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1.
J Acad Nutr Diet ; 2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34560291

RESUMO

BACKGROUND: Previous studies examined the association between shopping distance, frequency, and store type separately. OBJECTIVES: The objective is to explore food acquisition and shopping habits using multidimensional measures and examine its association with body mass index (BMI). DESIGN: A cross-sectional study was conducted. PARTICIPANTS/SETTING: Four thousand four hundred sixty-six households from the US Food Acquisition and Purchase Survey during April 2012 to January 2013 were included in this analysis. MAIN OUTCOMES MEASURES: Both continuous BMI and categorical BMI were used. STATISTICAL ANALYSES: Latent class analysis was used to identify the latent profiles using travel distance and perceived travel time between residential location and primary store, store type, transportation mode, and farmers' market utilization. Multivariable linear regression and multinomial logistic regression were used to assess the association between the identified patterns and continuous and categorical BMI. All analyses were stratified by urbanicity. RESULTS: Overall, 65% (weighted percentage) of households were located in an urban tract. Thirty-seven percent were categorized as Class 1 (households that shopped more proximally, used their own vehicle, and shopped at a farmers' market), 50% as Class 2 (households that shopped more distally, used their own vehicle, and shopped at a farmers' market), and 14% as Class 3 (households that shopped proximally but perceived longer travel time, used someone else's vehicle, and did not shop at a farmers' market). Among rural households, 54% were Class 1 and 46% were Class 2 (Class 3 was not identified). Socioeconomic status characteristics, proximity, and store food price concerns were associated with the identified patterns. However, no significant association was found between the identified patterns and BMI. CONCLUSIONS: Food acquisition and shopping patterns were not associated with BMI in this national sample. However, future studies should also investigate the role of economic factors, such as food prices, in relation to shopping patterns and BMI.

2.
BMC Public Health ; 21(1): 1703, 2021 09 19.
Artigo em Inglês | MEDLINE | ID: mdl-34537021

RESUMO

BACKGROUND: The inclusion of self-reported differential treatment by race/ethnicity in population-based public health surveillance and monitoring systems may provide an opportunity to address long-standing health inequalities. While there is a growing trend towards decreasing response rates and selective non-response in health surveys, research examining the magnitude of non-response related to self-reported discrimination warrants greater attention. This study examined the distribution of sociodemographic variables among respondents and non-respondents to the South Carolina Behavioral Risk Factor Surveillance System (SC-BRFSS) Reactions to Race module (6-question optional module capturing reports of race-based treatment). METHODS: Using data from SC-BRFSS (2016, 2017), we examined patterns of non-response to the Reactions to Race module and individual items in the module. Logistic regression models were employed to examine sociodemographic factors associated with non-response and weighted to account for complex sampling design. RESULTS: Among 21,847 respondents, 15.3% were non-responders. Significant differences in RTRM non-response were observed by key sociodemographic variables (e.g., age, race/ethnicity, labor market participation, and health insurance status). Individuals who were younger, Hispanic, homemakers/students, unreported income, and uninsured were over-represented among non-respondents. In adjusted analyses, Hispanics and individuals with unreported income were more likely to be non-responders in RTRM and across item, while retirees were less likely to be non-responders. Heterogeneity in levels of non-responses were observed across RTRM questions, with the highest level of non-response for questions assessing differential treatment in work (54.8%) and healthcare settings (26.9%). CONCLUSIONS: Non-responders differed from responders according to some key sociodemographic variables, which could contribute to the underestimation of self-reported discrimination and race-related differential treatment and health outcomes. While we advocate for the use of population-based measures of self-reported racial discrimination to monitor and track state-level progress towards health equity, future efforts to estimate, assess, and address non-response variations by sociodemographic factors are warranted to improve understanding of lived experiences impacted by race-based differential treatment.


