Examining Race-Based and Gender-Based Discrimination, Trust in Providers, and Mental Well-Being Among Black Women.

OBJECTIVES: To examine experiences of discrimination among Black women, and to determine if experiencing race- and gender-based discrimination is associated with mental well-being and trust. METHODS: Data from the TRUST study were used to examine experiences of discrimination among 559 Black women with hypertension receiving healthcare at a safety-net hospital in Birmingham, Alabama. A three-level variable was constructed to combine the race-based and gender-based measures of the Experiences of Discrimination scale. Linear regression was used to examine the association between experiences of discrimination with mental well-being and trust. RESULTS: Women who reported no experiences of race- or gender-based discrimination were older and reported higher mental well-being scores and greater trust. Fifty-three percent of study participants reported experiencing discrimination. Compared to participants who did not experience race- or gender-based discrimination, participants reporting experiences of race- or gender-based discrimination and those reporting experiencing both race- and gender-based discrimination were more likely to report poorer mental health. CONCLUSION: Reported experiences of gender- and/or race-based discrimination in this study were associated with lower mental health scores and less trust in health care providers. Our findings highlight the importance of examining experiences of discrimination among Black women, and the role of discrimination as a stressor and in reducing trust for providers. Incorporating an understanding and acknowledgement of experiences of discrimination into interventions, programs, and during clinical encounters may foster more trusting relationships between providers and patients.

Evaluating the relationship between physical activity and quality of life in a racially diverse sample of breast cancer survivors.

PURPOSE: Physical activity (PA) has been shown to improve quality of life (QoL) in predominantly White cancer survivors. Very few studies have examined the association between PA and QoL among Black breast cancer survivors (BCS). We investigated the association between PA and multiple QoL domains and the effects of race on the proposed association in a racially diverse group of BCS. METHODS: This was an exploratory study using secondary data from a completed 12-month randomized controlled  trial (RCT). Mixed effects models were tested on a subset of participants in the control and exercise groups of the RCT. The primary outcomes were changes in the QoL domains (baseline to 12 months post baseline). RESULTS: There were 173 participants included in this analysis, averaging 59 years of age; about 33% of the participants were Black women. There were no significant differences in the QoL outcomes between the control and exercise groups at 12 months post baseline. Race was not a significant moderator. Exercise improved emotional/mental wellbeing and body image as it relates to social barriers at 12 months post baseline in Black and White BCS, but the changes in these outcomes were only statistically significant in White BCS (p < 0.05). CONCLUSIONS: Results show that exercise can improve multiple QoL domains over time in Black BCS. However, the significance of the effect on QoL was isolated to White BCS. The small sample size in Black women could constrain the statistical significance of observed effects. Future studies are warranted to assess associations between exercise and QoL in larger samples of Black women.

Exploring Quality of Life Experiences and Concerns of Black Breast Cancer Survivors: a Narrative Approach.

Black breast cancer survivors (BCS) in comparison with White BCS are more likely to experience suboptimal quality of life (QoL). QoL is a multi-dimensional concept that focuses on different aspects of well-being (e.g., emotional well-being). There is limited evidence on the perspectives and experiences of QoL (e.g., the influence of breast cancer on QoL) and the QoL concerns (e.g., negative perceptions of body appearance) among Black BCS. The purpose of this study was to explore the QoL experiences and QoL concerns of Black BCS. Primary data was collected in semi-structured interviews and analyzed using a thematic analysis. A narrative approach (detailed stories or life experiences of a small group of people) was used to better understand the research topic among the target group. Ferrell's Conceptual Framework on QoL in Breast Cancer was used to guide the development of the interview questions, codes, and themes. There were 10 Black BCS, averaging 58 years of age. Two coders achieved a moderate level of agreement (i.e., Kappa) of 0.77. Five major themes were identified: defining QoL (what QoL means to them), behavioral changes (e.g., altering behaviors due to cancer), phases of cancer (e.g., breast cancer diagnosis), QoL experiences and factors affecting QoL, and impactful statements from cancer survivors (other meaningful information shared by the participants). The survivors reported multiple QoL concerns and body image issues. The study findings warrant cancer education interventions or programs to address the relevant survivorship issues of Black BCS.

