Religiosity prevalence and its association with depression and anxiety symptoms among Hispanic/Latino adults.

OBJECTIVES: Religion plays an important role in the lives of people in the United States. We examined the prevalence of religiosity among Hispanic/Latinos in four regions of the United States and looked at its correlation to depression and anxiety symptoms. DESIGN: The population-based Hispanic Community Health Study/ Study of Latinos enrolled a cohort of Hispanic/Latino adults (N = 16,415) ages 18-74 in four US cities from June 2008 to June 2011. Participants with complete data on religiosity (i.e., religious affiliation, frequency of attending religious activities and importance of religion), depression (assessed with the CESD-10), and trait anxiety (assessed with the STAI-10) were included in the present study. Distribution of religiosity is described by sociodemographic characteristics. Associations between religiosity with depression and anxiety were examined with logistic regression models controlling for sex, age group, education, Hispanic/Latino background, clinical center, and nativity. RESULTS: The majority of the population (89.5%) reported having a religious affiliation. Weekly attendance at religious activities was reported by 41.6% of participants, while 20.6% did not attend any religious activities. Religion was very important to 63.9% and not at all important to 6.7% of the population. The CES-D scores and trait anxiety scores were not significantly related in the overall group to frequency of attending religious activity or perceived importance of religion. However, in age-stratified analyses, among older individuals (65+ years old) reporting "never" participating in religious activities compared to more than once per week was associated with an 80% higher likelihood of having high depressive symptomatology. Similarly, in the older age group, no religious affiliation or reporting that religion is "not at all important" was associated with greater anxiety symptomatology. CONCLUSION: Religiosity varied by Hispanic/Latino background. Lack of religiosity was associated with elevated depressive or anxiety symptomology in older adults but not in young or middle-aged adults.

Periodontitis and Sleep Disordered Breathing in the Hispanic Community Health Study/Study of Latinos.

STUDY OBJECTIVES: To investigate the association between sleep disordered breathing (SDB) and severe chronic periodontitis. DESIGN: Cross-sectional data analysis from the Hispanic Community Health Study/Study of Latinos. SETTING: Community-based setting with probability sampling from four urban US communities. PARTICIPANTS: 12,469 adults aged 18-74 y. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Severe chronic periodontitis was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology case classification based on full-mouth periodontal assessments performed by calibrated dentists. SDB was evaluated in standardized home sleep tests, and defined as the number of apnea plus hypopnea events associated with ≥ 3% desaturation, per hour of estimated sleep. SDB was quantified using categories of the apnea-hypopnea index (AHI): 0.0 events (nonapneic); 0.1-4.9 (subclinical); 5.0-14.9 (mild); and ≥ 15 (moderate/severe). Covariates were demographic characteristics and established periodontitis risk factors. C-reactive protein was a potential explanatory variable. Using survey estimation, multivariable binary logistic regression estimated odds ratios (OR) and 95% confidence limits (CL). Following adjustment for confounding, the SDB and periodontitis relationship remained statistically significant, but was attenuated in strength and no longer dose-response. Compared with the nonapneic referent, adjusted odds of severe periodontitis were 40% higher with subclinical SDB (OR = 1.4, 95% CL: 1.0, 1.9), 60% higher with mild SDB (OR = 1.6, 95% CL: 1.1, 2.2) and 50% higher with moderate/severe SDB (OR = 1.5, 95% CL: 1.0, 2.3) demonstrating an independent association between SDB and severe periodontitis. CONCLUSIONS: This study identifies a novel association between mild sleep disordered breathing and periodontitis that was most pronounced in young adults.

Smoking among U.S. Hispanic/Latino adults: the Hispanic community health study/study of Latinos.

