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1.
Ethn Dis ; 30(2): 321-330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32346278

RESUMO

Introduction: Mentorship is crucial for academic success. And yet, there are few mentoring programs that address the needs of underrepresented, racially/ethnically diverse junior faculty conducting health-related research in the United States. Methods: To expand mentoring capacity for these racially/ethnically diverse faculty, we developed a Peer Mentor Development Program (PMDP) to prepare near-peers, who have similar characteristics and personal experiences, to provide support to participants in an NIH-PRIDE funded Institute. The PMDP program is designed based on the 8-year experience of the Mentor Development Program of the NYU-Health and Hospitals Clinical Translational Science Institute. Annually, up to six alumni are selected into the PMDP, participate in the 12-hour program over 4 days, are paired with 1 to 3 scholar participants to mentor and join monthly PMDP conference calls during the ensuing year. Results: We describe the program, participant experience and lessons learned from our first 18 peer mentors in three PMDP cohorts. Additionally, all 18 peer mentors completed a post-evaluation survey to assess the program. Overall, peers agreed that participating in the PMDP enhanced most of the specific skills targeted. Participants rated 53%-86% of skills as "more than before" participating in PMDP, demonstrating the appreciation and impact of the program. Conclusions: The PMDP may be a model for higher education and academic medicine programs committed to mentoring and retaining racially/ethnically diverse faculty and ultimately contributing to reducing entrenched health disparities between majority and minority populations.

2.
Acad Med ; 95(5): 704-709, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32079959

RESUMO

Members of the lesbian, gay, bisexual, transgender, and queer community experience marginalization, bias, and discrimination, including in the world of academic medicine. People who are transgender and nonbinary (TGNB) experience further marginalization compared with individuals who are lesbian, gay, bisexual, and queer. According to a recent survey, more than half of medical students who are TGNB chose not to disclose their gender identities during training due to fears of discrimination, feeling a lack of support, and concerns about future career options. Academic medicine has historically pathologized TGNB individuals, perpetuating discrimination structurally and reinforcing discriminatory behaviors of peers and faculty. In this Perspective, the authors provide a comprehensive overview of the challenges that administrators and educators face in creating a learning environment that is inclusive of TGNB trainees. They outline opportunities for change and provide strategies to address administrative and educational challenges, including those related to institutional climate, policies, data collection, physical spaces, health care, curriculum, mentoring, and the evaluation of TGNB trainees. Finally, the authors issue a call to action for medical educators and administrators to create environments in which trainees who are TGNB can fulfill their educational mission: to learn the practice of medicine.

3.
J Cancer Educ ; 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32060860

RESUMO

To assess colorectal cancer (CRC) screening among South Asians (SAs) and explore the challenges and facilitators to CRC screening among SA subgroups in New York City (NYC). Fifty-one semi-structured in-depth interviews and surveys were conducted among SA immigrants in NYC. Qualitative results suggested challenges to CRC screening were related to socio-cultural factors, such as a lack of knowledge on CRC and CRC screening, and structural factors, such as cost and language. A physician referral was the most cited facilitator to CRC screening. Participants reported culturally and linguistically adapted education and information on CRC and CRC screening would help to overcome noted challenges. Our findings support the development of targeted, linguistically and culturally adapted campaigns for this population that facilitate access to health systems and leverage natural community assets and social support systems.

5.
Prev Chronic Dis ; 16: E101, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370917

RESUMO

INTRODUCTION: Although screening for diabetes is recommended at age 45, some populations may be at greater risk at earlier ages. Our objective was to quantify age disparities among patients with type 2 diabetes in New York City. METHODS: Using all-payer hospital claims data for New York City, we performed a cross-sectional analysis of patients with type 2 diabetes identified from emergency department visits during the 5-year period 2011-2015. We estimated type 2 diabetes prevalence at each year of life, the age distribution of patients stratified by decade, and the average age of patients by sex, race/ethnicity, and geographic location. RESULTS: We identified 576,306 unique patients with type 2 diabetes. These patients represented more than half of all people with type 2 diabetes in New York City. Patients in racial/ethnic minority groups were on average 5.5 to 8.4 years younger than non-Hispanic white patients. At age 45, type 2 diabetes prevalence was 10.9% among non-Hispanic black patients and 5.2% among non-Hispanic white patients. In our geospatial analyses, patients with type 2 diabetes were on average 6 years younger in hotspots of diabetes-related emergency department use and inpatient hospitalizations. The average age of patients with type 2 diabetes was also 1 to 2 years younger in hotspots of microvascular diabetic complications. CONCLUSION: We identified profound age disparities among patients with type 2 diabetes in racial/ethnic minority groups and in neighborhoods with poor health outcomes. The younger age of these patients may be due to earlier onset of diabetes and/or earlier death from diabetic complications. Our findings demonstrate the need for geographically targeted interventions that promote earlier diagnosis and better glycemic control.

