ABSTRACT
Built environment approaches that improve active transportation infrastructure and environmental design can increase physical activity. Funded by the Centers for Disease Control and Prevention, the Texas Department of State Health Services rejuvenated the Texas Plan4Health program from 2018 to 2023 to expand such approaches in Texas by providing technical assistance to teams of local public health professionals and planners to identify and implement projects connecting people to everyday destinations via active transport in their communities. However, the COVID-19 pandemic prompted Texas Plan4Health to modify the delivery of technical assistance to accommodate restrictions on travel and in-person gatherings. We used qualitative methods to conduct a postintervention process evaluation to describe the modified technical assistance process, understand the experiences of the 4 participating communities, and identify short-term outcomes and lessons learned. Texas Plan4Health helped communities overcome common barriers to built environment change, facilitated collaboration across community public health and planning professionals, and educated professionals about active transportation infrastructure and the relationship between their disciplines, thereby increasing community capacity to implement built environment improvements. This outcome, however, was mediated by the pre-existing resources and previous experiences with active transportation planning among the participating communities. Public health practitioners seeking to improve active transportation infrastructure and environmental design for physical activity should consider community-engaged approaches that advance partnership-building and collaborative experiential education among public health, planning, and other local government representatives, directing particular attention and additional training toward communities with fewer resources.
Subject(s)
Built Environment , COVID-19 , Exercise , Health Promotion , Humans , Texas , COVID-19/prevention & control , COVID-19/epidemiology , Health Promotion/methods , Public Health/methods , SARS-CoV-2 , Transportation/methods , Health Planning Technical AssistanceABSTRACT
OBJECTIVE: The aim of the study is to estimate inpatient asthma hospital visit rates among impacted Texans in Public Health Region 6/5S during the year of and after Hurricane Harvey. METHODS: Asthma inpatient hospitalization discharges were collected from the Texas Health Care Information Collection database (2016-2019). RESULTS: Females (age-adjusted rates [AARs] = 4.8-5.0) and Black Texans (AARs = 5.0-8.1) experienced significantly higher AARs compared with males and White Texans during the year of and after Harvey. During the year of Hurricane Harvey, females were 1.49 times as likely to have an inpatient asthma visit compared with males, while Black Texans were 2.78 times as likely to have an inpatient asthma hospitalization compared with White Texans. CONCLUSIONS: Findings from this study may assist public health professionals and local officials to allocate future resources to the most impacted subgroups as well as establish effective processes to mitigate consequences.
Subject(s)
Cyclonic Storms , Male , Female , Humans , Texas/epidemiology , Inpatients , Delivery of Health Care , HospitalizationABSTRACT
BACKGROUND: People with HIV (PWH) commonly have elevated cholesterol and triglycerides levels that have been linked to medications. However, healthy behaviors including lifestyle changes can lower high cholesterol (CHOL) or high triglycerides (TG), thereby reducing individual risk for cardiovascular diseases. This study aimed to determine the prevalence and risk factors associated with high CHOL or TG among PWH in Texas. METHODS: Cross-sectional data of 981 PWH from the 2015-2017 Texas and Houston Medical Monitoring Projects were examined. High CHOL or TG was identified by medical chart diagnosis, CHOL or TG medication use, or most recent fasting lab ≥ 200 mg/dl (total CHOL) or ≥ 150 mg/dl (TG). High CHOL or TG associations with sociodemographic and clinical characteristics were assessed using Rao-Scott chi-square tests. Prevalence of high CHOL or TG development was calculated using multivariable logistic regression model. RESULTS: High CHOL or TG prevalence was 41% with participants being mostly male (73%), ≥ 40 years (68%), with overweight (31%) or obesity (28%), and virally suppressed (62%). Compared with PWH < 40 years of age, PWH in their 40s, 50s, and ≥ 60s were 57%, 64%, and 62% more likely to have high CHOL or TG, respectively. Participants with overweight and obesity were 41% and 30% more likely to have high CHOL or TG than those with normal weight (BMI: 18.5- < 25), respectively. CONCLUSION: Since high CHOL and TG are modifiable CVD risk factors, increased education and lifestyle modification interventions are warranted to prevent the development of high CHOL or TG among PWH.
