Social and behavioral risk marker clustering associated with biological risk factors for coronary heart disease: NHANES 2001-2004.

BACKGROUND: Social and behavioral risk markers (e.g., physical activity, diet, smoking, and socioeconomic position) cluster; however, little is known whether clustering is associated with coronary heart disease (CHD) risk. Objectives were to determine if sociobehavioral clustering is associated with biological CHD risk factors (total cholesterol, HDL cholesterol, systolic blood pressure, body mass index, waist circumference, and diabetes) and whether associations are independent of individual clustering components. METHODS: Participants included 4,305 males and 4,673 females aged ≥ 20 years from NHANES 2001-2004. Sociobehavioral Risk Marker Index (SRI) included a summary score of physical activity, fruit/vegetable consumption, smoking, and educational attainment. Regression analyses evaluated associations of SRI with aforementioned biological CHD risk factors. Receiver operator curve analyses assessed independent predictive ability of SRI. RESULTS: Healthful clustering (SRI = 0) was associated with improved biological CHD risk factor levels in 5 of 6 risk factors in females and 2 of 6 risk factors in males. Adding SRI to models containing age, race, and individual SRI components did not improve C-statistics. CONCLUSIONS: Findings suggest that healthful sociobehavioral risk marker clustering is associated with favorable CHD risk factor levels, particularly in females. These findings should inform social ecological interventions that consider health impacts of addressing social and behavioral risk factors.

Implementation of permutation testing to determine clustering of social and behavioral risk factors for coronary heart disease, National Health and Nutrition Examination Survey 2001-2004.

PURPOSE: To determine whether social and behavioral risk factors for coronary heart disease, including education, physical activity, fruit/vegetable intake, and smoking, cluster (i.e., co-occur more than expected as the result of chance) in U.S. adults. METHODS: The study included 4305 male and 4673 female subjects aged ≥20 years from the National Health and Nutrition Examination Survey. Risk factors included: ≤high school diploma/general educational development certificate; <150 minutes of moderate/vigorous physical activity per week; <3 or <2 servings of vegetables and fruit, respectively, per day; and smoking cigarettes. Indicator variables were summed into a sociobehavioral risk index (SRI, range 0 [no risk factors] to 4 [all risk factors]). Ratios of observed-to-expected prevalence (under the assumption of independence) of the SRI were assessed. Statistical significance was evaluated by the use of randomly permuted average observed-to-expected SRI ratios and 95% confidence intervals (95% CIs). RESULTS: In male subjects, the ratio of observed-to-expected prevalence of SRI = 0 was 1.70 (permuted ratio = 1.00; 95% CI: 0.92-1.08), and SRI = 4 was 2.10 (permuted ratio = 1.00, 95% CI: 0.86-1.14), demonstrating significant clustering. In females, the ratio of observed-to-expected prevalence of SRI = 0 was 1.67 (permuted ratio = 1.00, 95% CI: 0.92-1.08), and SRI = 4 was 1.86 (permuted ratio = 1.00, 95% CI: 0.85-1.15). CONCLUSIONS: Social and behavioral risk factors for coronary heart disease cluster in this sample of U.S. adults.

Pregnant and moving: understanding residential mobility during pregnancy and in the first year of life using a prospective birth cohort.

To examine residential mobility (i.e., moving) during pregnancy and in the first year of an infant's life using a large, prospective birth cohort in Rhode Island. Participants were recruited from Women and Infants Hospital of Rhode Island between January 5, 2009 and March 19, 2009. Residential histories were collected from mothers in-person immediately post-partum and by phone at 7 months and at 13 months post-partum. Of 1,040 mothers interviewed at birth, 71% (n = 740) completed the 13 month follow-up interview. Forty-one percent of mothers (n = 300) moved at least once between conception and 1 year post-partum, with the number of moves ranging from 0 to 8. Among movers, 69.0% moved once, 21.0% moved twice, and 10.0% moved three or more times. Mothers who moved tended to be younger, have fewer children, were not White, and had lower household incomes than those who did not move. Mothers who moved during pregnancy had 2.05 (95% CI: 1.40-2.98) times the odds of moving post-partum than mothers who had not moved in the antenatal period. There were statistical differences across socio-demographic groups with regard to when, where, and why mothers moved. Forty percent of movers during pregnancy (n = 61) moved for at least one negative reason, while 32.2% of movers during infancy (n = 64) relocated under negative circumstances. A substantial proportion of mothers moved pre- and post-partum, frequently under negative circumstances. Study findings have important implications for obstetric and pediatric providers who seek to understand, retain, and improve the health of their patient populations.

