs in which likely or very likely was most often reported were stressful events in one's life (72%), social factors (65%), and one's weak will (56%). On the other hand, the least reported beliefs were genetic or inherited problems (24%), chemical imbalance (30%), and punishment for wrong doings (35%). The interaction between adolescents' depression severity and depression beliefs significantly predicted personal stigma. Adolescent sex, age, and region of residence significantly affected the relationship between depression beliefs and stigma. CONCLUSIONS: Nurses need to consider the beliefs and attitudes their patients have around depression, as these can influence symptom severity, comprehensive treatment plans, and adherence to provider recommendations. This study provides a better understanding of how depression beliefs affect Jordanian adolescents' attitudes toward depression, which can guide intervention programs to increase awareness about depression and promote treatment utilization.