BACKGROUND: Prior national surveys capture smoking behaviors of the aggregated U.S. Hispanic/Latino population, possibly obscuring subgroup variation. PURPOSE: To describe cigarette use among Hispanic/Latino adults across subgroups of age, gender, national background, SES, birthplace, and degree of acculturation to the dominant U.S. culture. METHODS: A cross-sectional survey of 16,322 participants in the Hispanic Community Health Study/Study of Latinos aged 18-74 years, recruited in Bronx NY, Chicago IL, Miami FL, and San Diego CA, was conducted during 2008-2011. RESULTS: Prevalence of current smoking was highest among Puerto Ricans (men, 35.0%; women, 32.6%) and Cubans (men, 31.3%; women, 21.9%), with particularly high smoking intensity noted among Cubans as measured by pack-years and cigarettes/day. Dominicans had the lowest smoking prevalence (men, 11.0%; women, 11.7%). Individuals of other national backgrounds had a smoking prevalence that was intermediate between these groups, and typically higher among men than women. Non-daily smoking was common, particularly although not exclusively among young men of Mexican background. Persons of low SES were more likely to smoke, less likely to have quit smoking, and less frequently used over-the-counter quit aids compared to those with higher income and education levels. Smoking was more common among individuals who were born in the U.S. and had a higher level of acculturation to the dominant U.S. culture, particularly among women. CONCLUSIONS: Smoking behaviors vary widely across Hispanic/Latino groups in the U.S., with a high prevalence of smoking among population subgroups with specific, readily identifiable characteristics.

Risk perception and its association with cardiac risk and health behaviors among urban minority adults: the Bronx Coronary Risk Perception study.

PURPOSE: Examine the relationship among risk perceptions, health behaviors, and a measure for actual risk of coronary heart disease (CHD). DESIGN: Cross-sectional survey. SETTING/SUBJECTS: Adults from three outpatient medical clinics with at least one CHD risk factor. MEASURES: Perceived risk using the new Coronary Risk, Individual Perception (CRIP) scale, an index of CHD risk, and summary scores for self-reported diet and exercise. ANALYSIS: Bivariate associations using Spearman rank and Kruskal-Wallis; multiple regression models for outcomes (health behaviors). RESULTS: The 16-item CRIP scale had acceptable internal consistency (alpha = 0.76; interitem total correlation = 0.34 +/- 0.17). The response rate was 80.3%, and the mean age of 256 respondents was 56.6 (+/- 9.9) years; 70% were women, 63% Hispanic, and 27% black. CRIP scores were inversely associated with low fat/high fiber intake (r = - 0.17; p = .007) and exercise (r = -0.19; p = .003). Among respondents with three or more CHD risk factors (n = 132), 44% perceived themselves to be at low risk for CHD. In multivariable models, men with high CRIP scores had higher fat intake than women (p = .02), but men exercised more (p = .04). CONCLUSIONS: In this study, gender moderated the relationship between risk perception and health behaviors, and many respondents underestimated their risk of CHD. Behavioral intervention research aimed at reducing cardiometabolic risk in minority populations should resolve differences between perceived and actual risk of CHD to foster lifestyle changes and examine temporal relationships between risk perception and health behaviors.

Clinical risk factors for fractures in multi-ethnic women: the Women's Health Initiative.