6.
JAMA Neurol ; 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31260028

RESUMO

Importance: Black individuals and Hispanic individuals are less likely to recognize stroke and call 911 (stroke preparedness), contributing to racial/ethnic disparities in intravenous tissue plasminogen activator use. Objective: To evaluate the effect of culturally tailored 12-minute stroke films on stroke preparedness vs the usual care practice of distributing stroke education pamphlets. Design, Setting, and Participants: Cluster randomized clinical trial between July 26, 2013, and August 16, 2018, with randomization of 13 black and Hispanic churches located in urban neighborhoods to intervention or usual care. In total, 883 congregants were approached, 503 expressed interest, 375 completed eligibility screening, and 312 were randomized. Sixty-three individuals were ineligible (younger than 34 years and/or did not have at least 1 traditional stroke risk factor). Interventions: Two 12-minute stroke films on stroke preparedness for black and Hispanic audiences. Main Outcomes and Measures: The primary outcome was the Stroke Action Test (STAT), assessed at baseline, 6 months, and 12 months. Results: In total, 261 of 312 individuals completed the study (83.7% retention rate). Most participants were female (79.1%). The mean (SD) age of participants was 58.57 (11.66) years; 51.1% (n = 159) were non-Hispanic black, 48.9% (n = 152) were Hispanic, and 31.7% (n = 99) had low levels of education. There were no significant end-point differences for the STAT at follow-up periods. The mean (SD) baseline STAT scores were 59.05% (29.12%) correct for intervention and 58.35% (28.83%) correct for usual care. At 12 months, the mean (SD) STAT scores were 64.38% (26.39%) correct for intervention and 61.58% (28.01%) correct for usual care. Adjusted by education, a post hoc subgroup analysis revealed a mean (SE) intervention effect of 1.03% (0.44%) (P = .02) increase per month in the low-education subgroup (about a 10% increase in 12 months). In the high-education subgroup, the mean (SE) intervention effect was -0.05% (0.30%) (P = .86). Regarding percentage correct, the low-education intervention subgroup improved from 52.4% (7 of 21) to 66.7% (14 of 21) compared with the other subgroups. Conclusions and Relevance: No difference was observed in stroke preparedness at 12 months in response to culturally tailored 12-minute stroke films or conventional stroke education pamphlets. Additional studies are required to confirm findings from a post hoc subgroup analysis that suggested a significant education effect. Trial Registration: ClinicalTrials.gov identifier: NCT01909271.

7.
Prev Chronic Dis ; 15: E121, 2018 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-30289105

RESUMO

INTRODUCTION: Differences in the social determinants of health and cardiovascular health outcomes by nativity have implications for understanding the immigrant health paradox among black immigrants. We aimed to understand whether blood pressure awareness, a precursor to achieving blood pressure control among hypertensive patients, varied by nativity among a sample of black men. METHODS: Data were collected from 2010 through 2014. In 2016, we conducted logistic regression models using data from a large sample of urban-dwelling middle-aged and older black men. All men in the study had measured high blood pressure at the time of enrollment and were also asked whether they were aware of having high blood pressure. Independent variables included demographics, socioeconomic status, access to care, and health-related behaviors. RESULTS: Foreign-born participants were significantly less likely than US-born participants to report awareness of having high blood pressure (P < .001). We observed a significant positive relationship between proportion of life spent in the US and being aware of having hypertension (ß = 0.863; 95% CI, 0.412-1.314; P < .001). This relationship remained after adjusting the model for salient independent variables (ß = 0.337; 95% CI, 0.041-0.634; P = .03). CONCLUSIONS: Difference in hypertension awareness by nativity may skew surveillance estimates used to track health disparities by large heterogeneous racial categories. Our results also indicate that prior health care experience and circumstances should be considered when studying the immigrant health paradox.