Short sleep duration is associated with carotid intima-media thickness among men in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

BACKGROUND AND PURPOSE: Carotid intima-media thickness (CIMT) is a subclinical marker of cardiovascular disease. Recent studies suggest that shorter sleep duration is a risk factor for cardiovascular disease, but there is limited evidence regarding this association using high-quality, objective assessments of sleep. The aim of this study is to determine whether sleep duration is associated with CIMT. METHODS: The study used an observational cohort consisting of 617 black and white middle-aged healthy participants (37-52 years; 58% female) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Multivariable-adjusted linear regression analyses were performed. Sleep duration was measured using wrist actigraphy monitors. CIMT was calculated using the average of 20 measurements of the mean common carotid, bulb, and internal CIMT, which was assessed using ultrasound images. RESULTS: After adjusting for covariates, 1 hour of longer sleep duration was associated with 0.026 mm less CIMT among men (P=0.02; 95% CI, -0.047 to -0.005) and 0.001 mm less CIMT among women (P=0.91; 95% CI, -0.020 to 0.022). Segment-specific analyses indicated that the carotid bulb was a key driver of the observed association. CONCLUSIONS: Shorter objectively assessed sleep duration was associated with greater CIMT among men but not women.

Decreased births among black female adolescents following school desegregation.

Although the socioeconomic impact of school desegregation in the U.S. has been well documented, little is known about the health consequences of this policy. The purpose of this study was to quantify the associations between school desegregation and adolescent births among black and white females. We compared the change in prevalence of adolescent births in areas that implemented school desegregation plans in the 1970s with areas that implemented school desegregation plans in other decades, using difference-in-difference methods with 1970 and 1980 Census microdata. School desegregation policy in the U.S. in the 1970s was associated with a significant reduction of 3.2 percentage points in the prevalence of births among black female adolescents between 1970 and 1980. This association was specific to black female adolescents and was not observed among white adolescents.

Inverse associations between perceived racism and coronary artery calcification.

PURPOSE: To evaluate whether racial discrimination is associated with coronary artery calcification (CAC) in African-American participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study. METHODS: The study included American Black men (n = 571) and women (n = 791) aged 33 to 45 years in the CARDIA study. Perceived racial discrimination was assessed based on the Experiences of Discrimination scale (range, 1-35). CAC was evaluated using computed tomography. Primary analyses assessed associations between perceived racial discrimination and presence of CAC using multivariable-adjusted logistic regression analysis, adjusted for age, gender, socioeconomic position (SEP), psychosocial variables, and coronary heart disease (CHD) risk factors. RESULTS: In age- and gender-adjusted logistic regression models, odds of CAC decreased as the perceived racial discrimination score increased (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90-0.98 per 1-unit increase in Experiences of Discrimination scale). The relationship did not markedly change after further adjustment for SEP, psychosocial variables, or CHD risk factors (OR, 0.93; 95% CI, 0.87-0.99). CONCLUSIONS: Perceived racial discrimination was negatively associated with CAC in this study. Estimation of more forms of racial discrimination as well as replication of analyses in other samples will help to confirm or refute these findings.

Development of a cardiovascular risk score for use in low- and middle-income countries.