Subject(s)
Cardiovascular Diseases , HIV Infections , Hypercholesterolemia , Cardiovascular Diseases/etiology , Cholesterol , Cross-Sectional Studies , Female , HIV Infections/complications , HIV Infections/epidemiology , Humans , Hypercholesterolemia/complications , Male , Obesity/complications , Obesity/epidemiology , Overweight/complications , Overweight/epidemiology , Prevalence , Risk Factors , Texas/epidemiology , TriglyceridesABSTRACT
Studies have consistently shown that diagnosis of a syphilis infection increases the risk of human immunodeficiency virus (HIV) infection. This study examines patterns in HIV incidence among men following a Primary and Secondary (P&S) syphilis diagnosis. P&S syphilis cases among men reported to the Texas Department of State Health Services between January 2010 and June 2018 were linked to the Enhanced HIV/AIDS Reporting System. Risk factors for HIV diagnosis were identified using univariate and multivariate extended Cox proportional hazards models. The 9113 men with syphilis without a concurrent or prior HIV diagnosis contributed a cumulative 35,674 person-years with a mean follow-up time of 3.9 years. The multivariate model showed that among men with a P&S syphilis diagnosis, age, race/ethnicity, transmission risk, comorbid STDs, subsequent STDs, and syphilis diagnosing facility were independently associated with a new HIV diagnosis. The results highlight disparities in HIV diagnoses, despite current prevention recommendations. Reducing these disparities will require multi-level, comprehensive interventions that are appropriate for the diverse populations around the state.
Subject(s)
HIV Infections , Sexually Transmitted Diseases , Syphilis , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/epidemiology , Homosexuality, Male , Humans , Incidence , Male , Risk Factors , Sexually Transmitted Diseases/epidemiology , Syphilis/diagnosis , Syphilis/epidemiology , Texas/epidemiologyABSTRACT
This study aimed to determine the prevalence and risk factors associated with type II diabetes mellitus (T2DM) among people living with HIV (PLWH). Cross-sectional data of 989 PLWH in Texas obtained from the 2015-2017 Texas and Houston Medical Monitoring Project were examined. T2DM was identified by formal medical chart diagnosis, insulin/oral hypoglycemic prescriptions, or most recent fasting blood glucose ≥126â mg/dL. T2DM adjusted prevalence ratios and 95% confidence intervals (CIs) were estimated using multiple logistic regression. Participants were mostly male (72%), ≥40 years (68%), overweight (31%) or obese (28%) and virally suppressed (62%). T2DM prevalence was 15% with variations by age, body mass index, education and health insurance (pâ <â 0.05 for all). Compared to PLWH ≥60 years, 18-39-year-olds had significantly lower likelihood of T2DM (pâ <â 0.001). Overweight and obese PLWH were 2.11 (95% CI: 1.23-3.63) and 3.89 times (95% CI: 2.30-6.56) more likely to have T2DM compared to normal weight PLWH. Over 1 in 6 PLWH in Texas had T2DM, with age and BMI as significant predictors. Since DM is a risk factor for cardiovascular disease and PLWH are living longer, increased education and lifestyle modification interventions are warranted to prevent T2DM development among PLWH.
Subject(s)
Diabetes Mellitus, Type 2 , HIV Infections , Cross-Sectional Studies , Diabetes Mellitus, Type 2/epidemiology , Female , HIV Infections/complications , HIV Infections/epidemiology , Humans , Male , Obesity/complications , Obesity/epidemiology , Overweight/complications , Overweight/epidemiology , Prevalence , Risk Factors , Texas/epidemiologyABSTRACT
BACKGROUND: Hypertension is a significant risk factor for cardiovascular disease, a leading cause of death among people living with HIV (PLWH). Studies suggest that hypertension prevalence among PLWH is high, yet none assess how the 2017 redefinition of hypertension as ≥130/80 rather than the previous standard of ≥140/90 mm Hg will affect prevalence among PLWH. This study addresses this gap. METHODS: We examined medical record abstractions of 957 PLWH in Texas from the 2013-2014 Medical Monitoring Project survey. Participants with hypertension were identified by charted diagnosis, antihypertensive medication use, or blood pressure readings ≥140/90 and ≥130/80 mm Hg. Associations with sociodemographic and clinical variables were assessed using Rao-Scott chi-square tests, and odds of having hypertension were calculated using multivariable logistic regression models while adjusting for several demographic and HIV-related variables. RESULTS: The 2017 redefinition of hypertension increased prevalence in the sample by 44.3%, from 47.6% to 68.7%. Age group, body mass index, sex, and race remained significantly associated with hypertension (all P < 0.01). Although prevalence was near equal between males and females at ≥140/90 mm Hg (47.4% and 48.5%, respectively), males were 2.36 times more likely to have hypertension than females (95% confidence interval [CI]: 1.55-3.60) at ≥130/80 mm Hg. Prevalence remained comparable between white (73.3%) and black participants (72.9%). CONCLUSIONS: This study shows that hypertension prevalence is remarkably high among PLWH and is further increased by updated guidelines. Barriers to hypertension control in the HIV care setting should be identified and addressed to facilitate continued improvement in the quality and length of life for PLWH.