Assuntos
Afro-Americanos/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades nos Níveis de Saúde , Hipertensão/etnologia , Afro-Americanos/estatística & dados numéricos , Idoso , Emigrantes e Imigrantes/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Hipertensão/psicologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
8.
Trials ; 19(1): 519, 2018 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-30249293

RESUMO

BACKGROUND: Compared to whites, blacks are at increased risk for obstructive sleep apnea (OSA) yet less likely to adhere to physician-recommended sleep assessment and treatment. Poor OSA health literacy and lack of social support to navigate the current healthcare system are two potential barriers to adequate OSA care. This study is designed to address these barriers by evaluating the effectiveness of a peer-based sleep health education program on adherence to OSA assessment and treatment among blacks at risk for OSA. METHOD/DESIGN: In a two-arm, randomized controlled trial, we will ascertain the effectiveness of peer-based sleep health education and social support in increasing OSA evaluation and treatment rates among 398 blacks at low to high OSA risk. Participants at risk of OSA will receive quality controlled, culturally, and linguistically tailored peer education based on Motivational Enhancement principles over a period of 12 months. During this 12-month period, participants are encouraged to participate in a sleep home study to determine risk of OSA and, if found to be at risk, they are invited to undergo a diagnostic sleep assessment at a clinic. Participants who are diagnosed with OSA and who are prescribed continuous positive airway pressure treatment will be encouraged, through peer-based education, to adhere to recommended treatment. Recruitment for the project is ongoing. DISCUSSION: The use of a culturally tailored sleep health education program, peer health educators trained in sleep health, and home-based sleep assessment are novel approaches in improving OSA assessment and treatment adherence in blacks who are significantly at risk for OSA. Empirical evidence from this trial will provide clinical and population level solutions on how to improve and increase assessment and treatment of OSA among blacks. TRIAL REGISTRATION: NCT02427815 . Registered on 20 April 2015. ClinicalTrials.gov title: Sleep Health Education and Social Support Among Blacks With OSA.


Assuntos
Afro-Americanos/psicologia , Pressão Positiva Contínua nas Vias Aéreas , Assistência à Saúde Culturalmente Competente/etnologia , Cooperação do Paciente , Educação de Pacientes como Assunto/métodos , Infuência dos Pares , Apneia Obstrutiva do Sono/terapia , Sono , Apoio Social , Humanos , Cidade de Nova Iorque/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Apneia Obstrutiva do Sono/etnologia , Apneia Obstrutiva do Sono/fisiopatologia , Apneia Obstrutiva do Sono/psicologia , Fatores de Tempo , Resultado do Tratamento
9.
Ethn Dis ; 28(3): 193-200, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30038481

RESUMO

Introduction: Sleep disturbance is a major public health issue and is comorbid with the cluster of conditions associated with metabolic syndrome (MetS). Our study explored the presence of sleep disturbance, including daytime sleepiness, the risk for obstructive sleep apnea (OSA), and insomnia symptoms, in a cohort of adult Black men and women with MetS. Methods: Patients (n=1,013) from the Metabolic Syndrome Outcome Study (MetSO), 2009-2012, met criteria for MetS based on guidelines from the National Cholesterol Education Program's Adult Treatment Panel and provided sociodemographic data and the Apnea Risk Evaluation System (ARES) questionnaire to assess OSA risk, sleep characteristics, and physician-reported diagnosis of a sleep disorder. Results: Prevalence of the components of MetS included: diabetes (60%); obesity (67%); hypertension (94%); and dyslipidemia (74%). Based on the ARES, 49% were at risk for OSA. Of all study patients, slightly more than half (53%) reported feeling sleepy during the day, and 10% reported an insomnia diagnosis. The most common sleep disturbance reported by 46% of the patients was early morning awakenings (EMA). This was closely followed by 42% who reported difficulty staying asleep (DSA) and 38% reporting difficulty falling asleep (DFA). Seventy percent reported short sleep (≤ 6 hours), whereas a minority (19%) reported long sleep (≥ 9 hours). Only 12% used sleep aids. Women, compared with men, reported greater daytime sleepiness, greater DFA, and greater DSA (57% vs 45%; 41% vs 32.4%; 45% vs 37%), respectively. Conclusion: Blacks with MetS reported insomnia symptoms and insomnia disorder, use of sleep aids, feeling sleepy during the day, and inadequate sleep durations. The presence of these sleep characteristics suggests that patients with MetS should be referred for further sleep assessment.


