A Randomized Clinical Trial of Group Acupuncture for Painful Diabetic Neuropathy Among Diverse Safety Net Patients.

OBJECTIVE: Existing pharmacologic approaches for painful diabetic neuropathy (PDN) are limited in efficacy and have side effects. We examined the feasibility, acceptability, and effects of group acupuncture for PDN. DESIGN AND SETTING: We randomized patients with PDN from a public safety net hospital to 1) usual care, 2) usual care plus 12 weeks of group acupuncture once weekly, or 3) usual care plus 12 weeks of group acupuncture twice weekly. METHODS: The primary outcome was change in weekly pain intensity (daily 0-10 numerical rating scale [NRS] averaged over seven days) from baseline to week 12. We also assessed health-related quality of life and related symptoms at baseline and weeks 6, 12, and 18. RESULTS: We enrolled 40 patients with PDN (baseline pain = 5.3). Among participants randomized to acupuncture, 92% attended at least one treatment (mean treatments = 10.1). We observed no significant differences between once- vs twice-weekly acupuncture and combined those groups for the main analyses. Compared with usual care, participants randomized to acupuncture experienced greater decreases in pain during the 12-week intervention period (between-group differences from baseline = -2.06, 95% confidence interval [CI] = -3.01 to -1.10), but benefits were not maintained after acupuncture ended (baseline to week 18 = -0.61, 95% CI = -1.46 to 0.24). Quality of life improved for acupuncture participants (baseline to week 12 difference = 11.79, 95% CI = 1.92 to 21.66), but group differences were not significant compared with usual care (25.58, 95% CI = -3.90 to 55.06). CONCLUSIONS: Group acupuncture is feasible and acceptable among linguistically and racially diverse safety net patients. Findings suggest clinically relevant reduction in pain from PDN and quality of life improvements associated with acupuncture, with no differences based on frequency.

Sleep duration in Mexican American children: Do mothers' and fathers' parenting and family practices play a role?

This study examined parenting styles, parenting practices and family practices that may be associated with weeknight sleep duration among 8- to 10-year-old Mexican American (MA) children. This cross-sectional study of MA children used baseline data from a 2-year cohort study of mother-child pairs (n = 308) with additional data on fathers (n = 166). Children's weeknight sleep duration was accelerometer estimated and averaged for 2 weeknights. Parents reported on their parenting styles and practices regarding food and family food-related practices. Multivariable linear regression analysis was used to examine sleep duration with parenting styles and practices, and family practices, and adjusting for child gender and body mass index. Model 1 included mothers' parenting styles and practices; Model 2 included both mothers' and fathers' parenting styles and practices. Children's average sleep duration was 9.5 (SD = 0.8) hr. Mothers who used pressure to encourage their children to eat and those who used food to control behavior had children with longer sleep duration (ß = 0.21, p < 0.01; ß = 0.15, p = 0.03, respectively). Mothers who reported their children ate dinner with the TV on and those who valued eating dinner as a family had children with shorter sleep duration (ß = -0.16, p = 0.01; ß = -0.18, p = 0.01, respectively). Fathers who restricted the amount of food their children ate had children with shorter sleep duration (ß = -0.27, p = 0.01). Mothers' and fathers' feeding practices, the child's eating dinner with the TV on, and valuing family dinners, played a role in children's weeknight sleep duration among Mexican American families. Parental feeding practices and family mealtime contexts may have an effect on children's weeknight sleep duration.

Short Sleep Duration Is Associated With Eating More Carbohydrates and Less Dietary Fat in Mexican American Children.

Study Objective: Short sleep duration is a risk factor for childhood obesity. Mechanisms are unclear, but may involve selection of high carbohydrate foods. This study examined the association between estimated sleep duration and macronutrient intake as percentages of total energy among Mexican American (MA) 9-11 year olds. Methods: This cross-sectional study measured diet using two 24-hour recalls and estimated sleep duration using hip-worn accelerometry in MA children (n = 247) who were part of a cohort study. Child and maternal anthropometry were obtained; mothers reported on demographic information. Using linear regression, we examined the relationship of sleep duration with energy intake, sugar intake, and the percentage of energy intake from carbohydrates, fat, and protein. Results: Children were 47% male; mean age was 10 (SD = 0.9) years. Mean sleep duration was 9.6 (SD = 0.8) hours; 53% were overweight/obese, with a mean energy intake of 1759 (SD = 514) calories. Longer sleep duration was independently associated with a lower percentage of energy intake from carbohydrates (ß = -0.22, p < .01) and a higher percentage of energy from fat (ß = 0.19, p < .01), driven by the percentage of energy from polyunsaturated fatty acids (PUFA; ß = 0.17, p < .05). No association was found with the intake of energy or total sugars, or the percent of calories from protein. Conclusions: MA children who slept longer consumed diets with a lower percentage of calories from carbohydrates and a higher percentage from fat, especially from PUFA. Short sleep duration may be a risk factor for food cravings that are high in carbohydrate content and may displace heart-healthy dietary fat, and thereby increase obesity risk among children.