Subject(s)
Blood Pressure Determination/standards , Blood Pressure , HIV Infections/epidemiology , HIV Long-Term Survivors , Hypertension/diagnosis , Hypertension/epidemiology , Practice Guidelines as Topic , Adolescent , Adult , Age Distribution , Anti-HIV Agents/therapeutic use , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Comorbidity , Cross-Sectional Studies , Databases, Factual , Female , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Male , Middle Aged , Predictive Value of Tests , Prevalence , Race Factors , Risk Assessment , Risk Factors , Sex Distribution , Texas/epidemiology , Young AdultABSTRACT
Using representative data among 1861 in care people living with HIV (PLWH) in four southern states (Texas, Mississippi, Florida, and Georgia) from the 2013-2014 Medical Monitoring Project (MMP) survey, we estimated the prevalence and odds of metabolic syndrome (MetS) among various demographic and HIV related risk factors. Overall MetS prevalence was 34%, with our participants being mostly black (55%), male (72%), ≥ 50 years old (46%), and overweight or obese (60%) with undetectable viral loads (≤ 200 copies/ml, 69%), and were currently taking antiretroviral medication (98%). Compared to those who were ≥ 60 years, 18-39 year olds had a 79% (95% CI 0.13-0.33) lower odds of having MetS. Women were 2.24 times more likely to have MetS than men (95% CI 1.69-2.97). Age and sex were significant predictors of MetS. Since MetS is a combination of chronic disease risk factors, regular screening for MetS risk factors among aging PLWH is crucial.
Subject(s)
Anti-Retroviral Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , HIV Infections/complications , Metabolic Syndrome/epidemiology , Adult , Anti-Retroviral Agents/therapeutic use , Antiretroviral Therapy, Highly Active/methods , Body Mass Index , Cardiovascular Diseases/epidemiology , Cross-Sectional Studies , Diabetes Mellitus, Type 2/epidemiology , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Hypertension/epidemiology , Male , Middle Aged , Obesity/epidemiology , Prevalence , Risk Factors , United States/epidemiology , Viral LoadABSTRACT
OBJECTIVE: To evaluate the relation between yogurt consumption as well as cheese, milk, and total dairy, and high blood pressure (HBP) in two Nurses' Health Study cohorts (NHS, nâ=â69â298), NHS II (nâ=â84â368) and the Health Professionals Follow-Up Study (HPFS, nâ=â30â512). METHODS: NHS, NHS II, and HPFS participants were followed for incident HBP for up to 30, 20, and 24 years, respectively. Hazard ratios were calculated using time-dependent multivariate-adjusted Cox proportional hazards models. Pooled risk estimates were derived from fixed effects meta-analyses. RESULTS: Participants consuming at least five servings per week (vs. <1 serving per month) of yogurt in NHS, NHS II, and HPFS had 19% (95% CI 0.75-0.87), 17% (95% CI 0.77-0.90), and 6% (95% CI 0.83-1.07) lower HBP risks, respectively. In pooled analyses of these cohorts, higher yogurt consumption was linked with 16% (95% CI 0.80-0.88) lower HBP risk; higher total dairy (3 to <6 vs. <0.5âservings/day), milk (2 to <6/day vs. <4/week) and cheese (1 to 4/day vs. <1/week) were associated with 16% (95% CI 0.81-0.87), 12% (95% CI 0.86-0.90), and 6% (95% CI 0.90-0.97) lower HBP risks, respectively. After controlling for BMI as a possible causal intermediate, total dairy, yogurt, milk, and cheese were associated with 13, 10, 8, and 8% lower HBP risks, respectively. The combination of higher yogurt intake and higher DASH ('Dietary Approaches to Stop Hypertension') diet scores was associated with 30% (95% CI 0.66-0.75) lower HBP risk compared with lower levels of both factors. CONCLUSION: Higher total dairy intake, especially in the form of yogurt, was associated with lower risk of incident HBP in middle-aged and older adult men and women.