Assuntos
Afro-Americanos/estatística & dados numéricos , Síndrome Metabólica/etnologia , Transtornos do Sono-Vigília/etnologia , Idoso , Estudos de Coortes , Comorbidade , Diabetes Mellitus/etnologia , Distúrbios do Sono por Sonolência Excessiva/etnologia , Dislipidemias/etnologia , Feminino , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Prevalência , Fatores Sexuais , Sono , Apneia Obstrutiva do Sono/etnologia , Distúrbios do Início e da Manutenção do Sono/etnologia
10.
J Endocr Soc ; 2(5): 460-470, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29719877

RESUMO

Geographic surveillance can identify hotspots of disease and reveal associations between health and the environment. Our study used emergency department surveillance to investigate geographic disparities in type 1 and type 2 diabetes prevalence among adults and children. Using all-payer emergency claims data from 2009 to 2013, we identified unique New York City residents with diabetes and geocoded their location using home addresses. Geospatial analysis was performed to estimate diabetes prevalence by New York City Census tract. We also used multivariable regression to identify neighborhood-level factors associated with higher diabetes prevalence. We estimated type 1 and type 2 diabetes prevalence at 0.23% and 10.5%, respectively, among adults and 0.20% and 0.11%, respectively, among children in New York City. Pediatric type 1 diabetes was associated with higher income (P = 0.001), whereas adult type 2 diabetes was associated with lower income (P < 0.001). Areas with a higher proportion of nearby restaurants categorized as fast food had a higher prevalence of all types of diabetes (P < 0.001) except for pediatric type 2 diabetes. Type 2 diabetes among children was only higher in neighborhoods with higher proportions of African American residents (P < 0.001). Our findings identify geographic disparities in diabetes prevalence that may require special attention to address the specific needs of adults and children living in these areas. Our results suggest that the food environment may be associated with higher type 1 diabetes prevalence. However, our analysis did not find a robust association with the food environment and pediatric type 2 diabetes, which was predominantly focused in African American neighborhoods.

11.
Am J Mens Health ; 12(4): 989-997, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29540129

RESUMO

There is a significant evidence base for the Diabetes Prevention Program, a lifestyle intervention to prevent onset of type 2 diabetes among high-risk individuals; however, translation of this intervention for men has been challenging. This report presents outcomes of the pilot study of an adapted 16-week diabetes prevention program entitled " Power Up for Health." The study goal was to better engage men of color with prediabetes from disadvantaged neighborhoods of New York City. It was implemented at five different recreation centers located in predominantly low-income neighborhoods across New York City. The curriculum was facilitated by male lifestyle coaches only; one group was conducted in Spanish. Primary outcome was weight loss from baseline to 16 weeks. Other measures included lifestyle activities, depressive symptoms, and self-reported health status. Men ( N = 47) were screened by telephone. Of the 29 eligible men who began the program, 25 attended at least 4 sessions (52% non-Latino Black, 32% Latino, mean age 51.7 ± SD 9.9 years, mean body mass index 35 ± SD 6.9 kg/m2). End of program outcomes ( n = 23) varied by site and included a mean weight loss of 3.8% (9.7 lbs); 3 of the 5 sites had a mean weight loss of 5.6%, meeting the national goal of 5%-7%. Men ( n = 23) attended a mean of 11.6 of 16 sessions. Improvement in depressive symptoms, healthy eating and exercise, and health status were also seen. While recruitment was challenging with many lessons learned, the adapted men's diabetes prevention program shows promise of success for participants and their coaches.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Educação em Saúde/organização & administração , Participação do Paciente/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Populações Vulneráveis/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Atitude Frente a Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Cidade de Nova Iorque , Projetos Piloto , Prevenção Primária/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Medição de Risco , Adulto Jovem
12.
J Relig Health ; 57(3): 1095-1107, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29417396