Health Social Networks of Black Women With Hypertension.

BACKGROUND: The prevalence of hypertension is 55% among African American/Black women, who have a higher risk for poor health outcomes compared to women from other racial and ethnic groups, in part because of uncontrolled blood pressure. Previous research results suggest that peers may positively influence self-management of chronic conditions like hypertension. However, few studies have described the personal characteristics of peers in the health social networks of Black women. OBJECTIVE: This substudy aimed to examine health social networks and describe the peers' characteristics, as reported by a convenience sample of Black women with hypertension. METHODS: In this analysis of data from a larger study, 94 Black women with hypertension attending a church conference participated in a cross-sectional, descriptive study. Their mean age was 59 years, and their mean systolic blood pressure was 143 mm Hg. All participants completed a survey to gather data about (a) the characteristics of individuals they discussed health matters with (their peers or health social network) and (b) their perceptions about hypertension status and knowledge of hypertension among the peers in their health social network. RESULTS: Collectively, participants from the larger study named a total of 658 peers who were part of their health social networks; the mean health social network size was six peers. The peers were mostly women, Black, family members, and, on average, 54 years old. The participants discussed hypertension with 71% of the peers, reported that 36% had hypertension, and felt that 67% were somewhat or very knowledgeable about the condition. A small, positive correlation existed between the participants' health social network size (number of peers named) and their systolic blood pressure levels. DISCUSSION: The health social network peers were similar to those in the larger study, with most of the same gender, race, and age. The findings of this analysis may be used to help practitioners and scientists guide patients in building health social networks for support in self-managing hypertension and conducting future studies to examine the best strategies for developing and using health social networks to improve health outcomes and reduce health disparities.

The role of social cohesion in explaining rural/urban differences in healthcare access and health status among older adults in the mid-Atlantic United States.

Social cohesion can influence health. It is higher among rural versus urban residents, but the burden of chronic disease is higher in rural communities. We examined the role of social cohesion in explaining rural/urban differences in healthcare access and health status. Rural (n = 1080) and urban (n = 1846) adults (ages 50+) from seven mid-Atlantic U.S. states completed an online, cross-sectional survey on social cohesion and health. We conducted bivariate and multivariable analyses to evaluate the relationships of rurality and social cohesion with healthcare access and health status. Rural participants had higher social cohesion scores than did urban participants (rural: mean = 61.7, standard error[SE] = 0.40; urban: mean = 60.6, SE = 0.35; adjusted beta = 1.45, SE = 0.54, p < .01). Higher social cohesion was associated with greater healthcare access: last-year check-up: adjusted odds ratio[aOR] = 1.25, 95% confidence interval[CI] = 1.17-1.33; having a personal provider: aOR = 1.11, 95% CI = 1.03-1.18; and being up-to-date with CRC screening: aOR = 1.17, 95% CI = 1.10-1.25. In addition, higher social cohesion was associated with improved health status: higher mental health scores (adjusted beta = 1.03, SE = 0.15, p < .001) and lower body mass index (BMI; beta = -0.26, SE = 0.10, p = .01). Compared to urban participants, rural participants were less likely to have a personal provider, had lower physical and mental health scores, and had higher BMI. Paradoxically, rural residents had higher social cohesion but generally poorer health outcomes than did urban residents, even though higher social cohesion is associated with better health. These findings have implications for research and policy to promote social cohesion and health, particularly for health promotion interventions to reduce disparities experienced by rural residents.

Impact of Health Literacy on Medication Adherence Among Black Medicaid Beneficiaries with Hypertension in Delaware: A Cross-Sectional Study.