Subject(s)
Diet , Hypertension/epidemiology , Yogurt , Adult , Aged , Animals , Cheese , Cohort Studies , Female , Health Surveys , Humans , Male , Middle Aged , Milk , Protective Factors , Time Factors , United States/epidemiologyABSTRACT
BACKGROUND: High blood pressure (HBP) is a major cardiovascular disease (CVD) risk factor. Clinical trials including Dietary Approaches to Stop Hypertension (DASH) have demonstrated beneficial effects of dairy consumption on risks of HBP and CVD. Yogurt, a fermented dairy product, may independently be related to CVD risk. OBJECTIVE: To evaluate the association between yogurt consumption and CVD risk among hypertensive individuals in 2 large cohorts and to determine whether the association differs among those whose eating pattern more closely resembles the DASH diet. METHODS: Overall, 55,898 female Nurses' Health Study (NHS) and 18,232 male Health Professionals Follow-Up Study (HPFS) participants with prevalent HBP were included. Cumulative average estimates of yogurt intake from validated food frequency questionnaires were related to verified self-reported CVD outcomes using Cox proportional hazards models. Hazard ratios and 95% confidence intervals (CI) were adjusted for CVD risk factors, medications, and diet covariates. RESULTS: Yogurt intake was inversely associated with CVD risk (myocardial infarction and stroke) among hypertensive participants (P <0.01 in both cohorts). Among participants consuming ≥2 servings/week of yogurt, NHS women had a 17% (95% CI: 0.74-0.92) lower risk while HPFS men experienced a 21% (95% CI: 0.66-0.96) lower CVD risk compared to those who consumed <1 serving/month. Regular yogurt consumers with higher DASH diet scores had 16% (95% CI: 0.73-0.96) and 30% (95% CI: 0.57-0.85) CVD risk reductions in the 2 cohorts, respectively. CONCLUSION: Hypertensive men and women who consumed ≥2 servings/week of yogurt, especially in the context of a healthy diet, were at lower risk for developing CVD.
Subject(s)
Cardiovascular Diseases/prevention & control , Hypertension/complications , Yogurt , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , RiskABSTRACT
IMPORTANCE: Identification of risk factors early in life for the development of high blood pressure is critical to the prevention of cardiovascular disease. OBJECTIVE: To study prospectively the effect of dietary sodium, potassium, and the potassium to sodium ratio on adolescent blood pressure. DESIGN, SETTING, AND PARTICIPANTS: The National Heart, Lung, and Blood Institute's Growth and Health Study is a prospective cohort study with sites in Richmond, California; Cincinnati, Ohio; and Washington, DC. Participants included 2185 black and white girls initially aged 9 to 10 years with complete data for early-adolescent to midadolescent diet and blood pressure who were followed up for 10 years. The first examination visits were from March 1987 through February 1988 and follow-up continued until February 1999. Longitudinal mixed models and analysis of covariance models were used to assess the effect of dietary sodium, potassium, and the potassium to sodium ratio on systolic and diastolic blood pressures throughout adolescence and after 10 years of follow-up, adjusting for race, height, activity, television/video time, energy intake, and other dietary factors. EXPOSURES: Mean dietary sodium and potassium intakes and the mean potassium to sodium ratio in individuals aged 9 to 17 years. To eliminate potential confounding by energy intake, energy-adjusted sodium and potassium residuals were estimated. MAIN OUTCOMES AND MEASURES: Mean systolic and diastolic blood pressures throughout adolescence and at the end of follow-up (individuals aged 17-21 years). RESULTS: Sodium intakes were classified as less than 2500 mg/d (19.4% of participants), 2500 mg/d to less than 3000 mg/d (29.5%), 3000 mg/d to less than 4000 mg/d (41.4%), and 4000 mg/d or more (9.7%). Potassium intakes ranged from less than 1800 mg/d (36.0% of participants) to 1800 mg/d to less than 2100 mg/d (26.2%), 2100 mg/d to less than 2400 mg/d (18.8%), and 2400 mg/d or more (19.0%). There was no evidence that higher sodium intakes (3000 to <4000 mg/d and ≥4000 mg/d vs <2500 mg/d) had an adverse effect on adolescent blood pressure and longitudinal mixed models showed that those consuming 3500 mg/d or more had generally lower diastolic blood pressures compared with individuals consuming less than 2500 mg/d (P = .18). However, higher potassium intakes were inversely associated with blood pressure change throughout adolescence (P < .001 for systolic and diastolic) and at the end of follow-up (P = .02 and P = .05 for systolic and diastolic, respectively). While the potassium to sodium ratio was also inversely associated with systolic blood pressure (P = .04), these effects were generally weaker compared with effects for potassium alone. CONCLUSIONS AND RELEVANCE: In this study of adolescent girls, consumption of 3500 mg/d of sodium or more had no adverse effect on blood pressure. The beneficial effects of dietary potassium on both systolic and diastolic blood pressures suggest that consuming more potassium-rich foods during childhood may help suppress the adolescent increase in blood pressure.