RESUMO

This article explores the role the Black Church could play in facilitating spiritually sensitive, culturally relevant and gender-specific services to address the mental health and well-being of Black males. The help-seeking behaviors of Black men are examined as the authors offer two theories: the body, mind, spirit, environment, social, transcendent, and health, illness, men, and masculinities that may assist the Black Church in functioning as an effective support networks for healthy Black male mental health. Next, the authors discuss implications for practice, research, and education, and lastly, eight recommendations for Black Church leadership, social workers, and mental health professionals are also discussed.


Assuntos
Afro-Americanos/psicologia , Cristianismo , Comportamento de Busca de Ajuda , Masculinidade , Saúde Mental/etnologia , Religião e Psicologia , Clero , Humanos , Masculino , Estados Unidos
13.
Circ Res ; 122(2): 213-230, 2018 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-29348251

RESUMO

Cardiovascular disparities remain pervasive in the United States. Unequal disease burden is evident among population groups based on sex, race, ethnicity, socioeconomic status, educational attainment, nativity, or geography. Despite the significant declines in cardiovascular disease mortality rates in all demographic groups during the last 50 years, large disparities remain by sex, race, ethnicity, and geography. Recent data from modeling studies, linked micromap plots, and small-area analyses also demonstrate prominent variation in cardiovascular disease mortality rates across states and counties, with an especially high disease burden in the southeastern United States and Appalachia. Despite these continued disparities, few large-scale intervention studies have been conducted in these high-burden populations to examine the feasibility of reducing or eliminating cardiovascular disparities. To address this challenge, on June 22 and 23, 2017, the National Heart, Lung, and Blood Institute convened experts from a broad range of biomedical, behavioral, environmental, implementation, and social science backgrounds to summarize the current state of knowledge of cardiovascular disease disparities and propose intervention strategies aligned with the National Heart, Lung, and Blood Institute mission. This report presents the themes, challenges, opportunities, available resources, and recommended actions discussed at the workshop.


Assuntos
Pesquisa Biomédica/tendências , Doenças Cardiovasculares/terapia , Educação/tendências , Disparidades em Assistência à Saúde/tendências , National Heart, Lung, and Blood Institute (U.S.)/tendências , Relatório de Pesquisa/tendências , Pesquisa Biomédica/economia , Pesquisa Biomédica/métodos , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/tendências , Educação/economia , Educação/métodos , Disparidades em Assistência à Saúde/economia , Humanos , National Heart, Lung, and Blood Institute (U.S.)/economia , Estados Unidos/epidemiologia
14.
Am J Prev Med ; 55(5 Suppl 1): S49-S58, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30670201

RESUMO

INTRODUCTION: This community-based participatory research pilot study explored multilevel perceptions and strategies for developing future faith-based organization blood pressure interventions for young black men. METHODS: Community partners recruited the sample through two, southeastern U.S. urban churches as potential intervention hubs; academic partners conducted phone interviews with church leader key informants, and three focus groups with black men aged 18-50 years. Qualitative content analysis helped generate themes from: key informant questions assessing organizational assets and capacities, and factors influencing participation; and focus group questions assessing lifestyle and self-management behaviors. Questions assessing themes on blood pressure intervention strategies were asked. Data were collected in 2016 and analyzed in 2016-2017. RESULTS: The sample included 21 key informants and 19 young black men. Key informants' leadership experience averaged 16.6 (SD=12.1) years and 28.6% were male. Focus group participants were primarily single (55.6%), college educated (61.1%), and employed (77.8%). Mean blood pressure was 131.1 (SD=15.3)/79.5 (SD=11.2) mmHg, 33.3% self-reported having hypertension, 88.9% report a family history of hypertension, and 88.9% see a provider annually. For key informants, young black men lack understanding of hypertension despite available resources, and pastors are important role models and advocates. For focus group participants, hidden sodium and stressful, busy schedules impact lifestyle behaviors; and church support for busy schedules are important. Common strategies included incentive-laden, activity-integrated programs, and male social context (testimonials, peer mentoring, engagement outside of the church). CONCLUSIONS: Findings and lessons learned will help design future community-based participatory research, faith-based organization-led blood pressure interventions relevant to young black men. SUPPLEMENT INFORMATION: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.