Assuntos
Racismo , Sistema de Vigilância de Fator de Risco Comportamental , Grupos Étnicos , Hispano-Americanos , Humanos , South Carolina/epidemiologia , Estados Unidos
3.
J Vasc Surg ; 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34506895

RESUMO

OBJECTIVE: Although it has been shown that patient socioeconomic status (SES) is associated with the surgical treatments chosen for severe peripheral arterial disease (PAD), the association between SES and outcomes of arterial reconstruction have not been well-studied. The objective of this study was to determine if SES is associated with outcomes following lower extremity arterial reconstruction. METHODS: Patients 40 years and older who had surgical revascularization for severe lower extremity PAD were identified in the Nationwide Readmissions Database, 2010 to 2014. Measures of SES including median household income (MHI) quartiles of patients' residential ZIP codes were extracted. Factors associated with repeat revascularization, subsequent major amputations, hospital mortality, and 30-day all-cause readmission were evaluated using multivariable regression analyses. RESULTS: Of the 131,529 patients identified, the majority (61%) were male, and the average age was 69 years. On unadjusted analyses, subsequent amputations were higher among patients in the lowest MHI quartile compared with patients in the highest MHI quartile (13% vs 10%; overall P < .001). On multivariable analyses, compared with patients in the lowest quartile, those in the highest quartile had lower amputation (adjusted odds ratio [aOR], 0.70; 95% confidence interval (CI), 0.63-0.77; overall P < .001) and readmission (aOR, 0.91; 95% CI, 0.84-0.99; overall P = .028) rates. However, subsequent revascularization (aOR, 1.04; 95% CI, 0.94-1.15) and mortality (aOR, 1.01; 95% CI, 0.79-1.28) rates were not different across the groups. CONCLUSIONS: Lower SES is associated with disproportionally worse outcomes following lower extremity arterial reconstruction for severe PAD. These data suggest that improving outcomes of lower extremity arterial reconstruction may involve addressing socioeconomic disparities.

4.
J Appl Gerontol ; : 7334648211039311, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404243

RESUMO

OBJECTIVES: We examine associations between social determinants and mental health and assess how the associations vary by race/ethnicity using a large, diverse sample of older adults. METHOD: A retrospective study of 444,057 older adults responding to the Medicare Health Outcomes Survey in 2015-2017 was conducted. Using a multilevel linear regression, we examined the associations between the self-reported number of unhealthy days due to mental health and social determinants, stratified by race/ethnicity. RESULTS: Health factors were most strongly associated with unhealthy days across all racial/ethnic groups. Strength of other factors varied by race/ethnicity. Social/economic factors had stronger associations among Whites, Asians, and multiracial individuals, while such factors were not significant for American Indians/Alaska Natives and Native Hawaiians/Other Pacific Islanders. DISCUSSION: We found varying degrees of associations between social determinants and poor mental health by racial/ethnic groups. These results suggest that homogeneous interventions may not meet the mental health needs of all.

5.
Innov Aging ; 4(5): igaa041, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33324760

RESUMO

Background and Objectives: Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults. Research Design and Methods: Data were analyzed from a subsample of black Health and Retirement Study respondents (2006-2018, N = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested. Results: Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49-1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06-1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29-1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point. Discussion and Implications: Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination.

6.
J Racial Ethn Health Disparities ; 7(6): 1225-1233, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32291577

RESUMO

There is a growing body of research documenting racial/ethnic differences in the relationship between adverse childhood experiences (ACEs) and negative health outcomes in adulthood. However, few studies have examined racial/ethnic differences in the association between ACEs and health care access. Cross-sectional data collected from South Carolina's Behavioral Risk Factor Surveillance System (2014-2016; n = 15,436) was used to examine associations among ACEs, race/ethnicity, and health care access among South Carolina adults. Specifically, logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for three health care access outcomes: having a personal doctor, routine checkup in the last 2 years, and delay in seeking medical care due to cost. Without adjusting for any covariates, in the overall population, the odds of having no personal doctor, no checkup in the last 2 years, and delay in medical care due to cost was significantly higher among those with at least one ACE, compared with those with no ACEs; and health care access varied by race, with significant relationships detected among Whites and Blacks. Among White adults, the odds of having no checkup in the last 2 years and delay in medical care due to cost was significantly higher among those with at least one ACE, compared with those with no ACEs. Among Black adults, a delay in medical care due to cost was significantly higher among those who reported ACEs compared with their counterparts. The results from this study suggest that ACEs may be an underrecognized barrier to health care for adults. Investing in strategies to mitigate ACEs may help improve health care access among adults.