Subject(s)
Blood Pressure/drug effects , Hypertension/etiology , Hypertension/prevention & control , Potassium, Dietary/administration & dosage , Sodium, Dietary/administration & dosage , Adolescent , Child , Female , Humans , Longitudinal StudiesABSTRACT
BACKGROUND: Short-term clinical trials suggest that dietary protein lowers blood pressure (BP); however, long-term effects of total, animal, and plant proteins are less clear. Our goal was to evaluate effects of these dietary proteins on mean systolic BP (SBP) and diastolic BP (DBP) and incident high BP (HBP) risk among middle-aged adults in the Framingham Offspring Study. METHODS: Men and women (aged 30-54 years) without prevalent HBP, cardiovascular disease, or diabetes with 3-day dietary records from exams 3 or 5 (n = 1,361) were included and followed for a mean of 11.3 years for development of HBP. Protein intakes adjusted for body size were derived using the residual method. Analysis of covariance and Cox proportional hazard's models were used to adjust for age, sex, education, height, activity, smoking, fat calories, diet quality, and body mass index. RESULTS: Higher protein intakes were associated with lower mean SBP and DBP. Both animal and plant proteins lowered BP and led to statistically significant reductions in HBP risk (hazard ratios of 0.68 and 0.51, respectively). Participants in the highest tertile of total protein intake had 40% less risk (95% confidence interval [CI], 0.45-0.78) of developing HBP. Beneficial effects of protein were apparent for men and women and for normal-weight and overweight individuals. Higher protein diets also characterized by higher fiber intakes led to a 59% reduction (95% CI, 0.37-0.66) in HBP risk. CONCLUSIONS: Adults consuming more dietary protein from either plant or animal sources had lower long-term risks of HBP.
Subject(s)
Blood Pressure/drug effects , Dietary Proteins/pharmacology , Hypertension/epidemiology , Adult , Female , Humans , Longitudinal Studies , Male , Massachusetts/epidemiology , Middle AgedABSTRACT
Dietary determinants of adolescent blood pressure (BP) are poorly understood. The goal of the present study was to assess the effects of an eating pattern similar to that from the Dietary Approaches to Stop Hypertension (DASH) study on adolescent BP. Data from 2185 girls followed-up over 10 years (until the girls were 18-20 years of age) in the National Heart Lung and Blood Institute's Growth and Health Study were used in this analysis. Diet was assessed during eight examination cycles using 3 d dietary records; girls were classified according to their consumption of foods associated with a DASH-style eating pattern. Analysis of covariance modelling, multiple logistic regression and longitudinal mixed models were used to control for potential confounding by age, race, socio-economic status, height, physical activity, television viewing time and other dietary factors. Girls who consumed ≥ 2 daily servings of dairy and ≥ 3 servings of fruits and vegetables (FV) had a 36 % lower risk (95 % CI: 0·43, 0·97) of elevated BP (EBP) in late adolescence. In longitudinal modelling, two dietary factors were associated with a lower systolic BP throughout adolescence: higher (≥ 2 daily servings) dairy intakes (P < 0·0001) and a DASH-style pattern (P = 0·0002). Only the DASH-style pattern led to consistently lower diastolic BP levels (P = 0·0484). Adjustment for BMI did not appreciably modify the results. In this study, adolescent girls whose diets were rich in dairy products and FV during the early- and mid-adolescent years were less likely to have EBP levels in later adolescence.