Racial and ethnic minorities are disproportionately affected by limited health literacy. Therefore, this study assessed census block health literacy level and medication adherence in Delaware among Black individuals with hypertension (HTN) receiving health care through Medicaid. This was a cross-sectional study of Black Delaware Medicaid beneficiaries (18-64 years old) from the 3 counties in Delaware (Kent, New Castle, and Sussex) from 2016 to 2019. The primary outcome was medication adherence (full adherence = 80%-100%, partial adherence = 50%-79%, and nonadherence = 0-49%) as a function of health literacy. Health literacy scores were categorized as below basic (0-184), basic (184-225), intermediate (226-309), and proficient (310-500). The results of the study showed that 18,958 participants (29%) had ≥1 HTN diagnosis during the study period. Mean area health literacy score for participants without HTN was significantly higher than participants with HTN (234.9 vs. 233.7, P < 0.0001). Men had lower odds of adherence compared with women (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.75-0.92, P < 0.001). Increased time enrolled in Medicaid decreased full adherence. Participants 21-30 and 31-50 years of age are significantly less likely to have full adherence in comparison with participants 51-64 years of age (P < 0.0001). Participants living in an area with basic level of health literacy reported lower medication adherence than those living in an area with an intermediate level of health literacy (OR: 0.72, 95% CI: 0.64-0.81, P < 0.001). In conclusion, men, younger adults, increased time enrolled in Medicaid for the study period, and basic health literacy were significantly associated with low adherence to medication among 3 census blocks in Delaware.

MindingMe: A Feasibility Study on Conducting Neuroimaging Research Among Diverse Groups.

BACKGROUND: Neuroimaging tools, such as functional magnetic resonance imaging, are useful in understanding differences in brain activity that predict behavior change. Designing interventions based on brain activity and response may enhance current self-management regimens. Yet, diverse groups, such as Black women with chronic illness, have historically been left out of neuroimaging research. OBJECTIVES: The aims of this study were to assess (a) the feasibility of conducting neuroimaging research among Black women with hypertension and (b) the predictors of willingness to participate in future studies. METHODS: A survey designed to assess interest in participating in neuroimaging research was distributed through a Facebook campaign targeting Metro-Detroit Blacks with hypertension. A 10-minute, 44-item survey queried the women regarding their perspectives related to participation in neuroimaging studies. Logistic regression analyses were conducted to predict willingness to participate in a future study; they included a range of predictors: demographic indicators, history of blood pressure diagnosis, systolic and diastolic blood pressure, and availability of a support person who could accompany the participant to a future study session. RESULTS: Two hundred fifty-seven Black women completed the survey. On average, the women were 59 years old, had been diagnosed with hypertension for 14 years, and had a systolic blood pressure of 141 mmHg. Participants were willing to travel 40 miles to participate, and many preferred to drive a personal vehicle. Some women were claustrophobic (20%) or had metal in their bodies (13%) and, therefore, would likely be ineligible to participate in neuroimaging studies. Some were nervous about the "small space" of a scanner, but others stated they would "enjoy participating" and wanted to "help future people…get well." Women who had a support person to attend their appointment with them were almost 4 times more likely to state they would participate in future studies. Those who had been diagnosed with hypertension for more than 11 years (the median) were almost 3 times more likely to report interest in participating in a future study than those participants who had been diagnosed with hypertension for 11 years or less. DISCUSSION: Black women with hypertension were interested and eligible to participate in neuroimaging research. Despite some of the facilitators and barriers we identified, the women in our sample were interested in participating in future studies. The presence of a support person and length of time with a hypertension diagnosis are important predictors of willingness to participate in a future study.

Influence of social and behavioral determinants on health-related quality of life among cancer survivors in the USA.

PURPOSE: Cancer survivors experience a worse health-related quality of life (HRQoL) than non-cancer survivors. However, it is not fully understood whether social determinants of health (SDOH) and health behaviors are significantly associated with HRQoL among cancer survivors. The purpose of this study was to investigate the influence of SDOH and health behaviors on HRQoL among cancer survivors. METHODS: We identified adult (18 years or older) cancer survivors (n = 5784) in the 2017 and 2019 Behavioral Risk Factor Surveillance System. The primary outcome (HRQoL) was defined as whether cancer survivors reported having poor mental or physical health (e.g., 14 or more mentally or physically unhealthy days). Unadjusted and adjusted logistic regression was used to compute the odds ratios and 95% CIs of factors associated with poor HRQoL among the cancer survivors. RESULTS: More than half of the cancer survivors were non-Hispanic White, female, and 65 years or older. In the adjusted multivariable logistic regression models, cancer survivors who were physically active and who did not avoid care because of costs had a lower risk of poor mental and physical health. Current smokers were more likely to report poor physical health. Homeowners were less likely to report poor mental health. Daily fruit and vegetable consumption and healthcare coverage were not associated with poor HRQoL. CONCLUSIONS: Some SDOH (healthcare access, economic stability, and the neighborhood and built environment) and health behavior (physical activity) are associated with lower likelihood of experiencing poor mental and/or physical health in the cancer survivors. The study findings can be used to target survivors who experience suboptimal HRQoL and to inform research, public health policies, and/or programs.