Summary measures of cardiovascular risk have long been used in public health, but few include nutritional predictors despite extensive evidence linking diet and heart disease. Study objectives were to develop and validate a novel risk score in a case-control study of myocardial infarction (MI) conducted in Costa Rica during 1994-2004. After restricting the data set to healthy participants (n = 1678), conditional logistic regression analyses modeled associations of lifestyle factors (unhealthy diet, decreased physical activity, smoking, waist:hip ratio, low or high alcohol intake, and low socioeconomic status) with risk for MI. Using the estimated coefficients as weights for each component, a regression model was fit to assess score performance. The score was subsequently validated in participants with a history of chronic disease. Higher risk score values were associated with a significantly increased risk of MI [OR = 2.72 (95% CI = 2.28-3.24)]. The findings were replicated in a model (n = 1392) that included the best covariate measures available in the study [OR = 2.71 (95% CI = 2.26-3.26)]. Performance of the score in different subsets of the study population showed c-statistics ranging from 0.63 to 0.67. The new score presents a quantitative summary of modifiable cardiovascular risk factors in the study population.

The association between blood pressure and years of schooling versus educational credentials: test of the sheepskin effect.

PURPOSE: Attaining a degree may offer greater opportunities for health than years of schooling alone. This study examines whether there is a degree, or "sheepskin," effect on the association between education and blood pressure. METHODS: Multivariable-adjusted ordinal and linear regression models assessed associations of years of schooling and degree attainment with systolic and diastolic blood pressure in a sample of 552 adults ages 38 to 47 years. RESULTS: Years of schooling was inversely associated with systolic blood pressure adjusting for age, gender and race (ß = -0.4, 95% confidence limit: -0.7, -0.1 mmHg systolic blood pressure/year of schooling). Additional adjustment for mother's education, childhood verbal intelligence quotient, childhood health, and childhood socioeconomic status had minimal impact on effect size (ß = -0.3, 95% confidence limit = -0.7, 0.0). However, years of schooling was no longer associated with blood pressure in the fully adjusted model which included additional adjustment for degree attained (ß = 0.0, 95% confidence limit: -0.5, 0.4). In the fully adjusted model (including adjustment for years of schooling), individuals with a graduate degree still had significantly lower systolic blood pressure than HS degree-holders (e.g., ß = -9.2, 95% confidence limit: -15.2, -3.2 for graduate vs high school degree). Findings were similar for diastolic blood pressure. CONCLUSIONS: The association of years of schooling with blood pressure may be largely due to degree attainment rather than simply the knowledge and skills accumulated due to years of schooling alone.

Opinion networks among long-term care specialists.

A challenge in the adoption of long-term care (LTC) policy reform is the number of constituency groups active in LTC and historical antagonism among these groups regarding critical issues such as LTC financing and regulation. As part of a national survey of LTC specialists, the authors asked previously identified specialists to nominate other "experts" with known or demonstrable experience in LTC. As a proxy for potential information exchange, data about nominations were used to construct and describe the networks of LTC specialists representing consumer advocates, provider representatives, public officials, policy experts, and others. Associations between network characteristics and attitudes about LTC policy reform were also examined. Individuals tended to nominate other people within their same constituency group as experts. Academic and research-based policy experts were most likely to be classified as prominent network members. Network structure was associated with attitudes toward LTC financing but not the regulation of nursing homes.

Advance care planning decisions of women with cancer: provider recognition and stability of choices.

Our prior research found that 43% of women with cancer relied on more than one person for advance care planning (ACP) and support. We conducted this follow-up study to address the stability of patient choices around ACP and providers' knowledge of patients' named supports. Living participants from the original survey were recontacted and asked to participate in this study. Of the original 215 participants, 113 (66%) participated. The median time between surveys was 23 months. At resurvey, 33 (26%) patients did not name the same person to all three roles. Controlling for age, race, partner status, tumor type, and remission status, naming one person for all three roles was associated with higher concordance at follow-up for primary support (PS) and health care proxy (HCP). Comparing patients' and providers' responses (N = 162), concordance was 71% for emergency contact (EC), 60% for PS, but only 51% for HCP. In this follow-up study, a smaller percentage of women named more than one person to the roles of EC, PS, and HCP compared to the original survey. Of concern, concordance between patient and provider was low, particularly for HCP. This was notable especially when responses changed over the interval time, and when ACP and PS roles were split between multiple people. Understanding the network of people who serve ACP and support roles may be important as we seek to improve the process of ACP and surrogate decision making.