Assuntos
Experiências Adversas da Infância , Grupos de Populações Continentais , Grupos Étnicos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Adolescente , Adulto , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Determinantes Sociais da Saúde , South Carolina , Adulto Jovem
7.
Int J Equity Health ; 19(1): 25, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041629

RESUMO

Self-identified race/ethnicity is largely used to identify, monitor, and examine racial/ethnic inequalities. A growing body of work underscores the need to consider multiple dimensions of race - the social construction of race as a function of appearance, societal interactions, institutional dynamics, stereotypes, and social norms. One such multidimensional measure is socially-assigned race, the perception of one's race by others, that may serve as the basis for differential or unfair treatment and subsequently lead to deleterious health outcomes. We conducted a scoping review to systematically appraise the socially-assigned race and health literature. A systematic search of the PubMed, Web of Science, 28 EBSCO databases and 24 Proquest databases up to September 2019 was conducted and supplemented by a manual search of reference lists and grey literature. Quantitative and qualitative studies that examined socially-assigned race and health or health-related outcomes were considered for inclusion. Eighteen articles were included in the narrative synthesis. Self-rated health and mental health were among the most frequent outcomes studied. The majority of studies were conducted in the United States, with fewer studies conducted in New Zealand, Canada, and Latin America. While most studies demonstrate a positive association between social assignment as a disadvantaged racial or ethnic group and poorer health, some studies did not document an association. We describe key conceptual and methodological considerations that should be prioritized in future studies examining socially-assigned race and health. Socially-assigned race can provide additional insight into observed differential health outcomes among racial/ethnic groups in racialized societies based upon their lived experiences. Studies incorporating socially-assigned race warrants further investigation and may be leveraged to examine nuanced patterns of racial health advantage and disadvantage.


Assuntos
Grupos de Populações Continentais , Equidade em Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Saúde da População , Racismo , Canadá , Grupos Étnicos , Humanos , América Latina , Saúde Mental , Nova Zelândia , Fatores Socioeconômicos , Estados Unidos
8.
Cardiol Ther ; 8(2): 329-343, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31432429

RESUMO

INTRODUCTION: Long-term risk for recurrent cardiovascular events among myocardial infarction (MI) patients in the acute versus chronic stable phase is not well characterized. This study was conducted to evaluate risk factors associated with all-cause mortality and cardiovascular (CVD) morbidity and to determine the transition period from the acute to chronic stable phase of disease. METHODS: Administrative claims data from a managed care database (2007-2012) were linked to the Social Security Death Index. Kaplan-Meier curves were generated over a 3-year period. The association between risk factors and clinical endpoints was assessed using Cox proportional hazard models. Poisson models estimated the 'transition time' from acute to chronic phase of disease. RESULTS: On average, recurrent cardiovascular event rates were higher among acute MI patients in comparison to the chronic MI patients during the first 3 months of follow-up. Over the 3-year follow-up period, survival curves became parallel and for some outcomes (i.e., acute myocardial infarction and bleeding events), were not statistically significantly different between the two groups. In both the acute and chronic MI cohorts, diabetes, heart failure, and renal disease were consistently statistically significant and positively associated with greater risk of death and ischemic events. PAD was consistently associated with increased risk among the chronic cohort and composite endpoints among the acute patients. CONCLUSIONS: Greater understanding of differences in the CVD risk profiles and the transition from acute to chronic stable phase may help identify high-risk patients and inform clinical risk stratification and long-term disease management in MI patients. FUNDING: Merck & Co., Inc., Kenilworth, NJ, USA.