Developing a Storytelling Study for African Americans with Hypertension:: A Study Protocol.

Objective: Storytelling is an engaging approach for promoting health and wellness among individuals with health conditions including type 2 diabetes (TTDM), breast cancer, and hypertension. Storytelling interventions are an evidence-based approach that has been effective in promoting behavioral change such as increasing physical activity, medication adherence, and making dietary changes. The use of storytelling to convey health information and promote behavior change is associated with increased engagement in self-management particularly in communities of color. The primary objective of this paper was to describe our process for developing the storytelling study; specifically, recruitment, screening, selecting storytellers, and developing a study-specific interactive website. The secondary objective was to describe the approach for conducting the feasibility study and conduct a 6-week web-based storytelling study. Methods: Between 2017 to 2020, we developed a storytelling study for African Americans with hypertension. During that period we recruited participants from a Federally Qualified Health Center, a local church, and at community events. We selected storytellers to share their experiences managing hypertension and filmed 10 storytellers. Presently, a feasibility and pilot study are underway, the goal of the feasibility study is to ascertain feedback about the stories and the study website from African American adults with hypertension. We will also conduct a 6-week pilot study with 30 African American adults to see if conducting a storytelling study online would be an effective approach for promoting behavioral change. Conclusions: We successfully recruited and filmed 10 storytellers and produced 9 stories about living with and managing hypertension. The feedback we received from participants in the feasibility and pilot study will be useful as we refine the design of the study to determine the potential for a future randomized controlled trial (RCT).

The influence of patriarchy on Nepali-speaking Bhutanese women's diabetes self-management.

INTRODUCTION: The Nepali-speaking Bhutanese (NSB) community is a rapidly growing population in Central Pennsylvania. A community-based diabetes education pilot program found a large gender disparity with fewer women in attendance; participants reported that primary household cooks and caretakers were women. This may be an indication of women's status in the NSB community, their healthcare access, autonomy, and ability to manage their diabetes. Hence, this study aims to understand the manifestations of patriarchy and its impact on NSB women's diabetes self-management employing a conceptual framework based on Walby's structures of patriarchy. METHODS: An exploratory feminist qualitative inquiry was conducted. Fifteen NSB women with Type 2 Diabetes were interviewed about their diabetes self-management. Transcripts were coded for key concepts that emerged from the data. A thematic analysis was conducted. Themes were developed inductively through those categories as well as through an a priori approach using the conceptual framework. RESULTS: Cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women's patriarchal upbringing and lifestyle. Unpaid household production was largely dependent on women. Multiple immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women's access to healthcare (including diabetes) was entirely reliant on other family members due to poor autonomy. Women experienced adverse physical and emotional symptoms related to diabetes and their ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and self-efficacy. CONCLUSION: Patriarchal practices that start early on within women's lives, such as child marriage, religious restrictions as well as women's access to education and autonomy impacted NSB women's access to healthcare, knowledge regarding their diabetes and self-efficacy. Future interventions tailored for diabetes prevention and self-management among NSB women should factor in patriarchy as an important social determinant of health.

Systematic review of menstrual health and hygiene in Nepal employing a social ecological model.