UNLABELLED: To identify risk factors for fractures in multi-ethnic women, we studied 159,579 women enrolled in the Women's Health Initiative. In general, risk factors for fractures were similar across ethnic groups. However, irrespective of their ethnicity, women with multiple risk factors have a high risk of fracture. Targeting these high-risk women for screening and intervention could reduce fractures. INTRODUCTION: Fracture rates tend to be lower in minority women, but consequences may be greater. In addition, the number of fractures is expected to increase in minority women because of current demographic trends. There are limited prospective data on risk factors for fractures in minority women. MATERIALS AND METHODS: We studied 159,579 women 50-79 yr of age enrolled in the Women's Health Initiative. Information on risk factors was obtained by questionnaire or examination. Nonspine fractures that occurred after study entry were identified over an average follow-up of 8 +/- 2.6 (SD) yr. RESULTS: Annualized rates (%) of fracture in whites, blacks, Hispanics, Asians, and American Indians were 2.0, 0.9, 1.3, 1.2, and 2.0, respectively. Significant predictors [HR (95% CI)] of fractures by ethnic group were as follows: blacks: at least a high school education, 1.22 (1.0, 1.5); (+) fracture history, 1.7 (1.4, 2.2); and more than two falls, 1.7 (1.9, 2.0); Hispanics: height (>162 cm), 1.6 (1.1, 2.2); (+) fracture history, 1.9 (1.4, 2.5); more than two falls, 1.8 (1.4, 2.3); arthritis, 1.3 (1.1, 1.6); corticosteroid use, 3.9 (1.9, 8.0); and parental history of fracture, 1.3 (1.0, 1.6); Asians: age (per 5 yr), 1.2 (1.0, 1.3); (+) fracture history, 1.5 (1.1, 2.0); current hormone therapy (HT), 0.7 (0.5, 0.8); parity (at least five), 1.8 (1.1, 3.0); more than two falls, 1.4 (1.1, 1.9); American Indian: (+) fracture history, 2. 9 (1.5, 5.7); current HT, 0.5 (0.3, 0.9). Women with eight or more risk factors had more than a 2-fold higher rate of fracture compared with women with four or fewer risk factors. Two ethnicity x risk factor interactions were identified: age and fall history. CONCLUSIONS: Irrespective of their ethnicity, women with multiple risk factors have a high risk of fracture. Targeting these high-risk women for screening and intervention could reduce fractures.

Can non-medical factors contribute to disparities in coronary heart disease treatments?

Racial/ethnic and sex disparities in coronary heart disease treatment exist. We previously reported that physicians perceive non-clinical variables, such as a patient's desire for a second opinion, as affecting revascularization decisions. The results of that study are further examined here, using factor analysis to identify significant interrelationships among the non-clinical variables, which could contribute to disparities in coronary revascularization (i.e., percutaneous transluminal coronary angioplasty [PTCA] or coronary artery bypass graft [CABG]). Five content themes emerged using factor analysis; these are related to the patient's socioeconomic/lifestyle status, treatment preference, physician interaction, health-assertiveness, and aggressiveness. For the lifestyle theme, family physicians had higher mean scores (14.8) than internists, cardiologists, and cardiothoracic surgeons (13.7, 13.6, and 12.6, respectively; overall p=.001); women had higher mean scores than men (15.0 vs. 13.7; p=.009). This implies that family medicine and female physicians perceived variables pertaining to patients' socioeconomic status or lifestyle (e.g., financial barriers, unlikely to adopt healthy behaviors) as precluding some patients from being revascularized. Additionally, female, more than male, physicians (15.0 vs.13.6; p=.006) perceived health assertive patients (e.g., involved in treatment decisions, will quit smoking) as having easier access to the procedures. The results of the present analysis suggest that disparities in cardiac care arise from complex psychosocial interactions, which are influenced by characteristics of the physician as well as the patient.

The effect of race/ethnicity, sex, and social circumstances on coronary revascularization preferences: a vignette comparison.

Disparities in cardiac care cannot be explained by clinical factors alone. We previously found that physicians' perceived nonclinical factors such as patient preferences influenced decisions for coronary revascularization. For this study, we mailed a questionnaire to a random sample of family medicine physicians, internists, cardiologists, and cardiothoracic surgeons to examine whether the patient's sex, race/ethnicity, and social circumstances impacted treatment preferences for different physician subgroups. All physicians were randomized to receive 1 of 4 questionnaires that contained a vignette describing certain hypothetical situations (desire for an active lifestyle, heavy career or family demands) for a 50-year patient who was a candidate for coronary revascularization who was 1) female, 2) male, 3) black male, or 4) white male. The response rate was 70% (544 of 777). The patient's race/ethnicity and sex did not significantly affect the physicians' treatment preferences. However, significant differences were found according to the social circumstance. More male physicians (78%) than female physicians (66%) recommended revascularization for patients with heavy family demands (P < 0.05). In logistic regression analyses, if the patient desired an active lifestyle, black and Hispanic physicians and fee-for-service physicians preferred revascularization less often than white and salaried physicians, respectively (odds ratio [OR] = 0.45 [0.21-0.94] for black/Hispanic; OR = 0.40 [0.18-0.86] for fee-for-service). Based on these results, certain social circumstances might influence treatment preferences among physician subgroups more than sex- or race-based patient factors. Research examining for causes of disparities in cardiac care should consider the effects of sociocultural issues on management decisions.