9.
Qual Life Res ; 28(10): 2799-2811, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31183603

RESUMO

PURPOSE: To investigate whether emotional and physical reactions to perceived discrimination are associated with health-related quality of life (HRQOL) among whites and Latinos (by language preference) in Arizona. METHODS: A cross-sectional analysis using the Arizona Behavioral Risk Factor Surveillance System (2012-2014) was restricted to non-Hispanic white and Latino (grouped by English- or Spanish-language preference) participants who completed the Reactions to Race optional module (N = 14,623). Four core items from the Centers for Disease Control and Prevention's Healthy Days Measures were included: self-rated health; physically unhealthy, mentally unhealthy; and functionally limited days. Poisson regression models estimated prevalence ratios and 95% confidence intervals (CIs) for poor self-rated health. Multinomial logistic models estimated odds ratios and 95% CI for poor mental, physical, and functionally limited days (defined as 14 + more days). Models were adjusted for sociodemographics, health behaviors, and multimorbidity. RESULTS: Reports of emotional and physical reactions to perceived discrimination were highest among Spanish-language preference Latinos. Both Spanish- and English-language preference Latinos were more likely to report poor self-rated health in comparison to whites. In separate fully adjusted models, physical reactions were positively associated with each HRQOL measure. Emotional reactions were only associated with reporting 14 + mental unhealthy (aOR 3.16; 95% CI 1.82; 5.48) and functionally limited days (aOR 1.93; 95% CI 1.04, 3.58). CONCLUSIONS: Findings from this study suggest that physical and emotional reactions to perceived discrimination can manifest as diminished HRQOL. Consistent collection of population-based measures of perceived discrimination is warranted to track and monitor differential health vulnerability that affect Latinos.


Assuntos
Sistema de Vigilância de Fator de Risco Comportamental , Grupo com Ancestrais do Continente Europeu/psicologia , Hispano-Americanos/psicologia , Idioma , Vigilância da População/métodos , Qualidade de Vida/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
10.
J Racial Ethn Health Disparities ; 6(5): 926-934, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31065999

RESUMO

Socially assigned race, the racial/ethnic categorization of individuals by others, may serve as the basis for differential or unfair treatment. Latinxs are commonly socially assigned to a race/ethnicity with which they do not self-identify. However, it is unclear the degree to which self-identified Latinxs who are socially assigned as white or Latinx may differentially predict health outcomes beyond general health status and healthcare utilization. We examine the association between socially assigned race and type 2 diabetes mellitus (T2DM). Data from the Arizona's Behavioral Risk Factor Surveillance System (2013, 2014) was used in a cross-sectional analysis (restricted to Latinxs and non-Hispanic whites; N = 8370) to examine the association between self-identified (SI) and socially assigned (SA) race/ethnicity agreement and T2DM. Latinxs were categorized according to SI-SA race/ethnicity agreement: discordant (SI-SA, different) and concordant (SI-SA, same). T2DM was based on self-reported physician diagnosis. Data were analyzed using Poisson regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Latinxs comprised 28.5% of our sample, of which, 18.5% was discordant and 81.5% was concordant. In fully adjusted models, concordant Latinxs were more likely to have T2DM than whites (aPR 2.01, 95% CI 1.44, 2.82). There were no significant differences in T2DM between discordant Latinxs and whites. Our results suggest that socially assigned race is an understudied determinant of health and may further understanding of the impact of racial stratification on Latinx health inequities. Additional research examining socially assigned race and other health outcomes are warranted to gain further insight of the biological impact of racialized lived experiences.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Grupo com Ancestrais do Continente Europeu/classificação , Hispano-Americanos/classificação , Adolescente , Adulto , Arizona/epidemiologia , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Autoimagem , Adulto Jovem
11.
Int J Obes (Lond) ; 43(6): 1210-1222, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30718822

RESUMO

BACKGROUND/OBJECTIVES: Overweight and obesity (OWOB) is a global epidemic. Adults and adolescents from low-income households are at higher risk to be OWOB. This study examined the relationship between income and OWOB prevalence in children and adolescents (518 years) in the United States (US) within and across race/ethnicities, and changes in this relationship from 1971 to 2014. SUBJECTS/METHODS: A meta-analysis of a nationally representative sample (N = 73,891) of US children and adolescents drawn from three datasets (i.e., National Health and Nutrition Examination Survey, National Longitudinal Survey of Youth, & the Early Childhood Longitudinal Program) which included 14 cross-sectional waves spanning 1971-2014 was conducted. The exposure was household income-to-poverty ratio (low income = 0.00-1.00, middle income = 1.01-4.00, high income >4.00) with prevalence of overweight or obesity (body mass index ≥ 85th percentile) as the outcome. RESULTS: Children and adolescents from middle-income and high-income households were 0.78 (95% CI = 0.72, 0.83) and 0.68 (95% CI = 0.59, 0.77) times as likely to be OWOB compared to children and adolescents in low-income households. Separate analyses restricted to each racial/ethnic group showed children and adolescents from middle- and high-income households were less likely to be OWOB compared to their low-income peers within the White, Hispanic, and Other race/ethnic groups. Children and adolescents from low-income households who were Black were not more likely to be OWOB than their high- and middle-income counterparts. Analyses within each income stratum indicated that race/ethnicity was not related to the prevalence of OWOB in low-income households. However, racial/ethnic differences in OWOB were evident for children and adolescents in middle- and high-income households. Disparities in the prevalence of OWOB between low-income children and adolescents and their middle- and high-income counterparts have increased from 1971 to 2014. CONCLUSIONS: Income and OWOB are related in US children and adolescents. Racial/ethnic differences in the prevalence of OWOB emerge in middle- and high-income households. Disparities in OWOB prevalence are growing.