Assuntos
Clero , Participação da Comunidade/métodos , Pesquisa Participativa Baseada na Comunidade/métodos , Grupos Focais , Hipertensão/prevenção & controle , Adolescente , Adulto , Afro-Americanos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Hipertensão/epidemiologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Projetos Piloto , Sistemas de Apoio Psicossocial , Projetos de Pesquisa , Autorrelato/estatística & dados numéricos , Adulto Jovem
15.
J Racial Ethn Health Disparities ; 5(5): 913-918, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29247405

RESUMO

BACKGROUND: African Americans develop hypertension earlier and have worse cardiovascular outcomes than Caucasians. Accumulating evidence suggests that psychological distress may play a role in the observed racial differences in hypertension. Several studies have investigated the relationship between depression and hypertension while little is still known about the role of demoralization. METHODS: Using data from the Trial Using Motivational Interviewing, Positive Affect, and Self-affirmation in African Americans with Hypertension (TRIUMPH), logistic regression models were used to estimate differences in blood pressure control at 12 months among participants with demoralization, depression, and both conditions. RESULTS: Our logistic models showed that reported psychosocial symptoms significantly differed in predicting success in blood pressure control at 12 months. Contrast analyses showed that, after adjusting for sociodemographic, clinical, and psychosocial variables, demoralized patients were less likely to achieve blood pressure control than participants without affective conditions (p = 0.020). Similar results emerged for patients with depression (p = 0.042) and both conditions (p = 0.022). CONCLUSIONS: Depression can be extremely debilitating and has serious health consequence. Our findings confirm this result and show that, even though depression and demoralization share common features, they are two distinct clinical phenomena with similar negative impact on blood pressure control in African Americans.


Assuntos
Afro-Americanos/psicologia , Depressão/psicologia , Hipertensão/terapia , Moral , Adulto , Idoso , Pressão Sanguínea , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão/psicologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
16.
J Racial Ethn Health Disparities ; 5(4): 712-720, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-28791583

RESUMO

Traditional methods of health surveillance often under-represent racial and ethnic minorities. Our objective was to use geospatial analysis and emergency claims data to estimate local chronic disease prevalence separately for specific racial and ethnic groups. We also performed a regression analysis to identify associations between median household income and local disease prevalence among Black, Hispanic, Asian, and White adults in New York City. The study population included individuals who visited an emergency department at least once from 2009 to 2013. Our main outcomes were geospatial estimates of diabetes, hypertension, and asthma prevalence by Census tract as stratified by race and ethnicity. Using emergency claims data, we identified 4.9 million unique New York City adults with 28.5% of identifying as Black, 25.2% Hispanic, and 6.1% Asian. Age-adjusted disease prevalence was highest among Black and Hispanic adults for diabetes (13.4 and 13.1%), hypertension (28.7 and 24.1%), and asthma (9.9 and 10.1%). Correlation between disease prevalence maps demonstrated moderate overlap between Black and Hispanic adults for diabetes (0.49), hypertension (0.57), and asthma (0.58). In our regression analysis, we found that the association between low income and high disease prevalence was strongest for Hispanic adults, whereas increases in income had more modest reductions in disease prevalence for Black adults, especially for diabetes. Our geographically detailed maps of disease prevalence generate actionable evidence that can help direct health interventions to those communities with the highest health disparities. Using these novel geographic approaches, we reveal the underlying epidemiology of chronic disease for a racially and culturally diverse population.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Saúde das Minorias , Vigilância em Saúde Pública/métodos , Adolescente , Adulto , Idoso , Doença Crônica/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prevalência , Análise de Regressão , Adulto Jovem
17.
Am J Public Health ; 107(9): 1433-1440, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28727540