Is it time for bed? Short sleep duration increases risk of obesity in Mexican American children.

OBJECTIVE: Cross-sectional studies show that sleep is related to childhood obesity. We aimed to examine the longitudinal impact of sleep on the risk of obesity in Mexican American children. DESIGN AND METHODS: We evaluated 229 Mexican American 8-10-year-olds and their mothers at baseline and at 12- and 24-month follow-ups. Sleep duration and anthropometrics were collected. Age- and gender-specific body mass index (BMI) z-scores (BMIz) were calculated based on Centers for Disease Control and Prevention guidelines. Sleep duration was estimated using accelerometry. Children were also categorized as long or short sleepers, using the National Sleep Foundation's recommendation to define adequate sleep duration (10-11 h for 5-12-year-olds). Using linear regressions, we examined whether sleep duration predicted BMIz, waist-to-height ratio (WHtR), and weight gain at 24 months. RESULTS: Children were mostly short sleepers (82%). Children who slept less were more likely to have a higher BMIz, WHtR, and weight gain at the 24-month follow-up (ß = -0.07, P = 0.01; ß = -0.11, P <0.01; and ß = -0.14, P = 0.02, respectively), after controlling for baseline weight status, child gender, maternal BMI, and occupation. CONCLUSION: In Mexican American children, shorter sleep duration at baseline was associated with increased weight status over 24 months.

Substance use and experienced stigmatization among ethnic minority men who have sex with men in the United States.

Research has documented deleterious effects of racism among ethnic minorities and of homophobia among men who have sex with men (MSM). Less is known about the impact of multiple forms of stigmatization on ethnic minority MSM. This study examined substance use by African American, Asian/Pacific Islander and Latino MSM, and the associations of experienced racism and homophobia from various sources with polydrug use and stimulant drug use. Experienced racism within the general community was associated with higher levels of use; other forms of discrimination were either not associated with polydrug or stimulant use or had more complex relationships with use. Implications for further research and interventions are discussed.

Colorectal cancer screening: what do women from diverse ethnic groups want?

BACKGROUND: Little is known about factors associated with willingness to undergo colorectal cancer (CRC) screening for personal or public health benefit among women from diverse race/ethnic groups. OBJECTIVE: To evaluate factors associated with willingness to undergo CRC screening for personal and public health benefit among women from diverse race/ethnic groups. METHODS: We interviewed women aged 50 to 80 from four racial/ethnic groups from primary care clinics in 2003-2005. We asked about demographics, CRC screening knowledge and history, perceived risk of colon cancer, and about the outcomes of intention to be screened for personal benefit and for public health benefit. RESULTS: Of the 492 women who completed the interview, 32 % were White, 16 % were African American, 21 % were Latina and 32 % were Asian. Up-to-date screening was reported by 77 % of women, with similar numbers obtaining fecal occult blood test (FOBT) within 2 years or colonoscopy within 10 years. The majority of women were "likely or very likely" to get FOBT or colonoscopy after learning the benefits and risks. Multivariate models showed that compared to Whites, fewer Asians would undergo colonoscopy (OR = 0.28; 95 % CI: 0.12, 0.63), while more Latinas would undergo colonoscopy (OR = 6.14; 95 % CI: 1.77, 21.34) and obtain regular CRC screening (OR = 4.47; 95 % CI: 1.66, 12.04). The majority would obtain CRC screening even if they would not personally benefit; those who perceived themselves to be at higher than average cancer risk were more likely to participate in CRC screening for public health benefit (OR = 2.32; 95 % CI: 1.32, 4.09). CONCLUSIONS: The majority of women are willing to undergo screening for personal benefit. Asians were less likely, and Latinas more likely, to accept colonoscopy. Most are also willing to undergo screening for public health benefit. Self-perceived risk of CRC was the most consistent predictor of willingness and intention to be screened for either personal or public health benefit.

Smoking and exposure to racial insults among multiethnic youth in Jujuy, Argentina.