Awareness of heart attack symptoms and lifesaving actions among New York City area residents.

The American Heart Association has a national network of community-based programs designed to reduce response times to cardiac emergencies by improving access to automatic external defibrillators (AEDs) among laypersons. Success of these Operation Heartbeat programs depends in part on the public's knowledge of the warning signs of a myocardial infarction (MI) and appropriate response to cardiac arrest victims. In May 2000, a 7-minute telephone survey was administered to a random sample of adults residing within the American Heart Association affiliate territories of New York, New Jersey, and Connecticut to determine the knowledge of MI symptoms, confidence in cardiopulmonary resuscitation (CPR) use, and the awareness of AEDs. Of the respondents, 60% were women (n=1,128), 83% were Caucasians (n=1,558), 15.2% were non-whites (African American, Asian, or Hispanic), and 38.5% had at least a college degree (n=724). Women were significantly more likely than men to know that sex differences exist in the warning signs for an MI (63% vs. 30.7%, respectively; P< .001). Whites had above-average confidence in MI recognition compared with non-whites (39.2% vs. 27.4%, respectively; P< .001) and were more cognizant of the public availability of AEDs (54.5% vs. 33.2%, respectively; P< .001). Our findings suggest that racial/ethnic and sex disparities exist in the awareness of AEDs and in the knowledge of atypical MI symptoms in women, respectively. Innovative CPR outreach programs might be needed in New York area communities to increase CPR training among all adults, to increase AED awareness in vulnerable populations, and to improve knowledge and confidence in the recognition of acute MI symptoms.

Differential use of coronary revascularization and hospital mortality following acute myocardial infarction.

BACKGROUND: The effect of racial/ethnic disparity in the use of cardiac procedures on short-term outcomes, such as hospital mortality, is limited. We sought to determine the association of revascularization procedures (percutaneous transluminal coronary angioplasty or coronary artery bypass graft) to hospital mortality in non-Hispanic black and white patients and Hispanic patients with acute myocardial infarction. METHODS: Analysis of the New York State Department of Health Statewide Planning and Research Cooperate System (SPARCS) data for 12 555 patients admitted to New York City hospitals with acute myocardial infarction in 1996. Revascularization procedure frequencies and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for hospital mortality were calculated. RESULTS: Whites were older than Hispanics and blacks (mean +/- SD age, 70 +/- 13.3 vs 64 +/- 13.3 and 64 +/- 12.9 years, respectively; P<.001) and more likely to have heart failure (36.3% vs 29.1% and 29.6%, respectively; P<.001). Blacks were least likely to be revascularized compared with Hispanics and whites (15.8% vs 25.8% and 25.2%, respectively; P<.001). Hispanics were more likely to survive than whites (adjusted OR, 0.73 [95% CI, 0.59-0.91]); this difference was not significant for blacks (adjusted OR, 0.83 [95% CI, 0.69-1.00]). Nonrevascularized blacks and Hispanics were more likely to be discharged alive than nonrevascularized whites (OR, 0.80 [95% CI, 0.66-0.98] for blacks; OR, 0.74 [95% CI, 0.59-0.93] for Hispanics). There were no significant racial/ethnic differences in hospital survival among revascularized patients. CONCLUSIONS: Nonclinical and clinical factors appear to account for blacks being least likely to have been revascularized. Despite these differences in revascularization rates, survival was similar for blacks and whites, whereas Hispanics were more likely to survive than whites.