RESUMO

OBJECTIVES: To test the effectiveness of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer (CRC) screening among older Black men. METHODS: We conducted a 3-parallel-arm, randomized trial among 731 self-identified Black men recruited at barbershops between 2010 and 2013 in New York City. Participants had to be aged 50 years or older, not be up-to-date on CRC screening, have uncontrolled high blood pressure, and have a working telephone. We randomized participants to 1 of 3 groups: (1) patient navigation by a community health worker for CRC screening (PN), (2) motivational interviewing for blood pressure control by a trained counselor (MINT), or (3) both interventions (PLUS). We assessed CRC screening completion at 6-month follow-up. RESULTS: Intent-to-treat analysis revealed that participants in the navigation interventions were significantly more likely than those in the MINT-only group to be screened for CRC during the 6-month study period (17.5% of participants in PN, 17.8% in PLUS, 8.4% in MINT; P < .01). CONCLUSIONS: Telephone-based preclinical patient navigation has the potential to be effective for older Black men. Our results indicate the importance of community-based health interventions for improving health among minority men.


Assuntos
Afro-Americanos/psicologia , Barbearia , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Navegação de Pacientes/métodos , Idoso , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/prevenção & controle , Serviços de Saúde Comunitária , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque
18.
Circulation ; 136(9): 798-812, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28634217

RESUMO

BACKGROUND: Data from before the 2000s indicate that the majority of incident cardiovascular disease (CVD) events occur among US adults with systolic and diastolic blood pressure (SBP/DBP) ≥140/90 mm Hg. Over the past several decades, BP has declined and hypertension control has improved. METHODS: We estimated the percentage of incident CVD events that occur at SBP/DBP <140/90 mm Hg in a pooled analysis of 3 contemporary US cohorts: the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), the MESA (Multi-Ethnic Study of Atherosclerosis), and the JHS (Jackson Heart Study) (n=31 856; REGARDS=21 208; MESA=6779; JHS=3869). Baseline study visits were conducted in 2003 to 2007 for REGARDS, 2000 to 2002 for MESA, and 2000 to 2004 for JHS. BP was measured by trained staff using standardized methods. Antihypertensive medication use was self-reported. The primary outcome was incident CVD, defined by the first occurrence of fatal or nonfatal stroke, nonfatal myocardial infarction, fatal coronary heart disease, or heart failure. Events were adjudicated in each study. RESULTS: Over a mean follow-up of 7.7 years, 2584 participants had incident CVD events. Overall, 63.0% (95% confidence interval [CI], 54.9-71.1) of events occurred in participants with SBP/DBP <140/90 mm Hg; 58.4% (95% CI, 47.7-69.2) and 68.1% (95% CI, 60.1-76.0) among those taking and not taking antihypertensive medication, respectively. The majority of events occurred in participants with SBP/DBP <140/90 mm Hg among those <65 years of age (66.7%; 95% CI, 60.5-73.0) and ≥65 years of age (60.3%; 95% CI, 51.0-69.5), women (61.4%; 95% CI, 49.9-72.9) and men (63.8%; 95% CI, 58.4-69.1), and for whites (68.7%; 95% CI, 66.1-71.3), blacks (59.0%; 95% CI, 49.5-68.6), Hispanics (52.7%; 95% CI, 45.1-60.4), and Chinese-Americans (58.5%; 95% CI, 45.2-71.8). Among participants taking antihypertensive medication with SBP/DBP <140/90 mm Hg, 76.6% (95% CI, 75.8-77.5) were eligible for statin treatment, but only 33.2% (95% CI, 32.1-34.3) were taking one, and 19.5% (95% CI, 18.5-20.5) met the SPRINT (Systolic Blood Pressure Intervention Trial) eligibility criteria and may benefit from a SBP target goal of 120 mm Hg. CONCLUSIONS: Although higher BP levels are associated with increased CVD risk, in the modern era, the majority of incident CVD events occur in US adults with SBP/DBP <140/90 mm Hg. While absolute risk and cost-effectiveness should be considered, additional CVD risk-reduction measures for adults with SBP/DBP <140/90 mm Hg at high risk for CVD may be warranted.