Menstrual health and hygiene are a major public health and social issues in Nepal. Due to inadequate infrastructure to provide education, healthcare, and communication as well as religious teachings, women and girls are excluded from participation in many activities of daily living and community activities during menstruation. Evidence based research addressing menstrual health and hygiene in Nepal is scares. The objective of this paper is to review the current state of knowledge on menstrual health and hygiene in Nepal through a socio-ecological perspective. This systematic review identifies knowledge gaps and targets for future research and interventions. Studies from Nepal that examined factors contributing to menstrual health and hygiene were identified through searches across six databases (Medline, CINAHL, Web of Science, PsychInfo, Nepal Journals Online and Kathmandu University Medical Journal) in January 2019. The SEM is a public health framework that describes how health is impacted at multiple levels including the individual, interpersonal, community, organizational and policy levels. Key themes were identified, and factors contributing to menstrual health and hygiene were categorized as per the level of socio-ecological model (SEM). After a comprehensive literature review, twenty peer-reviewed publications, published between 2003 and January 2019 were included in this review. Eighteen studies were descriptive and two were interventional. The main outcomes reported were reproductive health concerns and menstrual hygiene practices. Nine studies focused on knowledge, attitude, and practices regarding menstruation, seven studies highlighted reproductive health issues, three studies focused on prevalence of culturally restrictive practices, and one on school absenteeism and intimate partner violence. Lack of awareness regarding menstrual health and hygiene, inadequate WASH facilities, no sex education and culturally restrictive practices makes menstruation a challenge for Nepali women. These challenges have negative implications on women and girls' reproductive as well as mental health and school attendance among adolescent girls. There are gaps in the evidence for high quality interventions to improve menstrual health and hygiene in Nepal. Future research and interventions should address needs identified at all levels of the SEM.

Menstrual health and hygiene are major public health and social issues in Nepal, due to a lack of health and education infrastructure, gender-based disparities and restrictive cultural and social norms. This study reviewed the current state of research on menstrual health and hygiene in Nepal. The socio-ecological model (SEM)­a public health framework that examines individual, interpersonal, community, organizational, and policy impacts on health­was employed to describe impacts on menstrual health and hygiene. After a comprehensive literature review, 20 papers were included in this analysis, of which 18 were descriptive and two were interventional. The primary menstrual health and hygiene outcomes reported were reproductive health concerns and menstrual hygiene practices. Key themes identified were knowledge, attitude, and practices regarding menstruation, reproductive health issues, prevalence of culturally restrictive practices, school absenteeism and intimate partner violence. The study results indicated lower menstrual health and hygiene challenges arose from lack of education around menstruation, lack of proper water, sanitation, and hygiene (WASH) facilities, poor sex education, and culturally restrictive practices. These challenges negatively impact women and girls' reproductive health as well as mental health and school attendance. There is need for high quality, effective interventions to improve menstrual health and hygiene in Nepal. Future research and interventions should address improvements in menstrual health and hygiene at all levels of the socio-ecological model.

The Association between Gender and Physical Activity Was Partially Mediated by Social Network Size during COVID-19.

The COVID-19 pandemic has disrupted physical activity, particularly among women. Limited research has explored how social network support may explain gender-based variations in physical activity during COVID-19. The purpose of this study was to examine the mediating role of social networks in the association between gender and physical activity during a pandemic. This cross-sectional survey assessed whether social network characteristics (i.e., in-person social network size, frequency of in-person social network interactions, and online friend network size) mediate the relationship between gender and either past-week or past-year physical activity. Multiple mediation analyses were conducted to determine the indirect effect of gender on physical activity through social networks. Among 205 participants, women (n = 129) were significantly less physically active (ß = −73.82; p = 0.02) than men (n = 76) and reported significantly more Facebook friends (ß = 0.30; p < 0.001) than men, which was inversely associated with past-week physical activity (ß = −64.49; p = 0.03). Additionally, the indirect effect of gender on past-week physical activity through Facebook friends was significant (ß = −19.13; 95% CI [−40.45, −2.09]). Findings suggest that social media sites such as Facebook could be used to encourage physical activity among women during a pandemic.

Sex differences in clinical outcomes for obstructive hypertrophic cardiomyopathy in the USA: a retrospective observational study of administrative claims data.