Assuntos
Conjuntos de Dados como Assunto , Disparidades nos Níveis de Saúde , Renda/estatística & dados numéricos , Sobrepeso/economia , Sobrepeso/epidemiologia , Obesidade Pediátrica/economia , Obesidade Pediátrica/epidemiologia , Adolescente , Criança , Estudos Transversais , Bases de Dados Factuais , Grupos Étnicos , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Pobreza , Prevalência , Estados Unidos/epidemiologia
12.
J Am Coll Health ; 67(4): 308-317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29952734

RESUMO

Objective: Explore the ways in which a sample of college women interpret racially/ethnically coded vignettes to understand their perceptions of responsibility and trauma experienced by a hypothetical female sexual assault survivor and her need for social support. Participants: Convenience sample of college women (N = 51) attending a large, predominately white university in the Southeastern United States recruited between January and March 2013. Methods: Participants were randomly assigned one of three vignettes describing a hypothetical date rape scenario. Vignette scenarios were identical except for discrete statements coded to signify either an African American, Latina, or white female student. Participants responded to open-ended questions that gauged their interpretations of responsibility, trauma, and social support. Results: Qualitative analysis of open-ended responses revealed six overarching themes, including overt victim blaming/shaming, justification of the sexual assault, and perceived need for social support. Conclusions: Findings point to the significance of including race in discussions about and programs that address sexual assault on college campuses to ensure that all women who experience sexual violence receive the support that they need.


Assuntos
Vítimas de Crime/psicologia , Estupro/psicologia , Estudantes/psicologia , Sobreviventes/psicologia , Adulto , Grupos Étnicos , Feminino , Humanos , Distribuição Aleatória , Comportamento Social , Apoio Social , Sudeste dos Estados Unidos , Universidades
13.
Am J Health Promot ; 33(4): 507-515, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30157668

RESUMO

PURPOSE: To assess the relationship between light-intensity physical activity (LIPA) and cardiometabolic risk factors among middle-aged and older adults with multiple chronic conditions. DESIGN: Cross-sectional design utilizing data from the Health and Retirement Study (2010, 2012). SETTING: Laboratory- and survey-based testing of a nationally representative sample of community-dwelling middle aged and older adults. PARTICIPANTS: Adults aged 50 years and older (N = 14 996). MEASURES: Weighted metabolic equivalent of tasks was calculated using self-reported frequency of light, moderate, and vigorous physical activity. Cardiometabolic risk factors (systolic and diastolic blood pressure, glycosylated hemoglobin [HbA1c], high-density lipoprotein cholesterol [HDL-C], total cholesterol, and non-HDL-C) were objectively measured. A multiple chronic condition index was based on 8 self-reported chronic conditions. ANALYSIS: Weighted multivariate linear regression models. RESULTS: Light-intensity physical activity was independently associated with favorable HDL-C (ß = 1.25; 95% confidence interval [CI]: 0.46-2.05) and total cholesterol (ß = 2.72; 95% CI: 0.53-4.90) after adjusting for relevant confounders. The HDL-C health benefit was apparent when stratified by number of chronic conditions, for individuals with 2 to 3 conditions (ß = 1.73; 95% CI: 0.58-2.89). No significant associations were observed between LIPA and blood pressure, HbA1c, or non-HDL-C. CONCLUSIONS: Engaging in LIPA may be an important health promotion activity to manage HDL-C and total cholesterol. Additional longitudinal research is needed to determine the causal association between LIPA and cardiometabolic risk which can potentially inform physical activity guidelines targeting older adults with multiple chronic conditions.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Doença Crônica/terapia , Terapia por Exercício/métodos , Exercício Físico , Multimorbidade , Idoso , Pressão Sanguínea , Colesterol/sangue , HDL-Colesterol/sangue , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Comportamento de Redução do Risco
14.
Int J Soc Psychiatry ; 64(8): 726-736, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30375248