Assuntos
Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/diagnóstico , Fatores Etários , Idoso , Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/etiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/etnologia , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etnologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etnologia , Obesidade/complicações , Fatores de Risco , Fatores Sexuais , Fumar
19.
J Am Heart Assoc ; 6(4)2017 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-28381465

RESUMO

BACKGROUND: Abnormal diurnal blood pressure (BP), including nondipping patterns, assessed using ambulatory BP monitoring, have been associated with increased cardiovascular risk among white and Asian adults. We examined the associations of BP dipping patterns (dipping, nondipping, and reverse dipping) with cardiovascular target organ damage (left ventricular mass index and left ventricular hypertrophy), among participants from the Jackson Heart Study, an exclusively black population-based cohort. METHODS AND RESULTS: Analyses included 1015 participants who completed ambulatory BP monitoring and had echocardiography data from the baseline visit. Participants were categorized based on the nighttime to daytime systolic BP ratio into 3 patterns: dipping pattern (≤0.90), nondipping pattern (>0.90 to ≤1.00), and reverse dipping pattern (>1.00). The prevalence of dipping, nondipping, and reverse dipping patterns was 33.6%, 48.2%, and 18.2%, respectively. In a fully adjusted model, which included antihypertensive medication use and clinic and daytime systolic BP, the mean differences in left ventricular mass index between reverse dipping pattern versus dipping pattern was 8.3±2.1 g/m2 (P<0.001) and between nondipping pattern versus dipping pattern was -1.0±1.6 g/m2 (P=0.536). Compared with participants with a dipping pattern, the prevalence ratio for having left ventricular hypertrophy was 1.65 (95% CI, 1.05-2.58) and 0.96 (95% CI, 0.63-1.97) for those with a reverse dipping pattern and nondipping pattern, respectively. CONCLUSIONS: In this population-based study of blacks, a reverse dipping pattern was associated with increased left ventricular mass index and a higher prevalence of left ventricular hypertrophy. Identification of a reverse dipping pattern on ambulatory BP monitoring may help identify black at increased risk for cardiovascular target organ damage.


Assuntos
Afro-Americanos , Pressão Sanguínea , Ritmo Circadiano , Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Idoso , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Ecocardiografia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia , Prevalência
20.
Sleep ; 40(1)2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-28364475

RESUMO

Study Objectives: To assess effectiveness of a culturally and linguistically tailored telephone-delivered intervention to increase adherence to physician-recommended evaluation and treatment of obstructive sleep apnea (OSA) among blacks. Methods: In a two-arm randomized controlled trial, we evaluated effectiveness of the tailored intervention among blacks with metabolic syndrome, relative to those in an attention control arm (n = 380; mean age = 58 ± 13; female = 71%). The intervention was designed to enhance adherence using culturally and linguistically tailored OSA health messages delivered by a trained health educator based on patients' readiness to change and unique barriers preventing desired behavior changes. Results: Analysis showed 69.4% of the patients in the intervention arm attended initial consultation with a sleep specialist, compared to 36.7% in the control arm; 74.7% of those in the intervention arm and 66.7% in the control arm completed diagnostic evaluation; and 86.4% in the intervention arm and 88.9% in the control arm adhered to PAP treatment based on subjective report. Logistic regression analyses adjusting for sociodemographic factors indicated patients in the intervention arm were 3.17 times more likely to attend initial consultation, compared to those in the control arm. Adjusted models revealed no significant differences between the two arms regarding adherence to OSA evaluation or treatment. Conclusion: The intervention was successful in promoting importance of sleep consultation and evaluation of OSA among blacks, while there was no significant group difference in laboratory-based evaluation and treatment adherence rates. It seems that the fundamental barrier to OSA care in that population may be the importance of seeking OSA care.


Assuntos
Grupo com Ancestrais do Continente Africano , Terapia Comportamental , Síndrome Metabólica/psicologia , Síndrome Metabólica/terapia , Apneia Obstrutiva do Sono/psicologia , Apneia Obstrutiva do Sono/terapia , Grupo com Ancestrais do Continente Africano/psicologia , Feminino , Humanos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Motivação , Cooperação do Paciente , Apneia Obstrutiva do Sono/complicações , Telefone
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