PURPOSE: Exposure to racial insults among youth in Jujuy, Argentina, was examined as a factor associated with smoking behavior. METHODS: Youth sampled from eighth-grade classes in 27 randomly selected middle schools completed annual surveys in the ninth and tenth grades. Demographics, race/ethnicity (Indigenous/Amazonian, Indigenous/Andean, Indigenous unspecified group, Mixed European-Indigenous, European), cigarette smoking, and other attitudinal and behavioral factors were measured. Exposure to racial insults, measured in the ninth grade, was modeled to predict cigarette smoking in the previous 30 days (defined as current) in the tenth grade conditional on ninth grade smoking. RESULTS: Of the 3,122 respondents, 35.5% reported exposure to racial insults and 33.8% were current smokers. Factors associated with racial insults were being male, indigenous language spoken at home, ever and current smoking, smoking in a ceremonial context, exposure to second-hand smoke at home, number of friends who smoke, having low expectations for the future, low identification with conforming role models, high identification with defiant role models, and depressive symptoms. Reported exposure to racial insults increased the risk of current smoking in the 10th grade among Indigenous Amazonian respondents (OR = 3.8; 95% CI 1.4-10.4) and among the Indigenous-unspecified group (OR = 1.8; 95% CI 1.1-2.8), but not among European or Indigenous Andean youth. CONCLUSIONS: Exposure to racial insults is commonplace among youth in Jujuy. Evidence of a longitudinal effect of ninth-grade racial insults on tenth-grade smoking rates provides support for an association of racial insults with smoking behavior.

Valued life activity disability played a significant role in self-rated health among adults with chronic health conditions.

OBJECTIVE: Because self-rated health (SRH) is strongly associated with health outcomes, it is important to identify factors that individuals take into account when they assess their health. We examined the role of valued life activities (VLAs), the wide range of activities deemed to be important to individuals, in SRH assessments. STUDY DESIGN AND SETTING: Data were from three cohort studies of individuals with different chronic conditions--rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and chronic obstructive pulmonary disease (COPD). Each cohort's data were collected through structured telephone interviews. Logistic regression analyses identified factors associated with ratings of fair/poor SRH. All analyses included sociodemographic characteristics, general and disease-specific health-related factors, and general measures of physical functioning. RESULTS: Substantial portions of each group rated their health as fair/poor (RA 37%, SLE 47%, COPD 40%). In each group, VLA disability was strongly associated with fair/poor health (RA: OR=4.44 [1.86,10.62]; SLE: OR=3.60 [2.10,6.16]; COPD: OR=2.76 [1.30,5.85]), even after accounting for covariates. CONCLUSION: VLA disability appears to play a substantial role in individual perceptions of health, over and above other measures of health status, disease symptoms, and general physical functioning.

Association between cancer risk perception and screening behavior among diverse women.

BACKGROUND: We measured the perception of breast, cervical, and colon cancer risks and screening in diverse women to examine the association between risk perception and screening behavior. METHODS: Cross-sectional telephone and in-person interviews of women aged 50 to 80 years were conducted in English, Spanish, or Chinese. The women were recruited from primary care practices in San Francisco, California (academic general internal medicine, family medicine, women's health practices, a community-based clinic in Chinatown, and the Community Health Network Clinics, which is affiliated with the San Francisco Department of Public Health), with at least 1 visit within the previous 2 years. Perceived personal risk for each cancer was measured on a word scale (no risk to very high risk) and compared with self-reported screening behavior by ethnicity. RESULTS: A total of 1160 women participated: 338 (29%) were White, 167 (14%) were African American, 239 (21%) were Latina, and 416 (36%)were Asian. The average participant was 61 years old and a high school graduate; 18% had a personal history of cancer, and 42% had a family history of cancer. The perceived lifetime risk of cancer varied by ethnicity. Compared with White women, Latinas had a higher perceived risk for cervical cancer (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.6) and colon cancer (OR, 3.0; 95% CI, 1.8-5.0) after multivariate adjustment, and Asians had a lower perceived risk for cervical cancer (OR, 0.6; 95% CI, 0.4-0.9) and colon cancer (OR, 0.6; 95% CI, 0.3-0.9). Higher colon cancer risk perception was associated with having undergone colonoscopy within 10 years (OR, 2.8; 95% CI, 1.4-5.4). CONCLUSIONS: Risk perception was significantly associated with colon cancer screening behavior (P=.001). Evaluation of patients' perceived risk of cancer may be useful to clinicians who are recommending screening tests.