RESUMO

BACKGROUND: Network- and cohesion-based social capital may play an important role in improving mental health. However, there is limited understanding about these relationships among adults in Taiwan. AIM: The aim of this study was to examine the association between individual-level network and cohesion-based social capital and depressive symptoms among a population-based sample of Taiwanese adults. METHODS: Data were obtained from the 1997 Taiwan Social Change Survey (n = 2,598). The 20-item Center for Epidemiological Studies Depression Scale was used to measure depressive symptom scores; ⩾16 represented high depressive symptoms. Network-based social capital was measured using a position generator. Two dimensions of cohesion-based social capital were assessed: cognitive (perceived neighborhood trust and reciprocity) and structural (local community participation and organizational participation). Multivariable log-binomial regression models, weighted to account for the complex sampling design and adjusted for confounders, estimated prevalence ratios and 95% confidence intervals (CIs) to examine the association between each social capital measure and depressive symptoms. RESULTS: In this study, 29.6% of respondents were classified as having high depressive symptom scores. Higher scores of composite cognitive social capital (adjusted Prevalence Ratios (aPR) = 0.92, 95% CI = [0.90, 0.95]) and structural social capital (aPR = 0.80, 95% CI = [0.65, 0.99]) were associated with a lower likelihood of high depressive symptom scores after controlling for confounders. However, there was no association between network social capital and depressive symptoms. CONCLUSION: The findings suggest that the relationship between social capital and depressive symptoms in Taiwan differs according to the specific dimension of social capital assessed. Differentiating between network- and cohesion-based social capital merits greater attention to inform our understanding of building social capital to promote and improve mental health outcomes.


Assuntos
Participação da Comunidade , Relações Interpessoais , Saúde Mental , Capital Social , Rede Social , Adulto , Participação da Comunidade/psicologia , Participação da Comunidade/estatística & dados numéricos , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental/normas , Saúde Mental/estatística & dados numéricos , Prevalência , Apoio Social , Taiwan/epidemiologia
15.
J Acad Nutr Diet ; 118(10): 1844-1854, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30049654

RESUMO

BACKGROUND: Little is known about the food acquisition and shopping habits of residents living in food deserts. OBJECTIVE: To identify distinct food acquisition and shopping patterns among residents, most of whom (81%) live in food desert (low income and low access) census tracts, and characterize these patterns with respect to the residents' socioeconomic status, nutrition knowledge, and perceptions of their food environment. DESIGN: This is a cross-sectional study. PARTICIPANTS/SETTING: Four hundred sixty-six primary food shoppers were included from two counties in South Carolina during 2013-2014. MAIN OUTCOME MEASURES: Participants' self-reported food acquisition and shopping habits, including shopping distance; frequency; store type; transportation mode; use of farmers' markets, food banks/pantries, and church/social service organizations, were used to develop shopping patterns and group residents. Supplemental Nutrition Assistance Program participation, food security, income, and education, nutrition knowledge, and perceptions of the food environment were used to characterize these groups. STATISTICAL ANALYSES PERFORMED: Latent class analysis and multinomial logistic regression were used to identify and characterize patterns, respectively. RESULTS: Three patterns were identified, including those who use community food resources, are infrequent grocery shoppers, and use someone else's car or public transportation when shopping (Class 1) (35%), those who use community food resources and are more frequent and proximal shoppers (Class 2) (41%), and those who do not use community food resources and are distal shoppers (Class 3) (24%). Compared with Class 3, Class 1 had comparatively lower socioeconomic status. Class 2 also had comparatively lower socioeconomic attributes except for income. Class 2 was not significantly different from Class 1 except that a higher proportion in Class 1 saw food access as a problem. No significant differences across classes were found regarding fruit and vegetable recommendation knowledge. CONCLUSIONS: Shopping frequency, use of community food resources, transportation methods, and shopping distance were the key factors that defined distinct patterns among residents living in low-income areas. Future interventions to increase healthy food access in underserved areas should not only consider accessibility but also community food resource use.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Dieta/estatística & dados numéricos , Preferências Alimentares/psicologia , Abastecimento de Alimentos/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Idoso , Comércio , Estudos Transversais , Feminino , Geografia , Comportamentos Relacionados com a Saúde , Humanos , Análise de Classes Latentes , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Pobreza/psicologia , South Carolina , Transportes/estatística & dados numéricos
17.
J Am Heart Assoc ; 5(8)2016 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-27543306