OBJECTIVES: To evaluate sex differences in demographic and clinical characteristics, treatments and outcomes for patients with diagnosed obstructive hypertrophic cardiomyopathy (oHCM) in the USA. SETTING: Retrospective observational study of administrative claims data from MarketScan Commercial Claims and Encounters Database from IBM Watson Health. PARTICIPANTS: Of the 28 million covered employees and family members in MarketScan, 9306 patients with oHCM were included in this analysis. MAIN OUTCOME MEASURES: oHCM-related outcomes included heart failure, atrial fibrillation, ventricular tachycardia/ fibrillation, sudden cardiac death, septal myectomy, alcohol septal ablation (ASA) and heart transplant. RESULTS: Among 9306 patients with oHCM, the majority were male (60.5%, p<0.001) and women were of comparable age to men (50±15 vs 49±15 years, p<0.001). Women were less likely to be prescribed beta blockers (42.7% vs 45.2%, p=0.017) and undergo an implantable cardioverter-defibrillator (1.7% vs 2.6%, p=0.005). Septal reduction therapy was performed slightly more frequently in women (ASA: 0.08% vs 0.05%, p=0.600; SM: 0.35% vs 0.18%, p=0.096), although not statistically significant. Women were less likely to have atrial fibrillation (6.7% vs 9.9%, p<0.001). CONCLUSION: Women were less likely to be prescribed beta blockers, ACE inhibitors, anticoagulants, undergo implantable cardioverter-defibrillator and have ventricular tachycardia/fibrillation. Men were more likely to have atrial fibrillation. Future research using large, clinical real-world data are warranted to understand the root cause of these potential treatment disparities in women with oHCM.

Serial Mediation Roles of Perceived Stress and Depressive Symptoms in the Association Between Sleep Quality and Life Satisfaction Among Middle-Aged American Adults.

In this study, we used data from the second wave of Midlife in the United States (MIDUS) Study, MIDUS Biomarkers and MIDUS 3. We applied the serial mediation model to explore the serial mediating effects of perceived stress and depressive symptoms on the relationship between sleep quality and life satisfaction. A total of 945 participants were included in our study. The total indirect effect of sleep quality on life satisfaction through perceived stress, depressive symptoms and the combination of perceived stress and depressive symptoms accounted for within the overall model was 45.5%. At the intervention level, programs designed to improve the level of life satisfaction among adults should focus on perceived stress and depressive symptoms. The prevention of perceived stress and depression contributes to improving life satisfaction and wellbeing. The serial mediation results should be confirmed by further longitudinal study.

The Nepali-speaking Bhutanese Immigrants: A Population Overlooked amidst the COVID-19 Crisis.

The Nepali-speaking Bhutanese (NSB) community living in Central Pennsylvania has been significantly affected by COVID-19 due to various biopsychosocial determinants of health. In this paper, we discuss interventions developed by a tertiary care health system in Central Pennsylvania to provide immediate support to the NSB community.

Vitamin D and family history of hypertension in relation to hypertension status among college students.

Hypertension and vitamin D concentrations have heritable components, although these factors remain uninvestigated in young adults. The objective of this study was to investigate hypertension risk among young adults with respect to family history of hypertension, adjusting for vitamin D status. Resting blood pressure (BP) was measured in 398 individuals aged 18-35 and classified according to the 2017 American Heart Association criteria. Plasma vitamin D metabolite (25(OH)D3; 24,25(OH)2D3; 1,25(OH)2D3) concentrations were determined using liquid chromatography tandem mass spectrometry (LC-MS/MS). Stepwise logistic regression was used to select covariates. Participants' mean age was 21, 30.3% had hypertension, and nearly all unaware of their hypertensive status (90.7%). Compared with no parental history, the adjusted odds ratio (AOR) for hypertension was elevated among participants with two parents having hypertension (AOR = 4.5, 95% CI: 1.70-11.76), adjusting for sex, body mass index, physical activity, and plasma 25(OH)D3. Results for systolic hypertension (SH) were similar but more extreme (two parents AOR = 7.1, 95% CI: 2.82, 17.66), although dihydroxy metabolites (1,25(OH)2D3 and 24,25(OH)2D3) were significant. There was a strong, independent association with dual parental history and hypertension status, regardless of vitamin D status. Hypertension was prevalent in nearly one-third of the sample and underscores the need for targeted prevention for young adults.