RESUMO

BACKGROUND: Healthy People 2020 aim to reduce fatal atherosclerotic cardiovascular disease (ASCVD) by 20%, which translates into 310 000 fewer events annually assuming proportional reduction in fatal and nonfatal ASCVD. We estimated preventable ASCVD events by implementing the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Cholesterol Guideline in all statin-eligible adults. Absolute risk reduction (ARR) and number needed-to-treat (NNT) were calculated. METHODS AND RESULTS: National Health and Nutrition Examination Survey data for 2007-2012 were analyzed for adults aged 21 to 79 years and extrapolated to the US population. Literature-guided assumptions were used including (1) low-density lipoprotein cholesterol falls 33% with moderate-intensity statins and 51% with high-intensity statins; (2) for each 39 mg/dL decline in low-density lipoprotein cholesterol, 10-year ASCVD10 risk would fall 21% when ASCVD10 risk was ≥20% and 33% when ASCVD10 risk was <20%; and (3) either all statin-eligible untreated adults or all with ASCVD10 risk ≥7.5% would receive statins. Of 175.9 million adults aged 21 to 79 years not taking statins, 44.8 million (25.5%) were statin eligible. Treating all statin-eligible adults would prevent an estimated 243 589 ASCVD events annually (ARR 5.4%, 10-year NNT 18). Treating all statin-eligible adults with ASCVD10 risk ≥7.5% reduces the number treated to 32.2 million (28.2% fewer), whereas ASCVD events prevented annually fall only 10.5% to 217 974 (6.8% ARR, NNT 15). CONCLUSIONS: Implementing the ACC/AHA 2013 Cholesterol Guideline in all untreated, statin-eligible adults could achieve ≈78% of the Healthy People 2020 ASCVD prevention goal. Most of the benefit is attained by individuals with 10-year ASCVD risk ≥7.5%.


Assuntos
Anticolesterolemiantes/uso terapêutico , Aterosclerose/prevenção & controle , LDL-Colesterol/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adulto , Idoso , LDL-Colesterol/metabolismo , Feminino , Objetivos , Programas Gente Saudável , Humanos , Hipercolesterolemia/prevenção & controle , Masculino , Pessoa de Meia-Idade , Números Necessários para Tratar , Guias de Prática Clínica como Assunto , Prevenção Primária , Prevenção Secundária , Adulto Jovem
18.
Ethn Dis ; 26(3): 331-8, 2016 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-27440972

RESUMO

OBJECTIVES: To examine within-state geographic heterogeneity in hypertension prevalence and evaluate associations between hypertension prevalence and small-area contextual characteristics for Black and White South Carolina Medicaid enrollees in urban vs rural areas. DESIGN: Ecological. SETTING: South Carolina, United States. MAIN OUTCOME MEASURES: Hypertension prevalence. METHODS: Data representing adult South Carolina Medicaid recipients enrolled in fiscal year 2013 (N=409,907) and ZIP Code Tabulation Area (ZCTA)-level contextual measures (racial segregation, rurality, poverty, educational attainment, unemployment and primary care physician adequacy) were linked in a spatially referenced database. Optimized Getis-Ord hotspot mapping was used to visualize geographic clustering of hypertension prevalence. Spatial regression was performed to examine the association between hypertension prevalence and small-area contextual indicators. RESULTS: Significant (alpha=.05) hotspot spatial clustering patterns were similar for Blacks and Whites. Black isolation was significantly associated with hypertension among Blacks and Whites in both urban (Black, b=1.34, P<.01; White, b=.66, P<.01) and rural settings (Black, b=.71, P=.02; White, b=.70, P<.01). Primary care physician adequacy was associated with hypertension among urban Blacks (b=-2.14, P<.01) and Whites (b=-1.74, P<.01). CONCLUSIONS: The significant geographic overlap of hypertension prevalence hotspots for Black and White Medicaid enrollees provides an opportunity for targeted health intervention. Provider adequacy findings suggest the value of ACA network adequacy standards for Medicaid managed care plans in ensuring health care accessibility for persons with hypertension and related chronic conditions.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Acesso aos Serviços de Saúde , Hipertensão/epidemiologia , Medicaid/estatística & dados numéricos , Adulto , Doença Crônica , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , Prevalência , Análise de Pequenas Áreas , Isolamento Social , South Carolina , Estados Unidos
19.
J Racial Ethn Health Disparities ; 3(4): 573-581, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27294761