Healthy Eating Index Scores Differ by Race/Ethnicity but Not Hypertension Awareness Status among US Adults with Hypertension: Findings from the 2011-2018 National Health and Nutrition Examination Survey.

BACKGROUND: Little is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension. OBJECTIVE: The aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness. DESIGN: Analysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population. PARTICIPANTS/SETTING: A total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included. MAIN OUTCOME MEASURES: Diet quality was assessed by Healthy Eating Index 2015 (HEI-2015). STATISTICAL ANALYSIS PERFORMED: Weighted χ2 tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates. RESULTS: Among the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status. CONCLUSIONS: There were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness.

Examining medication adherence and preferences for a lifestyle intervention among Black and Latinx adults with hypertension: a feasibility study.

BACKGROUND: Approximately 116.4 million adults in the USA have hypertension, and the rates of uncontrolled hypertension remain higher among racial and ethnic minorities. There is a need for effective interventions that promote healthy behaviors and long-term behavioral change in the management of hypertension. The primary objective of this study was to determine the feasibility of developing a lifestyle intervention that would assess hypertension management and the use of technology among Blacks and Latinx with hypertension. The secondary objective is to explore perceptions of community-based resources for hypertension and preferences for a lifestyle intervention for hypertension among Blacks and Latinx with hypertension. METHODS: In this explanatory mixed-methods study, quantitative data were collected using surveys, participants reported their use of technology and adherence to antihypertensive medication. Participants were Black and Latinx adults with hypertension living in Central Pennsylvania, USA. Qualitative data were obtained from semi-structured interviews and focus groups, and participants were asked about managing hypertension, local resources, and preferences for a behavioral intervention. Data were examined using summary statistics for quantitative data and thematic analysis for qualitative data. RESULTS: Black and Latinx participants (n=30) completed surveys for the quantitative study. The majority (75%) of participants self-reported being confident in managing their medication without help and remembering to take their medication as prescribed. Fewer participants (54.2%) reported using technology to help manage medication. There were 12 participants in the qualitative phase of the study. The qualitative findings indicated that participants felt confident in their ability to manage hypertension and were interested in participating in a lifestyle intervention or program based online. Some participants reported a lack of resources in their community, while others highlighted local and national resources that were helpful in managing high blood pressure. CONCLUSION: This study provides important insights on barriers and facilitators for managing hypertension, current use of technology and interest in using technology to manage hypertension, and preferences for future lifestyle interventions among racial and ethnic minorities. This study also provides insights to the health needs and resources available in this community and how future behavioral interventions could be tailored to meet the needs of this community. The findings of this study will be used to inform the tailoring of future lifestyle interventions; specifically, we will include text messaging reminders for medication and to disseminate educational materials related to hypertension and provide resources to connect study participants with local and national resources.

Telehealth Interventions and Outcomes Across Rural Communities in the United States: Narrative Review.

BACKGROUND: In rural communities, there are gaps in describing the design and effectiveness of technology interventions for treating diseases and addressing determinants of health. OBJECTIVE: The aim of this study is to evaluate literature on current applications, therapeutic areas, and outcomes of telehealth interventions in rural communities in the United States. METHODS: A narrative review of studies published on PubMed from January 2017 to December 2020 was conducted. Key search terms included telehealth, telemedicine, rural, and outcomes. RESULTS: Among 15 included studies, 9 studies analyzed telehealth interventions in patients, 3 in health care professionals, and 3 in both patients and health care professionals. The included studies reported positive outcomes and experiences of telehealth use in rural populations including acceptability and increased satisfaction; they also noted that technology is convenient and efficient. Other notable benefits included decreased direct and indirect costs to the patient (travel cost and time) and health care service provider (staffing), lower onsite health care resource utilization, improved physician recruitment and retention, improved access to care, and increased education and training of patients and health care professionals. CONCLUSIONS: Telehealth models were associated with positive outcomes for patients and health care professionals, suggesting these models are feasible and can be effective. Future telehealth interventions and studies examining these programs are warranted, especially in rural communities, and future research should evaluate the impact of increased telehealth use as a result of the COVID-19 pandemic.