RESUMO

With mounting evidence of how neighborhood socioeconomic context influences individual behavior, investigation of neighborhood social context and sex/drug use risk behavior could help explain and provide insight into solutions to solve persistent racial disparities in HIV. Interviewer-administered surveys and HIV testing among street-recruited individuals who reported illicit drug use in New York City were conducted from 2000 to 2004. Individuals were geocoded to census tracts, and generalized estimating equations were used to determine correlates of being newly diagnosed with HIV at study enrollment. Analyses were completed in 2014. Of the 920 participants, 10.5 % were HIV-positive, and among those, 45 % were diagnosed at study enrollment. After restricting the sample to those who self-reported negative HIV status (n = 867), 72 % were male, 65 % Latino, and 5.1 % tested HIV-positive. After adjustment, those testing HIV-positive were more likely to report male same-sex partnership (p < 0.01) and less likely to be homeless compared with those confirmed HIV-negative (p < 0.01). Neighborhood-adjusted models indicated those from neighborhoods with less deprivation (p < 0.05), and a higher proportion of owner-occupied homes (p < 0.01) were more likely to test HIV-positive. Additionally, Black individuals who used drugs and were from neighborhoods with a higher proportion of Black residents were more likely to be newly diagnosed compared to Latino individuals who used drugs and were from neighborhoods with lower proportions of Black residents (p < 0.05). These data suggest that HIV prevention and treatment efforts should continue widening its reach to those unaware of their HIV infection, namely men who have sex with men, heavy, drug-involved Black communities, and both Black and Latino communities from relatively less disadvantaged neighborhoods.


Assuntos
Afro-Americanos , Infecções por HIV/etnologia , Hispano-Americanos , Características de Residência , Adulto , Infecções por HIV/prevenção & controle , Humanos , Masculino , Cidade de Nova Iorque , Minorias Sexuais e de Gênero , Transtornos Relacionados ao Uso de Substâncias
20.
J Clin Hypertens (Greenwich) ; 18(7): 663-71, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26606899

RESUMO

Electronic health record data were analyzed to estimate the number of statin-eligible adults with the 2013 American College of Cardiology/American Heart Association cholesterol guidelines not taking statin therapy and the impact of recommended statin therapy on 10-year atherosclerotic cardiovascular disease (ASCVD10 ) events. Adults aged 21 to 80 years in an outpatient network with ≥1 clinic visit(s) from January 2011 to June 2014 with data to calculate ASCVD10 were eligible. Moderate-intensity statin therapy was assumed to lower low-density lipoprotein cholesterol by 30% and high-intensity therapy was assumed to reduce low-density lipoprotein cholesterol by 50%. ASCVD events were assumed to decline 22% for each 39 mg/dL decline in low-density lipoprotein cholesterol. Among 411,768 adults, 260,434 (63.2%) were not taking statins and 103,478 (39.7%) were eligible for a statin, including 79,069 (76.4%) patients with hypertension. Estimated ASCVD10 events were 18,781 without and 13,328 with statin therapy, a 29.0% relative and 5.3% absolute risk reduction with a number needed to treat of 19. The 2013 cholesterol guidelines are a relatively efficient approach to reducing ASCVD in untreated, statin-eligible adults who often have concomitant hypertension.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Colesterol/metabolismo , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipertensão/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/metabolismo , Relação Dose-Resposta a Droga , Registros Eletrônicos de Saúde , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/metabolismo , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Estados Unidos , Adulto Jovem
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